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Xu Z, Zheng F, Zhao X, Wang S, Wang R, He J, Gan F. Complications of Fat Grafting and Repositioning for Correction of Lower Eyelid Pouch With Tear Trough Deformity or Lid-Cheek Junction: A Systematic Review. Ann Plast Surg 2024; 93:e9-e25. [PMID: 39158343 DOI: 10.1097/sap.0000000000004022] [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: 08/20/2024]
Abstract
BACKGROUND Fat grafting and repositioning may serve as a convenient, economical, and effective surgical method for correcting lower eyelid pouch with a tear trough deformity or lid-cheek junction. However, comprehensive systematic reviews and meta-analyses investigating the complications associated with this technique are lacking. OBJECTIVE This study aimed to summarize and gather data on complications related to fat grafting and repositioning for the correction of tear trough deformity or lid-cheek junction in lower eyelid blepharoplasty. METHODS A thorough search was performed across multiple databases including PubMed, Cochrane, Embase, ProQuest, Ovid, Scopus, and Web of Science. Specific inclusion and exclusion criteria were applied to screen the articles. The occurrence of complications was analyzed using a random-effects model. RESULTS A total of 33 studies involving 4671 patients met the criteria for systematic evaluation and were included in this meta-analysis. The overall complication rates were 0.112 (95% confidence interval [CI]: 0.060-0.177) for total complications, 0.062 (95% CI: 0.003-0.172) for unsatisfactory correction or contour irregularity, 0.062 (95% CI: 0.009-0.151) for hematoma, swelling (not specified as bulbar conjunctiva), ecchymosis, or oozing of blood, and 0.024 (95% CI: 0.013-0.038) for reoperation. CONCLUSIONS Fat grafting and repositioning for correcting a lower eyelid pouch with tear trough deformity or lid-cheek junction was associated with high rates of complications. Therefore, it is crucial to closely monitor the rates of unsatisfactory correction or contour irregularity, hematoma, swelling (not specified as bulbar conjunctiva), ecchymosis, or oozing of blood, and reoperation. In addition, effective communication with patients should be prioritized.
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Affiliation(s)
- Zenghui Xu
- From the Plastic and Cosmetic Department, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital Kunming, Kunming, China
| | - Fan Zheng
- From the Plastic and Cosmetic Department, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital Kunming, Kunming, China
| | - Xian Zhao
- From the Plastic and Cosmetic Department, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital Kunming, Kunming, China
| | - Songmei Wang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Ruiheng Wang
- From the Plastic and Cosmetic Department, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital Kunming, Kunming, China
| | - Jia He
- From the Plastic and Cosmetic Department, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital Kunming, Kunming, China
| | - Fengshan Gan
- From the Plastic and Cosmetic Department, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital Kunming, Kunming, China
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Zhou LC, Dong YX, Cao MB, Li JY, Peng T, Zhang SY, Zhou YW, Shu HN, Luo SK. The Safety of Injections in the Infraorbital Region. Aesthetic Plast Surg 2024; 48:2231-2238. [PMID: 38528128 DOI: 10.1007/s00266-024-03976-5] [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: 01/27/2024] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Infraorbital filler injection is a commonly used minimally invasive cosmetic procedure on the face, which can cause vascular complications. OBJECTIVE In this study, we aimed to explore the anatomical structure of the infraorbital vasculature and to establish an accurate protocol for infraorbital filler injection. METHODS The vascular structure of the infraorbital region was evaluated in 84 hemifacial specimens using computed tomography. Four segments (P1-P4) and five sections (C1-C5) were considered. We recorded the number of identified arteries in each slice and at each location and the number of deep arteries. Furthermore, we also measured the infraorbital artery (IOA) distribution. RESULTS At P1-P4, the lowest number of arteries was detected in segment P4, with a 317/1727 (18.4%) and 65/338 (2.3%) probability of total and deep arterial identification, respectively. The probabilities of encountering an identified artery at the five designated locations (C1-C5) were 277/1727 (16%), 318/1727 (18.4%), 410/1727 (23.7%), 397/1727 (23%), and 325/1727 (18.8%), respectively. The probability of an IOA being identified at C2 was 68/84 (81%). CONCLUSION We described an effective filler injection technique in the infraorbital region to minimize the associated risks. 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)
- Ling-Cong Zhou
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
- Department of Plastic and Cosmetic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Yun-Xian Dong
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Mi-Bu Cao
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Jun-Yu Li
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Tong Peng
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Si-Yi Zhang
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Yang-Wu Zhou
- Department of Plastic and Cosmetic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Hai-Ning Shu
- Department of Plastic and Cosmetic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
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Zhou LC, Cao MB, Peng T, Yu H, Li JY, Zeng MQ, Li T, Luo SK. Clinical Relevance of the Variability of the Infraorbital Arterial Anatomy Evaluated by Three-Dimensional Computed Tomography. Aesthetic Plast Surg 2024; 48:1698-1705. [PMID: 38480656 DOI: 10.1007/s00266-024-03929-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/09/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Knowledge of the anatomy of the infraorbital artery (IOA) is crucial for the rejuvenation of the anterior medial aspect of the midface; however, studies adequately describing the anatomy of the IOA branches are lacking, and their connection with the ophthalmic artery branches remains unclear. OBJECTIVES This study aims to elucidate the anatomical characteristics of the IOA in its deployment within the lower eyelid using three-dimensional (3D) technology, thereby offering an anatomical foundation for clinical surgical procedures. METHODS An analysis was conducted on computed tomography scans of 132 cadaveric head sides post-contrast injection, utilizing the Mimics software for reconstruction. The study focused on examining the anastomosis of the IOA, its principal branches, and the branches emanating from the ophthalmic artery. RESULTS The prevalence of type I IOA was observed at 38.6% (51/132), while Type II IOA was found in 61.4% (81/132) of cases. A 7.6% incidence (10/132) of IOA directly anastomosing with the angular artery was noted. The presence of palpebral branches (PIOA) was identified in 57.6% (76/132) of instances. In the lower eyelid, four distinct distribution patterns of IOA were discerned: The likelihood of Type I PIOA was 5.3%, whereas for Types IIA, IIB, and IIC PIOA, the probabilities were 8.3%, 32.6%, and 11.4%, respectively. The occurrence of the orbital branch of IOA was recorded at 41.7% (55/132). CONCLUSIONS 3D technology can map IOA variants and identify the deployment patterns of IOA branches in the lower eyelid vascular vesicles at high resolution as a guide in clinical practice. 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)
- Ling-Cong Zhou
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
- Department of Plastic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Mi-Bu Cao
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Tong Peng
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Hao Yu
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jun-Yu Li
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Mai-Qiu Zeng
- Department of Plastic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Ting Li
- Department of Plastic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Sheng-Kang Luo
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China.
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, China.
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Shin HJ, Kim HJ, Song WC. Superimposition Study to Determine the Angular Arterial Distribution and Its Clinical Application. Plast Reconstr Surg 2024; 153:706-711. [PMID: 37104463 DOI: 10.1097/prs.0000000000010596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND The purpose of this study was to determine the distribution of the angular artery (AA) in the medial canthal area with the aim of defining an arterial course to prevent AA injury during facial surgery in this region. METHODS The authors dissected 36 hemifaces of 18 cadavers. The horizontal distance from the vertical level through the medial canthus to the AAs was measured. The AA course of each specimen was then recorded, and all of them were then superimposed to determine the AA course. The diameter and depth of the AA around the medial canthal area were also investigated using ultrasonography on living subjects. RESULTS The horizontal distances from the medial canthus level and 2 cm below the medial canthus were 9.0 ± 2.0 mm (mean ± SD) and 1.9 ± 2.4 mm, respectively. The superimposed image demonstrated that most of the AAs were present inside the vertical line through the medial canthus. Ultrasonography indicated that the AA was 2.3 ± 0.9 mm below the skin and 1.7 ± 0.3 mm in diameter. CONCLUSIONS The AA course was relatively constant along the nasojugal fold. The AAs were most often present between the middle of the medial canthus and the facial midline, but were very scarce in both the medial and lateral thirds. Knowledge of the detailed course of the AA may help surgeons to avoid arterial injury and decrease the risk of surgical morbidities around the nasal root and medial canthal area.
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Affiliation(s)
- Hyun Jin Shin
- From the Department of Ophthalmology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry
| | - Wu-Chul Song
- Department of Oral Anatomy and Developmental Biology, College of Dentistry, Kyung Hee University
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Liu X, Gao Y, Ma J, Li J. The Efficacy and Safety of Hyaluronic Acid Injection in Tear Trough Deformity: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2024; 48:478-490. [PMID: 37684413 DOI: 10.1007/s00266-023-03613-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/12/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Hyaluronic acid (HA) injection is an effective method to correct tear trough deformity. Nevertheless, the quantitative data of cosmetic results and complications of HA injection in tear troughs remained unemployed. The purpose of this meta-analysis was to synthesize the current quantitative data on the aesthetic outcomes and adverse effects of tear trough deformity correction with HA injection. METHODS This meta-analysis consulted PubMed, Embase, Web of Science, Scopus and Cochrane databases based on the search terms published before September 2022. Data extracted was analyzed to evaluate the satisfaction rates and complications of HA injection. Meta-analysis was performed using the random-effect model for overall and subgroup analysis. RESULTS This meta-analysis comprised 31 reports involving 2556 participants. The pooled overall satisfaction rate was 91.0% (95% CI 84.9-95.7%). The pooled rates of swelling/edema and bruising/ecchymosis were 19.2% (95% CI 10.4-29.9%) and 18.4% (95% CI 10.1-28.4%), respectively. The pooled rates of redness/erythema, contour irregularity/lump and blue discoloration/Tyndall effect were 7.1% (95% CI 1.5-15.6%), 5.3% (95% CI 1.8-10.2%) and 0.9% (95% CI 0.0-2.5%), respectively. CONCLUSIONS The present meta-analysis manifested a low risk of complication rate and a high satisfaction rate in tear trough rejuvenation with HA injection. LEVEL OF EVIDENCE I 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)
- Xuanchen Liu
- Department of Facial and Cervical Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Gao
- Department of Facial and Cervical Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiguang Ma
- Department of Facial and Cervical Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Li
- Department of Facial and Cervical Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Atiyeh B, Hakim CR, Oneisi A, Ghieh F, Chahine F. Surgical Correction of Tear Trough Deformity (TTD) with Orbicularis Retaining Ligament Release and Volume Augmentation for Periorbital Rejuvenation: Review of the Literature. Aesthetic Plast Surg 2023; 47:199-214. [PMID: 36456652 DOI: 10.1007/s00266-022-03183-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Tear trough deformity is a hallmark of periorbital aging. It is not, however, an exclusive feature of old age. While protruding orbital fat results in lower lid bags that are traditionally corrected by excision, correction of TTD can constitute a real challenge requiring volume enhancement in addition to addressing prolapse of orbital fat and descent of cheek tissues. Described therapeutic options include minimally invasive soft tissue augmentation with fillers or structural autologous fat transfer as well as invasive surgical procedures concomitantly with lower lid blepharoplasty or other facial rejuvenation procedures. MATERIAL AND METHODS Six eponyms have been used in the literature to describe the condition: (1) naso-jugal fold, (2) naso-jugal groove, (3) naso-jugal ditch, (4) tear trough, (5) tear trough deformity, and (6) tear trough depression. A separate PubMed database search of each of the 6 terms was conducted in addition to an advanced literature and systematic PICO searches to identify all described clinical retrospective or prospective, comparative or simple cohort studies related to surgical correction of TTD. An additional screening of references of retrieved clinical studies was performed to identify any missed reports. RESULTS A total of 435 publications were identified with the initial search. After excluding all none relevant studies, 44 papers were selected for review. 6 additional studies were identified by screening relevant references. CONCLUSION Almost all authors agree on the necessity to release the tear trough retaining ligament together with volume enhancement. Transconjunctival and transcutaneous incisions are reported. Most recommend repositioning of the protruding orbital fat for volume enhancement to mostly subperiosteal, or pre-periosteal pockets. Other reported options include pedicled buccal fat pad transposition, segmental fat grafting, and minced micrografts. Internal as well as external fixation of repositioned fat flaps have been described. Despite lack of solid objective evidence, several of these techniques when properly executed for the proper indication in selected patients are reported to result in a rewarding and long-lasting outcome. Unfortunately, it is difficult to determine the most appropriate technique that would universally yield the most pleasant and harmonious facial contour without creating an unnatural puffy appearance. It remains for the surgeon to identify the safe surgical approach that does not compromise lower eyelid function and achieves the most pleasing aesthetic outcome with the least complications and downtime. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Bishara Atiyeh
- Annals of Burns & Fire Disasters, Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christopher-Roland Hakim
- 6th Year Surgical resident in Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Ahmad Oneisi
- 7th Year Surgical resident in Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Ghieh
- 7th Year Surgical resident in Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadel Chahine
- Annals of Burns & Fire Disasters, Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Unravelling the Complex Anatomy of the Tear Trough and Lower Eyelid Folds: A Review of Cadaveric Studies in the Literature. J Craniofac Surg 2022; 33:2670-2676. [PMID: 35946827 DOI: 10.1097/scs.0000000000008756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 04/02/2022] [Indexed: 11/26/2022] Open
Abstract
The lower eyelid tear trough deformity is a common cosmetic concern which is the result of multiple anatomic changes in the lower eyelid, usually resulting from age. A sound understanding of the underlying anatomy is vital to inform surgeons about the ideal treatment options for rejuvenation of this region and to minimize the risk of complications. Cadaveric studies provide unique insight into underlying anatomic changes. Here we review the relevant published cadaveric studies relating to the tear trough deformity and its treatment.
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Chen J, Xiao C, Su N, Han Y, Liang Z, Han C, Yu W. Clinical Efficacy, Healing Efficacy, and Safety Analysis of Skin Orbicularis Oculi Muscle Combined with Tissue Flap for Eyelid Trauma. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:3466070. [PMID: 35655720 PMCID: PMC9142311 DOI: 10.1155/2022/3466070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
This study investigates the efficacy, healing efficiency, and safety of skin orbicularis oculi muscle combined with tissue flap repair for eyelid trauma patients. According to the different methods of surgical intervention, this study chooses 78 cases of eyelid injury patients. This study sets up the joint intervention group and the routine repair group, including the joint intervention group adopting the orbicularis oculi muscle skin of composite tissue flap to repair surgery. The routine repair group is treated by conventional repair skin flap transfer operation. Spearman correlation coefficient is used to analyze the correlation between postoperative healing of eyelid trauma patients and quality of life (SF-36) and self-image satisfaction (BIS) scale scores. The surgical intervention of skin orbicularis oculi muscle combined with tissue flap for patients with eyelid trauma has a better plastic repair effect in clinical practice. It can also effectively reduce the risk of postoperative complications, which is conducive to improve the postoperative quality of life and self-image satisfaction of patients.
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Affiliation(s)
- Jie Chen
- Medical Cosmetology Department, The Second Affiliated Hospital of Xi'an Medical College, Xi'an 710061, China
| | - Chao Xiao
- Medical Cosmetology Department, The Second Affiliated Hospital of Xi'an Medical College, Xi'an 710061, China
| | - Na Su
- Medical Cosmetology Department, The Second Affiliated Hospital of Xi'an Medical College, Xi'an 710061, China
| | - Yubo Han
- Medical Cosmetology Department, The Second Affiliated Hospital of Xi'an Medical College, Xi'an 710061, China
| | - Zhai Liang
- Medical Cosmetology Department, The Second Affiliated Hospital of Xi'an Medical College, Xi'an 710061, China
| | - Chao Han
- Department of Plastic Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, China
| | - Wenjuan Yu
- Medical Cosmetology Department, The Second Affiliated Hospital of Xi'an Medical College, Xi'an 710061, China
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Calomeni M, Alfertshofer MG, Frank K, Moellhoff N, Dennison R, Bravo B, Schelke L, Velthuis P, Green JB, Cotofana S. Real-Time Ultrasound Imaging of the Tear Trough: Lessons Learned From Functional Anatomy. Aesthet Surg J 2022; 42:518-526. [PMID: 34610093 DOI: 10.1093/asj/sjab351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The tear trough is one of the most challenging facial regions for soft-tissue filler injections. A thorough understanding of the underlying facial, muscular, and vascular anatomy is crucial to perform safe and effective tear trough injectable treatments. OBJECTIVES The authors sought to evaluate the location and function of the angular vein in the tear trough in 3 different facial expressions: repose, smiling, and max. orbicularis oculi contraction. METHODS Twenty study participants with a mean age of 48.3 years and mean BMI of 24.5 kg/m2 were investigated via functional ultrasound imaging. The diameter of the angular vein and the velocity and direction of venous blood flow were analyzed in repose, smiling, and during max. orbicularis oculi contraction. RESULTS The angular vein was identified in 100% of the cases to travel inside the orbicularis oculi muscle (intra-muscular course) within the tear trough, whereas the angular artery was not identified in this location. The distance between the angular vein and the inferior orbital rim was (lateral to medial): 4.6 mm, 4.5 mm, 3.9 mm, and 3.8 mm. The caudally directed blood flow was in repose 10.2 cm/s and was 7.3 cm/s at max. orbicularis oculi muscle contraction; however, no blood flow was detectable during smiling. CONCLUSIONS The diameter and the venous blood flow of the angular vein varied between the 3 tested facial expressions. Based on these anatomical findings, the deep injection approach to the tear trough is recommended due to the intramuscular course of the angular vein.
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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
| | - Nicholas Moellhoff
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany
| | | | | | - Leonie Schelke
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
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Abstract
ABSTRACT With the sudden emergence of new medical aesthetic fillers, the number of fillers injected worldwide has exploded, but there are also worrying risks in the pursuit of beauty. At present, many cases of blindness caused by injection of aesthetic fillers have been reported. Most of the cases are caused by irreversible vascular embolism. This is a rare yet greatly feared complication of using facial cosmetic fillers. This article reviewed and analyzed the literature and summarized the changes in the anatomical structure of facial blood vessels related to blindness during facial injection.
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Affiliation(s)
- Dan Li
- From the Department of Plastic and Burn Surgery, the First Affiliated Hospital Chongqing Medical University, Chongqing, China
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Fabi S, Zoumalan C, Fagien S, Yoelin S, Sartor M, Chawla S. A Prospective, Multicenter, Single-Blind, Randomized, Controlled Study of VYC-15L, a Hyaluronic Acid Filler, in Adults for Correction of Infraorbital Hollowing. Aesthet Surg J 2021; 41:NP1675-NP1685. [PMID: 34351386 PMCID: PMC8520027 DOI: 10.1093/asj/sjab308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rejuvenation of the under-eye area is a popular facial aesthetic treatment option. OBJECTIVES This study evaluated the safety and effectiveness of VYC-15L for the correction of moderate or severe infraorbital hollowing. METHODS This was a randomized, controlled, single-blind study with a primary endpoint defined as the proportion of participants with ≥1-grade improvement at Month 3 assessed by an evaluating investigator employing the Allergan Infraorbital Hollow Scale. Three-dimensional imaging was conducted to assess infraorbital volume up to Month 12. Procedure pain and injection-site responses (ISRs) were documented, and safety was monitored throughout the study. RESULTS At Month 3, the difference between treatment (83.1%) and control (15.6%) was 67.5% (95% CI = 52.9 to 82.0, P < 0.0001). 3D imaging showed a mean volume increase from baseline of 0.733 mL (left) and 0.777 mL (right) at Month 12. Mean pain scores were ≤1.7 (scale of 0 to 10). Most ISRs with initial treatment were mild/moderate and resolved in ≤1 week, including tenderness (49.5%), bruising (42.7%), and swelling (41.7%). Thirty-four participants had treatment-emergent adverse events (TEAEs), of which 14 (10.3%) had treatment-related TEAEs, including bruising (3.8%) and swelling/edema (2.9%), which resolved in ≤2 weeks. Three participants had swelling/edema starting >30 days posttreatment; 2 resolved in ≤4 days, 1 by 45 days. No treatment-related serious AEs were reported. CONCLUSIONS VYC-15L was safe and effective for the correction of moderate or severe infraorbital hollowing and lasted through 1 year. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Sabrina Fabi
- Corresponding Author: Dr Sabrina Fabi, 9339 Genesee Avenue, Suite 300, San Diego, CA 92121, USA. E-mail: ; Instagram: @sabrina.fabi
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Noell CM, Weiss RA. Handheld Doppler Localization of the Angular Artery to Reduce Intravascular Injection in Tear Trough Rejuvenation. Dermatol Surg 2021; 47:1171-1173. [PMID: 33927092 DOI: 10.1097/dss.0000000000003051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Claire M Noell
- Maryland Laser, Skin and Vein Institute, Hunt Valley, Maryland
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Hedén P, Fischer S. Comparison of Fat Repositioning Versus Onlay Segmental Fat Grafting in Lower Blepharoplasty. Aesthet Surg J 2021; 41:NP717-NP727. [PMID: 33595637 DOI: 10.1093/asj/sjab070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lower blepharoplasty is one of the most challenging procedures in aesthetic surgery. In particular, blending the lid-cheek junction and correction of the tear trough are prone to failure and unsatisfactory outcomes. OBJECTIVES The aim of this study was to combine lower eyelid blepharoplasty with a novel technique of autologous fat grafting, commonly called segmental fat grafting, and to analyze the safety and efficacy of this approach. METHODS A retrospective analysis of 339 lower blepharoplasties was performed to compare the novel technique of segmental fat grafting to traditional fat transposition during lower blepharoplasty. Outcomes were assessed objectively by several measurements as well as via online survey of 148 invited experts in plastic surgery. Statistical analysis included t test for unpaired and paired samples as well as 1-way analysis of variance for matched data. RESULTS There were no differences in baseline characteristics and comorbidities between study groups. After a mean follow-up of 12.9 months (range, 5-120 months), the group that underwent segmental fat grafting had a significant reduction in tear trough width compared compared with the group receiving lower blepharoplasty with fat transposition. Based on an expert (blinded) online survey, segmental fat grafting was superior or equal in 47% and 35% of cases, respectively. Complications (4%) and revision surgeries (9%) did not differ significantly between study groups. CONCLUSIONS The novel technique of transplantation of a segmental fat graft during lower blepharoplasty is a safe and effective way to overcome tear trough deformity and blend the lid-cheek junction. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Per Hedén
- Karolinska Institutet, Solna, Sweden
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Peng HLP, Peng JH. Treating the tear trough-eye bag complex: Treatment targets, treatment selection, and injection algorithms with case studies. J Cosmet Dermatol 2020; 19:2237-2245. [PMID: 32716132 DOI: 10.1111/jocd.13622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The tear trough is a commonly requested area for aesthetic correction, but is difficult to treat well, especially when concurrent with other deformities such as eye bags. There are multiple possible treatment methods for the tear trough and eye bag, such as surgery and hyaluronic acid (HA) filler injection, with the latter gaining popularity in recent years. AIMS To explore tear trough and eye bags etiology, describe the process for treatment selection, outline possible contraindications for filler injection, and expand upon the previously published atrophy-bulging-laxity (ABL) system of tear trough classification and treatment algorithm, with special focus on tear troughs complicated with eye bags. METHODS Six major etiologies of the eye bag were described, and three main contraindications for HA injection were outlined. Three useful tests (snap test, push test, lift test) to aid in treatment selection were described. A comprehensive treatment algorithm was developed to counteract each etiology: "Lifting" injections at the zygoma and anteromedial cheek help counteract senescent or congenital bone deficiency; "Supporting" injections into the anteromedial cheek fat pads help counteract fat atrophy or prolapse; and "Volumization" injections directly at the deformity help smooth out structural grooves or troughs. RESULTS Patients with pronounced eye bags and tear troughs were treated according to this algorithm and obtained good, long-lasting outcomes. CONCLUSIONS Tear troughs complicated with eye bags can be successfully classified and treated with the ABL system and the additional procedures described by this report.
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Affiliation(s)
- Hsien-Li Peter Peng
- P-Skin Professional Clinic, Kaohsiung City, Taiwan.,Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jui-Hui Peng
- Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung City, Taiwan
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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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Reply. Plast Reconstr Surg 2019; 144:710e-711e. [DOI: 10.1097/prs.0000000000006035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wongkietkachorn A, Surakunprapha P, Wongkietkachorn N, Wongkietkachorn S. Safe Zone for Infraorbital Nerve Block. Plast Reconstr Surg 2019; 144:709e-710e. [PMID: 31568330 DOI: 10.1097/prs.0000000000006034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Apinut Wongkietkachorn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Palakorn Surakunprapha
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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