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Kabakcı AG, Bozkır MG. Dimension, Location and Clinical Importance of Supraorbital Foramen and Notch: A Combined Cadaveric and Dry Skull Study. Aesthetic Plast Surg 2024:10.1007/s00266-024-04196-7. [PMID: 38951229 DOI: 10.1007/s00266-024-04196-7] [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: 04/26/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE The exit points of the supraorbital nerve and its branches hold significant importance in various medical procedures, including supraorbital endoscopic surgeries, forehead-facial aesthetic plastic surgeries, medical aesthetic applications and maxillofacial surgeries. Therefore, the primary objective of the present study was to precisely define the dimension, location and clinical significance of the supraorbital foramen/notch. By doing so, we aimed to enhance our understanding of this anatomical structure and its implications for surgical and aesthetic interventions in the supraorbital region. METHODS For our study, we conducted anatomical dissections and bone measurements to assess the significance of anatomical variations of the supraorbital foramen/notch. We utilized a sample consisting of 28 cadavers and 38 skulls. The supraorbital foramen/notch was bilaterally analyzed in all 28 cadavers and 38 dry bones. We morphometrically analyzed the distance between the supraorbital foramen/notch and various anatomical landmarks, including the nasion, supraorbital margin, infraorbital margin, temporal crest, glabella, frontal cavity and midline of the face. Additionally, we measured the distance between the supraorbital foramen/notches and the frontal foramen/notches, and the width of the supraorbital foramen/notch and the distance between both supraorbital foramina/notches. RESULTS There are 32 (57.14%) supraorbital foramina, and the remaining are 24 (42.86%) supraorbital notches in cadavers and there are 36 (47.37%) supraorbital foramina, and the remaining are 40 (52.63%) supraorbital notches in skulls. We observed consistency in the dimension and location values of anatomical measurement parameters between cadavers and dry skulls on both right and left sides, with the exception of the parameter "distance from temporal crest" (p=0.042). Furthermore, our correlation analysis revealed a significant positive relationship between the right and left sides across all parameters, except for the following instances: in dry skulls, "distance from supraorbital margin" and in cadaver parameters, "distance from temporal crest, " "distance from frontal cavity" and "width." CONCLUSION In our study, we observed that the distributions of supraorbital foramina and notches were nearly similar. Furthermore, our findings indicated comparable measurements between the right and left sides in both cadavers and skulls. These results suggest a degree of consistency in supraorbital anatomy within our study sample, regardless of the specimen type (cadavers or skulls) or laterality (right or left side). NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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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Affiliation(s)
- Ayşe Gül Kabakcı
- Faculty of Medicine Department of Anatomy, Cukurova University, Adana, Turkey.
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Liao ZF, Cong LY, Li FW, Zhou YH, Luo CE, Zhan WF, Luo SK. Positions of the Glabellar Arteries: Implications for Glabellar Injection. Aesthetic Plast Surg 2023; 47:2037-2044. [PMID: 36538055 DOI: 10.1007/s00266-022-03218-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Glabellar filler injection is linked to an increased risk of blindness. A thorough understanding of vascular changes in the glabellar area is critical for safety. The study's goal was to precisely determine the three-dimensional placements of the arteries in the glabellar area. METHODS In 117 cadavers, the vascular structures in the glabellar area were examined. There were four segments (S1/S1'-S4/S4') and five points (P1-P5) specified. The number of identified arteries found in each section and at each position was tallied. Additionally, the depth of the underlying identified artery under each site was measured. RESULTS One to three named arteries per glabellar segment were found. Each segment had at least one named artery, and the number of named arteries detected between S1/S1' and S4/S4' decreased. The chance of encountering identified arteries at the 5 designated locations, P1-P5, was 7/117 (6.0%), 6/117 (5.1%), 7/117 (6.0%), 6/117 (5.1%), and 16/117 (13.7%), respectively. At P1-P5, the major artery trunk was 1.8 ± 0.3 mm, 1.6 ± 0.3 mm, 1.4 ± 0.2 mm, 1.3 ± 0.3 mm, and 1.1 ± 0.2 mm below the skin. CONCLUSIONS The site of the glabellar arteries was clearly shown in this investigation; these arteries were met at a rate of 14% from P1 to P5. We demonstrated that a single entry site through the glabella via cannula could readily keep the needle deep enough for safe glabellar filler injection. 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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Affiliation(s)
- Zhi-Feng Liao
- 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
| | - Li-Yao Cong
- 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
| | - Fang-Wei Li
- 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
| | - 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
| | - 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
| | - Wen-Feng Zhan
- Department of Radiology, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 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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Scott G, Khonda M, Hsu T, Rivkin A, Frank K, Fezza J, Woodward J. An Experimental Model Exhibiting Anterograde and Retrograde Vascular Occlusion of Facial Fillers to Avoid Vision Loss. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5270. [PMID: 37711726 PMCID: PMC10499102 DOI: 10.1097/gox.0000000000005270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023]
Abstract
Background Facial filler injection techniques that help decrease the risk of vascular occlusion are an important growing area of study. This study demonstrates a model of injecting fillers into a simulated bifurcated arterial system, using different sized needle gauges at a constant injection pressure. Methods Three facial fillers were injected into a bifurcated intravenous tubing with continuous irrigation at a constant pressure to simulate a vascular system. Videography was used to observe for retrograde flow through the simulated supratrochlear artery to the bifurcation point, where the filler was redirected by anterograde flow into the branch representing the ophthalmic artery. Results Filler injection with retrograde flow to the bifurcation occurred with all the 27G needle trials. In comparison, the 30G needle trials were only able to reach the bifurcation point in three of the nine trials. The average time to the bifurcation point with subsequent ophthalmic artery anterograde flow with the 27G and 30G needles were 8.44 (95% confidence interval ±2.06) and 33.33 (95% confidence interval ±16.56) seconds, respectively. Conclusions Larger 27G needles consistently reached retrograde flow and the bifurcation point faster than 30G needles. This study suggests thinner needles may be less likely to cause retrograde occlusion.
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Affiliation(s)
- Gabriel Scott
- From the Department of Ophthalmology, Duke University Medical Center, Durham, N.C
| | - Meghana Khonda
- From the Department of Ophthalmology, Duke University Medical Center, Durham, N.C
| | - Tammy Hsu
- From the Department of Ophthalmology, Duke University Medical Center, Durham, N.C
| | | | - Konstantin Frank
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig–Maximilians University, Munich, Germany
| | | | - Julie Woodward
- From the Department of Ophthalmology, Duke University Medical Center, Durham, N.C
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Beer K, Biesman B, Cox SE, Smith S, Picault L, Trevidic P. Efficacy and Safety of Resilient Hyaluronic Acid Fillers Injected with a Cannula: A Randomized, Evaluator-Blinded, Split-Face Controlled Study. Clin Cosmet Investig Dermatol 2023; 16:959-972. [PMID: 37038451 PMCID: PMC10082220 DOI: 10.2147/ccid.s402315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/04/2023] [Indexed: 04/12/2023]
Abstract
Purpose Cannulas are increasingly used for injecting hyaluronic acid fillers, as they are thought to improve patient comfort safety and treatment tolerability. This study aimed to demonstrate the non-inferiority of a Resilient Hyaluronic Acid 4 (RHA 4) filler injected with a cannula versus a needle for the treatment of moderate to severe nasolabial folds (NLF). Patients and Methods A total of 50 subjects were included in a randomized, evaluator-blinded, split-face trial. The NLF were injected with RHA 4 using a cannula on one side of the face and using a needle on the other side on Day 0. A touch-up could be performed 4 weeks later. The subjects were followed up for 12 weeks after the last injection, ie, injection on Day 0 or touch-up. Efficacy was evaluated using a Wrinkle Severity Rating Scale (WSRS), the Global Aesthetic Improvement Scale (GAIS), and patient-reported outcomes. Safety assessments included the injection-site pain, common treatment reactions (CTRs), and adverse events (AEs). Results Twelve weeks after the last injection, the efficacy of the cannula treatment was found to be non-inferior to that of the needle treatment, based on the WSRS score improvements. The other study endpoints showed the equivalent efficacy and safety of the two methods. No serious or unexpected AEs were reported. Conclusion RHA 4 may be effectively and safely injected into the NLF using a cannula or a needle, provided it is administrated by a trained practitioner.
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Affiliation(s)
| | | | | | - Stacy Smith
- California Dermatology & Clinical Research Institute, Encinitas, CA, USA
| | - Laura Picault
- Teoxane Clinical Development Department, Genève, Switzerland
| | - Patrick Trevidic
- Expert 2 Expert, Paris, France
- Correspondence: Patrick Trevidic, Expert 2 Expert, 7 Rue de Sontay, Paris, 75116, France, Tel +33 145 016 415, Fax +33 145 008 981, Email
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Tear Trough Ligament Release and Autologous Fat Injection as a New Method for Tear Trough Deformity Correction. Aesthetic Plast Surg 2022; 46:2814-2822. [PMID: 35857083 DOI: 10.1007/s00266-022-03002-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/20/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Even though the tear trough (TT) deformity is only 2 cm in length, it can give a worn, even haggard appearance on the face. The authors developed a novel approach and presented findings from the clinical effect. METHODS Between February 2018 and January 2021, the medical records of patients treated with autologous fat injection for TT deformity were researched. The fat was placed under the orbicularis oculi muscle with a sharp cannula. During that period, the TT ligament was also released with the cannula. After the fat was injected entirely, we still needed to repeatedly puncture this ligament to release it until there was no puncture resistance. Improvement was evaluated by measuring patients' and investigators' global aesthetic improvement scale. RESULTS 152 of 173 patients completed the follow-up plan and were enrolled in this study. The most common complications reported were temporary swelling and lumpiness. At 1 month, 3 months, 6 months, 12 months, and 24 months, the satisfaction rate of patient self-assessment was 93.4%, 89.5%, 86.8%, 84.3%, and 82.4%, respectively. The Investigator Global Aesthetic Improvement Scale showed 94.1% of patients' improvement after one month, 83.6% after three months, 78.3% after six months, 75% after 12 months, and 71.8% after 24 months. CONCLUSION Fat injection based on TT ligament release to correct TT deformity is a novel, easy and effective treatment that deserves to be further used. 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 .
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Affiliation(s)
- Sharon Ann Van Wicklin
- Sharon Ann Van Wicklin, PhD, RN, CNOR, CRNFA(E), CPSN-R, PLNC, FAAN, ISPAN-F, is the Editor-in-Chief, Plastic and Aesthetic Nursing , and is a Perioperative and Legal Nurse Consultant, Aurora, CO
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Kern JA, Kollipara R, Hoss E, Boen M, Wu DC, Groff W, Goldman MP. Serious Adverse Events With Injectable Fillers: Retrospective Analysis of 7,659 Patient Outcomes. Dermatol Surg 2022; 48:551-555. [PMID: 35170541 DOI: 10.1097/dss.0000000000003409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In total, 2.7 million injectable filler treatments were performed in 2019 in the United States. Although generally considered to be a safe treatment modality, adverse events may occur in rare situations. OBJECTIVE Analyze serious adverse events from injectable filler treatments, including infections, cutaneous necrosis, blindness, or delayed-onset nodule formation, spanning 11 years for 3 board-certified dermatologists and review their incidence, management, and outcomes. MATERIALS AND METHODS A retrospective analysis was performed of injectable filler treatments spanning 11 years at a multipractitioner outpatient clinic. Serious adverse events were identified, and treatment measures were documented. A literature search was performed to determine recent trends and outcomes for comparison. RESULTS Between January 2009 and August 2020, 18,013 mL of injectable filler was administered to 7,659 patients. Of the 18,013 mL administered, 74.1% comprised hyaluronic acid derivatives, 19.19% poly-l-lactic acid, and 6.71% calcium hydroxylapatite. Four serious adverse events were identified. Three events were delayed-onset skin nodule formation. One adverse event was related to vascular compromise and subsequent cutaneous necrosis. After appropriate treatment, all adverse events resolved without significant long-term sequelae. CONCLUSION Serious adverse events associated with injectable fillers, when performed by board-certified dermatologists, are extremely rare and can be successfully managed with appropriate treatment.
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Affiliation(s)
- Jessica A Kern
- University of California, San Diego School of Medicine, San Diego, California
| | | | - Elika Hoss
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Monica Boen
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
| | - Douglas C Wu
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
| | - William Groff
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
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Application of Nonsurgical Modalities in Improving Facial Aging. Int J Dent 2022; 2022:8332631. [PMID: 35251183 PMCID: PMC8894069 DOI: 10.1155/2022/8332631] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022] Open
Abstract
Objective. This review aims to summarize different kinds of applications of minimally invasive surgery in improving facial aging to provide a comprehensive and accurate introduction on the issue of esthetic treatment of facial skin. Overview. In the twentieth century, facial rejuvenation has become a new beauty trend. Facial cosmetology has entered a period of antiaging and rejuvenation therapies and microplastic surgery. The pursuit of beauty has promoted the development of minimally invasive plastic surgery. This review introduces the possible causes of facial aging and its related topics with a focus on facial injectable drugs, such as botulinum toxin, main filler materials (hyaluronic acid, calcium hydroxyapatite, poly L-lactic acid, collagen, autologous fat, and polymethyl methacrylate), and some current antiwrinkle technologies, such as thread lift and radiofrequency rhytidectomy. Conclusions. Despite the difference in mechanisms of action, each technique can address facial aging involving the loss of collagen, displacement and enlargement of fat, and muscle relaxation. Combinations of these treatments can provide patients with reasonable, comprehensive, and personalized treatment plans.
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Abstract
ABSTRACT With the sudden emergence of new medical aesthetic fillers, the number of fillers injected worldwide has exploded, but there are also worrying risks in the pursuit of beauty. At present, many cases of blindness caused by injection of aesthetic fillers have been reported. Most of the cases are caused by irreversible vascular embolism. This is a rare yet greatly feared complication of using facial cosmetic fillers. This article reviewed and analyzed the literature and summarized the changes in the anatomical structure of facial blood vessels related to blindness during facial injection.
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Affiliation(s)
- Dan Li
- From the Department of Plastic and Burn Surgery, the First Affiliated Hospital Chongqing Medical University, Chongqing, China
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Liao ZF, Cong LY, Hong WJ, Luo CE, Luo SK. Three-Dimensional Computed Tomographic Study of the Supratrochlear Artery and Supraorbital Artery to Determine Arterial Variations and Their Relationship. Dermatol Surg 2022; 48:225-231. [PMID: 34923528 DOI: 10.1097/dss.0000000000003347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The forehead has high risks associated with filler injection considering its highly complex vascular system. This study aims to thoroughly describe the anatomical variations and relationships between the supratrochlear artery (STA) and supraorbital artery (SOA). MATERIALS AND METHODS We studied 56 cadaveric heads by computed tomography after contrast-agent injection. RESULTS The deep branch of the STA originated in the deep superior orbital arcade and the ophthalmic artery (OA), whereas that of the SOA originated at 3 locations: the deep superior orbital arcade, deep superior orbital artery, and OA. The superficial branch of the STA also had 3 origins: the superficial superior orbital arcade, OA, and angular artery, whereas the superficial branch of the SOA had 2 origins: the superficial superior orbital arcade and OA. Based on the relationship between the STA and SOA, 2 main arterial distribution patterns were observed in both superficial and deep layer arteries: STA/SOA connected pattern and STA/SOA disconnected pattern, of which the latter pattern has 3 subtypes. CONCLUSION The forehead arteries have complex origins. The relationship of the supratrochlear and supraorbital arteries could be categorized into 2 main patterns. The study elucidated the complexity of the forehead vasculature.
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Affiliation(s)
- Zhi-Feng Liao
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Li-Yao Cong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Wei-Jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Cheng-En Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
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Trévidic P, Kaufman-Janette J, Weinkle S, Wu R, Dhillon B, Antunes S, Macé E, Maffert P. Injection Guidelines for Treating Midface Volume Deficiency With Hyaluronic Acid Fillers: The ATP Approach (Anatomy, Techniques, Products). Aesthet Surg J 2022; 42:920-934. [PMID: 35039828 PMCID: PMC9373948 DOI: 10.1093/asj/sjac007] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Midface rejuvenation is among the most valuable indications of hyaluronic acid dermal fillers, because malar projection and full upper cheeks significantly contribute to a youthful appearance. Hyaluronic acid fillers have evolved over the past 2 decades to meet specific clinical needs such as strong projection capacity and adaptability to facial dynamism. As a result, they now represent the treatment of choice for midface rejuvenation throughout age ranges by offering the potential for noninvasive treatment, immediate results, and minimal downtime. Because the 5-layered structure of the midface plays a central role in the human face, injecting the midface area may also indirectly improve other aesthetic concerns such as infraorbital hollowing and nasolabial folds. Nonetheless, midface rejuvenation requires a tailored treatment approach and a thorough knowledge of anatomy to minimize procedural risks and achieve natural-looking results. This article provides an extensive anatomical description of the midface and of the usual course and depth of vascular structures circulating nearby to delineate a treatment area and minimize procedural risks. Furthermore, considering the differential mobility and mechanical constraints of each layer of the midface, a multilayer treatment algorithm is proposed for adapting the treatment strategy to patient specificities (including age, gender, skin type, and morphology). Emphasis is also placed on desirable filler properties to create deep structural support on the one hand and accompany facial movement on the other hand.
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Affiliation(s)
| | | | | | | | | | - Stéphanie Antunes
- Clinical and Medical Affairs Department, Teoxane SA, Geneva, Switzerland
| | - Emilie Macé
- Clinical and Medical Affairs Department, Teoxane SA, Geneva, Switzerland
| | - Pauline Maffert
- Clinical and Medical Affairs Department, Teoxane SA, Geneva, Switzerland
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Complications and Disasters After Minimally Invasive Tissue Augmentation with Different Types of Fillers: A Retrospective Analysis. Aesthetic Plast Surg 2021; 46:1388-1397. [PMID: 34939150 PMCID: PMC9411215 DOI: 10.1007/s00266-021-02691-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/20/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The interest in youthful appearance and rejuvenating procedures is unbroken in our society. Besides surgical procedures, permanent fillers are utilized. The incorrect and unprofessional use of these substances, auto-injections in particular, have devastating results for patients and are challenging for the plastic surgeon. The aim of this retrospective study was to delineate the differences between permanent and non-permanent filler complications and appropriate treatment options. METHODS We conducted a retrospective study and researched the hospital information system in the time period from 2001 to 2020. Patients with unprofessional use of permanent fillers, auto-injections and injections of unformulated substances were determined. Age, gender, localization, complications, length of hospital stay, comorbidities, histopathological workups and surgical salvage procedures were noted. Descriptive statistics were calculated. RESULTS Seventeen patients were identified from 2001 till 2020. In four cases, auto-injections by the patients were the cause, whereas in the other patients the injections were performed by medical staff. Ages range from 18 to 57 years. Fourteen patients were female and three were male. The injected substances could be recognized as synthol, silicone, vaseline, fat tissue, hyaluronic acid as well as non-medical substances. Surgical procedures were necessary in eleven cases. One patient died because of the underlying diseases. CONCLUSION Our results indicate different sequels of filler materials injected in an unprofessional way, possible complications, conservative and surgical techniques to resolve these rare complications. We suggest a staged therapy adjusted to the clinical symptoms. Milder symptoms can be handled conservatively, whereas severe infections, skin breakdowns or persistent granuloma are justifying indications for surgical treatment. 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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Invited Response on: "Tissue Fillers for the Nasolabial Fold Area-A Systematic Review and Meta-Analysis of Randomized Clinical Trials". Aesthetic Plast Surg 2021; 46:27-28. [PMID: 34859275 DOI: 10.1007/s00266-021-02695-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
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Hyaluronic Acid Embolism Treated with Subcutaneous High and Low Hyaluronidase Doses: Efficacy and Surrounding Tissue Effect. Plast Reconstr Surg 2021; 148:1281-1288. [PMID: 34847115 DOI: 10.1097/prs.0000000000008523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of hyaluronidase in hyaluronic acid vascular occlusion has been evaluated; however, the models used do not accurately assimilate the facial morphologic characteristics or study the effects on adjacent tissues. The purpose of this study was to determine an effective concentration of subcutaneous hyaluronidase to dissolve a hyaluronic acid embolism and its effect on surrounding tissue. METHODS Fifteen rabbits were divided into six groups. An inguinal incision was performed on the femoral artery to create a hyaluronic acid embolism in the control and treatment groups (low-, medium-, and high-hyaluronidase groups). Hyaluronidase was injected subcutaneously. Photographic follow-up, histologic analysis, and quantification of hyaluronic acid were performed. Kruskal-Wallis test and post hoc with Bonferroni correction (p < 0.05) was used to compare the presence of hyaluronic acid in the arterial lumen between groups. RESULTS Despite the persistence of intravascular hyaluronic acid, macroscopic and microscopic differences were found between the embolism control group and embolism hyaluronidase high-dose group. Histologic analysis demonstrated thrombosis throughout groups. Skeletal muscle was least affected in the embolism hyaluronidase 500 IU group with less lysis and inflammatory infiltrate. CONCLUSIONS A 500 IU hyaluronidase dose partially prevents the damage caused by the embolism, and does not affect the surrounding tissue. The use of thrombolytic therapy combined with higher doses of hyaluronidase subcutaneously in this model is proposed.
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Surek CC. High Yield Injection Targets and Danger Zones for Facial Filler Injection. Aesthet Surg J Open Forum 2021; 3:ojab034. [PMID: 34738082 PMCID: PMC8564707 DOI: 10.1093/asjof/ojab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Park SSE, Barmettler A. Vision Loss Secondary to Facial and Periorbital Steroid Injection: A Systematic Review. Ophthalmic Plast Reconstr Surg 2021; 37:511-521. [PMID: 33481540 DOI: 10.1097/iop.0000000000001910] [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
PURPOSE The risk of ophthalmic and retinal artery occlusions following facial and periorbital steroid injection has not been explored. This systematic review examines the prevalence, risk factors, and treatment outcomes of steroid-induced vision losses. METHODS A literature search in Evidence Based Medicine Reviews, MEDLINE, Embase, Pubmed, ClinicalTrials, and WHO ICTRP was performed for vision loss following facial and periorbital corticosteroid injections through July 2020. RESULTS Of 35 case reports, series, and reviews, 49 patients (56 eyes) with steroid-induced vision loss were analyzed. Injection sites predominantly involved the nose (45%) and periocular regions (10%). The most common type of steroid is triamcinolone (54%). Most cases were unilateral, except 7 cases of bilateral vision losses, 4 of which resulted from unilateral steroid injection. Symptoms were reported during or immediately after injections in 49% of cases. Most occlusions occurred in the ophthalmic (53%) or central retinal artery (33%). Vision most commonly presented as no light perception (37%), and 90% were 20/200 or worse. Final visual outcomes varied from 20/200 or worse (56%), 20/40 or better (30%), to in between (13%). CONCLUSION Most vision losses resulted from steroid injections in the nasal and periorbital area. Triamcinolone was the most common offending agent, likely due to large particle size, low solubility, and extensive particle aggregation. Dexamethasone has the opposite pharmacologic properties and has never been reported in association with vascular occlusion related vision loss. Careful steroid selection, injection techniques, and treatment strategies should be considered to prevent and treat artery occlusion.
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Affiliation(s)
| | - Anne Barmettler
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY
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Complications of Nonpermanent Facial Fillers: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3851. [PMID: 34703713 PMCID: PMC8542164 DOI: 10.1097/gox.0000000000003851] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/13/2021] [Indexed: 01/03/2023]
Abstract
Background: A variety of complications after injection of nonpermanent fillers for facial rejuvenation have been reported so far. However, to date, the overall complication rate is still a matter of debate. The aim of this study was to perform a systematic review of literature to assess the type and severity of associated complications following injections in different anatomical regions of the face. Methods: The entire PubMed/Medline database was screened to identify case reports and clinical studies describing complications that have occurred after injection of nonpermanent fillers in the face. These complications have been reviewed and analyzed according to their occurrence in different anatomical regions of the face. Results: Forty-six articles including a total of 164 patients reported on a total of 436 complications during the time period between January 2003 and February 2020. The majority of the complications were reported after injections to the nose and the nasolabial fold (n = 230), the forehead and the eyebrows (n = 53), and the glabellar region (n = 36). Out of 436 complications, 163 have been classified as severe or permanent including skin necrosis (n = 46), loss of vision (n = 35), or encephalitis (n = 1), whereas 273 complications were classified as mild or transient, such as local edema (n = 74), skin erythema (n = 69), and filler migration (n = 2). The most severe complications were observed in treatments of nose, glabella, and forehead. Conclusions: Nonpermanent facial fillers are associated with rare but potentially severe complications. Severity and impact of complications depend on the anatomical region of the face and eventually require profound knowledge of facial anatomy.
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Mondal K, Mandal R. Nodular melanoma on lip with retrograde in-transit metastases on face. Indian J Dermatol Venereol Leprol 2021; 87:687-689. [PMID: 34245528 DOI: 10.25259/ijdvl_64_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 12/01/2020] [Indexed: 11/04/2022]
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Cotofana S, Gavril DL, Frank K, Schenck TL, Pawlina W, Lachman N. Revisit, Reform, and Redesign: A Novel Dissection Approach for Demonstrating Anatomy of the Orbit for Continuing Professional Development Education. ANATOMICAL SCIENCES EDUCATION 2021; 14:505-512. [PMID: 32729168 DOI: 10.1002/ase.2006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/24/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
Advanced postgraduate medical education for health-care professionals is constantly evolving. Understanding facial anatomy and especially its vascular system is crucial when performing soft tissue filler injections to avoid adverse events including tissue loss or irreversible blindness. Standard anatomical resources often fall short of elucidating clinically relevant concepts in more highly specialized areas of interest. A novel dissection approach for demonstrating the anatomy of the lateral orbit was presented at scientific meetings to participants from dermatology, plastic surgery, and general practice. Results from the post-course online survey (n = 52) were analyzed. The results of the survey reveal a high educational impact and a high clinical relevance of the novel dissection approach. In addition, the majority of respondents (97.7%; n = 51) felt that the exposed anatomical structure of the orbit and face improved their ability to safely perform cosmetic procedures on the face. More experienced respondents who had previously attended at least five cadaveric dissections were more likely to strongly agree that reviewing anatomy through this novel dissection approach increased their confidence in avoiding periorbital vascular danger zones. As minimally invasive outpatient procedures continue to evolve, practicing physicians and mid-level providers often face the challenge of having to reconcile preexisting anatomical knowledge with new clinical practice. Skills required to navigate high impact anatomy include visualization of structures that form the navigational landscape and avoidance of key danger zones. The novel dissection approach to the lateral orbit reflects the increasing focus on revisiting, reforming, and redesigning anatomy for continuing professional development activities.
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Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | - Konstantin Frank
- Department for Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilian University Klinikum, Ludwig-Maximilian University, Munich, Germany
| | - Thilo L Schenck
- Department for Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilian University Klinikum, Ludwig-Maximilian University, Munich, Germany
| | - Wojciech Pawlina
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Nirusha Lachman
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Rouanet C, Kestemont P, Winter C, Lerhe B, Savoldelli C. Management of vascular complications following facial hyaluronic acid injection: High-dose hyaluronidase protocol: A technical note. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:262-265. [PMID: 34157447 DOI: 10.1016/j.jormas.2021.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 03/07/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
Aesthetic medicine has experienced major developments in recent years, which is illustrated by the increasing number of hyaluronic acid injected in the area of facial rejuvenation. Although considered low risk, it can rarely result in arterial embolization with potentially major aesthetic and functional consequences. These vascular complications range from livedo to skin necrosis to permanent blindness. In such cases the management is urgent. Early care leads to a successful recovery but most of the time the diagnosis is delayed. Several treatments have been suggested and the use of hyaluronidase is decisive. There is no official guideline on the use of hyaluronidase. The aim of this article is to propose a protocol to clarify the management of vascular complications of HA with high doses of hyaluronidase based on the literature and our clinical experience of 35 patients treated.
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Affiliation(s)
- Cédric Rouanet
- Department of ENT and Maxillofacial surgery, Head and Neck Institute, University Hospital of Nice, France
| | - Philippe Kestemont
- Department of ENT and Maxillofacial surgery, Head and Neck Institute, University Hospital of Nice, France; Clinique Saint-George, Nice, France
| | | | - Barbara Lerhe
- Department of ENT and Maxillofacial surgery, Head and Neck Institute, University Hospital of Nice, France
| | - Charles Savoldelli
- Department of ENT and Maxillofacial surgery, Head and Neck Institute, University Hospital of Nice, France.
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Bravo BSF, Elias MC, da Rocha CRM, Carvalho RDM. Supraperiosteal application of hyaluronic acid with cannula: Is it possible? J Cosmet Dermatol 2021; 20:3177-3180. [PMID: 34021961 DOI: 10.1111/jocd.14241] [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: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aging process occurs in all anatomical layers of the face; therefore, rejuvenation should not be limited to the dermic signs of aging (Aesthet Surg J. 2018;38:73) The treatment with fillers in strategic points can reconstruct young anatomy, providing natural results (Aesthet Surg J. 2018;38:73). There are two instruments used for facial application of hyaluronic acid: cannula and needle. Both of them have advantages and disadvantages. OBJECTIVE In this study, we aim to compare the limitations of application with cannula by cutaneous ultrasound when compared to the needle by ultrasound, since some injectors suggest that one of the disadvantages would be the inability to reach certain application plans (periosteum). MATERIALS AND METHODS A 52-year-old female patient was treated with 22 mg/ml hyaluronic acid (Juvéderm® Voluma), guided by high-frequency ultrasound (LogicE device, Logic brand (GE Healthcare), with high-frequency linear probe (L8-L18i-RS). The left hemiface was treated with a 27G needle and the right hemiface with a 5 cm 22G cannula (SoftFil®). CONCLUSION This study proved that, in the malar/zygomatic and the chin region, it is possible the cannula and needle reached the supraperiosteal region. In the temporal region, the cannula did not reach the supraperiosteal plane.
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Topographic Anatomy of the Zygomatico-Orbital Artery: Implications for Improving the Safety of Temporal Augmentation. Plast Reconstr Surg 2021; 148:19e-27e. [PMID: 34003805 DOI: 10.1097/prs.0000000000008100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anatomical knowledge of the zygomatico-orbital artery and its most relevant clinical applications is essential for ensuring the safety of filler injection into the temporal region. The purpose of this study was to provide the precise position, detailed course, and relationship with surrounding structures of the zygomatico-orbital artery. METHODS Fifty-eight patients who underwent head contrast-enhanced three-dimensional computed tomography and 10 fresh frozen cadavers were investigated. RESULTS The zygomatico-orbital artery was identified in 93 percent of the samples in this work. Ninety-four percent of the zygomatico-orbital arteries derived directly from the superficial temporal artery, and the remaining arteries started from the frontal branch of the superficial temporal artery. According to the origin of the zygomatico-orbital artery, it was classified into type I and type II. Type I arteries were then classified into three subtypes. The trunk of the zygomatico-orbital artery was located between the deep temporal fascia and the superficial temporal fascia. Deep branches of the zygomatico-orbital artery pierced the superficial layer of the deep temporal fascia. The zygomatico-orbital artery originated from 11.3 mm in front of the midpoint of the apex of the tragus, and most of its trunks were located less than 20.0 mm above the zygomatic arch. The mean diameter of the zygomatico-orbital artery was 1.2 ± 0.2 mm. There were extensive anastomoses between the zygomatico-orbital artery and various periorbital arteries at the lateral orbital rim. CONCLUSION The precise anatomical knowledge of the zygomatico-orbital artery described in this study could be helpful for cosmetic physicians for improving the safety of temporal augmentation.
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Positional Variation of the Infraorbital Foramen in Caucasians and Black Africans from Britain: Surgical Relevance and Comparison to the Existing Literature. J Craniofac Surg 2021; 32:1162-1165. [PMID: 32956313 DOI: 10.1097/scs.0000000000007014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Midface augmentation and orbital surgery carry an inherent risk of injury to the infraorbital vascular bundle, especially the infraorbital nerve where it exits the infraorbital foramen (IOF). This can result in significant morbidity for the patient, including paresthesia and neuralgia. Studies report significant heterogeneity in IOF position according to gender, ethnicity, and laterality. A knowledge of the relationship of the IOF to regional soft tissue, bony landmarks, and its variation among ethnicities is likely to reduce iatrogenic injuries. METHODS A single-center retrospective computed tomography (CT)-based study was conducted. Twenty Caucasians and 20 Black Africans patients were selected from an existing radiologic database at Moorfields Eye Hospital, London, UK. DICOM image viewing software (Syngo, Siemens Healthineers) was used to record the position of the IOF using standardized sagittal and axial views. RESULTS There was a statistically significant difference in the horizontal position of the IOF in the 2 races (P = 0.00). The combined measurements were used to derive a rectangular zone of variability measuring 14.30 mm by 10.60 mm. This zone was found to lie 3.50 mm below the infraorbital rim, 7.10 mm medial to the piriform aperture, and 11.60 mm from the lateral orbital rim. CONCLUSION A sound knowledge of key facial landmarks is necessitated when performing midface augmentation and orbital surgery. An anatomical safe zone depicting the variation of the IOF will help reduce iatrogenic injury to the infraorbital nerve and prevent patient morbidity.
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Maione L, Vinci V, Costanzo D, Battistini A, Lisa A, Di Maria A. Upper eyelid blepharoplasty following hyaluronic acid injection with improved facial aesthetics and eye symptoms: a case report. J Med Case Rep 2021; 15:248. [PMID: 33926525 PMCID: PMC8086306 DOI: 10.1186/s13256-020-02641-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dermatochalasis of the upper eyelids (blepharochalasis) is a typical age-related change in the upper third of the face and a major concern for facial aesthetics. Nowadays both surgical and nonsurgical interventions are available for patients complaining of upper eyelid dermatochalasis. Although nonsurgical treatments are often easier to perform, if they are not performed correctly, complications may ensue and worsen the condition. CASE PRESENTATION We describe the case of a Caucasian patient presenting with bilateral upper eyelid dermatochalasis, previously treated with multiple injections of hyaluronic acid filler. Following these procedures, the patient reported nonspecific eye symptoms (such as a sense of heaviness and asthenopia) and cosmetic concerns. We decided to perform an upper eyelid blepharoplasty. During the procedure we found a ribbon of hard, fibrous material, which was carefully removed. The patient reported resolution of functional eye symptoms owing to the reduction of upper lid heaviness, which also resulted in subjective improvement of the visual field. Patient satisfaction was assessed preoperatively and 3 months postoperatively using the Blepharoplasty Outcomes Evaluation (BOE), which showed an overall satisfaction rate of 95.8 %. CONCLUSIONS Blepharoplasty not only treated the patient's blepharochalasis but also allowed us to correct the previous nonsurgical intervention by removing the excessive amount of injected hyaluronic acid. Both aesthetic and functional results were successfully achieved.
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Affiliation(s)
- Luca Maione
- Plastic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Rozzano, Milan, Italy.,Plastic Surgery Unit, Clinica San Carlo, Via Ospedale 21, 20037, Paderno Dugnano, Milan, Italy
| | - Valeriano Vinci
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | | | - Andrea Battistini
- Plastic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy. .,Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Rozzano, Milan, Italy.
| | - Andrea Lisa
- Plastic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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de Maio M. MD Codes™: A Methodological Approach to Facial Aesthetic Treatment with Injectable Hyaluronic Acid Fillers. Aesthetic Plast Surg 2021; 45:690-709. [PMID: 32445044 PMCID: PMC8012343 DOI: 10.1007/s00266-020-01762-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/30/2020] [Indexed: 01/02/2023]
Abstract
Background Patients often seek aesthetic correction of facial deficiencies (e.g., lines and folds) that are rarely the underlying cause of dissatisfaction with their appearance. Use of a more holistic approach focused on improving the emotional messages of the face (e.g., looking less sad) may improve patient satisfaction with treatment outcomes. The MD Codes™ system was developed to increase clinician success rates by reducing variability in the technical aspects of hyaluronic acid (HA) filler treatment and focusing on addressing unfavorable emotional attributes of the face. Methods The MD Codes, or medical codes, represent specific anatomical subunits for injection of HA fillers. Each MD Code includes information regarding the target depth of injection, the proper delivery tool (needle or cannula) and delivery technique (e.g., aliquot, bolus, fanning), and the minimum product volume recommended to achieve visible, reproducible results (active number). During treatment planning, the appropriate MD Codes are selected using algorithms focused on lessening unfavorable facial attributes (a saggy, tired, sad, or angry look) and enhancing positive attributes (an attractive, younger, more contoured, or feminine [soft] or masculine look). Results Three case studies are presented to illustrate how the MD Codes and their algorithms were used to address sagginess, tiredness, and sadness in two women and one man. Conclusions MD Codes provide a universal symbolic language for reducing variability in injection technique. The platform provides user-friendly algorithms to help clinicians increase patient satisfaction by going beyond treatment of lines and folds and to focus on reducing unfavorable facial attributes. 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. Electronic supplementary material The online version of this article (10.1007/s00266-020-01762-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maurício de Maio
- MD Codes Institute, Rua Santa Justina, 660 - cjs 121 e 124, Via Olímpia, Sao Paulo, SP, Brazil.
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Hung JH, Wang CT, Lee CN, Shieh SJ. Unilateral Vision Loss After Hyaluronic Acid Injection: A Case Report. Ann Plast Surg 2021; 86:S127-S131. [PMID: 33346533 DOI: 10.1097/sap.0000000000002624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Vascular occlusion causing vision loss is a rare yet one of the most devastating complications of facial esthetic fillers. In this article, we present a case of unilateral blindness and superficial skin necrosis in a 31-year-old woman after the injection of hyaluronic acid for esthetic purposes. The delicate ocular fundal findings of ophthalmic artery occlusion were demonstrated by ophthalmoscopy, optical coherence tomography, and fluorescein angiography. Magnetic resonance imaging also showed subsequent ischemic changes in the optic nerve and posterior scleral wall after ophthalmic artery occlusion. Despite management including intraocular pressure-lowering agents, globe massage, and anticoagulation with acetylsalicylic acid and hyperbaric oxygen therapy, her final vision was not restored. Given the lack of effective treatments, this report depicts the comprehensive ocular fundal findings of an ophthalmic artery occlusion after esthetic hyaluronic acid filler injection, and highlights the importance of a preventive approach to avoid such catastrophic complications.
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Reddy S, Nguyen TA, Gharavi N. Complications associated with infraorbital filler injection. J COSMET LASER THER 2020; 22:226-229. [PMID: 33794721 DOI: 10.1080/14764172.2021.1909067] [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] [Indexed: 10/21/2022]
Abstract
Soft tissue augmentation with injectable fillers is increasingly being performed, and providers must be prepared to understand and treat complications. Periorbital skin presents unique challenges due to its thin nature, easily evident pigmentary and textural irregularities, and anatomical considerations including vasculature and subcutaneous layers. The most common complications of infraorbital filler include ecchymosis, malar edema, blue-gray hue, and contour irregularities. Uncommon complications include infection and biofilm formation, skin necrosis, and blindness. This purpose of this review is to highlight the infraorbital anatomy, complications of filler injection in this region, and techniques to avoid these complications.
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Affiliation(s)
- Shivani Reddy
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Tuyet A Nguyen
- Department of Dermatology, California Skin Institute, Los Angeles, CA, USA
| | - Nima Gharavi
- Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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28
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van Loghem J, Funt D, Pavicic T, Goldie K, Yutskovskaya Y, Fabi S, Siebenga P, Thuis J, Hkeik J, Kadouch J, Prager W, Azib N, Casabona G, Dayan S, Bay Aguilera S, Snozzi P, Saeed P. Managing intravascular complications following treatment with calcium hydroxylapatite: An expert consensus. J Cosmet Dermatol 2020; 19:2845-2858. [PMID: 32185876 PMCID: PMC7687073 DOI: 10.1111/jocd.13353] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Inadvertent intra-arterial injection of dermal fillers including calcium hydroxylapatite (CaHA) can result in serious adverse events including soft tissue necrosis, permanent scarring, visual impairment, and blindness. When intra-arterial injection occurs, immediate action is required for optimal outcomes, but the infrequency of this event means that many physicians may never have experienced this scenario. The aim of this document is to provide evidence-based and expert opinion recommendations for the recognition and management of vascular compromise following inadvertent injection of CaHA. METHODS An international group of experts with experience in injection of CaHA and management of vascular complications was convened to develop a consensus on the optimal management of vascular compromise following intra-arterial CaHA injection. The consensus members were asked to provide preventative advice for the avoidance of intravascular injection and to produce a treatment protocol for acute and delayed presentation. To ensure all relevant treatment options were included, the recommendations were supplemented with a PubMed search of the literature. RESULTS For prevention of intra-arterial CaHA injection, consensus members outlined the importance of a thorough knowledge of facial vascular anatomy and patient history, as well as highlighting potential risk zones and optimal injection techniques. Individual sections document how to recognize the symptoms of vascular occlusion leading to vision loss and tissue necrosis as well as detailed treatment protocols for the management of these events. For impending tissue necrosis, recommendations are provided for early and delayed presentations with treatment protocols for acute and follow-up treatment. A separate section details the treatment options for open and closed wounds. CONCLUSIONS All physicians should be prepared for the eventuality of intra-arterial injection of a dermal filler, despite its rarity. These consensus recommendations combine advice from aesthetic experts with the latest reports from the published literature to provide an up-to-date office-based protocol for the prevention and treatment of complications arising from intra-arterial CaHA injection.
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Affiliation(s)
- Jani van Loghem
- Falck ClinicAesthetic Medicine CentreAmsterdamThe Netherlands
| | - David Funt
- Mount Sinai School of MedicineNew YorkNYUSA
- Mount Sinai School of MedicineGarden CityNYUSA
- Mount Sinai School of MedicineWoodmereNYUSA
| | - Tatjana Pavicic
- Private Practice for Dermatology and AestheticsMunichGermany
| | | | - Yana Yutskovskaya
- Dermatovenerology and Cosmetology DepartmentPacific State MedicalUniversity of HealthMoscowRussia
| | - Sabrina Fabi
- Department of DermatologyUniversity of CaliforniaSan DiegoCAUSA
| | - Pieter Siebenga
- Falck ClinicAesthetic Medicine CentreAmsterdamThe Netherlands
| | - Job Thuis
- Falck ClinicAesthetic Medicine CentreAmsterdamThe Netherlands
| | | | - Jonathan Kadouch
- ReSculpt ClinicPractice for Aesthetic DermatologyAmsterdamThe Netherlands
| | - Welf Prager
- Prager & Partner Dermatologische PraxisHamburgGermany
| | | | | | - Steve Dayan
- Division of Facial Plastic and Reconstructive SurgeryDepartment of OtolaryngologyUniversity of Illinois at ChicagoChicagoILUSA
| | - Shino Bay Aguilera
- Department of DermatologyNova Southeastern University College of Osteopathic MedicineFort LauderdaleFLUSA
| | | | - Peerooz Saeed
- Falck ClinicAesthetic Medicine CentreAmsterdamThe Netherlands
- Departments of Ophthalmology and EndocrinologyOrbital CenterAcademic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
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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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Better Results in Facial Rejuvenation with Fillers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2763. [PMID: 33173655 PMCID: PMC7647625 DOI: 10.1097/gox.0000000000002763] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/12/2020] [Indexed: 11/26/2022]
Abstract
Facial rejuvenation is a rapidly advancing field in aesthetic medicine. Minimally invasive techniques represent a powerful tool for rejuvenation, and fillers are a popular modality with which to restore and optimize facial proportions. Currently, our filler armamentarium is characterized by products with an increasing variety of biochemical compositions warranting tailored injection approaches. An intimate knowledge of anatomy, product characteristics, and appropriate injection techniques is essential to achieve optimal results while maintaining patient safety. Here, we review facial anatomy, structural changes secondary to aging, appropriate filler selection, safe injection techniques, and complications.
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Cook J, Pozner JN. Invited Discussion on: The Effect of Hyaluronidase on Depth of Necrosis in Hyaluronic Acid Filling-Related Skin Complications. Aesthetic Plast Surg 2020; 44:1786-1787. [PMID: 32500320 DOI: 10.1007/s00266-020-01796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathan Cook
- Sanctuary Plastic Surgery, 4800 N. Federal Highway, Suite c101, Boca Raton, FL, 33431, USA
| | - Jason N Pozner
- Sanctuary Plastic Surgery, 4800 N. Federal Highway, Suite c101, Boca Raton, FL, 33431, USA.
- Department of Plastic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
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Sharad J. Treatment of the tear trough and infraorbital hollow with hyaluronic acid fillers using both needle and cannula. Dermatol Ther 2020; 33:e13353. [DOI: 10.1111/dth.13353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/20/2020] [Indexed: 11/28/2022]
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Hirsch P, Infanger M, Kraus A. A case of upper lip necrosis after cosmetic injection of hyaluronic acid soft‐tissue filler—Does capillary infarction play a role in the development of vascular compromise, and what are the implications? J Cosmet Dermatol 2020; 19:1316-1320. [DOI: 10.1111/jocd.13391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Hirsch
- Department of Plastic, Aesthetic and Hand Surgery Otto‐von‐Guericke University Magdeburg Germany
| | - Manfred Infanger
- Department of Plastic, Aesthetic and Hand Surgery Otto‐von‐Guericke University Magdeburg Germany
| | - Armin Kraus
- Department of Plastic, Aesthetic and Hand Surgery Otto‐von‐Guericke University Magdeburg Germany
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Lee W, Oh W, Oh SM, Yang EJ. Comparative Effectiveness of Different Interventions of Perivascular Hyaluronidase. Plast Reconstr Surg 2020; 145:957-964. [PMID: 32221213 DOI: 10.1097/prs.0000000000006639] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Soft-tissue necrosis caused by vascular compromise is a frequent and troublesome complication of hyaluronic acid filler injection. Hyaluronidase has been proposed as a treatment for this condition. This study aimed to determine the effective dose and administration interval of hyaluronidase injection in a skin necrosis animal model. METHODS New Zealand rabbits were used to simulate the hyaluronic acid-associated vascular occlusion model. Hyaluronic acid filler (0.1 ml) was injected into the central auricular artery to create an occlusion. Three rabbit auricular flaps were injected with 500 IU of hyaluronidase once (group A) and three flaps each were injected at 15-minute intervals with 250 IU of hyaluronidase twice (group B), 125 IU of hyaluronidase four times (group C), 100 IU of hyaluronidase five times (group D), and 75 IU of hyaluronidase seven times (group E), all at 24 hours after occlusion. No intervention was administered after occlusion in the control group. Flap fluorescence angiography was performed immediately after hyaluronidase injection and on postoperative days 2, 4, and 7. Flap necrotic areas were analyzed. RESULTS All control and experimental flaps demonstrated total occlusion after hyaluronic acid injection. The average total survival rate (positive area/total area ×100 percent) of control flaps was 37.61 percent. For experimental groups, the average total survival rates were 74.83 percent, 81.49 percent, 88.26 percent, 56.48 percent, and 60.69 percent in groups A through E, respectively. CONCLUSION A better prognosis can be obtained by administering repeated doses rather than a single high dose of hyaluronidase.
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Affiliation(s)
- Won Lee
- From the Yonsei E1 Plastic Surgery Clinic; Samsung Feel Clinic; ON Clinic; and the Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine
| | - Wook Oh
- From the Yonsei E1 Plastic Surgery Clinic; Samsung Feel Clinic; ON Clinic; and the Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine
| | - Seung Min Oh
- From the Yonsei E1 Plastic Surgery Clinic; Samsung Feel Clinic; ON Clinic; and the Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine
| | - Eun-Jung Yang
- From the Yonsei E1 Plastic Surgery Clinic; Samsung Feel Clinic; ON Clinic; and the Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine
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Koziej M, Trybus M, Hołda M, Polak J, Wnuk J, Brzegowy P, Popiela T, Walocha J, Chrapusta A. Anatomical Map of the Facial Artery for Facial Reconstruction and Aesthetic Procedures. Aesthet Surg J 2019; 39:1151-1162. [PMID: 30721996 DOI: 10.1093/asj/sjz028] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The facial artery (FA) is the main blood vessel supplying the anterior face and an understanding of its anatomy is crucial in facial reconstruction and aesthetic procedures. OBJECTIVES The aim of this study was to assess the many anatomical features of the FA utilizing a multidimensional approach. METHODS Head and neck computed tomographic angiographies of 131 patients (255 FAs) with good image quality were evaluated. The FA was classified according to its termination pattern, course, and location with reference to soft tissue/bone surrounding structures. RESULTS In total, each branch was present as follows: the submental artery (44.8%), the inferior labial artery (60%), the superior labial artery (82.2%), the lateral nasal artery (25.1%), and the angular artery (42.5%). The most common FA course was the classic course, situated medially to the nasolabial fold (27.1%). In total 65.5% of the arteries were located medially to the nasolabial fold, and only 12.3% of them were totally situated lateral to the nasolabial fold. The median distance (with quartiles) from the inferior orbital rim reached the FA after the superior labial artery branched off in 50.2% of cases and was 36.6 mm (33.4; 43.3). The angle between the FA and the inferior border of the mandible was 49.8o (31.9; 72.4). The horizontal distances between the oral commissure and naris to the FA were 8.5 ± 4.0 mm and 12.1 ± 6.7 mm, respectively. CONCLUSIONS An anatomical map summarizing the major measurements and geometry of the FA was generated. The detailed anatomy and relative positioning of the FA should be considered to avoid any unexpected complications in plastic surgery.
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Affiliation(s)
- Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, The Ludwik Rydygier Hospital, Krakow, Poland
- The Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Krakow, Poland
| | - Marek Trybus
- Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Hołda
- Department of Anatomy, Jagiellonian University Medical College
| | - Jakub Polak
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Jakub Wnuk
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Paweł Brzegowy
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Tadeusz Popiela
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College
| | - Anna Chrapusta
- Head of The Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Krakow, Poland
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Abstract
Several researchers have analyzed the collocation of infraorbital foramen, but no study has so far considered the possible influence of cranial size.Three measurements (distances from anterior nasal spine, inferior orbital rim, angle at the intersection between the line from anterior nasal spine and the transversal plane parallel to the Frankfurt plane) were taken on 100 skulls belonging to a contemporary skeletal collection. In addition, maximum cranial length, maximum cranial breadth, cranial height, and bizygomatic breadth were measured, together with 2 indices (horizontal cephalic index and Giardina Y-index). Differences according to sex and side were assessed through 2-way analysis of variance test (P <0.05). Measurements showing statistically significant differences according to sex were further assessed through 1-way analysis of covariance test including cranial measurements and indices as covariates (P <0.05).Statistically significant differences according to sex and side were found respectively for the distance from anterior nasal spine and the angle at infraorbital foramen (P <0.05). One-way analysis of covariance test verified that the sexual dimorphism of infraorbital foramen- anterior nasal spine distance was independent from the general measurements of cranium.The present study first proved that sexually dimorphic parameters useful for the localization of infraorbital foramen do not depend upon the cranium size.
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Clinical Observations and the Anatomical Basis of Blindness After Facial Hyaluronic Acid Injection. Aesthetic Plast Surg 2019; 43:1054-1060. [PMID: 31006827 PMCID: PMC7340666 DOI: 10.1007/s00266-019-01374-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/31/2019] [Indexed: 11/16/2022]
Abstract
Background Blindness or visual loss is the most serious complication resulting from facial hyaluronic acid (HA) injection. In this study, three recent clinical cases were analyzed, and the relevant anatomy of cadavers was evaluated to investigate the mechanism behind visual impairment due to HA injection. Methods Three patients with different extents of visual loss after HA injection were studied. Ophthalmic testing and corresponding treatments were performed, and the clinical progress was observed. In addition, thirty-six fresh Asian cadaver hemifaces were anatomized to investigate the morphology of the ophthalmic artery and its branches. The minimum dose of HA for central retinal artery embolism was calculated based on the ophthalmic arterial volumes of cadavers. Results Visual impairment was more severe in central retinal artery occlusion and combined intraocular branch occlusion than in posterior ciliary artery occlusion. During follow-up, no improvement was observed in terms of visual impairment. Cadaver study reconfirmed that the ophthalmic artery included facial and intraocular branches. The ophthalmic arterial volumes running from the supraorbital artery and supratrochlear artery to the central retinal artery were 0.083 cm3 and 0.089 cm3, respectively. Conclusions The severity of blindness caused by HA injection may be associated with the occlusion site. Our clinical observations indicate that conventional treatments, such as retrobulbar hyaluronidase injection, are insufficient to relieve visual impairment. Injecting as little as 0.08 ml of HA into the facial branch is enough to cause central retinal artery embolism. Limiting the volume per injection could represent a simple prophylactic strategy. 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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Koziej M, Trybus M, Hołda M, Wnuk J, Polak J, Brzegowy P, Popiela T, Walocha J, Tomaszewski K, Chrapusta A. The Superficial Temporal Artery: Anatomical Map for Facial Reconstruction and Aesthetic Procedures. Aesthet Surg J 2019; 39:815-823. [PMID: 30351355 DOI: 10.1093/asj/sjy287] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The superficial temporal artery (STA), a terminal branch of the external carotid artery, supplies multiple regions of the scalp and face. Knowledge of the STA is important for reconstructive and aesthetic procedures of the head and face. OBJECTIVES The aim of this study was to map the STA in relation to anatomical landmarks. METHODS Computed tomographic head angiographies of 215 patients were included in this study; the final analysis comprised 419 STAs. The STA's main branches and variants were identified. The diameters of the STA and its frontal and occipital branches were measured, and the distance between the STA tree and anatomical landmarks was delineated. RESULTS Frontal and parietal branches were recorded in 98.1% and 90.7% of patients, respectively. The mean diameters, measured 1 and 7 cm from the STA bifurcation for the frontal branch, were 0.97 ± 0.32 and 0.81 ± 0.26 mm, respectively, and for the parietal branch, the diameters were 0.96 ± 0.28 and 0.76 ± 0.23 mm, respectively. The STA bifurcation point was located above the zygomatic arch (ZA) in 75.6%, below in 14.7%, and on the ZA in 9.7% of patients. The mean distance from the ZA center to the STA bifurcation was 16.8 ± 16.0 mm. CONCLUSIONS The STA artery and its main branches follow a conservative course, and serious anatomical variations are relatively rare. The STA and its main branches may be localized using simple anatomical landmarks. An anatomical map showing artery-free zones in the lateral forehead region was presented, which may prove useful for plastic, reconstructive, and aesthetic surgeons. Level of Evidence: 4.
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Affiliation(s)
- Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College
- Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Krakow, Poland
| | - Marek Trybus
- Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Hołda
- Professor and Head of the Department of Anatomy, Jagiellonian University Medical College
| | - Jakub Wnuk
- Radiologist and Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma University Hospital, Krakow, Poland
| | - Jakub Polak
- Radiologist and Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma University Hospital, Krakow, Poland
| | - Paweł Brzegowy
- Radiologist and Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma University Hospital, Krakow, Poland
| | - Tadeusz Popiela
- Radiologist and Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma University Hospital, Krakow, Poland
| | - Jerzy Walocha
- Professor and Head of the Department of Anatomy, Jagiellonian University Medical College
| | - Krzysztof Tomaszewski
- Professor and Head of the Department of Anatomy, Jagiellonian University Medical College
| | - Anna Chrapusta
- Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Krakow, Poland
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Denadai R, Raposo-Amaral CA, Buzzo CL, Ghizoni E, Cendes F, Raposo-Amaral CE. Anatomical Fat Grafting for Reconstruction of Frontotemporal Contour Deformities After Neurosurgical and Craniofacial Surgical Interventions: A Symmetry Outcome Study. World Neurosurg 2019; 127:e1064-e1082. [PMID: 30980984 DOI: 10.1016/j.wneu.2019.04.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 02/08/2023]
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Role of Ancillary Procedures in Facial Rejuvenation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2075. [PMID: 31624657 PMCID: PMC6635208 DOI: 10.1097/gox.0000000000002075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/19/2018] [Indexed: 11/26/2022]
Abstract
Face-lift techniques have evolved beyond the concept of lifting and now include incorporating superficial and deep filling of facial fat compartments to address volume deflation and aging. In addition to traditional face-lift methods involving the excision and tightening of skin and the underlying soft tissues, the following ancillary procedures have become paramount in achieving an optimal result: blending the lid-cheek junction; chin augmentation; lobule augmentation; hand rejuvenation; perioral rejuvenation; chemical peels; and laser resurfacing. We presented a summary of these integral techniques.
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Practical Approach and Safety of Hyaluronic Acid Fillers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2172. [PMID: 31624663 PMCID: PMC6635180 DOI: 10.1097/gox.0000000000002172] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/08/2019] [Indexed: 11/26/2022]
Abstract
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.
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Fitzgerald R, Carqueville J, Yang P. An approach to structural facial rejuvenation with fillers in women. Int J Womens Dermatol 2019; 5:52-67. [PMID: 30809580 PMCID: PMC6374711 DOI: 10.1016/j.ijwd.2018.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/24/2022] Open
Abstract
Newer understanding of volume loss as a critical component of facial aging and the integration of volume replacement into the surgical and nonsurgical therapeutic algorithm is arguably the most significant recent development in the field of facial rejuvenation. As all structural tissues play a role in the aging face, restoring youthful characteristics (or establishing them where they are congenitally absent) starts from the skeletal framework and builds progressively to the canvas of the face. The purpose of this article is to provide an introduction and brief summary of some of the current concepts concerning facial anatomy and the anatomy of facial aging, which serve as the basis for predictable and reproducible results with the use of injectable fillers. This article does not include the various types of fillers or techniques of filler injection, but covers how to decide where to use the filler and why, in different faces, as a result of the recognition and targeted correction of currently recognized specific anatomic deficiencies.
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Affiliation(s)
| | - J. Carqueville
- Private practice, Chicago, Illinois
- Department of Dermatology, Stroger Hospital of Cook County, Chicago, Illinois
| | - P.T. Yang
- Department of Oculoplastics, University of California San Diego, San Diego, California
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Novel technique of filler injection in the temple area using the vein detection device. J Plast Reconstr Aesthet Surg 2018; 72:335-354. [PMID: 30442565 DOI: 10.1016/j.bjps.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 09/17/2018] [Accepted: 10/28/2018] [Indexed: 11/21/2022]
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Novel Forehead Augmentation Strategy: Forehead Depression Categorization and Calcium-Hydroxyapatite Filler Delivery after Tumescent Injection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1858. [PMID: 30349771 PMCID: PMC6191212 DOI: 10.1097/gox.0000000000001858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/14/2018] [Indexed: 11/02/2022]
Abstract
Background The minimally invasive delivery of soft-tissue calcium hydroxyapatite fillers can ameliorate the appearance of forehead depressions and wrinkles. Forehead augmentations using fillers lead to fewer adverse events and to a faster recovery time than those using surgical procedures. However, many physicians avoid using them due to the risk of pain, intravascular injections, and embolisms that can cause skin necrosis and blindness. Strategy to address these issues includes pain reduction through tumescent solution before filler injection considering the vascular pathway. In addition, the strategy is also safer from embolism. Methods The author presents a forehead augmentation technique involving the injection of a tumescent solution for tissue hydrodissection. Not only does this create a pocket of space (TS) for filler placement, it also allows the physician to detect bleeding and prevent vessel compromise It is better to minimize the number of entry-points where no vessel exists. By minimizing the number of entry-points and physical proximity to vessels and nerves during injection, this technique reduces the risks of embolization and bleeding. For optimal, patient-customized results, the author also classifies forehead depressions in 5 different categories, depending on the severity, shape, contour, slope, and quantity of volume deficiency observed. Results The author treated 218 patients using the author's forehead augmentations (using one central entry-site after TS test injection). The method was easy to perform and safe from adverse effects such as vascular problem, irregularity, infection, and prolonged swelling. Conclusion Using this simple technique, I demonstrate how calcium hydroxyapatite fillers can be injected with little force or dilution, thus preserving its original properties while increasing procedural safety, minimizing pain, restoring convexity, and creating ideal curvatures.
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Hufschmidt K, Bronsard N, Foissac R, Baqué P, Balaguer T, Chignon-Sicard B, Santini J, Camuzard O. The infraorbital artery: Clinical relevance in esthetic medicine and identification of danger zones of the midface. J Plast Reconstr Aesthet Surg 2018; 72:131-136. [PMID: 30327185 DOI: 10.1016/j.bjps.2018.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/20/2018] [Accepted: 09/10/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Over the past decade, cosmetic injections of dermal fillers or fat have become a popular procedure in facial rejuvenation in an overconsuming society. However, complications such as arterial embolism and occlusion can occur even with experienced injectors, especially in high-risks zones namely the glabella, the nasal dorsum or the nasolabial fold. The aim of this study was to define the vascular danger zones of the infraorbital area in order to provide guidelines helping avoid them. MATERIALS AND METHODS The infraorbital artery, its main branches and their anastomoses with neighbouring vessels were studied in 18 fresh cadavers. Mimetic injections of inked hyaluronic acid were performed in the infraorbital area in the interest of analyzing its distribution and to determine potential vascular risks towards the infraorbital artery and its branches. RESULTS The infraorbital artery and its branches were located in common injection regions and anastomosed to the supratrochlear artery, the dorsal nasal artery and the angular artery through the nasal branch of the infraorbital artery. Two danger zones could be depicted: injections can be risky when performed too superficially in the midcheek area, and likewise risky when performed in a periosteal layer in infraorbital hollow or tear-trough correction, because of an obvious possibility of retrograde embolism. CONCLUSION The infraorbital artery can be involved in anatomic mechanism of arterial occlusion, further blindness and stroke, among the related neighbouring arteries. Based on the findings of this study, injections to the periosteum layer in tear-trough correction and above the periosteum on the zygomatic arch is not advised.
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Affiliation(s)
- K Hufschmidt
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Pasteur 2, 30, avenue de la Voie Romaine, 06000 Nice, France.
| | - N Bronsard
- Institut Universitaire Locomoteur et Sport (iULS), Hôpital Pasteur 2, University of Nice Sophia Antipolis (UNSA), Nice, France
| | - R Foissac
- Unit of Plastic and Esthetic Surgery, Clinic Saint George, 2 avenue de Rimiez, 06105 Nice, France
| | - P Baqué
- Department of General and Emergency Surgery, University Hospital Nice, Pasteur 2, 30, avenue de la Voie Romaine, 06000 Nice, France
| | - T Balaguer
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Pasteur 2, 30, avenue de la Voie Romaine, 06000 Nice, France
| | - B Chignon-Sicard
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Pasteur 2, 30, avenue de la Voie Romaine, 06000 Nice, France
| | - J Santini
- Head and Neck Institute, University Hospital of Nice, 31, avenue de Valombrose, 06000 Nice, France
| | - O Camuzard
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Pasteur 2, 30, avenue de la Voie Romaine, 06000 Nice, France
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Definitions of groove and hollowness of the infraorbital region and clinical treatment using soft-tissue filler. Arch Plast Surg 2018; 45:214-221. [PMID: 29788683 PMCID: PMC5968317 DOI: 10.5999/aps.2017.01193] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 01/17/2018] [Accepted: 01/25/2018] [Indexed: 11/18/2022] Open
Abstract
Clarification is needed regarding the definitions and classification of groove and hollowness of the infraorbital region depending on the cause, anatomical characteristics, and appearance. Grooves in the infraorbital region can be classified as nasojugal grooves (or folds), tear trough deformities, and palpebromalar grooves; these can be differentiated based on anatomical characteristics. They are caused by the herniation of intraorbital fat, atrophy of the skin and subcutaneous fat, contraction of the orbital part of the orbicularis oculi muscle or squinting, and malar bone resorption. Safe and successful treatment requires an optimal choice of filler and treatment method. The choice between a cannula and needle depends on various factors; a needle is better for injections into a subdermal area in a relatively safe plane, while a cannula is recommended for avoiding vascular compromise when injecting filler into a deep fat layer and releasing fibrotic ligamentous structures. The injection of a soft-tissue filler into the subcutaneous fat tissue is recommended for treating mild indentations around the orbital rim and nasojugal region. Reducing the tethering effect of ligamentous structures by undermining using a cannula prior to the filler injection is recommended for treating relatively deep and fine indentations. The treatment of mild prolapse of the intraorbital septal fat or broad flattening of the infraorbital region can be improved by restoring the volume deficiency using a relatively firm filler.
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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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Wang Q, Zhao Y, Li H, Li P, Wang J. Vascular Complications After Chin Augmentation Using Hyaluronic Acid. Aesthetic Plast Surg 2018; 42:553-559. [PMID: 29260270 DOI: 10.1007/s00266-017-1036-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/13/2017] [Indexed: 11/29/2022]
Abstract
Vascular complications after hyaluronic acid (HA) filling of the chin have rarely been reported. In this report, two cases of vascular occlusion after HA augmentation of the mentum are presented. The first case involved local skin necrosis that resulted from a massive microcirculatory embolism and/or external compression of the chin skin microvasculature. The second case involved vascular compromise in the tongue that resulted from HA injection in the chin. The diagnosis was established on the basis of interventional angiography findings. Concerning the pathogenesis, we hypothesized that the filler embolus flowed into the branches of the deep lingual artery through the rich vascular anastomoses among the submental, sublingual, and deep lingual arteries, after being accidentally injected into the submental artery (or its branches). 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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Affiliation(s)
- Qianwen Wang
- Head and Neck Aesthetic and Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33# Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Yongliang Zhao
- Private Clinic of Cosmetic Surgery, 1# Hongqiao North Street, Xingqing District, Yinchuan City, Ningxia Hui Autonomous Region, China
| | - Hui Li
- Private Clinic of Cosmetic Surgery, 29# Shijingshan Road, Shijingshan District, Beijing, China
| | - Peng Li
- Vascular Surgery Department of Beijing Hospital, 1# Dahua Road, Dongdan, Dongcheng District, Beijing, China
| | - Jiaqi Wang
- Head and Neck Aesthetic and Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33# Badachu Road, Shijingshan District, Beijing, 100144, China.
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