Anatomic Characteristics and Treatment of the Midcheek Groove by Deep Filling

Efficacy and Safety of Hyaluronic Acid Combined with Botulinum Toxin Type A in the Treatment of Midcheek Groove: A Prospective Study

BACKGROUND

The midcheek groove, a diagonal wrinkle in the infraorbital and infrazygomatic regions, disrupts the entire midface smooth lines and impacts facial aesthetics. Despite current treatments' limited effectiveness, including hyaluronic acid fillers and surgical risks, and the neglect of the medial orbicularis oculi muscle, this study explores the efficacy and safety of combining botulinum toxin type A with sodium hyaluronate injection for midcheek groove treatment, considering anatomical and clinical factors.

METHODS

In this prospective study, healthy participants with midcheek grooves (depth >3 mm) were treated with botulinum toxin type A combined with hyaluronic acid injections. Data were collected at baseline, 4, 12, and 32 weeks as well as 30 min after treatment, and at 1, 3, and 6 months follow-up. Changes in the depth of the midcheek groove were measured using a three-dimensional scanner and assessed using the Patient Satisfaction Assessment Scale. Subgroup analyses were performed to assess the impact of different clinical subtypes on treatment outcomes.

RESULTS

Thirty-six volunteers completed this study, and the midcheek groove depth was significantly reduced at 30 min after treatment and at 1, 3, and 6 months of follow-up (p < 0.001). The medial half of the midcheek groove had the best efficacy at 1 month after treatment, while the lateral half responded best at 30 min after treatment. Subgroup analyses showed that clinical subtypes affected treatment efficacy. No complications or severe adverse reactions were observed.

CONCLUSIONS

Botulinum toxin type A combined with hyaluronic acid injection effectively improved the midcheek groove.

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 .

Clinical efficacy of stromal vascular fraction gel in the treatment of mature striae distensae

BACKGROUND

Striae Distensae (SD) is a common dermatological lesion. The mechanism of formation is unclear, the prevailing theory is mechanical pulling of the skin and hormonal changes. Traditional SD treatment methods include topical drugs, photoelectric therapy, stripping and others, but each has limitations. Stromal vascular fraction gel (SVF-gel) is a filler physically prepared from granular fat, enriched with adipose-derived stem cells (ADSCs) and extracellular matrix (ECM). A good effect in the treatment of neck lines, wounds, acne, and other aspects. SD formation and treatment goals are comparable to those of neck lines. In this study, SVF-gel filling will be used to treat mature SD, and its effectiveness and safety will be discussed in detail.

METHODS

From December 2019 to June 2022, recruit patients who want to treat SD caused by obesity or pregnancy among those who have "autologous fat aspiration" to change their body shape. Preoperatively, the area to be treated for SD was marked, autologous fat aspiration was performed, and the aspirated fat was prepared as SVF-gel and filled into the preoperatively marked SD. All patients had preoperative and postoperative follow-up with planar photographs and VISIA skin analyzer photographs to assess surgical results and safety from subjective and objective perspectives.

RESULTS

A total of 36 patients were enrolled, with 31 of them successfully followed up on. The mean Global Aesthetic Improvement Scale (GAIS) score six months after surgery was 1.87 ± 0.03. At six months postoperatively, the overall patient satisfaction rate was 90%. The depth, area, and color of SD improved six months after surgery, and no serious complications occurred in any of the patients.

CONCLUSIONS

SVF-gel is a safe and effective method of improving mature SD and can be used as a clinical treatment option.

U-type soft tissue lifting: A new composited technique for reversing lower eyelid and midfacial aging

BACKGROUND

Facial rejuvenation is becoming more and more popular, particularly among middle-aged persons. There are currently many techniques for improving the aforementioned situations, but each has its drawbacks. Our study aimed to discuss the treatment effect of a composited technique for reversing both lower eyelid and midface aging.

METHODS

The patient's face was designed and measured before surgery. During surgery, a traditional lower blepharoplasty incision was made. The layer between the orbital septum and the orbicularis oculi muscle was separated to approximately 4-5 mm below the infraorbital, then the orbital septum and orbicularis retaining ligament were found to be released. A self-made suspension curving needle subconsciously passed through the brim of the superficial cheek fat pad via the "U-type" path and raised them to the proper location. Then sutured them to the infraorbital rim periosteum, as well as the suborbicularis oculi fat (SOOF) and the orbital septum fat. Secured the outside canthus to keep the lower lid position stable.

RESULTS

From February 2020 to November 2022, 106 patients underwent the new surgical procedure and were successfully followed up for 20 ± 6.5 months postoperatively. The mean GAIS score was 2.42 ± 0.78, patient satisfaction rate was 95%. All of the Barton grades were decreased. The nasal base level suspension points were elevated to a level of 5 ± 2 mm. 3D measurement data revealed significant improvements.

CONCLUSIONS

The composited technique is a safe and effective way to reverse the aging of the lower eyelid and midface.

The Retention-Rate Improvement of Stromal Vascular Fraction Gel in Prefrontal Filling With Botulinum Toxin-A Injection: A Retrospective Analysis

BACKGROUND

As a derivative of adipose tissues, stromal vascular fraction gel has been widely utilized in facial soft tissue filling, but it still does not achieve the expected effect in forehead filling. The reason may be related to the corrugator muscles movements.

OBJECTIVES

The authors aimed to evaluate the effect of botulinum toxin-A (BTX-A) on the retention rate of stromal vascular fraction gel by limiting the corrugator muscles movements and to provide a theoretical basis that short-term inhibition of movement in the affected area could improve the effects of the fat graft.

METHODS

From January 2019 to June 2021, patients with stromal vascular fraction gel facial filling (including frontal and temporal parts) were selected. According to whether or not BTX-A treatment was received, patients were divided into injected and the noninjected groups. A questionnaire and the Global Aesthetic Improvement Scale (GAIS) were administered to evaluate 2-dimensional photos. The retention rate and curvature were calculated with 3-dimensional images utilizing Artec Studio 13 Professional and MATLAB software.

RESULTS

The graft retention, forehead curvature, and GAIS scores were all higher in the injected group than the noninjected group (P < .01). On the questionnaire, the injected group also showed more satisfaction with the treatment effect and were more willing to recommend the treatment to their friends.

CONCLUSIONS

BTX-A injection can improve the retention rate of prefrontal stromal vascular fraction gel filling, with higher patient satisfaction and better postoperative effects.

LEVEL OF EVIDENCE: 5

Effect of Positional Changes on Skin Landmarks in Midface Filling

BACKGROUND

The design lines for midfacial filling shift upward with a patient's position changes from upright to supine during operation. This will cause the actual filled part to deviate from the target area.

OBJECTIVES

This authors aimed to evaluate the effect of positional changes on midfacial landmarks and find the optimal body position for midface filling.

METHODS

The process involved the grading and evaluation stages. The midfacial laxity of each sample in the evaluation stage was graded into minimal, moderate, and severe by the system established in the grading stage. Measured through the 3-dimensional images in each grade, the vertical distances from landmarks C, D, and E (representing the region of the tear trough, infraorbital area, and nasolabial fat pad, respectively) to the horizontal line of the inner canthus and depth of nasolabial fold at an angle of 90° were separately compared with those from the other angles (60°, 45°, 30°, and 0°) of the operating table.

RESULTS

In the minimal midfacial laxity group, all 3 landmarks significantly moved upward when the angle decreased to 30°. However, landmark E of the moderate and severe and landmark D of the severe midfacial laxity groups both significantly moved upward when the angle decreased to 45°. The depth of the nasolabial fold at a 45° angle was significantly less than that at a 90° angle in the moderate and severe groups.

CONCLUSIONS

In midface filling, a patient's body position should be optimally selected according to the midfacial laxity and filling area.

The Facial Vein on Computed Tomographic Angiography: Implications for Plastic Surgery and Filler Injection

BACKGROUND

Knowledge of the anatomy of the facial vein is essential for plastic surgery and filler injection.

OBJECTIVES

The authors sought to investigate the variation and 3-dimensional (3D) course of the facial vein utilizing computed tomographic angiography.

METHODS

The computed tomographic angiography images of 300 facial veins from 150 Asian patients were included in this study. The distance between each anatomical landmark and the facial vein was measured to position the course. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum were measured at 5 anatomical planes.

RESULTS

The facial vein showed a relatively constant course with a frequency of 7.0% variation. The vertical distance between the medial canthus, midpoint of inferior orbital rim, or external canthus and the facial vein was 10.28 ± 2.17 mm, 6.86 ± 2.02 mm, or 48.82 ± 7.26 mm, respectively. The horizontal distance between medial canthus, nasal alar, or oral commissure and the facial vein was 6.04 ± 1.44 mm, 22.34 ± 3.79 mm, or 32.21 ± 4.84 mm, respectively. The distance between the mandibular angle or oral commissure and the facial vein at the inferior of mandible was 24.99 ± 6.23 mm or 53.04 ± 6.56 mm. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum varied from the plane of the medial canthus to the plane of the mandible.

CONCLUSIONS

This study revealed the 3D course of the facial vein with reference to anatomical landmarks. Detailed findings of the facial vein will provide a valuable reference for plastic surgery and filler injection.