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Kaur MN, Patel VD, Leung KX, Klassen AF. Psychometric validation of the FACE-Q Aesthetics Satisfaction with Temples scale in individuals seeking minimally invasive treatment to improve temple hollowing. J Cosmet Dermatol 2024. [PMID: 39101674 DOI: 10.1111/jocd.16450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/28/2024] [Accepted: 06/26/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND The FACE-Q Aesthetics is used extensively to measure patient reported outcomes for minimally invasive and surgical facial aesthetic treatments. We recently developed a new FACE-Q scale to assess satisfaction with the appearance of the temples. AIM The aim of this study was to field test the FACE-Q Satisfaction with Temples scale to examine its psychometric properties. METHODS The FACE-Q Satisfaction with Temples scale was administered to 171 adults (22 years or older) seeking minimally invasive treatment to improve temple hollowing as part of a clinical trial. The severity of temple hollowing was established through the clinician-reported Allergan Temple Hollowing scale (clinician-rated). The psychometric properties of the FACE-Q Satisfaction with Temples scale were established by testing Rasch Measurement Theory (RMT) assumptions and model fit; unidimensionality by principal component analysis; and construct validity by hypothesis testing. RESULTS The study sample consisted of 171 adults (mean age 54.7 ± 9.9, range, 25-82 years). RMT analysis provided evidence for the scientific soundness of a 12-item Satisfaction with Temples scale. The data fit the Rasch model (χ2 = 20.47, df = 24, p = 0.67), all items had ordered thresholds, and good item fit. Scale reliability was high, with Person Separation Index and Cronbach alpha values with and without extremes ≥0.93. Principal component analysis revealed a single component with high factor coefficients. Construct validity was established as scores for the Satisfaction with Temples and Face Overall scales were correlated (r = 0.623, p < 0.001). CONCLUSION The FACE-Q Satisfaction with Temples scale is a reliable and valid measure that can be used in clinical practice and research to measure outcomes following treatment for temple hollowing.
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Affiliation(s)
- Manraj N Kaur
- Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Anne F Klassen
- Department of Pediatrics, McMaster University, 3N-27, Health Sciences Center, Hamilton, Ontario, Canada
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2
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Ahn HS, Kim HM, Oh W, Yi KH, Kim J, Kim HJ. Singular entry point technique for forehead and temple filler augmentation: Anatomical and clinical perspectives. J Cosmet Dermatol 2024. [PMID: 38837504 DOI: 10.1111/jocd.16411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The depressed volume of the forehead and temple is resolved by filler injection. However, the current method has the potential to cause pain and side effects in patients, depending on the skill of the clinician. Therefore, this study proposes a new method for safer and simpler injection using only one injection entry point. METHODS Using the novel injection method, the filler was injected into the forehead and temple regions in three unembalmed cadavers and two healthy Korean volunteers. The cannula and filler locations were identified using dissection, ultrasonography, and three-dimensional (3D) scanning. RESULTS Ultrasonographic images and dissection results showed that the filler injected into the cadavers was in the target layer. The cannula and filler were located on the layer as the supraperiosteal layer on the forehead and the supra deep temporal fascia layer in the temple. Finally, 3D scanning images showed that the filler was injected precisely and effectively into the forehead and temples of the volunteer who underwent the procedure. CONCLUSIONS This method can reduce pain and minimize externally visible wounds caused by injections. The injected filler was naturally connected from the forehead to the temple and maintained for around 3 months. Additionally, it is possible to inject fillers into the forehead and temple at a constant and safe depth without requiring specific skills. It is expected that this method will become a universal method because it minimizes the burden on both patients and clinicians.
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Affiliation(s)
- Hyo-Sang Ahn
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | | | | | - Kyu-Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
- Maylin Clinic, Apgujeong Seoul, Korea
| | | | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
- Department of Electric and Electronical Engineering, College of Engineering, Yonsei University, Seoul, Korea
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3
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Crocco EI, de Camargo Votto Calbucci KB, Vasconcelos RCF, Vasconcelos ACB. 3:2 proportion eye-opening technique using 2 mL of hyaluronic acid filler. J Cosmet Dermatol 2024; 23:2290-2294. [PMID: 38348634 DOI: 10.1111/jocd.16230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 05/19/2024]
Affiliation(s)
- Elisete Isabel Crocco
- Department of Internal Medicine, Dermatology Clinic, Santa Casa Medical School and Hospital, São Paulo, Brazil
- Nomina Institute, São Paulo, Brazil
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Bae J, Park SH, Yi K. Consideration of the diameter of superficial temporal arteries related to filler injections in the temporal region. Skin Res Technol 2024; 30:e13674. [PMID: 38558211 PMCID: PMC10982667 DOI: 10.1111/srt.13674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The concavity of the temple due to adipose tissue atrophy from aging accentuates the zygomatic arch and lateral orbital rim, leading to an aged appearance. The use of hyaluronic acid filler in the temporal region has gained popularity due to its procedural simplicity and consistent outcomes. OBJECTIVE To evaluate the safety of administering hyaluronic acid filler in the temporal region concerning the frontal branch of the superficial temporal artery, which is at risk of injury. METHODS Empirical observations were conducted on the internal diameter of the frontal branch of the superficial temporal artery, a critical anatomical site for potential injury. RESULTS A significant proportion of the artery segments exhibited an internal diameter below 1 mm. Given that the outer diameter of an 18-gauge cannula is 1.27 mm, this method can be considered a relatively secure approach for enhancing the temporal region. CONCLUSION The use of an 18-gauge cannula for hyaluronic acid filler administration in the temporal region appears to be a safe and effective method, with the potential risk to the frontal branch of the superficial temporal artery being minimal.
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Affiliation(s)
- Jung‐Hee Bae
- Department of Dental HygieneNamseoul UniversityCheonanSouth Korea
| | | | - Kyu‐Ho Yi
- Division in Anatomy and Developmental BiologyDepartment of Oral BiologyHuman Identification Research InstituteBK21 FOUR ProjectYonsei University College of DentistrySeoulSouth Korea
- Maylin Clinic (Apgujeong)SeoulSouth Korea
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5
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Zhou YH, Chen CL, Luo CE, Wang HB, Luo SK. Deep Temporal Artery Anatomy: Implications for Improving the Safety of Deep Temporal Injections. Aesthetic Plast Surg 2023; 47:2045-2050. [PMID: 37076704 DOI: 10.1007/s00266-023-03341-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Knowledge of the anatomy of the deep temporal artery (DTA) is critical to ensure safe filling of the deep temporal region. However, current treatment guidelines still focus on how to avoid the superficial temporal artery and the middle temporal vein, and an understanding of the safety of avoiding DTA injury is lacking. OBJECTIVE The purpose of this study was to determine the positioning and course of the DTA to help clinicians safely perform the injection and filling in the temporal region. METHODS Computed tomography (CT) scans and dissections of the skulls of 34 fresh frozen cadavers perfused with lead oxide were performed. Reconstruction and trajectory analysis of all DTA branches were performed using Mimics and MATLAB software. RESULTS In this study, the DTA was identified in all samples, which originated from the maxillary artery of the external carotid artery system. According to image reconstruction and anatomical observations, the distribution of the anterior and posterior branches of the DTA had two different distribution patterns. The anatomical level of the DTA is located between the temporal muscle and the periosteal layer. Compared with observations in previous studies, the anterior branch of the DTA is slightly different, and we found that its course is closer to the frontal area in Asian specimens. CONCLUSION The anatomical information on the DTA described in this study may help improve awareness of the safety of temporal injection by aesthetic physicians. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266. .
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Affiliation(s)
- Yu-Hao Zhou
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China
| | - Chun-Lin Chen
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China
| | - Cheng-En Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China
| | - Hai-Bin Wang
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China.
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6
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Wu GT, Wong A, Bloom JD. Injectable Treatments and Nonsurgical Aspects of Gender Affirmation. Facial Plast Surg Clin North Am 2023; 31:399-406. [PMID: 37348983 DOI: 10.1016/j.fsc.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Injectable treatments are valuable tools to be considered in those seeking facial gender-affirming therapies. As stand-alone procedures, they are unlikely to meet expectations, particularly in those seeking facial feminization. However, injectables can be useful for those seeking to transition into another gender role, who are not ready for more permanent surgical treatment. They are also useful to help fine-tune features to one's satisfaction. Transgender people in the United States are more likely than the general population to be impoverished, and thus the cost of injectables may be a more salient concern.
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Affiliation(s)
- Grace T Wu
- Department of Otorhinolaryngology, University of Pennsylvania, 3737 Market Street, Suite 302, Philadelphia, PA 19104, USA
| | - Anni Wong
- Department of Otorhinolaryngology, University of Pennsylvania, 3737 Market Street, Suite 302, Philadelphia, PA 19104, USA
| | - Jason D Bloom
- Department of Otorhinolaryngology, University of Pennsylvania, 3737 Market Street, Suite 302, Philadelphia, PA 19104, USA; Bloom Facial Plastic Surgery, Two Town Place, Suite 110, Bryn Mawr, PA 19010, USA.
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Roshdy OH, Abdallah WI, Farid CI, Mehanna RA, Bayoumi NH, Ismail AI. Stromal vascular fraction improves the durability of autologous fat temple augmentation-A split-face randomized study using ultrasound biomicroscopy. J Plast Reconstr Aesthet Surg 2022; 75:1870-1877. [PMID: 35125305 DOI: 10.1016/j.bjps.2021.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 12/05/2021] [Accepted: 12/19/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Autologous lipotransfer aims to restore aging-associated volume loss, but with low predictability owing to 20-90% first-year loss of transferred fat. Enrichment by adipose-derived stem cells within the stromal vascular fraction (SVF) aims to improve volume retention through their differentiation potential and paracrine actions exerted by secreted trophic and angiogenic factors. Assessing studies lacked split-face designs, and used multitudes of enrichment ratios, preparation techniques and evaluation methods ending in contradictory reports regarding enrichment advantage. AIM To test whether enriching the autologous fat graft with SVF will increase its residual volume as compared to non-enriched graft. A standardized enrichment protocol and ratio and objective assessment were employed. PATIENTS AND METHODS In a split-face design, and after random assignment, bilateral temple augmentation using non-enriched versus SVF-enriched autologous lipotransfer were compared in middle-aged females otherwise healthy non-pregnant or breast-feeding females abstaining from esthetic or weight-controlling procedures. Temple volume scale (TVS), skin layers' thickness measured by ultrasound biomicroscopy (UBM), visual analog scale for patients' satisfaction, and side effects were blindly assessed at 1 week, 3 months, and 6 months. RESULTS In the included 15 females, TVS was significantly lower (0.5 ± 0.5 versus 1.1 ± 0.7, P = 0.0001), and% hypodermal augmentation was significantly higher (70.92 ± 58.09 versus 18.93 ± 19.33, P = 0.001) on the SVF-enriched side at 6 months. Patient satisfaction was similar bilaterally (P = 1), as were sequelae frequencies as lumping, edema, and ecchymosis. CONCLUSION SVF enrichment of transferred fat significantly improved its residual volume at 6 months; a conclusion that needs further validation. UBM was an informative objective tool for the following temple skin thickness changes. Trial registration clinical trials.gov (NCT03965936).
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Affiliation(s)
- O H Roshdy
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Alexandria University, 106 Port Said street, Camp Cesar, Alexandria, Egypt
| | - W I Abdallah
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Alexandria University, 106 Port Said street, Camp Cesar, Alexandria, Egypt
| | - C I Farid
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Alexandria University, 106 Port Said street, Camp Cesar, Alexandria, Egypt.
| | - R A Mehanna
- Department of Physiology, Faculty of Medicine, Alexandria University, Egypt; Center of Excellence for Research in Regenerative Medicine and Applications (CERRMA), Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - N H Bayoumi
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Egypt
| | - A I Ismail
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Alexandria University, 106 Port Said street, Camp Cesar, Alexandria, Egypt
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8
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The Fascias of the Forehead and Temple Aligned—An Anatomic Narrative Review. Facial Plast Surg Clin North Am 2022; 30:215-224. [DOI: 10.1016/j.fsc.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Lee W, Park J, Yang E. Temple augmentation by injecting a hyaluronic acid filler between the superficial and deep temporal fasciae. J Cosmet Dermatol 2022; 21:4313-4318. [DOI: 10.1111/jocd.15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/06/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Won Lee
- Yonsei E1 Plastic Surgery Clinic Anyang South Korea
| | - Jin‐Woo Park
- Department of Plastic and Reconstructive Surgery Yonsei University College of Medicine Seoul South Korea
| | - Eun‐Jung Yang
- Department of Plastic and Reconstructive Surgery Yonsei University College of Medicine Seoul South Korea
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10
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Lazzarotto A, Robiony M, Cambiaso-Daniel J, Nocini R, Gualdi A. Social Profiloplasty:A Practical Assessment and Injection Guide. Facial Plast Surg 2022; 38:135-142. [PMID: 35253136 DOI: 10.1055/a-1789-4621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The trend of aesthetic medical procedures continues growing every year since decades all over the globe, especially considering minimal invasive treatments since the results are immediate and the downtime minimal. Hence, treatments with hyaluronic acid fillers have become extremely popular and routinely used in common practice. However, numerous areas of treatment were identified and described in the last years clinical training and consciousness of possibly complication remain still under represented. In the following article, we present four key treatment areas for optimal overall facial rejuvenation of what the authors define the social profile. Of each area an assessment, anatomical considerations, danger zones and the preferred personal technique of the authors are described.
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Affiliation(s)
| | | | - Janos Cambiaso-Daniel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Graz University of Technology, Graz, Austria
| | - Riccardo Nocini
- 3Department of Otolaryngology, Verona City Council, Verona, Italy
| | - Alessandro Gualdi
- Division of Plastic, Aesthetic and Reconstructive Surgery, San Raffaele Hospital, Milano, Italy
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11
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Nikolis A, Enright KM, Troupis T, Koutsilieris M, Stratigos AJ, Rigopoulos D, Cotofana S. Topography of the deep temporal arteries and implications for performing safe aesthetic injections. J Cosmet Dermatol 2021; 21:608-614. [PMID: 34921494 DOI: 10.1111/jocd.14672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have started investigating the safety of temporal rejuvenation using soft tissue fillers. However, as the temporal region is highly vascularized, adverse events due to intravascular injection are of primary concern. The scarcity of treatment guidelines to date have focused primarily on avoiding the superficial and middle temporal arteries. The aim of the present anatomical study was to describe the topography of the deep temporal arteries (DTAs) with reference to superficial landmarks, to aid clinicians who perform temporal injections. METHODS The tissue layers of eight fresh-frozen cephalic cadavers were dissected and assessed, bilaterally in the temporal region (N = 16). Distance (D) of the anterior (D1 and D3) and posterior (D2 and D4) arteries was measured from (i) the zygomaticofrontal suture line at the lateral orbital rim (D1 and D2) and (ii) the junction of the superior border of the zygomatic arch and lateral orbital rim (D3 and D4). The distance between the anterior and posterior DTAs was also recorded, at the two regions (D5). RESULTS Bifurcations of the DTAs were observed in 18.75% (3/16) and 12.5% (2/16) of cases, for the anterior and posterior branches, respectively. On average [mean (standard deviation)], D1 (anterior DTA to the zygomaticofrontal suture line at the lateral orbital rim) = 1.56 cm (0.59); D2 (posterior DTA to the zygomaticofrontal suture line at the lateral orbital rim) = 2.98 cm (0.70); D3 (anterior DTA to the junction of the superior border of the zygomatic arch and lateral orbital rim) = 1.14 cm (0.63); D4 (posterior DTA to the junction of the superior border of the zygomatic arch and lateral orbital rim) = 2.37 cm (0.62); and D5 (distance between the anterior and posterior DTAs) = 1.54 cm (0.68). CONCLUSION To help avoid vascular adverse events while performing temporal injections, aesthetic clinicians should be conscientious of safety implications related to the anatomical location of the DTAs and their ramifications.
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Affiliation(s)
- Andreas Nikolis
- Clinical Research Unit, Erevna Innovations Inc., Westmount, Quebec, Canada.,Department of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | - Kaitlyn M Enright
- Clinical Research Unit, Erevna Innovations Inc., Westmount, Quebec, Canada
| | - Theodore Troupis
- Department of Anatomy, Medical School of the National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Koutsilieris
- Department of Experimental Physiology, Medical School of the National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander J Stratigos
- 1(st) Department of Dermatology-Venereology, Medical School of the National and Kapodistrian University of Athens, Athens, Greece.,Andreas Sygros Hospital, Athens, Greece
| | - Dimitrios Rigopoulos
- 1(st) Department of Dermatology-Venereology, Medical School of the National and Kapodistrian University of Athens, Athens, Greece.,Andreas Sygros Hospital, Athens, Greece
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Kaur MN, Baradaran S, Patel V, Klassen AF. Measuring outcomes for temple hollowing treatment: Content validity of new and existing FACE-Q scales. J Cosmet Dermatol 2021; 21:167-175. [PMID: 34855266 DOI: 10.1111/jocd.14646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The FACE-Q, a validated, modular patient-reported outcome measure with global uptake, currently does not have a scale to measure the appearance of the temples. Objectives of our study were to develop a new FACE-Q scale for appearance of temples and assess content validity of two existing FACE-Q scales in the context of temple hollowing: Satisfaction with Facial Appearance and Psychological Function. METHODS A heterogeneous sample of adults who were seeking or had received treatments for temple hollowing was recruited from three outpatient clinics in the United States. Semi-structured interviews using an interpretive description approach were completed to elicit concepts and generate an item pool and assess content validity of the two existing FACE-Q scales. The item pool data were used to develop preliminary Temple scale, which was refined based on patient and expert feedback. RESULTS Participants (N = 15, 55 ± 9 years) described a range of esthetic concerns related to temple hollowing and its treatment. The data were used to draft the FACE-Q Satisfaction with Temples scale, which was refined through input from patients (N = 12) and clinicians (N = 5), resulting in a 16-item FACE-Q Satisfaction with Temples scale. The scale covers concepts of fullness, harmony, scenarios (eg, mirror, bright lights), age, and shape. Content validity of the two existing FACE-Q scales was substantiated. CONCLUSION The FACE-Q Satisfaction with Temples scale fills an important gap in patient-reported outcome measurement in facial esthetics. The scale will be field-tested to finalize content and develop the scoring algorithm prior to implementation in clinical practice and research.
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Surek CC. A New Target for Temple Volumization? An Anatomical and Ultrasound-Guided Study of the Intermediate Temporal Fat Pad. Aesthet Surg J 2021; 41:1339-1343. [PMID: 33630064 DOI: 10.1093/asj/sjaa425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current techniques for temple volumization primarily focus on deep or superficial targets. Further anatomical exploration of intermediate injection targets is warranted. OBJECTIVES The purpose of this study was to examine the anatomy of the intermediate temporal fat pad (ITFP) as it relates to filler injection procedures and to explore the utilization of ultrasound technology for clinical localization. METHODS Ultrasound technology was utilized to identify and inject red dyed hyaluronic acid filler into the ITFP in 20 hemifacial fresh cadavers. Cross-sectional dissection was performed to confirm injection accuracy and document pertinent anatomical relationships. The same technique was performed in a single clinical patient case employing ultrasound guidance and injectable saline. RESULTS The ITFP is a quadrangular structure located in the anterior-inferior bony trough. The ITFP is supplied by a middle temporal artery branch and encased between the superficial and deep layers of deep temporal fascia. In 18 of 20 (90%) injections performed under ultrasound guidance, the injected product was accurately delivered to the substance of the ITFP, and in 2 of 20 (10%), the product was found immediately below the deep layer of deep temporal fascia within the temporalis muscle. In the single clinical case, saline was successfully injected in the ITFP under ultrasound guidance. CONCLUSIONS The ITFP is a consistent anatomical structure in the anterior-inferior trough of the temporal fossa. Ultrasound technology can be utilized to identify and inject the fat pad. Further clinical evaluation will determine the role of this fat pad as a potential intermediate injection target for temple volumization procedures.
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14
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Chen CL, Cong LY, Kong XX, Zhao WR, Hong WJ, Luo CE, Luo SK. Three-Dimensional Computed Tomography Scanning of Temporal Vessels to Assess the Safety of Filler Injections. Aesthet Surg J 2021; 41:1306-1313. [PMID: 33647932 DOI: 10.1093/asj/sjaa371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Temple filler injection is one of the most common minimally invasive cosmetic procedures involving the face; however, vascular complications are not uncommon. OBJECTIVES This study aimed to investigate the anatomy of the temporal vessels and provide a more accurate protocol for temple filler injection. METHODS Computed tomography (CT) scans of 56 cadaveric heads injected with lead oxide were obtained. We then used Mimics software to construct 3-dimensional (3D) images of the temporal vessels described by a coordinate system based on the bilateral tragus and right lateral canthus. RESULTS In the XOY plane, the superficial temporal artery (STA), middle temporal artery (MTA), zygomatico-orbital artery (ZOA), posterior branch of the deep temporal artery (PDTA), and lateral margin of the orbital rim divide the temple into 4 parts (A, B, C, and D). The probabilities of the STA, MTA, ZOA, and PDTA appearing in parts A, B, C, and D were 30.73%, 37.06%, 39.48%, and 77.18%, respectively. In 3D images, these vessels together compose an arterial network that is anastomosed with other vessels, such as the external carotid, facial, and ocular arteries. CONCLUSIONS 3D CT images can digitally elucidate the exact positions of temporal vessels in a coordinate system, improving the safety of temple filler injections in a clinical setting.
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Affiliation(s)
- Chun-Lin Chen
- Jinan University, The First Affiliated Hospital, Guangzhou, China
| | - Li-Yao Cong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Xiang-Xue Kong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Wei-Rui Zhao
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Wei-Jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Cheng-En Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
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15
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Pavicic T, Sattler G, Prager W, Fischer T, Gauglitz G, Hofmann M, Dersch H, Riaz S, Kerscher M. Safety of Cohesive Polydensified Matrix Cross-Linked Hyaluronic Acid Volumizing Gel in Temporal Hollows and Cheeks: A Prospective, Open-Label, Postmarket Study. Dermatol Surg 2021; 47:1359-1364. [PMID: 34417392 DOI: 10.1097/dss.0000000000003176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Facial aging is characterized by volume loss and progressive hollowing of temples and cheeks. Biodegradable filler materials are preferred over nonabsorbable materials; of these, hyaluronic acid (HA) fillers are the most often used because of their favorable effectiveness and safety profile. OBJECTIVE To confirm the safety and effectiveness of Cohesive Polydensified Matrix (CPM)-HA26 gel in the treatment of volume deficiency. METHODS Subjects received up to 2 treatments in the temples and/or cheeks. A blinded investigator assessed improvement according to the Merz Temple Volume Scale (MTVS) and Merz Cheek Fullness Assessment Scale (MCFAS). Subjects were followed for 48 weeks after the last treatment. RESULTS In total, 87 healthy subjects were enrolled. The proportion of subjects achieving at least a 1-grade improvement on MTVS and/or MCFAS was above 70% for each (MTVS: Weeks 4, 24, and 48 = 95.4%, 94.2%, and 77.0%; MCFAS: Weeks 4, 24, and 48 = 92.3%, 83.1%, and 71.8%). Based on MTVS and MCFAS scores at Visit 5, improvement remained visible at up to 48 weeks. No treatment-related serious AEs occurred. CONCLUSION CPM-HA26 demonstrated both a favorable safety and effectiveness profile, with improvement in facial volume evident for up to 48 weeks. It was well tolerated and had a positive, long-lasting effect.
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Affiliation(s)
- Tatjana Pavicic
- Privatpraxis für Dermatologie und Ästhetik Maximilianstr, Munich, Germany
| | | | - Welf Prager
- Prager & Partner Dermatologische Praxis, Hamburg, Germany
| | - Tanja Fischer
- Haut-und Lasercentrum Berlin-Potsdam, Praxis Potsdam, Potsdam, Germany
| | - Gerd Gauglitz
- Dermatologie München-Neuhausen, Leonrodstraße, Munich, Germany
| | | | - Hanna Dersch
- Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany
| | - Shahbaz Riaz
- Merz North America, Inc., Raleigh, North Carolina
| | - Martina Kerscher
- Division of Biochemistry and Molecular Biology, Cosmetic Science, University of Hamburg, Hamburg, Germany
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Poly-l-Lactic Acid Injected in the Temples Improves Excessive Upper Eyelid Skin. Dermatol Surg 2021; 47:855-856. [PMID: 33481450 DOI: 10.1097/dss.0000000000002855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zein M, Tie-Shue R, Pirakitikulr N, Lee WW. Complications after cosmetic periocular filler: prevention and management. ACTA ACUST UNITED AC 2020; 7. [PMID: 33102629 PMCID: PMC7583139 DOI: 10.20517/2347-9264.2020.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Soft tissue fillers are a mainstay in contemporary, minimally invasive facial rejuvenation procedures owing to timely results and minimal recovery period. Although associated with a low complication rate, soft tissue fillers are not without risk. Complications range from mild superficial skin irregularities to granuloma formation to vascular occlusion leading to skin necrosis or even blindness. Fillers vary in composition, elasticity, hydrophilicity and duration of effect that is tailored to specific cosmetic indications. Selecting the right product for the desired effect can cut down on unwanted outcomes. Severe adverse events can be avoided with safe injection technique, early recognition of symptoms and a thorough knowledge of the local anatomy. This review outlines several complications all providers should recognize and discusses strategies for their prevention and management.
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Affiliation(s)
- Mike Zein
- Mcknight Vision Research Center, Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, FL 33136, USA
| | - Ryan Tie-Shue
- Department of Biomedical Research, Yale University, New Haven, CT 06520, USA
| | - Nathan Pirakitikulr
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, FL 33136, USA
| | - Wendy W Lee
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, FL 33136, USA
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Tran AQ, Staropoli P, Rong AJ, Lee WW. Filler-Associated Vision Loss. Facial Plast Surg Clin North Am 2019; 27:557-564. [DOI: 10.1016/j.fsc.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huang RL, Xie Y, Wang W, Tan P, Li Q. Long-term Outcomes of Temporal Hollowing Augmentation by Targeted Volume Restoration of Fat Compartments in Chinese Adults. JAMA FACIAL PLAST SU 2019; 20:387-393. [PMID: 29710230 DOI: 10.1001/jamafacial.2018.0165] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Importance Previous anatomical and clinical studies have suggested that targeted restoration of the volume and distribution of fat compartments using appropriate cannula entry sites and injection planes is an excellent fat-grafting technique for facial contouring and hand rejuvenation. Objective To perform subjective and objective evaluations of the safe and effective profile of the targeted fat-grafting technique for temporal hollowing augmentation. Design, Setting, and Participations In a retrospective cohort study, a total of 96 consecutive patients with temporal hollowing were treated at the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai, China, with the targeted fat-grafting technique from January 1, 2009, to January 1, 2017. Main Outcomes and Measures The safety and efficacy profile of this technique was evaluated by the following methods: (1) a quantitative measurement of fat-graft survival and temporal augmentation rates by using 3-dimensional laser scanning, (2) a subjective assessment using a satisfaction survey and the Hollowness Severity Rating Scale (grades range from 0-3, with higher grades representing more hollowness), and (3) the complication rate. Results Of the 96 study patients, 94 (97.9%) were women and the mean (SD) age was 34.4 (7.4) years. Of the 142 autologous fat-grafting procedures performed, the mean (SD) total follow-up time was 16.3 (3.2) months, with a mean (SD) of 1.5 (0.7) procedures performed. The mean (SD) baseline volume requirement per temple for each patient was 12.8 (4.8) mL, and the total volume of the fat graft per temple was 17.8 (7.5) mL. Quantitative analysis revealed that the mean (SD) total augmentation volume per temple was 11.7 (3.0) mL, the total survival rate of the fat grafts was 65.7% (12.6%), and total augmentation rate of hollowness was 91.4% (23.4%). Subjective analysis revealed that all patients showed an improved appearance after fat grafting, and 142 temples (74.0%) exhibited clinical improvement by more than 2 grades. In all, 88 patients (91.7%) were satisfied with the outcomes, with a low complication rate reported. Conclusions and Relevance The targeted fat-grafting technique allows the transplant of fat tissue into 4 separate fat compartments in a double-plane manner through a unique cannula entry site that avoids severe neurovascular injury. The long-term results demonstrate that this technique is an effective, reproducible, and safe approach for temporal hollowing augmentation. Level of Evidence 4.
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Affiliation(s)
- Ru-Lin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Xie
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjin Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pohching Tan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Khunkhet S, Rattananukrom T, Thanasarnaksorn W, Suchonwanit P. Alopecia Induced by Autologous Fat Injection into the Temporal Area: Case Report and Review of the Literature. Case Rep Dermatol 2019; 11:150-156. [PMID: 31244640 PMCID: PMC6587213 DOI: 10.1159/000500710] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/01/2019] [Indexed: 01/06/2023] Open
Abstract
Alopecia secondary to facial filler injections is a highly unusual sequela. Only 2 cases of hyaluronic acid-induced alopecia have been reported to date. Accumulating evidence suggests vascular compromise as its etiology, which can be accidental intravascular injection or external compression by overfilled materials. We hereby present, to the best of our knowledge, the first case of localized nonscarring and scarring alopecia secondary to autologous fat grafting and review the literature regarding filler-induced alopecia.
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Affiliation(s)
- Saranya Khunkhet
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Rattananukrom
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wilai Thanasarnaksorn
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Ueland HO, Nilsen RM, Rødahl E, Jensen SA. Hyaluronic acid is superior to autologous fat for treatment of temporal hollowing after lateral orbital wall decompression: A prospective interventional trial. J Plast Reconstr Aesthet Surg 2019; 72:973-981. [DOI: 10.1016/j.bjps.2018.12.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/30/2018] [Accepted: 12/09/2018] [Indexed: 11/26/2022]
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Palomar-Gallego MA, Gómez-Esquer F, Gómez-Sánchez SM, Díaz-Gil G, Linares García-Valdecasas R. Influence of the Topographic Vascular Distribution of the Face on Dermal Filler Accidents. Dermatology 2019; 235:156-163. [PMID: 30650420 DOI: 10.1159/000495292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Dermal fillers are an important tool in the field of aesthetic dermatology. Fillers are relatively noninvasive and easy to use but are not free of secondary complications. The main complications are vascular and are due to either the compression of an artery or the direct introduction of the product into the arterial lumen. The aim of this study is to provide an overview of the vascular territories of the face to avoid many possible complications when using facial fillings. Anatomical localization of the main arterial supply to the face has been described to assess the risk of vascular injury. METHODS The authors dissected 17 hemifaces of embalmed adult cadavers that had previously been injected, through the common carotid artery, with latex containing a red dye. RESULTS A topographic distribution was generated by facial regions following a clinical approach from where the facial fillings were placed and related to the pathways of the arteries. Following these criteria, we established 8 topographic regions (I-VIII) that indicate the main vascular problems of each of these regions. Detailed anatomical localizations of the main arteries in these topographic regions of the face and their relationships are described. CONCLUSIONS The highest index of vascular lesions and especially visual alterations occurred for fillings of the upper third of the face. To prevent and avoid this type of lesion, it is advisable to avoid, as much as possible, treatments with filling materials in the upper third of the face, mainly including the glabellar and nasal region (III) and supraorbital region (VIII).
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Affiliation(s)
- María Angustias Palomar-Gallego
- Área de Anatomía y Embriología Humana, Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Francisco Gómez-Esquer
- Área de Anatomía y Embriología Humana, Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain,
| | - Stella Maris Gómez-Sánchez
- Área de Anatomía y Embriología Humana, Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Gema Díaz-Gil
- Área de Anatomía y Embriología Humana, Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Rafael Linares García-Valdecasas
- Área de Anatomía y Embriología Humana, Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
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Amirlak B, Chung MH, Pezeshk RA, Sanniec K. Accessory Nerves of the Forehead. Plast Reconstr Surg 2018; 141:1252-1259. [DOI: 10.1097/prs.0000000000004320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Intracranial Penetration During Temporal Soft Tissue Filler Injection—Is It Possible? Dermatol Surg 2018; 44:84-91. [DOI: 10.1097/dss.0000000000001260] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Melo F, Nicolau P, Piovano L, Lin SL, Baptista-Fernandes T, King MI, Camporese A, Hong K, Khattar MM, Christen MO. Recommendations for volume augmentation and rejuvenation of the face and hands with the new generation polycaprolactone-based collagen stimulator (Ellansé ®). Clin Cosmet Investig Dermatol 2017; 10:431-440. [PMID: 29184426 PMCID: PMC5685142 DOI: 10.2147/ccid.s145195] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background The range of fillers currently available for soft-tissue augmentation is constantly expanding. The latest advances in filler technology include collagen biostimulators that exert their esthetic effect by promoting neocollagenesis. One such product is the next-generation collagen biostimulator (Ellansé®) that demonstrates properties as yet unseen in soft-tissue fillers. It is composed of polycaprolactone (PCL) microspheres in an aqueous carboxymethylcellulose gel carrier. Given its specific characteristics and the number of areas that can be treated with this innovative product, experts’ recommendations were deemed necessary and are therefore presented in this paper with a specific focus on the indications, treatment areas and procedures as well as injection techniques. Methods A multinational, multidisciplinary group of plastic surgeons and dermatologists convened to develop recommendations with a worldwide perspective. This publication provides information on the specific characteristics of the product and focuses on the recommendations on the injection techniques. Results Recommendations on injection techniques are provided for the upper face, mid-face and lower face and zone by zone for each of these areas, as well as hands. Based on the particular anatomy of each area, the focus is on the techniques and devices of injection and the volume and depth of injection. The information is tabulated, and photos are presented for illustration. Conclusion These recommendations provide a guideline for physicians who wish to perform safe and efficacious treatment with the PCL collagen stimulator for face and rejuvenation with volume augmentation.
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Affiliation(s)
| | | | | | - Shang-Li Lin
- Shang-Li Dermatologic & Aesthetic Clinic, New Taipei City, Taiwan, Republic of China
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Yang Q, Qiu L, Yi C, Xue P, Yu Z, Ma X, Su Y, Guo S. Reversible Alopecia with Localized Scalp Necrosis After Accidental Embolization of the Parietal Artery with Hyaluronic Acid. Aesthetic Plast Surg 2017; 41:695-699. [PMID: 28341954 DOI: 10.1007/s00266-017-0841-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
Hyaluronic acid (HA) filler injection is widely used for soft-tissue augmentation. Complications associated with HA filling are not uncommon; however, HA-induced alopecia is a rarely reported complication that could result in severe secondary psychological trauma. The etiology, clinical traits, treatment strategies, outcomes, and possible reversibility of HA-induced alopecia have not been characterized. Here, we report a case in which bilateral temple injections of 6.5 mL of HA led to persistent pain over the left scalp for several days. Although the pain was relieved at day 9 after 600 U of hyaluronidase were injected in the left temple, the patient developed localized alopecia at the left temporoparietal region with central skin necrosis at day 15. After topical applications of recombinant bovine basic fibroblast growth factor gel and 2% minoxidil spay, the necrotic skin wound was healed at day 42. Hair regrowth and normal hair density were restored at day 74. Analyses of Doppler ultrasound examinations and histopathology of the skin biopsy suggested that mild ischemia of the left temporoparietal region led to reversible alopecia, while the permanent hair loss in the left parietal area was associated with severe skin ischemia. Therefore, the key to treatment would be to focus on the effective correction of severe ischemia-induced skin necrosis to prevent permanent hair loss. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Carruthers J, Jones D, Hardas B, Murphy DK, Donofrio L, Sykes JM, Carruthers A, Creutz L, Marx A, Dill S. Development and Validation of a Photonumeric Scale for Evaluation of Volume Deficit of the Temple. Dermatol Surg 2016; 42 Suppl 1:S203-S210. [PMID: 27661742 PMCID: PMC5671790 DOI: 10.1097/dss.0000000000000848] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A validated scale is needed for objective and reproducible comparisons of temple appearance before and after aesthetic treatment in practice and clinical studies. OBJECTIVE To describe the development and validation of the 5-point photonumeric Allergan Temple Hollowing Scale. METHODS The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 298) completed during 2 sessions occurring 3 weeks apart. RESULTS A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.1 [0.94-1.26] for clinically different image pairs and 0.67 [0.51-0.83] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (mean weighted kappa = 0.86). Interrater agreement was almost perfect during the second session (0.81, primary endpoint). CONCLUSION The Allergan Temple Hollowing Scale is a validated and reliable scale for physician rating of temple volume deficit.
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Affiliation(s)
- Jean Carruthers
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek Jones
- Division of Dermatology, University of California at Los Angeles, Los Angeles, California
| | | | | | - Lisa Donofrio
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Alastair Carruthers
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lela Creutz
- Peloton Advantage, LLC, Parsippany, New Jersey
| | - Ann Marx
- Allergan plc, Irvine, California
| | - Sara Dill
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Hyaluronic acid soft tissue fillers include a range of products (Juvederm Ultra, Juvederm Ultra Plus, Voluma, Restylane Silk, Restylane, Restylane Lyft, and Belotero Balance) that are used commonly for facial rejuvenation and enhancement of facial features. Although these products are similar in many ways, they are not interchangeable and have unique characteristics that need to be considered. Injection sites and techniques for facial rejuvenation are discussed.
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Affiliation(s)
- Karol A Gutowski
- Division of Plastic Surgery, University of Illinois, Chicago, IL 60611, USA.
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