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Fuchs B, Mert S, Kuhlmann C, Taha S, Birt A, Nickelsen J, Schenck TL, Giunta RE, Wiggenhauser PS, Moellhoff N. Biocompatibility of Synechococcus sp. PCC 7002 with Human Dermal Cells In Vitro. Int J Mol Sci 2024; 25:3922. [PMID: 38612734 PMCID: PMC11012068 DOI: 10.3390/ijms25073922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Being the green gold of the future, cyanobacteria have recently attracted considerable interest worldwide. This study investigates the adaptability and biocompatibility of the cyanobacterial strain Synechococcus sp. PCC 7002 with human dermal cells, focusing on its potential application in biomedical contexts. First, we investigated the adaptability of Synechococcus PCC 7002 bacteria to human cell culture conditions. Next, we evaluated the biocompatibility of cyanobacteria with common dermal cells, like 3T3 fibroblasts and HaCaT keratinocytes. Therefore, cells were directly and indirectly cocultured with the corresponding cells, and we measured metabolic activity (AlamarBlue assay) and proliferation (cell count and PicoGreen assay). The lactate dehydrogenase (LDH) assay was performed to determine the cytotoxic effect of cyanobacteria and their nutrition medium on human dermal cells. The cyanobacteria exhibited exponential growth under conventional human cell culture conditions, with the temperature and medium composition not affecting their viability. In addition, the effect of illumination on the proliferation capacity was investigated, showing a significant impact of light exposure on bacterial growth. The measured oxygen production under hypoxic conditions demonstrated a sufficient oxygen supply for further tissue engineering approaches depending on the number of bacteria. There were no significant adverse effects on human cell viability and growth under coculture conditions, whereas the LDH assay assessed signs of cytotoxicity regarding 3T3 fibroblasts after 2 days of coculturing. These negative effects were dismissed after 4 days. The findings highlight the potential of Synechococcus sp. PCC 7002 for integration into biomedical approaches. We found no cytotoxicity of cyanobacteria on 3T3 fibroblasts and HaCaT keratinocytes, thus paving the way for further in vivo studies to assess long-term effects and systemic reactions.
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Affiliation(s)
- Benedikt Fuchs
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany; (S.M.); (C.K.); (S.T.); (A.B.); (T.L.S.); (R.E.G.); (P.S.W.); (N.M.)
| | - Sinan Mert
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany; (S.M.); (C.K.); (S.T.); (A.B.); (T.L.S.); (R.E.G.); (P.S.W.); (N.M.)
| | - Constanze Kuhlmann
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany; (S.M.); (C.K.); (S.T.); (A.B.); (T.L.S.); (R.E.G.); (P.S.W.); (N.M.)
| | - Sara Taha
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany; (S.M.); (C.K.); (S.T.); (A.B.); (T.L.S.); (R.E.G.); (P.S.W.); (N.M.)
| | - Alexandra Birt
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany; (S.M.); (C.K.); (S.T.); (A.B.); (T.L.S.); (R.E.G.); (P.S.W.); (N.M.)
| | - Jörg Nickelsen
- Molecular Plant Science, Department Biology I, LMU Munich, 80336 Munich, Germany;
| | - Thilo Ludwig Schenck
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany; (S.M.); (C.K.); (S.T.); (A.B.); (T.L.S.); (R.E.G.); (P.S.W.); (N.M.)
| | - Riccardo Enzo Giunta
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany; (S.M.); (C.K.); (S.T.); (A.B.); (T.L.S.); (R.E.G.); (P.S.W.); (N.M.)
| | - Paul Severin Wiggenhauser
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany; (S.M.); (C.K.); (S.T.); (A.B.); (T.L.S.); (R.E.G.); (P.S.W.); (N.M.)
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany; (S.M.); (C.K.); (S.T.); (A.B.); (T.L.S.); (R.E.G.); (P.S.W.); (N.M.)
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Alfertshofer M, Calomeni M, Welch S, Metelitsa A, Knoedler S, Frank K, Green JB, Moellhoff N, Knoedler L, Cotofana S. Increasing Precision When Targeting the Depressor Anguli Oris (DAO) Muscle With Neuromodulators - An Ultrasound-Based Investigation. Aesthet Surg J 2024:sjae067. [PMID: 38513359 DOI: 10.1093/asj/sjae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Neuromodulator treatments of the perioral region are increasingly popular and aim to modulate the position of the modiolus. The predominantly targeted muscle is the depressor anguli oris (DAO) which allows for the modiolus to reposition cranially once temporarily relaxed. OBJECTIVES To identify the precise anatomic position of the DAO in relation to the Marionette Line for increasing precision and reducing adverse events during neuromodulator treatments. METHODS A total of n = 80 DAO muscles were investigated in n = 40 healthy, toxin naïve volunteers (11 males, 29 females) having a mean age of 48.15 (15) years and a mean body mass index of 24.07 (3.7) kg/m2. The location of the DAO in relation to the labiomandibular sulcus (LMS), its depth, extent, and thickness were investigated with high frequency ultrasound imaging. RESULTS The skin surface projection of the LMS separates the DAO into medial and lateral portions. The distance between skin surface and muscle surface was on average 4.4 mm with males having a greater distance (p < 0.001) and higher BMI being an important influencing factor for a greater distance (p < 0.001). The thickness of the DAO was on average 3.5 mm with a range of 2.8-4.8 mm and with females having thinner muscles when compared to men (p < 0.001). The most favorable injection depth was calculated to be 6.1 mm for intra-muscular product placement. CONCLUSIONS Understanding the perioral anatomy and the influence of age, sex, and BMI will potentially allow the injectors to increase efficacy and duration of neuromodulator treatments while expertly managing adverse events.
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Affiliation(s)
- Michael Alfertshofer
- Research fellow, Department of Oromaxillofacial Surgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Scott Welch
- Aesthetic practitioner in private practice, Newport Beach, CA, USA
| | - Andrei Metelitsa
- Dermatologist, Department of Dermatology, University of Calgary, Calgary, Canada
| | - Samuel Knoedler
- Medical student, Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Jeremy B Green
- Dermatologist in private practice, Coral Gables, FL, USA
| | - Nicholas Moellhoff
- Plastic surgeon, Department of Hand-, Plastic and Aesthetic Surgery, University Hospital Munich, Munich, Germany
| | - Leonard Knoedler
- Medical student, Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Sebastian Cotofana
- Professor, Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Calomeni M, Alfertshofer M, Moellhoff N, Freytag DL, Nikolis A, Biesman B, Davidovic K, Schelke L, Velthuis PJ, Cotofana S. Understanding Platysma Muscle Contraction Pattern and Its Relationship to Platysmal Banding: A Real-Time Ultrasound Study. Aesthet Surg J 2024; 44:233-239. [PMID: 37418617 DOI: 10.1093/asj/sjad216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Addressing neck contouring with surgical and nonsurgical aesthetic procedures includes understanding the origin of platysmal banding. A theory was postulated to explain this phenomenon by isometric vs isotonic muscular contraction patterns. However, no scientific proof had been provided to date for its correctness. OBJECTIVES The aim of this study was to confirm the correctness of the platysmal banding theory based on isometric vs isotonic muscular contractions. METHODS Eighty platysma muscles from 40 volunteers (15 males and 25 females) were investigated (mean age 41.8; SD 15.2 years; mean BMI of 22.2; SD 2.3 kg/m2). Real-time ultrasound imaging was utilized to measure the increase in local muscle thickness inside and outside of a platysmal band as well as platysma mobility. RESULTS Within a platysmal band, the local thickness of the muscle increases during muscular contractions by 0.33 mm (37.9%; P < .001). Outside of a platysmal band the thickness of the platysma muscle decreased by 0.13 mm (20.3%; P < .001). It was identified that within a platysmal band no gliding was detectable, whereas outside of a band an average muscle gliding of 2.76 mm was observed. CONCLUSIONS The results confirm the correctness of the isometric vs isotonic platysma muscle contraction pattern theory: isotonic muscle contraction (gliding without increase in tension and therefore in muscle thickness) vs isometric muscle contraction (no gliding but increase in tension and therefore in muscle thickness). These 2 types of contraction patterns occur within the platysma simultaneously and are an indicator for zones of adhesion in the neck to guide surgical and nonsurgical aesthetic procedures. LEVEL OF EVIDENCE: 4
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Frank K, Zeng R, Sedlbauer S, Prantl L, Giunta R, Cotofana S, Moellhoff N, Alfertshofer M, Kaye K, Brébant V. The Influence of Scar Patterns After Reduction Mammoplasty on Eye Movement and Gaze Pattern: An Eye-Tracking Investigation. Aesthetic Plast Surg 2024; 48:250-258. [PMID: 37853080 PMCID: PMC10917861 DOI: 10.1007/s00266-023-03689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Given that scars are acknowledged as the primary cause of postoperative dissatisfaction following reduction mammoplasty, it is imperative to comprehend the patient's visual perception of different scar patterns in order to enhance patient satisfaction. To achieve this, eye-tracking technology provides an unbiased method of evaluating how observers assess breast scars. METHODS 58 participants (32 females and 26 males) between the ages of 19 and 82 years (mean age of 29.47 ± 10.98 years) were shown 18 color photographs, taken at 3 viewing angles (right 45° oblique, frontal and frontal view with arms raised), from 6 patients undergone reduction mammoplasty with the inverted T-scar technique (3 patients) or no-vertical-scar technique (3 patients). The images were presented to every participant for a fixed duration of 5 s each. Eye-tracking device was used to collect and analyze the gaze data of viewers. RESULTS The nipple-areola complex (NAC) and the periareolar scar captured observers' gaze faster, had longer duration and more count of eye fixation than all other parts of breast scars, regardless of the viewing angle and scar pattern. Moreover, the scar region in the inverted T-scar pattern received greater and faster visual attraction of observer's gaze than the no-vertical-scar pattern. CONCLUSION The NAC and the periareolar scar seem to be perceived as the most important regions for breast aesthetics. The findings can be helpful to assist plastic surgeons in determining the most appropriate technique for reduction mammoplasty, meanwhile underlining the importance of a fine periareolar scar and symmetric NAC for excellent aesthetic outcomes. This is to our best knowledge the first study using eye-tracking technology in evaluating reduction mammoplasty outcomes. This study explored the influence of different scar patterns after reduction mammoplasty on eye movements and gaze patterns among observers. The study have validated the significance of the NAC and the periareolar scar for breast aesthetics and revealed that the scar region in the inverted T-scar pattern may be judged less visually attractive than the no-vertical-scar pattern. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Rui Zeng
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stephanie Sedlbauer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Riccardo Giunta
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sebastian Cotofana
- Department of Dermatology, Erasmus Hospital, Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Vanessa Brébant
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Moellhoff N, Kuhlmann C, Giunta RE. A 10-year analysis of citations and impact factors in plastic surgery journals. J Plast Reconstr Aesthet Surg 2024; 88:475-477. [PMID: 38101260 DOI: 10.1016/j.bjps.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany.
| | - Constanze Kuhlmann
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Riccardo E Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
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Kaye KO, Paprottka F, Moellhoff N, Fertsch S, Frank K, Casabona G. Radiofrequency and pulsed electromagnetic field application following liposuction-Clinical evaluation of performance and safety. J Cosmet Dermatol 2023; 22:3298-3304. [PMID: 37909850 DOI: 10.1111/jocd.15937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/25/2023] [Accepted: 07/12/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE With more than 1.5 million performed procedures, liposuction was the second most performed esthetic surgical procedure all over the world in males and in females in the year 2020. The objective of this open-label, evaluator-blinded study was to assess the efficacy and safety of an energy-based device that combines multipolar radiofrequency with pulsed electromagnetic field (PEMF) in patients that underwent liposuction. MATERIALS AND METHODS A total of 30 subjects, of whom 24 were females (80%), with a mean age of 48.4 ± 11.0 years (range: 27-69 years) and a mean weight of 69.5 ± 11.7 kg underwent unilateral treatment with radiofrequency and application of PEMF after bilateral liposuction. One month after the last of a total of six weekly treatments, skin elasticity, visco-elasticity and net elasticity, as well as subject reported satisfaction on a 5-point scale ranging from -1 (worse) to 3 (very much improved) and esthetic improvement ranging from 0 (very unsatisfied) to 4 (very satisfied) rated by three independent reviewers were assessed. RESULTS Three independent and blinded reviewers rated the improvement of the treated side on average as 1.17 + 0.07 compared with baseline. Subjects were very satisfied with their treatment, with a mean score of 3.24 (0.03) out of 4 at the 1-month follow-up visit. Cutometer measurements showed no significant changes. CONCLUSION This study revealed that the subjective satisfaction with the results of the application of RF and PEMF after liposuction is high, while at the same time the esthetic appearance as rated by independent raters improved on the treated side.
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Affiliation(s)
| | | | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU, Munich, Germany
| | - Sonia Fertsch
- Department of Plastic Surgery, SANA Clinic Düsseldorf Gerresheim, Düsseldorf, Germany
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Moellhoff N, Kuhlmann C, Frank K, Kim BS, Conte F, Cotofana S, Piccolo NS, Pallua N. Arterial Embolism After Facial Fat Grafting: A Systematic Literature Review. Aesthetic Plast Surg 2023; 47:2771-2787. [PMID: 37563433 PMCID: PMC10784353 DOI: 10.1007/s00266-023-03511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/30/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND While autologous fat grafting of the face is considered a generally safe procedure, severe complications such as arterial embolism (AE) have been reported. OBJECTIVE To summarize data on injection-related visual compromise, stroke, and death caused by arterial embolism after facial fat transplantation. MATERIALS AND METHODS Plastic surgery societies were contacted for reports on AE after autologous facial fat injection. In addition, a systematic literature review was performed. Data extracted included study design, injection site/technique, symptoms, management, outcome, and etiology. RESULTS 61 patients with a mean age of 33.56 ± 11.45 years were reported. Injections targeted the glabella or multiple facial regions (both n = 16/61, 26.2%) most commonly, followed by injections in the temples (n = 10/61, 16.4%) and the forehead (n = 9/61, 14.8%). The mean volume injected was 21.5 ± 21.5 ml. Visual symptoms were described most frequently (n = 24/58, 41.4%) followed by neurological symptoms (n = 20/58, 34.5%), or both (n = 13/58, 22.4%). Ophthalmic artery (OA, n = 26/60, 43.3%), anterior or middle cerebral artery (CA, n = 11/60, 18.3%) or both (n = 14/60, 23.3%) were most frequently occluded. Outcome analysis revealed permanent vision loss in all patients with OA occlusion (n = 26/26, 100%), neurological impairment in most patients with CA occlusion (n = 8/10, 80%), and vision loss in most patients suffering from both OA and CA occlusion (n = 7/11, 63.6%). Six patients died following embolisms. CONCLUSIONS AE causes severe complications such as blindness, stroke, and death. Due to a lack of high-quality data, no evidence-based treatment algorithms exist. To increase patient safety, a database collecting cases and complications should be established. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany.
| | - Constanze Kuhlmann
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zürich, Switzerland
| | - Francesco Conte
- Medical Faculty Rhenish, Westphalian Technical University, Aachen, Germany
- Pallua-Clinic Duesseldorf, Duesseldorf, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nelson S Piccolo
- Division of Plastic Surgery, Pronto Socorro para Queimaduras, Goiânia, Brazil
- International Society of Plastic Regenerative Surgeons, Arlington Heights, IL, USA
| | - Norbert Pallua
- Medical Faculty Rhenish, Westphalian Technical University, Aachen, Germany
- Pallua-Clinic Duesseldorf, Duesseldorf, Germany
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Hayano W, Kerscher M, Day D, Ogilvie A, Pavicic T, Lim T, Lorenc PZ, Hernandez C, Frank K, Moellhoff N, Prinz V, Mia C, Pooth R, Green J. Novel, Validated, 5-Point Photonumeric Scales for Assessment of the Perioral Region. Aesthet Surg J 2023; 43:1347-1356. [PMID: 37052953 DOI: 10.1093/asj/sjad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/02/2023] [Accepted: 03/17/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The use of validated scales is still considered the gold standard for evaluating the severity of an aesthetic facial condition. OBJECTIVES The aim of this investigation was to create and validate 5-point photonumeric scales for the assessment of perioral lines and marionette lines. METHODS A medical team created 2 different novel 5-point photonumeric scales for the assessment of perioral lines and marionette lines. Eleven international raters were involved in the digital validation, and 4 raters performed a live validation. RESULTS For the Croma Static Perioral Lines-Assessment Scale, the digital interrater intraclass correlation coefficients (ICCs) were 0.88 (95% CI, 0.85-0.91) in the first rating and 0.87 (95% CI, 0.83-0.90) in the second rating. The digital intrarater ICCs were 0.90 (95% CI, 0.87-0.92). In the live rating, the interrater ICCs were 0.89 (95% CI, 0.85-0.93) in the first rating and 0.91 (95% CI, 0.87-0.93) in the second rating with an intrarater ICC of 0.91 (95% CI, 0.88-0.95). For the Croma Marionette Lines-Assessment Scale, the digital rating interrater ICCs were 0.85 (95% CI, 0.81-0.89) in the first rating and 0.87 (95% CI, 0.84-0.90) in the second rating with an intrarater ICC of 0.89 (95% CI, 0.88-0.91). In the live rating, the interrater ICCs were 0.73 (95% CI, 0.54-0.83) in the first rating and 0.79 (95% CI, 0.65-0.87) in the second rating with an intrarater ICC of 0.88 (95% CI, 0.83-0.94). CONCLUSIONS The Croma Static Perioral Lines-Assessment Scale and the Croma Marionette Lines-Assessment Scale have exceptional inter- and intrarater agreements that justify their use in clinical and study settings for all ethnic groups. LEVEL OF EVIDENCE: 5
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Li XR, Hong WJ, Luo SK, Zhang YL, Li WM, Moellhoff N, Freytag DL, Nikolis A, Alfertshofer M, Cotofana S. A Computed Tomographic Investigation of the Ophthalmic Artery Volume and Its Relevance to Soft Tissue Filler Injections. Aesthet Surg J 2023; 43:1025-1032. [PMID: 36866393 DOI: 10.1093/asj/sjad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The measured intraarterial volume of cadaveric ophthalmic arteries was utilized for safety recommendations during facial soft tissue filler injections. However, its clinical practicability and model applicability have become questionable. OBJECTIVES To measure the volume of the ophthalmic artery in living individuals by utilizing computed tomography (CT) imaging technology. METHODS A total of 40 Chinese patients (23 males, 17 females) were included in this study with a mean age of 61.0 (14.2) years and a mean body mass index of 23.7 (3.3) kg/m2. Patients were investigated with CT imaging technology to evaluate the length, diameter, and volume of the bilateral ophthalmic arteries as well as the length of the bony orbits, resulting in a total of 80 investigated ophthalmic arteries and orbits. RESULTS Independent of gender, the average length of the ophthalmic artery was 80.6 (18.7) mm, the calculated volume of the ophthalmic artery was 0.16 (0.05) mL and the minimal and maximal internal diameter of the ophthalmic artery were 0.50 (0.05) mm and 1.06 (0.1) mm, respectively. CONCLUSIONS Based on the results obtained from the investigation of 80 ophthalmic arteries it must be concluded that current safety recommendations should be reevaluated. The volume of the ophthalmic artery appears to be 0.2 mL rather than 0.1 mL as previously reported. In addition, it appears impractical to limit the volume of soft tissue filler bolus injections to 0.1 mL due to the aesthetic requirements of each individual patient and treatment plan.
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Cotofana S, Moellhoff N, Frank K, Freytag LD, Alfertshofer MG. Commentary on: Novel Technology for Facial Muscle Stimulation Combined With Synchronized Radiofrequency Induces Structural Changes in Muscle Tissue: Porcine Histology Study. Aesthet Surg J 2023; 43:928-929. [PMID: 37071792 DOI: 10.1093/asj/sjad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/20/2023] Open
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fuchs B, Birt A, Moellhoff N, Kuhlmann C, Giunta R, Wiggenhauser PS. The use of commercial fibrin glue in dermal replacement material reduces angiogenic and lymphangiogenic gene and protein expression in vitro. J Biomater Appl 2023; 37:1858-1873. [PMID: 37082911 DOI: 10.1177/08853282231171681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Commercial fibrin glue is increasingly finding its way into clinical practice in surgeries to seal anastomosis, and initiate hemostasis or tissue repair. Human biological glue is also being discussed as a possible cell carrier. To date, there are only a few studies addressing the effects of fibrin glue on the cell-molecular level. This study examines the effects of fibrin glue on angiogenesis and lymphangiogenesis, as well as adipose-derived stem cells (ASCs) with a focus on gene and protein expression in scaffolds regularly used for tissue engineering approaches. METHODS Collagen-based dermal regeneration matrices (DRM) were seeded with human umbilical vein endothelial cells (HUVEC), human dermal lymphatic endothelial cells (LECs), or adipose-derived stem cells (ASC) and fixed with or without fibrin glue according to the experimental group. Cultures were maintained for 1 and 7 days. Finally, angiogenic and lymphangiogenic gene and protein expression were measured with special regard to subtypes of vascular endothelial growth factor (VEGF) and corresponding receptors using Multiplex-qPCR and ELISA assays. In addition, the hypoxia-induced factor 1-alpha (HIF1a) mediated intracellular signaling pathways were included in assessments to analyze a hypoxic encapsulating effect of fibrin polymers. RESULTS All cell types reacted to fibrin glue application with an alteration of gene and protein expression. In particular, vascular endothelial growth factor A (VEGFA), vascular endothelial growth factor B (VEGFB), vascular endothelial growth factor C (VEGFC), vascular endothelial growth receptor 1 (VEGFR1/FLT1), vascular endothelial growth receptor 2 (VEGFR2/KDR), vascular endothelial growth receptor 3 (VEGFR3/FLT4) and Prospero Homeobox 1 (PROX1) were depressed significantly depending on fibrin glue. Especially short-term fibrin effect led to a continuous downregulation of respective gene and protein expression in HUVECs, LECs, and ASCs. CONCLUSION Our findings demonstrate the impact of fibrin glue application in dermal regeneration with special regard to angiogenesis and lymphangiogenesis. In particular, a short fibrin treatment of 24 hours led to a decrease in gene and protein levels of LECS, HUVECs, and ASCs. In contrast, the long-term application showed less effect on gene and protein expressions. Therefore, this work demonstrated the negative effects of fibrin-treated cells in tissue engineering approaches and could affect wound healing during dermal regeneration.
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Affiliation(s)
- Benedikt Fuchs
- Department of Hand, Plastic and Aesthetic Surgery, LMU, Munich, Germany
| | - Alexandra Birt
- Department of Hand, Plastic and Aesthetic Surgery, LMU, Munich, Germany
| | | | | | - Riccardo Giunta
- Department of Hand, Plastic and Aesthetic Surgery, LMU, Munich, Germany
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Cotofana S, Alfertshofer MG, Frank K, Freytag L, Moellhoff N. Commentary on: The Dorsal Nasal Complex in Asians: Anatomical Variations and Injection Guide for BoNT-A. Aesthet Surg J 2023:7109172. [PMID: 37018463 DOI: 10.1093/asj/sjad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Michael G Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Konstantin Frank
- Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
| | - Lysander Freytag
- Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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14
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Fuchs B, Birt A, Moellhoff N, Kuhlmann C, Giunta RE, Wiggenhauser PS. Adipose-Derived Stem Cells Improve Angiogenesis and Lymphangiogenesis in a Hypoxic Dermal Regeneration Model In Vitro. Medicina (B Aires) 2023; 59:medicina59040706. [PMID: 37109664 PMCID: PMC10142758 DOI: 10.3390/medicina59040706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/07/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
Background and Objectives: Impaired wound healing represents an unsolved medical issue with a high impact on patients’ quality of life and global health care. Even though hypoxia is a significant limiting factor for wound healing, it reveals stimulating effects in gene and protein expression at cellular levels. In particular, hypoxically treated human adipose tissue-derived stem cells (ASCs) have previously been used to stimulate tissue regeneration. Therefore, we hypothesized that they could promote lymphangiogenesis or angiogenesis. Materials and Methods: Dermal regeneration matrices were seeded with human umbilical vein endothelial cells (HUVECs) or human dermal lymphatic endothelial cells (LECs) that were merged with ASCs. Cultures were maintained for 24 h and 7 days under normoxic or hypoxic conditions. Finally, gene and protein expression were measured regarding subtypes of VEGF, corresponding receptors, and intracellular signaling pathways, especially hypoxia-inducible factor-mediated pathways using multiplex-RT-qPCR and ELISA assays. Results: All cell types reacted to hypoxia with an alteration of gene expression. In particular, vascular endothelial growth factor A (VEGFA), vascular endothelial growth factor B (VEGFB), vascular endothelial growth factor C (VEGFC), vascular endothelial growth factor receptor 1 (VEGFR1/FLT1), vascular endothelial growth factor receptor 2 (VEGFR2/KDR), vascular endothelial growth factor receptor 3 (VEGFR3/FLT4), and prospero homeobox 1 (PROX1) were overexpressed significantly depending on upregulation of hypoxia-inducible factor 1 alpha (HIF-1a). Moreover, co-cultures with ASCs showed a more intense change in gene and protein expression profiles and gained enhanced angiogenic and lymphangiogenic potential. In particular, long-term hypoxia led to continuous stimulation of HUVECs by ASCs. Conclusions: Our findings demonstrated the benefit of hypoxic conditioned ASCs in dermal regeneration concerning angiogenesis and lymphangiogenesis. Even a short hypoxic treatment of 24 h led to the stimulation of LECs and HUVECs in an ASC-co-culture. Long-term hypoxia showed a continuous influence on gene expressions. Therefore, this work emphasizes the supporting effects of hypoxia-conditioned-ASC-loaded collagen scaffolds on wound healing in dermal regeneration.
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Affiliation(s)
- Benedikt Fuchs
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital Ludwig-Maximilians-Universität, Ziemssenstraße 5, 80336 Munich, Germany
| | - Alexandra Birt
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital Ludwig-Maximilians-Universität, Ziemssenstraße 5, 80336 Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital Ludwig-Maximilians-Universität, Ziemssenstraße 5, 80336 Munich, Germany
| | - Constanze Kuhlmann
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital Ludwig-Maximilians-Universität, Ziemssenstraße 5, 80336 Munich, Germany
| | - Riccardo E. Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital Ludwig-Maximilians-Universität, Ziemssenstraße 5, 80336 Munich, Germany
| | - Paul Severin Wiggenhauser
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital Ludwig-Maximilians-Universität, Ziemssenstraße 5, 80336 Munich, Germany
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15
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Kerscher M, Green J, Day D, Ogilvie A, Pavicic T, Lim T, Hayano W, Lorenc ZP, Hernandez C, Frank K, Moellhoff N, Prinz V, Cajkovsky M, Pooth R. Novel, Validated Five-Point Photonumeric Scales for Assessment of the Neck and Décolleté. Aesthet Surg J 2023:7058062. [PMID: 36840504 DOI: 10.1093/asj/sjad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND A scarcity of scales which assess platysmal bands, wrinkles in the décolleté, and horizontal necklines in the digital and live setting exist. OBJECTIVES The objective of this investigation was to create and validate 5-point photo numeric scales which assess horizontal necklines, platysmal bands and wrinkles in the décolleté. METHODS A medical team created 3 different novel 5-point photonumeric scale for the assessment of horizontal necklines, platysmal bands and décolleté wrinkling. Eleven international raters were involved in the digital validation, while 4 raters performed a live validation. RESULTS The Croma Horizontal Neck Line - Assessment Scale showed substantial inter-rater agreement and almost perfect intra-rater agreement in the digital and live validations. The Croma Platysmal Bands-Assessment Scale showed substantial intra-rater agreement in both, digital and live validations. For the décolleté, a static and a dynamic scale was created and validated. The Croma Static Décolleté Wrinkling-Assessment Scale showed substantial and almost perfect inter-rater agreement in the digital validation and live-validation, respectively, while the intra-rater agreement was in both almost perfect. The Croma Dynamic Décolleté Wrinkling-Assessment Scale showed almost perfect agreement in both validation settings for both, inter-and intra-rater agreement. CONCLUSIONS The Croma Horizontal Neck Line - Assessment Scale, the Croma Static and Dynamic Décolleté Wrinkling-Assessment Scales have sufficient inter and intrarater agreements to be justifiably used in the clinical and study setting.
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Affiliation(s)
- Martina Kerscher
- Division of Cosmetic Science, Department of Chemistry, University of Hamburg, Hamburg, Germany
| | - Jeremy Green
- Physician in private practice in Coral Gables, Florida, USA
| | - Doris Day
- NYU Langone Health, New York, New York, USA
| | | | | | - Tingsong Lim
- Physician in private practice in Kuala Lumpur, Malaysia
| | - Windie Hayano
- Physician in private practice in Manila, the Philippines
| | - Z Paul Lorenc
- Department of Plastic Surgery, Lenox Hill Hospital, New York, NY, USA
| | | | | | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Valentina Prinz
- Clinical project manager at a private aesthetic clinic in Vienna, Austria
| | - Mia Cajkovsky
- Clinical project manager at a private aesthetic clinic in Vienna, Austria
| | - Rainer Pooth
- ICA Aesthetic Navigation GmbH, Frankfurt, Germany
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16
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Calomeni M, Bravo BSF, Schelke LW, Velthuis PJ, Schalet G, Frank K, Guertler A, Alfertshofer M, Cotofana S, Moellhoff N. Precision of Soft-Tissue Filler Injections: An Ultrasound-Based Verification Study. Aesthet Surg J 2023; 43:353-361. [PMID: 36281772 DOI: 10.1093/asj/sjac272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Uncontrolled product spread is an important issue to consider in facial filler injections. Lack of precision can result in reduced effectiveness and surface projection, as well as irregularities and product visibility. OBJECTIVES The authors sought to assess the precision of soft-tissue filler injections in the face by employing a cannula. METHODS This single-center observational study investigated soft-tissue filler distribution utilizing real-time non-invasive ultrasound imaging. Outcome parameters included (1) the tissue plane of product distribution, (2) the extent of horizontal as well as vertical product spread at the injection site, and (3) the product surface area taking into account the multifactorial influence of several independent variables. Participants were followed up to 30 days post-injection. RESULTS A total 100 facial injections were performed in 8 patients (2 males, 6 females) with a mean age of 37.20 (±6.34) years and a mean BMI of 22.21 (±1.39) kg/m.2. The plane of product distribution remained constant in approximately 90% of cases at day 0 (d0), d14, and d30. Mean horizontal product spread was higher compared with vertical spread, and both significantly decreased over all time points (P < .001). Mean product surface area was 22.51 ± 16.34 mm2 at d0, 15.97 ± 11.28 mm2 at d14, and 12.9 ± 9.15 mm2 at d30. Analysis employing generalized linear models revealed that injection volume and injection depth significantly influenced product surface area. CONCLUSIONS Injection of soft-tissue filler employing a cannula allows precise application of the product within the intended tissue plane. Precision can be improved by injecting less product into deeper tissue layers. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Mariana Calomeni
- Dermatology Department, Bravo Private Clinic, Rio de Janeiro, Brazil
| | - Bruna S F Bravo
- Dermatology Department, Bravo Private Clinic, Rio de Janeiro, Brazil
| | - Leonie W Schelke
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter J Velthuis
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Grant Schalet
- Department of Surgery, Broward Health Medical Center, Ft. Lauderdale, FL, USA
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Anne Guertler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
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17
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Moellhoff N, Prantl L, Behr B, Beier JP, Daigeler A, Dragu A, Eisenhardt SU, Fuchs PC, Germann G, Hirsch T, Horch RE, Infanger M, Jakubietz R, Kneser U, Langer S, Lehnhardt M, Machens HG, Mailänder P, Reichert B, Radtke C, Schaefer DJ, Siemers F, Vogt PM, Menke H, Giunta RE. [Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) and Research Funding Report 2021/2022]. HANDCHIR MIKROCHIR P 2023; 55:95-105. [PMID: 36780931 DOI: 10.1055/a-2007-4475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Research is an integral part of academic medicine. In plastic surgery, it sets the course for innovations in the specialty. The purpose of this study is to present the research performance of plastic surgeons in Germany for the period 2021/2022 and to compare it with previous periods. MATERIALS AND METHODS The directors of plastic surgical academic institutions reported all requested/approved and rejected research applications to public, non-public and industrial funding organizations. Data was gathered within an established online database. In addition, the DFG´s public database GEPRIS was screened for plastic surgical research grants. Data was also collected regarding research infrastructure and organization at the participating centers. RESULTS 105 applications were reported to 54 different funding agencies from 20 plastic surgery centers. 37 funding applications were submitted to the major public funding agencies DFG, BMBF, BMWi, BMG, BMVg, G-BA and EU. Of these, 59,5% (22/37) were DFG, 13,5% (5/37) each BMBF and EU, 5,4% (2/37) BMWi, and 2,7% (1/37) each BMG, BMVg, and G-BA applications. The average funding volume of these proposals was 401,515 euros. Approved DFG proposals were most frequently assigned to the review board 205-27 Orthopedics, Trauma Surgery, Reconstructive Surgery (n=10/16, 62,5%). Over time, the research registry shows an increase in the number of proposals in general and those granted. 70,0% (14/20) of participating sites had their own experimental research laboratory, while only 40,0% (8/20) had their own clinical trial center. CONCLUSION The 2021/2022 Research Funding Report once again highlights the impressive research accomplishments of the plastic surgery community.
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Affiliation(s)
- N Moellhoff
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
| | - L Prantl
- Hochschulzentrum für Plastische und Ästhetische, Hand- und Wiederherstellungschirurgie der Universität Regensburg
| | - B Behr
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinik Bergmannsheil
| | - J P Beier
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen
| | - A Daigeler
- Klinik für Hand-, Plastische Chirurgie, Rekonstruktive und Verbrennungschirurgie der Eberhard Karls Universität/BG Unfallklinik Tübingen
| | - A Dragu
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Abteilung für Plastische und Handchirurgie, Carl Gustav Carus Universitätsklinikum an der TU Dresden
| | - S U Eisenhardt
- Klinik für Plastische und Handchirurgie, Medizinische Fakultät, Universitätsklinikum Freiburg
| | - P C Fuchs
- Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie - Schwerbrandverletztenzentrum -, Klinikum Köln-Merheim, Universität Witten/Herdecke
| | - G Germann
- ETHIANUM, Klinik für Plastische, Ästhetische und Präventive Medizin am Universitätsklinikum Heidelberg
| | - T Hirsch
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
| | - R E Horch
- Hochschulzentrum für Plastische und Ästhetische, Hand- und Wiederherstellungschirurgie der Universität Regensburg
| | - M Infanger
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinik Bergmannsheil
| | - R Jakubietz
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen
| | - U Kneser
- Klinik für Hand-, Plastische Chirurgie, Rekonstruktive und Verbrennungschirurgie der Eberhard Karls Universität/BG Unfallklinik Tübingen.,UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Abteilung für Plastische und Handchirurgie, Carl Gustav Carus Universitätsklinikum an der TU Dresden
| | - S Langer
- Klinik für Plastische und Handchirurgie, Medizinische Fakultät, Universitätsklinikum Freiburg
| | - M Lehnhardt
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinik Bergmannsheil
| | - H G Machens
- Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie - Schwerbrandverletztenzentrum -, Klinikum Köln-Merheim, Universität Witten/Herdecke
| | - P Mailänder
- ETHIANUM, Klinik für Plastische, Ästhetische und Präventive Medizin am Universitätsklinikum Heidelberg
| | - B Reichert
- Plastische-, Rekonstruktive und Ästhetische Chirurgie, Fachklinik Hornheide, Plastische Chirurgie, Universitätsklinikum Münster
| | - C Radtke
- Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU
| | - D J Schaefer
- Klinik für Plastische, Wiederherstellungs-und Handchirurgie, Otto-von-Guericke-Universität, Magdeburg
| | - F Siemers
- Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie/ Sektion Plastische & Ästhetische Chirurgie/Universitätsklinikum Würzburg
| | - P M Vogt
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie - Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen
| | - H Menke
- Klinik für Plastische und Handchirurgie der Ruprecht-Karls-Universität Heidelberg
| | - R E Giunta
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
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Frank K, Ehrl D, Bernardini F, Walbrun A, Moellhoff N, Alfertshofer M, Davidovic K, Mardini S, Gotkin RH, Cotofana S. How We Look At Mature Faces-An Eye-Tracking Investigation Into the Perception of Age. Aesthet Surg J 2023; 43:115-122. [PMID: 36099471 DOI: 10.1093/asj/sjac251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It is still unclear which facial region contributes most to the perception of an aged face when evaluated by eye-tracking analyses. OBJECTIVES The authors sought to apply eye-tracking technology to identify whether mature faces require longer fixation durations than young faces and which facial region contributes most to the perception of a mature face. METHODS Eye-tracking analyses were conducted in 74 volunteers (37 males, 37 females; 43 ≤ 40 years, 31 > 40 years) evaluating their gaze pattern and the fixation durations for the entire face and 9 facial subregions. Frontal facial images of 16 younger (<40 years) and older (>40 years) gender-matched individuals were presented in a standardized setting. RESULTS Independent of age or gender of the observer, a younger stimulus image was viewed shorter than an older stimulus image with 0.82 (0.63) seconds vs 1.06 (0.73) seconds with P < 0.001. There was no statistically significant difference in their duration of a stable eye fixation when observers inspected a male vs a female stimulus image [0.94 (0.70) seconds vs 0.94 (0.68) seconds; P = 0.657] independent of the observer's age or gender. The facial image that captured the most attention of the observer (rank 9) was the perioral region with 1.61 (0.73) seconds for younger observers and 1.57 (0.73) seconds for older observers. CONCLUSIONS It was revealed that the perioral region attracts the most attention of observers and contributes most to an aged facial appearance. Practitioners should be mindful of the importance of the perioral region when designing an aesthetic treatment plan.
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Affiliation(s)
- Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | | | - Alina Walbrun
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Kristina Davidovic
- Department of Radiology and Medical School, University of Belgrade, Belgrade, Serbia
| | - Samir Mardini
- Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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Ehlinger-David A, Gorj M, Braccini F, Loreto F, Grand-Vincent A, Garcia P, Taieb M, Benadiba L, Catoni I, Mathey ER, Deutsch JJ, Bahadoran P, Vincent T, David M, Cartier H, Nadra K, Moellhoff N, Fanian F. A prospective multicenter clinical trial evaluating the efficacy and safety of a hyaluronic acid-based filler with Tri-Hyal technology in the treatment of lips and the perioral area. J Cosmet Dermatol 2023; 22:464-472. [PMID: 35718985 PMCID: PMC10087550 DOI: 10.1111/jocd.15169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Age-related changes of facial soft tissue cause clinical signs of facial aging such as lip atrophy, marionette lines, and an accentuated nasolabial fold. These changes can be modified using dermal fillers. AIMS To evaluate efficacy, longevity, and safety of a cross-linked hyaluronic acid-based filler with Tri-Hyal technology in the treatment of lips, nasolabial folds, and marionette lines. MATERIALS AND METHODS This prospective, multi-center trial evaluated injections of three different areas (lips, nasolabial fold alone, or with marionette wrinkles) with a soft tissue filler containing 25 mg/ml cross-linked hyaluronic acid and 0.3% lidocaine. Primary endpoint was the aesthetic correction 3 weeks after one injection session without touch-up. Follow-up was 18 months. Assessments were performed using the Global Aesthetic Score (GAS), clinical scoring based on photographic scales, high-frequency ultrasound imaging, and the Global Aesthetic Improvement Scale (GAIS). RESULTS In total, 100 subjects were injected. GAS improved significantly for all treatment indications at 3 weeks (p < 0.0001). Success rates were highest for nasolabial folds (98.4%), followed by marionette lines (94.4%) and lips (73.5%). After 18 months post-injection, success was observed in 91%, 88%, and 33% of subjects injected into nasolabial folds, marionette lines, and lips, respectively. GAIS scored highest for nasolabial folds (SGAIS: 71%; IGAIS: 40%), followed by marionette lines (SGAIS: 56%; IGAIS: 33%) and lips (SGAIS: 30%; IGAIS: 22%) at 18 months follow-up. CONCLUSIONS The filler demonstrated high efficacy and safety in all indications. Regional differences in longevity were evident. Thus, the necessity of regional retreatments should be discussed with patients before injection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
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21
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Casabona G, Alfertshofer M, Kaye K, Frank K, Moellhoff N, Davidovic K, Cotofana S. Ex-Vivo Product Distribution of Injectable Biostimulator Substances. Aesthet Surg J 2023; 43:NP348-NP356. [PMID: 36662772 DOI: 10.1093/asj/sjad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Previously, an increasing demand for minimally invasive aesthetic treatments such as injection of biostimulator substances to induce the production of extracellular matrix (ECM) has been reported. Recent studies have reported on a variety of different product characteristics influencing the integration and distribution of biostimulator substances after injection. OBJECTIVES To analyze ex-vivo product integration and distribution behavior of six different biostimulator substances after injection. METHODS A total of n = 21 abdominal soft tissue flaps were analyzed with regards to horizontal and vertical spread of six different injected biostimulator substances immediately after injection and after massaging using real-time ultrasound imaging. The six different biostimulator substances were: R-CaHA-based, H-CaHA-based, PCL-based, PLLA-1-based, PLLA-2-based and H-HA-based products. RESULTS Overall, the R-CaHA-, H-CaHA- and PCL-based substances showed greater product spread after massaging when compared to the product distribution immediately after the injection with all p < 0.001 with exception for the vertical dimension of the H-CaHA-based substance with p = 0.064. The PLLA-1-, PLLA-2- and H-HA-based substances showed smaller product spread after massaging when compared to the product distribution immediately after the injection with all p < 0.001 with exception for the horizontal dimension of the H-HA-based substance with p = 0.314 indicating higher tissue integration. CONCLUSIONS Different biostimulator substances behave differently when injected into subcutaneous soft tissues while differences exist at the level of initial product diffusion and during tissue integration.
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Affiliation(s)
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Kai Kaye
- Physicians in private practice in Marbella, Spain
| | | | | | - Kristina Davidovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
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22
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Alfertshofer M, Engerer N, Frank K, Moellhoff N, Freytag DL, Cotofana S. Multimodal Analyses of the Aging Forehead and Their Clinical Implications. Aesthet Surg J 2023:6988321. [PMID: 36647564 DOI: 10.1093/asj/sjad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Recent research has indicated that in the upper face a delicate arrangement exists between the muscles of facial expression and the skin. This arrangement allows for immediate transmission of movements following muscle contraction which results in skin movements and skin rhytid formation. OBJECTIVES To investigate age-related changes to the biomechanical unit formed between facial muscles, connective tissue envelope, and skin in the upper face. METHODS A total of n = 76 Caucasian volunteers (30 males, 46 females) with a mean age of 42.2 (18.6) years and a mean body mass index of 24.58 (3.7) kg/m2 were investigated. Three upper facial regions were analyzed for skin firmness and elasticity via cutometry, vertical and horizontal skin vector displacement via 3D-imaging, and muscle activity via surface-derived electromyography. RESULTS Study participants of older age (> 42.2 years) (when compared to younger participants; ≤ 42.2 years) showed increased skin firmness with 0.20 mm vs 0.30 mm with p < 0.001, decreased skin elasticity with 53.2% vs 69.0% (p < 0.001), increased vertical (not horizontal) skin mobility with 3.56 mm vs 1.35 mm (p < 0.001), and decreased muscle sEMG derived signal of the frontalis muscle with 309 µV vs 174 µV (p = 0.039). CONCLUSIONS This study reveals that age-related changes occur in each of the components of the biomechanical unit formed between facial muscles, connective tissue envelope, and skin in the upper face. Knowledge and understanding of such changes can allow for more targeted and individualized surgical and non-surgical aesthetic treatments.
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Affiliation(s)
- Michael Alfertshofer
- Physicians, Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nina Engerer
- Medical student, Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | | | - Nicholas Moellhoff
- Physicians, Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - David L Freytag
- Physician, Department of Plastic Surgery, Gemeinschaftsklinikum Havelhoehe, Berlin, Germany
| | - Sebastian Cotofana
- Associate professor of anatomy, Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
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23
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Moellhoff N, Throner V, Frank K, Benne A, Coenen M, Giunta RE, Haas-Lützenberger EM. Epidemiology of hand injuries that presented to a tertiary care facility in Germany: a study including 435 patients. Arch Orthop Trauma Surg 2023; 143:1715-1724. [PMID: 36138241 PMCID: PMC9958136 DOI: 10.1007/s00402-022-04617-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/05/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Hand injuries compose up to 30% of all injuries in emergency care. However, there is a lack of epidemiological data reflecting patient or accident-related variables, injury types, injured anatomical structures or trauma localization. OBJECTIVE The objective of this study is (1) to provide epidemiological information on hand injuries and their patterns and (2) to visualise the frequencies of affected areas of the hand in relation to the most common trauma mechanisms using color-coded heatmaps. METHODS This prospective single-center observational trial conducted at a surgical emergency department in Germany collected data of hand trauma patients using a standardized documentation form. Demographic data, trauma-related data, diagnostic and therapeutic measures were analyzed. Color-coded heatmaps were generated marking anatomic danger zones. RESULTS 435 patients with a mean age of 39.5 were included. Most patients admitted on their own initiative (79%). Leisure and sport injuries were most frequent (75%). Digiti II-V were injured most commonly (43%), followed by metacarpals (19%) and the thumb (14%). Blunt trauma and cuts accounted for most injuries (74%). Hand-graphics depicted color-coded frequencies of the affected areas of the palmar and dorsal aspect of the hand for the most common types of injury, as well as the most frequent circumstances of accident. Elective surgery was recommended in 25% of cases, and hand surgical follow-up was proposed in over 50% of cases. CONCLUSIONS The dorsal aspect of the hand including the 5th metacarpal, the radial wrist and thenar region, as well as the fingertips of Digiti II/III represent anatomic danger zones to injury of the hand. Due to the large variety of potentially injured structures, diagnosis and treatment is not trivial. Specific training is required for all surgical specialties in emergency care, to increase quality of diagnostic work-up and management of hand injuries.
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Affiliation(s)
- Nicholas Moellhoff
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Veronika Throner
- grid.5252.00000 0004 1936 973XDepartment of Medical Information Processing, Biometry, and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, LMU Munich, Munich, Germany ,Pettenkofer School of Public Health, Munich, Germany
| | - Konstantin Frank
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Ashley Benne
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Michaela Coenen
- grid.5252.00000 0004 1936 973XDepartment of Medical Information Processing, Biometry, and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, LMU Munich, Munich, Germany ,Pettenkofer School of Public Health, Munich, Germany
| | - Riccardo E. Giunta
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Elisabeth M. Haas-Lützenberger
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
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24
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Moellhoff N, Throner V, Frank K, Benne A, Adelmann S, Coenen M, Giunta RE, Haas-Lützenberger E. Visualization of the location and level of pain in common wrist pathologies using color-coded heatmaps. Arch Orthop Trauma Surg 2023; 143:1095-1102. [PMID: 35666312 PMCID: PMC9925519 DOI: 10.1007/s00402-022-04479-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/12/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Pain of the hand and wrist affects a large patient population. If the onset is unrelated to recent trauma, the first medical contact is rarely established with a specialized hand surgeon. OBJECTIVE The objective of this investigation was to (1) visualize the localization of hand pain using pain-related heatmaps in common wrist pathologies, (2) to test whether differences between these pathologies exist with regard to sociodemographic and pain-related aspects, and (3) to evaluate the major patient-reported complaints associated with the pathologies. METHODS This observational cross-sectional study included patients suffering from: thumb basal joint arthritis (CMC-1-OA), dorsal wrist ganglions, and TFCC tears. Patients marked the location of maximum pain projection on hand graphics depicting the outline of the palmar and dorsal hand. Color-graded frequency heat maps were generated for the wrist pathologies investigated. Daily life impairments were assessed and clustered into groups of functions/activities. RESULTS 120 patients with a mean age of 44.3 years were investigated. The diagnostic groups showed significant differences regarding the level and location of pain, as well as daily life impairments. Patients with CMC-1-OA presented with increased pain levels compared to patients with dorsal wrist ganglions and TFCC tears. Daily life impairment was rated highest when household chores were adversely affected, and sport activities were symptomatic/painful. All groups showed significant skin surface pain projection, which was visualized in heatmaps. While general trends in pain localization were visible, pain levels were also reported distal/proximal and palmar/dorsal to the pathology. CONCLUSIONS Knowledge of main demographic parameters, pain projection, and degree of impairment in daily activities can help physicians to narrow differential diagnosis of wrist pain during first patient contact. Patients should then be referred to hand surgeons for specialist examination, to further differentiate the origin of the pain.
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Affiliation(s)
- Nicholas Moellhoff
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Veronika Throner
- grid.5252.00000 0004 1936 973XDepartment of Medical Information Processing, Biometry, and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, LMU Munich, Munich, Germany ,Pettenkofer School of Public Health, Munich, Germany
| | - Konstantin Frank
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Ashley Benne
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Sonja Adelmann
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Michaela Coenen
- grid.5252.00000 0004 1936 973XDepartment of Medical Information Processing, Biometry, and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, LMU Munich, Munich, Germany ,Pettenkofer School of Public Health, Munich, Germany
| | - Riccardo E. Giunta
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Elisabeth Haas-Lützenberger
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336, Munich, Germany.
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25
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Cotofana S, Frank K, Alfertshofer MG, Freytag L, Chaney GK, Ziebart R, Moellhoff N. Invited Discussion on: A 7-Step Guide to High-Definition Liposuction. Aesthetic Plast Surg 2022; 46:2880-2881. [PMID: 35840696 DOI: 10.1007/s00266-022-03005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022]
Abstract
Athanasiou et al. present a 7-step guide to high-definition (HD) liposuction in the current issue of Aesthetic Plastic Surgery. [1] The guide was based on the authors vast experience in HD-liposuction performed in 568 patients (247 males and 321 females) with a mean age of 43 years (range, 22-64) and a mean BMI of 25.6 (range 21-29 kg/m2) over a 6-year time-period. The authors provide detailed information on their approach regarding pre-operative markings, methods of anesthesia and composition of tumescence solution, incision points and access, surgical technique, and fat transfer. In addition, they performed a time-dependent analysis of the type and quantity of observed complications over the study-period, as well as the mean surgical operative time. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
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Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Michael G Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Lysander Freytag
- Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
| | - Grace K Chaney
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Rachel Ziebart
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
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26
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Moellhoff N, Staiger TJ, Ehrl D, Kohler LH, Guertler A, Giunta RE, Cotofana S, Frank K. Identifying the most attractive umbilical position - an eye tracking- and survey-based investigation. J Plast Surg Hand Surg 2022; 56:369-375. [PMID: 34935586 DOI: 10.1080/2000656x.2021.2017946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abdominoplasty is a popular procedure in plastic surgery providing aesthetic, functional and psychological relief for patients suffering from excess abdominal tissue. Correct umbilical positioning is crucial for a successful aesthetic surgical outcome. This study aims to assess the most attractive position of the umbilicus by means of subjective and objective outcome measures. 58 Caucasian study participants with a mean age of 36.87 (15.6) years rated eight different umbilical positions. The various positions were determined based on the ratio of the distance between the xiphoid process and the umbilicus and the distance between the umbilicus and the infra-umbilical crease: 1:1, 1.25:1, 1.5:1, 1.75:1, 2:1, 2.5:1, 3:1 and 5.5:1. Semi-quantitative scoring of attractiveness based on a 5-point Likert scale and eye tracking analyses were utilized. The results revealed that the volunteers perceived as most attractive the ratio of 2:1 with 4.32 (out of possible 5.0). The ratio of 5.5:1 received the lowest rating with 1.8. The results of the objective eye tracking analyses confirmed the subjective rating as the 2:1 ratio was fixated last amongst all other displayed ratios with 1.85 s whereas the 5.5:1 ratio had the shortest interval between image display and first stable eye fixation with 0.94 s. The study confirms the concept of 'internal representation of beauty'. Abdominoplasty procedures could rely on this easy to perform ratio by dividing the distance into thirds and using the boundary between the inferior and middle third as a clinically reliable landmark.
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Affiliation(s)
- Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Tim J Staiger
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Lukas H Kohler
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Anne Guertler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Riccardo E Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
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27
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Bravo BSF, de Melo Carvalho R, Penedo L, de Bastos JT, Calomeni Elias M, Cotofana S, Frank K, Moellhoff N, Freitag L, Alfertshofer M. Applied anatomy of the layers and soft tissues of the forehead during minimally-invasive aesthetic procedures. J Cosmet Dermatol 2022; 21:5864-5871. [PMID: 35634970 DOI: 10.1111/jocd.15131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/21/2022] [Accepted: 05/25/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND An increasing demand of minimally-invasive aesthetic procedures of the forehead concomitantly leads to higher numbers of adverse events. Adequate application of anatomical knowledge is required to increase safety and efficacy of different minimally-invasive aesthetic procedures in this anatomical region. OBJECTIVE To describe the layered anatomy of the forehead soft tissues with respect to their thicknesses and how they relate to different minimally-invasive aesthetic treatments. METHODS A total of n = 85 healthy study participants (69 females and 16 males) with a mean age of 40.84 ± 10.9 years and a mean body mass index of 22.65 ± 2.6 kg/m2 were investigated with ultrasound-based imaging to measure the thickness of different forehead soft tissues. RESULTS The mean overall soft tissue thickness of the forehead was measured to be 4.18 ± 0.7 mm for the entire study population. Increasing BMI values correlated statistically significantly with increasing thickness of all measured forehead soft tissues with exception of the frontalis muscle. On a statistically significant level, males showed thicker forehead soft tissues than females, with exception of the retrofrontalis fat and the frontalis muscle. CONCLUSION On basis of the findings obtained in this study, basic treatment principles can be derived and improved for the injection of neuromodulators, hyaluronic acid as well as the application of polydiaxonane (PDO) threads and micro-focused ultrasound. Precise knowledge and thorough understanding of the layers and soft tissues of the forehead is required to guarantee safe and effective procedures in this aesthetically important facial region.
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Affiliation(s)
| | | | - Lais Penedo
- Dermatology Department, Bravo Private Clinic, Rio de Janeiro, Brazil
| | | | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU, Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU, Munich, Germany
| | - Lysander Freitag
- Department of General Surgery, Community Hospital Havelhöhe, Berlin, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU, Munich, Germany
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Cotofana S, Lowrey N, Frank K, Ziebart R, Guertler A, Freytag L, Helm S, Alfertshofer MG, Moellhoff N. Vascular Safe Zones for Facial Soft Tissue Filler Injections. Plast Aesthet Nurs (Phila) 2022; 42:238-245. [PMID: 36469395 DOI: 10.1097/psn.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The number of soft tissue filler injections performed by aesthetic injectors has continued to increase over the last few years. To provide a high standard of safety and achieve individualized, reproducible, and long-lasting outcomes, aesthetic injectors must have a solid foundation in anatomy, facial biomechanics, rheology, and injection biomechanics. Adverse events associated with soft tissue filler injections can be severe, especially if the aesthetic injector unintentionally injects the soft tissue filler into the patient's arterial vascular circulation and the administered product reaches the arterial bloodstream. Although the face has a rich arterial vascular supply that may seem overwhelmingly complex, it can be broken down systematically according to its internal and external vascular territories. To provide guidance for aesthetic practitioners performing minimally invasive facial injections for aesthetic purposes, this narrative article will discuss the course, depth, and branching pattern of the facial arteries based on the most frequently injected anatomical regions. In this article, we focus on vascular safe zones rather than danger zones .
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Affiliation(s)
- Sebastian Cotofana
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicola Lowrey
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Konstantin Frank
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Rachel Ziebart
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Anne Guertler
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Lysander Freytag
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Sabrina Helm
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael G Alfertshofer
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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Li ZH, Alfertshofer M, Hong WJ, Li XR, Zhang YL, Moellhoff N, Frank K, Luo SK, Cotofana S. Upper Facial Anastomoses Between the External and Internal Carotid Vascular Territories - A 3D Computed Tomographic Investigation. Aesthet Surg J 2022; 42:1145-1151. [PMID: 35305018 DOI: 10.1093/asj/sjac060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Facial regions with a high risk for causing injection-related visual comprise are dual-supply vascular areas such as the nose, glabella, and forehead. These regions have in common that they receive arterial blood supply both by branches of the internal (ICA) and the external carotid artery (ECA). OBJECTIVE The authors sought to investigate the anastomotic pathways between ICA and ECA branches in the upper face. METHODS Postmortem computed tomographic angiographic scans of n = 38 Chinese non-embalmed hemifaces (25 males, 13 females; mean age, 37.79 [11.8] years; mean BMI, 21.90 [2.3] kg/m2) were conducted. Data analysis relied on the calculation of depth, distances, and pathways of forehead and temporal arteries to investigate the number of anastomotic connections, the connecting branches, and the layer of connection between ICA and ECA territories. RESULTS Between ICA and ECA territories, only 1 connection in 57.9%, 2 connections in 31.6%, 3 connections in 5.3%, and 4 and 5 connections in 2.6% each were identified. A superficial connection was observed in 15.8% whereas in 84.2% the anastomotic connection was identified to be both superficial and deep. CONCLUSIONS Adverse events following facial minimally invasive soft-tissue filler injections for aesthetic purposes are not frequent but devastating if they occur. Anatomic knowledge as presented in this study can help to increase awareness of 3-dimensional vascular anastomotic pathways and identify safer injection zones and safer fascial planes. Evidence-based injection techniques should be followed, and safety aspects should be placed over the aesthetic outcome.
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Affiliation(s)
- Zhen-Hao Li
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University, Munich, Germany
| | - Wei-Jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Xin-Rui Li
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - You-Liang Zhang
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University, Munich, Germany
| | | | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Moellhoff N, Arnez T, Athanasopoulos E, Costa H, De Santis G, De Mortillet S, Demirdöver C, Benedetto GD, Dzonov B, Elander A, Hansson E, Henley M, Jecan CR, Kaartinen I, Karabeg R, Kharkov A, Kneafsey B, Gjorgova ST, Palencar D, Portincasa A, Psaras G, Rakhorst H, Alonso MER, Rouif M, Saboye J, Pompeo FSD, Spendel S, Stepic N, Vasar O, Zic R, Giunta RE. ESPRAS Survey on Continuing Education in Plastic, Reconstructive and Aesthetic Surgery in Europe. HANDCHIR MIKROCHIR P 2022; 54:365-373. [PMID: 35944539 DOI: 10.1055/a-1894-7436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Specialty training in plastic, reconstructive and aesthetic surgery is a prerequisite for safe and effective provision of care. The aim of this study was to assess and portray similarities and differences in the continuing education and specialization in plastic surgery in Europe. MATERIAL AND METHODS A detailed questionnaire was designed and distributed utilizing an online survey administration software. Questions addressed core items regarding continuing education and specialization in plastic surgery in Europe. Participants were addressed directly via the European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). All participants had detailed knowledge of the organization and management of plastic surgical training in their respective country. RESULTS The survey was completed by 29 participants from 23 European countries. During specialization, plastic surgeons in Europe are trained in advanced tissue transfer and repair and aesthetic principles in all parts of the human body and within several subspecialties. Moreover, rotations in intensive as well as emergency care are compulsory in most European countries. Board certification is only provided for surgeons who have had multiple years of training regulated by a national board, who provide evidence of individually performed operative procedures in several anatomical regions and subspecialties, and who pass a final oral and/or written examination. CONCLUSION Board certified plastic surgeons meet the highest degree of qualification, are trained in all parts of the body and in the management of complications. The standard of continuing education and qualification of European plastic surgeons is high, providing an excellent level of plastic surgical care throughout Europe. HINTERGRUND Die Facharzt-Weiterbildung für Plastische und Ästhetische Chirurgie ist eine Grundvoraussetzung für sichere und effektive Patientenversorgung. Ziel der vorliegenden Studie war die Darstellung von Gemeinsamkeiten und Unterschieden in der Weiterbildung für Plastische Chirurgie innerhalb von Europa. MATERIALIEN UND METHODEN Ein internetbasierter Fragebogen wurde mit Hilfe eines kostenlosen Formularerstellungstools erstellt und verteilt. Die Fragen betrafen Kernpunkte der Weiterbildung für Plastische Chirurgie in Europa. Die Teilnehmer wurden direkt über das European Leadership Forum (ELF) der European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) kontaktiert. Alle Teilnehmer hatten weitreichende Kenntnisse über die Organisation und Struktur der plastisch-chirurgischen Weiterbildung in ihrem jeweiligen Land. ERGEBNISSE 29 Teilnehmer*innen aus 23 europäischen Ländern nahmen an der Umfrage teil. Die Weiterbildung für Plastische Chirurgie beinhaltet grundlegende Prinzipien und Techniken zur Wiederherstellung von Form und Funktion innerhalb der verschiedenen Säulen der Plastischen Chirurgie, sowie in allen Körperregionen. In den meisten europäischen Ländern ist eine Rotation in der Intensiv- und Notfallmedizin und die Behandlung kritisch kranker Patienten obligatorisch. Voraussetzung für die Facharztbezeichnung ist die mehrjährige, national organisierte Weiterbildung, der Nachweis einer festgelegten Anzahl selbstständig durchgeführter Operationen, sowie die mündliche und/oder schriftliche Abschlussprüfung. SCHLUSSFOLGERUNG Fachärzte für Plastische und Ästhetische Chirurgie sind hochqualifiziert und auch im Umgang mit Komplikationen geschult. Der Standard der Weiterbildung der europäischen Plastischen Chirurgen ist hoch, so dass innerhalb Europas eine hohe Qualität plastisch-chirurgischer Versorgung gewährleistet ist.
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Affiliation(s)
- Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Tine Arnez
- Department of Plastic, Reconstructive and Aesthetic Surgery and Burns, University Medical Centre Ljubljana, Slovenia
| | - Elias Athanasopoulos
- Department of Plastic Surgery, General Military Training Hospital, Thessaloniki, Greece
| | - Horacio Costa
- Aveiro University Plastic Reconstructive Craniomaxillofacial Hand and Microsurgical Unit, Gaia Hospital Center, Portugal
| | - Giorgio De Santis
- Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Stephane De Mortillet
- Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | | | - Giovanni di Benedetto
- Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Dokuz Eylul University, Izmir, Turkey
| | - Boro Dzonov
- Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Dokuz Eylul University, Izmir, Turkey
| | - Anna Elander
- Department of Plastic and Reconstructive Surgery, Marche Polytechnic University, Ancona, Italy
| | - Emma Hansson
- Department of Plastic and Reconstructive Surgery, Marche Polytechnic University, Ancona, Italy
| | - Mark Henley
- Medical Faculty Skopje, University St Cyril and Methodius, Skopje, Uni. Clinic for plastic and reconstructive surgery, Vodnjanska bb, Skopje, N. Macedonia
| | - Cristian Radu Jecan
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ilkka Kaartinen
- Department of Plastic and Reconstructive Surgery, Nottingham University Hospitals, United Kingdom
| | - Reuf Karabeg
- Department of Plastic and Reconstructive Microsurgery, "Prof Dr Agrippa Ionescu" Clinic Emergency Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | - Andrey Kharkov
- Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland
| | | | | | - Drahomir Palencar
- Department of Plastic & Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| | - Aurelio Portincasa
- University Clinic for Plastic and Reconstructive Surgery, Skopje, N. Macedonia
| | - Georgios Psaras
- Department of Plastic Surgery, Medical Faculty of Comenius University Bratislava, Slovakia
| | - Hinne Rakhorst
- Department of Plastic Reconstructive and Aesthetic Surgery, Foggia Medical School, University of Foggia , Italy
| | | | | | - Jacques Saboye
- Plastic and reconstructive surgery, ZGT, Hengelo, The Netherlands
| | | | | | - Nenad Stepic
- Clinique Médipôle Garonne, 45, rue de Gironis, 31036 Toulouse, France
| | - Olavi Vasar
- Plastic Surgery Unit, Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Rado Zic
- Clinic for Plastic Surgery and Burns Military Medical Academy, Belgrade, Serbia
| | - Riccardo E Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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Engerer N, Frank K, Moellhoff N, Alfertshofer M, Giunta RE, Green JB, Lorenc PZ, Chaney GK, Ehrl D, Cotofana S. Aging of the Neck Decoded: New Insights for Minimally Invasive Treatments. Aesthetic Plast Surg 2022; 46:1698-1705. [PMID: 35701594 DOI: 10.1007/s00266-022-02961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many signs of aging manifest in the neck region, including platysmal bands, excess skin, horizontal neck lines and decreasing contour of the neck. While the clinical signs of an aged neck are well-known, data determining the underlying aging process are limited. OBJECTIVE To decode aging of the neck. MATERIALS AND METHODS This prospective study investigated elasticity and firmness of skin, muscle activity and skin displacement upon muscular contraction in the neck in 77 young-, middle- and old-age individuals. Objective outcome measures, including 3-dimensional imaging, cutometry and surface electromyography, were utilized for all assessments. RESULTS Mean firmness of skin decreased significantly from young to old individuals (0.37 ± 0.13 mm, 0.30 ± 0.12 mm and 0.26 ± 0.12 mm in young, middle and old subjects, respectively; p < 0.001). Gross elasticity decreased significantly from 75.1 ± 13.0% in young subjects, to 64.53 ± 15.7% in middle-aged subjects and 55.79 ± 13.0% in old subjects (p < 0.001). The mean y-axis skin displacement increased from 2.48 ± 4.33 mm in young subjects, to 3.11 ± 4.49 mm in middle-aged subjects and 3.61 ± 5.38 mm in old subjects (p = 0.006). The mean signal-to-noise ratio decreased significantly from 16.74 ± 5.77 µV in young subjects, to 14.41 ± 4.86 µV in middle-aged subjects and to 12.23 ± 5.99 µV in old subjects (p < 0.001). CONCLUSION This study provides insights into the interplay between skin elasticity, muscular activity and the reflected movement of the skin of the neck. Appreciation of these age-related changes lays the fundament for aesthetic treatments in this delicate region. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Nina Engerer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Riccardo E Giunta
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Jeremy B Green
- Skin Associates of South Florida and Skin Research Institute, Coral Gables, Florida, USA
| | | | - Grace K Chaney
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Stabile Building 9-38, 200 First Street, Rochester, MN, 55905, USA
| | - Denis Ehrl
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Stabile Building 9-38, 200 First Street, Rochester, MN, 55905, USA.
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Leibrock LB, Hofmann DM, Fuchs B, Birt A, Reinholz M, Guertler A, Frank K, Giunta RE, Egaña JT, Nickelsen J, Schenck TL, Moellhoff N. In vitro and in vivo detection of microbial gene expression in bioactivated scaffolds seeded with cyanobacteria. Lett Appl Microbiol 2022; 75:401-409. [PMID: 35587396 DOI: 10.1111/lam.13740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/30/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
Dermal replacement materials bioactivated with cyanobacteria have shown promising potential for wound regeneration. To date, extraction of cyanobacteria RNA from seeded scaffolds has not been described. Aim of this study was to develop a method to isolate total RNA from bioactivated scaffolds and to propose a new approach in determining living bacteria based on real-time PCR. Transgenic synechococcus sp. PCC 7002 (tSyn7002) were seeded in liquid cultures or in scaffolds for dermal regeneration in vitro and in vivo for 7 days. RNA was extracted with a 260/280 ratio of ≥ 2. The small subunit of the 30S ribosome in prokaryotes (16S) and RNAse P protein (rnpA) were validated as reference transcripts for PCR analysis. Gene expression patterns differed in vitro and in vivo. Expression of 16S was significantly upregulated in scaffolds in vitro, as compared to liquid cultures, while rnpA expression was comparable. In vivo, both 16S and rnpA showed reduced expression compared to in vitro (16S: in vivo Ct value 13.21±0.32, in vitro 12.44±0.42; rnpA in vivo Ct value 19.87±0.41, in vitro 17.75±1.41). Overall, the results demonstrate rnpA and 16S expression after 7 days of implantation in vitro and in vivo, proving presence of living bacteria embedded in scaffolds using qPCR.
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Affiliation(s)
- Lars B Leibrock
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Daniel M Hofmann
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Benedikt Fuchs
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Alexandra Birt
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Markus Reinholz
- Department of Dermatology and Allergy, University Hospital of Munich, LMU, Germany
| | - Anne Guertler
- Department of Dermatology and Allergy, University Hospital of Munich, LMU, Germany
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Riccardo E Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - José T Egaña
- Institute for Biological and Medical Engineering, Schools of Engineering, Biological Sciences and Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joerg Nickelsen
- Molecular Plant Science, Department Biology I, LMU Munich, Munich, Germany
| | - Thilo L Schenck
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany.,Frauenklinik Dr. Geisenhofer GmbH, 80538, Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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Alfertshofer MG, Frank K, Moellhoff N, Helm S, Freytag L, Mercado-Perez A, Hargiss JB, Dumbrava M, Green JB, Cotofana S. Ultrasound Anatomy of the Dorsal Nasal Artery as it Relates to Liquid Rhinoplasty Procedures. Facial Plast Surg Clin North Am 2022; 30:135-141. [DOI: 10.1016/j.fsc.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Frank K, Assemi-Kabir S, Alfertshofer MG, Ehrl D, Gotkin RH, Moellhoff N, Lorenc PZ, Pavicic T, Hernandez CA, Cotofana S. Electrophysiologic Frontalis Muscle Response Following Neuromodulator Injections. Facial Plast Surg Clin North Am 2022; 30:225-231. [DOI: 10.1016/j.fsc.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Bernardini F, Staiger T, Moellhoff N, Giunta RE, Braig D, Ehrl D, Woodward J, Cotofana S, Kohler LH, Frank K. Facial Recognition Pattern before and after Lower Eyelid Blepharoplasty. Facial Plast Surg Clin North Am 2022; 30:271-276. [DOI: 10.1016/j.fsc.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Freytag L, Alfertshofer MG, Frank K, Moellhoff N, Helm S, Redaelli A, Voropai D, Hernandez CA, Green JB, Cotofana S. Understanding Facial Aging Through Facial Biomechanics. Facial Plast Surg Clin North Am 2022; 30:125-133. [DOI: 10.1016/j.fsc.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Moellhoff N, Heidekrueger PI, Frank K, Pistek S, Alt V, Giunta RE, Ehrl D. Comparing the Time-Dependent Evolution of Microcirculation in Gracilis vs. ALT Flaps Using Laser-Doppler Flowmetry and Tissue-Spectrometry. J Clin Med 2022; 11:2425. [PMID: 35566551 PMCID: PMC9099565 DOI: 10.3390/jcm11092425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/10/2022] [Accepted: 04/24/2022] [Indexed: 11/19/2022] Open
Abstract
Postoperative free flap monitoring is considered a key component of care after microsurgical reconstruction. To achieve successful flap salvage after surgical revision, early recognition of vascular compromise is required. The aim of this study was to assess and compare the time-dependent evolution of microcirculation in gracilis muscle (GM) and anterolateral thigh (ALT) flaps. This study included continuous measurements of blood flow (flow), hemoglobin oxygenation (SO2) and the relative amount of hemoglobin (rHb) using laser-doppler flowmetry and tissue-spectrometry (O2C, LEA Medizintechnik, Gießen, Germany) over a time-period of 72 h. Microcirculation was assessed in a total of 66 viable free flaps (GM n = 40; ALT n = 26). A statistically significant positive correlation between time post-anastomosis and microvascular flow was found for both GM and ALT flaps with rs = 0.384 (p < 0.001) and rs = 0.178 (p = 0.015), respectively. No significant positive or negative correlations between time post-anastomosis and SO2 were found for both GM and ALT flaps with rs = 0.052 (p = 0.387) and rs = −0.018 (p = 0.805), respectively. Overall, a significant negative correlation between time post-anastomosis and rHb was found for GM flaps with rs = −0.140 (p = 0.019). For ALT flaps, no significant positive or negative correlation was found with rs = −0.011 (p = 0.887). Microcirculation differs in different flap entities, and surgeons should be aware of these differences in order to correctly evaluate and classify the values of flow, SO2 and rHb obtained when using the O2C device for postoperative monitoring.
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Affiliation(s)
- Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany; (N.M.); (K.F.); (S.P.); (V.A.); (R.E.G.)
| | - Paul I. Heidekrueger
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, 93053 Regensburg, Germany;
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany; (N.M.); (K.F.); (S.P.); (V.A.); (R.E.G.)
| | - Svenja Pistek
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany; (N.M.); (K.F.); (S.P.); (V.A.); (R.E.G.)
| | - Verena Alt
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany; (N.M.); (K.F.); (S.P.); (V.A.); (R.E.G.)
| | - Riccardo E. Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany; (N.M.); (K.F.); (S.P.); (V.A.); (R.E.G.)
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany; (N.M.); (K.F.); (S.P.); (V.A.); (R.E.G.)
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Hernandez CA, Davidovic K, Avelar LET, Alfertshofer M, Freytag DL, Frank K, Moellhoff N, Bihun R, Green JB, Cotofana S. Facial Soft Tissue Repositioning With Neuromodulators: Lessons Learned From Facial Biomechanics. Aesthet Surg J 2022; 42:1163-1171. [PMID: 35416929 DOI: 10.1093/asj/sjac090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Neuromodulators have proven efficacy in reducing facial rhytides and have also been reported to improve jawline contour and the appearance of platysmal bands. Lifting effects of the tail of the eyebrow are expected outcomes when targeting the lateral peri-orbital region underscoring the versatility of neuromodulator treatments. OBJECTIVE To analyze the clinical effectiveness of a novel neuromodulator-based injection algorithm with regards to its ability to reposition the middle and lower facial soft tissues. METHODS Seventy-five study participants (8 males, 67 females) with a mean age of 37.5 (8.5) years were injected with neuromodulators in the subdermal plane of the mandibular soft tissues following a standardized algorithm. Live rating of clinical appearance was performed, as well as volume change and skin vector displacement using 3-dimensional imaging at baseline, day 14 and day 30. RESULTS 3-dimensional volume analysis revealed an increase in midfacial volume by 0.46 cc, and a decrease of the lower facial volume by 0.30 cc compared to baseline. Additionally, an improvement of midfacial fullness (change of 0.13) and jawline contour (change of 0.44) was reported on clinical rating scales at day 30 compared to baseline. CONCLUSIONS Facial soft tissues can be repositioned during the 30 days follow-up period following a neuromodulator treatment; this was reflected through an increase in middle facial volume as well as through a decrease in lower facial volume. The novel injection algorithm presented can provide a safe and effective option for patients desiring improvement of midfacial fullness and jawline contour with neuromodulator treatment alone.
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Affiliation(s)
| | - Kristina Davidovic
- Department of Radiology & Medical School, University of Belgrade , Belgrade, Serbia
| | | | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University of Munich , Munich , Germany
| | - David L Freytag
- Department of General Surgery, Community Hospital Havelhöhe , Berlin , Germany
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University of Munich , Munich , Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University of Munich , Munich , Germany
| | - Rebekah Bihun
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science , Rochester , MN , USA
| | - Jeremy B Green
- Skin Associates of South Florida and Skin Research Institute , Coral Gables, FL , USA
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science , Rochester , MN , USA
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Calomeni M, Alfertshofer MG, Frank K, Moellhoff N, Dennison R, Bravo B, Schelke L, Velthuis P, Green JB, Cotofana S. Real-Time Ultrasound Imaging of the Tear Trough: Lessons Learned From Functional Anatomy. Aesthet Surg J 2022; 42:518-526. [PMID: 34610093 DOI: 10.1093/asj/sjab351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The tear trough is one of the most challenging facial regions for soft-tissue filler injections. A thorough understanding of the underlying facial, muscular, and vascular anatomy is crucial to perform safe and effective tear trough injectable treatments. OBJECTIVES The authors sought to evaluate the location and function of the angular vein in the tear trough in 3 different facial expressions: repose, smiling, and max. orbicularis oculi contraction. METHODS Twenty study participants with a mean age of 48.3 years and mean BMI of 24.5 kg/m2 were investigated via functional ultrasound imaging. The diameter of the angular vein and the velocity and direction of venous blood flow were analyzed in repose, smiling, and during max. orbicularis oculi contraction. RESULTS The angular vein was identified in 100% of the cases to travel inside the orbicularis oculi muscle (intra-muscular course) within the tear trough, whereas the angular artery was not identified in this location. The distance between the angular vein and the inferior orbital rim was (lateral to medial): 4.6 mm, 4.5 mm, 3.9 mm, and 3.8 mm. The caudally directed blood flow was in repose 10.2 cm/s and was 7.3 cm/s at max. orbicularis oculi muscle contraction; however, no blood flow was detectable during smiling. CONCLUSIONS The diameter and the venous blood flow of the angular vein varied between the 3 tested facial expressions. Based on these anatomical findings, the deep injection approach to the tear trough is recommended due to the intramuscular course of the angular vein.
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Affiliation(s)
| | - Michael G Alfertshofer
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany
| | - Konstantin Frank
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany
| | - Nicholas Moellhoff
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany
| | | | | | - Leonie Schelke
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
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Cotofana S, Lowrey N, Frank K, Alfertshofer MG, Antezana L, Freytag L, Moellhoff N. Commentary on: Facial Arterial Variations in Asians: A Study on Computed Tomographic Angiography. Aesthet Surg J 2022; 42:535-536. [PMID: 34951452 DOI: 10.1093/asj/sjab405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael G Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Luis Antezana
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lysander Freytag
- Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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Cotofana S, Lowrey N, Frank K, Ziebart R, Guertler A, Freytag L, Helm S, Alfertshofer MG, Moellhoff N. Vascular Safe Zones for Facial Soft Tissue Filler Injections. Plast Aesthet Nurs (Phila) 2022; 42:80-87. [PMID: 36450087 DOI: 10.1097/psn.0000000000000430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The number of soft tissue filler injections performed by aesthetic injectors has continued to increase over the last few years. To provide a high standard of safety and achieve individualized, reproducible, and long-lasting outcomes, aesthetic injectors must have a solid foundation in anatomy, facial biomechanics, rheology, and injection biomechanics. Adverse events associated with soft tissue filler injections can be severe, especially if the aesthetic injector unintentionally injects the soft tissue filler into the patient's arterial vascular circulation and the administered product reaches the arterial bloodstream. Although the face has a rich arterial vascular supply that may seem overwhelmingly complex, it can be broken down systematically according to its internal and external vascular territories. To provide guidance for aesthetic practitioners performing minimally invasive facial injections for aesthetic purposes, this narrative article will discuss the course, depth, and branching pattern of the facial arteries based on the most frequently injected anatomical regions. In this article, we focus on vascular safe zones rather than danger zones.
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Affiliation(s)
- Sebastian Cotofana
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicola Lowrey
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Konstantin Frank
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Rachel Ziebart
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Anne Guertler
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Lysander Freytag
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Sabrina Helm
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael G Alfertshofer
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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Alfertshofer MG, Frank K, Ehrl D, Freytag DL, Moellhoff N, Gotkin RH, Mardini S, Beleznay K, Swift A, Cotofana S. The Layered Anatomy of the Nose: An Ultrasound-Based Investigation. Aesthet Surg J 2022; 42:349-357. [PMID: 34363459 DOI: 10.1093/asj/sjab310] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND An increasing number of soft tissue filler procedures in the nasal region has been reported. Concomitant with demand, the number of complications has risen due to the difficulty in administering filler in a region where soft tissue layering is complex. OBJECTIVES The authors sought to describe the layered soft tissue arrangement of the nose as it relates to the underlying arterial vasculature and to define safer zones for nasal filler enhancement. METHODS A total of 60 (28 males and 32 females) study participants were investigated with respect to their layered anatomy in the midline of the nose utilizing ultrasound imaging. The presence and extent of the layered arrangement was examined as well as the depth of the arterial vasculature. RESULTS In the mid-nasal dorsum, a 5-layer arrangement was observed in 100% (n = 60) of all investigated cases, whereas it was found to be absent in the nasal radix and tip. The 5-layer arrangement showed an average extent of 26.7% to 67.5% in relation to nasal length. The nasal arteries coursed superficially in 91.7% of all cases in the nasal radix, in 80% in the mid-nasal dorsum, and in 98.3% in the nasal tip. CONCLUSIONS Soft tissue filler administration in the nose carries the highest risk for irreversible vision loss compared with any other facial region. The safety of soft tissue filler rhinoplasty procedures is enhanced by knowledge of the layered anatomy of the nose, the location and depth of the major nasal vasculature, and employment of maneuvers to decrease the risk of blindness.
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Affiliation(s)
- Michael G Alfertshofer
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Konstantin Frank
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Denis Ehrl
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - David L Freytag
- Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
| | - Nicholas Moellhoff
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | | | - Samir Mardini
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | - Katie Beleznay
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Moellhoff N, Gernert C, Frank K, Giunta RE, Ehrl D. The 72-Hour Microcirculation Dynamics in Viable Free Flap Reconstructions. J Reconstr Microsurg 2022; 38:637-646. [PMID: 35158397 DOI: 10.1055/s-0042-1742733] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The risk for vascular complications is the highest within the first 24 hours after free flap transfer. Clinical signs of critical perfusion are often recognized with time delay, impeding flap salvage. To detect failing flaps as soon as possible and to prevent persisting microvascular impairments, knowledge of physiological perfusion dynamics in free flaps is needed. Aim of this study was to investigate the physiological perfusion dynamics of viable free flaps using the Oxygen to See (O2C) device for continuous monitoring. METHODS Microcirculation was continuously monitored in 85 viable free flaps over a period of up to 72 hours following microvascular anastomosis using tissue spectrophotometry and laser Doppler flowmetry (O2C, LEA Medizintechnik, Gießen, Germany). The parameters investigated included capillary-venous blood flow (flow), oxygen saturation (SO2), and relative amount of hemoglobin (rHB). RESULTS Microcirculatory blood flow increased significantly overall, especially within the first 18 hours after microsurgical anastomosis, after which peak formation was occurred. Mean values of SO2 showed a decreasing trend and the steepest decrease of SO2 (slope: 1.0) occurred during the steepest increase of flow between 3 and 6 hours (slope: 4.7) postanastomosis. The rHB values remained fairly constant throughout the study period. CONCLUSION Hyperemia after free flap transfer accounts for a significant increase of microvascular flow. Tissue oxygenation is reduced, likely due to an increase of oxygen consumption after anastomosis. A better understanding of physiological perfusion dynamics in free flaps can aid surgeons in recognizing compromised vasculature earlier and improve free flap salvage.
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Affiliation(s)
- Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Clara Gernert
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Riccardo E Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
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Broer PN, Moellhoff N, Forte AJ, Topka C, Richter D, Sinno S, Columbo M, Prantl L, Rohrich R, Heidekrueger PI. Common practices in patient care after mammaplasty and perioperative safety measures to prevent thromboembolic events – an observational study across all continents. J Plast Reconstr Aesthet Surg 2022; 75:2601-2608. [DOI: 10.1016/j.bjps.2022.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 01/18/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
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Freytag DL, Alfertshofer MG, Frank K, Melnikov DV, Moellhoff N, Swift A, Heisinger S, Gotkin RH, Ehrl D, Cotofana S. The Difference in Facial Movement Between the Medial and the Lateral Midface: A 3-Dimensional Skin Surface Vector Analysis. Aesthet Surg J 2022; 42:1-9. [PMID: 33784397 DOI: 10.1093/asj/sjab152] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Our understanding of the functional anatomy of the face is constantly improving. To date, it is unclear whether the anatomic location of the line of ligaments has any functional importance during normal facial movements such as smiling. OBJECTIVES The authors sought to identify differences in facial movements between the medial and lateral midface by means of skin vector displacement analyses derived from 3-dimensional (3D) imaging and to further ascertain whether the line of ligaments has both a structural and functional significance in these movements. METHODS The study sample consisted of 21 healthy volunteers (9 females and 12 males) of Caucasian ethnic background with a mean age of 30.6 (8.3) years and mean BMI of 22.57 (2.5) kg/m2. 3D images of the volunteers' faces in repose and during smiling (Duchenne type) were taken. 3D imaging-based skin vector displacement analyses were conducted. RESULTS The mean horizontal skin displacement was 0.08 (2.0) mm in the medial midface (lateral movement) and was -0.08 (1.96) mm in the lateral midface (medial movement) (P = 0.711). The mean vertical skin displacement (cranial movement of skin toward the forehead/temple) was 6.68 (2.4) mm in the medial midface, whereas it was 5.20 (2.07) mm in the lateral midface (P = 0.003). CONCLUSIONS The results of this study provide objective evidence for an antagonistic skin movement between the medial and lateral midface. The functional boundary identified by 3D imaging corresponds to the anatomic location of the line of ligaments. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- David L Freytag
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig–Maximilian University, Munich, Germany
| | | | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig–Maximilian University, Munich, Germany
| | - Dmitry V Melnikov
- Plastic Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow,Russia
| | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig–Maximilian University, Munich, Germany
| | | | - Stephan Heisinger
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna,Austria
| | | | - Denis Ehrl
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig–Maximilian University, Munich, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Broer PN, Moellhoff N, Aung T, Forte AJ, Topka C, Richter DF, Colombo M, Sinno S, Kehrer A, Zeman F, Rohrich RJ, Prantl L, Heidekrueger PI. How to Approach Secondary Breast Reduction: International Trends and a Systematic Review of the Literature. Aesthetic Plast Surg 2021; 45:2555-2567. [PMID: 33821309 PMCID: PMC8677686 DOI: 10.1007/s00266-021-02243-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022]
Abstract
Background Secondary breast reduction is complex and poses significant challenges to surgeons. Complication rates exceed those of primary reduction, commonly caused by impaired vascular supply of the nipple-areolar complex (NAC). Literature on the topic is scare and provides contradicting recommendations, especially with regard to pedicle choice in cases with unknown primary reduction technique. Aim of this study was to investigate international trends and to compare findings with literature. Methods A large-scale web-based questionnaire on international trends in mammaplasty (mastopexy and breast reduction) was designed and distributed to over five thousand surgeons in eight geographic regions. The presented manuscript evaluated information regarding pedicle choice in secondary breast reduction and compared data to literature identified in a systematic review. Results The survey was completed by 1431 participants. Overall, secondary procedures were performed in less than 5% or in 5 to 10% of cases. The preferred pedicle for secondary reductions differed significantly between geographic regions (p<0.001). The majority of respondents reported to use a superior or supero-medial pedicle (34.8% and 32.2%, respectively). Residual analysis revealed a strong association between the use of an inferior pedicle and procedures performed in North America. Conclusions Secondary breast reduction is challenging and there remains international disparity with regard to pedicle choice for secondary procedures. Studies investigating outcome when the primary pedicle is unknown are scarce and provide incoherent recommendations. High-quality data is needed to provide evidence-based practice guidelines.
Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266
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Affiliation(s)
- P Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Muenchen Klinik Bogenhausen, Technical University Academic Teaching Hospital, Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Thiha Aung
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Charlotte Topka
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Muenchen Klinik Bogenhausen, Technical University Academic Teaching Hospital, Munich, Germany
| | - Dirk F Richter
- Department of Plastic and Reconstructive Surgery, Dreifaltigkeitskrankenhaus, Wesseling, Germany
| | - Martin Colombo
- Private practice in Buenos Aires, Buenos Aires, Argentina
| | | | - Andreas Kehrer
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | | | - Lukas Prantl
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Paul I Heidekrueger
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Moellhoff N, Groene P, Ney L, Hauer D. [Development of a giant bulla under spontaneous breathing by self-inflicted lung injury in a patient with COVID-19 pneumonia]. Anaesthesist 2021; 71:303-306. [PMID: 34811572 PMCID: PMC8608363 DOI: 10.1007/s00101-021-01072-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022]
Abstract
SARS-CoV‑2 und die damit assoziierte COVID-19-Erkrankung stellen Gesundheitssysteme weltweit vor große Herausforderungen. Fast täglich werden neue Erkenntnisse zu Diagnostik, Klinik und Therapie der Erkrankung publiziert. Dieser Fallbericht beschreibt den letalen Krankheitsverlauf eines 81-jährigen Patienten ohne pulmonale Vorerkrankungen, der als Komplikation der COVID-19-Pneumonie unter nichtinvasiver High-Flow-Sauerstofftherapie eine Riesenbulla entwickelte. Pathophysiologisch kommen/kommt eine virusbedingte diffuse Zerstörung des Alveolargewebes und/oder die „patient self-inflicted lung injury“ in Betracht.
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Affiliation(s)
- Nicholas Moellhoff
- Abteilung für Hand‑, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| | - Philipp Groene
- Intensivstation ANIS 5, Klinik für Anaesthesiologie, Klinikum der Universität München, LMU München, Nussbaumstraße 20, 80336, München, Deutschland
| | - Ludwig Ney
- Intensivstation ANIS 5, Klinik für Anaesthesiologie, Klinikum der Universität München, LMU München, Nussbaumstraße 20, 80336, München, Deutschland
| | - Daniela Hauer
- Intensivstation ANIS 5, Klinik für Anaesthesiologie, Klinikum der Universität München, LMU München, Nussbaumstraße 20, 80336, München, Deutschland.
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Xu Y, Frank K, Kohler L, Ehrl D, Alfertshofer M, Giunta RE, Moellhoff N, Cotofana S, Koban KC. Reliability of 3-dimensional surface imaging of the face using a whole-body surface scanner. J Cosmet Dermatol 2021; 21:1464-1470. [PMID: 34731521 DOI: 10.1111/jocd.14555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/11/2021] [Accepted: 09/27/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To the knowledge of the authors, no data about the reproducibility and accuracy of 3-dimensional surface imaging of the face using a whole-body scanner are available. Thus, the objective of this investigation was to assess the reproducibility of facial scans acquired using a whole-body imaging device. MATERIAL AND METHODS This investigation investigated 220 3-D scans of a total of 22 healthy volunteers (with a mean age of 29.36 years). Two consecutive 3-D images using a Vectra WB360 of the volunteers were obtained utilizing a whole-body imaging device. Predefined distances in the face were performed in each scan and compared. Furthermore, surface deviation between two consecutively captured scans was assessed. RESULTS The distance with the smallest statistical significance was found to be at the nose with p = 0.998, while the biggest statistical significance was found in the midface with p = 0.658. The area with the biggest surface deviation between the superimposed scans was the neck with a root mean square (RMS) of 1.62 ± 1.71, and the area with the smallest surface deviation was the forehead with a RMS of 0.17 ± 0.05. CONCLUSION The whole-body imaging device investigated in this study can be utilized to capture the face and provides enough accuracy to compare scans. Even though not directly investigated, it can be hypothesized that the error caused by repositioning the patient between a baseline and a follow-up scan will not be too big to consider measurements performed with the whole-body imaging device as impractical.
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Affiliation(s)
- Ya Xu
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Lukas Kohler
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Denis Ehrl
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Riccardo Enzo Giunta
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Konstantin Christoph Koban
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
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Bernardini FP, Casabona G, Alfertshofer MG, Frank K, Moellhoff N, Gotkin RH, Davidovic K, Voropai D, Valli A, Cotofana S. Soft tissue filler augmentation of the orbicularis retaining ligament to improve the lid-cheek junction. J Cosmet Dermatol 2021; 20:3446-3453. [PMID: 34679226 DOI: 10.1111/jocd.14495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The orientation of facial ligaments changes with increasing age due to the loss of bony support. Soft tissue filler injections placed in close proximity to facial ligaments can alter their orientation to help achieve an improved and younger aesthetic appearance. OBJECTIVE To assess the anatomic and aesthetic effects of a standardized injection with soft tissue filler placed directly inferior to the orbicularis retaining ligament in the infraorbital region. METHODS A total of 163 patients with signs of infraorbital aging were treated with a standardized soft tissue filler injection into and in close proximity to the orbicularis retaining ligament (ORL). 2D frontal images of the infraorbital region were rated by eleven blinded and independent raters with regards to the aesthetic appearance of the infraorbital region before and after the standardized injection treatment. RESULTS The aesthetic appearance of the entire infraorbital region (lid-cheek junction) was rated before and after the treatment. The severity of the tear trough (medial aspect of the infraorbital region) as well as the hollowing of the lateral aspect of the infraorbital region also was rated before and after the treatment. Aesthetic improvement was statistically significant when evaluated by the blinded raters, the treating physician, and the patients. All the results were "very much improved" compared to baseline. CONCLUSION The effectiveness of this injection technique is thought to be due to the strategic placement of soft tissue filler that helps to reposition facial ligaments that have changed their orientation during the aging process.
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Affiliation(s)
| | | | - Michael G Alfertshofer
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Konstantin Frank
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Nicholas Moellhoff
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | | | - Kristina Davidovic
- Department of Radiology, & Medical School, University of Belgrade, Serbia
| | | | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Moellhoff N, Kandelhardt C, Ehrl D, Kohler L, Koban K, Giunta RE, Guertler A, Mardini S, Cotofana S, Frank K. The Impact of Breast Symmetry on Eye Movement and Gaze Pattern: An Eye-Tracking Investigation. Aesthet Surg J 2021; 41:NP1512-NP1518. [PMID: 34272851 DOI: 10.1093/asj/sjab285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The objective assessment of beauty remains challenging despite ongoing research efforts. A new method of objectively determining the aesthetic appeal of body features by analyzing gaze patterns and eye movements has recently been investigated. OBJECTIVES The objective of this study was to assess, by means of objective eye-tracking technology, differences in the gaze patterns of observers presented with standardized 3-dimensional images showing different degrees of breast asymmetry. METHODS A total of 83 Caucasian study participants with a mean age of 38.60 (19.8) years were presented with 5 images depicting varying degrees of breast asymmetry. In addition to the assessment of eye movements, participants were asked to rate the aesthetic appeal and the asymmetry of the breasts on a 5-point Likert scale. RESULTS Overall, the data showed that participants' rating of the breasts' aesthetic appeal was inversely related to the level of asymmetry. The mean [standard deviation] time until fixation was shortest for the image depicting the greatest breast asymmetry (50 cc) at 0.77 [0.7] seconds (P < 0.001). In addition, the mammary region was also viewed longest in this image at 3.76 [0.5] seconds (P < 0.001). A volume difference of 35 cc between breasts deflected the observers' gaze significantly toward the larger of the asymmetric breasts (P < 0.001). CONCLUSIONS Surgeons should focus on achieving symmetric breast volume (ie, differences <35 cc between breasts) to avoid noticeable asymmetry with regard to breast size.
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Affiliation(s)
- Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Chiara Kandelhardt
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Lukas Kohler
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Konstantin Koban
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Riccardo E Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Anne Guertler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Samir Mardini
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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