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Zhang M, Yang Y, Dong R, Wang L, Sun Y, Li Y, Wang Z, Xu R, Yang W, Jin L, Huang J, Yu N, Long X. Deciphering Depressor Anguli Oris for Lower Face Rejuvenation: A Prospective Ultrasound-based Investigation. Aesthet Surg J 2024; 44:880-888. [PMID: 38377399 DOI: 10.1093/asj/sjae037] [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: 12/22/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The depressor anguli oris muscle (DAO) is a pivotal treatment target when creating a harmonic jawline. However, evidence of its live morphology remains scarce. OBJECTIVES In this study we aimed to reevaluate the DAO with a facile ultrasound analysis and thereby guide safer and more effective botulinum toxin type A (BTX-A) injection. METHODS A prospective ultrasound assessment was conducted in 41 patients. Morphology of the DAO and its relative position to neighboring structures were appraised at the ubiquitous facial landmark, the labiomandibular fold (LMF). Three-dimensional images were captured before and after the patient received the BTX-A injection based on sonographic evidence. RESULTS The skin-to-muscle depths of the DAO on average (measured from the medial to lateral border) were 5.26, 5.61, and 8.42 mm. The DAO becomes thinner and wider from zone 1 to zone 3 (P < .001). Overlapping lengths of the DAO and the depressor labii inferioris increased from zone 1 to zone 3: 4.74, 9.68, 14.54 mm (P < .001). The medial border of the DAO was located at 4.33, 6.12, 8.90 mm medial to the LMF (zone 1-3), and no muscle fibers of the DAO were observed in zone 1 or zone 2 in nearly one-third of patients. Improvement of the mouth corner downturn angle upon receiving BTX-A injection at zones 2 and 3 were 88.3%, 32.3%, and 14.7% for the neutral, maximum smile, and down-turning mouth corner expressions. CONCLUSIONS This work established an informative ultrasound portrait of the DAO and structures in the perioral region, which suggested the LMF as a convenient landmark for locating the DAO. Injection at the middle and lower thirds of the LMF at a 4- to 5-mm depth is recommended.
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Kefalas N, Ruiz del Cueto S, Urdiales-Gálvez F, Barry L, Gritti A, Marchac A, Lim M, de la Guardia C, Kerson G, Silberberg M. Development and Validation of a Photonumeric Scale to Assess Marionette Lines. Dermatol Surg 2024; 50:172-177. [PMID: 38100623 PMCID: PMC10833177 DOI: 10.1097/dss.0000000000004040] [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: 12/17/2023]
Abstract
BACKGROUND A validated scale is needed for objective and reproducible comparisons of marionette lines before and after treatment in clinical studies. OBJECTIVE To describe the development and validation of a 5-point photonumeric marionette lines scale. METHODS The scale was developed to include an assessment guide, verbal descriptors, and real and morphed subject images for each scale grade. Intrarater and interrater reliability was evaluated in initial scale validation (web-based review) ( N = 51 ) and live-subject validation ( N = 75 ) studies, each completed during 2 sessions. RESULTS In the initial scale validation study, intrarater agreement for 2 physician raters was near perfect (weighted kappa = 0.92 and 0.94). Interrater agreement was excellent during sessions 1 and 2 (intraclass correlation coefficients of 0.94 and 0.95, respectively). In the live-subject validation study, intrarater agreement for 3 physician raters showed a strong correlation (mean weighted kappa = 0.77). Interrater agreement was high during live-subject validation sessions 1 and 2 (intraclass correlation coefficients = 0.89 for both sessions). CONCLUSION This new marionette lines scale is a validated and reliable scale for physician rating of marionette line severity.
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Affiliation(s)
| | | | | | | | | | | | - Maria Lim
- Peloton Advantage, LLC, an OPEN Health Company, Parsippany, New Jersey
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van der Sluis N, Gülbitti HA, van Dongen JA, van der Lei B. Lifting the Mouth Corner: A Systematic Review of Techniques, Clinical Outcomes, and Patient Satisfaction. Aesthet Surg J 2022; 42:833-841. [PMID: 35373812 PMCID: PMC9342679 DOI: 10.1093/asj/sjac077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Mouth corners are an essential part of the centrofacial area for perception of attractiveness and emotions. Downturned mouth corners are a result of aging or have a congenital origin. Different mouth corner lifting techniques are described in the literature. OBJECTIVES This review was performed to systematically assess and compare invasive and noninvasive mouth corner lifting techniques and their effectiveness, patient satisfaction, and adverse effects. METHODS MEDLINE (via PubMed), EMBASE (OvidSP), and the Cochrane Central Register of controlled trials databases were searched for clinical and observational studies published in peer-reviewed academic journals with abstracts available (searched from May 18, 2019, to December 18, 2021). Outcomes of interest were aesthetic mouth corner lifting techniques, the degree of lift as well as the longevity of the lifting effect, patient satisfaction, and adverse effects. Techniques were subdivided in invasive techniques and noninvasive techniques. RESULTS Out of 968 studies found from the search, 11 were included in the qualitative analysis. In general, surgical techniques seem to have a better mouth corner lifting effect than nonsurgical techniques; however, objective evidence is weak, and surgery inevitably results in a scar. Reported patient satisfaction was good for both surgical and nonsurgical techniques and no severe complications have been described. CONCLUSIONS Surgical techniques seem to have a better lifting effect on mouth corners than nonsurgical techniques. Nevertheless, objective evidence is weak, and a scar is inevitable. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Nanouk van der Sluis
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Haydar A Gülbitti
- Department of Dentistry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joris A van Dongen
- Department of Plastic, Reconstructive, and Hand Surgery, Utrecht University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - Berend van der Lei
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Pereira IN, Hassan H. Botulinum toxin A in dentistry and orofacial surgery: an evidence-based review - part 2: cosmetic applications. Evid Based Dent 2022:10.1038/s41432-022-0277-4. [PMID: 35710887 DOI: 10.1038/s41432-022-0277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/31/2021] [Indexed: 11/08/2022]
Abstract
Objective An evidence-based review on the role of botulinum toxin type A (BoNTA) on diverse cosmetic applications of interest to dental practitioners and allied specialities. In this context, to identify the cosmetic treatments that have an evidence-based rationale against areas requiring further research, with a view to assess the safety and efficacy of BoNTA.Data source and selection A comprehensive search was conducted using Cochrane Library of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PubMed (Medline) electronic databases. Thirty-nine studies of variable quality were included. The Best Evidence Topics (BETs) Critical Appraisal Tool was used to facilitate the quality assessment of relevant studies.Data extraction Based on current level II evidence, BoNTA was safe and effective to improve facial contour, reduce volume and thickness of bilateral hypertrophic masseter. Conservative doses using a combined approach of BoNTA and hyaluronic acid was recommended as a safe and effective treatment for perioral enhancement supported by level II evidence. There was limited evidence, not higher than level III, to support BoNTA effectiveness for gummy smile associated to perioral musculature hyperactivity, while jawline sculpting targeting the platysma muscle had lower level IV evidence up to this date.Conclusion BoNTA has been widely used off-label for the investigated cosmetic orofacial conditions, with reports of 'good patient and practitioner satisfaction'. However, there is limited high-quality evidence to support the long-term safety and effectiveness of repetitive BoNTA injections. Additionally, no studies were found that provided a cost-effectiveness evaluation of BoNTA formulations against other current cosmetic interventions. Well-designed clinical trials, including long-term follow-up, would help to provide robust evidence-based recommendations for clinical practice, supporting BoNTA popularity, independently or in a combined approach.
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Affiliation(s)
- Ines Novo Pereira
- Academic Plastic Surgery, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK
| | - Haidar Hassan
- Academic Plastic Surgery, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK.
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Application of Nonsurgical Modalities in Improving Facial Aging. Int J Dent 2022; 2022:8332631. [PMID: 35251183 PMCID: PMC8894069 DOI: 10.1155/2022/8332631] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022] Open
Abstract
Objective. This review aims to summarize different kinds of applications of minimally invasive surgery in improving facial aging to provide a comprehensive and accurate introduction on the issue of esthetic treatment of facial skin. Overview. In the twentieth century, facial rejuvenation has become a new beauty trend. Facial cosmetology has entered a period of antiaging and rejuvenation therapies and microplastic surgery. The pursuit of beauty has promoted the development of minimally invasive plastic surgery. This review introduces the possible causes of facial aging and its related topics with a focus on facial injectable drugs, such as botulinum toxin, main filler materials (hyaluronic acid, calcium hydroxyapatite, poly L-lactic acid, collagen, autologous fat, and polymethyl methacrylate), and some current antiwrinkle technologies, such as thread lift and radiofrequency rhytidectomy. Conclusions. Despite the difference in mechanisms of action, each technique can address facial aging involving the loss of collagen, displacement and enlargement of fat, and muscle relaxation. Combinations of these treatments can provide patients with reasonable, comprehensive, and personalized treatment plans.
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Moon H, Lee W, Choi JY. Dynamic evaluation of facial muscles: 3D skin displacement vector analysis using a facial painting model. Laryngoscope Investig Otolaryngol 2021; 6:650-656. [PMID: 34401486 PMCID: PMC8356875 DOI: 10.1002/lio2.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/09/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Botulinum toxin A can be used to eliminate dynamic wrinkles by relaxing the muscles involved in facial expressions. Therefore, it is essential to know the location, origin, insertion, function, and changes of the facial expression muscles according to their contraction. METHODS After drawing the muscles on the face of a model, pictures were taken at rest. The model was then asked to make facial expressions that cause facial wrinkles. All images were taken with the Vectra H1 camera system (Canfield Scientific, Inc., Fairfield, New Jersey). Each expression image was aligned to its respective static image to compute the differences in skin position, so as to calculate the skin displacement vectors. The values for local changes in skin displacement were calculated by applying the automated algorithms of the Vectra Software Mirror Suite and visualized using the color and size of the arrow. RESULTS Face painting and 3D skin vector displacement analyses enabled visualization of all the facial muscles involved in facial expressions working dynamically, allowing us to visualize the effect of each muscle in the creation of hyperkinetic wrinkles. Face painting and 3D skin vector displacement analyses can be combined to determine the location of the wrinkles, extent of the muscle, part of the muscle that contracts, presence of asymmetry, direction in which the muscle contracts, and correlation between the antagonists and synergistic muscles. CONCLUSION The botulinum toxin A injection educational model using body painting and 3D skin vector displacement analyses can provide a deeper understanding of actual moving muscle anatomy. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - Won Lee
- Yonsei E1 Plastic Surgery ClinicAnyangSouth Korea
| | - Ji Yun Choi
- Department of OtorhinolaryngologyChosun University College of MedicineGwangjuSouth Korea
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Clevens RA, Khelemsky R, Sayal NR. The Corner of Lip Lift Technique. Facial Plast Surg Aesthet Med 2020; 22:389-390. [PMID: 32250643 DOI: 10.1089/fpsam.2020.0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ross A Clevens
- Facial Plastic and Reconstructive Surgery, Clevens Face and Body Specialists, Melbourne, Florida
| | - Renata Khelemsky
- Facial Plastic and Reconstructive Surgery, Clevens Face and Body Specialists, Melbourne, Florida
| | - Navdeep R Sayal
- Facial Plastic and Reconstructive Surgery, Clevens Face and Body Specialists, Melbourne, Florida
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Rovatti PP, Pellacani G, Guida S. Hyperdiluted Calcium Hydroxylapatite 1:2 for Mid and Lower Facial Skin Rejuvenation: Efficacy and Safety. Dermatol Surg 2020; 46:e112-e117. [DOI: 10.1097/dss.0000000000002375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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