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Schelke L, Lowrey N, Mojallal A, Rowland-Warmann MJ, Wortsman X, Sigrist RM, Velthuis PJ, Cotofana S. Post-Treatment Displacement of Facial Soft Tissue Fillers-A Retrospective Ultrasound-based Investigation of 382 Zygomatic Regions. Dermatol Surg 2024:00042728-990000000-00828. [PMID: 38833408 DOI: 10.1097/dss.0000000000004257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND Clinical and ultrasound experience has revealed that after soft tissue injections of the lateral cheek, the filler may displace from the zygoma to the caudal temporal area. OBJECTIVE To obtain more data to provide insight into product distribution when soft tissue fillers are injected in the zygomatic region. METHODS Two hundred patients were examined with facial ultrasound imaging of the zygomatic and temporal region. Inclusion criteria were simply a positive response on the screening questionnaire as to whether or not they had filler injections placed in their lateral cheek. Control injections were also performed to the zygomatic regions of a body donor and in 10 patients ultrasound-guided. RESULTS A correlation was found between the layers in which filler was detected on the zygoma and where it was ultimately found in the temples. Four different redistribution patterns were observed: (1) migration of filler within the superficial muscular aponeurotic system (SMAS) on the zygoma into the superficial temporal fascia. Migration of filler from the lateral suborbicularis oculi fat to (2) the deep interfacial plane of the temple or (3) to the superficial temporal fat pad; (4) migration from the supraperiosteal layer of the zygoma to the superficial temporal fat pad. Body donor and patients: filler deposits injected on the zygoma were witnessed to shift during injection into the caudal part of the temple. CONCLUSION Soft tissue filler aliquots may be redistributed into the temples after injections of the lateral side of the zygomatic arch. The displacement follows a distinct pattern depending on the initial layer of injection.
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Affiliation(s)
- Leonie Schelke
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicola Lowrey
- Department of Plastic, Reconstructive, and Aesthetic Surgery, N2 Aesthetics, Manhattan Beach, CA
| | - Ali Mojallal
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospices Civils de Lyon, Lyon, France
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Université Claude Bernard, Lyon, France
| | - M J Rowland-Warmann
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Smileworks Liverpool, Liverpool, UK
| | - Ximena Wortsman
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Institute for Diagnostic Imaging of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Universidad de Chile, Santiago, Chile
| | - Rosa M Sigrist
- Department of Radiology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Peter J Velthuis
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sebastian Cotofana
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong Province, China
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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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Jiang M, Shao H, Li Q. Analysis of Anatomy and Age-related Changes in Infraorbital Cheek Using Computed Tomography. Aesthetic Plast Surg 2024:10.1007/s00266-024-04093-z. [PMID: 38710814 DOI: 10.1007/s00266-024-04093-z] [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: 02/16/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND There is no consensus regarding age-related facial anatomical changes. In this study, aging-related changes in soft and hard cheek tissues were quantitatively analyzed using computed tomography. METHODS We performed a retrospective study of 90 Asian females who underwent facial computed tomography. Three-dimensional model of soft tissue in apple zone was reconstructed, and age-related changes in fat volume and pyriform aperture area were quantified using Mimics software. RESULTS The apple zone is an aesthetic unit of the infraorbital cheek, with soft tissue located between the lateral wall of the pyriform aperture and the zygomatic major muscle. The superficial fat volume significantly decreased with age (P < 0.05). In contrast, a significant decrease in total fat volume was only observed between the young and old groups (P < 0.05). In linear regression modeling, age was a significant predictor of pyriform aperture area (R2 = 0.194, P < 0.001). CONCLUSIONS These results suggest that superficial fat atrophy and bone remodeling in the cheek with age, and both of which combine to contribute to an aging facial appearance. 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)
- Mengyuan Jiang
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Hao Shao
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Qingchun Li
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China.
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Zhu C, Li F, Tang X, Cai L, Yin B, Zhang X, Jiang C, Han X. Buccal Fat Pad Augmentation for Midfacial Rejuvenation: Modified Fat Grafting Technique and Ogee Line Remodeling. Aesthet Surg J 2024; 44:117-130. [PMID: 37418635 DOI: 10.1093/asj/sjad214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The volume and position of the buccal fat pad (BFP) change with age, which manifests as a hollow midface. Previous studies showed that autologous fat grafting for BFP augmentation could effectively ameliorate midfacial hollowing. OBJECTIVES The aim of this study was to introduce a modified fat grafting technique for female patients with midfacial hollowing to restore the volume of BFP, and to evaluate the safety and effectiveness of this approach. METHODS Two cadavers were used for the dissection of the BFP and to demonstrate the surgical procedures. Forty-eight patients were treated for midfacial hollowing with the modified grafting strategy. The BFP was filled through a percutaneous zygomatic incision and an immediate amelioration in the hollow area was observed. Improvements were evaluated from measurements of the ogee line and ogee angle, FACE-Q questionnaires, and 3-party satisfaction ratings. Clinical profiles were reviewed and statistically analysed. RESULTS The mean [standard deviation] ogee angle was 6.6° [1.9°] preoperatively and 3.9° [1.4°] postoperatively (average reduction, 2.7°). Patients' ogee lines were smoother postoperatively, with marked improvements in overall appearance, psychological well-being, and social confidence. Patients reported high satisfaction with decision-making and postoperative outcomes and felt 6.61 [2.21] years younger. Overall, 88%, 76%, and 83% of the cases were graded as good or excellent in improvement by surgeon, patient, and the third party, respectively. CONCLUSIONS For age-dependent midfacial hollowing in female patients, the modified percutaneous grafting technique described here was safe and efficacious in restoring BFP volume. This technique produced a smoother ogee line and a natural, younger midfacial contour. LEVEL OF EVIDENCE: 4
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Schelke L, Harris S, Cartier H, Alfertshofer M, Doestzada M, Cotofana S, Velthuis PJ. Treating facial overfilled syndrome with impaired facial expression-Presenting clinical experience with ultrasound imaging. J Cosmet Dermatol 2023; 22:3252-3260. [PMID: 37772766 DOI: 10.1111/jocd.16013] [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: 07/19/2023] [Revised: 08/26/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Facial overfilled syndrome is an adverse event following minimally invasive soft tissue filler injections. It presents in most cases as excess midfacial volume and/or as unnatural smile which is difficult to detect due to the absence of standardized evaluation methods. OBJECTIVE To showcase how to identify, evaluate, and treat facial overfilled syndrome by utilizing facial ultrasound and simultaneous hyaluronidase injections. METHODS Twenty-eight consecutive patients (26 females, 2 males) were enrolled in this study in which facial ultrasound was performed to evaluate the location previously implanted filler material. The position of the oral commissure was objectively measured in relation to bony landmarks, and the severity of lateral canthal lines was assessed by independent and blinded raters. RESULTS The material was identified in 35.7% inside the subdermal fatty layer, in 28.6% inside the deep supra-periosteal fatty layer, in 10.7% inside the fibrous layer deep to the subdermal fatty layer, whereas in 25.0%, the product was not possible to locate clearly inside one specific layer. On average, 81.6 I.U. [range: 75-150] of hyaluronidase were injected. Lateral canthal line severity was before the treatment 2.28 (1.4) and was after the hyaluronidase treatment 2.02 (1.3) with p = 0.578. The position of the oral commissure increased by 0.60 cm in vertical and by 0.30 cm in horizontal directions (both p < 0.001). CONCLUSION Facial overfilled syndrome following aesthetic soft tissue filler injections can present as excess midfacial volume but also as unnatural smile. Targeted hyaluronidase injections into the culprit pockets inside the midfacial soft tissues have shown to re-establish a natural smile, to reduce excess midfacial volume, and to decrease lateral canthal line severity.
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Affiliation(s)
- Leonie Schelke
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Sebastian Cotofana
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Peter J Velthuis
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Li Z, Xia Z, Qiu Z, Ting W, Dong R, Wang X, Jin L, Zeng A, Liu Z, Wang X, Yu N, Long X. Studying Dynamics of Mid-face Lifting During Hyaluronic Acid Filler Injection Using Ultrasound Imaging. Aesthetic Plast Surg 2023; 47:2661-2676. [PMID: 36536094 DOI: 10.1007/s00266-022-03221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The ageing in the mid-face involves volume deficiency in multiple anatomical units, including the zygomatic arch, infraorbital region, medial and lateral cheek and nasolabial fold (NLF). Hyaluronic acid (HA) is extensively used in the minimally invasive procedures of mid-face rejuvenation. OBJECTIVES MD CodesTM is proposed to perform combined treatment of multiple sites to reduce treatment variability and increase clinician success rates. Although the detailed procedure of this technique, aesthetic effects and complications have been disclosed, its anatomical information has yet to be discussed. This paper elaborated on the static and dynamic anatomical characteristics of MD CodesTM through cadaveric dissection and ultrasound imaging. METHODS Anatomical dissection and ultrasound imaging help us look back on the injection methods and anatomical principles of MD CodesTM. RESULTS The treatment is threefold: (1) the bolus injections, for lifting purposes, are performed at the most depressing point along the zygomatic arch, zygomatic eminence, the prominent optimal point in the zygomatic region, the most depressed point of upper NLF with 0.2-0.3 ml HA. (2) The linear injections, featuring facial contouring refinement, are performed at the deep fat pad of the medial cheek and infraorbital region with 0.4 ml HA. (3) The linear injections, featuring volume replacement, are performed at the subcutaneous fat layer of lateral cheek and NLF with 0.8 and 0.4 ml HA. CONCLUSIONS MD CodeTM is led by the principle of "less dosage and better effect", and a special injection sequence is formulated based on the anatomical characteristics. Ultrasound is a useful tool to make for a dynamic anatomical understanding of MD CodeTM and visualize the anatomical information such as layers and thicknesses. 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)
- Zhijin Li
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Zenan Xia
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Zikai Qiu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Wenyun Ting
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Ruijia Dong
- Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Xue Wang
- Department of Anatomy, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Jin
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Ang Zeng
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Zhifei Liu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
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Zhang YL, Hong WJ, Chen Y, Zhou YF, Chen YQ, Li ZH, Li XR, Yu H, Cotofana S, Luo SK. Age-Related Changes of the Zygomatic Ligament: An Experimental Animal Study. Aesthet Surg J 2023; 43:NP979-NP986. [PMID: 37462665 DOI: 10.1093/asj/sjad235] [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] [Received: 05/23/2023] [Revised: 07/08/2023] [Accepted: 07/17/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Facial aging is a multifactorial process involving the skin, fat, muscles, bones, and ligaments. The role of facial ligaments in the facial aging process remains elusive. OBJECTIVES The aim of this study was to identify whether age-related changes in facial ligaments exist and how to best quantify such changes when investigating the zygomatic ligament in the rat. METHODS A total of 30 male Sprague-Dawley rats (10 young, 10 middle-aged, 10 mature) were investigated to visualize the zygomatic ligament. Samples of the ligaments spanning the zygomatic arch and the skin were taken and histologically examined with hematoxylin-eosin, Masson, Verhoeff's elastic, and picrosirius red staining. Quantification of the Type I/III collagen ratio and collagen content was performed by color deconvolution and electron microscopic imaging. RESULTS With increasing age, collagen fibers inside of the examined ligaments appeared thicker and more closely arranged. The Type I/III collagen ratio was measured to be 1.74 in young animals, 3.93 in middle-aged animals, and 5.58 in mature animals. The ultra-microstructure of the ligament was less coordinated in direction and orientation in young and middle-aged animals than in mature animals, in which collagen fibers were bundled together in a strong and oriented mesh. CONCLUSIONS Ligaments appeared thinner, transparent, more elastic, and less robust in young animals, whereas ligaments in mature animals appeared thicker, more fascia-like, less elastic, and more robust. An increase in the Type I/III collagen ratio, indicating greater stiffness and reduced elasticity, was observed with higher age of the investigated animals. These findings indicate that ligaments might increase in stiffness and rigidity with age.
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Martín JM, Revelles JM, Aznar NM, Jiménez LM, Orellana JB, Gomariz MÁ, Alfertshofer M, Cotofana S. Superficial versus deep injections of the upper midface-A prospective interventional split-face study. J Cosmet Dermatol 2023; 22:2940-2949. [PMID: 37594172 DOI: 10.1111/jocd.15795] [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: 03/10/2023] [Accepted: 04/16/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Various injection algorithms have been proposed in the past which are in line with the three aesthetic principles: upper face first, lateral face first, and deep regions first. However, increasing evidence is provided that the upper midface can be targeted with superficial soft tissue filler injections alone too. OBJECTIVE To investigate in a prospective split-face study design whether superficial or deep upper midfacial injections provide superior aesthetic outcomes. METHODS A total of n = 20 study participants (100% females; age 43.95 (11.7) years; BMI 22.92 (2.6) kg/m2 ) were treated with superficial soft tissue filler injections on side of their face and deep injections on the contralateral side with a mean volume of 0.78 cc. Outcome was evaluated at 7 weeks follow-up for midfacial, and lower facial volume, for medial and lateral facial skin vector displacement, and for improvement of nasolabial, crow's feet, and upper cheek fullness severity scores. RESULTS No adverse events related to safety or product tolerability were observed during the entire study period. All semiquantitative scores improved statistically significantly after the observational period (p < 0.001) but displayed no difference between the two applied injection techniques (p > 0.05). CONCLUSION The results of this split-face study revealed that both the superficial and the deep cannula injection technique for midface volumization statistically significantly improve the midfacial volume, reduce nasolabial fold and crow's feet severity. No statistically significant difference was observed between the two injection techniques when compared via semiquantitative and objective outcome evaluation after 7 weeks follow-up.
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Affiliation(s)
| | | | | | | | | | | | - Michael Alfertshofer
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munchen, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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Eid L, Mao X, Zhao B, Mao J, Qian S, Zhang Y, Zhang Y, Zhang L, Cheng L, Zhang Y, Sun X. Fat Compartment Gliding Theory - A Novel Technique for the Repositioning of Superficial Fat Compartments for Facial Rejuvenation. Clin Cosmet Investig Dermatol 2023; 16:3077-3090. [PMID: 37908409 PMCID: PMC10614658 DOI: 10.2147/ccid.s415467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023]
Abstract
Background Facial fat compartments and their role in facial aging have gained increased recognition and are playing a significant role in facial rejuvenation. The superficial fat compartments glide inferiorly during the aging process, leading to the flattening and elongation of the face and the appearance of facial bulges, folds, and grooves. Patients and Methods Ultrasound imaging of the facial soft tissues was performed on nine female volunteers to demonstrate the change in superficial facial fat compartments from an upright to supine position. The net suture jowl and medial cheek fat compartment repositioning technique was operated on 165 Asian patients between September 2020 and July 2021. Volume and projection change of malar and jowl regions, as well as change in elevation of malar protrusion were measured 1, 3, and 6 months postoperatively using a three-dimensional imaging system. Results Ultrasound measurements confirmed the medial and middle cheek, nasolabial, and jowl fat compartments changed in thickness during positional changes with age-related differences. Postoperative three-dimensional imaging showed volume and projection increase in the malar region (2.23mL and 1.11mm) and decrease in the jowl region (-0.18mL and -0.52mm) by the 6-month follow-up date, and malar projection saw a superior displacement of 3.08mm. Conclusion The superficial fat glide inferiorly within their compartments under the force of gravity and naturally reposition themselves when the effect of gravity is reversed. The net suture technique offers a minimally invasive method for lifting the jowl fat, volumizing the mid-cheek and achieving facial rejuvenation by repositioning the superficial fat compartments.
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Affiliation(s)
- Loy Eid
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of China
| | - Xiyuan Mao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of China
| | - Binfan Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of China
| | - Jiayi Mao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of China
| | - Shutong Qian
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of China
| | - Yuyu Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of China
| | - Ying Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of China
| | - Lu Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of China
| | - Liying Cheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of China
| | - Yuguang Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of China
| | - Xiaoming Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of China
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Estler A, Grözinger G, Estler E, Hepp T, Feng YS, Daigeler A, Seabra Robalo Gomes Jorge AC, Santos Stahl A, Nikolaou K, Stahl S. Quantification of Facial Fat Compartment Variations: A Three-Dimensional Morphometric Analysis of the Cheek. Plast Reconstr Surg 2023; 152:617e-627e. [PMID: 36877747 DOI: 10.1097/prs.0000000000010357] [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: 03/07/2023]
Abstract
BACKGROUND Cheek contour is a main determinant of facial attractiveness. The aim of this study was to evaluate the relationship between age, sex, and body mass index (BMI) and cheek fat volume in a large cohort to better understand and treat facial aging. METHODS The authors performed a retrospective review of the archives of the Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen. Epidemiologic data and medical history were assessed. Cheek superficial and deep fat compartment volumes were measured on magnetic resonance images. Statistical analyses were performed using SPSS and SAS statistical software. RESULTS A total of 87 patients with a mean age of 46 years (range, 18 to 81 years) were included. The superficial and deep fat compartment volumes of the cheek increased with BMI ( P < 0.001 and P = 0.005), but there was no significant relationship between age and volume. The ratio of superficial versus deep fat did not change with age. No significant difference of the superficial or deep fat compartments was found between men and women in a regression analysis ( P = 0.931 and P = 0.057). CONCLUSIONS Cheek fat volume measurements on magnetic resonance imaging scans using reconstruction software suggest that the fat volume of the cheek increases with BMI but does not change significantly with age. Further studies are needed to elucidate the role of age-related changes of bone structures or sagging of the fat compartments.
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Affiliation(s)
- Arne Estler
- From the Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen
| | - Gerd Grözinger
- From the Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen
| | - Eva Estler
- Faculty of Medicine, University of Tübingen
| | - Tobias Hepp
- From the Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen
| | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive, and Burn Surgery, BG Trauma Centre Tübingen
| | | | | | - Konstantin Nikolaou
- From the Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen
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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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12
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Newsome HA, Chi JJ. Mastering Midface Injections. Clin Plast Surg 2023; 50:437-446. [PMID: 37169409 DOI: 10.1016/j.cps.2022.12.008] [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] [Indexed: 05/13/2023]
Abstract
Injectable filler is one of the most common cosmetic procedures performed annually. An aging face shows a characteristic loss of volume in the deep fat pads of the midface. The goal of midfacial rejuvenation with injectable filler is to restore lost volume, with the suborbicularis fat pad and deep medial cheek fat being the most critical areas. Filler can be instilled here with a cannula or needle with successful outcomes. However, this procedure is not without complications if proper technique and underlying anatomy are not respected.
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Affiliation(s)
- Hillary A Newsome
- Division of Facial Plastic & Reconstructive Surgery, Washington University Facial Plastic Surgery Center, Washington University in St. Louis-School of Medicine, 660 S Euclid AveCampus Box 8115St. Louis, MO 63110, USA
| | - John J Chi
- Division of Facial Plastic & Reconstructive Surgery, Washington University Facial Plastic Surgery Center, Washington University in St. Louis-School of Medicine, 660 S Euclid AveCampus Box 8115St. Louis, MO 63110, USA.
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13
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Magnusson MR. Commentary on: Precision of Soft-Tissue Filler Injections: An Ultrasound-Based Verification Study. Aesthet Surg J 2023; 43:362-364. [PMID: 36411515 DOI: 10.1093/asj/sjac303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mark R Magnusson
- Griffith University School of Medicine and Dentistry, Queensland, Australia
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14
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Calomeni M, Bravo BSF, Schelke LW, Velthuis PJ, Schalet G, Frank K, Guertler A, Alfertshofer M, Cotofana S, Moellhoff N. Precision of Soft-Tissue Filler Injections: An Ultrasound-Based Verification Study. Aesthet Surg J 2023; 43:353-361. [PMID: 36281772 DOI: 10.1093/asj/sjac272] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Uncontrolled product spread is an important issue to consider in facial filler injections. Lack of precision can result in reduced effectiveness and surface projection, as well as irregularities and product visibility. OBJECTIVES The authors sought to assess the precision of soft-tissue filler injections in the face by employing a cannula. METHODS This single-center observational study investigated soft-tissue filler distribution utilizing real-time non-invasive ultrasound imaging. Outcome parameters included (1) the tissue plane of product distribution, (2) the extent of horizontal as well as vertical product spread at the injection site, and (3) the product surface area taking into account the multifactorial influence of several independent variables. Participants were followed up to 30 days post-injection. RESULTS A total 100 facial injections were performed in 8 patients (2 males, 6 females) with a mean age of 37.20 (±6.34) years and a mean BMI of 22.21 (±1.39) kg/m.2. The plane of product distribution remained constant in approximately 90% of cases at day 0 (d0), d14, and d30. Mean horizontal product spread was higher compared with vertical spread, and both significantly decreased over all time points (P < .001). Mean product surface area was 22.51 ± 16.34 mm2 at d0, 15.97 ± 11.28 mm2 at d14, and 12.9 ± 9.15 mm2 at d30. Analysis employing generalized linear models revealed that injection volume and injection depth significantly influenced product surface area. CONCLUSIONS Injection of soft-tissue filler employing a cannula allows precise application of the product within the intended tissue plane. Precision can be improved by injecting less product into deeper tissue layers. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Mariana Calomeni
- Dermatology Department, Bravo Private Clinic, Rio de Janeiro, Brazil
| | - Bruna S F Bravo
- Dermatology Department, Bravo Private Clinic, Rio de Janeiro, Brazil
| | - Leonie W Schelke
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter J Velthuis
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Grant Schalet
- Department of Surgery, Broward Health Medical Center, Ft. Lauderdale, FL, USA
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Anne Guertler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
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15
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Frank K, Ehrl D, Bernardini F, Walbrun A, Moellhoff N, Alfertshofer M, Davidovic K, Mardini S, Gotkin RH, Cotofana S. How We Look At Mature Faces-An Eye-Tracking Investigation Into the Perception of Age. Aesthet Surg J 2023; 43:115-122. [PMID: 36099471 DOI: 10.1093/asj/sjac251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It is still unclear which facial region contributes most to the perception of an aged face when evaluated by eye-tracking analyses. OBJECTIVES The authors sought to apply eye-tracking technology to identify whether mature faces require longer fixation durations than young faces and which facial region contributes most to the perception of a mature face. METHODS Eye-tracking analyses were conducted in 74 volunteers (37 males, 37 females; 43 ≤ 40 years, 31 > 40 years) evaluating their gaze pattern and the fixation durations for the entire face and 9 facial subregions. Frontal facial images of 16 younger (<40 years) and older (>40 years) gender-matched individuals were presented in a standardized setting. RESULTS Independent of age or gender of the observer, a younger stimulus image was viewed shorter than an older stimulus image with 0.82 (0.63) seconds vs 1.06 (0.73) seconds with P < 0.001. There was no statistically significant difference in their duration of a stable eye fixation when observers inspected a male vs a female stimulus image [0.94 (0.70) seconds vs 0.94 (0.68) seconds; P = 0.657] independent of the observer's age or gender. The facial image that captured the most attention of the observer (rank 9) was the perioral region with 1.61 (0.73) seconds for younger observers and 1.57 (0.73) seconds for older observers. CONCLUSIONS It was revealed that the perioral region attracts the most attention of observers and contributes most to an aged facial appearance. Practitioners should be mindful of the importance of the perioral region when designing an aesthetic treatment plan.
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Affiliation(s)
- Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | | | - Alina Walbrun
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Kristina Davidovic
- Department of Radiology and Medical School, University of Belgrade, Belgrade, Serbia
| | - Samir Mardini
- Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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16
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Kato K, Kajiwara T, Furuyama N, Liew S. Filler-based correction of tear trough depressions and eye bags in Japanese patients: A classification system and treatment algorithm. J Cosmet Dermatol 2023; 22:439-448. [PMID: 36208029 PMCID: PMC10092177 DOI: 10.1111/jocd.15449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/02/2022] [Accepted: 10/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tear trough depressions are widely treated with fillers. However, it is questionable whether the same strategies can always be used for Caucasian and Japanese patients, owing to differences in bone and skin structures and epithelial thickness. AIMS To assess a novel classification system and treatment algorithm for correcting tear trough depressions and eye bags in Japanese patients. METHODS Tear trough depressions can be classified into three types according to the presence or absence of a "negative vector" based on retrusion of the maxilla relative to the anterior corneal surface, with or without eye-bag protrusion when smiling. Type 1 patients (without the negative vector) can be treated simply by filling the depression in the tear trough and the palpebromalar groove region. Type 2 patients (with a negative vector and no eye-bag protrusion on smiling) also require volume restoration in the mid-cheek (deep medial cheek fat, suborbicularis oculi fat, and pre-maxillary space); this not only enables volume recovery but also compensates for maxillary deficiency. Type 3 patients (with a negative vector and eye-bag protrusion on smiling) require an additional step, based on placing a filler in front of the eye bags and pushing orbital fat backward. RESULTS Case presentations demonstrate the utility of the techniques involved. CONCLUSIONS This system provides a simple and practical method for classifying and treating Japanese patients with tear trough depressions and eye bags. Further studies are warranted.
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Affiliation(s)
| | - Tomoe Kajiwara
- Azabu Beauty Clinic, Tokyo, Japan.,Jiyugaoka Clinic, Tokyo, Japan
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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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Newsome HA, Chi JJ. Mastering Midface Injections. Facial Plast Surg Clin North Am 2022; 30:347-356. [DOI: 10.1016/j.fsc.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Hernandez CA, Alfertshofer M, Frank K, Freytag L, Gavril DL, Davidovic K, Gotkin RH, Mercado-Perez A, Mardini S, Cotofana S. Quantitative Mobility Analysis of the Face and its Relevance for Surgical and Non-surgical Aesthetic Facial Procedures. Aesthetic Plast Surg 2022; 46:2237-2245. [PMID: 35648191 DOI: 10.1007/s00266-022-02921-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Understanding the degree of facial mobility upon postural changes is of great clinical relevance especially if facial assessment, facial measurements and/or facial markings are done in an upright position, but facial procedures are performed in a supine position. OBJECTIVE The objective of this study is to investigate regional facial skin displacement and facial volume changes in individuals between upright and supine positions. METHODS This multi-center study analyzed a total of 175 study participants with a mean age of 35.0 (10.2) years and a mean body mass index of 24.71 (3.5) kg/m2. 3D surface scanning technology with automated registration and alignment was utilized, and multivariate analyses were performed with adjustment for age, gender, body mass index, facial skin sagging and laxity. RESULTS The medial face displaced less than the lateral face in both cranial (0.88 mm) and in lateral (0.76 mm) directions, and the lower face displaced more than the middle face in both cranial (1.17 mm) and lateral directions (1.37 mm). Additionally, the medial face lost, on average, 3.00cc whereas the lateral face increased by 5.86cc in volume; the middle face increased by 2.95cc, whereas the lower face decreased by 0.98cc in volume. All p < 0.001. CONCLUSION Practitioners should be mindful that there is a statistically significant change in facial soft tissues between the upright and supine positions and that the magnitude of the change does not necessarily reflect on the aging process alone but is a multi-factorial process which should be individualized for each patient's needs. 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)
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Lysander Freytag
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | | | - Kristina Davidovic
- Department of Radiology & Medical School, University of Belgrade, Belgrade, Serbia
| | | | - Arnaldo Mercado-Perez
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Stabile Building 9-38, 200 First Street, Rochester, MN, 55905, USA
| | - Samir Mardini
- Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Stabile Building 9-38, 200 First Street, Rochester, MN, 55905, USA.
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Cotofana S, Kaminer MS. Anatomic Update on the
3‐Dimensionality
of the Subdermal Septum and its Relevance for the Pathophysiology of Cellulite. J Cosmet Dermatol 2022; 21:3232-3239. [DOI: 10.1111/jocd.15087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy Mayo Clinic College of Medicine and Science Rochester MN USA
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21
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Anatomic Differences Between the Asian and Caucasian Nose and Their Implications for Liquid Rhinoplasties. Facial Plast Surg Clin North Am 2022; 30:167-173. [DOI: 10.1016/j.fsc.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Abstract
BACKGROUND Hyaluronic acid soft-tissue augmentation fillers are commonly injected into multiple areas of the face, including the tear trough. Despite well-documented risks, there is no standardized, evidence-based approach to inject filler in this area, be it using a hypodermic needle or a microcannula. The authors, therefore, sought to establish a preference between the two methods to facilitate progression toward standardization and prevention of adverse events. METHODS This is a systematic review of articles discussing hyaluronic acid tear trough injection techniques performed in vivo and related outcomes. Searches were conducted across The Cochrane Library, PubMed, Scopus, Web of Science, and Embase to yield relevant articles published before February of 2020. All selected articles incorporated discrete patient cases and were analyzed by a variety of variables assessing evidence strength, outcomes, technique, and patient safety. RESULTS After appraisal, 42 articles met eligibility criteria: 20 using needles, 12 using cannulas, and 10 focusing on adverse events. Level III was the most commonly awarded evidence grade, corresponding to retrospective, nonexperimental descriptive studies. There were no statistically significant differences in reported aesthetic results, patient satisfaction, or incidence of adverse events across the needle-based and cannula-based articles. Some technique trends, such as targeted anatomical plane and needle position, emerged in subsequent articles. CONCLUSION Given that there were no statistically significant differences in patient safety or outcomes, an evidence-based preference for needle or cannula injection into the tear trough cannot be made at this time. Current inconsistencies make tear trough injection procedures difficult to replicate, making standardization based on avoidance of adverse events not feasible.
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Bernardini F, Staiger T, Moellhoff N, Giunta RE, Braig D, Ehrl D, Woodward J, Cotofana S, Kohler LH, Frank K. Facial Recognition Pattern before and after Lower Eyelid Blepharoplasty. Facial Plast Surg Clin North Am 2022; 30:271-276. [DOI: 10.1016/j.fsc.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Freytag L, Alfertshofer MG, Frank K, Moellhoff N, Helm S, Redaelli A, Voropai D, Hernandez CA, Green JB, Cotofana S. Understanding Facial Aging Through Facial Biomechanics. Facial Plast Surg Clin North Am 2022; 30:125-133. [DOI: 10.1016/j.fsc.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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25
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Liao X, Wang X, Xu Z, Guo S, Gu C, Jin Z, Su T, Chen Y, Xue H, Yang M. Assessment of facial autologous fat grafts using Dixon magnetic resonance imaging. Quant Imaging Med Surg 2022; 12:2830-2840. [PMID: 35502384 PMCID: PMC9014153 DOI: 10.21037/qims-21-570] [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: 05/29/2021] [Accepted: 01/24/2022] [Indexed: 09/07/2023]
Abstract
BACKGROUND Autologous fat grafting is a procedure that treats soft tissue defects by reallocating fat to improve a patient's physical appearance. Imaging methods may be used to evaluate and monitor the grafted fat after transplantation. The goal of imaging is to examine the signal and volume of the grafted fat after autologous fat grafting during the adipose tissue recovery. However, researchers have yet to examine the feasibility of using fat-only imaging to assess the autologous fat graft. METHODS In this prospective and observational study, 46 injected sides in 23 female patients (age 35±7.8 years) were included in the image evaluation. The patients underwent autologous fat grafting surgery with filtered and washed fat. A total of 16, 18, and 12 sides were scanned 7 days, 3 months, and 1 year after fat grafting, respectively. Fat-only images were obtained using Dixon imaging, and then the image quality and contrast of the T1W and T2W were rated to evaluate the application of this method when imaging the autologous fat. The signal and volume of the autologous fat graft were recorded to assess the retention during recovery of the autologous fat tissue. RESULTS Fat-only T1W magnetic resonance imaging (MRI) was used to identify and delineate grafted fat because this method had better image quality and image differentiation than did T2W MRI. The average signal contrast and retention rate measured 7 days postoperation (28.8%±4.7%; 94.1%±5.8%) was the highest and then decreased at 3 months (16.3%±2.1%; 48.7%±17.3%) and 1 year (3.3%±1.3%, 33.1%±12.9%) after surgery. There were statistically significant differences between the signal and volume retention measurements at each postoperative recovery phase. CONCLUSIONS The T1W fat-only images produced by Dixon MRI is a feasible approach for identifying grafted fat and measure postoperative changes during clinical evaluation. We found a significant decrease in signal contrast and volume of the grafted fat from the surgery date to 3 months postoperation and from 3 months to 1-year postoperation.
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Affiliation(s)
- Xueyin Liao
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoqi Wang
- Philips Healthcare, the World Profit Centre, Beijing, China
| | - Zhentan Xu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shiwei Guo
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Congmin Gu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tong Su
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Chen
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingyong Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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26
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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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Combined Dermis Spacer Graft, Lateral Canthopexy and Subperiosteal Midface Lifting in the Management of Lower Eyelid Retraction Secondary to Chronic Facial Nerve Palsy. J Maxillofac Oral Surg 2022. [DOI: 10.1007/s12663-022-01688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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28
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Trévidic P, Kaufman-Janette J, Weinkle S, Wu R, Dhillon B, Antunes S, Macé E, Maffert P. Injection Guidelines for Treating Midface Volume Deficiency With Hyaluronic Acid Fillers: The ATP Approach (Anatomy, Techniques, Products). Aesthet Surg J 2022; 42:920-934. [PMID: 35039828 PMCID: PMC9373948 DOI: 10.1093/asj/sjac007] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Midface rejuvenation is among the most valuable indications of hyaluronic acid dermal fillers, because malar projection and full upper cheeks significantly contribute to a youthful appearance. Hyaluronic acid fillers have evolved over the past 2 decades to meet specific clinical needs such as strong projection capacity and adaptability to facial dynamism. As a result, they now represent the treatment of choice for midface rejuvenation throughout age ranges by offering the potential for noninvasive treatment, immediate results, and minimal downtime. Because the 5-layered structure of the midface plays a central role in the human face, injecting the midface area may also indirectly improve other aesthetic concerns such as infraorbital hollowing and nasolabial folds. Nonetheless, midface rejuvenation requires a tailored treatment approach and a thorough knowledge of anatomy to minimize procedural risks and achieve natural-looking results. This article provides an extensive anatomical description of the midface and of the usual course and depth of vascular structures circulating nearby to delineate a treatment area and minimize procedural risks. Furthermore, considering the differential mobility and mechanical constraints of each layer of the midface, a multilayer treatment algorithm is proposed for adapting the treatment strategy to patient specificities (including age, gender, skin type, and morphology). Emphasis is also placed on desirable filler properties to create deep structural support on the one hand and accompany facial movement on the other hand.
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Affiliation(s)
| | | | | | | | | | - Stéphanie Antunes
- Clinical and Medical Affairs Department, Teoxane SA, Geneva, Switzerland
| | - Emilie Macé
- Clinical and Medical Affairs Department, Teoxane SA, Geneva, Switzerland
| | - Pauline Maffert
- Clinical and Medical Affairs Department, Teoxane SA, Geneva, Switzerland
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29
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Reevaluation of the Layered Anatomy of the Forehead: Introducing the Subfrontalis Fascia and the Retrofrontalis Fat Compartments. Plast Reconstr Surg 2022; 149:587-595. [PMID: 35006205 DOI: 10.1097/prs.0000000000008826] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Novel imaging methods have provided new insights into the layered anatomy of the forehead. This study seeks to critically reevaluate the layered anatomy of the forehead by using ultrasound imaging and cadaveric dissection to provide an accurate anatomical description that can be used to guide safer surgical and minimally invasive frontal procedures. METHODS This study used ultrasound imaging in a sample of 20 volunteers (12 female and eight male volunteers; aged 35.25 ± 4.2 years; body mass index, 24.28 ± 3.5 kg/m2) and cadaveric dissections of 16 body donors (12 female and four male body donors; aged 72.76 ± 9.5 years) to reevaluate the layered anatomy of the forehead. Layer-by-layer dissections and ultrasound-based measurements of the frontal structures guided conclusions. RESULTS The following layered arrangement was identified: layer 1, skin; layer 2, superficial fatty layer; layer 3, suprafrontalis fascia; layer 4, orbicularis oculi and frontalis muscle (same plane); layer 5, a homogenous layer of fat [preseptal fat (in the upper eyelid), retro-orbicularis fat (deep to the orbicularis oculi muscle), and retro-frontalis fat (deep to the frontalis muscle); layer 6, subfrontalis fascia; layer 7, preperiosteal fat within the prefrontal space in the lower forehead and deep compartments in the upper forehead; and layer 8, periosteum. CONCLUSIONS The results of this study add to the current understanding of the layered arrangement of the forehead. The combination of ultrasound imaging and cadaveric dissections provided evidence for a continuous fatty layer deep to the frontalis muscle.
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Freytag DL, Alfertshofer MG, Frank K, Melnikov DV, Moellhoff N, Swift A, Heisinger S, Gotkin RH, Ehrl D, Cotofana S. The Difference in Facial Movement Between the Medial and the Lateral Midface: A 3-Dimensional Skin Surface Vector Analysis. Aesthet Surg J 2022; 42:1-9. [PMID: 33784397 DOI: 10.1093/asj/sjab152] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Our understanding of the functional anatomy of the face is constantly improving. To date, it is unclear whether the anatomic location of the line of ligaments has any functional importance during normal facial movements such as smiling. OBJECTIVES The authors sought to identify differences in facial movements between the medial and lateral midface by means of skin vector displacement analyses derived from 3-dimensional (3D) imaging and to further ascertain whether the line of ligaments has both a structural and functional significance in these movements. METHODS The study sample consisted of 21 healthy volunteers (9 females and 12 males) of Caucasian ethnic background with a mean age of 30.6 (8.3) years and mean BMI of 22.57 (2.5) kg/m2. 3D images of the volunteers' faces in repose and during smiling (Duchenne type) were taken. 3D imaging-based skin vector displacement analyses were conducted. RESULTS The mean horizontal skin displacement was 0.08 (2.0) mm in the medial midface (lateral movement) and was -0.08 (1.96) mm in the lateral midface (medial movement) (P = 0.711). The mean vertical skin displacement (cranial movement of skin toward the forehead/temple) was 6.68 (2.4) mm in the medial midface, whereas it was 5.20 (2.07) mm in the lateral midface (P = 0.003). CONCLUSIONS The results of this study provide objective evidence for an antagonistic skin movement between the medial and lateral midface. The functional boundary identified by 3D imaging corresponds to the anatomic location of the line of ligaments. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- David L Freytag
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig–Maximilian University, Munich, Germany
| | | | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig–Maximilian University, Munich, Germany
| | - Dmitry V Melnikov
- Plastic Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow,Russia
| | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig–Maximilian University, Munich, Germany
| | | | - Stephan Heisinger
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna,Austria
| | | | - Denis Ehrl
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig–Maximilian University, Munich, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Pooth R, Prinz V, Cajkovsky M, Green JB, Hernandez CA, Pavicic T, Mueller DS, Sattler S, Klepetko H, Fabi SG, Day D, Suwanchinda A, Cotofana S, Frank K. Validated 5-point photonumeric scales for the assessment of the jowls and chin. J Cosmet Dermatol 2021; 21:600-607. [PMID: 34902199 DOI: 10.1111/jocd.14661] [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: 11/04/2021] [Revised: 11/21/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this investigation was to create and to examine the reproducibility and validity of 5-point photonumeric assessment scales that allow objective assessment of chin retrusion and jawline sagging using a digital and a live validation. MATERIAL AND METHODS Two new 5-point photonumeric scales created to assess chin projection and jawline sagging were validated by 12 experts in a digital validation and by 5 experts in a live validation setting. Intra-rater agreement and inter-rater agreement were assessed. RESULTS For the digital validation, an almost perfect intra-rater (Kappa: 0.89 [95% CI: 0.86-0.91]) and almost perfect inter-rater agreement in both sessions (Kappa: 0.80 [95% CI: 0.74-0.86] and 0.80 [95% CI: 0.74-0.86]) was achieved for the Croma Chin Projection Assessment Scale, while intra-rater agreement (Kappa: 0.88 [95% CI: 0.85-0.91]) was almost perfect for the Croma Jawline Sagging Assessment Scale and inter-rater agreement being substantial in the first session (Kappa: 0.76 [95% CI: 0.71-0.81]) and almost perfect in the second session (Kappa: 0.81 [95%CI: 0.76-0.85]). For the live validation, intra-rater agreement was almost perfect for the Croma Chin Projection Assessment Scale (Kappa: 0.82 [95%CI: 0.74-0.90]) and the Croma Jawline Sagging Assessment Scale (Kappa: 0.83 [95%CI: 0.77-0.89]), while inter-rater agreement was substantial in both sessions for both scales. CONCLUSION The created chin and jawline photonumeric grading scales are valid and reliable tools for assessing chin projection and jawline sagging. The scales will be of value for standardized chin evaluation and quantifying outcomes in clinical research and daily practice.
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Affiliation(s)
- Rainer Pooth
- ICA Aesthetic Navigation GmbH, Frankfurt, Germany
| | | | | | - Jeremy B Green
- Skin Associates of South Florida, Skin Research Institute, Coral Gables, Florida, USA
| | | | - Tatjana Pavicic
- Private Practice for Dermatology & Aesthetics Dr. Tatjana Pavicic, Munich, Germany
| | | | | | | | | | - Doris Day
- Private Practice, New York City, New York, USA
| | - Atchima Suwanchinda
- Faculty of Medicine, Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
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32
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Pavicic T, Pooth R, Prinz V, Cajkovsky M, Green JB, Hernandez CA, Mueller DS, Sattler S, Klepetko H, Day D, Kerscher M, Suwanchinda A, Cotofana S, Frank K, Fabi SG. Validated 5-point photonumeric scales for the assessment of the periorbital region. J Cosmet Dermatol 2021; 21:158-166. [PMID: 34865301 DOI: 10.1111/jocd.14643] [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: 11/04/2021] [Accepted: 11/18/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this investigation was to create and validate 5-point photonumeric scales for the assessment of dynamic crow's feet, static crow's feet, and infraorbital hollows. MATERIAL AND METHODS Three novel 5-point photonumeric scales were created by a medical team. A total of 12 raters from all over the world performed a digital validation, and a total of 5 raters a live validation of the created scale. RESULTS The statistical analysis revealed almost perfect intra-rater and inter-rater reliability in the digital validation of the scales for the assessment of static and dynamic crow's feet as well as infraorbital hollows. In the live validation, both crow's feet scales showed almost perfect intra-rater reliability, while the Croma Infraorbital Hollow Assessment Scale showed substantial intra-rater reliability. Inter-rater reliability was substantial for all three scales in the live validation. All three scales, the Croma Dynamic Crow's Feet Assessment Scale, Croma Static Crow's Feet Assessment Scale, and Croma Infraorbital Hollow Assessment Scale, were validated digitally and in a live setting. CONCLUSION The created scales to assess infraorbital hollowing, dynamic and static crow's feet have been shown to provide substantial to almost perfect agreement in the digital and live validation and can thus be considered as helpful tools in the clinical and research setting. While technical methods and appliances to assess the degrees of severity of age-dependent features are advancing, validated scales are of great importance due to their ease of use and, as shown by the validations, reliability, and reproducibility.
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Affiliation(s)
- Tatjana Pavicic
- Private Practice for Dermatology & Aesthetics Dr. Tatjana Pavicic, Munich, Germany
| | - Rainer Pooth
- ICA Aesthetic Navigation GmbH, Frankfurt, Germany
| | | | | | - Jeremy B Green
- Skin Associates of South Florida, Skin Research Institute, Coral Gables, Florida, USA
| | | | | | | | | | - Doris Day
- Private Practice, New York City, New York, USA
| | - Martina Kerscher
- Division of Cosmetic Sciences, University of Hamburg, Hamburg, Germany
| | - Atchima Suwanchinda
- Faculty of Medicine, Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
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Jones D, Palm M, Cox SE, McDermott M, Sartor M, Chawla S. Safety and Effectiveness of Hyaluronic Acid Filler, VYC-20L, via Cannula for Cheek Augmentation: A Randomized, Single-Blind, Controlled Study. Dermatol Surg 2021; 47:1590-1594. [PMID: 34743118 PMCID: PMC8612896 DOI: 10.1097/dss.0000000000003246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Using cannulas to deliver facial fillers may reduce adverse events (AEs) compared with needle injection. OBJECTIVE To evaluate the safety and effectiveness of VYC-20L (20 mg/mL hyaluronic acid gel with lidocaine) via cannula for midface age-related volume deficit. MATERIALS AND METHODS This multicenter, evaluator-blind, randomized, within-subject, controlled study enrolled adults with moderate to severe Mid-Face Volume Deficit Scale (MFVDS) scores. VYC-20L was administered in one cheek via cannula (with optional needle use in the zygomaticomalar region) and in the other cheek via needle. The primary effectiveness end point was the mean (95% confidence interval [CI]) paired difference between treatments in MFVDS score change from baseline to Month 1; an upper CI limit of less than 0.5 determined noninferiority. Injection-site responses (ISRs), procedural pain, and AEs were assessed. RESULTS Of 60 randomized and treated subjects, the mean change in MFVDS score from baseline to Month 1 was -1.8 with cannulas and -1.9 with needles, providing a mean (95% CI) paired difference of 0.1 (-0.05 to 0.25). Most ISRs were mild/moderate and resolved within 2 weeks. Procedural pain was minimal, and no serious AEs were reported. CONCLUSION VYC-20L for cheek augmentation was safe and effective using a cannula and noninferior to needle injection.
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Affiliation(s)
- Derek Jones
- Skin Care and Laser Physicians of Beverly Hills, Los Angeles, California
| | | | | | | | - Marta Sartor
- Allergan Aesthetics, an AbbVie Company, Irvine, California
| | - Smita Chawla
- Allergan Aesthetics, an AbbVie Company, Irvine, California
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Bernardini FP, Casabona G, Alfertshofer MG, Frank K, Moellhoff N, Gotkin RH, Davidovic K, Voropai D, Valli A, Cotofana S. Soft tissue filler augmentation of the orbicularis retaining ligament to improve the lid-cheek junction. J Cosmet Dermatol 2021; 20:3446-3453. [PMID: 34679226 DOI: 10.1111/jocd.14495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The orientation of facial ligaments changes with increasing age due to the loss of bony support. Soft tissue filler injections placed in close proximity to facial ligaments can alter their orientation to help achieve an improved and younger aesthetic appearance. OBJECTIVE To assess the anatomic and aesthetic effects of a standardized injection with soft tissue filler placed directly inferior to the orbicularis retaining ligament in the infraorbital region. METHODS A total of 163 patients with signs of infraorbital aging were treated with a standardized soft tissue filler injection into and in close proximity to the orbicularis retaining ligament (ORL). 2D frontal images of the infraorbital region were rated by eleven blinded and independent raters with regards to the aesthetic appearance of the infraorbital region before and after the standardized injection treatment. RESULTS The aesthetic appearance of the entire infraorbital region (lid-cheek junction) was rated before and after the treatment. The severity of the tear trough (medial aspect of the infraorbital region) as well as the hollowing of the lateral aspect of the infraorbital region also was rated before and after the treatment. Aesthetic improvement was statistically significant when evaluated by the blinded raters, the treating physician, and the patients. All the results were "very much improved" compared to baseline. CONCLUSION The effectiveness of this injection technique is thought to be due to the strategic placement of soft tissue filler that helps to reposition facial ligaments that have changed their orientation during the aging process.
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Affiliation(s)
| | | | - Michael G Alfertshofer
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Konstantin Frank
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Nicholas Moellhoff
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | | | - Kristina Davidovic
- Department of Radiology, & Medical School, University of Belgrade, Serbia
| | | | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Sulovsky M, Müller D, Prinz V, Moellhoff N, Cajkovsky M, Duschek N, Frank K. A prospective open-label, multicentre study evaluating a non-cross-linked hyaluronic acid based soft-tissue filler in the correction of lateral canthal and perioral lines. J Cosmet Dermatol 2021; 21:191-198. [PMID: 34559948 DOI: 10.1111/jocd.14460] [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: 07/16/2021] [Revised: 08/28/2021] [Accepted: 09/02/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this investigation was to assess the effectiveness of a non-cross-linked hyaluronic acid based soft-tissue filler in the correction of lateral canthal lines and periorbital lines. MATERIAL AND METHODS A total of 59 female Caucasian patients with a mean age of 52.6 ± 9.0 years were enrolled in this prospective open-label, multicentre study and received intradermal injections of a soft-tissue filler at baseline, after 3 and 6 weeks. Aesthetic improvement and patient satisfaction, skin hydration, skin firmness and skin elasticity, as well as adverse events were assessed at 3, 6, 8, 12 and 16 weeks. RESULTS At baseline, the lateral canthal skin firmness was 0.206 ± 0.07 mm and increased after 8 weeks to 0.087 ± 0.08 mm with p < 0.001, while the perioral skin firmness was 0.205 ± 0.09 mm and increased after 8 weeks to 0.116 ± 0.08 mm with p < 0.001. Increases in skin hydration were observed after 8 weeks in both areas, however, did not reach statistical significance at any point. At week 8, 12 and 16 a majority (93.1%, 91.1% and 73.7% respectively) of the patients stated that they were 'satisfied' or 'very satisfied' with the treatment. CONCLUSION Overall, the skin firmness and skin visco-elasticity showed significant increases in the lateral canthal and perioral region. Moreover, albeit not statistically significant, skin hydration increased in both areas after 8 weeks. The procedure has been shown to be safe and satisfactory for the treated patients; however, emergence of oral herpes should be added to the safety profile of intradermally applied hyaluronic acid treatments.
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Affiliation(s)
| | - Daniel Müller
- Yuvell Home of Aesthetics, Private Clinic, Vienna, Austria
| | | | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Mia Cajkovsky
- Yuvell Home of Aesthetics, Private Clinic, Vienna, Austria
| | | | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
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Müller D, Prinz V, Sulovsky M, Cajkovsky M, Moellhoff N, Cotofana S, Frank K. Longevity and subject-reported satisfaction after minimally invasive jawline contouring. J Cosmet Dermatol 2021; 21:199-206. [PMID: 34536051 DOI: 10.1111/jocd.14410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Minimally invasive treatments as soft tissue filler injections can enhance the appearance of the jawline. This prospective, single-center study investigated aesthetic outcome, patient satisfaction, adverse events, and volume changes after jawline contouring using standardized reporting scales and objectifiable 3D surface analysis. METHODS A total of 30 patients (1 male and 29 females, mean age: 57.2 (±8.7) years) were investigated. Patients underwent jawline augmentation using a highly cross-linked hyaluronic acid-based soft tissue filler. Three-dimensional surface imaging was performed after 2 weeks, and 3, 6, 9, and 12 months. Furthermore, the aesthetic results and the occurrence of complications were investigated after two weeks, and 3, 6, 9, and 12 months. RESULTS The surface-volume coefficient (SVC) had an average of 1.10 ± 0.2 after 14 days, 0.95 ± 0.1 after 3 months, 0.83 ± 0.1 after 6 months, 0.74 ± 0.1 after 9 months, and 0.63 ± 0.1 after 12 months. A significant correlation was revealed between time of measurement and measured SVC with rp = -0.761, p < 0.001. Multivariate analysis revealed a significant difference between the measured SVC and the different time points of measurement with p < 0.001. The data revealed strong aesthetic improvement with results most often reported as "very much improved" according to the 5-point GAIS after 3, 6, and 9 months, both by the investigator and by the patients. A 12-month follow-up analysis showed "much improved" results in a majority of cases. CONCLUSION The result of this investigation showed that jawline enhancement using minimally invasive soft tissue filler injections produces durable, safe results that are generally rated as very satisfying from a patient's and investigator's perspective over a time period of 12 months.
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Affiliation(s)
- Daniel Müller
- Yuvell - Home of Aesthetics, Private Practice, Vienna, Austria
| | - Valentina Prinz
- Yuvell - Home of Aesthetics, Private Practice, Vienna, Austria
| | - Monika Sulovsky
- Yuvell - Home of Aesthetics, Private Practice, Vienna, Austria
| | - Mia Cajkovsky
- Yuvell - Home of Aesthetics, Private Practice, Vienna, Austria
| | - Nicholas Moellhoff
- 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, MN, USA
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
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Kapoor KM, Saputra DI, Porter CE, Colucci L, Stone C, Brenninkmeijer EEA, Sloane J, Sayed K, Winaya KK, Bertossi D. Treating Aging Changes of Facial Anatomical Layers with Hyaluronic Acid Fillers. Clin Cosmet Investig Dermatol 2021; 14:1105-1118. [PMID: 34471372 PMCID: PMC8405095 DOI: 10.2147/ccid.s294812] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/05/2021] [Indexed: 12/17/2022]
Abstract
The aging process affects every anatomical layer of the face. Improved knowledge of how aging occurs in each anatomical layer of the face has helped evolve the facial rejuvenation strategies with HA fillers. Understanding the age-related changes in the anatomical facial layers, including their time of onset and how the changes occur in the different tissue layers, an injector can provide much more targeted and refined HA filler treatments. As fillers’ use has increased, there has been a distinct shift away from procedures lifting the skin and SMAS. We can selectively target the anatomical facial layers with HA fillers for more refined and predictable outcomes. An extensive range of HA filler variants is now available. Each filler type is optimized and designed to be injected into specific tissue planes for the best results. Knowing the predictable aging changes in the different tissue layers of the face is crucial as this guides the optimum filler choice. Working knowledge of the individual characteristics of the numerous HA-based products allows for their effective placement in the correct layer. Familiarity with the correct HA product may also help to minimize the downtime and risk of adverse events.
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Affiliation(s)
- Krishan Mohan Kapoor
- Anticlock Clinic, Chandigarh, India.,Department of Plastic Surgery, Fortis Hospital, Mohali, India
| | | | | | | | | | | | - Jake Sloane
- Infinity Skin Clinic, Surry Hill, NSW, Australia
| | - Karim Sayed
- Faculty of Health and Social Sciences, University of South-East Norway, Drammen, Norway
| | | | - Dario Bertossi
- Department of Maxillo-Facial Surgery, University of Verona, Verona, Italy
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Cotofana S, Assemi-Kabir S, Mardini S, Giunta RE, Gotkin RH, Moellhoff N, Avelar LET, Mercado-Perez A, Lorenc ZP, Frank K. Understanding Facial Muscle Aging: A Surface Electromyography Study. Aesthet Surg J 2021; 41:NP1208-NP1217. [PMID: 33942051 DOI: 10.1093/asj/sjab202] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Facial aging is a multifactorial process that involves all tissues of the face, including skin, muscles, fat, ligaments, and bone. Whereas robust evidence is available for age-related changes of bone and facial fat, the influence of age on facial muscle activity is poorly understood. OBJECTIVES The objective of this study was to investigate the motor unit action potential of facial muscles by utilizing surface-derived, noninvasive electromyography in young and old healthy volunteers. METHODS The study investigated a total of 32 healthy volunteers with a mean [standard deviation] age of 42.6 [19.6] years (range, 21-82 years) and a mean BMI of 23.9 [2.7] kg/m2 (range, 18.5-29.7 kg/m2) by performing surface-derived, noninvasive facial electromyography. Nine facial muscles were investigated bilaterally, resulting in a total of 1632 measurements of the signal, baseline noise, and signal-to-noise ratio of these muscles. RESULTS The results of the study revealed that age does not significantly influence the signal (P = 0.234), the baseline noise (P = 0.225), or the signal-to-noise ratio (P = 0.432) of younger individuals (<30 years) vs older individuals (>50 years) in a gender- and BMI-matched statistical model. Exceptions were the zygomaticus major muscle (reduced activity), procerus muscle (increased activity), and corrugator supercilii muscle (increased activity). CONCLUSIONS The results of this facial electromyography study may help to increase the understanding of facial aging. Future studies need to reproduce the results presented herein to further increase our understanding of facial aging.
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Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Shirin Assemi-Kabir
- Department for Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Samir Mardini
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | - Riccardo E Giunta
- Department for Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilian University, Munich, Germany
| | | | - Nicholas Moellhoff
- Department for Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilian University, Munich, Germany
| | | | - Arnaldo Mercado-Perez
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Z Paul Lorenc
- Department of Plastic Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Konstantin Frank
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Schelke L, Velthuis PJ, Lowry N, Rohrich RJ, Swift A, Gotkin RH, Moellhoff N, Frank K, Dumbrava M, Cotofana S. The mobility of the superficial and deep midfacial fat compartments: An ultrasound-based investigation. J Cosmet Dermatol 2021; 20:3849-3856. [PMID: 34365716 DOI: 10.1111/jocd.14374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding the mobility of the midface and the separate contributions of the superficial and deep fat compartments is essential for natural esthetic outcomes following soft tissue filler or fat grafting procedures. A study was designed that used ultrasound imaging to demonstrate in vivo visualization and quantification of distances and movements in the midface. METHODS A total of 48 midfaces of 24 healthy Caucasian volunteers, all naïve of esthetic procedures, (22 females; 46.85 (9.8) years; 22.83 (3.1) kg/m2 ) were scanned using 18 MHz ultrasound imaging. Distances between bony landmarks (inferior orbital rim, infraorbital foramen) were used as markers to measure the cranial movement of the superficial (superficial nasolabial and superficial medial cheek fat compartment) and the deep (deep pyriform space, deep medial check fat compartment, deep lateral cheek fat compartment) midfacial fat compartments between resting and smiling facial position. RESULTS The superficial midfacial fat compartment moved, on average, 3.7 mm (p < 0.001) cranially, whereas the deep midfacial fat compartments moved, on average, 0.1 mm (p > 0.05) during smiling. No gender differences in mobility were identified (p > 0.05). CONCLUSION The results obtained are in line with previous cadaveric investigations and revealed, in a highly statistically significant fashion, that the superficial midfacial fat compartments move in cranial direction whereas the deep fat compartment did not display similar positional changes. These results help to guide facial injectable treatments and to understand why, in the midface, a deep supraperiosteal approach should be favored when augmenting the deep midfacial fat compartments.
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Affiliation(s)
- Leonie Schelke
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands.,Private Practice, Amsterdam, The Netherlands
| | - Peter J Velthuis
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Natalia Lowry
- Division of Anatomy, Department of Medical Education, Albany Medical College, Albany, NY, USA
| | | | - Arthur Swift
- Westmount Institute of Plastic Surgery, Montreal, Quebec, Canada
| | | | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Mihai Dumbrava
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Abstract
BACKGROUND Anatomical studies have identified separate superficial and deep facial fat compartments, leading some to theorize that volume loss from the deep midface causes overlying superficial fat pseudoptosis. Unfortunately, a paucity of evidence exists regarding whether facial fat volume is truly lost with age and, if so, whether it is lost equally or differentially from the superficial and deep compartments. The aim of this study was to quantify volume changes occurring with age within the superficial, deep, and buccal fat compartments of the midface. METHODS A retrospective longitudinal study was performed evaluating individuals aged 30 to 65 years who underwent facial computed tomography followed by facial computed tomography greater than or equal to 10 years later. Superficial midface, deep midface, and buccal fat volumes were quantified using Horos radiology software. RESULTS Nineteen subjects met inclusion criteria. Mean total fat volume decreased significantly from 46.47 cc to 40.81 cc (p < 0.01). The mean superficial and deep fat volumes both decreased significantly from 26.10 cc to 23.15 cc (p < 0.01) and from 11.01 cc to 8.98 cc (p < 0.01), respectively. No significant difference was observed in buccal fat volume over time (9.36 cc to 8.68 cc; p = 0.04). Patients lost an average of 11.3 percent of their initial superficial fat volume and 18.4 percent of their initial deep fat volume. CONCLUSIONS Significant volume loss was observed from both superficial and deep facial fat compartments over a mean 11.3 years. Patients lost a greater percentage of deep facial fat volume, providing support for the theory of pseudoptosis caused by deep midface fat loss.
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Lim T, Frank K, Hadjab B. Target-Specific Sandwich Technique: Facial rejuvenation leveraging CPM technology. J Cosmet Dermatol 2021; 21:207-219. [PMID: 34255904 DOI: 10.1111/jocd.14342] [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: 04/27/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
Injectable rejuvenation treatments used in Caucasians might not always suit Asians as the visible signs of aging manifest differently, underscoring a need for Asian-specific strategies that correct underlying structural deficiencies and cumulative age-related changes. The presented Target-Specific Sandwich Technique (TSST) aims to simultaneously restore, rejuvenate, and enhance faces through the distribution of minute amounts of different fillers with different rheologies, using a minimal number of entry points in strategic facial areas and different soft tissue layers in Asians. A total of 14 patients underwent the presented TSST and were subsequently assessed for satisfaction with the treatment and the outcome of the treatment. With 3 cc of fillers, patients experienced a rejuvenated appearance with brow support, brow ridge softening, less severe nasolabial folds, and corrected tear trough hollows. Fillers in the lateral canthal and mandibular angles lifted mouth corners, improved submandibular jowls, and defined the lower face. Although the prejowl sulcus received minimal filler, it appeared subtler, relaxed, and had fewer lines visible while smiling. Overall, patients appeared less tense, rejuvenated, and had improved light reflection and firmer skin. These were due to tissues being supported upward and laterally by fillers in areas of bone resorption-induced volume loss.
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Cotofana S, Gavril DL, Frank K, Schenck TL, Pawlina W, Lachman N. Revisit, Reform, and Redesign: A Novel Dissection Approach for Demonstrating Anatomy of the Orbit for Continuing Professional Development Education. ANATOMICAL SCIENCES EDUCATION 2021; 14:505-512. [PMID: 32729168 DOI: 10.1002/ase.2006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/24/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
Advanced postgraduate medical education for health-care professionals is constantly evolving. Understanding facial anatomy and especially its vascular system is crucial when performing soft tissue filler injections to avoid adverse events including tissue loss or irreversible blindness. Standard anatomical resources often fall short of elucidating clinically relevant concepts in more highly specialized areas of interest. A novel dissection approach for demonstrating the anatomy of the lateral orbit was presented at scientific meetings to participants from dermatology, plastic surgery, and general practice. Results from the post-course online survey (n = 52) were analyzed. The results of the survey reveal a high educational impact and a high clinical relevance of the novel dissection approach. In addition, the majority of respondents (97.7%; n = 51) felt that the exposed anatomical structure of the orbit and face improved their ability to safely perform cosmetic procedures on the face. More experienced respondents who had previously attended at least five cadaveric dissections were more likely to strongly agree that reviewing anatomy through this novel dissection approach increased their confidence in avoiding periorbital vascular danger zones. As minimally invasive outpatient procedures continue to evolve, practicing physicians and mid-level providers often face the challenge of having to reconcile preexisting anatomical knowledge with new clinical practice. Skills required to navigate high impact anatomy include visualization of structures that form the navigational landscape and avoidance of key danger zones. The novel dissection approach to the lateral orbit reflects the increasing focus on revisiting, reforming, and redesigning anatomy for continuing professional development activities.
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Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | - Konstantin Frank
- Department for Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilian University Klinikum, Ludwig-Maximilian University, Munich, Germany
| | - Thilo L Schenck
- Department for Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilian University Klinikum, Ludwig-Maximilian University, Munich, Germany
| | - Wojciech Pawlina
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Nirusha Lachman
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Paradoxical Temporal Enlargement: An Expansion of Superficial Temporal Fat Pad Following Interfacial Technique for Pterional Craniotomy. J Craniofac Surg 2021; 32:2597-2602. [PMID: 34183631 DOI: 10.1097/scs.0000000000007730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Contour irregularities in the temporal region have been reported previously after procedures involving temporal dissection. In this study, we report paradoxical temporal enlargement (PTE) following interfascial pterional craniotomy. METHODS A retrospective review of patients who underwent a unilateral transcranial procedure with frontotemporal approach at our institution between September 2013 and December 2017 was performed. Patients with a previous craniotomy or bilateral craniotomy were excluded. Radiological imaging series including computed tomography and magnetic resonance imaging were utilized to calculate temporal soft tissue volumes both preoperatively and postoperatively by using advanced software technology. Relative soft tissue volume differences between the operative side and the contralateral side were calculated at different time-points including preoperative, 3-months follow-up (3M), 12-months (12M) follow-up, and the last follow-up (LFU, over 1-year). RESULTS Forty-three patients were included. Mean age was 52.7 ± 4.5 years. Mean follow-up was 27.9 ± 15.8 months. Significant changes of temporal fat pad relative-volume difference were observed between the preoperative and the corresponding 3M (t [82] = -2.8865, P = 0.0050); 12M (t [77] = -4.4321, P < 0.0001), and LFU (t [74] = -4.9862, P < 0.0001) postoperative time points. No significant change of the temporalis muscle was observed between the preoperative and the corresponding 3M (P = 0.3629), 12M (P = 0.1553), or LFU (P = 0.0715). Soft tissue volume showed a significant increase on the operative side between the preoperative and the corresponding LFU (t [74] = -2.5866, P = 0.0117). CONCLUSIONS Paradoxical temporal enlargement with more than 10% volumetric change was observed in 24% of the patients at their LFU (>1-year). This change was not due to temporalis muscle changes. Paradoxical temporal enlargement was due to hypertrophy of the superficial temporal fat pad. Before surgical correction of postoperative temporal contour changes, it is important to obtain imaging and characterize the etiology of the deformity.
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Gombolevskiy V, Gelezhe P, Morozov S, Melnikov DV, Vorontsov A, Kulberg N, Frank K, Gotkin RH, Lachman N, Cotofana S. The Course of the Angular Artery in the Midface: Implications for Surgical and Minimally Invasive Procedures. Aesthet Surg J 2021; 41:805-813. [PMID: 32593170 DOI: 10.1093/asj/sjaa176] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Previous anatomic studies have provided valuable information on the 2-dimensional course of the angular segment of the facial artery in the midface and its arterial connections. The third dimension (ie, the depth of the artery) is less well characterized. OBJECTIVES The objective of the present study was to describe the 3-dimensional pathway of the angular segment of the facial artery and its relationship to the muscles of facial expression. METHODS The bilateral location and the depth of the midfacial segment of the facial artery was measured utilizing multi-planar computed tomographic image analyses obtained from contrast agent-enhanced cranial computed tomographic scans of 156 Caucasians aged a of 45.19 ± 18.7 years and with a mean body mass index of 25.05 ± 4.9 kg/m2. RESULTS At the nasal ala, the mean depth of the main arterial trunk was 13.7 ± 3.7 mm (range, 2.7-25.0 mm), whereas at the medial canthus it was 1.02 ± 0.62 mm (range, 1.0-3.0 mm). This was reflected by the arteries' relationship to the midfacial muscles: at the nasal ala superficial to levator anguli oris in 62.0% but deep to the levator labii superioris alaeque nasi in 53.6%; at the medial canthus superficial to the levator labii superioris alaeque nasi in 83.1% and superficial to the orbicularis oculi in 82.7%. CONCLUSIONS The results presented herein confirm the high variability in the course of the angular segment of the facial artery. Various arterial pathways have been identified providing evidence that, in the midface, there is no guaranteed safe location for minimally invasive procedures.
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Affiliation(s)
- Victor Gombolevskiy
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Pavel Gelezhe
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Sergey Morozov
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Dmitry V Melnikov
- Plastic Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Nikolay Kulberg
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
| | | | - Nirusha Lachman
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Garg S, Vashisht KR, Sushruth PR, Saka DV. Monopolar radiofrequency for reposing drooping fat planes and facial rejuvenation: A prospective study on 30 subjects towards true antiaging. J Cosmet Dermatol 2021; 21:1489-1500. [PMID: 34038038 DOI: 10.1111/jocd.14255] [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: 03/08/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Monopolar radiofrequency (MRF) for facial rejuvenation works by diffusely heating the dermis and subdermal fibro-septal network. Immediate collagen contraction and long-term neo-collagenesis produce antiaging effects. AIM To lift and repose drooping fat planes along their vectors of descent to restore natural, youthful contours using MRF and to objectively measure, quantify, and analyze the antiaging effects of MRF on the backdrop of functional facial anatomy. METHODS This was a prospective study on 30 subjects aged 25-65 years who underwent three sessions of MRF (Exilis, BTL Aesthetics) with a modified protocol at weekly intervals. Clinical evaluation at baseline and 4 weeks after the final session was done according to the global drooping and wrinkles classification and scoring system (GDWCSS) and statistically evaluated. Two patients were analyzed with Ultrasound and Vectra-H1 imaging for change in subcutaneous fat depth and volume over different facial areas, respectively. RESULTS There was improvement in all parameters (volume alteration and wrinkles) of the GDWCSS, of which improvement in cases that had baseline severe (grade-4) temporal fat loss, malar fat loss, periorbital hollowing, and puffiness was statistically significant. The results of imaging supported the clinical findings. CONCLUSION Monopolar radiofrequency targets facial collagen as deep as the facial fat, thereby achieving "reversal" of the grooves and bulges of aging with volume re-distribution and favorable "remolding" of fat pads. The result is simultaneous skin tightening, lifting and contouring in manner that is natural, regenerative, and corrective. Given its versatility, efficacy, safety, and tolerability, it is emerging as a power-player in the dermatologist's antiaging armamentarium.
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Affiliation(s)
- Suruchi Garg
- Department of Aesthetic and Intervention Dermatology, Aura Skin Institute, Chandigarh, India
| | - Kanya Rani Vashisht
- Department of Aesthetic and Intervention Dermatology, Aura Skin Institute, Chandigarh, India
| | - P Ram Sushruth
- Department of Aesthetic and Intervention Dermatology, Aura Skin Institute, Chandigarh, India
| | - Deepa V Saka
- Department of Aesthetic and Intervention Dermatology, Aura Skin Institute, Chandigarh, India
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Gelezhe P, Gombolevskiy V, Morozov S, Melnikov DV, Korb TA, Aleshina OO, Frank K, Gotkin RH, Green JB, Cotofana S. Three-Dimensional Description of the Angular Artery in the Nasolabial Fold. Aesthet Surg J 2021; 41:697-704. [PMID: 32504489 DOI: 10.1093/asj/sjaa152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Due to its arterial vasculature, the nasolabial sulcus is one of the most challenging facial regions to treat when trying to ameliorate the signs of facial aging. OBJECTIVES The aim of the present study was to provide data on the 3-dimensional course of the angular artery within the nasolabial sulcus in relation to age, gender, and body mass index to increase safety during minimally invasive treatments. METHODS Thee hundred nasolabial sulci from 75 males and 75 females of Russian Caucasian ethnic background (mean [standard deviation] age, 45.7 [18.7] years; mean body mass index, 25.14 [4.9] kg/m2) were analyzed. Bilateral multiplanar measurements were based on contrast-enhanced computed tomography cranial scans. RESULTS Up to 3 arteries could be identified within the nasolabial sulcus: ~90% contained 1 arterial trunk, ~9% had 2 trunks, and ~1% had 3 trunks; females had more arteries than men. The artery is located at mean depths of 21.6 mm at the oral commissure and 8.9 mm at the nasal ala. The angular artery was lateral to the nasolabial sulcus in 100% of cases; the smallest distance between the artery and the nasolabial sulcus was at the oral commissure (11.91 [7.9] mm) and the greatest was at the nasal ala (13.73 [3.9] mm). CONCLUSIONS In contrast to current concepts, the angular artery is not located strictly subdermal to the nasolabial sulcus but at a variable depth, and in 100% of the investigated cases lateral to the nasolabial sulcus. With increasing age, the depth and lateral distance between arteries and sulci reduces significantly, underscoring the need for special caution when injecting this site.
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Affiliation(s)
- Pavel Gelezhe
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Victor Gombolevskiy
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Sergey Morozov
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Dmitry V Melnikov
- Plastic Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Tatiana Aleksandrovna Korb
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Olga Olegovna Aleshina
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians University, Munich, Germany
| | | | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Yang CS, Huang YL, Chen CB, Deng CY, Liu YT, Huang PHP, Chang KC. Aging Process of Lateral Facial Fat Compartments: A Retrospective Study. Aesthet Surg J 2021; 41:NP247-NP254. [PMID: 33649752 DOI: 10.1093/asj/sjaa340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since 2007, when the anatomy of facial fat compartment was described, an increasing number of studies on the aging process of the compartment of cadavers has emerged. OBJECTIVES The authors evaluated the aging changes of lateral facial fat compartments on the same person. METHODS Sixty-three patients were included in this retrospective study. All patients had magnetic resonance imaging scans with at least 4 years apart. The authors targeted the fat compartments of the superficial temporal, subcutaneous temporal, and buccal fat pad, comparing the data on different time points. RESULTS The thickness of the subcutaneous temporal fat did not change significantly. The 3 diameters of the superficial temporal fat compartment all became thinner on the axial view (P < 0.05). On the sagittal view, the superficial temporal fat elongated from 38.89 mm to 43.74 mm (P < 0.05). The buccal fat compartment also lengthened from 68.73 mm to 74.39 mm (P < 0.05) and had a positive correlation with follow-up duration only. CONCLUSIONS The study revealed the fat compartment change on the same person with time. The temporal hollow mainly originates from the thinner part of the superficial temporal fat. The descending of the buccal fat pad aggravates the labiomandibular fold. By understanding the aging process more fully, we can rejuvenate our patients more naturally.
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Affiliation(s)
- Ching-Sheng Yang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yau-Li Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Ying Deng
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taiwan
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Topographic Anatomy of the Zygomatico-Orbital Artery: Implications for Improving the Safety of Temporal Augmentation. Plast Reconstr Surg 2021; 148:19e-27e. [PMID: 34003805 DOI: 10.1097/prs.0000000000008100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anatomical knowledge of the zygomatico-orbital artery and its most relevant clinical applications is essential for ensuring the safety of filler injection into the temporal region. The purpose of this study was to provide the precise position, detailed course, and relationship with surrounding structures of the zygomatico-orbital artery. METHODS Fifty-eight patients who underwent head contrast-enhanced three-dimensional computed tomography and 10 fresh frozen cadavers were investigated. RESULTS The zygomatico-orbital artery was identified in 93 percent of the samples in this work. Ninety-four percent of the zygomatico-orbital arteries derived directly from the superficial temporal artery, and the remaining arteries started from the frontal branch of the superficial temporal artery. According to the origin of the zygomatico-orbital artery, it was classified into type I and type II. Type I arteries were then classified into three subtypes. The trunk of the zygomatico-orbital artery was located between the deep temporal fascia and the superficial temporal fascia. Deep branches of the zygomatico-orbital artery pierced the superficial layer of the deep temporal fascia. The zygomatico-orbital artery originated from 11.3 mm in front of the midpoint of the apex of the tragus, and most of its trunks were located less than 20.0 mm above the zygomatic arch. The mean diameter of the zygomatico-orbital artery was 1.2 ± 0.2 mm. There were extensive anastomoses between the zygomatico-orbital artery and various periorbital arteries at the lateral orbital rim. CONCLUSION The precise anatomical knowledge of the zygomatico-orbital artery described in this study could be helpful for cosmetic physicians for improving the safety of temporal augmentation.
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Müller DS, Prinz V, Sulovsky M, Cajkovsky M, Cotofana S, Frank K. Volumization of the young and the old temple using a highly cross-linked HA filler. J Cosmet Dermatol 2021; 20:1634-1642. [PMID: 33773034 DOI: 10.1111/jocd.14109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A plethora of age-related changes contribute to hollowing of the temples, as bone remodeling, atrophy of the temporalis muscle, thinning of the skin, and deflation of the subcutaneous and deep temporal fat create the appearance of a skeletonized face. In addition, previous studies have established a relationship between facial skeletonization, temporal hollowing, and postmenopausal sarcopenia. OBJECTIVE To compare the volume change, adverse events, and patient satisfaction of soft-tissue filler injections in the temple between young (<51) and old (>51) females. MATERIAL AND METHODS A total of 30 women with a mean age of 53.1 ± 12.1 years underwent bilateral temporal volumization. Adverse events and satisfaction were assessed after 3 and 6 months. 3-Dimensional surface imaging was performed at baseline and after 2 weeks, 3 and 6 months to assess volumetric changes. RESULTS A mean volume of 5.55 ± 1.9 cc was injected into the temples. A total of 31 adverse events were observed in 13 patients. The overall satisfaction of the procedure was very high after 3 and 6 months in both patient groups, and raters showed a significant agreement in their assessment of the aesthetic improvement, while the self-reported patient satisfaction was also substantially high. The surface-volume coefficient differed significantly between 14 days and 3 months post-injection only in pre-menopausal patients, while no significant difference was detected between 3 and 6 months. CONCLUSION Temporal soft-tissue filler injections are safe and provide long-lasting aesthetic improvement both in pre- and postmenopausal women.
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Affiliation(s)
- Daniel S Müller
- YUVELL - Home of Aesthetics, Private Practice, Vienna, Austria
| | - Valentina Prinz
- YUVELL - Home of Aesthetics, Private Practice, Vienna, Austria
| | - Monika Sulovsky
- YUVELL - Home of Aesthetics, Private Practice, Vienna, Austria
| | - Mia Cajkovsky
- YUVELL - Home of Aesthetics, Private Practice, Vienna, Austria
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
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Quantitative Analysis of the Lifting Effect of Facial Soft-Tissue Filler Injections. Plast Reconstr Surg 2021; 147:765e-776e. [PMID: 33890889 DOI: 10.1097/prs.0000000000007857] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although injectable soft-tissue fillers are frequently used for facial rejuvenation, there is a dearth of objective data evaluating the tissue-lifting effects. Current practices for efficacy evaluation include some subjectivity. This study seeks to evaluate the lifting effects of facial soft-tissue fillers in a quantifiable, objective setting. METHODS Twenty fresh hemifaces obtained from 10 Caucasian body donors (seven women and three men) with a mean age of 83.5 ± 6.8 years and a mean body mass index of 25.3 ± 4.3 kg/m2 were injected with soft-tissue fillers following a predefined treatment algorithm. Three-dimensional surface scanning procedures were performed to assess postinjection effects. RESULTS Injections in the medial face [i.e., forehead, medial midface, and perioral (chin and labiomandibular sulcus)] increased the local surface volume by 0.67, 0.56, and 0.87 cc and created local (but not regional) lifting effects of 1.11, 0.11, and 0.74 mm. Injections in the lateral face (temple, lateral midface, and jawline) changed the local surface volume by 0.45, 0.02, and -0.38 cc, and created local lifting effects of 0.57, 0.81, and 0.29 mm, respectively. Lateral face injections, however, created additional regional lifting effects by co-influencing neighboring lateral facial regions, which was not observed for medial face injections. CONCLUSIONS This cadaveric study provides evidence that soft-tissue fillers, although typically classified as volumizers, can induce lifting effects of the face. Whereas temporal deep supraperiosteal injections have limited lifting effects, the combined effects of subdermal injections of the temple, lateral midface, and mandibular angle can induce lifting effects of the total lateral face. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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