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Ahn HS, Kim HM, Oh W, Yi KH, Kim J, Kim HJ. Singular entry point technique for forehead and temple filler augmentation: Anatomical and clinical perspectives. J Cosmet Dermatol 2024; 23:3195-3201. [PMID: 38837504 DOI: 10.1111/jocd.16411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The depressed volume of the forehead and temple is resolved by filler injection. However, the current method has the potential to cause pain and side effects in patients, depending on the skill of the clinician. Therefore, this study proposes a new method for safer and simpler injection using only one injection entry point. METHODS Using the novel injection method, the filler was injected into the forehead and temple regions in three unembalmed cadavers and two healthy Korean volunteers. The cannula and filler locations were identified using dissection, ultrasonography, and three-dimensional (3D) scanning. RESULTS Ultrasonographic images and dissection results showed that the filler injected into the cadavers was in the target layer. The cannula and filler were located on the layer as the supraperiosteal layer on the forehead and the supra deep temporal fascia layer in the temple. Finally, 3D scanning images showed that the filler was injected precisely and effectively into the forehead and temples of the volunteer who underwent the procedure. CONCLUSIONS This method can reduce pain and minimize externally visible wounds caused by injections. The injected filler was naturally connected from the forehead to the temple and maintained for around 3 months. Additionally, it is possible to inject fillers into the forehead and temple at a constant and safe depth without requiring specific skills. It is expected that this method will become a universal method because it minimizes the burden on both patients and clinicians.
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Affiliation(s)
- Hyo-Sang Ahn
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | | | | | - Kyu-Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
- Maylin Clinic, Apgujeong Seoul, Korea
| | | | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
- Department of Electric and Electronical Engineering, College of Engineering, Yonsei University, Seoul, Korea
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Cotofana S, Mehta T, Davidovic K, Swift A, Rohrich RJ, Biesman BS, Gold M, Nikolis A, Dayan S, Alfertshofer M. Identifying Levels of Competency in Aesthetic Medicine: A Questionnaire-based Study. Aesthet Surg J 2024; 44:1105-1117. [PMID: 38636497 PMCID: PMC11403812 DOI: 10.1093/asj/sjae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND In 2022, the US experienced a significant increase in demand for minimally invasive aesthetic procedures, underscoring its rising acceptance amid an unregulated educational environment for practitioners. The absence of standardized educational pathways and quality control in aesthetic medicine, primarily provided by nonacademic institutions, highlights a critical need for establishing educational standards to ensure practitioner competence and patient safety. OBJECTIVES The aim of this study was to identify levels of competency for the aesthetic practitioner and necessary achievement milestones during the educational path from novice to expert injector. METHODS A total of n = 386 international study participants responded to an online questionnaire regarding their experience in aesthetic medicine practice. The questionnaire comprised 58 questions focusing on professional data, the perceived difficulty of injection, and risk for the occurrence of adverse events for specific facial regions in soft tissue filler and toxin injections. RESULTS Regardless of medical specialty and experience level, averages of 3.85 (1.8) years, 786.4 (2628) filler injections and 549.9 (1543) toxin injections were estimated to progress from novice to advanced injector, while averages of 6.10 (3.7) years, 1842.2 (4793) filler injections, and 1308.5 (3363) toxin injections were estimated to advance from advanced to expert injector. The nose and the perioral region have been ranked as the facial regions where it is most difficult to achieve a perfect aesthetic outcome and with the greatest risk for the occurrence of adverse events for filler and toxin injections, respectively. CONCLUSIONS In this study we establish an educational framework in aesthetic medicine by defining the progression from novice to competent and expert injector levels, suggesting 4 years of practice and over 790 filler and 550 neuromodulator injections for competence, and at least 6 years with 1840 filler and 1310 neuromodulator injections for expertise. We also identify critical facial regions for targeted treatments by different expertise levels. LEVEL OF EVIDENCE: 4
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Faria GEDL, Nassif AD, Medina RIS, Espicalsky S, Zattar L, Boggio RF. Precise Needle and Cannula Placement in the Forehead During Aesthetic Procedures: Can Device and Angulation Influence Accuracy? A Fresh Frozen Specimen Study. Aesthetic Plast Surg 2024:10.1007/s00266-024-04350-1. [PMID: 39227473 DOI: 10.1007/s00266-024-04350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 08/23/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Myomodulation is a technique aimed at enhancing the dynamics of muscle contraction and relaxation through methods like hyaluronic acid (HA) injection. Achieving optimal outcomes depends on the precise placement of the injected product within the targeted anatomical plane. This is particularly important in the forehead, an area with elevated vascular risk. The selected treatment techniques must ensure both efficacy and safety. This study aims to assess the anatomical precision of HA injections in the forehead using different techniques and devices. METHODS Four fresh frozen specimens were injected with HA by five experienced board-certified plastic surgeons using three different techniques/devices: (1) a 50 mm, 22G microcannula; (2) a 13 mm, 27G needle with the bevel down at a 45-degree angle; and (3) the same needle positioned at a 90-degree angle. Ultrasound analysis was used to evaluate the precision of each approach. RESULTS Both the cannula technique and the needle technique with the bevel down at a 45-degree angle consistently delivered the filler to the supraperiosteal layer in 100% of cases without spreading. However, the 90-degree needle technique, despite correct placement on the periosteum, resulted in filler dispersion across multiple layers. CONCLUSION The accuracy of filler placement in the forehead is influenced by the choice of device and its angulation. It is recommended to use a cannula with the entry point at the frontalis crest or a needle angled at 45 degrees to the skin. The use of a needle at a 90-degree angle should be avoided to ensure precise placement and avoid filler migration. NO LEVEL ASSIGNED 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)
| | - Alexander D Nassif
- Instituto Boggio - Medicina, ensino e pesquisa, Rua Cincinato Braga, 37, 8°Andar, Bela Vista, SP, 04004-030, Brazil
| | | | - Sheila Espicalsky
- Instituto Boggio - Medicina, ensino e pesquisa, Rua Cincinato Braga, 37, 8°Andar, Bela Vista, SP, 04004-030, Brazil
| | - Luciana Zattar
- Instituto Boggio - Medicina, ensino e pesquisa, Rua Cincinato Braga, 37, 8°Andar, Bela Vista, SP, 04004-030, Brazil
| | - Ricardo Frota Boggio
- Instituto Boggio - Medicina, ensino e pesquisa, Rua Cincinato Braga, 37, 8°Andar, Bela Vista, SP, 04004-030, Brazil
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Sigrist R, Desyatnikova S, Chammas MC, Vasconcelos-Berg R. Best Practices for the Use of High-Frequency Ultrasound to Guide Aesthetic Filler Injections-Part 1: Upper Third of the Face. Diagnostics (Basel) 2024; 14:1718. [PMID: 39202206 PMCID: PMC11353849 DOI: 10.3390/diagnostics14161718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 09/03/2024] Open
Abstract
Filler injections in the upper face pose significant challenges due to its complex anatomy and proximity to vascular structures. High-frequency Doppler ultrasound offers real-time visualization of facial anatomy, improving both safety and aesthetic outcomes. This paper presents a detailed overview of the ultrasonographic anatomy of the temples, forehead, and glabella, along with reproducible, ultrasound-guided filler injection techniques for these areas. We use two scanning techniques previously described: "scan before injecting" and "scan while injecting", applicable to subdermal, interfascial, and supraperiosteal planes in the temporal region, as well as the glabella, forehead, and supraorbital region. Ultrasound guidance for filler injections in the upper face can enhance procedural efficacy and safety. By integrating real-time imaging, practitioners can navigate the intricate vascular anatomy more effectively, thereby minimizing the risk of complications. This study highlights the need for ongoing research and continuous education to further refine these techniques and improve patient outcomes.
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Affiliation(s)
- Rosa Sigrist
- Department of Radiology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil;
| | | | - Maria Cristina Chammas
- Department of Radiology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil;
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Kliniec K, Domagała Z, Kempisty B, Szepietowski JC. Arterial Vascularization of the Forehead in Aesthetic Dermatology Procedures: A Review. J Clin Med 2024; 13:4238. [PMID: 39064278 PMCID: PMC11278280 DOI: 10.3390/jcm13144238] [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: 06/21/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Background: The growing popularity of aesthetic procedures on the face raises the question of their safety. The forehead region is crucial aesthetically, but due to its abundant vascularization, it is also one of the most dangerous areas for dermatologic procedures, especially in the glabella area. The purpose of this article is to review the literature on the arterial vascularization of the forehead to identify potential high-risk zones for aesthetic dermatology procedures. Methods: A database search (PubMed, Web of Science, Scopus, and Embase) was conducted, and the titles and abstracts of all identified studies were screened, followed by full-text evaluation. Results: We identified 714 articles during the database search, and 25 articles were included in the review. The included studies used cadaveric dissection and computed tomography applied to cadavers as well as Doppler ultrasonography on volunteers to evaluate the forehead arteries (supratrochlear (STrA), supraorbital (SOA), central (CA), paracentral artery (PCA), and frontal branch of superficial temporal artery(FBSTA)). A total of 1714 cases involving the forehead arteries were analyzed. The included arteries were observed over a relatively large area, and their locations varied. The CA and PCA in cadaver studies were observed in an area of 0.2 to 10.8 mm and 0.8 to 16.2 mm, respectively, on the entire path from the glabellar point to the frontal prominence point. The distances from the midline in cadaveric studies at various measurement points ranged from 0.6 to 28.0 mm for the superficial branch of the STrA and 13.6 to 40.7 mm for the deep branch of STrA. In case of SOA, the distance from the midline ranged from 23 to 32 mm. Measurements from the midline in Doppler studies ranged from 0 to 23 mm for STrA and from 10 to 50 mm for the SOA. In studies using computed tomography, STrA was observed at a distance of 11 to 21 mm and the SOA at a distance of 21 to 32 mm, both lateral to the midline. Conclusions: Medical professionals should be aware of zones where frontal arteries are more likely to be encountered. The glabella region appears to be one of the most dangerous areas for dermatologic procedures. It is believed that the supratrochlear, supraorbital, and the paracentral arteries may cause ophthalmic complications due to occlusion of the ophthalmic artery, while this risk for the frontal branch of the superficial temporal artery seems to be low but cannot be completely excluded.
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Affiliation(s)
- Katarzyna Kliniec
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Zygmunt Domagała
- Division of Anatomy, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (Z.D.); (B.K.)
| | - Bartosz Kempisty
- Division of Anatomy, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (Z.D.); (B.K.)
- Institute of Veterinary Medicine, Nicolaus Copernicus University, 87-100 Torun, Poland
- Physiology Graduate Faculty, North Carolina State University, Raleigh, NC 27695, USA
- Center of Assisted Reproduction, Department of Obstetrics and Gynecology, University Hospital and Masaryk University, 625 00 Brno, Czech Republic
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
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Lee W, Koh IS, Kim KM, Kim KH, Kim SH. Assessing the Practical Application of Rheological Properties of Hyaluronic Acid Fillers: A 1-Year Follow-Up Photographic Analysis. Aesthetic Plast Surg 2024; 48:1606-1627. [PMID: 37731074 DOI: 10.1007/s00266-023-03632-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/20/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND A hyaluronic acid filler is a viscoelastic substance that can be evaluated by rheology. Rheological properties are important for the longevity of the filler, which can be deformed due to the various forces that exist on the face. This study aimed to evaluate the maintenance of the lifting capacity of hyaluronic acid filler injection. METHODS Rheological evaluation of five different products was performed on nine patients who had undergone hyaluronic acid filler injection from Jan 18, 2021 to Jan 27, 2022. Photographs from different time points up to 1 year after filler injection were used to determine the maintenance of the lifting effect of the filler injection. RESULTS After 1 year of follow-up, the filler on the forehead, temple area, nose, chin, nasojugal fold, and mid-cheek groove areas showed good maintenance, while the nasolabial fold slightly improved. CONCLUSIONS Appropriate rheological parameters of hyaluronic acid fillers should be considered before injection into different facial areas. A good choice of filler can result in a good aesthetic effect 1 year after 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)
- Won Lee
- Yonsei E1 Plastic Surgery Clinic, Anyang, South Korea
| | - Ik-Soo Koh
- Kohiksoo Plastic Surgery Clinic, Seoul, South Korea
| | - Kyung Min Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singillo, Yongdeongpo-gu, Seoul, 07441, Korea
| | - Ki Hyun Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singillo, Yongdeongpo-gu, Seoul, 07441, Korea
| | - Seong Hwan Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singillo, Yongdeongpo-gu, Seoul, 07441, Korea.
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Ismailoglu AV, Ismailoglu P, Aktekin M. Mapping the Vascular and Muscular Topography of the Glabellar Region: Implication for Improving Safety and Efficacy of the Glabellar Injections. Aesthetic Plast Surg 2024; 48:1628-1634. [PMID: 37855934 DOI: 10.1007/s00266-023-03708-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Botulinum neurotoxin (BoNT) and filler injections into the highly vascularized glabellar region for aesthetical purposes are extremely common. Injections into the glabellar region without precise anatomical knowledge of its vascular and muscular topography may pose the risk of severe complications. OBJECTIVES We aimed to improve the safety and efficacy of the glabellar injections by mapping the regional muscles and vasculature in relation to the medial canthus and the defined reference lines. METHODS Meticulous dissection was performed to reveal glabellar region muscles and arteries under surgical microscope, in 16 hemifaces of whom arteries are injected with red-dyed latex. Location of the angular artery (AA) along with its branches was noted in relation to glabellar muscles. RESULTS The AA was always located superficial to the levator labii superioris alaeque nasi muscle (LLSAN) and then coursed toward the medial canthus to anastomose with the supratrochlear artery deep to the origin of the depressor supercilii (DS). The AA gave subcutaneously located central and paracentral branches coursing close to the mid-face line in 14 out of 16 hemifaces. Variable muscular connections were also present between the LLSAN, the DS and the procerus (P) muscles. No arteries were detected at the base of the medial eyebrow to which the DS, the P, and the frontalis (F) inserted. CONCLUSIONS This study provides a detailed map of muscular and vascular anatomy of the glabellar region to facilitate safe and efficient filler and BoNT injections without complications. 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)
- Abdul Veli Ismailoglu
- Department of Anatomy, School of Medicine, Marmara University, Maltepe Basibuyuk Yolu, No:9, 34854, Maltepe, Istanbul, Turkey.
| | - Pelin Ismailoglu
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Program, Fenerbahce University, Ataturk Mah. Atasehir Bulvarı, Metropol Istanbul, 34758, Atasehir, Istanbul, Turkey
| | - Mustafa Aktekin
- Department of Anatomy, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Kayisdagi cad, Kerem Aydinlar Kampusu, No: 32, 34752, Atasehir, Istanbul, Turkey
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Zhang L, Zhao Y, Gu Q, Feng X, Li J, Lai F, Pan L, Sun Y, Wu S. A roadmap for safety during facial filler injections: A fresh frozen cadaver study. J Plast Reconstr Aesthet Surg 2023; 86:155-164. [PMID: 37717300 DOI: 10.1016/j.bjps.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/05/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Filler injections are commonly applied to reshape facial contouring. However, cadaveric injections of filler for facial contouring on the whole face, followed by anatomic analysis and measurement, have rarely been reported. This study aimed to provide comprehensive anatomical information, including topographies and roadmap of injection point entry, penetration depth, filler location, the hierarchy of facial structure, and vital vascular course. METHODS Thirty faces on fresh frozen cadaver heads were used for this anatomic study. The whole face was divided into seven facial zones and 14 injection points for penetration depth measurement and cadaveric injection. Static periosteum injections with a sharp-needle technique were performed. Specimens were then dissected to observe the precise locations of fillers and their relationships with surrounding anatomic structures. RESULTS The topography of penetration depth gradually increased from the upper face to the middle face, lower face, and temporal region. Most of the injected hyaluronic acid filler flowed backward to the loose areolar tissue layer between the superficial musculoaponeurotic system and periosteum or deep fascia. Multilevel layer distributions and anastomosis of the vessels were found in the face, especially in the glabella, dorsum nasi, and temporal regions. CONCLUSIONS This study can provide clinicians with a comprehensive reference for facial contouring injections: topographies of the injection point and penetration depth and the vascular anatomical structure in high-risk facial zones. The static periosteum injection with effective aspiration is recommended as a relatively safe technique. Clinicians are supposed to grasp the anatomy and injection technique to achieve maximum safety during filler injections.
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Affiliation(s)
- Lei Zhang
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Ye Zhao
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Qinghao Gu
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Xiao Feng
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Jingyu Li
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Fangyuan Lai
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Lei Pan
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Yi Sun
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Sufan Wu
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China.
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Kareem ZM, Muthana A, Hassan SF, Ahmed FO, Hadi RT, Algburi HA, Atallah O, Ismail M, Hoz SS. Supraorbital artery: Anatomical variations and neurosurgical applications. Surg Neurol Int 2023; 14:318. [PMID: 37810326 PMCID: PMC10559381 DOI: 10.25259/sni_597_2023] [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: 07/18/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023] Open
Abstract
Background The supraorbital artery (SOA) originates from the ophthalmic artery in a superomedial aspect of the orbit, exiting through the supraorbital groove to emerge onto the forehead. The SOA has important neurosurgical considerations regarding different approaches and bypasses. The SOA is poorly described in the standard anatomical textbooks. Therefore, we present this article to describe the anatomical variations of the SOA and their implications on the neurosurgical field. Methods We conducted a literature review in PubMed and Google Scholar databases to review the existing literature describing the SOA anatomy and its neurosurgical applications. Results While reading the available articles and original works regarding SOA, we identified 22 studies that discuss the SOA. We noticed the anatomical variations of the SOA in terms of origin, course, diameter, branches, depth, and distance in relation to the midline and vertical glabellar line. We also discussed certain applications of SOA and its importance in neurosurgical approaches, bypass, photoplethysmography, aneurysms, and reconstruction of cranial fossa defects. Conclusion The variable anatomy of the SOA has a paramount impact on performing different neurosurgical approaches. Therefore, cadaveric studies of the SOA are important to explore potential methods for the preservation of the artery in different neurosurgical applications.
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Affiliation(s)
- Zahraa M. Kareem
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Ahmed Muthana
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Sarah F. Hassan
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Fatimah Oday Ahmed
- Department of Neurosurgery, University of Mustansiriyah, College of Medicine, Baghdad, Iraq
| | - Rania Thamir Hadi
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Hagar A. Algburi
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Mustafa Ismail
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | - Samer S. Hoz
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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Lee W. Hyaluronic Acid Filler Injection Guided by Doppler Ultrasound. Arch Plast Surg 2023; 50:348-353. [PMID: 37564711 PMCID: PMC10411166 DOI: 10.1055/s-0043-1770078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/24/2023] [Indexed: 08/12/2023] Open
Abstract
Doppler ultrasound can be used to detect almost all arteries of the face before injecting the hyaluronic acid (HA) filler. The relatively more dangerous sites of filler injection are the glabellar wrinkle, forehead, temple, nose, and nasolabial fold area, and it is recommended to map the vasculature of these areas by Doppler ultrasound before performing filler injection. The Doppler ultrasound detection method is included as a video. Internal carotid arterial branches, the supratrochlear, supraorbital, and dorsal nasal arteries, and external carotid arterial branches, the superficial temporal and facial arteries, are very important arteries when injecting HA filler; thus, Doppler ultrasound detection is recommended.
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Affiliation(s)
- Won Lee
- Yonsei E1 Plastic Surgery Clinic, Anyang, South Korea
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Khorasanizadeh F, Delazar S, Gheidari O, Daneshpazhooh M, Balighi K, Ehsani AH, Emadi SN, Sadeghinia A, Mahmoudi H. Anatomic evaluation of the normal variants of the arteries of face using color Doppler ultrasonography: Implications for facial aesthetic procedures. J Cosmet Dermatol 2023; 22:1844-1851. [PMID: 36718833 DOI: 10.1111/jocd.15646] [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: 06/05/2022] [Revised: 11/09/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Knowledge of normal facial vascular variations could prevent catastrophic complications of cosmetic procedures as well as providing a guide for surgical planning. Color Doppler ultrasound is a safe and noninvasive method for real time vascular evaluation. OBJECTIVE The aim of this study was to evaluate the normal variations of the facial, angular, transverse facial, supratrochlear and supraorbital arteries in a sample of normal individuals. METHODS Normal individuals referred for dermal filler injection to the tertiary dermatologic center, were selected. Patients who were smoker or had a history of facial filler injection, facial surgery, or trauma were excluded from the study. Facial artery at three levels as well as angular, supratrochlear, supraorbital, and transverse facial arteries were evaluated by an 18 MHz ultrasound linear probe regarding their distance from facial reference lines and landmarks, and also their depths in various regions of face. RESULTS A total number of 43 individuals were evaluated in this study. Thirty-one (72.1%) were women. The number of absent facial artery was zero in level one, three (3.48%) in level two, and nine (10.46%) in level three. The angular artery was absent in 10 (11.62%) participants. The transverse facial artery was absent in 27 (31.39%) assessed individuals. Distance from reference lines at level 2 and 3 of facial artery and its depth at level 2 were significantly different between left and right side (p-values: <0.001, 0.01, and 0.03, respectively). No significant difference was seen between depth and distance of two sides for angular and transverse facial arteries. The comparison of the depths and distances from the reference lines of the assessed arteries between two sexes revealed only a significantly greater value of facial artery distance in level 1 in males (p-value: 0.001). BMI was also significantly correlated with the depth of facial artery in level 2 (Pearson correlation coefficient = 0.471, p-value = 0.002) and level 3 (Pearson correlation coefficient = 0.357, p-value = 0.03) and the distance of the facial artery in level 1 (Pearson correlation coefficient = 0.333, p-value = 0.029). CONCLUSIONS Color Doppler ultrasound could be used to map the arteries of face to prevent vascular complications and safely guide cosmetic procedures.
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Affiliation(s)
- Faezeh Khorasanizadeh
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Delazar
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Gheidari
- Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Houshang Ehsani
- Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Nasser Emadi
- Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sadeghinia
- Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Hu H, Piao JZ, Lee JH, Bae H, Choi YJ, Hong SO, Gil YC, Hu KS, Kim HJ. Face painting as an anatomical learning tool based on individual ultrasonographic examination. Clin Anat 2023; 36:426-432. [PMID: 36342361 DOI: 10.1002/ca.23974] [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: 09/28/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
Considering the shift to online education during the COVID-19 pandemic, new and easily accessible educational videos and content on clinical anatomy are necessary. This study utilized numerous references and data on the anatomy of Asian facial muscles and blood vessels to accurately depict human anatomy through face painting. It aimed to provide clinicians accurate educational video content on anatomy to help prevent possible complications during noninvasive facial and surgical procedures. A 26-year-old Korean-Chinese male volunteer was used as a face painting model. The location of the blood vessels of the face was confirmed through ultrasonography images using a real-time two-dimensional B-mode. The model's face was painted by an artist majoring in anatomy. To reveal most anatomical structures on both sides of the face, the left side showed the structures observed when the skin and superficial fat layer are removed, and the right side revealed the deeper layer structures that can be seen when some muscles are cut. Fifteen superficial and deep muscles important in esthetic procedures were meticulously painted on the face. The face painting took a total of 6 h, and the video was edited to 5 min. This study merged the advantages of 2D and 3D by painting directly on the skin surface of a living model. Thus, it can provide more dynamic surface anatomy data. These contents inform clinicians about 3D anatomic location, which can help avoid complications when performing clinical procedures on the face.
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Affiliation(s)
- Hyewon Hu
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Jiong-Zhen Piao
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ji-Hyun Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Hyungkyu Bae
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - You-Jin Choi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Sung Ok Hong
- Department of Oral and Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Young-Chun Gil
- Department of Anatomy, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Kyung-Seok Hu
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea.,Department of Electrical and Electronic Engineering, Yonsei University, Seoul, South Korea
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13
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Akdemir Aktaş H, Mine Ergun K, Tatar İ, Arat A, Mutlu Hayran K. Investigation into the ophthalmic artery and its branches by superselective angiography. Interv Neuroradiol 2022; 28:737-745. [PMID: 35317633 PMCID: PMC9706266 DOI: 10.1177/15910199221067664] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The vascular anatomy of orbit is highly complex, and the main blood supply to the orbit is via the ophthalmic artery, which is a branch of the internal carotid artery. The purpose of this study was to determine the morphometry of the ophthalmic artery and its branches by superselective angiography in a large series of pediatric patients. METHODS We evaluated 134 angiographies performed on children with intraocular retinoblastoma undergoing intra-arterial chemotherapy. The origin, diameter, and angiographic visibility percentages of the ophthalmic artery and its branches were examined according to age group and sex. RESULTS The ophthalmic artery originated 97.8% from the internal carotid artery and 2.2% from the middle meningeal artery. The mean diameter of ophthalmic artery was measured 0.76 ± 0.14 mm in girls, 0.80 ± 0.15 mm in boys and 0.79 ± 0.15 mm in general. The posterior ciliary, lacrimal, inferior muscular, and anterior ethmoidal arteries had a higher angiographic visibility percentages (> 85%) than the other OA branches. Only the diameter of the dorsal nasal artery showed a significant correlation with age. The supratrochlear and posterior ciliary arteries showed statistically significant relationship with sex. CONCLUSIONS Present study will make a substantial contribution to the pediatric literature about the ophthalmic artery and its branches. A better understanding of ophthalmic artery morphology can help surgeons and neurointerventional radiologists to avoid possible severe complications during embolization, intra-arterial chemotherapy, cosmetic procedures, endonasal and orbital surgeries.
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Affiliation(s)
- Hilal Akdemir Aktaş
- Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey, 06100
| | - Kadriye Mine Ergun
- Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey, 06100
| | - İlkan Tatar
- Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey, 06100
| | - Anıl Arat
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey, 06100
| | - Kadir Mutlu Hayran
- Department of Preventive Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey, 06100
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Shen WW, Du JN, Ma JX, Xia YC, Cui LG. Evaluation of Supratrochlear, Supraorbital and Angular Artery Course Variations and Depth by Doppler Ultrasound. Aesthetic Plast Surg 2022; 47:791-798. [PMID: 36443416 DOI: 10.1007/s00266-022-03188-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Supratrochlear (STA), supraorbital (SOA), and dorsal nasal artery (DNA) branches from the ophthalmic artery and angular artery (AA) from the facial artery are the primary suppliers of blood to the upper face. Filler injection without precise knowledge of its vascular topography poses a risk of severe complications. METHODS Seventy-four hemifaces from 37 subjects with a median age of 25.0 (21.0, 35.0) years and a median body mass index of 21.2 (20.0, 25.4) kg/m2 underwent high-frequency ultrasound tests between March 2022 and April 2022. The bilateral location, depth, peak systolic velocity (PSV), and inner diameter (ID) of the four periorbital arteries (STA, SOA, DNA, AA) were measured. RESULTS The average ID ranges from 0.6~1.0 mm, and the average PSV ranges from 9.2~24.9 cm/s. All arteries detected passed through the superficial subcutaneous fascia. Most subjects' STAs traveled within 1.0 to 2.0 cm from the midline (left 96.8%, right 93.8%), while SOAs were mainly concentrated within 2.0 to 4.0 cm (left 83.9%, right 81.3%). STAs were more superficial and had a larger internal ID and PSV than SOAs (p<0.001). Except for the ID of the right SOA2 being significantly larger than that of the left SOA2 (p<0.05), no dominant side was found. The depth of STAs and SOAs was moderately correlated with BMI (p<0.05), except for STA1 on the left side. The course of AAs presented a high variability. CONCLUSION These findings emphasize that the periorbital arteries carry with it a likelihood of ocular complication risks during injection. Targeting the supraperiosteal layer in the STA area and the supramuscular layer in the SOA area of the inferior forehead during injection seems reasonable, and an area within 1.0~2.0 cm from the midline should be avoided. Additionally, the high variability of AAs will enhance the understanding of the anatomy of the facial artery terminals. 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)
- Wei-Wei Shen
- Department of Ultrasound, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Jia-Ning Du
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Jian-Xun Ma
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing, 100191, China.
| | - You-Chen Xia
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing, 100191, China
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Transfer Patterns and Clinical Applications of the Forehead Flaps Based on the Supratrochlear Artery and Supraorbital Artery. J Craniofac Surg 2022; 34:936-941. [PMID: 36730218 DOI: 10.1097/scs.0000000000009135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This study aimed to describe the application of transferring preexpanded forehead flaps based on the supratrochlear and supraorbital arteries in 3 patterns for facial reconstruction: Pattern I, interpolated flap; Pattern II, island flap; and Pattern III, propeller flap, which was subdivided into direct propeller flap (Pattern IIIa) and indirect propeller flap (Pattern IIIb). During the first stage, a tissue expander was inserted underneath the forehead. After sufficient inflation of the expander, a forehead flap based on the supratrochlear or supraorbital artery was elevated and transferred to reconstruct the facial defects. Three weeks after the surgery, pedicle division was performed, in which Pattern I and Pattern IIIb flaps were used. Twenty-four patients underwent facial reconstruction. Twenty-three flaps survived without any perfusion-related complications. Venous congestion developed in an island flap. All patients were followed up after surgery, ranging from 2 to 156 (mean, 19) months. The color and texture of the flap matched those of the adjacent skin. The patients and their families were satisfied with the final functional and esthetic outcomes. The forehead flap based on the supratrochlear and supraorbital arteries provides reliable coverage of facial defects. The conventional interpolated flap continues to be the most dependable. Single-stage reconstruction using the island flap and direct propeller flap is applicable to patients who decline the pedicle division procedure. The novel technique of using the indirect propeller flap is safe for cheek reconstruction with minimal donor-site morbidity and esthetically pleasing results.
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Bravo BSF, de Melo Carvalho R, Penedo L, de Bastos JT, Calomeni Elias M, Cotofana S, Frank K, Moellhoff N, Freitag L, Alfertshofer M. Applied anatomy of the layers and soft tissues of the forehead during minimally-invasive aesthetic procedures. J Cosmet Dermatol 2022; 21:5864-5871. [PMID: 35634970 DOI: 10.1111/jocd.15131] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/21/2022] [Accepted: 05/25/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND An increasing demand of minimally-invasive aesthetic procedures of the forehead concomitantly leads to higher numbers of adverse events. Adequate application of anatomical knowledge is required to increase safety and efficacy of different minimally-invasive aesthetic procedures in this anatomical region. OBJECTIVE To describe the layered anatomy of the forehead soft tissues with respect to their thicknesses and how they relate to different minimally-invasive aesthetic treatments. METHODS A total of n = 85 healthy study participants (69 females and 16 males) with a mean age of 40.84 ± 10.9 years and a mean body mass index of 22.65 ± 2.6 kg/m2 were investigated with ultrasound-based imaging to measure the thickness of different forehead soft tissues. RESULTS The mean overall soft tissue thickness of the forehead was measured to be 4.18 ± 0.7 mm for the entire study population. Increasing BMI values correlated statistically significantly with increasing thickness of all measured forehead soft tissues with exception of the frontalis muscle. On a statistically significant level, males showed thicker forehead soft tissues than females, with exception of the retrofrontalis fat and the frontalis muscle. CONCLUSION On basis of the findings obtained in this study, basic treatment principles can be derived and improved for the injection of neuromodulators, hyaluronic acid as well as the application of polydiaxonane (PDO) threads and micro-focused ultrasound. Precise knowledge and thorough understanding of the layers and soft tissues of the forehead is required to guarantee safe and effective procedures in this aesthetically important facial region.
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Affiliation(s)
| | | | - Lais Penedo
- Dermatology Department, Bravo Private Clinic, Rio de Janeiro, Brazil
| | | | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU, Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU, Munich, Germany
| | - Lysander Freitag
- Department of General Surgery, Community Hospital Havelhöhe, Berlin, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU, Munich, Germany
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17
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Cong LY, Liao ZF, Zhang YS, Li DN, Luo SK. Three-Dimensional Arterial Distribution Over the Midline of the Nasal Bone. Aesthet Surg J 2022; 42:784-790. [PMID: 34971367 DOI: 10.1093/asj/sjab432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A comprehensive understanding of arterial variations around the midline of the nose is of great importance for the safety of filler injection. OBJECTIVES The aim of the study was to clearly define the 3-dimensional location of the arteries along the midline of the nasal bone. METHODS The arterial structures overlapping the nasal bone along the midline were observed in 79 cadavers. RESULTS The present study found that 0 to 3 named arteries per nose segment could be identified. All the arterial structures were located in or above the superficial musculoaponeurotic system layer overlapping the nasal bone. The probability of encountering named arteries at 5 defined points, P1 to P5, was 5/79 (6.3%), 4/79 (5.1%), 1/79 (1.3%), 6/79 (7.6%), and 9/79 (11.4%), respectively. The depth of the main arterial trunk was 1.2 ± 0.4 mm, 1.6 ± 0.6 mm, 1.8 ± 0 mm, 1.0 ± 0.4 mm, and 0.9 ± 0.5 mm below the skin at P1 to P5, respectively. CONCLUSIONS The authors confirmed that sub-superficial musculoaponeurotic system injection along the midline through a needle is anatomically reliable and that a technique with 1 entry point through the rhinion via a cannula can easily keep the needle sufficiently deep for safe nasal filler injection.
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Affiliation(s)
- Li-Yao Cong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital , Guangzhou City, Guangdong Province , People’s Republic of China
| | - Zhi-Feng Liao
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital , Guangzhou City, Guangdong Province , People’s Republic of China
| | - Yun-Song Zhang
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital , Guangzhou City, Guangdong Province , People’s Republic of China
| | - Dong-Ni Li
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital , Guangzhou City, Guangdong Province , People’s Republic of China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital , Guangzhou City, Guangdong Province , People’s Republic of China
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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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19
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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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Cotofana S, Velthuis PJ, Alfertshofer M, Frank K, Bertucci V, Beleznay K, Swift A, Gavril DL, Lachman N, Schelke L. The Change of Plane of the Supratrochlear and Supraorbital Arteries in the Forehead-An Ultrasound-Based Investigation. Aesthet Surg J 2021; 41:NP1589-NP1598. [PMID: 33652475 DOI: 10.1093/asj/sjaa421] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Injecting soft tissue fillers into the deep plane of the forehead carries the risk of injection-related visual compromise due to the specific course of the arterial vasculature. OBJECTIVES The aim of this study was to investigate the 2- and 3-dimensional location of the change of plane of the deep branch of the supratrochlear and supraorbital artery, respectively. METHODS A total of 50 patients (11 males and 39 females; mean age, 49.76 [13.8] years, mean body mass index, 22.53 [2.6] kg/m2) were investigated with ultrasound imaging. The total thickness and the distance of the arteries from the skin and bone surface were measured with an 18-MHz broadband compact linear array transducer. RESULTS The deep branch of the supraorbital artery changed plane from deep to superficial to the frontalis muscle at a mean distance of 13 mm (range, 7.0-19.0 mm) in males and at 14 mm (range, 4.0-24.0 mm) in females and for the deep branch of the supratrochlear artery at a mean distance of 14 mm in males and females (range, 10.0-19.0 in males, 4.0-27.0 in females) when measured from the superior orbital rim. CONCLUSIONS Based on the ultrasound findings in this study, it seems that the supraperiosteal plane of the upper and lower forehead could be targeted during soft tissue filler injections because the deep branches of both the supraorbital and supratrochlear arteries do not travel within this plane. The superficial plane of the lower forehead, however, should be avoided due to the unpredictability and inconsistent presence of the central and paracentral arteries. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Peter J Velthuis
- Department of Dermatology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Konstantin Frank
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Vince Bertucci
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Kate Beleznay
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Nirusha Lachman
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Leonie Schelke
- Department of Dermatology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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Demirel O. Forehead Contouring as an Adjunct to Rhinoplasty: Evaluation of the Effect on Facial Appearance, Personal Traits and Patient Satisfaction. Aesthetic Plast Surg 2021; 45:2257-2266. [PMID: 33811290 DOI: 10.1007/s00266-021-02236-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/07/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The nose has a great impact on facial beauty and appearance. Therefore rhinoplasty is one of the most performed procedures worldwide. However, considering the varying degrees of cosmetic operations holistic approach to face is essential to achieve more successful results. In order to this, the forehead is noteworthy with its gender-related features and important relation to the nose. The purpose of this study is to assess the effect of forehead contouring with fat grafting adjunct to rhinoplasty on personal traits, facial appearance and patient satisfaction. METHODS A total of 15 patients who underwent rhinoplasty and forehead contouring with fat grafting were enrolled in this retrospective study. Facial appearance and personal traits were evaluated via subject Global Aesthetic Improvement Scale (S-GAIS), and patient satisfaction was assessed with custom design Forehead Rhinoplasty Outcome Evaluation Questionnaire (F/ROE-Q). Forehead inclination was calculated as an objective indicator of fat graft survival and contour improvement. Pre- and postoperative photographs were taken and used for evaluation. RESULTS According to the F/ROE-Q score, mean total preoperative score was 9,13 and the mean total postoperative score was 24,86 (p < 0,01). High postoperative satisfaction scores were observed in all patients. Statistically significant improvement was observed in attractiveness, femininity, youthfulness, facial harmony, forehead contour, facial profile view parameters based on S-GAIS assessment. The mean forehead inclination angle was 19,04o preoperatively and 16,74° postoperatively. CONCLUSION With the important benefits such as higher patient satisfaction and improvement on facial appearance and personal traits, forehead contouring with fat grafting was an efficient and applicable procedure adjunct to rhinoplasty. 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)
- Oguzhan Demirel
- Denizli State Hospital Department of Plastic, Reconstructive, and Aesthetic Surgery, Sırakapılar, Selcuk Caddesi, Merkezefendi, 20100, Denizli, Turkey.
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22
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Park HJ, Lee JH, Lee KL, Choi YJ, Hu KS, Kim HJ. Ultrasonography Analysis of Vessels Around the Forehead Midline. Aesthet Surg J 2021; 41:1189-1194. [PMID: 33313774 DOI: 10.1093/asj/sjaa354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Filler injection into the glabella is well known to be a highly dangerous procedure due to the high risk of embolism and intravascular injection. Although it is conventional practice to insert the cannula into the middle of the forehead to perform injections into the glabella or radix, vascular structures can be observed in this region during anatomic dissection procedures. OBJECTIVES The aim of this study was to characterize the blood vessels around the forehead midline in order to provide crucial anatomic information for ensuring the safety of noninvasive procedures involving the forehead and glabella. METHODS Ultrasonography image scanning was performed at the following 4 points on the forehead midline: trichion (P1), metopion (P2), halfway point between metopion and glabella (P3), and glabella (P4). The courses and locations of vessels were identified and classified according to their proximity to the forehead midline. RESULTS Vessels coursing within 0.75 cm either side of the forehead midline were found in 34% to 50% of individuals. Arteries running near the forehead midline tended to be dominant on the right side of the forehead except in the P4 area. About half of the individuals had vessels in the P4 area, of which 96.7% were veins. CONCLUSIONS The present results indicate that there are superficial vessels running close to the midline of the forehead. This anatomic information can explain the higher incidence of vascular complications during conventional aesthetic procedures. To ensure safety, the cannula entry point or needle puncture point for glabella augmentation should be reconsidered.
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Affiliation(s)
- Hyun Jin Park
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ji-Hyun Lee
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Kyu-Lim Lee
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - You-Jin Choi
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Kyung-Seok Hu
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Hee-Jin Kim
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
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Lee W, Moon HJ, Kim JS, Yang EJ. Safe Glabellar Wrinkle Correction With Soft Tissue Filler Using Doppler Ultrasound. Aesthet Surg J 2021; 41:1081-1089. [PMID: 32644130 DOI: 10.1093/asj/sjaa197] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Glabellar wrinkle corrections are usually performed by injecting botulinum toxin and hyaluronic acid fillers. The glabella is one of the most dangerous locations for filler injection because of possible visual complications. OBJECTIVES The aim of this study was to use Doppler ultrasound to determine the anatomic relation between glabellar wrinkles and the supratrochlear artery pathway, perform safe hyaluronic acid filler injection to correct glabellar wrinkles, and determine the efficacy of the procedure. METHODS From January 2019 to July 2019, 42 patients (74 glabellar wrinkle lines; 32 bilateral and 10 unilateral wrinkles) were evaluated. Glabellar wrinkle lines were corrected with hyaluronic acid filler. Doppler ultrasound was used to avoid the supratrochlear artery. RESULTS Among the 74 wrinkle lines, the supratrochlear arteries were located either at the glabellar wrinkle lines (30/74, 41%) or lateral to the glabellar wrinkle lines (44/74, 59%). In the latter 44 wrinkles, fillers were injected into the subdermal layer of the glabellar wrinkle lines. In the 30 wrinkles where supratrochlear artery was located at the glabellar wrinkle lines, the artery was located at the deep subcutaneous layer in 24 and at the subdermal layer in 6; thus, filler injection was not performed. CONCLUSIONS The supratrochlear artery may be located either at or lateral to the glabellar wrinkle lines. When performing glabellar wrinkle correction, Doppler ultrasound can be used to confirm the location of the supratrochlear artery before filler injection, which helps in avoiding vascular complications. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | - Eun-Jung Yang
- Department of Plastic and Reconstructive Surgery, Yonsei University, College of Medicine, Seoul, Korea
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Cotofana S, Alfertshofer M, Frank K, Bertucci V, Beleznay K, Nikolis A, Sykes J, Swift A, Lachman N, Schenck TL. Relationship Between Vertical Glabellar Lines and the Supratrochlear and Supraorbital Arteries. Aesthet Surg J 2020; 40:1341-1348. [PMID: 32469392 DOI: 10.1093/asj/sjaa138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Glabellar soft tissue filler injections have been shown to be associated with a high risk of causing injection-related visual compromise. OBJECTIVES The aim of this study was to identify the course of the superficial branch of the supratrochlear and of the deep branch of the supraorbital artery in relation to the ipsilateral vertical glabellar line and to test whether an artery is located deep to this line. METHODS Forty-one healthy volunteers with a mean age of 26.17 [9.6] years and a mean BMI of 23.09 [2.3] kg/m2 were analyzed. Ultrasound imaging was applied to measure the diameters, distance from skin surface, distance between the midline, distance between vertical glabella lines, and the cutaneous projection of the supratrochlear/supraorbital arteries at rest and upon frowning. RESULTS The mean distance between the superficial branch of the supratrochlear artery and the ipsilateral vertical glabellar line was 10.59 [4.0] mm in males and 8.21 [4.0] mm in females, whereas it was 22.38 [5.5] mm for the supraorbital artery in males and 20.73 [5.6] mm in females. Upon frowning, a medial shift in supratrochlear arterial position of 1.63 mm in males and 1.84 mm in females and of 3.9 mm in supraorbital arterial position for both genders was observed. The mean depth of the supratrochlear artery was 3.34 [0.6] mm at rest, whereas the depth of the supraorbital artery was 3.54 [0.8] mm. CONCLUSIONS The hypothesis that injecting soft tissue fillers next to the vertical glabellar line is safe because the supratrochlear artery courses deep to the crease should be rejected. Additionally, the glabella and the supraorbital region should be considered as an area of mobile, rather than static, soft tissues.
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Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Michael Alfertshofer
- Department for Hand, Plastic, and Aesthetic Surgery, Ludwig- Maximilians University Munich, Munich, Germany
| | - Konstantin Frank
- Department for Hand, Plastic, and Aesthetic Surgery, Ludwig- Maximilians University Munich, Munich, Germany
| | - Vince Bertucci
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Katie Beleznay
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Andreas Nikolis
- Erevna Innovations Inc, Clinical Research Unit, Montreal, Quebec, Canada
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | - Jonathan Sykes
- Facial Plastic and Reconstructive Surgery, UC Davis Medical Centre, Sacramento, CA, USA
| | | | - Nirusha Lachman
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Thilo L Schenck
- Department for Hand, Plastic, and Aesthetic Surgery, Ludwig- Maximilians University Munich, Munich, Germany
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Expert Consensus on Hyaluronic Acid Filler Facial Injection for Chinese Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3219. [PMID: 33173709 PMCID: PMC7647603 DOI: 10.1097/gox.0000000000003219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 09/03/2020] [Indexed: 02/05/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Beauty standards vary by race and region, which must be accounted for in creating beauty. Chinese have unique features, including a depressed nose, flat midface, and small chin, and have different cosmetic concerns. We performed a consensus study on filler injections based on the Chinese standard of beauty due to a lack of such study. Methods: We organized the YVOIRE Consensus Group, including 5 plastic surgeons. We discussed common problematic areas seen in Chinese and described techniques based on our experience with hyaluronic acid fillers, while considering peer-reviewed articles, followed by multiple consensus-developing sessions. Results: Chinese faces are characterized by retruded forehead, chin, and low nasal bridge, with certain features believed to bring good fortune. Therefore, profiles of the forehead, nose, lip, and chin have substantial effects on attractiveness. The demand for cosmetic procedures is high among the young generation who particularly desire nose and chin augmentation. Attractive Chinese facial shapes are characterized by a long, slender facial shape and pointed chin. Lips are narrow and thick. When injecting fillers for Chinese, it is necessary to apply special methods that produce results consistent with these characteristics. Conclusions: Understanding the concept and demand of beauty depending on race and region is important. Patients should be evaluated before aesthetic procedures. Maintaining hygiene during the procedure is crucial. Moreover, methods for preventing pain are essential. Fillers should be injected into the correct anatomical site and layer to minimize side effects and maximize effectiveness.
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Koziej M, Polak J, Hołda J, Trybus M, Hołda M, Kluza P, Moskała A, Chrapusta A, Walocha J, Woźniak K. The Arteries of the Central Forehead: Implications for Facial Plastic Surgery. Aesthet Surg J 2020; 40:1043-1050. [PMID: 31651024 DOI: 10.1093/asj/sjz295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The forehead has substantial importance as an aesthetic unit. The central and supraorbital parts of this area are supplied by the supratrochlear (ST) and supraorbital (SO) arteries as well as the recently defined paracentral (PA) and central arteries. OBJECTIVES The authors aimed to assess the morphometry of the vessels of the forehead in the context of plastic surgery and minimally invasive cosmetic procedures. METHODS This research included 40 cadavers directed for forensic autopsy and subjected to postmortem computed tomography angiography. In total, 75 hemifaces were examined for the course and location of arteries relative to the bones and surrounding structures. RESULTS The arteries were observed as follows: ST in 97.3%, SO in 89.3%, and PA in 44.0%. The PA can be expected in the 13-mm-wide zone starting 2 mm laterally from the midline. The ST should be expected in the 10-mm-wide area extended laterally from the tenth millimeter from the midline, and the SO should be expected in the slightly wider (11 mm) area extending laterally from the 20th millimeter from the midline. For the proximal main trunks of the ST and SO arteries, we observed no overlap between the zones of occurrence, whereas the zones for the PA and ST main proximal trunks did overlap. No distinctive central artery was observed in the midline region of the forehead, but instead a network of small vessels in the midline region was visible. CONCLUSIONS The ST is the main and most conservative artery of this region and the PA is the most variable. A unique and detailed anatomical map was created to better understand the vasculature of the forehead area.
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Affiliation(s)
- Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Polak
- Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Hołda
- Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Trybus
- Second Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Hołda
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Kluza
- Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Moskała
- Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Chrapusta
- The Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Woźniak
- Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland
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Tomography of the Forehead Arteries and Tailored Filler Injection for Forehead Volumizing and Contouring. Dermatol Surg 2020; 46:1615-1620. [PMID: 32740211 DOI: 10.1097/dss.0000000000002561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The forehead is a challenging area for filler injection because of the risk of serious complications. Anatomy-based filler injection techniques help to avoid severe vascular complications. MATERIALS AND METHODS Sixty-six cadaver heads were infused with adequate lead oxide contrast through the external carotid arteries, internal carotid arteries, facial artery, and superficial temporal artery. Three-dimensional computed tomography scans were reconstructed using validated algorithms. We measured the length and arc length of "beautiful" foreheads evaluated by 3 skilled surgeons. RESULTS The frontal branch of the superficial temporal artery (FBSTA) was classified based on the main trunk as follows: Type I FBSTA (89.72%) took a sudden turn (89.56° ± 11.76°) once passing through the temporal crest, whereas Type II FBSTA (10.28%) barely turned (52.26° ± 6.81°) at the temporal crest. A total of 319 arteries passed through the midline in 48 cadaver heads. There were more superficial arteries (292 of 319) than deep arteries (27 of 319). The difference in the length and arc length of the forehead was 19.66 ± 4.35 mm. CONCLUSION This study introduces an effective technique for forehead filler injection that minimizes the risk of filler injection and improves patient satisfaction.
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Localization and Topography of the Arteries on the Middle Forehead Region for Eluding Complications Following Forehead Augmentation: Conventional Cadaveric Dissection and Ultrasonography Investigation. J Craniofac Surg 2020; 31:2029-2035. [PMID: 32604295 DOI: 10.1097/scs.0000000000006644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Forehead augmentation with filler injection is one of the most dangerous procedures associated with iatrogenic intravascular injection resulting in the severe complications. Nonetheless, few studies have determined the explicit arterial localization and topography related to the facial soft tissues and landmarks. Therefore, this study aimed to determine an arterial distribution and topography on the middle forehead region correlated with facial landmarks to grant an appropriate guideline for enhancing the safety of injection. Nineteen Thai embalmed cadavers were discovered with conventional dissection and 14 Thai healthy volunteers were investigated with ultrasonographic examination on the middle forehead. This study found that at the level of mid-frontal depression point, the transverse distance from the medial canthal vertical line to the superficial and deep branches of supraorbital artery were 9.1 mm and 15.1 mm, respectively. Whereas the depths from the skin of these arteries were 4.1 mm and 4.3 mm, respectively. Furthermore, the frontal branch of superficial temporal artery was detectable in 42.1% as an artery entering the forehead area. At the level of lateral canthal vertical line, the vertical distance of frontal branch was 31.6 mm, and the depth from skin of the artery was 2.7 mm. In conclusion, a proper injection technique could be performed based on an intensive arterial distribution and topography, and ultrasonographic examination before the injection is also suggested in order to restrict the opportunity of severe complications.
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Liao ZF, Hong WJ, Cong LY, Luo CE, Zhan WF, Ke JQ, Luo SK. A case series: 3-dimensional computed tomographic study of the superior orbital vessels: Superior orbital arcades and their relationships with the supratrochlear artery and supraorbital artery. J Am Acad Dermatol 2020; 84:1364-1370. [PMID: 32592875 DOI: 10.1016/j.jaad.2020.06.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascular complications from periorbital intravascular filler injection are major safety concerns. OBJECTIVE To thoroughly describe the superior orbital vessels near the orbital rim and propose considerations for upper eyelid and forehead injections. METHODS Fifty-one cadaver heads were infused with lead oxide contrast media through the external carotid artery, internal carotid artery, and facial and superficial temporal arteries. Computed tomography (CT) images were obtained after contrast agent injection, and 3-dimensional CT scans were reconstructed by using a validated algorithm. RESULTS Eighty-six qualified hemifaces clearly showed the origin, depth, and anastomoses of the superior orbital vessels, which consistently deployed 2 distinctive layers: deep and superficial. Of all hemifaces, 59.3% had deep superior orbital vessels near the orbital rim, including 44.2% with deep superior orbital arcades and 15.1% with deep superior orbital arteries, which originated from the ophthalmic artery. Additionally, 97.7% of the hemifaces had superficial superior orbital arcades, for which 4 origins were identified: ophthalmic artery, superior medial palpebral artery, angular artery, and anastomosis between the angular and ophthalmic arteries. LIMITATIONS The arterial depth estimated from 3-dimensional CT needs to be confirmed by standard cadaver dissection. CONCLUSION This study elucidated novel arterial systems and proposed considerations for upper eyelid and forehead injections.
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Affiliation(s)
- Zhi-Feng Liao
- Second School of Clinical Medicine, Southern Medical University, Guangzhou City, People's Republic of China; Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Wei-Jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Li-Yao Cong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Cheng-En Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Wen-Feng Zhan
- Department of Radiology, Guang Dong Second Provincial General Hospital, Guangzhou City, People's Republic of China
| | - Jia-Qia Ke
- Department of Neurology, Integrated Hospital of Traditional Chinese Medicine, The Third School of Clinical Medicine, Southern Medical University, Guangzhou City, People's Republic of China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China; Second School of Clinical Medicine, Southern Medical University, Guangzhou City, People's Republic of China.
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30
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Lee W. Prevention of hyaluronic acid filler-induced blindness. Dermatol Ther 2020; 33:e13657. [PMID: 32445274 DOI: 10.1111/dth.13657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/02/2020] [Accepted: 05/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Won Lee
- Yonsei E1 Plastic Surgery Clinic, Anyang, South Korea
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Sahan A, Karaosmanoglu N, Ozdemir Cetinkaya P. A new three-point filler technique to maximize safety for the correction of glabellar rhytids: Evaluation of 50 patients. J Cosmet Dermatol 2020; 19:1311-1315. [PMID: 32243052 DOI: 10.1111/jocd.13399] [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: 10/30/2019] [Revised: 03/08/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyaluronic acid (HA) fillers have been widely used for reversing the signs of the aging face. Injectable fillers are particularly effective in treating vertical glabellar wrinkles. AIMS The aim of this study was to share our own safe glabella filling technique and to evaluate our results in 50 patients with facial rejuvenation. METHODS A total of 50 patients consisting of women and men with moderate to severe glabellar rhytids were enrolled in the study. Patients were evaluated before the injection procedure and 2 weeks after the procedure by using the Rao-Goldman scale. We have described a new three-point filler technique. RESULTS Of 50 patients, 39 were females and 11 males, and the mean age was 39.82 ± 6.44 years. The mean volume of HA that was injected into the glabellar wrinkles was 0.61 ± 0.12 mL. Eight patients had experienced mild complications related to the procedure. None of the patients had experienced skin necrosis and visual impairment. CONCLUSION Our technique is a simple and safe procedure to correct glabellar rhytids. Practitioners should be aware of the safe injection techniques, potential complications, and management of these complications for a good clinical practice.
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Affiliation(s)
- Ali Sahan
- Doctor Al-Sa Aesthetic, Cosmetic and Dermatology Clinic, Ankara, Turkey
| | - Nermin Karaosmanoglu
- Dermatology and Venereology, Ankara Training and Research Hospital, Ankara, Turkey
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Agorgianitis L, Panagouli E, Tsakotos G, Tsoucalas G, Filippou D. The Supratrochlear Artery Revisited: An Anatomic Review in Favor of Modern Cosmetic Applications in the Area. Cureus 2020; 12:e7141. [PMID: 32257686 PMCID: PMC7105260 DOI: 10.7759/cureus.7141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The supratrochlear artery represents a terminal branch of the ophthalmic artery. Cosmetic interventions may traumatize it, resulting in a circulation in the lesion in glabellar region and in the medial aspect of the forehead. This review article aims to synopsise the existing knowledge of the anatomy of the supratrochlear artery in close correlation with minimally invasive cosmetic procedures in the facial area such as soft-tissue filler injections. Their possible adverse effects and their safe application based on the topographic anatomy were included. A literature review was performed in PubMed/Medline online medical database. The superficial course of the supratrochlear artery, as well as the rich, variable anastomotic network that it forms with the supraorbital, angular and dorsal nasal artery raise clinical questions in the case of soft-tissue filler injections in the nasoglabellar and central forehead area. Accidental cannulation of the supratrochlear artery and ultimately, the risk of embolization of the central retinal artery in a retrograde fashion might lead to injury with questionable cosmetic results. Although the risk of complications from the use of soft tissue fillers is considered rare, once happen, the results could be devastating for the quality of life. Thus, the comprehension of the anatomy of the supratrochlear artery is paramount for the health practitioners.
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Affiliation(s)
- Loukas Agorgianitis
- Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Eleni Panagouli
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - George Tsakotos
- Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Gregory Tsoucalas
- Anatomy, School of Medicine-Democritus University of Thrace, Alexandroupolis, GRC
| | - Dimitrios Filippou
- Surgery, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
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Abstract
BACKGROUND Aesthetic facial contouring procedures, particularly forehead augmentation, continue to increase in popularity in the Asian population. However, there are very few reports in the literature specifically examining the long-term outcomes of forehead fat grafting. In the present study, the authors aimed to objectively evaluate the efficacy of autologous forehead fat grafting through evaluation of facial proportions and patient-reported outcomes. METHODS Patients who underwent autologous fat grafting for forehead contouring procedures between July of 2011 and June of 2017 were recruited for participation in the study. Patient demographic and clinical variables were collected preoperatively and postoperatively. Facial proportion analysis was collected and compared from preoperative and postoperative photographs. Satisfaction with outcome was assessed by the patient, the surgeon, and a layperson postoperatively. A related-samples Wilcoxon signed rank test was used for statistical analysis. RESULTS Postoperative outcomes were evaluated in a total of 24 patients who underwent forehead autologous fat-grafting procedures. The average postoperative follow-up was 8.1 months. There were no intraoperative or postoperative complications. More than 50 percent of the postoperative results were evaluated as "satisfactory" by all three groups (i.e., patient, surgeon, and layperson) in terms of aesthetic contouring. Average forehead projection increased 0.24 U (ratio of horizontal distance from midforehead plane to cornea plane/cornea diameter) after one round of fat grafting (p = 0.01). Seven patients (29.2 percent) required more than a single round of fat grafting to achieve optimal results. CONCLUSIONS Autologous fat grafting remains a viable option for forehead contouring and augmentation. The findings of this study demonstrate that the operation is effective and offers stable satisfactory results after long-term follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Abstract
The sexual identity of an individual is obvious to most observers with a glance or when only noticing a portion of the face. The overall appearance of the male face is quite different from the female face. Differences in facial structures-such as brow bone, chin, nose, or lips-can be quite small. It is the sum of these differences that creates the obvious dimorphism in facial appearance. This article outlines sexual differences between facial features and discusses surgical procedures designed to alter facial appearance and sexual identity. The diagnosis of facial dimorphism and limitations of these techniques are outlined.
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Affiliation(s)
- Jonathan M Sykes
- Facial Plastic Surgery, UC Davis Medical Center, Sacramento, CA, USA; Facial Plastic Surgery, Roxbury Institute, Beverly Hills, CA, USA.
| | - Amanda E Dilger
- Facial Plastic and Reconstructive Surgery, 5 Medical Plaza, Suite 100. Roseville, CA 95661, USA
| | - Alexander Sinclair
- Transgender Center, Southern California Hospital System, Culver City, CA, USA
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Phumyoo T, Jiirasutat N, Jitaree B, Rungsawang C, Uruwan S, Tansatit T. Anatomical and Ultrasonography‐Based Investigation to Localize the Arteries on the Central Forehead Region During the Glabellar Augmentation Procedure. Clin Anat 2019; 33:370-382. [DOI: 10.1002/ca.23516] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/13/2019] [Accepted: 10/26/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Thirawass Phumyoo
- Department of Anatomy, Faculty of Medicine, and The Chula Soft Cadaver Surgical Training CenterChulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand
- Department of Basic Medical ScienceFaculty of Medicine Vajira Hospital, Navamindradhiraj University Bangkok Thailand
| | | | - Benrita Jitaree
- Department of Anatomy, Faculty of Medicine, and The Chula Soft Cadaver Surgical Training CenterChulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand
| | - Chalermquan Rungsawang
- Department of Anatomy, Faculty of Medicine, and The Chula Soft Cadaver Surgical Training CenterChulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand
| | - Sukanya Uruwan
- Department of Anatomy, Faculty of Medicine, and The Chula Soft Cadaver Surgical Training CenterChulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand
| | - Tanvaa Tansatit
- Department of Anatomy, Faculty of Medicine, and The Chula Soft Cadaver Surgical Training CenterChulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand
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Lee W, Koh IS, Oh W, Yang EJ. Ocular complications of soft tissue filler injections: A review of literature. J Cosmet Dermatol 2019; 19:772-781. [PMID: 31709739 DOI: 10.1111/jocd.13213] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/03/2019] [Accepted: 10/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Soft tissue filler is commonly used for facial contouring. However, incorrect use can lead to severe ocular complications. Even though filler injections are quite different from fat grafts, they are considered similar procedures. However, to date, there are no proven preventive measures or treatments for blindness secondary to soft tissue filler injections. OBJECTIVES This literature review aimed to investigate visual compromise secondary to soft tissue filler injection and discuss the related vascular anatomy, pathophysiology, and prevention of ocular complications of soft tissue filler injections. METHODS A literature search until July 2018 was performed for reports on visual compromise after filler injections. We evaluated the previous literature and eliminated cases using fat grafts and unknown fillers. RESULTS A total of 50 reports of filler-induced visual compromise were identified. Analysis of these cases showed that the procedure with greatest risk was nasal augmentation, followed by glabellar wrinkle treatment. Within the last 3 years searched, 35% of reported cases involved treatment of the nose. There were no reports of blindness from injections into the temple or chin and relatively few case reports involving forehead injections. CONCLUSION The most common injection site associated with blindness in a previous report was the glabella; however, the most common site currently associated with blindness due to filler injections was the nose. Extreme caution is necessary when performing nasal augmentation or glabellar wrinkle correction using soft tissue fillers to avoid the branches of the internal carotid artery.
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Affiliation(s)
- Won Lee
- Yonsei E1 Plastic Surgery Clinic, Anyang, South Korea
| | - Ik-Soo Koh
- Kohiksoo Plastic Surgery Clinic, Seoul, South Korea
| | - Wook Oh
- Samsung Feel Clinic, Seoul, South Korea
| | - Eun-Jung Yang
- Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Seoul, South Korea
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Zhao WR, Wang HB, Luo CE, Kong XX, Zhan WF, Luo SK. Three-Dimensional Computed Tomographic Study on the Periorbital Branches of the Ophthalmic Artery: Arterial Variations and Clinical Relevance. Aesthet Surg J 2019; 39:1109-1117. [PMID: 30192913 DOI: 10.1093/asj/sjy228] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Filler injection is a popular cosmetic procedure, but it can entail vascular complications. Periorbital injections have the highest risk within the entire injection area. OBJECTIVES The authors sought to systematically screen for periorbital arterial variations prior to treatment. METHODS The external carotid arteries of 10 cadaveric heads were infused with adequate lead oxide contrast. The facial and superficial temporal arteries of another 11 cadaveric heads were injected with the contrast in sequential order. Computed tomography (CT) scanning was performed after injection of contrast, and 3-dimensional (3D) CT scans were reconstructed using validated algorithms. RESULTS Three types of periorbital blood vessels were found to derive from the ophthalmic artery, including 30% directly originating from the ophthalmic artery, 65% originating from its trochlear branch, and 5% originating from its supraorbital branch. In the forehead, the ophthalmic artery, originating from the internal carotid arteries, formed anastomoses between the frontal branch of the superficial temporal artery, originating from the external carotid artery, with the deep and superficial branches of the supratrochlear and supraorbital arteries, respectively. The lateral orbit and malar plexus can be classified into 4 types based on the trunk artery: the zygomatic orbital artery (27%), the transverse facial artery (23%), the premasseteric branch of the facial artery (19%), and all 3 contributing equally (31%). CONCLUSIONS Postmortem 3D CT can map periorbital arterial variations. The branching pattern of the ophthalmic artery, the ophthalmic angiosome in the forehead, and the distribution of the lateral orbit and malar plexus were identified at high resolution to guide clinical practice.
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Affiliation(s)
- Wei-Rui Zhao
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Hai-Bin Wang
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Cheng-En Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Xiang-Xue Kong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Wen-Feng Zhan
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
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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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The Inside-Out Septal Mucoperichondrial Flap: Reconstruction of Nasal Lining Simplified. Plast Reconstr Surg 2018; 142:100e-101e. [PMID: 29952916 DOI: 10.1097/prs.0000000000004508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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High-Throughput Screening of Full-Face Clinically Relevant Arterial Variations Using Three-Dimensional Postmortem Computed Tomography. Plast Reconstr Surg 2018; 142:653e-664e. [DOI: 10.1097/prs.0000000000004834] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Abstract
BACKGROUND During periorbital noninvasive and surgical procedures, there is the risk of iatrogenic injury to the emerging point of the ophthalmic artery. This study aimed to determine the three-dimensional location of the emerging point of the ophthalmic artery and to provide clinicians with anatomical information that would help them to avoid associated complications. METHODS Seventeen hemifaces of the emerging point of the ophthalmic artery from 10 Korean and seven Thai cadavers were dissected and scanned by a three-dimensional scanner. The emerging points of the ophthalmic artery of 30 healthy Korean volunteers were also detected using an ultrasound imaging system. RESULTS The transverse distance from the medial canthus to the emerging of the ophthalmic artery was 3.8 ± 1.0 mm medially, and the vertical distance was 14.0 ± 2.9 mm superiorly. The transverse distance from the midline was 16.5 ± 1.7 mm to the emerging point of the ophthalmic artery and 20.0 ± 2.0 mm to the medial canthus. The measured depth from the skin surface to the emerging point of the ophthalmic artery was 4.8 ± 1.7 mm by means of three-dimensional scanning and 4.5 ± 1.1 mm using ultrasound detection. The vertical distance from the inferior margin of the superior orbital rim to the emerging point of the ophthalmic artery was 5.3 ± 1.4 mm. CONCLUSION These data inform clinicians about the anatomical three-dimensional location of the emerging point of the ophthalmic artery, which will help them to avoid iatrogenic injury when they are performing periorbital clinical procedures.
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Brunetti B, Tenna S, Barone M, Cassotta G, Casale M, Persichetti P. Bipaddle chimaeric forehead flap: A new technique for simultaneous lining and cutaneous reconstruction in case of full thickness defects of the nose. Microsurgery 2018; 39:124-130. [PMID: 30221388 DOI: 10.1002/micr.30376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 07/15/2018] [Accepted: 08/24/2018] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Many techniques have been described to treat full thickness nasal defects. The authors introduce the bipaddle chimaeric forehead flap (BCFF), a new alternative technique to achieve simultaneous lining and cutaneous reconstruction in case of full thickness hemi-nasal defects, presenting surgical details and applications for its clinical use. PATIENTS AND METHODS From June 2015 to April 2017, 10 patients presenting with oncological full thickness defects involving nasal sidewall and/or nasal ala were reconstructed with the BCFF technique. Mean age was 69.4 years. The chimaeric flap was composed of 2 paddles (cutaneous and periosteal), nourished by a single supratrochlear pedicle, which were used to independently reconstruct the deficient cutaneous and mucosal layers of the nose. Cartilage grafts were used in 8/10 patients. RESULTS Mean surgical time was 114 minutes. An intermediate thinning operation was performed in 3 out of 10 patients. All the flaps survived with no partial necrosis or cartilage exposure observed. Viability and mucosalization of the periosteal paddle was documented both intra-operatively (during the 2nd stage of the operation) and postoperatively (with fiberoptic rhinoscopy performed 3 months after the procedure). Clinical follow-up period ranged from 4 to 24 months postoperatively. The final result was judged sufficient, good and excellent in 1, 5, and 4 cases, respectively. CONCLUSIONS The BCFF technique may be a new alternative approach to address full thickness hemi-nasal defects with no extra donor site morbidity, allowing primary placement of structural cartilage grafts and immediate definition of the nasal subunits to be reconstructed.
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Affiliation(s)
- Beniamino Brunetti
- Plastic, Reconstructive and Aesthetic Surgery Department, Campus Bio-Medico University School of Medicine, Rome, Italy
| | - Stefania Tenna
- Plastic, Reconstructive and Aesthetic Surgery Department, Campus Bio-Medico University School of Medicine, Rome, Italy
| | - Mauro Barone
- Plastic, Reconstructive and Aesthetic Surgery Department, Campus Bio-Medico University School of Medicine, Rome, Italy
| | - Gabriella Cassotta
- Plastic, Reconstructive and Aesthetic Surgery Department, Campus Bio-Medico University School of Medicine, Rome, Italy
| | - Manuele Casale
- Otorhinolaryngology Department, Campus Bio-Medico University School of Medicine, Rome, Italy
| | - Paolo Persichetti
- Plastic, Reconstructive and Aesthetic Surgery Department, Campus Bio-Medico University School of Medicine, Rome, Italy
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Lee W, Yoon JH, Koh IS, Oh W, Kim KW, Yang EJ. Clinical application of a new hyaluronic acid filler based on its rheological properties and the anatomical site of injection. BIOMEDICAL DERMATOLOGY 2018. [DOI: 10.1186/s41702-018-0032-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Reply: Topographic Analysis of the Supratrochlear Artery and the Supraorbital Artery: Implication for Improving the Safety of Forehead Augmentation. Plast Reconstr Surg 2017; 140:753e-755e. [PMID: 29068957 DOI: 10.1097/prs.0000000000003782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Topographic Analysis of the Supratrochlear Artery and the Supraorbital Artery: Implication for Improving the Safety of Forehead Augmentation. Plast Reconstr Surg 2017; 140:753e. [PMID: 29068956 DOI: 10.1097/prs.0000000000003781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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