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

Evaluation of soft tissue profile changes following autogenous fat or onlay PEEK augmentation versus sliding genioplasty for correction of deficient chin: Randomized controlled clinical trial

AIM

The study was conducted to evaluate soft tissue profile changes using autogenous fat augmentation or onlay PEEK versus sliding genioplasty for correction of deficient chin in patients with retruded chin.

MATERIAL AND METHODS

Thirty-three patients with deficient chins were included in the study. The patients were distributed into 3 groups: the fat augmentation group as intervention I, the PEEK augmentation group as intervention II, and the osseous genioplasty group as control group. Preoperative and postoperative CBCT were performed for all patients. With the aid of MIMICS,3-MATIC, and PROPLAN software, diagnosis, virtual planning, and evaluation were performed. The Face-Q questionnaire was used to assess patient satisfaction.

RESULTS

There was a statistically significant difference regarding soft tissue relapse in the fat group after 6 months when compared to the control group (mean difference= 0.770), while there was no statistically significant difference regarding soft tissue relapse between PEEK and control group (mean difference= -0.060). Intragroup comparison has shown no statistically significant difference regarding soft tissue relapse within all groups between follow-up periods (P = 0.1389 for the fat group, P = 0.8739 for the peek group, and P = 0.8410 for the control group). All patients showed a statistically significant increase in scores of satisfaction with the chin between follow-up periods (P = 0.0165, P = 0.0150, and P = 0.0293) respectively.

CONCLUSIONS

Fat augmentation can be a good intervention choice in mild-moderate deficient cases. PEEK PSI has a stable surgical outcome.

Custom-Made Implant Fabrication for Chin Augmentation Using Piled-Up Expanded Polytetrafluoroethylene Sheets: An Innovative Surgical Technique and Literature Review

BACKGROUND

Alloplastic chin augmentation is the most common esthetic surgical treatment to reshape the chin. However, factory-made chin implants are typically standardized rather than custom-made and have potential to cause complications. Although the fabrication of custom-made implants by using computer-assisted planning and 3D-printing technology has become widespread, the process has several disadvantages, including long preoperative prosthesis preparation times, high costs, and unsuitability for patients with asymmetric chins or those who undergo combined mandibuloplasty before implant placement. The present study developed an innovative chin augmentation technique involving stacked expanded polytetrafluoroethylene (e-PTFE) sheets that is suitable for most patients and has minimal side effects.

MATERIALS AND METHODS

A retrospective review of a single surgeon's experience was performed over a 2 year period for patients who underwent a procedure involving piled-up e-PTFE sheets for alloplastic chin augmentation. This study analyzed the outcomes, complications (temporary nerve numbness, wound infection, hematoma formation, and implant displacement), and patient satisfaction during follow-up.

RESULTS

Between January 2018 and December 2020, 38 patients underwent the procedure involving piled-up e-PTFE sheets for alloplastic chin augmentation. Six patients (15.8%) experienced nerve-related temporary numbness, and one (2.6%) experienced wound infection. None had developed major complications such as implant displacement or wound infection at follow-up. Moreover, the patients demonstrated a high level of satisfaction with the surgical results.

CONCLUSION

Piled-up e-PTFE sheets can be used to produce custom-fit porous polyethylene chin implants that result in minimal complications and a very high satisfaction rate.

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 .

Treatment of Chin Retrusion With Botulinum Toxin Plus Hyaluronic Acid Filler in Comparison With Hyaluronic Acid Filler Alone: A Randomized, Evaluator-Blinded, Controlled Study

BACKGROUND

Hyaluronic acid (HA) has already been widely administered for chin augmentation. Patients with chin retrusion frequently present with increased chin hypertonia. Monotherapy with HA falls short in addressing the multifaceted cosmetic concerns associated with chin retrusion.

OBJECTIVES

This study aimed to investigate the clinical efficacy and safety of the combination therapy involving botulinum toxin (BTX) and HA in the treatment of chin retrusion.

METHODS

We enrolled patients with moderate to severe chin retrusion for 9 months of follow-up after they received either combined treatment with BTX plus HA or monotreatment with HA. We also calculated the surface-volume coefficient with 3-dimensional digital scanning technique, and evaluated outcomes based on the Allergan Chin Retrusion Scale (ACRS), the Global Aesthetic Improvement Scale (GAIS), and treatment-related adverse events (TRAEs).

RESULTS

A total of 50 patients were recruited and randomized to the treatment group (BTX plus HA) or control group (HA alone) in a 1:1 ratio. Patients in the treatment group exhibited significantly higher surface-volume coefficients during the first 6 months (P < .05). ACRS scores and responder rates in the 2 groups remained similar throughout the follow-up (P > .05). Within the initial 3 months, the GAIS responder rate in the treatment group was significantly higher than that in the control group (P < .05). Mild TRAEs were observed in both groups, and subsided within 7 days. There was no increase in adverse effects with the combined treatment.

CONCLUSIONS

In comparison to monotherapy, the combined treatment not only improved the surface-volume coefficient of hyaluronic acid but also achieved similar ACRS scores with less HA volume. Furthermore, the combination treatment yielded superior treatment outcomes for individuals with chin retrusion.

LEVEL OF EVIDENCE: 2

Injectable Fillers for Lower Face Rejuvenation

The lower face is an integral component of a beautiful face. Age-related changes in this region are so significant that they are often easily appreciated by patients. The aging process not only includes volume loss or downward fat repositioning, but also soft tissue laxity, skin changes, and even bony resorption. In the lower face, this results in sagging of the soft tissue leading to the formation of jowling, loss of an attractive well-defined jaw line, and a retruded chin. Both surgical and non-surgical options are available to reverse the aging signs; however, the popularity of non-surgical treatment has dramatically increased in last 2 decades.

A Review of Aesthetic Considerations for Treating the Transgender Patient

BACKGROUND

As gender diversity becomes increasingly embraced by society, and despite growing recognition of the unique needs of transgender patients, the literature remains devoid of guidelines for gender affirming facial feminization or masculinization techniques.

OBJECTIVE

The authors seek to identify and discuss target feminine and masculine facial features, as well as an armamentarium of surgical and nonsurgical strategies to effectively address and achieve them in the transgender population.

METHODS

A search of the National Library of Medicine database (PubMed) was undertaken to identify the existing literature on gender-affirming facial feminization and masculinization techniques.

RESULTS

The importance of assessing proportional relationships between the bitemporal, bizygomatic, and bigonial distances is discussed; ideal masculine faces possess a rectangular face shape, with ratios for these 3 areas tending toward 1:1:1. Conversely, the ideal female face is heart shaped with projection at the zygoma and a tapered jawline. Strategic positioning of the cheek apex serves as an anchor in sculpting a distinctly masculine or feminine face. Other considerations include the enhancement of skin quality and implications of hormonal therapy.

CONCLUSION

The aesthetic considerations provided in this study can serve as a valuable guidance for aesthetic physicians seeking to deliver optimal care for their transitioning patients.

Analysis of Sexual Dimorphic Features of the Jawline and Chin in White Celebrity Faces

BACKGROUND

The jawline greatly influences facial shape and contributes to facial dimorphism. Analysis of lower facial shape and sexual dimorphic differences in contemporary attractive white faces can advance the goals of lower facial aesthetics and facial gender-affirming surgery (FGAS).

METHODS

Full-face, front-view photos of 47 white female and 21 white male celebrities were included from a list generated using GQ magazine's Highest Paid Models issue, People Magazine's Beautiful issue (1991-2022), and celebrities featured on lifestyle websites. Facial landmarks were detected through a facial analysis program using Vision framework and MATLAB. After converting pixel distances to absolute distances, lower face measurements were compared between males and females.

RESULTS

The mean lower facial height was 6.08 cm in females and 7.00 cm in males (P value<0.001). The mean bigonial width was 11.21 cm in females and 12.30 cm in males (P value<0.001). The ratio of facial height to lower facial height was 2.98 in females and 2.76 in males (P value<0.001), signifying that symmetry in facial thirds is more prevalent in attractive female faces, while a longer lower face is more common in attractive male faces. The greatest differences in female and male facial contours were at gonial angles and chin.

CONCLUSIONS

Analysis of contemporary white celebrity faces demonstrated significantly wider and longer lower facial measurements in males. The overall contour of the female lower face was more tapered at the gonial angles and chin compared to males. These results are important when planning lower facial rejuvenation or FGAS, as lower face size and proportions influence perceived gender and attractiveness.

Choosing Juvéderm Volux™ to chin augmentation: Case report and flowchart for clinical evaluation

INTRODUCTION

The development of filler biomaterials with high hyaluronic acid concentrations, cohesiveness, and elastic modulus has become an option for chin augmentation, as the balance of these rheological properties promotes high lifting capacity, providing minimally invasive perceptible improvements in patient appearance.

PRESENTATION OF CASE

The present study reviewed clinical and anatomical aspects of patients referred for chin augmentation and created a flowchart to assertively diagnose patients with an indication of Juvéderm® Volux™ for defining the lower third of the face.

DISCUSSION

The chin is vital for facial proportions and attractiveness perception. Its relevance to facial appearance is noticed the most when chin size is less than ideal, making other facial areas seem larger or smaller. The adjacent soft tissues of the neck and jaw appear prematurely aged when chin projection or width is inadequate. Hyaluronic acid-based fillers have a confirmed history of safe and effective use for treating facial volume loss or deficiency.

CONCLUSION

Juvéderm® Volux™ is a safe, effective, and long-lasting alternative for restoring and creating facial volume and sculpting, shaping, and contouring the chin and jaw.

The Application and Efficacy of Hyaluronic Acid Fillers for Chin Enhancement and Retrusion Correction: A Systematic Review of Patient-Reported Outcomes

A frequent facial abnormality called chin retrusion, also known as retrognathia, can be detrimental to a person's self-esteem and overall face aesthetics. Hyaluronic acid (HA) injections are one non-surgical approach to this problem that may provide individuals seeking chin augmentation with a relatively less invasive and potentially more affordable alternative. The present literature does not provide enough in-depth systematic reviews of the use of HA in chin augmentation. By completing a complete examination of the information that is currently available, this study intends to fill this knowledge gap, supporting physicians and researchers in better comprehending the efficacy and implications of HA in chin augmentation. The safety and success of any esthetic procedure should be made based on the results reported by the patients, including satisfaction and quality of life. Patients need to receive comprehensive surgical instructions from a medical professional to optimize the results of the HA injections for chin enhancement surgery. Regardless of the reported safety of using HA injections, some unwanted side effects have also been recorded. Indeed, healthcare professionals can make more informed decisions and give a patient comprehensive information about the procedure's risks and benefits to the patients. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EMBASE, OVID, and Google Scholar databases were searched up to June 2023. We concentrated on adult patients treated with HA for chin enhancement, and our research was limited to studies conducted in English. A total of 2,738 patients from 24 articles were studied, with 2,259 receiving HA injections for chin augmentation. When applicable, aesthetic outcomes were assessed using scales such as the Global Aesthetic Improvement Scale (GAIS)/FACE-Q and the Galderma Chin Retrusion Scale. Patient satisfaction increased noticeably. Among the studies, some reported complications following HA injection. While three studies found no significant negative effects, one highlighted a major necrotic complication. HA has proven to be an effective and safe alternative to chin augmentation surgery, with the majority of patients showing high satisfaction rates. However, large-scale randomized controlled trials are needed to obtain meaningful results, which will contribute to the further development of non-surgical cosmetic procedures. These studies may facilitate further innovation and refinement of these techniques and potentially expand the application of HA fillers in facial aesthetics.

Nonsurgical Chin Augmentation Using Hyaluronic Acid: A Systematic Review of Technique, Satisfaction, and Complications

BACKGROUND

Nonsurgical chin augmentation using hyaluronic acid (HA) has become a common procedure in cosmetic practices. This is offered to patients that prefer a nonsurgical, temporary method to correcting underdeveloped or retruded chin and restoring the volume loss. This systematic review highlights the main HA injection technique and associated patient satisfaction and complications of chin augmentation to further guide practitioners.

METHODS

A systematic review was performed according to PRISMA guidelines. PubMed, Embase, and Web of Science were searched using the appropriate keywords. Data collected from each study included patient satisfaction and complications, in addition to injection protocol and technique.

RESULTS

A total of 1305 studies were found based on search criteria. After full-text screening for inclusion and exclusion criteria, 8 studies were included. A total of 917 patients underwent HA chin augmentation, with different injection protocols. Most patients were satisfied with the results, and there were only 2 relatively major complications reported. The most common adverse events were local responses at the injection sites (swelling, bruising, pain, redness, and itching). There were no reports of vascular complications.

CONCLUSIONS

HA filler is an effective temporary method to correct chin retraction and absorption for chin augmentation, with a high degree of patient satisfaction and a low risk of severe complications.

LEVEL OF EVIDENCE III

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 .

Aesthetic Concerns of Chin Augmentation With Hyaluronic Acid Soft Tissue Filler in Chinese: A Prospective, Observational Study

BACKGROUND

The chin is an important facial structure that directly affects the overall contour of the face. The key to achieving a beautiful, effective, and safe chin injection is to make a good facial assessment and use an appropriate injection technique to achieve the best injection effect.

OBJECTIVE

In this article, the authors will discuss cosmetic concepts for the chin area and verify the effectiveness of chin augmentation techniques.

MATERIALS AND METHODS

Chin volume injections were performed on 23 Asian female subjects and 15 Asian male subjects. Demographic and imaging data were collected, and the facial aesthetic length was calculated. The authors also measured the length of beautiful chins, as evaluated by 2 plastic surgeons, and the ratios of chins from "The 100 Most Beautiful/Handsome Faces in China" published by TCC Asia in 2020.

RESULTS

The mean volume of chin filling was 1.89 ± 0.74 mL in female subjects and 2.68 ± 1.28 mL in male subjects. The ideal length of the chin was equal to that of the nasal dorsum in male subjects, and the ideal chin-to-nasal dorsum ratio was 0.9 in female subjects.

CONCLUSION

In this study, the authors investigate sex differences in chin aesthetics among the Chinese population and introduce an aesthetic and anatomical approach to chin injection.

Effectiveness of Jawline, Jaw angle, and Marionette Lines Correction in Combination with APTOS Threads and ELLANSE; An Innovative Technique

INTRODUCTION

Facial aging is a multifactorial process in which considerable changes occur in different face structures. Thread lifting is one of the most common minimally invasive treatments related to facial rejuvenation. This study aimed to evaluate the efficacy and safety of jawline, jaw angle, and marionette lines correction in combination with APTOS threads and ELLANSE M types through an innovative technique.

MATERIALS AND METHODS

In this prospective chart review study, 50 patients with ptosis candidates for lower face correction were included between October 2019 to February 2020. To perform correction of the jawline, jaw angle, and marionette lines, APTOS thread (LLN2GS) and ELLANSE M type were used through an innovative technique. The efficacy (six and twelve months after the surgery) and safety (one, six, and eight weeks after the surgery) were assessed by two surgeons independently. Data were analyzed by SPSS ver. 22 for windows (IBM Inc, NY).

RESULTS

In this study, 50 patients (4 male, 46 female) with Mean±SD age of 53.84±10.79 years old (Range: 42 years) were included. Regarding the results, patients' level of satisfaction (improved to excellent levels) increased from 74% six months after the surgery to 86% twelve months after the surgery. Moreover, the level of satisfaction obtained from surgeons (improved to excellent levels) decreased from 96% to 86% at six months and twelve months after the surgery, respectively. Based on the results, there were substantial and perfect agreements between the surgeon and the independent surgeon to evaluate the surgery efficacy of facial rejuvenation six and twelve months after the surgery. No side effects were reported after 6 and 8 weeks after surgery.

CONCLUSION

Regarding the results, due to rare complications, deep satisfaction, and short downtime, the correction of the lower face in combination with APTOS thread (LLN2G) and ELLANSE M type through our innovative technique be considered an efficient and safe treatment.

Refining Male Injectables in Aesthetics

The number of men interested in non-surgical cosmetic procedures has been increasing in recent years. Given the gender differences in cutaneous biology and anatomy, the aesthetic treatment of men requires certain nuances and modifications from the more frequently completed procedures in women. In addition, photoaging and sun protective practices can vary between gender, which may be a consequence of the stigma that surrounds skincare and its relation to traditional gender roles. We have reviewed pertinent biologic, anatomic, and behavioral aspects of men as they relate to cosmetic injectable treatments. Men may require higher doses of injectable neuromodulators due to their larger and stronger facial mimetic muscles. Injectable soft-tissue fillers should also accentuate the ideal facial shape of men, which includes a squared jawline and inferiomedial projection of the cheeks. The approach to injectable treatments differs between men and women in the aesthetic setting, and this should be addressed by practitioners.

Consensus on the Use of Hyaluronic Acid Fillers from the Cohesive Polydensified Matrix Range: Best Practice in Specific Facial Indications

Background

As the treatment indications for the Cohesive Polydensified Matrix^® hyaluronic acid (CPM-HA) portfolio continue to expand and diversify, injectors new to the range or those who are expanding the treatments they offer may be unsure of the optimal product and injection technique for specific facial areas. Each product in the CPM-HA portfolio has been intentionally designed to provide the best physical properties for a specific indication and target tissue. This document has been developed to provide a comprehensive, one-stop reference for clinicians using the portfolio.

Methods

An international panel of experts in the field of aesthetic medicine convened to develop guidelines on effective and safe injection technique when performing treatments with the CPM-HA range of soft-tissue fillers.

Results

Consensus members considered treatment indications in the upper, middle and lower face. Landmark deficiencies and anatomical considerations are described for each indication and consensus recommendations provided on the optimal product, injection depth and treatment technique. This is supplemented by the experts advice on avoidance of complications. Throughout, an evidence-based approach to selection of products and injection techniques is provided. The result is a fully tailored approach to a range of indications covering the full portfolio of CPM-HA products, including the newest addition for skin revitalization.

Conclusion

The recommendations in this consensus document are provided to assist clinicians in the selection of CPM-HA products, administration techniques and depths of injection with the aim of providing seamless and natural treatment results, enhanced safety and patient satisfaction.

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 .

The Pyramid Chin Augmentation: A New Technique

ABSTRACT

The surgical approach to chin for esthetical purpose can be isolated or in a combination with other treatments like maxillomandibular surgery. Both possibilities include sliding genioplasty or implants of autologous or alloplastic materials. In this article, the authors present their new technique, the Pyramid Chin Augmentation.In January 2020, a 40-year-old male patient came to authors' observation asking for a great augmentation in the sagittal dimension of the chin, a better pronunciation of mandibular angles and of his cheekbones. The surgical treatment consisted in three different procedures at the same time: a chin wing osteotomy, a Pyramid Chin Augmentation and zygomatic PEEK custom-made malar implants. The pyramid was created on the body of the chin wing with a cortical bone graft from the oblique line of the ascending ramus of the mandible. The harvested bone was cut into strips of rectangular shape gradually shorter to be superimposed on the wing forming a pyramid. A fixation with 2 screws was performed and then was necessary to smoothen the edges of the bone layers.The result immediately after the end of the surgery was in line with the set goals. The mandibular angles were more prominent, the chin was more sagittal pronounced, and there was no evidence of depression in the symphysial region.The Pyramid Chin Augmentation Technique can be a valid tool in chin augmentation surgery and can also represent an effective procedure in the finishing touch of other facial surgery techniques.

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.

VYC-25L Hyaluronic Acid Injectable Gel Is Safe and Effective for Long-Term Restoration and Creation of Volume of the Lower Face

BACKGROUND

Juvéderm Volux (VYC-25L; Allergan plc) is an injectable hyaluronic acid gel designed to restore and create facial volume.

OBJECTIVE

The aim of this study was to evaluate the safety and effectiveness of Volux for chin retrusion over 18 months and after repeat treatment.

METHODS

This prospective, single-blind, controlled study enrolled subjects aged ≥18 years with chin retrusion (glabella-subnasale-pogonion facial angle 145°-165°). Subjects were randomized (3:1) to Volux at study onset or 3 months later (control group), and could receive a single repeat treatment during months 18 to 24. Assessments included mean facial-angle change from baseline, Global Aesthetic Improvement Scale (GAIS) responder rates (improved/much improved), improvements in 3 subject-reported FACE-Q scales, and safety.

RESULTS

Of 132 enrolled subjects, 119 received initial Volux treatment and 89 received repeat treatment. Mean changes (95% confidence interval) in glabella-subnasale-pogonion angle from baseline for treatment and control groups, respectively, were: 1.15° (0.75°, 1.56°) and 1.16° (0.57°, 1.75°) at month 18, and 3.14° (2.68°, 3.61°) and 2.72° (1.78°, 3.66°) 1 month after repeat treatment. Investigators rated 52.5%/60.0% of treated/control subjects at month 18 and 96.9%/100% after retreatment as GAIS responders; subject-reported rates were 62.0%/64.0% and 93.8%/100%. Durable improvements in Satisfaction with Chin, Satisfaction with Lower Face and Jawline, and Psychological Well-Being were reported in 82.1%, 78.2%, and 60.3% of subjects, respectively, at month 18, and 92.3%, 93.8%, and 67.7% of subjects after retreatment. The safety profile was as expected.

CONCLUSIONS

Volux injectable gel is a safe, effective, and durable alternative to surgical treatments for increasing chin projection and jaw volume, and results in high patient satisfaction.

LEVEL OF EVIDENCE: 2

Correlation between facial attractiveness and facial components assessed by laypersons and orthodontists

Background/purpose

Relationship between facial attractiveness and facial components is not completely clear. The aim was to analyze the correlation between facial attractiveness and facial components assessed by laypersons and orthodontists.

Materials and methods

The attractiveness of 100 adult patients (50 males and 50 females with their frontal, lateral, and frontal smiling photos), before orthodontic treatment, was assessed by 24 laypersons and 24 orthodontists using visual analog scale. Pearson correlation coefficient and stepwise regression were used for statistical analysis.

Results

When laypersons assessed, a significant correlation was found between facial attractiveness and the chin (r = 0.671), eyes (r = 0.669), lips (r = 0.585), hair (r = 0.527), teeth (r = 0.338), and nose (r = 0.247); the chin was responsible for 45.1% of the variation in facial attractiveness, the eyes for 14.3%, and the lips for 0.8%. When orthodontists assessed, a significant correlation was found between facial attractiveness and the lips (r = 0.789), eyes (r = 0.646), hair (r = 0.613), chin (r = 0.565), nose (r = 0.264), and teeth (r = 0.221); the lips were responsible for 62.2% of the variation in facial attractiveness, the eyes for 8.2%, the chin for 1.4%, and the hair for 0.5%.

Conclusion

When laypersons evaluate, the chin contributes the most to facial attractiveness, and when orthodontists evaluate, the lips contribute the most. Whether in the evaluation of laypersons or orthodontists, the contribution of teeth to facial attractiveness is significantly less than that of the lips and chin.

Mandibular osteomyelitis after hyaluronic acid injection

BACKGROUND

Mandibular osteomyelitis after filler injection is extremely rare.

AIMS

We reported a case of mandibular osteomyelitis after hyaluronic acid injection.

PATIENTS

A 33-year-old woman received 1 mL hyaluronic acid injection on her chin 1 year ago, after which her chin kept swelling and painful, and gradually ulcerated with pus flowing out. She received antibiotics, debridement procedures, negative pressure wound therapy, and hyperbaric oxygen therapy without symptoms improved. Cone-beam computed tomography scan showed local bone destruction, sequestrum formation, and tissue calcification on the right mandible body. The patient was diagnosed with mandibular osteomyelitis and received local curettage for the removal of necrotized bone.

RESULTS

Literature search found no case reports on mandibular osteomyelitis after filler injection so far.

CONCLUSION

Minimizing the risk of contamination and infection is strictly required during the filler injection process. Once the patient shows signs of incurable mandibular infection postoperation, clinicians should consider the possibility of osteomyelitis.

Auxiliary usage of botulinum toxin A in plastic surgery in China

BACKGROUND

Currently, botulinum toxin A (BTA) is mainly used in the treatment of muscle spasms and in cosmetic procedures, and its cosmetic indications are expanding rapidly. There have been sporadic reports focused on the preoperative usage of BTA complementing plastic surgery. We briefly summarize the current experience of BTA complementing plastic surgery in China based on clinical experience.

METHODS

We reported a brief review of the preoperative use of BTA as an accessory to plastic surgery (blepharoplasty, chin augmentation, mandibular angle ostectomy, rhinoplasty, hyaluronic acid fillers injection for wrinkle reduction) based on previous studies and our experience.

RESULTS

Preoperative treatment with BTA in plastic surgery helps surgeons operate and results in better cosmetic results.

CONCLUSIONS

Preoperative BTA treatment can reduce the occurrence of surgical complications as well as improve the surgical results in some plastic surgeries. The procedure is suitable for clinical application and worth promoting.

Nonsurgical jawline rejuvenation using injectable fillers

BACKGROUND

A well-defined jawline is a critical component in the perception of facial attractiveness in both men and women. Dermal fillers offer a nonsurgical, temporary method of correcting mild-to-moderate mandibular bone resorption.

AIMS

The authors discuss pertinent aspects of anatomy, pathophysiology of aging, patient evaluation, gender considerations, injection technique, and complications in jawline augmentation using injectable fillers.

METHODS

A brief review of the literature surrounding jawline augmentation using injectable fillers in both men and women, as well as the authors' experience in this area, is provided.

RESULTS

Nonsurgical jawline 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 are also reviewed.

CONCLUSION

Jawline rejuvenation is a key component to global facial aesthetic rejuvenation. Therefore, it is important for physicians to understand how to safely and effectively perform nonsurgical jawline rejuvenation using injectable fillers.

Midline Volume Filler Injection for Facial Rejuvenation and Contouring in Asians

BACKGROUND

Hyaluronic acid (HA) injection is popular in cosmetic surgery because of its minimal invasion and immediate recovery. However, few injection techniques are specifically designed for Asians, considering their aesthetic and structural differences from those of Caucasians.

METHODS

The midline volume injection technique was performed on 37 Asian females and 3 males at sites including the forehead, glabella, nasal dorsum, nasal base and chin. The treatment focused on improving the facial profile projection. 3D image data were collected, and facial aesthetic angles were calculated. Volume changes in facial parts were analyzed before injection and during follow-up. Patient satisfaction was assessed using the visual analog scale (VAS).

RESULTS

The average injected filler volume was 6.14 ± 2.82 ml. The treatment optimized the facial contour and produced instant facial rejuvenation. On 3D images, the average midline volume increased by 6.02 ± 2.23 ml. An average volume decrease of 3.92 ± 1.94 ml was observed in the cheeks and was positively related to the increased midline volume. The average nasolabial and nasal facial angles were increased from 100.00 ± 7.37° to 107.93 ± 9.01° and 28.78 ± 3.28° to 31.78 ± 2.97°, while the mentolabial angle was decreased from 146.55 ± 7.83° to 141.13 ± 6.23°. The mean VAS scores were 2.28 ± 1.27 immediately after injection and 2.56 ± 1.20 after 6 months.

CONCLUSIONS

The midline volume injection technique of HA fillers is suitable for Asians. It greatly enhances the facial profile, as illustrated by volume changes in 3D images, leading to a more attractive facial appearance.

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.

Practical Approach and Safety of Hyaluronic Acid Fillers

Supplemental Digital Content is available in the text.

Soft-tissue filler use has grown considerably related to the increasing popularity of minimally invasive cosmetic procedures. Hyaluronic acid products are currently the most utilized soft-tissue fillers. Proper working knowledge of individual products, limitations to use, and anatomic principles can improve outcomes. Prevention is key to minimize complications; however, when present, complications must be managed methodically. Complications are categorized based on the timing of presentation and include early, late, and delayed. Vascular compromise and tissue necrosis are among the most devastating complications seen with filler use. Nodules can be related to an inflammatory or infectious etiology but should be distinguished as treatment varies. Hyaluronidase is mandatory to have available as a reversal agent for hyaluronic acid products and can be used in treatment for many complications and untoward sequela.