Mental Artery Occlusion From Poly-l-Lactic Acid Injection at the Lateral Chin

Using injectable fillers for chin and jawline rejuvenation

Objective

As the population ages, facial plastic providers must remain aware of the treatments to prevent and reverse the external signs of aging. In the mandibular region, skin laxity and soft tissue sagging in the jawline may lead to jowling and chin ptosis along with reduced chin projection. While surgical procedures, including chin implantation, may be performed, nonsurgical procedures are becoming increasingly popular due to their temporary, noninvasive, yet effective methods. This review covers the use of hyaluronic acid, calcium hydroxylapatite, poly-l-lactic acid, and polymethyl methacrylate in the jawline.

Methods

PubMed was searched for data on the mechanism of action, pertinent anatomy, indications, contraindications, technique, and evidence supporting the safety and efficacy of the fillers.

Results

There are a wide variety of fillers available for use in the lower face with unique characteristics and application methods. While the advantages of injectable fillers include relatively affordable cost, minimal patient discomfort, and limited recovery times, taking measures to prevent short- and long-term complications is necessary for optimal results.

Conclusions

Understanding the benefits and limitations of injectable fillers in the jawline can help providers appropriately counsel and treat patients.

Clinical Anatomy of the Chin Evaluated by 3-Dimensional Tomography and Cadaveric Dissection: Implications for Safety and Optimal Injection Techniques in Chinese

BACKGROUND

Soft tissue fillers have been widely used for the correction of chin volume loss because of congenital conditions and aging.

OBJECTIVE

This study aimed to discuss anatomical concerns for chin filler injections, which may help to reduce the incidence of severe intravascular embolization complications and improve patient satisfaction.

METHODS AND MATERIALS

We scanned 40 cadaveric heads with a contrast agent using a 64-row spiral computed tomography scanner. The scan was visualized by a Philips IntelliSpace workstation and analyzed by Materialise's interactive m image control system software to measure and quantify the arterial data. Twenty of 40 cadavers were dissected to define the layers of tissue.

RESULTS

In total, 221 arteries passed through the sagittal plane of 40 specimens. The number of superficial arteries (163 of 221) was much greater than the number of deep arteries (58 of 221). The number of arteries gradually decreased with distance from the lower lip vermilion border plane, which formed the lower third of the face.

CONCLUSION

This study introduces a safe and effective technique for administering chin filler injections that minimizes risks and improves patient satisfaction.

Soft Tissue Dermal Filler-Associated Necrosis and Impending Necrosis: A Systematic Review of the Literature

BACKGROUND

Cosmetic soft tissue fillers are a popular minimally invasive procedure. Necrosis is a rare yet devastating complication of soft tissue fillers. To date, the relationship between soft tissue fillers and necrosis has not been fully described.

OBJECTIVE

To systematically compile published cases of soft tissue fillers resulting in necrosis and collect data regarding the injection, treatment, and outcome.

METHODS AND MATERIALS

Using PRISMA protocol, a comprehensive search for soft tissue filler necrosis was performed using no time constraints, resulting in 97 articles encompassing 192 cases of soft tissue filler necrosis containing individual-level data.

RESULTS

Of the cases analyzed, 66.1% had progressed to necrosis, whereas 33.9% of patients had impending necrosis. Necrosis most commonly resulted from injection of the nasolabial fold (32.4%, n = 88). The filler material most commonly used was hyaluronic acid (71.9%, n = 138). Hyaluronidase was used most frequently as an initial treatment agent (19.1%, n = 88). Forty-three patients (22.4%) with necrosis had a prior minor procedure or surgery.

CONCLUSION

This systematic review is an extensive overview of necrosis as a complication of soft tissue fillers. It serves as a reference tool for any clinician who injects soft tissue fillers and any provider who encounters soft tissue filler necrosis.

Chin Augmentation With Hyaluronic Acid: An Injection Technique Based on Anatomical Morphology

BACKGROUND

Chin augmentation with hyaluronic acid (HA) injections can effectively improve mental appearance.

OBJECTIVE

To introduce a HA injection technique for chin augmentation and evaluate its clinical effects.

METHODS

A total of 326 patients who received HA injection for chin augmentation from January 2018 to May 2021 were retrospectively reviewed. All patients were injected with the technique according to the anatomical morphology of the chin using a needle and cannula. Patient data were collected, the effects were analyzed, and adverse reactions were observed and recorded.

RESULTS

There were 326 patients involved in this study with a mean age of 26.4 years. The median volume of HA injected was 1.85 mL. The shape and contour of the chin was significantly improved in all patients immediately after injection. Most improvements were retained up to 6 months and partial improvements remained visible for 12 months. Swelling and pain occurred in 284 patients (87.1%), local ecchymosis occurred in 31 patients (9.5%), and asymmetry was found in 8 patients (2.5%). There were no other complications such as infection, embolism, necrosis, nodule, or witch's chin. All patients reported satisfaction with results of the HA injections.

CONCLUSION

Injection of HA according to the anatomical morphology of the chin is a safe and effective technique for chin augmentation and results in high patient satisfaction.

Cutaneous Vascular Compromise and Resolution of Skin Barrier Breakdown After Dermal Filler Occlusion-Implementation of Evidence-Based Recommendations Into Real-World Clinical Practice

BACKGROUND

Vascular occlusions that threaten skin integrity, although not an emergency like those that threaten a patient's vision, is an urgent situation. Accurately interpreting physical examination findings is paramount. The use of high-dose, pulsed hyaluronidase is the mainstay of therapy; however, adjunctive measures that may optimize clearance of an occlusion and/or skin barrier repair such as the use of image guidance and hyperbaric oxygen should be considered.

OBJECTIVE

To provide a review of the literature on the treatment of vascular occlusions threatening skin barrier integrity and develop a step-wise treatment guide.

MATERIALS AND METHODS

The authors searched PubMed for peer-reviewed studies, consensus statements, case series, and case reports using a variety of keywords.

RESULTS

Twenty-six articles focusing on vascular occlusions threatening the skin barrier were reviewed. The authors collectively agreed on treatments to reverse vascular occlusions and restore the skin barrier. The importance of high-dose, pulsed hyaluronidase was clear. Therapies that lacked evidence such as sodium thiosulfate were also revealed.

CONCLUSION

Vascular occlusions that threaten skin integrity is an urgent matter which requires accurate interpretation of physical examination findings that will help guide intervention. High-dose, pulsed hyaluronidase along with adjunctive measures performed in a step-wise manner is key to an optimal outcome.

A Reliable Method for Chin Augmentation by Mechanical Micronization of Lipoaspirates

BACKGROUND

Desire for improved aesthetic contour of the lower third of the face has resulted in an increase in chin augmentation. Although many fillers, including hyaluronic acid (HA), autologous fat and stromal vascular fraction gel (SVF-gel), have been used to improve facial morphology, chin augmentation requires fillers that provide greater support.

METHODS

The elastic and viscous moduli of SVF-gel and Coleman fat were assessed in vitro by rheological testing, whereas their elasticity were evaluated in vivo by ultrasonic elastography. Results in vitro were compared with those of highly elastic HA (HE-HA) and highly viscous HA (HV-HA), whereas results in vivo were compared with HE-HA. Changes in chin volume, SVF-gel retention rate and absorptivity for at least 12 months were measured by 3D white light scanning. Questionnaires were administered to assess patient satisfaction.

RESULTS

The elastic and viscous modulus of SVF-gel was, respectively, slightly lower than HE-HA and HV-HA but higher than the other two in vitro, with the elasticity of the three layers of SVF-gel lower than HE-HA but slightly higher than normal control in vivo. The average retention rate was 62.34±3.34% at 12 months. The absorptivity of 90% of the samples was <3% from 6 to 12 months, which was considered stable. Patients expressed satisfaction with their results.

CONCLUSION

SVF-gel has ideal rheologic characteristics in vitro, which has slightly higher elasticity than normal fat tissue of chin in vivo, and could keep well retention rate for chin augmentation in clinic.

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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reshaping the Lower Face Using Injectable Fillers

The lower third is very important for the pleasant appearance of the face. A well-contoured jawline is desirable in men and women, giving a perception of beauty and youth. It is also key to sexual dimorphism, defining masculine and feminine characteristics. The nonsurgical rejuvenation and beautification of the lower third of the face is becoming more frequent. Injectable fillers can reshape the jawline, lift soft tissues, and improve facial proportions, effectively improving the appearance of the area.

It is paramount to understand the facial anatomy and perform a good facial assessment in order to propose a proper aesthetic treatment plan. The aesthetic goal of the rejuvenation approach is to redefine the mandibular angle and line. In young patients, beautification can be achieved through correction of constitutional deficit or enhancement of the contour of the face, improving the facial shape. It is very important to possess knowledge of facial anatomy and of the aging process in order to deliver effective and safe results.

In this article, we discuss the anatomy of the lower third of the face, facial assessment, aging process, and treatments of the chin, prejowls and mandibular line and angle with injectable fillers. The authors’ experience in the approach of this area is discussed.

Implication of Location of the Ascending Mental Artery at the Chin Injection Point

BACKGROUND

Facial proportions can be improved by means of chin augmentation in patients with a receding chin. The ascending mental artery is the main arterial supply to the top of the chin, and arterial occlusion of this artery can result in soft-tissue infarction. This study aims to measure the topographic anatomy of the ascending mental artery at the chin injection area, using a three-dimensional camera.

METHODS

Thirty-one embalmed cadaveric faces were dissected at the chin. The midline of the inferior margin of the mandibular protuberance was marked with a pin. A variation in size between the two opposite ascending mental arteries was noticed. The depth of the artery from the skin surface and distance from the midline were measured using a three-dimensional camera.

RESULTS

There were 19 dominant ascending mental arteries on the right and 12 on the left. The dominant ascending mental arteries enter the chin paracentrally, approximately 6 mm (mean ± SD, 5.64 ± 4.34 mm) from the midline, within the muscular plane, and at a depth of 4.15 ± 1.95 mm from the skin. Furthermore, the artery formed an anastomosis with the sublingual artery, within the floor of the mouth.

CONCLUSION

Every aesthetic physician should recognize the course of the ascending mental artery and use the appropriate techniques to avoid vascular injury during chin augmentation using filler injections.

Role of Nonsurgical Chin Augmentation in Full Face Rejuvenation: A Review and Our Experience

BACKGROUND

The chin is a critical component to the perception of facial attractiveness. Dermal fillers offer a nonsurgical, temporary method of correcting mild to moderate chin retrusion and resorption. Thus far, discussion of this procedure has been largely limited to the plastic surgery and otolaryngology literature.

OBJECTIVE

To review pertinent aspects of anatomy, patient evaluation, injection technique, concomitant therapies, and complications in chin augmentation using injectable fillers.

METHODS

A brief review of the literature surrounding chin augmentation using injectable fillers, as well as the authors' experience in this area, is provided.

RESULTS

Chin augmentation using injectable fillers can be performed effectively and safely with adequate background knowledge of the regional anatomy and appropriate patient selection. The authors discuss both injection techniques in the published literature and their own approach. Potential complications and concomitant therapies are also reviewed.

CONCLUSION

As chin augmentation is increasingly recognized as an essential component to complete facial aesthetic rejuvenation, dermatologic surgeons should be familiar with how to safely and effectively perform augmentation with injectable fillers to achieve an optimal cosmetic outcome.