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Wang D, Zhang Q, Zeng N, Wu Y. Age-Related Changes in Facial Soft Tissue of Han Chinese: A Computed Tomographic Study. Dermatol Surg 2022; 48:741-746. [PMID: 35446271 DOI: 10.1097/dss.0000000000003460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Facial lifting and volume restoration are the major strategies of facial rejuvenation, but the aging of facial soft tissues has not been sufficiently explored. OBJECTIVE This study aimed to reveal the age-related changes in full facial soft tissue of Han Chinese by using computed tomography. MATERIALS AND METHODS The measurements were performed on head computed tomographic images of 200 Han Chinese subjects (100 men and 100 women). The thickness of facial soft tissue was measured at 20 anthropological landmarks of the skull. RESULTS The thickness at rhinion was increased, whereas the thickness at midphiltrum, supradentale, and infradentale was decreased, indicating the significant differences in both sexes. Besides, the thickness at glabella, nasion, supramentale, and menton was decreased significantly in women. The thickness at supraorbital and lateral orbit was increased with aging in either sex. The thickness at frontal eminence, infraorbital, supraglenoid, and gonion showed significant age-related increases in women, and the thickness at zygomatic arch, supra M2, and infra M2 was significantly decreased in men. CONCLUSION These results suggest that soft tissues in different areas of the face are selectively thickened or thinned with aging, thus providing a reference for rejuvenation procedures.
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Affiliation(s)
- Dawei Wang
- All authors are affiliated with the Department of Plastic and Cosmetic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Swift A, Liew S, Weinkle S, Garcia JK, Silberberg MB. The Facial Aging Process From the "Inside Out". Aesthet Surg J 2021; 41:1107-1119. [PMID: 33325497 PMCID: PMC8438644 DOI: 10.1093/asj/sjaa339] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The normal course of aging alters the harmonious, symmetrical, and balanced facial features found in youth, not only impacting physical attractiveness but also influencing self-esteem and causing miscommunication of affect based on facial miscues. With this evidence-based paper, the authors aim to provide a comprehensive overview of the latest research on the etiology and progression of facial aging by explaining the aging process from the “inside out,” that is, from the bony platform to the skin envelope. A general overview of the changes occurring within each of the main layers of the facial anatomy is presented, including facial skeleton remodeling, fat pad atrophy or repositioning, changes in muscle tone and thickness, and weakening and thinning of the skin. This is followed by an in-depth analysis of specific aging regions by facial thirds (upper, middle, and lower thirds). This review may help aesthetic physicians in the interpretation of the aging process and in prioritizing and rationalizing treatment decisions to establish harmonious facial balance in younger patients or to restore balance lost with age in older patients.
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Affiliation(s)
- Arthur Swift
- Westmount Institute of Plastic Surgery in Montréal, QC, Canada
| | - Steven Liew
- Shape Clinic in Darlinghurst, NSW, Australia
| | - Susan Weinkle
- Dermatology at the University of South Florida, Tampa, FL, USA
| | - Julie K Garcia
- Health Economics Outcomes Research at Allergan plc, an AbbVie Company, Irvine, CA, USA
| | - Michael B Silberberg
- Allergan Ltd, an AbbVie Company, Parkway, Marlow, Buckinghamshire, United Kingdom
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Pavicic T, Mohmand HM, Yankova M, Schenck TL, Frank K, Freytag DL, Green JB, Hamade H, Cassuto D, Cotofana S. Influence of needle size and injection angle on the distribution pattern of facial soft tissue fillers. J Cosmet Dermatol 2019; 18:1230-1236. [PMID: 31282607 DOI: 10.1111/jocd.13066] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 06/19/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Soft tissue filler injections are performed using either sharp-tip needles or blunt-tip cannulas. Product can change planes in an uncontrolled manner during needle injections, potentially leading to unintentional intra-arterial placement. There is a paucity of data on the influence of injection angle on the dispersion patterns of soft tissue fillers. MATERIALS AND METHODS A total of 126 injection procedures were conducted in seven Caucasian body donors (four males, three females) with a mean age of 75.29 ± 4.95 years and a mean body mass index of 23.53 ± 3.96 kg/m2 . Injection procedures were performed in various facial regions (forehead, scalp, zygomatic arch, mandibular angle), utilizing different needle sizes (25G, 27G, 30G) and different angles (90°, 45°, 10°). Layer-by-layer dissections were performed to verify the location of the injected product. Dissections were facilitated by the colored material. RESULTS Utilizing a 30G needle (compared to a 25G needle) reduces the superficial spread with OR 0.70 (95% CI, 0.48-0.99) and P = 0.049, whereas injecting at 90° (vs 10° with the bevel down) increases the odds for superficial spread with OR 10.0 (95% CI, 7.11-14.09) and P < 0.001. CONCLUSION Precision during soft tissue filler injections, defined as the product remaining in the plane of intended implantation, can be enhanced by changing the needle size and the injection angle. Utilizing a 30G needle and injecting at a 10° angle with bevel facing down reduces the uncontrolled product distribution into superficial fascial layers.
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Affiliation(s)
| | | | | | - Thilo L Schenck
- 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
| | - David L Freytag
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig Maximilians University Munich, Munich, Germany
| | | | - Hassan Hamade
- Division of Anatomy, Department of Medical Education, Albany Medical College, Albany, NY, USA
| | | | - Sebastian Cotofana
- Division of Anatomy, Department of Medical Education, Albany Medical College, Albany, NY, USA.,Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA
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Wen LH, Zhong PH, Wang XL, An Y, Hu ZQ, Liu DL, Wang JH. Analysis of age-related changes in midfacial fat compartments in Asian women using computed tomography. J Plast Reconstr Aesthet Surg 2019; 72:1839-1846. [PMID: 31248828 DOI: 10.1016/j.bjps.2019.05.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/17/2019] [Accepted: 05/15/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Volume restoration is no more a fresh theory for midfacial rejuvenation. However, lack of knowledge regarding the natural ageing process of fat compartments often leads to an insufficient or excessive clinical result. The aim of this study is to reveal the age-related changes in midfacial fat compartments and the correlation between midfacial grooves and the related fat compartments. METHODS This study included 60 Asian females in defined age-based categories. The thickness of the infraorbital fat compartment, the nasolabial fat compartment, and the cheek fat compartments were measured using computed tomography (CT) images. Analysis of correlations between midfacial grooves and the related fat compartments was performed using the SPSS software. RESULTS A tendency of thickening in the infraorbital fat and nasolabial fat compartments with age was observed. The superficial layer of cheek fat compartments was found to be thinner, and a similar tendency was observed in the medial part of deep medial cheek fat. However, it was thicker in the lateral part of deep medial cheek fat. There was a negative correlation between the fat thickness of deep medial cheek fat and both the severity of tear trough deformity and the nasolabial fold. A positive correlation between the lower third of the nasolabial fat compartment and the severity of the nasolabial fold was found as well. CONCLUSION Different midfacial fat compartments tended to undergo selective hypertrophy or atrophy with ageing. The findings of this study suggested that augmentation of the deflated fat compartment and liposuction of the hypertrophic fat compartment can provide a more natural effect in facial rejuvenation.
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Affiliation(s)
- Li-Hong Wen
- Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, People's Republic of China; Department of plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, No.1838, North of Guangzhou Avenue, Guangzhou, People's Republic of China
| | - Pei-Hua Zhong
- Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, People's Republic of China
| | - Xian-Long Wang
- Department of radiology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, People's Republic of China
| | - Yang An
- Department of Plastic Surgery, Peking University Third Hospital, 49 Huayuan North Road, Beijing, People's Republic of China; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Zhi-Qi Hu
- Department of plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, No.1838, North of Guangzhou Avenue, Guangzhou, People's Republic of China.
| | - Da-Lie Liu
- Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, People's Republic of China.
| | - Jin-Huang Wang
- Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, People's Republic of China.
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Kim YS, Lee KW, Kim JS, Gil YC, Tanvaa T, Shin DH, Kim HJ. Regional thickness of facial skin and superficial fat: Application to the minimally invasive procedures. Clin Anat 2019; 32:1008-1018. [PMID: 30629772 DOI: 10.1002/ca.23331] [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: 11/14/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 11/06/2022]
Abstract
Various recently introduced minimally invasive treatment modalities are now widely used for enhancing the aging face. In a special, filler is used to increase the volume of tissue, and so understanding the regional thickness and distribution of the facial superficial fat is essential for optimizing minimally invasive procedures. The aim of this study was to establish the overall facial skin and superficial fat thicknesses using a three-dimensional (3D) scanning system. From 53 adult Korean and Thai embalmed adult cadavers, the undissected and serially-dissected facial specimens were scanned and reconstructed. The facial skin and superficial fat thicknesses on seven facial regions were calculated from the superimposed images. The facial skin tended to become thicker in the order of the radix and dorsum, and the temple, supraorbital, forehead, perioral, cheek, and infraorbital areas. The skin was thinnest at radix and dorsum (1.51 ± 0.55 mm), and thickest in infraorbital region (1.97 ± 0.84 mm). The facial superficial fat thickness tended to increase in the order of the radix and dorsum, supraorbital, forehead, temple, cheek, infraorbital, and perioral regions. The superficial fat was thinnest at the radix and dorsum (1.61 ± 1.07 mm), and thickest in the perioral region (5.14 ± 3.31 mm). The facial superficial fat thickness tended to increase in the order of the radix and dorsum, supraorbital, forehead, temple, cheek, infraorbital, and perioral regions. The present findings indicate that 3D scanning system can yield crucial anatomical information about depths of the facial skin and superficial fat layers for utilization in various clinical procedures. Clin. Anat. 32:1008-1018, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- You-Soo Kim
- Department of Anatomy, Institute of Forensic Science, Seoul National University College of Medicine, Seoul, South Korea.,YSBio Co. Ltd., Seoul, South Korea
| | - Kang-Woo Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ji-Soo Kim
- YSBio Co. Ltd., Seoul, South Korea.,Dr. Youth Clinic, Seoul, South Korea
| | - Young-Chun Gil
- Department of Anatomy, Chungbuk National University School of Medicine, Cheongju, South Korea
| | - Tansatit Tanvaa
- Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Dong Hoon Shin
- Department of Anatomy, Institute of Forensic Science, Seoul National University College of Medicine, Seoul, South Korea
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea.,Department of Materials Science & Engineering, College of Engineering, Yonsei University Seoul, Seoul, South Korea
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High-Resolution Magnetic Resonance Imaging of Aging Upper Face Fat Compartments. Plast Reconstr Surg 2017; 141:186e-187e. [PMID: 28938357 DOI: 10.1097/prs.0000000000003993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Garson S, Delay E, Sinna R, Cornette de Saint Cyr B, Taha F. [The third dimension of the face aging, improvement of its understanding]. ANN CHIR PLAST ESTH 2017; 62:387-398. [PMID: 28943216 DOI: 10.1016/j.anplas.2017.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/04/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Over the past 30 years, surface imaging has made tremendous progress. Surgical management has also been subject of numerous technical and strategic developments. For a better understanding of the curative strategies of face aging, the authors have put into perspective the three-dimensional data acquired up to date. METHOD A review of the literature focused on the three-dimensional study of facial aging was carried out. RESULTS Thanks to the precision of new surface acquisition systems and larger patient cohorts, our understanding of surfaces and volumes is now much more accurate. 3D, particularly highlights the major impact of aging on the perioral area, which was up to now neglected compared to other facial areas. CONCLUSION A technical discussion is needed to identify the best techniques to correct the defects and provide a natural result for those anatomical areas that are heavily impacted by aging but not corrected in the final.
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Affiliation(s)
- S Garson
- Cabinet de chirurgie plastique reconstructrice et esthétique, 7, impasse de la Passerelle, 60300 Senlis, France; Laboratoire d'analyse morphologique et cognitive, centre Léon-Bérard, 69008 Lyon, France.
| | - E Delay
- Service de chirurgie plastique et reconstructrice, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France; Laboratoire d'analyse morphologique et cognitive, centre Léon-Bérard, 69008 Lyon, France.
| | - R Sinna
- Service de chirurgie plastique reconstructrice et esthétique, CHU Amiens-Picardie-Site sud, 80054 Amiens cedex 1, France; Laboratoire d'analyse morphologique et cognitive, centre Léon-Bérard, 69008 Lyon, France.
| | - B Cornette de Saint Cyr
- Cabinet de chirurgie plastique reconstructrice et esthétique, 15, rue Spontini, 75116 Paris, France.
| | - F Taha
- Service de maxillofaciale, centre hospitalier Compiègne, 8, avenue Henri-Adnot, ZAC de Mercières 3, 60200 Compiegne, France.
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