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Veronese S, Costa E, Portuese A, Ossanna R, Sbarbati A. Histological analysis of the dermal and hypodermal layers of the face and correlation with high-frequency 24 MHz ultrasonography and elastosonography. Eur J Histochem 2024; 68:3912. [PMID: 38619113 PMCID: PMC11059464 DOI: 10.4081/ejh.2024.3912] [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: 11/10/2023] [Accepted: 12/22/2023] [Indexed: 04/16/2024] Open
Abstract
Knowledge of the structure of the face is of fundamental importance. In fact, the face is treated in many areas of medicine, from dermatology, to maxillofacial surgery, to otorhinolaryngology, to ophthalmology, etc. and anti-aging aesthetic treatments, and those for the resolution of blemishes are on the increase. For ethical reasons it is not possible to take biopsy samples for facial analysis in the aesthetic field. The main aim of this study was to demonstrate that a high-resolution bimodal ultrasound examination, combined with elastosonography, could be a valid tool for pre-treatment morphological evaluation. To achieve this goal, skin samples were taken from the forehead, zygomatic area, nasolabial fold, upper and lower lip from cadavers to histologically characterize their structure. Subsequently, these same areas were evaluated in vivo using conventional B-mode ultrasound with a 24 MHz high-frequency probe, and elastosonography. The data obtained with the different techniques were compared, in order to state that modern ultrasound techniques can provide similar histological information. The analysis showed that the superficial hypodermis presented a different shape and structure in the different areas, with the exception of the areas of the upper and lower lip, which appeared similar. With aging, the forehead and zygomatic area showed a volumetric increase in the superficial hypodermic layer, while the lip showed non-structural changes. The morphology of the nasolabial fold remained unchanged. When it is not possible to perform histological investigations on the face, to understand its characteristics and dynamics, ultrasound with a 24 MHz probe would seem to be the most suitable method, while elastosonography could be a valid method for evaluating the stiffness of the structural components.
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Affiliation(s)
- Sheila Veronese
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona.
| | | | | | - Riccardo Ossanna
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona.
| | - Andrea Sbarbati
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona.
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Minelli L, Mendelson BC. Commentary on: Age-Related Changes of the Zygomatic Ligament: An Experimental Animal Study. Aesthet Surg J 2023; 43:NP987-NP989. [PMID: 37682872 DOI: 10.1093/asj/sjad291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
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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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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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Cotofana S, Ziebart R, Chaney GK, Alfertshofer MG, Frank K, Freytag L, Moellhoff N. Discussion: Zygomatico-Orbital Artery: A Reevaluation of the Temporal Blood Vessels. Plast Reconstr Surg 2023; 151:1186-1188. [PMID: 37224340 DOI: 10.1097/prs.0000000000010113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Sebastian Cotofana
- From the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science
| | - Rachel Ziebart
- From the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science
| | - Grace K Chaney
- From the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science
| | - Michael G Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, Ludwig Maximilian University of Munich
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, Ludwig Maximilian University of Munich
| | | | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, Ludwig Maximilian University of Munich
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Fabi SG, Hernandez C, Montes JR, Cotofana S, Dayan S. Aesthetic considerations when treating the Latin American patient: Thriving in diversity international roundtable series. J Cosmet Dermatol 2023; 22:593-602. [PMID: 36468194 DOI: 10.1111/jocd.15516] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/10/2022] [Accepted: 11/03/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND The Hispanic/Latin American population is the fastest growing non-Caucasian group in the United States. Within this group, demand for aesthetic procedures is on the rise. High ethnic variability among these patients influences treatment approaches and patient priorities. Understanding these ethnic differences is central to providing optimal care. AIMS To discuss similarities and differences in anatomy and treatment preferences of Hispanic/Latin American patients both within the United States and internationally and explore how these differences may influence or inform aesthetic practices. PATIENTS/METHODS In support of clinicians who wish to serve a diverse patient population, a 6-part, international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021 to May 16, 2022. In this roundtable, held in Medellin, Columbia, expert clinicians from across Latin America and the United States were invited to contribute and share best practices. RESULTS The results of the second roundtable in the series, the Latin American Patient, are described here. A special emphasis is placed on procedures that address the most commonly encountered concerns in these patients. CONCLUSIONS Hispanic and Latino patients represent a broad demographic with unique anatomical features, aesthetic preferences, and treatment priorities. Clinicians should consider these differences when treating this patient population.
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Affiliation(s)
| | | | - José Raúl Montes
- Ophthalmology Department, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.,Jose Raul Montes Eyes & Facial Rejuvenation, San Juan, Puerto Rico
| | | | - Steve Dayan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois at Chicago, Chicago, Illinois, USA
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Hernandez CA, Zapata DEU, Bermudez MP, Frank K, Moellhoff N, Alfertshofer M, Gotkin RH, Davidovic K, Cotofana S. Clinical validation of the upper face first principle-A clinical, prospective, interventional split-face study. J Cosmet Dermatol 2023; 22:418-425. [PMID: 36573471 DOI: 10.1111/jocd.15563] [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: 08/18/2022] [Revised: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous clinical and anatomic investigations have identified the clinical relevance of facial biomechanics. Based on this new understanding, principles for facial aesthetic procedures were established: Lateral Face First, Deep Layers First, and Upper Face First. OBJECTIVE To test the upper face first principle by showing that an injection sequence, starting in the upper face is superior to an injection sequence starting in the lower face. METHODS This study was designed as an interventional split-face study administering the same amount and type of soft tissue filler for the upper, middle, and lower face but in a different sequence: upper, middle, lower face versus lower, middle, and upper face. A total of 15 patients (5 males and 10 females) with a mean age of 39.4 years (9.6) and a mean BMI of 23.4 kg/m2 (1.7) were studied. Follow-up at D0, D30, and D90 was conducted utilizing semiquantitative scores and objective 3D imaging. RESULTS Despite not reaching statistical significance, midfacial volume and jawline contouring were rated better at every follow-up visit (D0, D30, D90) when treated with the upper versus the lower face first injection algorithm. The global aesthetic improvement scale showed statistically significantly better values for the upper face first algorithm when compared to the lower face first algorithm at all evaluated time points with all p < 0.001. CONCLUSION Applying the upper face first injection algorithm seems to result in better aesthetic outcomes when directly compared to the lower face first algorithm. Semiquantitative and objective outcome measurements confirm its clinical effectiveness.
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Affiliation(s)
| | | | | | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, Munich, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, Munich, Germany
| | | | - Kristina Davidovic
- Center for Radiology and Magnetic Resonance Imaging, Clinical Center of Serbia, Belgrade, Serbia
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Haykal D, Cartier H, Benzaquen M, Damiani G, Habib SM. The growing importance of ultrasonography in cosmetic dermatology: An update after the 23rd IMCAS Annual World Congress (2022). J Cosmet Dermatol 2023; 22:222-225. [PMID: 36374262 DOI: 10.1111/jocd.15503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/09/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrasound (US) has been used for many years in the field of medicine. Many specialties have embraced US as a quick, painless, and relatively inexpensive tool to assist the clinician in determining anatomy, pathology, and aid in diagnostic or therapeutic procedures. US allows for precise mapping of cutaneous and subcutaneous structures in the face, in particular vascular structures. The use of US leads to reduced chances of complications and clinical failures, rendering more safety and high quality. METHODS US is considered the first-imaging technique for dealing with fillers and managing their potential complications. US can be deployed for vascular mapping, safe placement of fillers, and directed low-dose hyaluronidase reversal of vascular adverse events. It is a noninvasive imaging modality that provides a good definition for studying the skin, deeper layers, and blood flow in real time. In other words, we go from static to dynamic anatomy. In addition, US can guide with the application of botulinum toxin, in order to define the muscular planes. US may contribute to a more personalized procedure, better cosmetic results, and help to avoid complications. In general, physicians tend to use it for prevention. Last, for research purposes, US examination provides valuable information on the behavior, longevity, and interaction of the filler within the tissues. CONCLUSION This new approach for US-guided treatments is a very practical and an effective method in cosmetic dermatology. As doctors, we owe it to our patients to do our best to prevent any harm. We feel that in near future, US will be an essential diagnostic tool in any dermatology or cosmetic doctor's office to both ensure safety and provide legal protection for the professional.
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Affiliation(s)
| | | | | | - Giovanni Damiani
- Dermatology Unit, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Fabi SG, Callender VD, Lee WW, Dayan S. Aesthetic considerations for treating the North American multi-ethnic patient: Thriving in diversity international roundtable series. J Cosmet Dermatol 2022; 21:6976-6984. [PMID: 36176035 DOI: 10.1111/jocd.15422] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/27/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The United States is becoming increasingly diverse, and between 2016 and 2019, an increase of 945 832 aesthetic procedures was recorded for Hispanic, African American, and Asian American patients combined. In aesthetics, where outcomes are technique dependent and tied to the clinician's ability to tailor treatment to the needs of individual patients, a knowledge of ethnic differences in anatomy and how aesthetic issues can be safely and effectively addressed in different groups is paramount. AIMS To discuss similarities and difference in anatomy and treatment preferences of patients from a variety of ethnic and racial backgrounds and how these differences may influence the products or techniques utilized to achieve natural-looking results and minimize side effects. PATIENTS/METHODS In support of clinicians who wish to serve a diverse patient population, a 6-part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022. RESULTS The results of the first roundtable in the series, the North American Multiethnic Patient, are described here. CONCLUSIONS A diverse range of patients can benefit from the tailored use of fillers, fat transfer, neuromodulators, lasers, and energy-based devices, as long as differences in structural support, skin, and aging patterns, are appreciated.
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Affiliation(s)
| | - Valerie D Callender
- Dermatologist at Callender Dermatology & Cosmetic Center, Glenn Dale, Maryland, USA.,Howard University College of Medicine, Washington, District of Columbia, USA
| | - Wendy W Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Steven Dayan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois at Chicago, Chicago, Illinois, USA
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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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Affiliation(s)
- Peter Velthuis
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Leonie Schelke
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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