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Cotofana S, Hong WJ, Horne J, Harris S, Surek CC, Frank K, Alfertshofer M, Kattil PK, Sakuma T, Onishi EC, Bertucci V, Green JB, Smith MP, Khan A, Lowry N. Intralabial Lip Compartments and Their Potential Clinical Relevance. Plast Reconstr Surg 2024; 153:1293-1300. [PMID: 37314374 DOI: 10.1097/prs.0000000000010820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Aesthetic soft-tissue filler injections for lip enhancement are popular and performed throughout the world. When injecting lips with a cannula, as the cannula is advanced, resistance is perceived in consistent locations, potentially indicating boundaries between intralabial compartments. OBJECTIVE We aimed to investigate whether intralabial compartments exist and, if so, to describe their volumes, location, boundaries, and dimensions. METHODS This cadaveric study investigated a total of 20 human body donors (13 male, seven female) with a mean (SD) age at death of 61.9 years (23.9) and body mass index of 24.3 kg/m 2 (3.7). The investigated cohort included 11 White donors, eight Asian donors, and one Black donor. Dye injections simulating minimally invasive lip treatments were conducted. RESULTS Independent of sex or race, six anterior and six posterior compartments in the upper and lower lip were identified, for a total of 24 lip compartments. Compartment boundaries were formed by vertically oriented septations that were found in consistent locations. The anterior compartments had volumes ranging from 0.30 to 0.39 cc; the posterior compartment volume ranged from 0.44 to 0.52 cc. The compartment volumes were larger centrally and decreased gradually toward the oral commissure. CONCLUSIONS The volume and size of each of 24 compartments contribute to the overall appearance and shape of the lips. To achieve a natural lip shape preserving aesthetic outcome it may be preferable to administer the volumizing product using a compartment-respecting injection approach.
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Affiliation(s)
- Sebastian Cotofana
- From the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science
| | - Wei-Jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital
| | | | | | | | - Konstantin Frank
- Division of Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilians-University Munich
| | - Michael Alfertshofer
- Division of Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilians-University Munich
| | - Punnose K Kattil
- From the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science
| | | | - Emy C Onishi
- Department of Dermatology, University of the Philippines, Philippine General Hospital
| | | | - Jeremy B Green
- Skin Associates of South Florida, Skin Research Institute
| | - Michael P Smith
- Division of Anatomy, Department of Medical Education, Albany Medical College
| | - Amanda Khan
- Division of Anatomy, Department of Medical Education, Albany Medical College
| | - Natalia Lowry
- Division of Anatomy, Department of Medical Education, Albany Medical College
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Wan J, Chan LKW, Lee KWA, Cartier H, Yi K. Volumizing threads and hyaluronic acid filler for lip augmentation. Skin Res Technol 2024; 30:e13797. [PMID: 38887137 PMCID: PMC11182780 DOI: 10.1111/srt.13797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/17/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Jovian Wan
- Asia‐Pacific Aesthetic AcademyHong KongHong Kong
| | | | | | | | - Kyu‐Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral BiologyHuman Identification Research Institute, BK21 FOUR Project, Yonsei University College of DentistrySeoulSouth Korea
- Maylin Clinic (Apgujeong)SeoulSouth Korea
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Farollch-Prats L, Braz A, Urdiales-Gálvez F, de la Guardia C, Nazari A. Profiloplasty and facial contouring with injectables: A holistic, practical, and user-friendly approach. J Cosmet Dermatol 2024. [PMID: 38769652 DOI: 10.1111/jocd.16375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/18/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Expansion of the aesthetic treatment armamentarium with novel injectable products has greatly improved our ability to reshape and enhance the facial profile. However, full-face "profiloplasty" with injectables remain a nascent concept and is insufficiently considered in daily practice. While techniques have been widely published for treating the individual facial areas that constitute an attractive profile-including the forehead, nose, lips, jawline, and chin-the literature remains fragmented on more universal methods for profile improvement. AIMS To collate disparate knowledge on profile optimization with injectables, and define a holistic, practical, and user-friendly approach to profiloplasty and facial contouring. METHODS Consideration is given to key anatomical aspects and the changes that occur with age; patient assessment parameters for planning profiloplasty; and the technical specifications, product selection, and essential safety considerations for minimizing the risk of complications and optimizing the effectiveness of treatment. RESULTS Relevant case studies are presented. CONCLUSIONS Holistic approaches of this type are essential if we are to maximize the potential of full-face treatment with injectables-both now and in the future.
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Affiliation(s)
| | - André Braz
- Dermatología Láser Cosmiatria Clinic, Rio de Janeiro, Brazil
| | | | - Carola de la Guardia
- Global Aesthetics Medical Affairs, Allergan Aesthetics, an AbbVie Company, Madrid, Spain
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Ozturk MK, Kibar Guzin AK. A Natural Flat Volumized Lips Filler Technique: Retrospective Analysis of 920 Patients. Dermatol Surg 2024; 50:453-458. [PMID: 38386847 DOI: 10.1097/dss.0000000000004128] [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: 02/24/2024]
Abstract
BACKGROUND Traditionally, hyaluronidase (HYAL) is used after hyaluronic acid (HA) injection to dissolve the undesired migration of product. OBJECTIVE To describe a novel lip augmentation technique that uses HA and HYAL simultaneously in patients who previously had HA migration. METHODS AND MATERIALS Nine hundred twenty female patients were included. In the first group ( n = 793), HA injections were performed in subcutaneous plane of the lips. In the second group who had previous product migration ( n = 127), 7.5 units of HYAL is injected in 4 points in ergotrid area before proceeding with HA injection. RESULTS The medicis lip fullness scale scores after 2 weeks improved in all patients, while 92% of patients perceived the results as "very much improved" with Global Aesthetic Improvement Scale ( p ˂ .001). There was no difference between 2 groups regarding the patient satisfaction rates ( p ˃.05), while filler migration was seen in 0.2% ( n : 15) of patients in the first group during the follow-up period. CONCLUSION The new vertical injection approach provided an increased vertical height, optimal eversion, and an incisor display on the lips. The simultaneous use of HYAL before HA injection seems to be a safe and effective practice in 1-stage treatment of the previously injected lips with filler migration into ergotrid area.
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Alhallak K, Omran D, Tomi S. Achieving Bratz Doll Look with Lip Fillers: A Prospective Observational Study on Blunt Cannula Techniques. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5731. [PMID: 38623443 PMCID: PMC11018163 DOI: 10.1097/gox.0000000000005731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/20/2024] [Indexed: 04/17/2024]
Abstract
Background This study aims to evaluate the efficacy and safety of a blunt cannula technique using hyaluronic acid fillers for achieving the Bratz doll lip aesthetic, characterized by enhanced volume and sharp definition. Methods Thirty volunteers, 22-40 years of age, were selected based on specific inclusion criteria at Albany Cosmetic and Laser Center for 6 months. The technique involved precise filler injections using a Steriglide blunt cannula. Pre- and postprocedure measurements of lip dimensions and angular changes were meticulously documented and analyzed using IBM SPSS Statistics software. Results The procedure significantly increased the average height of both the upper and lower vermilion zones, with notable changes in angular measurements and the distance between the midline and oral commissure, aligning with the Bratz doll aesthetic. Importantly, none of the participants experienced bruising, a common side effect in traditional needle-based methods. The overall satisfaction rate was high, with an average score of 8.5 out of 10, reflecting the procedure's success in meeting aesthetic goals and ensuring participant comfort. Conclusions The blunt cannula technique for lip augmentation presents a safe and effective alternative to traditional needle-based methods. The absence of bruising and high satisfaction rates underscore the technique's precision and alignment with patient safety and comfort. This study contributes to the field of cosmetic lip enhancement, offering a novel approach that balances aesthetic aspirations with health considerations, potentially influencing future practices in cosmetic procedures.
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Affiliation(s)
- Kamal Alhallak
- From the Alberta Pharmacist Cosmetic Association, Edmonton, Alberta, Canada
- Albany Cosmetic and Laser Centre, Alberta, Canada
| | - Dima Omran
- Albany Cosmetic and Laser Centre, Alberta, Canada
| | - Salem Tomi
- Albany Cosmetic and Laser Centre, Alberta, Canada
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Denadai R, Tangco I, Valentine M, Wallace CG, Hsiao YC, Huang JJ, Chang FCS, Lo LJ, Chen JP, Chen YR. Enhancing Philtrum Morphology Using Fat Grafting Combined with Percutaneous Rigottomy in Repaired Unilateral Cleft Lip. Plast Reconstr Surg 2024; 153:605e-611e. [PMID: 37053450 DOI: 10.1097/prs.0000000000010548] [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: 04/15/2023]
Abstract
BACKGROUND Improving the philtrum morphology of patients with a secondary cleft lip deformity has been a challenge in cleft care. Combining fat grafting with percutaneous rigottomy has been advocated for treatment of volumetric deficiency associated with a scarred recipient site. This study assessed the outcome of synchronous fat grafting and rigottomy for improvement of cleft philtrum morphology. METHODS Consecutive young adult patients ( n = 13) with a repaired unilateral cleft lip who underwent fat grafting combined with rigottomy expansion technique for enhancement of philtrum morphology were included. Preoperative and postoperative three-dimensional facial models were used for three-dimensional morphometric analyses including philtrum height, projection, and volume parameters. Lip scar was qualitatively judged by a panel composed by two blinded external plastic surgeons using a 10-point visual analogue scale. RESULTS Three-dimensional morphometric analysis revealed a significant (all P < 0.05) postoperative increase of the lip height-related measurements for cleft philtrum height, noncleft philtrum height, and central lip length parameters, with no difference ( P > 0.05) between cleft and noncleft sides. The postoperative three-dimensional projection of the philtral ridges was significantly ( P < 0.001) larger in cleft (1.01 ± 0.43 mm) than in noncleft sides (0.51 ± 0.42 mm). The average philtrum volume change was 1.01 ± 0.68 cm 3 , with an average percentage fat graft retention of 43.36% ± 11.35%. The panel assessment revealed significant ( P < 0.001) postoperative scar enhancement for the qualitative rating scale, with mean preoperative and postoperative scores of 6.69 ± 0.93 and 7.88 ± 1.14, respectively. CONCLUSION Synchronous fat grafting and rigottomy improved philtrum length, projection, and volume and lip scar in patients with repaired unilateral cleft lip. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Rafael Denadai
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital
- Plastic and Cleft-Craniofacial Surgery, A&D DermePlastique
| | - Ivy Tangco
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital
| | - Maria Valentine
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital
| | - Christopher Glenn Wallace
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital
- Department of Plastic Surgery, Royal Devon & Exeter Hospital
| | - Yen-Chang Hsiao
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital
- Graduate Institute of Clinical Medical Sciences, School of Medicine
| | - Jung-Ju Huang
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital
- Department of Plastic Surgery, Taipei Medical University Hospital
| | - Frank Chun-Shin Chang
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital
- Graduate Institute of Clinical Medical Sciences, School of Medicine
- Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University
- Department of Plastic Surgery, Taipei Medical University Hospital
- Elysée Aesthetics Medical Center
| | - Lun-Jou Lo
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital
| | - Jyh-Ping Chen
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital
- Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University
- Research Center for Food and Cosmetic Safety, Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology
- Department of Materials Engineering, Ming Chi University of Technology
| | - Yu-Ray Chen
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital
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Tsai MF, Yu CM, Chen YF, Chung TY, Lin GH, Lee AL, Yang CY, Yu CM, Huang HY, Liu YC, Huang WC, Tung KY, Yao WT. Laser Speckle Contrast Imaging Guides Needling Treatment of Vascular Complications from Dermal Fillers. Aesthetic Plast Surg 2024; 48:1067-1075. [PMID: 37816946 DOI: 10.1007/s00266-023-03629-z] [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: 05/29/2023] [Accepted: 08/07/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Although laser Doppler imaging (LDI) accurately delineates a hypoperfused area to help target hyaluronidase treatment, laser speckle contrast imaging (LSCI) is more appropriate for assessing microvascular hemodynamics and has greater reproducibility than LDI. This study investigated the use of LSCI in the evaluation and treatment of six patients who developed vascular complications after facial dermal filler injections. METHODS The areas of vascular occlusion were accurately defined in real time by LSCI and were more precise than visual inspections or photographic evidence for guiding needling and hyaluronidase treatment. RESULTS All patients had achieved satisfactory outcomes as early as Day 2 of treatment and no procedure-related complications were reported after a median follow-up of 9.5 (7-37) days. CONCLUSION LSCI accurately and noninvasively delineated vascular occlusions in real time among patients experiencing complications of facial dermal filler injections. Moreover, LSCI was more accurate than visual and photographic evaluations. Clinicians can use LSCI to reliably follow-up therapeutic outcomes after salvage interventions for vascular occlusions. 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)
- Ming-Feng Tsai
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, 25245, Taiwan
- Graduate Institute of Medical Science and Technology, Taipei Medical University, Taipei City, 101, Taiwan
| | - Chia-Meng Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, 25245, Taiwan
| | - Yu-Fan Chen
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, 25245, Taiwan
| | - Tzu-Yi Chung
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, 10449, Taiwan
| | - Guan-Heng Lin
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, 10449, Taiwan
| | - An-Li Lee
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, 25245, Taiwan
| | - Chin-Yi Yang
- Department of Dermatology, New Taipei Municipal TuCheng Hospital, New Taipei City, 236, Taiwan
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkuo, Taoyuan, 333, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chieh-Ming Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, 25245, Taiwan
| | - Hsuan-Yu Huang
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, 25245, Taiwan
| | - Ying-Chun Liu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, 25245, Taiwan
| | - Wen-Chen Huang
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, 25245, Taiwan
| | - Kwang-Yi Tung
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, 25245, Taiwan
| | - Wen-Teng Yao
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei City, 10449, Taiwan.
- Department of Medicine, MacKay Medical College, New Taipei, 25245, Taiwan.
- Department of Materials Science and Engineering, National Taiwan University, Taipei, 106, Taiwan.
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Mole B. [Restoration of the labial barcode by simultaneous "one shot" injection of botulinum toxin-hyaluronic acid in the same syringe]. ANN CHIR PLAST ESTH 2024; 69:2-16. [PMID: 37865560 DOI: 10.1016/j.anplas.2023.05.005] [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: 05/03/2023] [Revised: 05/20/2023] [Accepted: 05/29/2023] [Indexed: 10/23/2023]
Abstract
The purpose of this technique is to offer patients wishing a labial restoration without morphological changes a simple, fast, discreet, comfortable, adaptable and reversible method by combining the two compounds most used in aesthetic medicine, botulinum toxin and hyaluronic acid. The originality of this combination is based on their mixing in the same syringe and their injection with cannula through a paracommissural approach which makes it possible to treat the entire upper lip in a very homogeneous manner. Botulinum toxin diffuses directly into the underlying muscle layer; hyaluronic acid allows to unfold the damaged cutaneous fan. The useful reciprocal dose of the two products remains intuitive; for starting barcodes the dose of botulinum toxin will be 8-10 Speywood units (4 Allergan units), for those already marked at rest 10-20 Speywood units (4-8 Allergan units); the hyaluronic acid will be chosen according to the depth of the wrinkles. We present a series of 63 patients with an average age of 67 years with a result deemed positive in 79% of cases. The incidents reported are generally due to excessive doses of botulinum toxin which can lead to the classic incidents of fluid leaks in this location (6%). The expected efficacy of the treatment depends on that of the components used (four to six months) but prolonged results have been regularly observed (up to 18 months). All complementary resurfacing treatments have been discarded here since the aim pursued is that of a natural labial restoration allowing an immediate return to socio-professional activities.
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Affiliation(s)
- B Mole
- 15, avenue de Tourville, 75007 Paris, France.
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9
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Nguyen VH, Cheng-Kuan L, Nguyen TA, Cai THNT. Facial artery: anatomical variations in the perioral region in cadavers. Arch Craniofac Surg 2023; 24:266-272. [PMID: 38176760 PMCID: PMC10766500 DOI: 10.7181/acfs.2023.00493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/27/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND In recent years, there has been an increase in reports of perioral vascular complications resulting from filler injections, such as necrosis of the lip or alar rim, occlusion, and in severe cases, blindness. Conversely, the use of perioral arterial flaps is becoming more prevalent in the treatment of cleft lips, cancer, and trauma. A thorough understanding of perioral arteries is essential to minimize complications and maximize the success of these flaps. However, the course of the facial artery (FA) in the perioral region remains incompletely understood. The aim of this study was to describe the variations of the FA in the perioral region. METHODS We dissected 52 embalmed and formaldehyde-fixed Vietnamese cadavers. We then studied the size and distribution of perioral arteries in 102 specimens. RESULTS The superior labial artery (SLA) was the most common branch, occurring in 87.25% of cadavers, followed by the inferior labial artery (ILA) at 78.43%. The SLA primarily originated above the mouth corner (cheilion), accounting for 91.01% of cases, and predominantly exhibited a tortuous course within the submucosa (78.65%). The ILA's branching pattern varied, but it was primarily located below the cheilion (91.25%). The ILA also followed a twisted path, generally within the submucosa. The ILA exhibited two patterns: the typical pattern, distributed at the vermilion border of the lower lip (8.82%), and the horizontal labiomental artery pattern, which ran horizontally in the middle of the lower lip area (69.61%). At their origin, the SLA and ILA had average external diameters of 1.29 mm and 1.28 mm, respectively. CONCLUSION Numerous anatomical variations in the FA in the perioral region were found. A detailed anatomic description, suggested landmarks, and angiography before the procedure will be useful to help doctors avoid complications.
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Affiliation(s)
- Vu Hoang Nguyen
- Department of Anatomy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Lin Cheng-Kuan
- Department of Environmental Health, Harvard Chan School of Public Health, Boston, MA, USA
| | - Tuan Anh Nguyen
- Department of Plastic and Cosmetic Surgery, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Trang Huu Ngoc Thao Cai
- Department of Plastic and Cosmetic Surgery, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
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Nathan NR, Lopes Almeida Gomes L, Wang-Evers M, Patel PM, Doyle A, Manstein D. Novel assessment of lip redness and microcirculation using optical coherence tomography after dermal filler injection. Lasers Surg Med 2023; 55:838-845. [PMID: 37434586 DOI: 10.1002/lsm.23705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Lip filler injections are one of the most popular procedures in esthetic dermatology. In this study, we used three-dimensional colorimetric photography to assess lip color and optical coherence tomography-angiography (OCT-A), a noninvasive alternative to histopathology, to evaluate microcirculation after hyaluronic acid (HA) injection. The pain of the injection procedure was also assessed. METHODS An average of 0.85cc of the total volume of HA with lidocaine was injected into the upper and lower lip of eighteen young (<30yo) and nine postmenopausal healthy women. OCT-A, two-dimensional, and three-dimensional images were acquired immediately before (visit 1) and 15 days after injection (visit 2). Custom-made software was used to analyze the imaging data to detect vessel morphology and redness changes. The Wong-Baker FACES pain rating scale (0-10) was used to score the subject procedural pain. RESULTS For young and old subjects, three-dimensional lip volume was greater than the injected volume. OCT-A images of the lips showed higher vessel density and thickness, reaching statistical significance in the younger cohort. The overall trend of increased redness assessed by three-dimensional colorimetric imaging and increased vascularity evaluated by OCT-A imaging were similar. However, the correlation was not statistically significant for standard two-dimensional digital photography. The average pain score after the first needle insertion and overall procedure were 2.9 and 3.5, respectively. CONCLUSIONS The results suggest an increased microvasculature network observed in OCT-A images in young females. The increased blood vessel density and thickness observed by OCT-A after HA lip filler injection is associated with increased lip redness and volume as assessed by colorimetric three-dimensional photography; however, more research is needed to confirm these findings. This study presents OCT-A as a novel noninvasive tool to investigate changes in lip microvascularity after HA filler injection and indicates that HA filler procedures may affect lip vascularity.
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Affiliation(s)
- Neera R Nathan
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Department of Dermatology, Lahey Health and Medical Center, Burlington, Massachusetts, USA
| | - Lais Lopes Almeida Gomes
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Michael Wang-Evers
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Payal M Patel
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Abigail Doyle
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Dieter Manstein
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
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11
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Antipova V, Niedermair JF, Siwetz M, Fellner FA, Löffler S, Manhal S, Ondruschka B, Pietras SM, Poilliot AJ, Pretterklieber ML, Wree A, Hammer N. Undergraduate medical student perceptions and learning outcomes related to anatomy training using Thiel- and ethanol-glycerin-embalmed tissues. ANATOMICAL SCIENCES EDUCATION 2023; 16:1144-1157. [PMID: 37337999 DOI: 10.1002/ase.2306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 06/21/2023]
Abstract
Anatomical dissection is known to serve as an integral tool in teaching gross anatomy, including postgraduate training. A variety of embalming techniques exist, resulting in different haptic and optical tissue properties. This study aimed to objectify learning outcomes and medical student perceptions related to the use of two widely used embalming techniques, namely Thiel and ethanol-glycerin embalming. Between 2020 and 2022, first- and second-year medical students enrolled in the course on topographic anatomy participated in this study. Objective structured practical examinations were carried out for the head, neck, thorax, abdomen, pelvis, and extremity regions following regional dissection just before the oral examinations began. Six to ten numbered tags were marked in prosections of each region in Thiel- and ethanol-glycerin-embalmed specimens. Following the examinations, the students were surveyed regarding the suitability of the two embalming techniques with respect to preservation, colorfastness, tissue pliability, and the suitability in preparing for their anatomy examinations. Consistently higher scores were achieved for the thoracic and abdominal regions in ethanol-glycerin-embalmed specimens when compared to Thiel. No benefit was found for Thiel-embalmed upper or lower extremities. Tissues embalmed with ethanol-glycerin were rated higher for preservation and suitability to achieve the learning objectives, tissue pliability was rated higher for Thiel-embalmed tissues. Ethanol-glycerin embalming appears to offer certain advantages for undergraduate students in recognizing visceral structures, which may align with students' ideas on tissue suitability for their learning. Consequently, the benefits reported for Thiel embalming for postgraduate study unlikely reflect its suitability for novices.
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Affiliation(s)
- Veronica Antipova
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Julian F Niedermair
- Central Radiology Institute, Johannes Kepler University Hospital, Linz, Austria
| | - Martin Siwetz
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Franz A Fellner
- Central Radiology Institute, Johannes Kepler University Hospital, Linz, Austria
- Division of Virtual Morphology, Institute of Anatomy and Cell Biology, Johannes Kepler University, Linz, Austria
| | - Sabine Löffler
- Department of Anatomy, University of Leipzig, Leipzig, Germany
| | - Simone Manhal
- Office of the Vice-Rector for Studies and Teaching, Medical University of Graz, Graz, Austria
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra M Pietras
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | | | - Michael L Pretterklieber
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Andreas Wree
- Institute of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
- Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology Dresden, Dresden, Germany
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12
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Kroumpouzos G, Harris S, Bhargava S, Wortsman X. Complications of fillers in the lips and perioral area: Prevention, assessment, and management focusing on ultrasound guidance. J Plast Reconstr Aesthet Surg 2023; 84:656-669. [PMID: 37002059 DOI: 10.1016/j.bjps.2023.01.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/30/2022] [Accepted: 01/29/2023] [Indexed: 03/09/2023]
Abstract
An ever-increasing interest in perioral rejuvenation with dermal fillers reflects the esthetic importance of this region. However, filler injections in the lips and perioral area have been associated with various complications. Such complications are classified according to severity (mild, moderate, severe) or by the time of onset: immediate (within 24 h after injection), early (24 h to 4 weeks post-procedure), and late or delayed (>4 weeks after injection). While most complications are mild and manageable, vascular compromise, infections, and the development of delayed-onset nodules may significantly undermine the ultimate esthetic outcome and cause substantial morbidity. These more serious complications often require more invasive treatment modalities. This article details the prevention and management of such adverse events and discusses safe filler injection principles, including safety recommendations for the lips. Lastly, we highlight the use of ultrasound guidance in complication prevention (vascular mapping, filler identification, location, and extent), assessment (identification of intravascular embolus or external vascular compression by the filler implant), and management (real-time imaging of hyaluronidase or other drug injection in the affected area). Esthetic practitioners should be versed in injection anatomy, and the prevention, recognition, and management of filler complications in the perioral area.
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Affiliation(s)
- George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI, USA.
| | | | - Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College and C.R. Gardi Hospital, Ujjain, India.
| | - Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile; Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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13
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Philipp-Dormston WG, Weinmann C, Frank K. [Injection anatomy-a new discipline in aesthetic medicine]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:621-631. [PMID: 37460865 DOI: 10.1007/s00105-023-05185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/25/2023]
Abstract
The basic anatomical understanding of aesthetic medicine has changed fundamentally since the turn of the millennium. With the advent of modern minimally invasive injection procedures using botulinum toxin and hyaluronic acid fillers, anatomical structures that had previously received little attention and were not considered relevant have steadily gained in importance and moved into the scientific focus. Understanding the three-dimensional arrangement of the face with its defined anatomical layers and compartments serves the procedural dermatologist in the sense of a navigation system to optimize treatment success and patient safety when performing aesthetic injections in the facial region. The principles of the biomechanical interaction of the structures are of elementary importance in the creation of individual treatment plans for the implementation of natural and balanced therapeutic results. Modern injection anatomy as an interdisciplinary subject of the three fields of anatomy, dermatology and plastic surgery makes a decisive contribution here.
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Affiliation(s)
- Wolfgang G Philipp-Dormston
- Hautzentrum Köln, Schillingsrotter Str. 39-41, 50996, Köln, Deutschland.
- Department of Dermatology, Faculty of Health, Universität Witten/Herdecke, Witten, Deutschland.
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14
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Loyo M, Kontis T. Creating Ideal Lips with Toxins and Fillers. Clin Plast Surg 2023; 50:455-464. [PMID: 37169411 DOI: 10.1016/j.cps.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Myriam Loyo
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology & Head and Neck Surgery, Oregon Health & Sciences University, CH5E, 3303 SW Bond Avenue, Portland, OR 97239, USA.
| | - Theda Kontis
- Department of Otolaryngology-Head and Neck Surgery, Department of Plastic and Reconstructive Surgery, Johns Hopkins, 1838 Greene Tree Road, Suite 370, Baltimore, MD 21208, USA
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15
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Hilton S, Frank K, Alfertshofer M, Cotofana S. Clinical outcomes after lip injection procedures-Comparison of two hyaluronic acid gel fillers with different product properties. J Cosmet Dermatol 2023; 22:119-127. [PMID: 36459413 DOI: 10.1111/jocd.15548] [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: 10/11/2022] [Revised: 11/02/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Transient swelling is common after lip injections with hyaluronic acid (HA) based fillers. Swelling and other injection-site reactions may relate to the injection procedure itself, or to gel properties, which differ between fillers due to differences in manufacturing methods. OBJECTIVES To evaluate safety and effectiveness of lip injections with two HA fillers manufactured using different gel technologies. METHODS In a study sample of 40 subjects, treatment with two soft tissue filler product (HARK or HAJUS ) was randomly assigned. Subjects were injected with 0.5 cc per upper and lower lip using a standardized injection procedure. Early-onset adverse events (AEs) were assessed by evaluation up to Day 14. Aesthetic improvement, subject satisfaction, and AEs post-Day 14 were assessed up to 24 weeks. RESULTS In subjects treated with HARK , the intensity of early onset swelling, erythema, and pain/tenderness was lower than in subjects treated with HAJUS . Aesthetic improvement was achieved in both groups, and most subjects were satisfied with the appearance of their lips. Treatment-related AEs post-Day 14 mostly related to the implant site; most were mild-to-moderate, and none were serious. CONCLUSIONS The intensity of early-onset swelling, and other injection-site reactions was lower in subjects treated with HARK than in subjects treated with HAJUS . Since both the injection volume and injection procedure were standardized, the difference in local tolerability between the two HA fillers may relate to differences in gel properties. Aesthetic improvement, subject satisfaction, and AE profiles post-Day 14, however, were similar between filler groups.
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Affiliation(s)
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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16
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Manzoni APD, Venier NAB. Hyaluronic Acid Filler Correction of Scars and Asymmetries Secondary to Cleft Lip Repair. Dermatol Surg 2022; 48:1264-1266. [PMID: 36342260 DOI: 10.1097/dss.0000000000003615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ana Paula Dornelles Manzoni
- Department of Dermatology, Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde Porto Alegre (UFCSPA), Porto Alegre, Brazil
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17
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Cotofana S, Lowrey N, Frank K, Ziebart R, Guertler A, Freytag L, Helm S, Alfertshofer MG, Moellhoff N. Vascular Safe Zones for Facial Soft Tissue Filler Injections. PLASTIC AND AESTHETIC NURSING 2022; 42:238-245. [PMID: 36469395 DOI: 10.1097/psn.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The number of soft tissue filler injections performed by aesthetic injectors has continued to increase over the last few years. To provide a high standard of safety and achieve individualized, reproducible, and long-lasting outcomes, aesthetic injectors must have a solid foundation in anatomy, facial biomechanics, rheology, and injection biomechanics. Adverse events associated with soft tissue filler injections can be severe, especially if the aesthetic injector unintentionally injects the soft tissue filler into the patient's arterial vascular circulation and the administered product reaches the arterial bloodstream. Although the face has a rich arterial vascular supply that may seem overwhelmingly complex, it can be broken down systematically according to its internal and external vascular territories. To provide guidance for aesthetic practitioners performing minimally invasive facial injections for aesthetic purposes, this narrative article will discuss the course, depth, and branching pattern of the facial arteries based on the most frequently injected anatomical regions. In this article, we focus on vascular safe zones rather than danger zones .
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Affiliation(s)
- Sebastian Cotofana
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicola Lowrey
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Konstantin Frank
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Rachel Ziebart
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Anne Guertler
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Lysander Freytag
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Sabrina Helm
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael G Alfertshofer
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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18
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Isaac J, Walker L, Ali SR, Whitaker IS. An illustrated anatomical approach to reducing vascular risk during facial soft tissue filler administration – a review. JPRAS Open 2022; 36:27-45. [PMID: 37064503 PMCID: PMC10102405 DOI: 10.1016/j.jpra.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022] Open
Abstract
Vascular complications from soft tissue fillers can have catastrophic consequences for patients. Adverse events are rare, but they are increasing, and their appearance may be the result of intravascular injection. A comprehensive understanding of the 2-dimensional anatomy (distribution) and 3-dimensional anatomy (depth) of the facial vasculature is fundamental for the safe delivery of nonsurgical cosmetic procedures. The purpose of this review is to provide an illustrated approach to examine surgical anatomy specific to the facial vascular system and the anatomical considerations clinicians need to give in specific danger during injectable cosmetic procedures. A grounding in safety and anatomy will help the new injector to mitigate the risk of vascular complications.
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Affiliation(s)
| | - Lee Walker
- B City Clinic, Liverpool, United Kingdom
| | - Stephen R Ali
- Reconstructive Surgery and Regenerative Medicine Research Centre. Institute of Life Sciences, Swansea University Medical School. Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Centre. Institute of Life Sciences, Swansea University Medical School. Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
- Corresponding author: Professor Iain S. Whitaker MA Cantab PhD FRCS Plast FAcadTM, Reconstructive Surgery & Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea SA2 8PP, United Kingdom, Tel: 01792205678.
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19
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Creating Ideal Lips with Toxins and Fillers. Facial Plast Surg Clin North Am 2022; 30:365-374. [DOI: 10.1016/j.fsc.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Canever LE, Degner DA. Evaluation of the superior and inferior labial musculomucosal flaps in cats: An angiographic study and case series. Vet Surg 2022; 51:638-647. [PMID: 35383980 DOI: 10.1111/vsu.13811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/13/2022] [Accepted: 03/14/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the angiosomes of the superior and inferior labial arteries in the cat and describe the use of a musculomucosal axial pattern flap incorporating each artery for reconstruction of palatal defects in cats. STUDY DESIGN Cadaveric study and a series of two clinical cases. SAMPLE POPULATION Five feline cadavers and two client-owned cats. METHODS The common carotid arteries of five feline cadavers were injected with barium sulfate. Radiographs of excised tissue specimens were examined to map the location of the superior and inferior labial arteries and to visualize each angiosome available for an axial pattern flap. Labial musculomucosal flaps were utilized to reconstruct palatal defects in two live cats. RESULTS The superior and inferior labia were predominantly perfused by the superior and inferior labial arteries, respectively, and the angiosome of each artery encompassed the majority of its respective labium. Comparative positive contrast angiograms revealed the vascular supply was located within the musculomucosal layer. Reconstruction of recurrent palatal defects utilizing musculomucosal flaps based on these angiosomes in two clinical cases was successful with complete survival of the flaps. CONCLUSION The upper and lower lips were found to have robust vascular supplies within the musculomucosal layer which can support musculomucosal axial pattern flaps. CLINICAL SIGNIFICANCE This information provides the veterinary surgeon with additional surgical options for reconstruction of central and caudal palatal defects in the cat.
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Affiliation(s)
| | - Daniel A Degner
- Department of Surgery, Animal Surgical Center of Michigan, Flint, Michigan, USA
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21
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Cotofana S, Lowrey N, Frank K, Ziebart R, Guertler A, Freytag L, Helm S, Alfertshofer MG, Moellhoff N. Vascular Safe Zones for Facial Soft Tissue Filler Injections. PLASTIC AND AESTHETIC NURSING 2022; 42:80-87. [PMID: 36450087 DOI: 10.1097/psn.0000000000000430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The number of soft tissue filler injections performed by aesthetic injectors has continued to increase over the last few years. To provide a high standard of safety and achieve individualized, reproducible, and long-lasting outcomes, aesthetic injectors must have a solid foundation in anatomy, facial biomechanics, rheology, and injection biomechanics. Adverse events associated with soft tissue filler injections can be severe, especially if the aesthetic injector unintentionally injects the soft tissue filler into the patient's arterial vascular circulation and the administered product reaches the arterial bloodstream. Although the face has a rich arterial vascular supply that may seem overwhelmingly complex, it can be broken down systematically according to its internal and external vascular territories. To provide guidance for aesthetic practitioners performing minimally invasive facial injections for aesthetic purposes, this narrative article will discuss the course, depth, and branching pattern of the facial arteries based on the most frequently injected anatomical regions. In this article, we focus on vascular safe zones rather than danger zones.
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Affiliation(s)
- Sebastian Cotofana
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicola Lowrey
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Konstantin Frank
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Rachel Ziebart
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Anne Guertler
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Lysander Freytag
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Sabrina Helm
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael G Alfertshofer
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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22
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Waked K, Mespreuve M, De Ranter J, Collard B, Hahn S, Hendrickx B. Visualising the individual arterial anatomy of the face through augmented reality - a useful and accurate tool during dermal filler injections. Aesthet Surg J Open Forum 2022; 4:ojac012. [PMID: 35517577 PMCID: PMC9067448 DOI: 10.1093/asjof/ojac012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The arterial anatomy of the face is extremely variable. Despite numerous cadaver dissections and anatomical descriptions, the exact location of the superficial facial arteries remains unpredictable. This ignorance is a determining factor in the pathophysiology of intravascular filler injections, potentially causing skin necrosis and blindness. Objectives The main objective of this study is to evaluate the accuracy of an augmented reality (AR) application that visualizes the individual arterial anatomy of the face. Methods A workflow was developed during which a magnetic resonance angiography (MRA) mapped the superficial arteries of the face. The images were further processed into an AR image that was visualized on the patient’s face using a specifically designed smartphone application. The accuracy of the AR image and the position of each individual artery were analyzed using duplex ultrasound (US). Results A total of 216 facial arteries were visualized in 20 patients. The superficial temporal (100%), supratrochlear (92.5%), facial (75%), and angular (82.5%) arteries were visualized the most. The inferior labial (17.5%), dorsal nasal (22.5%), and supraorbital (42.5%) arteries were the most difficult to visualize through MRA. The average deviation between the artery visible on the AR image and the location assessed by US was 0.30 mm (standard deviation = +/− 0.66 mm). There were no complications reported. Conclusions The combination of a risk-free MRA to map the individual arteries of the face and the processing into an AR image may be considered as a useful and accurate tool during dermal filler injections to potentially minimize the risk of intravascular filler injections.
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Affiliation(s)
- Karl Waked
- Department of Plastic and Reconstructive Surgery, University Hospital Brussel, Brussels, Belgium
| | - Marc Mespreuve
- Department of Medical Imaging, University Hospital Ghent, Ghent, Belgium
| | - Joris De Ranter
- Department of Plastic and Reconstructive Surgery, University Hospital Leuven, Leuven, Belgium
| | - Barbara Collard
- Department of Medical Imaging, AZ Zeno Hospital, Knokke-Heist, Belgium
| | - Stephan Hahn
- Université Libre de Bruxelles, Brussels, Belgium
| | - Benoit Hendrickx
- Department of Plastic and Reconstructive Surgery, University Hospital Brussel, Brussels, Belgium
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23
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Guo Y, Wei W, Li Q, Tao C, Li X, Zhang A, Jin P. Efficacy and safety of hyaluronic acid fillers for lip augmentation in a Chinese population. J Cosmet Dermatol 2022; 21:1959-1966. [PMID: 35132743 DOI: 10.1111/jocd.14757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hyaluronic acid (HA) is an effective dermal filler for facial rejuvenation. This study aimed to observe the clinical efficacy of HA injection for lip augmentation in Chinese patients. METHODS From May 2019 to April 2020, 70 patients with lip fullness scale (LPS) ≤3 underwent local HA injection using the "three-point" injection technique. All patients were followed up to observe the clinical efficacy, LPS, adverse events, and complications. RESULTS All 70 patients were followed up for 12 months. Statistically significant improvements were observed in the height of lips within 6-9 months post-treatment (p < 0.05). The LFS improved significantly at follow-up compared with baseline (p < 0.05). Local redness occurred in two patients, and serious swelling occurred in three patients. These adverse events were generally tolerated and disappeared gradually within 1 week. No other serious adverse events and complications were reported in the remaining patients. CONCLUSIONS Hyaluronic acid injection can be used for lip augmentation in the Chinese population. The "three-point" technique is simple, safe, and effective and does not cause serious complications.
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Affiliation(s)
- Yanping Guo
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Wuhan Wei
- School of Clinical Medicine, Xuzhou Medical University, Jiangsu, China
| | - Qiang Li
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Changbo Tao
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Xueyang Li
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Aijun Zhang
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Peisheng Jin
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
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24
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Alfertshofer MG, Sattler G, Frank K, Melnikov DV, Freytag L, Mercado‐Perez A, Hargiss JB, Dumbrava M, Cotofana S. The subjectively perceived injectability as an early indicator for adverse events? J Cosmet Dermatol 2022; 21:3943-3948. [DOI: 10.1111/jocd.14697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Michael G. Alfertshofer
- Department of Hand, Plastic and Aesthetic Surgery Ludwig‐Maximilians‐University Munich Germany
| | | | - Konstantin Frank
- Department of Hand, Plastic and Aesthetic Surgery Ludwig‐Maximilians‐University Munich Germany
| | - Dimitry V. Melnikov
- Department of Plastic Surgery I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Lysander Freytag
- Department of General Surgery Community Hospital Havelhöhe Berlin Germany
| | - Arnaldo Mercado‐Perez
- Department of Clinical Anatomy Mayo Clinic College of Medicine and Science Rochester Minnesota USA
| | - John B. Hargiss
- Department of Clinical Anatomy Mayo Clinic College of Medicine and Science Rochester Minnesota USA
| | - Mihai Dumbrava
- Department of Clinical Anatomy Mayo Clinic College of Medicine and Science Rochester Minnesota USA
| | - Sebastian Cotofana
- Department of Clinical Anatomy Mayo Clinic College of Medicine and Science Rochester Minnesota USA
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25
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Velthuis PJ, Jansen O, Schelke LW, Moon HJ, Kadouch J, Ascher B, Cotofana S. A Guide to Doppler Ultrasound Analysis of the Face in Cosmetic Medicine. Part 2: Vascular Mapping. Aesthet Surg J 2021; 41:NP1633-NP1644. [PMID: 33954749 DOI: 10.1093/asj/sjaa411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Duplex mode ultrasound imaging can detect the course of the main vascular structures in the face, which are known to be subject to variation. Once duplex mapping has been performed, measures can be taken to prevent injection into an artery, thereby avoiding skin necrosis or, worse, vision loss. For this reason, in particular, we predict that in the coming years sonography will become standard equipment in the offices of cosmetic doctors. We discuss the basics of vascular imaging by Doppler ultrasound, both in normal and pathologic situations. Starting from the 7 basic positions for the ultrasound probe, all facial arteries relevant in cosmetic medicine can be found.
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26
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van Loghem J, Sattler S, Casabona G, Cotofana S, Fabi SG, Goldie K, Gout U, Kerscher M, Lim TS, de Sanctis Pecora C, Sattler G, Trindade de Almeida A, Wanitphakdeedecha R, Werschler P, Pavicic T. Consensus on the Use of Hyaluronic Acid Fillers from the Cohesive Polydensified Matrix Range: Best Practice in Specific Facial Indications. Clin Cosmet Investig Dermatol 2021; 14:1175-1199. [PMID: 34526796 PMCID: PMC8435881 DOI: 10.2147/ccid.s311017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/24/2021] [Indexed: 11/23/2022]
Abstract
Background As the treatment indications for the Cohesive Polydensified Matrix® hyaluronic acid (CPM-HA) portfolio continue to expand and diversify, injectors new to the range or those who are expanding the treatments they offer may be unsure of the optimal product and injection technique for specific facial areas. Each product in the CPM-HA portfolio has been intentionally designed to provide the best physical properties for a specific indication and target tissue. This document has been developed to provide a comprehensive, one-stop reference for clinicians using the portfolio. Methods An international panel of experts in the field of aesthetic medicine convened to develop guidelines on effective and safe injection technique when performing treatments with the CPM-HA range of soft-tissue fillers. Results Consensus members considered treatment indications in the upper, middle and lower face. Landmark deficiencies and anatomical considerations are described for each indication and consensus recommendations provided on the optimal product, injection depth and treatment technique. This is supplemented by the experts advice on avoidance of complications. Throughout, an evidence-based approach to selection of products and injection techniques is provided. The result is a fully tailored approach to a range of indications covering the full portfolio of CPM-HA products, including the newest addition for skin revitalization. Conclusion The recommendations in this consensus document are provided to assist clinicians in the selection of CPM-HA products, administration techniques and depths of injection with the aim of providing seamless and natural treatment results, enhanced safety and patient satisfaction.
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Affiliation(s)
- Jani van Loghem
- Falck Clinic, Aesthetic Medicine Centre, Amsterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | - Ada Trindade de Almeida
- Clínica de Dermatologia do Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | | | | | - Tatjana Pavicic
- Private Practice for Dermatology and Aesthetics, Munich, Germany
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27
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Lee AL, Chen YF, Yao WT, Liu YC, Yu CM, Yu CM, Tu CP, Huang WC, Tung KY, Tsai MF. Laser Doppler Imaging for Treating Vascular Complications from Procedures Involving Dermal Fillers: Case Series and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11091640. [PMID: 34573980 PMCID: PMC8468831 DOI: 10.3390/diagnostics11091640] [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: 06/24/2021] [Revised: 08/20/2021] [Accepted: 09/03/2021] [Indexed: 11/28/2022] Open
Abstract
Vascular occlusion is a rare but severe complication of dermal filler injections. Early treatment of this complication produces better outcomes. Current diagnostic methods for vascular occlusion in the skin are subjective and imprecise; these include capillary refill time, skin color, and reports of pain. This study aimed to assess the use of laser Doppler imaging (LDI) in the evaluation and treatment of vascular complications caused by dermal filler injections. This retrospective study used laser Doppler imaging (LDI) in 13 patients who developed vascular occlusion after facial dermal filler injections, with subsequent follow-up. The precise areas of perfusion observed on LDI were compared with the findings of clinical and photographic evaluation. The results showed that LDI accurately identified areas of vascular occlusion and improved treatment precision among these thirteen patients. The procedure was more precise than visual inspection or photographic evidence. Satisfactory outcomes were achieved for all patients, and no procedure-related complications were reported. Collectively, LDI provides fast, noninvasive, and accurate delineation of areas of vascular occlusion caused by complications of dermal filler injections and avoids several subjective shortcomings of visual and photographic evaluations. Thus, LDI effectively tracks treatment outcomes. However, large-scale studies are required to confirm the present findings.
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Affiliation(s)
- An-Li Lee
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Burn Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Yu-Fan Chen
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Wen-Teng Yao
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Burn Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Ying-Chun Liu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Burn Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Chia-Meng Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Burn Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Chieh-Ming Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Chih-Peng Tu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Wen-Chen Huang
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Kwang-Yi Tung
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Ming-Feng Tsai
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Correspondence: ; Tel.: +886-2-2543-3535; Fax: +886-2-2543-3642
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28
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Shen D, Ono K, Do Q, Ohyama H, Nakamura K, Obata K, Ibaragi S, Watanabe K, Tubbs RS, Iwanaga J. Clinical anatomy of the inferior labial gland: a narrative review. Gland Surg 2021; 10:2284-2292. [PMID: 34422599 DOI: 10.21037/gs-21-143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/03/2021] [Indexed: 12/20/2022]
Abstract
Objective In this article we review the literature on the inferior labial gland from a clinical and anatomical perspective. Background Regardless of its importance in clinical practice, there are no medical literature that comprehensively reviewed the inferior labial gland. Methods A database search using PubMed and Google Scholar was conducted. The following keywords were used in the search: "lower labial salivary gland", "lower labial gland", "inferior labial salivary gland", AND "inferior labial gland". Conclusions The human labial glands are types of minor salivary gland that continuously secrete small amounts of mucous and serous substances to maintain oral health. The inferior labial glands are innervated by the inferior labial branch of the mental nerve, and the inferior labial branch of the facial artery is the main arterial supply to the lower lip. Although they only have an auxiliary role in saliva production compared to the major salivary glands, minor salivary glands provide a certain amount of lubrication in the oral cavity by the continuous outflow of saliva. The inferior labial gland not only promotes moisturization in the oral cavity but also secretes substances with antibacterial effects, which is important for the function of the oral cavity. A recent study showed that the rate of salivary secretion from the inferior labial glands does not change with age, and in some cases the inferior labial glands are used for diagnosing intractable diseases such as Sjogren's syndrome and cystic fibrosis. In addition, since the inferior labial glands themselves can be the site of cyst and/or neoplasia development, we should be careful to distinguish them from other diseases. Elucidation of the anatomy, physiology, and pathology of the inferior labial glands, is important for understanding human health and diseases.
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Affiliation(s)
- Daniel Shen
- Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Kisho Ono
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Quang Do
- Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Hiroe Ohyama
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA
| | - Ken Nakamura
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kyoichi Obata
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joe Iwanaga
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
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29
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Safran T, Swift A, Cotofana S, Nikolis A. Evaluating safety in hyaluronic acid lip injections. Expert Opin Drug Saf 2021; 20:1473-1486. [PMID: 34328377 DOI: 10.1080/14740338.2021.1962283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Soft tissue filler augmentation has become increasingly popular due to its perceived ease and impressive results. Unfortunately, although the results are impressive, so are the reported complications. This article describes complications specific to peri-oral soft tissue filler injection and then discusses evidence-based, anatomic prevention and treatment guidelines. AREAS COVERED The authors aimed at providing an overview of the complications associated with peri-oral soft tissue filler. Hyaluronic Acid (H.A) fillers may have devastating complications which are oft undisclosed or published. This narrative review aims to describe the various complications and provide preventative strategies. EXPERT OPINION Given the paucity of prospective, randomized clinical trials on the subject and in light of complication underreporting, the authors believe that efficacy and safety literature on the subject is lacking. Injectors must rely on the one strength which exists in the lip literature to date, that is anatomy. The basis of all successful injections is a mandatory understanding of normal as well as variations of vital structures in an area, combined with meticulous injection techniques, deposition of small aliquots of product and the ability to recognize unwanted adverse events early enough to act on them.
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Affiliation(s)
- Tyler Safran
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada
| | - Arthur Swift
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada.,Westmount Institute of Plastic Surgery, Montreal, QC, Canada
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Andreas Nikolis
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada.,Erevna Innovations Inc, Montreal, Quebec, Canada
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Alghoul MS, Vaca EE, Bricker JT, Mioton LM. Enhancing the Lateral Orbital "C-Angle" With Calcium Hydroxylapatite: An Anatomic and Clinical Study. Aesthet Surg J 2021; 41:952-966. [PMID: 32719841 DOI: 10.1093/asj/sjaa218] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Deliberate injection of specific facial subunits may improve aesthetic outcomes in facial rejuvenation. We contend that the lateral orbital area (LOA) is a key anatomic subunit in the perception of eye attractiveness, with a C-shaped distribution of fat contributing to the formation of a distinct angle in the lateral orbit. OBJECTIVES The aim of this study was to describe the anatomy of the LOA that constitutes the C-shaped angle and to investigate the safety and cosmetic outcomes of nonsurgical enhancement of that area with calcium hydroxylapatite (CaHA). METHODS Four injected fresh-frozen cadaver heads were dissected. Twenty patients were enrolled in a prospective clinical study. Participants were seen on the day of injection, and at 2 weeks and 3 months postinjection. Two-dimensional and 3D photographs were analyzed to quantify the volumetric changes between pretreatment and postinjection time points. Secondary outcomes included Global Aesthetic Improvement Scale score and subject satisfaction at 3 months. RESULTS Cadaver dissections revealed distinct fat compartments and a zone of adhesion forming the C-shaped area around the lateral orbit. In the clinical study, a mean of 1.88 mL of CaHA was injected into each lateral periorbital region. There was 97% and 76% volume retention at 2 weeks and 3 months, respectively, with 70% of patients being "very satisfied" at 3 months. The average Global Aesthetic Improvement Scale rating at 3 months was 3.95. There were no complications. CONCLUSIONS The LOA is a distinct facial subunit that can be enhanced safely by CaHA injection with good cosmetic outcomes. Focusing on the C-angle can improve periorbital aesthetics. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Elbert E Vaca
- Northwestern Feinberg School of Medicine Plastic Surgery Program, Chicago, IL
| | | | - Lauren M Mioton
- Northwestern Feinberg School of Medicine Plastic Surgery Program, Chicago, IL
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Tansatit T, Kenny E, Phumyoo T, Jitaree B. Cadaveric Dissections to Determine Surface Landmarks Locating the Facial Artery for Filler Injections. Aesthet Surg J 2021; 41:NP550-NP558. [PMID: 32789518 DOI: 10.1093/asj/sjaa235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The facial artery is a high-risk structure when performing filler injections at the nasolabial fold, buccal, and mandibular regions. OBJECTIVES This study aimed to establish reference landmarks locating the course of the facial artery and its essential branches. METHODS Thirty-one embalmed cadavers were enrolled in this study. The course of the facial artery was observed in regard to the following reference points: masseter insertion, oral commissure, and common bony landmarks. The corner of the mouth was utilized as the landmark to measure the turning point of the facial artery. RESULTS Seven points were established to identify the course and turning point of the facial artery. These included the anterior masseteric, lateral mental, infraorbital, medial canthal, basal alar, post-modiolar (PMP), and supra-commissural (SCP) points. The course of the facial artery deviates at least twice at the lateral mental points and at the SCP or PMP. The facial artery appeared more medially when the artery turned at the PMP and SCP. It presented through the lateral channel if the turning point was solely at the PMP. Wherever the facial artery deviates, it can be divided into 3 segments: the mandibular, buccal, and nasolabial segments. The arterial course may deviate laterally from the mouth corner towards PMP. The nasolabial segment may also deviate laterally to the basal alar point at the alar grove for 0.5 to 1 cm. CONCLUSIONS The deviation of facial artery closely relates with mandibular, buccal, and nasolabial segments. It is essential in avoiding arterial injury for physicians and surgeons who perform procedures in these areas.
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Affiliation(s)
- Tanvaa Tansatit
- Department of Anatomy, Faculty of Medicine; and The Chula Soft Cadaver Surgical Training Center, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Thirawass Phumyoo
- Department of Basic Medical Science, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Benrita Jitaree
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
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Cotofana S, Alfertshofer M, Schenck TL, Bertucci V, Beleznay K, Ascher B, Lachmann N, Green JB, Swift A, Frank K. Anatomy of the Superior and Inferior Labial Arteries Revised: An Ultrasound Investigation and Implication for Lip Volumization. Aesthet Surg J 2020; 40:1327-1335. [PMID: 32469050 DOI: 10.1093/asj/sjaa137] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Lips are considered a key element of facial attractiveness due to their central position in the face and their elemental role in verbal and nonverbal communication. OBJECTIVES The authors sought to provide clinically relevant information on the 3-dimensional pathway of the superior and inferior labial arteries within the lips to increase safety during labial soft tissue filler injections. METHODS The study enrolled 41 healthy volunteers with a mean age of 26.17 ± 9.6 years and a mean body mass index of 23.09 ± 2.3 kg/m2. Ultrasound imaging was performed at 6 different locations. The position of the labial arteries within the lips, depth of the arteries, cranio-caudal location of each artery in relation to the vermilion border, and diameter of the superior/inferior labial arteries were recorded. RESULTS The most frequent location of both the superior and inferior labial arteries was the submucosal plane (58.5%) followed by intramuscular (36.2%) and subcutaneous (5.3%) planes. The depth of the superior labial artery in the upper lip was 5.6 ± 0.13 mm, whereas the depth of the inferior labial artery in the lower lip was 5.2 ± 0.14 mm. Both arteries were more frequently located within the red lip: upper lip (83% vs 18.7%) and lower lip (86.2% vs 13.8%). In the midline, the artery coursed within the red lip in all investigated volunteers. CONCLUSIONS Clinically, results of this study favor a superficial injection plane for lip volumization procedures. A perpendicular approach to the lip (coming from the cutaneous lip) might increase safety because the artery is located most frequently within the red lip.
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Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
| | - Thilo L Schenck
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
| | | | - Katie Beleznay
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Nirusha Lachmann
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | | | | | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
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Papadopoulos T. Commentary on: Anatomy of the Superior and Inferior Labial Arteries Revised: An Ultrasound Investigation and Implication for Lip Volumization. Aesthet Surg J 2020; 40:1336-1340. [PMID: 33165602 DOI: 10.1093/asj/sjaa248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Tim Papadopoulos
- Department of Plastic and Reconstructive Surgery, Westmead Private Hospital, Westmead NSW, Australia
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Peng J, Peng HP. Classifications and injection strategy for lip reshaping in Asians. J Cosmet Dermatol 2020; 19:2519-2528. [DOI: 10.1111/jocd.13635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jui‐Hui Peng
- Kaohsiung Chang‐Gung Memorial Hospital Kaohsiung Taiwan
| | - Hsien‐Li Peter Peng
- P‐Skin Professional Clinic Kaohsiung Taiwan
- Department of Dermatology Tri‐Service General Hospital National Defense Medical Center Taipei Taiwan
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Wollina U, Goldman A. Facial vascular danger zones for filler injections. Dermatol Ther 2020; 33:e14285. [PMID: 32902108 DOI: 10.1111/dth.14285] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 01/03/2023]
Abstract
Filler injections are widely used for facial rejuvenation. The technique is safe as long as some precautions are respected. In this review we will focus on vascular anatomy in the upper, middle and lower face. We performed a PUBMED research on "facial danger zones" and "filler injections" and "hyaluronic acid" and "vascular compromise" with a focus on the last decade. This is of particular importance since vascular compromise is one of the most severe adverse events possibly leading to tissue necrosis and in rare cases to loss of vision. We describe the danger zones in these esthetic units and provide recommendations how to avoid severe adverse events. We report on temporal region, glabella and nose, infraorbital region, nasolabial folds and nasal triangle, lips, and chin. Although we focus on hyaluronic acid fillers, our recommendations will also scope other filler types and autologous adipose tissue transfer. We also take a closer look on innovations to improve the safety of facial filler injections. Facial rejuvenation with hyaluronic acid fillers is a popular method. It is safe if the facial danger zones are recognized and proper injection techniques and fillers are used.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | - Alberto Goldman
- Department of Plastic Surgery, Hospital São Lucas da PUCS, Porto Alegre, Brazil
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Age-related changes in the vasculature of the dermis of the upper lip vermilion. Aging (Albany NY) 2020; 11:3551-3560. [PMID: 31170092 PMCID: PMC6594803 DOI: 10.18632/aging.101996] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/23/2019] [Indexed: 01/09/2023]
Abstract
Lip redness is unique to humans and creates an important facial impression, but this redness decreases with age. Here, using histological and immunohistological staining of human upper lip vermilion from donors of different ages, we investigated blood vessels in the upper lip dermis and age-dependent histological changes. We found that both total vessel area in the dermis and vessel number in the upper dermis decreased with aging. Moreover, vessel number in the upper dermis correlated positively with development of rete ridges, which flattened with age, despite no significant change in the thickness of the stratified squamous epithelium. These findings suggest that age-related reductions in lip redness result from a decrease of blood vessels, which in turn leads to a flattening of the epithelium caused by the loss of rete ridges. This is the first study to histologically demonstrate age-related reductions in blood vessels in the lip. Our results provide an opportunity for enhancing blood flow/vascularization to improve the aesthetic appearance of the lips in the elderly.
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Goodman GJ, Al‐Niaimi F, McDonald C, Ciconte A, Porter C. Why we should be avoiding periorificial mimetic muscles when injecting tissue fillers. J Cosmet Dermatol 2020; 19:1846-1850. [DOI: 10.1111/jocd.13531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Greg J. Goodman
- Monash University Carlton Vic. Australia
- Skin Health Institute Carlton Vic. Australia
- University College of London London UK
| | - Firas Al‐Niaimi
- Guy’s Hospital London London UK
- 152 Harley Street Clinic London UK
- Department of Dermatology Aalborg University Hospital Aalborg Denmark
| | - Cara McDonald
- St Vincent’s Hospital Fitzroy Fitzroy Vic. Australia
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Lumen Diameter and Associated Anatomy of the Superior Labial Artery With a Clinical Application to Dermal Filler Injection. Dermatol Surg 2020; 46:678-684. [DOI: 10.1097/dss.0000000000002074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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French Kiss Technique: An Anatomical Study and Description of a New Method for Safe Lip Eversion. Dermatol Surg 2020; 46:1410-1417. [DOI: 10.1097/dss.0000000000002325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mole B. [Lip lifting and philtral restoration with a mustache flap]. ANN CHIR PLAST ESTH 2019; 65:100-105. [PMID: 31791555 DOI: 10.1016/j.anplas.2019.11.002] [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: 09/15/2019] [Accepted: 11/07/2019] [Indexed: 11/30/2022]
Abstract
The restoration of the philtrum is an often neglected aspect in the technique of labial lifting with a perinasal scar, or it is secondarily resorted to by simple injections of hyaluronic acid. We are not in favor of the classic continuous bull's horn scar because, on the one hand, we consider that most of the labial shortening is due to the nasal floor resection -the internal excursion of which determines the final result-, and on the other hand that the approximation of 2 skins of very different nature (columella and lip) may cause a visible scar. The base of the columella is particularly well vascularized by the anastomosis of branches derived from the external carotid artery via the superior labial artery and septal branches distributed from the internal carotid system. We therefore consider that this zone on each side of the base of the columella constitutes the vascular pivot of our "mustache flap" drawn according to the classic peri nasal incision: this flap is desepidermized and then totally elevated from the orbicularis muscle except for its internal part where it is simply discarded so as not to compromise its vascularity; it is then rotated at 90° and inserted into a tunnel fitted in the subcutaneous plane down to the red lip corresponding to the restoration of the 2 philtral crests. Thus, all of the superior labial deformations observed over time (elongation and convexity of the white lip, flattening of the philtrum are corrected in a long lasting manner. The intervention is carried out under local anesthesia and, if necessary, the other elements of aging (loss of volume of the red lip, vertical wrinkles, defect of pigmentation etc.) can be corrected without risk at the same time.
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Affiliation(s)
- B Mole
- 15, avenue de Tourville, 75007 Paris, France.
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DeLorenzi C. Commentary on: Anatomical Variations in the Course of Labial Arteries: A Literature Review. Aesthet Surg J 2019; 39:1236-1240. [PMID: 30657849 DOI: 10.1093/asj/sjy339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Samizadeh S, Pirayesh A, Bertossi D. Anatomical Variations in the Course of Labial Arteries: A Literature Review. Aesthet Surg J 2019; 39:1225-1235. [PMID: 30204834 DOI: 10.1093/asj/sjy235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nonsurgical lip enhancement using dermal fillers is a very popular procedure. The trend for enlarged lips has been popularized by media and social media. The lips have considerable aesthetic and functional importance, in addition to having a complex anatomy. Serious complications, including vascular compromise or occlusion leading to cutaneous necrosis and blindness, can occur as the result of lip enhancement using dermal fillers. Therefore, aesthetic practitioners require an in-depth understanding of the anatomy and vasculature of the lips and the perioral area prior to providing lip enhancement using dermal fillers. OBJECTIVES This literature review aimed to summarize existing data describing the origin, path, and depth of the superior and inferior labial arteries, and to help aesthetic practitioners in providing safer injections to the lips. METHODS A literature search was carried out to summarize the available data describing the origin, path, and depth of the labial arteries. RESULTS Analysis of the literature revealed that the labial arteries display great variability with respect to path (distribution), presence, and location. CONCLUSIONS Increasing the volume of lips through injections of dermal filler needs to be undertaken with caution, and awareness of the anatomical variation in artery location and path is a crucial concept that is essential when injecting the lips.
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Affiliation(s)
| | | | - Dario Bertossi
- Maxillofacial and ENT Surgeon, University of Verona, Verona, Italy
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Translucent and Ultrasonographic Studies of the Inferior Labial Artery for Improvement of Filler Injection Techniques. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2399. [PMID: 31942380 PMCID: PMC6908380 DOI: 10.1097/gox.0000000000002399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022]
Abstract
Lower lip augmentation by filler injection is an aesthetic procedure essential for achieving a feminine look and to enhance attractiveness. Complications as a result of injury to the inferior labial artery can result in undesirable outcomes. Methods The translucent technique was used to study the origin of the inferior labial artery in 11 cadavers. Ultrasonography of the inferior labial artery was also performed in 20 volunteers, which provided supplemental data to this study, in relation to establishing recommendations for filler injection. Results Five different types of inferior labial artery were described. These types were found in various combination patterns. Types 2, 4, and 5 are more vulnerable to arterial injury during filler injection. Ultrasonography revealed a depth of 6 mm and an arterial position at the vermillion border as the dangerous injection plane. Conclusion The origins and courses of the inferior labial artery are classified into 5 types. These types are often found in combination with each other in different faces, resulting in large anatomical variation between people. Types of combination influence severity of lower lip necrosis when arterial injury occurs. The physician should be aware of these anatomical variations during aesthetic treatments and reconstructive procedures to avoid the dangers of accidental arterial injury.
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Lee K, Lee H, Youn K, Kim H. Positional relationship of superior and inferior labial artery by ultrasonography image analysis for safe lip augmentation procedures. Clin Anat 2019; 33:158-164. [DOI: 10.1002/ca.23379] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Kyu‐Lim Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS ProjectYonsei University College of Dentistry Seoul South Korea
| | - Hyung‐Jin Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS ProjectYonsei University College of Dentistry Seoul South Korea
| | - Kwan‐Hyun Youn
- Division in Biomedical ArtIncheon Catholic University Graduate School Incheon South Korea
| | - Hee‐Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS ProjectYonsei University College of Dentistry Seoul South Korea
- Department of Materials Science & Engineering, College of EngineeringYonsei University Seoul Seoul South Korea
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Cotofana S, Lachman N. Anatomie der Fettkompartimente des Gesichts und ihre Bedeutung für die ästhetische Chirurgie. J Dtsch Dermatol Ges 2019; 17:399-415. [PMID: 30958928 DOI: 10.1111/ddg.13737_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/03/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Sebastian Cotofana
- Department of Medical Education, Albany Medical College, Albany, New York, USA
| | - Nirusha Lachman
- Department of Anatomy and Department of Surgery, Division of Plastic Surgery, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
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Arteries of the Face and Their Relevance for Minimally Invasive Facial Procedures. Plast Reconstr Surg 2019; 143:416-426. [DOI: 10.1097/prs.0000000000005201] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Cotofana S, Lachman N. Anatomy of the Facial Fat Compartments and their Relevance in Aesthetic Surgery. J Dtsch Dermatol Ges 2019; 17:399-413. [DOI: 10.1111/ddg.13737] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/03/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Sebastian Cotofana
- Department of Medical EducationAlbany Medical College Albany New York USA
| | - Nirusha Lachman
- Department of Anatomy and Department of SurgeryDivision of Plastic SurgeryMayo Clinic College of Medicine and ScienceMayo Clinic Rochester Minnesota USA
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