The Aging Lip: A Comparative Histological Analysis of Age-Related Changes in the Upper Lip Complex:

A Comparison of Using Cuffed and Uncuffed Face Masks for Providing Manual Bag Ventilation in Elderly Patients with Obesity

BACKGROUND

With the improvement of healthcare, the number of elderly individuals, including those with obesity, is increasing. The accumulation of various ventilation problems associated with the use of face masks in both these patient groups can pose a challenge even for an experienced anesthesiologist. The main aim of this study was to evaluate the ventilation of elderly patients with obesity using face masks, uncuffed or cuffed, and compare it with values obtained among patients with obesity who are not elderly. The secondary aim of the study was to demonstrate which of the two masks tested is better for elderly patients with android and gynoid obesity.

METHODS

This study was conducted at University Clinical Hospital No. 1 in Lodz among 108 patients with obesity, 50 elderly and 58 non-elderly. Patients' BMIs ranged from 35.0 to 59.0. For the study, the uncuffed Intersurgical Eco Mask II and cuffed Ambu Ultra Seal face masks were used. Expiratory tidal volume and leakage obtained during the use of both types of masks were examined. The obtained data were analyzed using the Kolmogorov-Smirnov test and supplemented with Wilcoxon test values.

RESULTS

In elderly patients with obesity, especially those with gynoid obesity, the use of the Intersurgical Eco Mask II is associated with better ventilation parameters than the Ambu Ultra Seal mask. Only in the case of elderly patients with android obesity did the use of the Ambu Ultra Seal mask yield similar results to the Intersurgical Eco Mask II.

CONCLUSIONS

Uncuffed face masks provide better ventilation parameters during manual bag ventilation in elderly patients with obesity.

Micro-Coring: A Novel Approach to Perioral Rejuvenation

BACKGROUND

A long philtrum and poor perioral skin quality are stigmata of the aging face. Micro-Coring is a novel technology that allows for scarless skin removal.

OBJECTIVES

In this study we aimed to determine whether micro-coring can shorten the philtrum and improve perioral skin quality.

METHODS

A retrospective cohort study was performed on patients who underwent facelift with perioral micro-coring and age- and BMI-matched controls who underwent facelift alone. Preoperative and postoperative 3-dimensional facial imaging was performed. Standard perioral distances and percentage of change were calculated. Perioral skin quality was evaluated by blinded raters with the Scientific Assessment Scale of Skin Quality (SASSQ) and Global Aesthetic Improvement Scale (GAIS).

RESULTS

Thirteen patients and 13 controls were included, with a mean follow-up of 8.9 months (range 3.0-21.5). Patients had significantly shorter mean philtrum length postoperatively compared to preoperatively, with an average decrease of 6.18% (±2.25%; P < .05). Controls did not experience significant changes in philtrum length (P > .05). There were no significant changes in other perioral measurements. Perioral skin elasticity and wrinkles significantly improved in patients compared to controls and patients had significantly greater GAIS scores (P < .05).

CONCLUSIONS

Micro-Coring can achieve perioral rejuvenation through measurable shortening of the philtrum and observable improvement in skin quality. Nonsurgical techniques continue to find new ways to achieve aesthetic goals without significant recovery or scarring and offer value to patients and clinicians.

LEVEL OF EVIDENCE: 3

Additive Orthodiagonal Rhytidoplasty of the Ergotrid: A Novel Treatment Technique for Severe Dynamic Lip Lines

SUMMARY

Dynamic lip lines pose a challenge in perioral rejuvenation despite the availability of numerous hyaluronic acid dermal filler products and techniques. In this article, the authors introduce additive orthodiagonal rhytidoplasty of the ergotrid, or ADORE, a novel technique for the treatment of severe dynamic lip lines. Based on an objective analysis of treatment outcomes, the authors' technique demonstrates the ability to confer substantial improvement in dynamic lip line severity, with a median reduction in lip line intensity of 79% (average, 70%; SD, 19%) at 1 month and 72% (average, 61%; SD, 21%) at 6 months, and a high degree of patient satisfaction.

Gender- and Age-Related Characterization of Lip Morphology: A Three-Dimensional Analysis in a Chinese Population

BACKGROUND

Establishing facial anthropometric reference values is essential for diagnosis of deformity, assessment of aging, and planning for aesthetic and reconstructive treatment.

OBJECTIVES

This study aimed to provide detailed perioral anthropometric data in relation to sex and age in Chinese persons with a standardized 3-dimensional protocol.

METHODS

Three-dimensional facial photographs were obtained of 60 male and 64 female healthy Chinese participants ages 20 to 35 and 50 to 65 years old, as well as 2 acromegaly patients, with the VECTRA 3D camera. A standardized evaluation was performed to locate 37 perioral landmarks and generate corresponding measurements, including 26 linear distances, 5 ratios, 2 curvatures, 4 areas, and 9 angles. Measurements of different age groups and of different genders were compared, as were measurements of healthy individuals with those of acromegaly patients.

RESULTS

Sex discrepancy was noted in philtrum length, width, and area, lip width, and vermilion and cutaneous upper lip area; these were larger in Chinese males than females. However, vermilion heights were similar in both genders. With age, philtrum and cutaneous upper lip height and area, lip width, and angles related to cupid's bow significantly increased, whereas vermilion height and mouth corner angles decreased, and philtrum width, vermilion areas, and lip protrusion remained unchanged. Compared to healthy Chinese patients, acromegaly patients had a larger value for most measurements. Perioral rejuvenation based on detailed 3-dimensional anthropometry showed good results.

CONCLUSIONS

Chinese males have wider but not thicker lips than females, and aging features thin, flattened, and wide vermilions with a lengthened philtrum in both genders. These data can serve as a reference standard for disease diagnosis, aesthetic procedures, and reconstructive lip surgeries.

LEVEL OF EVIDENCE: 4

Quantification of Facial Fat Compartment Variations: A Three-Dimensional Morphometric Analysis of the Cheek

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.

Differences in the 3-dimensional aging changes of the lips among female adults with skeletal Class I, II, and III malocclusion

INTRODUCTION

The objective of this study was to evaluate and compare the 3-dimensional (3D) aging changes of the lips among adult skeletal Class I, II, and III malocclusion.

METHODS

Female adult orthodontic patients aged 20-50 years with pretreatment cone-beam computed tomography scans were retrospectively classified according to age (20s [20-29 years], 30s [30-39 years], and 40s [40-49 years]) and then subclassified by malocclusion into skeletal Class I, II, and III relationship (9 groups; n = 30 per group). Positional differences in midsagittal and parasagittal soft-tissue landmarks and 3D morphologic aging changes of the lips were evaluated using cone-beam computed tomography scans.

RESULTS

Labiale superius and cheilion for patients in their 40s indicated a significant downward and backward position compared with those in their 20s, regardless of skeletal classifications (P <0.05). Accordingly, the upper lip height decreased, and the mouth width increased significantly (P <0.05). For Class III malocclusion, the upper lip vermilion angle was greater for patients in their 40s than those in their 20s (P <0.05), whereas the lower lip vermilion angle was only lower for patients with Class II malocclusion (P <0.05).

CONCLUSIONS

Middle-aged adult females (40-49 years) had a lower upper lip height and greater mouth width than those in their 20s, regardless of skeletal malocclusion. However, prominent morphologic aging changes of the lips were noted on the upper lip for skeletal Class III malocclusion and the lower lip for skeletal Class II malocclusion, implying that the underlying skeletal features (or malocclusion) may influence 3D aging changes of the lips.

"Untying the knot": The primitive orofacial muscle architecture in the gorilla (Gorilla gorilla) as a key to the evolution of hominin facial movement

The anatomical underpinnings of primate facial expressions are essential to exploring their evolution. Traditionally, it has been accepted that the primate face exhibits a "scala natura" morphocline, ranging from primitive to derived characteristics. At the primitive end, the face consists of undifferentiated muscular sheets, while at the derived end there is greater complexity with more muscles and insertion points. Among these, the role of the human modiolus ("knoten" in German) has been emphasized. Recent studies have challenged this view by revealing significant complexity in the faces of several non-human primates, thereby rejecting the linear notion of facial evolution. However, our knowledge of the facial architecture in gorillas, the second closest living relatives to modern humans, remains a significant gap in the literature. Here, we present new findings based on dissection and histological analysis of one gorilla craniofacial specimen, alongside 30 human hemifaces. Our results indicate that while the number and overall arrangement of facial muscles in the gorilla are comparable to those of chimpanzees and modern humans, several orofacial features distinguish the gorilla's anatomy from that of hominins. Among these are the absence of a modiolus, the continuity of muscular fibers over the region of the mouth corner, the flat (uncurving) sheet of the orbicularis oris muscle, and the insertion of direct labial tractors both anterior and posterior to it. Collectively, the anatomical characteristics observed in the gorilla suggest that the complex anatomy of the hominin face should be considered synapomorphic (shared-derived) within the Pan-Homo clade.

Different Techniques and Quantitative Measurements in Upper lip lift: A Systematic Review

BACKGROUND

The upper lip area is an important component of facial aesthetics, and aging produces an increase in the vertical height of the upper lip. Different upper lip lifting techniques are described in the literature.

OBJECTIVES

This systematic review aimed to assess both invasive and noninvasive upper lip lifting techniques with patient satisfaction, adverse effects, and quantitative measurements of lifting efficiency.

METHODS

This study was conducted per PRISMA guidelines. MEDLINE (via PubMed), EMBASE (OvidSP), and Cochrane Library database were searched from September 14, 2022, to October 12, 2022. Inclusion criteria were reporting on upper lip lift efficiency with quantitative measurements of the lifting degree.

RESULTS

Out of 495 studies through the search strategy, nine articles were included in the systematic review, eight for surgical procedures and one for nonsurgical. Surgical procedures seem to have better longevity than nonsurgical techniques. Reported patient satisfaction for both surgical and nonsurgical treatments was good with no severe complaints. The quantitative measures differ between researches and may be classified into two metrics: anatomy ratio computation using photographic analysis or direct height measurement with a caliper and precise parameters utilizing a three-dimensional method.

CONCLUSION

In general, surgical therapies seem to have a longer-lasting lifting effect on upper lip lifts with an inevitable scar, while nonsurgical techniques are minimally invasive but temporary. There was a lack of consistency in the measurements used to assess lifting efficiency. A consistent quantitative assessment can be beneficial for both clinical decision-making and high-level evidence research.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prediction of root canal lengths and pulp volume of the maxillary permanent first molar based on stature, crown diameters, and facial morphometry

This study purposed to develop statistical models to predict palatal (PRL), mesial (MRL), and distal (DRL) root canal length and pulp volume (PV) of the maxillary first permanent molar using stature, gender, mesiodistal (MD), and buccopalatal (BP) crown diameters and some facial morphometries. 57 individuals were included in the study. Cone beam computed tomography was used to measure root canal lengths and PV. The PV calculation was carried out using the software ITK-SNAP 3.4.0. PRL was positively correlated with BP, stature, middle facial height, interalar distance, and bicommissural distance (BCD) (p < 0.05). DRL was positively correlated with BP, MD, and stature (p < 0.05). MRL was positively correlated with BP, MD, stature, lower face height, bizygomatic distance, and BCD (p < 0.05). PV was negatively correlated with age and BCD (p < 0.05). Although all models have significant predictive power for the root lengths and PV, no model could explain variances greater than 30%. The highest and lowest predictive ability was obtained for PRL and DRL, respectively. While the most significant predictor was BP for PRL and DRL, it was the age for PV.

Non-ablative laser treatment improves lip volume, texture, and color

Lips undergo several changes with age, decreased volume, elasticity, turgor, and collagen content. Q-switched Nd:YAG laser are known to increase the production of procollagen and elastin and can promote the generation of collagen, which visibly improves facial imperfections. We aimed to determine the efficacy of a 1064 nm Q-switched Nd:YAG fractional laser on improving lip definition, color, and volume. 32 female patients were treated every 2-3 weeks for a total of 3-5 treatments. Improvement was measured in a follow-up visit a month after the final treatment (29.9 ± 1.4 days) by patients' self-satisfaction questionnaire and physicians blinded evaluations (Likert scale). Patients achieved meaningful aesthetic improvement in in lip color (94% of patients), volume (72%), texture (91%), and overall lip appearance (82%). Furthermore, 91% were satisfied with treatment results and 100% from the overall experience. There were no associated side effects, and the associated pain level (on a 0-10 scale) was rated as 0 in 84% of individuals and 16% as 1. Therefore, laser treatment using a 1064 nm Q-switched Nd:YAG fractional laser on lips is a safe, noninvasive treatment that increases the color and volume of lips, with results that are maintained for at least one month following treatments.

Hemodynamic Changes in the Masseter and Superior Orbicularis Oris Muscles before and after Exercise Load: A Comparison between Young Adult Women and Middle-Aged to Old Adult Women

Background

The vascularity index (VI) is useful for measuring the hemodynamics on ultrasound imaging. However, there are no reports concerning the application of the VI to facial muscles.

Objective

The aim of this study was (1) to establish a method of measuring the hemodynamics in facial muscles in a constant way and (2) to evaluate the hemodynamic changes in the masseter and superior orbicularis oris muscles (SOOMs) before and after exercise load in two subject groups of females of different ages.

Methods

(1) The VI in the SOOM was calculated, and the test-retest reliability was assessed in seven healthy adults. (2) The VIs in the left-side masseter and SOOM were calculated in 3 sessions: before exercise loading (T0), immediately after loading (T1), and 5 minutes after T1 (T2) for the young adult group (YAG, n = 20; age range, 20–35 years) and the middle-aged to old group (MOG, n = 20; age range, 50–70 years). Tasks were gum chewing for the masseter muscle and lip sealing for the SOOM. The differences in the mean peak flows between two sessions were examined.

Results

(1) Significant differences were not noted for the repeatedly measured average volumes of blood flow with good test-retest agreement (intraclass correlation coefficient = 0.81). (2) In both muscles of the YAG, there were a significant increase in T1 compared with T0 and a significant decrease in T2 compared with T1 (all p < 0.05). In both muscles of the MOG, no significant differences were noted in either comparison.

Conclusions

A method of measuring the hemodynamics in facial muscles was developed and showed good reliability. Changes in the blood flow after exercise load in these muscles may vary with age in women.

Three-Dimensional Perioral Assessment Following Subnasal Lip Lift

BACKGROUND

The subnasal lip lift is a surgical technique that elevates the "lip line" (interface between vertical maxillary incisor height and upper lip) to achieve a more youthful aesthetic.

OBJECTIVES

The authors sought to offer the first ever definition, to their knowledge, of 3-dimensional (3D) changes to the upper lip due to subnasal lip lift.

METHODS

A lip lift procedure was performed (on cadaveric samples) in a sequential manner from 2.5- to 5.0-mm intervals (n = 13). 3D photographs were taken with the VECTRA H1 system (Canfield Scientific, Fairfield, NJ), and 3D analysis was performed including vermillion height and width, philtral height, sagittal lip projection, vermillion surface area, and incisor show. A subset of samples (n = 9) underwent a modification of the technique by undermining the upper lip subcutaneous tissue off the underlying muscular fascia.

RESULTS

Vermillion surface area (baseline range, 1.45-5.52 cm2) increased by an average of 20.5% and 43.1% with 2.5-mm and 5.0-mm lip lift, respectively. Anterior projection of the vermillion increased in all cases by an average of 2.13 and 4.07 mm at 2.5 and 5.0 mm, respectively. Philtral height decreased in all cases by an average of 3.37 and 7.23 mm at 2.5 and 5.0 mm, whereas incisal show increased on average of 1.9 and 4.09 mm, respectively.

CONCLUSIONS

This study is the first to our knowledge to define the 3D morphometric changes to the upper lip following subnasal lip lift. Quantifying these changes aids the surgeon in preoperative planning and guiding patient expectations.

Older adults' facial characteristics compared to young adults' in correlation with edentulism: a cross sectional study

Background

Facial ageing is a result of superficial wrinkling combined with changes to the underlying soft tissues and skeleton. The influence of tooth loss, as a geriatric characteristic, on facial appearance is still poorly explained. The aim was to evaluate the facial characteristics of older adults, correlate these characteristics with the dentition and make comparisons with young adults using a non-invasive 3D methodology.

Methods

90 participants older than 65 years, classified into 3 subgroups (edentulous, partially edentulous, toothed) and 30 young adults were evaluated. Their faces were scanned with an optical Artec 3D-scanner. Cephalometric analyses were made using the RapidForm computer program. An independent t-test and ANOVA were used for the comparisons. Pairwise, post-hoc tests were applied with respect to the significant differences (P < 0.05).

Results

The faces of older adults are wider and longer because of the longer middle facial height. Older adults also have a longer upper lip, a larger nose, a smaller nasolabial angle (due to the nasal ptosis), narrower upper- and lower-lip vermilions and larger facial and lower-facial-height angles, resulting in a flat facial profile.

The facial changes due to ageing are the most pronounced in the edentulous. In comparison with the toothed, they have a smaller facial height due to the smaller lower facial height, larger nasolabial angle, smaller mouth width, shorter upper lip and narrower lip vermilions. Their profile is flatter and their lips are more retruded.

Conclusions

The proportions of the whole face are changed in older adults and they are the most expressed when this is combined with tooth loss.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03190-5.

Efficacy and safety of hyaluronic acid fillers for lip augmentation in a Chinese population

BACKGROUND

Hyaluronic acid (HA) is an effective dermal filler for facial rejuvenation. This study aimed to observe the clinical efficacy of HA injection for lip augmentation in Chinese patients.

METHODS

From May 2019 to April 2020, 70 patients with lip fullness scale (LPS) ≤3 underwent local HA injection using the "three-point" injection technique. All patients were followed up to observe the clinical efficacy, LPS, adverse events, and complications.

RESULTS

All 70 patients were followed up for 12 months. Statistically significant improvements were observed in the height of lips within 6-9 months post-treatment (p < 0.05). The LFS improved significantly at follow-up compared with baseline (p < 0.05). Local redness occurred in two patients, and serious swelling occurred in three patients. These adverse events were generally tolerated and disappeared gradually within 1 week. No other serious adverse events and complications were reported in the remaining patients.

CONCLUSIONS

Hyaluronic acid injection can be used for lip augmentation in the Chinese population. The "three-point" technique is simple, safe, and effective and does not cause serious complications.

Rejuvenating the Aging Upper Lip: The Longevity of the Subnasal Lip Lift Procedure

Objective: This study sought to retrospectively analyze the longevity of the subnasal lip lift procedure on the aging upper lip by determining if the amount of skin resected was maintained. Methods: Patients who underwent subnasal upper lip lift procedure of 5-mm resection with the senior author (S.W.P.) from 2006 to 2020 were identified for a total of 52 patients who met inclusion criteria. Pre- and postoperative measurements of nasal base to upper lip vermillion border and vermillion height were taken. Longevity of results were measured through percentage retention of 5-mm lift and percentage improvements of lip show. Results: The percentage retention of the 5-mm lift and percentage improvement of lip measurements were maintained over time with a slow decline. The average percentage improvement of lip show was 48.2%. Patients <5 years out from surgery had 50.1% improvement compared with 40.3% for those ≥5 years out (p = 0.569). Conclusions: The subnasal lip lift procedure shortens the vertical height of the elongated upper lip and gives increased vermillion show with predictable results.

Injectable platelet-rich fibrin for perioral rejuvenation as assessed by 3D lip volume imaging

BACKGROUND

Various injectable autologous platelet aggregate preparations have been developed and used for facial rejuvenation. Limited evidence exists for the use of these for augmentation of the lip.

OBJECTIVES

This prospective, uncontrolled, single-center study evaluated the qualitative and quantitative effects of an injectable platelet-rich fibrin preparation (known as i-PRF+) for lip augmentation.

PATIENTS/METHODS

PRF^® PROCESS system technology was used to prepare i-PRF+ supernatant. Ten healthy females were included in the study and received a single intradermal injection of i-PRF+ in the upper and lower lips (5 ml in each quadrant, total ~2 ml). Participants were followed for 3 months post-procedure. The efficacy of the procedure was assessed qualitatively by a subjective patient-reported outcome (FACE-Q) assessment and quantitatively by objective 3D skin surface volume analysis (ProFace^® ) at baseline and after 3 months.

RESULTS

FACE-Q scales that measure satisfaction with skin and lip showed a statistically significant improvement from baseline (p = 0.04 and p = 0.02, respectively). Satisfaction with lip lines showed a numerical improvement with mean total scores for adverse effect scales related to the skin and lips reduced at 2 weeks post-procedure (p = 0.03 and p = 0.13, respectively). Overall lip volume at 3-month follow-up was unchanged (p = 0.11). The treatment was well tolerated with only minor adverse effects.

CONCLUSIONS

A single session of i-PRF+ injections resulted in significant lip rejuvenation at 3-month follow-up, shown by improved patient-reported outcome measure. No significant change in lip volume was observed.

The Facial Aging Process From the "Inside Out"

The normal course of aging alters the harmonious, symmetrical, and balanced facial features found in youth, not only impacting physical attractiveness but also influencing self-esteem and causing miscommunication of affect based on facial miscues. With this evidence-based paper, the authors aim to provide a comprehensive overview of the latest research on the etiology and progression of facial aging by explaining the aging process from the “inside out,” that is, from the bony platform to the skin envelope. A general overview of the changes occurring within each of the main layers of the facial anatomy is presented, including facial skeleton remodeling, fat pad atrophy or repositioning, changes in muscle tone and thickness, and weakening and thinning of the skin. This is followed by an in-depth analysis of specific aging regions by facial thirds (upper, middle, and lower thirds). This review may help aesthetic physicians in the interpretation of the aging process and in prioritizing and rationalizing treatment decisions to establish harmonious facial balance in younger patients or to restore balance lost with age in older patients.

A minimalistic approach for effective lip augmentation-A case report

BACKGROUND

Lip augmentation using dermal fillers is a widely performed procedure, which gives immediate and gratifying results. However, the cost associated with it is a major concern and reservation for a lot of patients. An innovative minimalistic technique can be used to enhance the lips using minimal amount of filler to provide maximum results, especially in aging lips. Though a simple and effective method, this technique has not yet gained popularity worldwide.

AIM

To present a case demonstrating a new and innovative technique for lip augmentation as a part of lower face rejuvenation.

METHOD

A 55-year-old female patient underwent augmentation of lips using the described technique. Since she had a limited budget, treatment was planned to rejuvenate her face in just 1 ml of filler. Areas on the face which would give maximum impact with minimal amount of filler were treated. Treatment was done using Juvederm Ultra Plus XC (JUV_X+ ; 24 mg/ml) dermal filler.

RESULTS

Using this technique, we were able to demonstrate that a small quantity of filler when used suitably with an understanding of the areas of concern could provide an impact on the overall rejuvenation.

CONCLUSION

The described technique is an effective method of lip enhancement with minimal cost, especially in aging patients. Skillful application of a suitable injection technique is required to achieve a desired esthetic outcome.

Nasal changes in different age groups

Objective

The objective of this study was to evaluate nasal changes in different age groups and to detect gender difference in nasal dimensions.

Materials and Methods

Clinical measurement and profile photographic records of 279 randomly selected subjects were obtained for the evaluation of nasal changes. Thirty-nine subjects were excluded, and the final sample consisted of 240 subjects. The subjects were divided into four groups by age: Group 1 (16-20 years), Group 2 (21-30 years), Group 3 (31-40 years), and Group 4 (41-50 years). Each group was further subdivided on the basis of gender. Data were collected and analyzed by two-way multivariate analysis of variance with Duncan's multiple range post hoc test.

Results

In both males and females, nasal height and breadth increased with except nasal index and nasolabial angle. More nasal changes were seen in males as compared to females of the same age group.

Conclusions

Nonconsistent age-related changes were found for nasal index and nasolabial angle. The rest of the nasal parameters increased with age and differ between the genders. Larger nasal changes were seen in males as compared to females of the same age group.

Adverse reactions associated with perioral rejuvenation using laser, fat and hyaluronic acid: systematic review

Perioral rejuvenation is carried out by surgical and non-surgical tools. The common procedures are laser resurfacing and volumanisation using alloplastic fillers or autogenous fat. Nonetheless, any such procedures are associated with complications. To evaluate a concise presentation of complications and safety associated with different perioral rejuvenation treatments including laser ablation, fat grafting and hyaluronic acid injections. A systematic literature review of all the relevant studies and case reports on complications and adverse reactions associated with the laser ablation, administration of fillers and fat for the rejuvenation of perioral region. Twelve articles passed the inclusion criteria (as per PRISMA guidelines) and were scrupulously analysed. Four publications evaluated complications associated with laser resurfacing, 5 were related to filler augmentation and 3 were related to fat administration. The results concluded that all three aesthetic treatments are associated with mild to moderate complications. Severe complications are rare but can arise. Clinicians should be mindful of possible complications and able to recognise adverse events so that remedies could be executed with minimal delay. Training and supervision are essential components of ensuring provision of safe aesthetic treatment, and lack of regulation is a concern.

Subject and partner satisfaction with lip and perioral enhancement using flexible hyaluronic acid fillers

BACKGROUND

The injection of hyaluronic acid (HA) dermal fillers is a popular minimally invasive approach to improve lip volume and contour, and with improved techniques has gained popularity because full lips are often associated with beauty and youth. Patient satisfaction is a key driver for successful aesthetic procedures, influencing individual treatment plans and future recommendations.

OBJECTIVE

To evaluate subject and partner satisfaction with the hyaluronic acid (HA) dermal filler HA_RK for lip enhancement at 8 weeks after the last treatment.

METHODS & MATERIALS

Subjects in this open-label study all received HA_RK in the lips, and an additional group also received HA_RR and/or HA_RD in nasolabial folds (NLFs) and marionette lines (MLs). Satisfaction was assessed at Weeks 4 and 8 after the last treatment using questionnaires (FACE-Q™ [subjects] and KISSABILITY [subjects and partners]).

RESULTS

Nineteen subjects received HA_RK only; 40 also received HA_RR and/or HA_RD . Subjects reported a high level of satisfaction with their lips following treatment. Increases from baseline in the mean total satisfaction score were statistically significant at Weeks 4 and 8 (P ≤ .001). Most subjects (≥89%) reported satisfaction on all FACE-Q questions at Week 8. Both subjects and partners were satisfied with the kissability, appearance, and natural look and feel of the post-treatment results.

CONCLUSION

This study demonstrated that HA_RK resulted in lip enhancement with high levels of subject and partner satisfaction, when used alone or in combination with HA_RR / HA_RD in NLFs and MLs.

Subnasal Lip Lift and Its Effect on Nasal Esthetics

BACKGROUND

The subnasal lip lift has emerged as a standard procedure for the treatment of an elongated upper lip. Despite its popularity, limited literature has studied its effect on nasolabial esthetics. The purpose of this study is to describe the effect of the subnasal lip lift on nasal and labial esthetic parameters.

METHODS

The authors conducted a retrospective case review of patients who underwent a subnasal lip lift procedure without concurrent rhinoplasty between January 1, 2008, and December 31, 2019. The outcome variables were lip length, tooth show, vermillion display, alar width, nasolabial angle, columellar-lobular angle, Crumley analysis, and Simons analysis. Preoperative and postoperative values were compared and analyzed using paired sample t-tests.

RESULTS

Overall, 55 female patients with an average age of 52 years and a mean follow-up of 14 months were included in the study. Subnasal lip lift resulted in a statistically significant 21.5% reduction in lip length, 31.5% increase in the vermilion show, and a 1.52 mm increase in tooth show (P < .0001). In relationship to nasal esthetics, there was a statistically significant decrease in nasolabial angle of 4.56° (P < .0001), a 2.2% increase in alar width (P < .001), and a 26.3% increase in nasal projection per Simons analysis (P < .0001). The study did not demonstrate a significant change in columellar-lobular angle or Crumley projection analysis.

CONCLUSIONS

Subnasal lip lift procedure can significantly impact lower nasal esthetics, specifically by decreasing the nasolabial angle and potentially contribute to pseudo-overprojection of the nasal tip, as shown by the results of this study.

Stereophotogrammetry to reveal age-related changes of labial morphology among Chinese women aging from 20 to 60

Background

The lip is of important aesthetic value and highly subjected to aging. Collecting anthropometric baseline data and understanding age‐related changes of labial morphology can help with diagnosis of deformity, assessment of aging, and planning of cosmetic procedures. Many studies have focused on Caucasians, while there is a lack of anthropometric data on Chinese women.

Methods

A total of 169 women were enrolled in this cross‐sectional study and divided into four consecutive age groups. Linear distances, angles, and surface area data were obtained via stereophotogrammetry. Intergroup comparisons between different age groups were performed to find age‐related differences.

Results

Lip width significantly increased with age while philtrum width seemed to show no obvious change. Cutaneous upper and lower lip height increased, lengthening the lip in the vertical dimension. Decrease of upper vermilion height and changes in angles indicated that aging process shortened the upper vermilion and flattened the vermilion border. Surface area also showed age‐related changes. Intergroup comparison showed no statistical significance in most variables between 20s and 30s or 30s and 40s, while age‐related changes in some variables were significant between 40s and 50s.

Conclusion

This study provided anthropometric data of labial morphology across a wide age range. Aging process affected a variety of labial anthropometric variables. Age‐related changes accelerated after 40 among Chinese women.

Comprehensive histological investigation of age-related changes in dermal extracellular matrix and muscle fibers in the upper lip vermilion

OBJECTIVE

Few histological studies have directly examined age-related changes within the lips, although non-invasive investigations of such changes are increasing. Therefore, this study aimed to provide histological and molecular data on age-dependent alterations in the vermilion.

METHODS

Upper vermilion specimens from 15 female Caucasian cadavers (age range, 27-78 years) were investigated histologically or immunohistochemically.

RESULTS

Histologically, age-dependent decreases in areas occupied by hyaluronan and collagenous fibres in the dermis of upper vermilion were demonstrated. Elastic fibre content varied widely between individuals. The area occupied by muscle fibres in the orbicularis oris muscle region within the vermilion also correlated negatively with age. Immunohistochemically, signals of four proteins were attenuated in vermilion from older individuals compared with young individuals: procollagen type I, hyaluronan synthase (HAS)1, myosin heavy chain (MYH)2 (a component of fast-twitch oxidative muscle fibres) and MYH7 (a component of slow-twitch muscle fibres). In contrast, signals of cell migration inducing hyaluronidase 1 (CEMIP) were intensified in vermilion from older individuals. No marked differences between young and older individuals were seen in procollagen type III, HAS2, HAS3, hyaluronidase (HYAL)1, HYAL2, MYH1 or MYH4.

CONCLUSION

Age-dependent decreases of hyaluronan in the dermis of vermilion were prominent, possibly due to both the decrease in synthesis (HAS1) and the increase in degradation (CEMIP). Furthermore, age-dependent decreases in collagenous fibres and two types of muscle fibre in the vermilion were also identified histologically. Type I collagen, MYH2 and MYH7 appear to represent the molecules responsible for these respective decrements.

Surgical Method of a Corner Mouth Lift

Background:

The mouth and perioral area play a primary role in emotional expression, and these are among the most important areas projecting youth and attractiveness. A downturned corner of the mouth presents negative feelings such as sadness, depression, and tiredness. A corner mouth lift (CML) may restore more attractive and youthful appearance, which can favorably affect first impression, self-esteem, and the quality of life in patients.

Methods:

From December 2016 to September 2018, 498 patients underwent a CML. There were 434 women and 64 men. The mean age was 38.99 years (19–63 years) and 34.19 years (21–67 years) in female and male patients, respectively. A total of 432 cases (86.7%) were primary surgical cases, whereas 66 (13.3%) were secondary cases. There were 178 patients (35.7%) who only underwent CML, whereas the remaining patients (64.3%) underwent the CML contemporarily with other perioral surgery such as subnasal lift.

Results:

Most patients were satisfied with the results. However, some patients showed unsatisfactory outcomes such as hypertrophic scar, asymmetry, persistent swelling, or undercorrection. The most common complaints immediately after surgery were swelling and bruise, which were improved spontaneously within 1–2 weeks. Postoperative scar and undercorrection were the most common complications that required revision surgery.

Conclusions:

CML showed reliable and satisfactory outcomes in most patients. It could be a good option for patients who desire CML regardless of their age.

Premaxillary Injection for Perioral Rejuvenation and Lip Enhancement

BACKGROUND

This is the first study to evaluate the effect of premaxillary filler injection on nasal tip projection, upper lip projection, and upper lip vermilion height.

OBJECTIVES

The primary objective of this study was to analyze the change in nasal tip projection (measured by the Goode ratio) and the change in upper lip projection (measured by the Z angle) following premaxillary hyaluronic acid injection. A secondary objective was to measure the change in upper lip vermilion height. We hypothesized that treated subjects will show an increase in nasal tip projection, upper lip projection, and upper lip vermilion height.

METHODS

Twenty volunteer patients with signs of perioral aging or poor upper lip projection were enrolled in this prospective cohort study and underwent premaxillary hyaluronic acid filler injection between November 2017 and June 2018. Nasal tip projection, upper lip projection, and upper lip vermilion height were assessed from baseline and posttreatment photographs based on the Goode ratio, Z angle, and lip vermilion height ratio, respectively.

RESULTS

No significant change was noted between pre- and posttreatment Goode ratio measurements (P = 0.841). There was a significant decrease in Z angle and therefore significant increase in upper lip projection with treatment (P < 0.001). The lip vermilion height ratio demonstrated a trend of increased upper lip vermilion height but this did not achieve statistical significance (P = 0.561).

CONCLUSIONS

Premaxillary filler treatment resulted in a significant increase in upper lip projection. Premaxillary filler injection when performed in a safe manner is a valuable treatment option for perioral rejuvenation.

LEVEL OF EVIDENCE: 4

Characterization and validation of an in vivo confocal Raman spectroscopy led tri-method approach in the evaluation of the lip barrier

Background/Aim

It was the aim to establish and validate in vivo confocal Raman spectroscopy for characterization of the lip barrier in conjunction with transepidermal water loss (TEWL) and skin capacitance assessments. For the first time in vivo, barrier‐relevant components of the lip (derived, natural moisturizing factors (NMFs) and ceramides are described.

Methods

In 32 healthy volunteers, a dental tongue fixation device was inserted to prevent both voluntary and involuntary lip moisturization during measurements. Seventeen individual parameters relating to water, ceramide, and NMF content were assessed via Raman spectroscopy. Additionally, corneometry and TEWL were measured. To give a guidance for the required volunteer group size of future lip barrier studies for all test parameters, coefficients of variation (CV) were calculated and plots showing the required sample size for a given percentage treatment effect.

Results

Raman spectroscopy assessed parameters on the lower lip comprehensively characterized the state of the lip barrier. Parameter variability was sufficiently low to corroborate changes in most parameters using relatively small study populations.

Conclusions

Lip skin is comparatively well hydrated. Biophysical measurement of the lip barrier function is a challenge, as unconscious licking of the lower lip has to be prevented. In vivo confocal Raman spectroscopy provides insightful parameters for the characterization of the lip barrier and sufficiently low inter‐individual variability to assess relatively small parameter changes employing relatively few study subjects. Differences at the molecular level and at a high spatial resolution are detectable, and these insights might provide a breakthrough in the evaluation of lip barrier function and developing solutions for lip care.

Mouth Width and Cupid's Bow Estimation in a Southern African Population

Standards for estimating mouth width and Cupid's bow width in craniofacial approximation and superimposition are limited. Currently, the only guideline for mouth width, using direct skeletal references, is a general rule indicating a 75% inter-canine to mouth width ratio. The philtrum, which closely corresponds to the Cupid's bow, is said to be equal to the inter-superior prominences of the maxillary central incisors. This study tested these guidelines against newly generated regression models and mean values. Cone-beam CT scans of 120 black and 39 white southern African adults were used. Comparative hard and soft tissue measurements were taken using a 3D DICOM viewer. Regression equations accounting population, sex, and approximate age variables (20-39 and 40+ years), utilizing maxillary inter-canine width to estimate mouth width and maxillary central-lateral incisor junction width to estimate Cupid's bow width, performed statistically best. The regression models were more reliable than existing standards in validation tests.

Nonsurgical correction of drooping mouth corners using monophasic hyaluronic acid and incobotulinumtoxinA

BACKGROUND

Nonsurgical correction of drooping of the corners of the mouth requires a multimodal approach combining botulinum toxin and soft tissue filler injections.

OBJECTIVE

To validate a nonsurgical therapeutic approach for correcting a "saddened" appearance characterized by drooping mouth corners, oral commissures, and/or marionette lines.

METHODS

In this prospective, evaluator-blinded study, monophasic hyaluronic acid (MHA) was infiltrated to correct drooping mouth corners in four steps, deep oral commissures in two steps, and/or deep marionette lines in two steps, in that order. Then, incobotulinumtoxinA was injected along the depressor anguli oris and mentalis muscles.

RESULTS

The total volumes of MHA used in steps 1-4 were 0.2 mL (interquartile range [IQR]: 0.19-0.3) for the right side of the face and 0.25 mL (IQR: 0.2-0.3) for the left side; total volumes in steps 5-8 were 0.18 mL (IQR: 0-0.4) for the right side and 0.15 mL (IQR: 0-0.33) for the left side. The total mean dose of incobotulinumtoxinA was 26.5 units (IQR: 24-28). The median degrees of drooping of the mouth corners were -4° (IQR: -7° to -2°) at baseline, -1° (IQR: -3° to 1°) at post-treatment 2 weeks, and -1° (IQR: -3° to 0°) at post-treatment 3 months. Median Global Aesthetic Improvement Scale scores were 3 (IQR: 2-3) at post-treatment 2 weeks and 3 (IQR: 2-3.75) at 3 months.

CONCLUSION

Our results demonstrated that nonsurgical treatment with MHA and incobotulinumtoxinA provides satisfactory therapeutic outcomes in patients with a saddened appearance by correcting drooping of the mouth corners, deep oral commissures, and/or deep marionette lines.

Cognitive Load Affects Speech Motor Performance Differently in Older and Younger Adults

Purpose The aim of this study was to determine the impact of cognitive load imposed by a speech production task on the speech motor performance of healthy older and younger adults. Response inhibition, selective attention, and working memory were the primary cognitive processes of interest. Method Twelve healthy older and 12 healthy younger adults produced multiple repetitions of 4 sentences containing an embedded Stroop task in 2 cognitive load conditions: congruent and incongruent. The incongruent condition, which required participants to suppress orthographic information to say the font colors in which color words were written, represented an increase in cognitive load relative to the congruent condition in which word text and font color matched. Kinematic measures of articulatory coordination variability and movement duration as well as a behavioral measure of sentence production accuracy were compared between groups and conditions and across 3 sentence segments (pre-, during-, and post-Stroop). Results Increased cognitive load in the incongruent condition was associated with increased articulatory coordination variability and movement duration, compared to the congruent Stroop condition, for both age groups. Overall, the effect of increased cognitive load was greater for older adults than younger adults and was greatest in the portion of the sentence in which cognitive load was manipulated (during-Stroop), followed by the pre-Stroop segment. Sentence production accuracy was reduced for older adults in the incongruent condition. Conclusions Increased cognitive load involving response inhibition, selective attention, and working memory processes within a speech production task disrupted both the stability and timing with which speech was produced by both age groups. Older adults' speech motor performance may have been more affected due to age-related changes in cognitive and motoric functions that result in altered motor cognition.

Smile dimensions in adult African American and Caucasian females and males

OBJECTIVES

To test smile dimension variations in adult African American and Caucasian females and males.

SETTING AND SAMPLE POPULATION

The University of Alabama at Birmingham School of Dentistry and Hospital. Three hundred and ninety-four participants were recruited; African American females and males distributed over five age groups: 20-30, 30-40, 40-50, 50-60 and older than 60.

MATERIAL & METHODS

Three-dimensional surface imaging was used to acquire two images of each participant, one at rest and one upon smile. Landmarks were plotted on the lips and linear distances measured to assess the length of the upper and lower lips, mouth width at rest and upon smile, gingival and dental display upon smile.

RESULTS

Linear dimensions are larger in males than in females, and in African Americans than in Caucasians, except for the length of the upper lip that does not differ between male African American and Caucasian males, in any given age group. Gingival display and dental display decrease with age in all groups.

CONCLUSION

Norms should reflect race, age and sex in order to optimize treatment goals.

Deposition of plant lipids after single application of a lip care product determined by confocal raman spectroscopy, corneometry and transepidermal water-loss

OBJECTIVE

Lip treatment products often incorporate oils and waxes in their formulations, and a desired outcome of their use is to prevent lip dryness and roughness as well as help to repair this condition. The objective of this study was to combine confocal Raman spectroscopy with skin capacitance (corneometry) and transepidermal water loss (closed chamber Aquaflux system) measurements, in the evaluation of the degree of moisturization and lip skin penetration of a fruit wax (Rhus vernicula peel cera) and natural oil-based (Cocos nucifera fruit oil and Olea europea oil) lip care product, following a single application.

METHODS

The study was conducted on a total of 15 healthy female volunteers. Instrumental measurements were performed before and 30 min, 2 h and 6 h after a single application of the product.

RESULTS

Lip skin barrier function as well as lip hydration were significantly improved and penetration of olive oil was maintained for at least 6 h post product application. The deposition of the three component lipids (berry fruit wax, coconut oil and olive oil) into the stratum corneum after a single application of the lip care product was maintained and data significant for 2-6 h post product application. Lipid deposition was regarded as a positive long-lasting skin care (depot-) effect combined with a profound hydrating effect for about 6 h.

CONCLUSION

The tri-method approach taken in this study is deemed relevant and valid for measuring lip hydration offering a complimentary assessment of the barrier function of lip skin and interactive effects of cosmetic ingredients.

Aging of the Upper Lip: Part I: A Retrospective Analysis of Metric Changes in Soft Tissue on Magnetic Resonance Imaging

BACKGROUND

In scientific literature, numerous theories on the mechanism of facial aging can be found. The debate about facial sagging versus deflation is still ongoing. In this study, the metric changes in perioral soft tissue were demonstrated. These data can contribute to a better understanding of physical changes in the aging perioral area.

METHODS

Upper lip measurements were performed on cranial magnetic resonance images of 200 Caucasian subjects (100 men and 100 women). The study population was aged between 20 to 30 and 65 to 80 years. The upper lip length and soft-tissue thickness were measured on sagittal and parasagittal section. Cross-section surface area of the upper lip was measured in the sagittal section to represent volume. The data were analyzed with a t test and results were considered significant at p < 0.01.

RESULTS

The upper lip in the old age group differed significantly in length (19.24 percent in women and 18.24 percent in men), thickness (up to -40.55 percent in women and -32.74 percent in men), and volume (-20.89 percent in women and -17.40 percent in men). Soft-tissue thickness at the alar nasolabial fold was significantly thinner in the old age group (-25 percent in women and -25.7 percent in men) and showed significantly greater tissue loss than elsewhere in the upper lip (p < 0.001).

CONCLUSIONS

These results suggest that the aging perioral area is affected with a combination of soft-tissue lengthening, thinning, and volume loss. The clinical implications of this study on perioral rejuvenating strategies will be explained in part II.

Variability of facial movements in relation to sexual dimorphism and age: three-dimensional geometric morphometric study

The aim of this study was to introduce suitable imaging technique and analytical methods for a detailed description of the facial movements in relation to sexual dimorphism and age in adult individuals. Removing of size factor from the analysis, we hypothesised that there will be no significant intersexual difference in facial mobility. We assume facial movements to be more pronounced in the older age category due to increasing the facial surface. We have compared five facial movements - raising eyebrows, closing eyes, pursing of the lips, inflating of the cheeks and smile - in relation to neutral expression of the human face. The material sample comprised three-dimensional facial surface models of healthy adult individuals of the Czech nationality (63 females, 58 males). Methods of geometric morphometry and multivariate statistics were used. Local tissue motion due to facial movements was expressed using colour-coded maps. The movement showing significant intersexual difference was inflating of the cheeks. Ageing in both sexes has significantly influenced the facial mobility on average after 50 years of age. Changes related to senescence have occurred in eye closing, smile and inflating of the cheeks. An enlarged facial surface has been noted in the group of individuals belonging to the older age category, what is probably the result of increased manifestation of skin folds and wrinkles. This is related to the loss of skin elasticity and overall weakening of the underlying muscles, especially in the infraorbital and cheeks area.

Randomized, Evaluator-Blinded Study Comparing Safety and Effect of Two Hyaluronic Acid Gels for Lips Enhancement

Hyaluronic acid (HA) fillers may differ in terms of gel characteristics and ease of use and it is of interest whether this might affect safety and duration of effect.

Procedural difficulties during successful intubation in octogenarians: A prospective observational study

OBJECTIVE

Octogenarians undergo anatomic and physiopathologic degradation, making airway management problematic, specific to intubation, bag mask ventilation, leading to desaturation and aspiration. Our study's aim was to examine the process of airway management regarding the steps involved in intubation and any deviations or delays in the tasks.

MATERIALS AND METHODS

An institutional review board-approved difficult airway prospective observational study in older adults was conducted. Inclusion criteria included airway features indicative of difficult airway, history of failed intubation, the planned use of specialized airway devices, and/or expected airway complications due to comorbidities. Patients 80 years and older were analyzed. Demographic data collected were age, weight, BMI, gender, ASA classification, airway indices, diagnosis, and procedures. Problems with intubation (INT) (≥3 intubation attempts), laborious assisted ventilation (VEN) (2-person and/or application of CPAP>20cmH₂O), and complications with oxygenation (OXY) (SpO₂<95%) were analyzed.

RESULTS

Of the 41 patients enrolled in the study, 3 (7.3%) had all 3: problematic (INT), laborious (VEN), and desaturated (OXY); 8 (19.5%) patients experienced problematic (INT), 20 (48.8%) were described as laborious (VEN), and 14 (34.1%) experienced complications with (OXY).

CONCLUSION

In octogenarians, we found a low incidence of difficulty with INT-VEN-OXY together. However, bag mask ventilation was found to be laborious with a high incidence of desaturation. Success rate of INT as a sole metric may not accurately describe the process of the intubation. We recommend alternative airway devices and techniques and the establishment of protocols for airway management in the elderly.

Association of Increasing Nasal Tip Projection With Lip Position in Primary Rhinoplasty

Importance

The effects of rhinoplasty maneuvers on adjacent facial features are an important component in preoperative planning and patient counseling. Tip projection modifications are commonly performed in both cosmetic and reconstructive rhinoplasty.

Objective

To evaluate the subsequent change in lip projection that results from increasing nasal tip projection.

Design, Setting, and Participants

In this case series, 20 patients underwent primary rhinoplasty with the objective of increasing tip projection during the period from October 1, 2014, to September 25, 2015. Preoperative and postoperative photographs were evaluated.

Main Outcomes and Measures

The increased tip projection was verified using the Goode ratio. Upper lip projection was calculated by the Z angle, which is based on the intersection between the Frankfort horizontal plane and the profile line. Vermilion height was also assessed.

Results

Of the 20 patients in the study (19 females and 1 male; mean [SD] age, 26.8 [10.2] years; range, 16-52 years) 18 (90%) demonstrated an increase in upper lip projection when the tip projection was increased by either a columellar strut or tongue-in-groove maneuver. The Z angle demonstrated a statistically significant decrease of 2.7° (95% CI, 1.5°-3.9°; P < .001). Although the vermilion height did not change a significant amount, there was a trend toward an increase in mean height of 0.051 (95% CI, -0.00515 to -0.10685; P = .09).

Conclusions and Relevance

Increasing nasal tip projection causes a measurable increase in upper lip projection. This new causal association has been applied to our filler injection armamentarium as an alternative way to achieve the desired result of a more youthful upper lip.

Level of Evidence

4.

The relationship between labial vibrotactile detection and pure-tone hearing thresholds in healthy, ageing adults

PURPOSE

Orofacial anatomy is unique from other body systems in that oral musculature inserts directly into the underlying cutaneous skin, allowing for tight temporal synchronicity between somatosensory and auditory performance feedback to maintain correct orofacial behaviours across the lifespan. Unfortunately, little is currently known regarding the changes in orofacial sensory capacities associated with ageing and how these somatosensory and auditory changes may impact feedback during functional behaviours such as speech or swallowing. The purpose of this descriptive study was to begin assessing the relationship between the auditory and labial somatosensory system in healthy ageing adults.

METHOD

Pure-tone hearing thresholds were determined for 500, 1000, 2000 and 4000 Hz. Using a 2-alternative forced choice paradigm, 60 adults (19-84 years) completed vibrotactile detection thresholds (VDT) at the 5 and 10 Hz test frequencies.

RESULT

A significant difference for age by group was identified at the 5 Hz test frequency. Spearman Correlations identified a significant correlation between age and pure tone hearing thresholds and the 5 Hz test frequency threshold.

CONCLUSION

A relationship between pure tone hearing thresholds and labial somatosensory was identified. Future studies will begin the processing of modelling the complex multivariate sensorimotor relationship in healthy individuals before moving to a disordered population.

Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management

There are many anatomical, physiopathological, and cognitive changes that occur in the elderly that affect different components of airway management: intubation, ventilation, oxygenation, and risk of aspiration. Anatomical changes occur in different areas of the airway from the oral cavity to the larynx. Common changes to the airway include tooth decay, oropharyngeal tumors, and significant decreases in neck range of motion. These changes may make intubation challenging by making it difficult to visualize the vocal cords and/or place the endotracheal tube. Also, some of these changes, including but not limited to, atrophy of the muscles around the lips and an edentulous mouth, affect bag mask ventilation due to a difficult face-mask seal. Physiopathologic changes may impact airway management as well. Common pulmonary issues in the elderly (eg, obstructive sleep apnea and COPD) increase the risk of an oxygen desaturation event, while gastrointestinal issues (eg, achalasia and gastroesophageal reflux disease) increase the risk of aspiration. Finally, cognitive changes (eg, dementia) not often seen as related to airway management may affect patient cooperation, especially if an awake intubation is required. Overall, degradation of the airway along with other physiopathologic and cognitive changes makes the elderly population more prone to complications related to airway management. When deciding which airway devices and techniques to use for intubation, the clinician should also consider the difficulty associated with ventilating the patient, the patient's risk of oxygen desaturation, and/or aspiration. For patients who may be difficult to bag mask ventilate or who have a risk of aspiration, a specialized supralaryngeal device may be preferable over bag mask for ventilation. Patients with tumors or decreased neck range of motion may require a device with more finesse and maneuverability, such as a flexible fiberoptic broncho-scope. Overall, geriatric-focused airway management is necessary to decrease complications in this patient population.

Central Lip Lift as Aesthetic and Physiognomic Plastic Surgery: The Effect on Lower Facial Profile

BACKGROUND

A central lip lift was introduced to Westerners in 1980s. However, no studies have been conducted on the facial aesthetic and physiognomic perspectives of a central lip lift in the Asian population.

OBJECTIVES

The authors presented the central lip lift as aesthetic and physiognomic treatment in Asians and explained its effect on lower facial profile.

METHODS

A retrospective chart review was performed in 202 cases of asians. The authors analyzed patient age, cause of long philtrum, purpose of the treatment, and postoperative satisfaction. The authors then performed an anthropometric assessment and a photographic analysis.

RESULTS

The vertical disproportion of the lower face was improved after the treatment, and there was significant shortening of the philtrum length (P < .001) and an increase in a visible upper vermilion (P < .001). In Westerners, a long philtrum was mainly caused by the aging process. Aging patients (range, 40-59 years) underwent the central lip lift for upper lip rejuvenation. In contrast, in Asia, a long philtrum was primarily caused by bone retraction after an orthognathic surgery or orthodontic procedure. Young patients (range, 20-39 years old) underwent the central lip lift to correct a relatively lengthened philtrum after 2-jaw surgery. Furthermore, about half of the patients (52.0%) underwent the central lip lift for facial physiognomic improvement.

CONCLUSIONS

In today's multiracial society, plastic surgeons planning a central lip lift in Asian patients should consider both aesthetic and physiognomic perspectives. Regardless of the aesthetic outcome, the surgeon should strive to maximize patient satisfaction.

LEVEL OF EVIDENCE

4 Therapeutic.

Classification of the Aging Lips: A Foundation for an Integrated Approach to Perioral Rejuvenation

BACKGROUND

Although perioral aging is highly individual with several distinct processes taking part simultaneously, there is scarce systematic information which helps to indicate the right rejuvenation approach among the multitude of proposed procedures. Existing data about perioral aging has not yet been transformed into a consistent therapeutic concept. The intention of this study was to provide a simple, yet reproducible classification and to offer appropriate rejuvenation approaches.

METHODS

To identify reliable and constant landmarks of the ongoing process of perioral aging, 462 perioral photo documentations were morphometrically analyzed. Based upon the identified landmarks a two-dimensional classification was developed. The classification was validated by three plastic surgeons. Inter- and intra-rater reliability was calculated using Cohen's kappa coefficient.

RESULTS

Perioral aging can be broken down into changes of the lip shape and changes of the lip surface. Both processes can be classified into three stages each: Lip shape according to the shape in profile view, the lip length in relation to the frontal incisors, and the degree of vermilion inversion. Lip surface according to the presence and degree of radial wrinkles and the visibility of the structural elements Cupid's bow, philtrum, and white roll. Inter-observer reliability was rated very good (kappa values between 0.819 and 0.963) and perfect for intra-observer reliability (1.0).

CONCLUSION

A better understanding of perioral aging leads to a simple classification for the aging lips. Using the classification helps to tailor an appropriate treatment to the individual patient and aids to achieve a natural rejuvenation result.

Labial Vibrotactile Somatosensory Perception: A Pilot Study in Healthy Aging versus Young Adult Participants

The purpose of this pilot study was to begin characterizing changes in labial vibrotactile somatosensation in healthy older adults as a foundational step in determining how changes in orofacial sensation can affect functional behaviors, such as speech and feeding. Labial vibrotactile perception capacity of healthy older adults ( n = 15) was compared to a cohort of healthy young adults ( n = 5). Vibrotactile inputs were delivered to the glabrous surface of the left lower lip at 5, 10, 50, and 150 Hz. A modified von Bekesy (staircase) method was used to identify participants' thresholds and response standard deviations for each test frequency. Consistent with findings in other body regions, a decrease in labial vibrotactile detection sensitivity was expected in healthy older adults. The threshold values for the 5 and 10 Hz test frequencies were higher in the older group and the differences in response standard deviations at these frequencies were statistically significant. This pilot study identified changes in labial perception among healthy older adults.