1
|
Ismailoglu AV, Ismailoglu P, Aktekin M. Mapping the Vascular and Muscular Topography of the Glabellar Region: Implication for Improving Safety and Efficacy of the Glabellar Injections. Aesthetic Plast Surg 2024; 48:1628-1634. [PMID: 37855934 DOI: 10.1007/s00266-023-03708-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Botulinum neurotoxin (BoNT) and filler injections into the highly vascularized glabellar region for aesthetical purposes are extremely common. Injections into the glabellar region without precise anatomical knowledge of its vascular and muscular topography may pose the risk of severe complications. OBJECTIVES We aimed to improve the safety and efficacy of the glabellar injections by mapping the regional muscles and vasculature in relation to the medial canthus and the defined reference lines. METHODS Meticulous dissection was performed to reveal glabellar region muscles and arteries under surgical microscope, in 16 hemifaces of whom arteries are injected with red-dyed latex. Location of the angular artery (AA) along with its branches was noted in relation to glabellar muscles. RESULTS The AA was always located superficial to the levator labii superioris alaeque nasi muscle (LLSAN) and then coursed toward the medial canthus to anastomose with the supratrochlear artery deep to the origin of the depressor supercilii (DS). The AA gave subcutaneously located central and paracentral branches coursing close to the mid-face line in 14 out of 16 hemifaces. Variable muscular connections were also present between the LLSAN, the DS and the procerus (P) muscles. No arteries were detected at the base of the medial eyebrow to which the DS, the P, and the frontalis (F) inserted. CONCLUSIONS This study provides a detailed map of muscular and vascular anatomy of the glabellar region to facilitate safe and efficient filler and BoNT injections without complications. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .
Collapse
Affiliation(s)
- Abdul Veli Ismailoglu
- Department of Anatomy, School of Medicine, Marmara University, Maltepe Basibuyuk Yolu, No:9, 34854, Maltepe, Istanbul, Turkey.
| | - Pelin Ismailoglu
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Program, Fenerbahce University, Ataturk Mah. Atasehir Bulvarı, Metropol Istanbul, 34758, Atasehir, Istanbul, Turkey
| | - Mustafa Aktekin
- Department of Anatomy, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Kayisdagi cad, Kerem Aydinlar Kampusu, No: 32, 34752, Atasehir, Istanbul, Turkey
| |
Collapse
|
2
|
Alhallak K. Optimizing Botulinum Toxin A Administration for Forehead Wrinkles: Introducing the Lines and Dots (LADs) Technique and a Predictive Dosage Model. Toxins (Basel) 2024; 16:109. [PMID: 38393186 PMCID: PMC10893323 DOI: 10.3390/toxins16020109] [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: 01/14/2024] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
This study introduces the Lines and Dots (LADs) technique, a new approach for administering botulinum toxin type A (BoNT-A) in treating forehead wrinkles. (1) Background: BoNT-A application patterns in the forehead often rely solely on the anatomy of the frontalis muscle. The LADs technique proposes a combination of anatomical features with nerve pathways. (2) Methods: The technique employed a grid system aligned with the supraorbital and supratrochlear nerve pathways and used an electronic acupuncture pen for validation. This study analyzed treatment outcomes for efficacy and safety and proposed a predictive model for BoNT-A dosage. (3) Results: LADs was associated with a high satisfaction rate and low side effect incidence. The predictive model followed BoNT-A Units=0.322×Muscle Pattern Code+1.282×Line Type Code+2.905×Severity Pre-Treatment+3.947. (4) Conclusions: The LADs technique offers an alternative approach to treating forehead wrinkles, optimizing efficacy while minimizing the BoNT-A dose required.
Collapse
Affiliation(s)
- Kamal Alhallak
- Albany Cosmetic and Laser Centre, Edmonton, AB T6V 1J6, Canada; or ; Tel.: +1-(587)520-2835
- Alberta Cosmetic Pharmacist Association ACPA, Edmonton, AB T6V 1J6, Canada
| |
Collapse
|
3
|
Yi KH, Lee JH, Seo KK, Kim HJ. Anatomical Proposal for Botulinum Neurotoxin Injection for Horizontal Forehead Lines. Plast Reconstr Surg 2024; 153:322e-325e. [PMID: 36988646 DOI: 10.1097/prs.0000000000010469] [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] [Indexed: 03/30/2023]
Abstract
SUMMARY The frontalis muscle is situated across the forehead and is a representative target muscle for botulinum neurotoxin (BoNT) injections aimed at treating horizontal wrinkles in this region. However, a lack of anatomical information regarding the shape and thickness of the frontalis may lead to unexpected adverse effects, such as ptosis and samurai eyebrows, caused by the lack of detail on anatomical variation. Achieving the maximum effect using the minimal amount of BoNT requires a precise injection into the frontalis muscle. The anatomical factors associated with BoNT injection into the frontalis muscle have been reviewed in the current study. Up-to-date understanding of the localization of the BoNT injection point according to an updated understanding of the anatomy leads to more accurate localization of the injection point into the frontalis muscle. Optimal injection sites have been provided for the frontalis muscle, and the injection method has been recommended. The authors suggest optimal injection sites according to the external anatomical landmarks of the forehead. Furthermore, these proposals could aid in a more precise procedure that avoids the deleterious effects of BoNT.
Collapse
Affiliation(s)
- Kyu-Ho Yi
- From the Wonju City Public Health Center
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry
| | - Ji-Hyun Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry
| | | | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry
- Department of Materials Science and Engineering, College of Engineering, Yonsei University
| |
Collapse
|
4
|
Bazán-Mendoza JR, Arias-Modesto PB, Ruíz-Mora GA, Rodríguez-Cárdenas YA, Castillo AAD, Dutra V, Arriola-Guillén LE. Sagittal Position of the Upper Incisor in Relation to the Forehead in Peruvian Individuals with Different Skeletal Relationships. J Contemp Dent Pract 2023; 24:821-825. [PMID: 38238267 DOI: 10.5005/jp-journals-10024-3590] [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] [Indexed: 01/23/2024]
Abstract
AIM The aim of this study was to determine the sagittal position of the upper incisor considering Andrews' analysis based on the position of the forehead in Peruvian individuals with different skeletal relationships. MATERIALS AND METHODS This retrospective, cross-sectional study included 212 lateral head radiographs of Peruvian individuals (males: 85, mean age 21.38 ± 6.88, and females: 127, mean age 21.18 ± 6.95), with different skeletal relationships (Class I group = 96, Class II group = 57, Class III group = 59). The values of the ANB, SNA, SNB angles as well as the forehead anterior limit line (FALL) and goal anterior limit line (GALL) points were identified in the radiographs, and then a vertical line was drawn in each point to determine if the upper incisor was positioned forward (protruded), backward (retruded) or within (adequate) these lines. Two trained and calibrated investigators performed all the measurements. The Chi-square test was used to evaluate associations. A p-value < 0.05 was considered statistically significant. RESULTS Overall, the sagittal position of the upper incisor showed a significant association with the sagittal skeletal relationship (p = 0.001). The upper incisors showed an adequate position (41.7%), protruded position (56.10%), and retruded position (42.40%), for Class I, II, and III skeletal relationships, respectively, as highest percentages in each Class. Statistical significance was found for females only (p = 0.005). CONCLUSION Skeletal Class I mainly showed an adequate position of the upper central incisor, whereas for Class II a protruded position was most frequently found, and Class III presented a retruded position. CLINICAL SIGNIFICANCE Andrews' analysis based on the position of the forehead in Peruvian individuals is a valuable tool for orthodontic diagnosis. How to cite this article: Bazán-Mendoza JR, Arias-Modesto PB, Ruíz-Mora GA, et al. Sagittal Position of the Upper Incisor in Relation to the Forehead in Peruvian Individuals with Different Skeletal Relationships. J Contemp Dent Pract 2023;24(11):821-825.
Collapse
Affiliation(s)
- José Renatto Bazán-Mendoza
- School of Dentistry, Universidad Científica del Sur, Lima, Perú, Orcid: https://orcid.org/0000-0002-2727-0129
| | - Paula Betzabe Arias-Modesto
- School of Dentistry, Universidad Científica del Sur, Lima, Perú, Orcid: https://orcid.org/0000-0002-8875-5365
| | - Gustavo Armando Ruíz-Mora
- Division of Orthodontics, Faculty of Dentistry, Universidad Nacional de Colombia, Bogotá, Distrito Capital, Colombia; Division of Oral and Maxillofacial Radiology, School of Dentistry, Universidad Científica del Sur, Lima, Perú, Orcid: https://orcid.org/0000-0002-9954-1047
| | - Yalil Augusto Rodríguez-Cárdenas
- Division of Oral and Maxillofacial Radiology, School of Dentistry, Universidad Científica del Sur, Lima, Perú; Universidad Nacional de Colombia, Bogotá, Distrito Capital, Colombia, Orcid: https://orcid.org/0000-0002-3107-3013
| | - Aron Aliaga-Del Castillo
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America, Orcid: https://orcid.org/0000-0003-3963-1742
| | - Vinicius Dutra
- Department of Oral Pathology, Medicine, and Radiology, School of Dentistry, Indiana University, Bloomington, Indiana, United States of America, Orcid: https://orcid.org/0000-0002-0534-3067
| | - Luis Ernesto Arriola-Guillén
- Division of Orthodontics and Division of Oral and Maxillofacial Radiology, School of Dentistry, Universidad Científica del Sur, Lima, Perú, Phone: +51992124507, e-mail: , Orcid: https://orcid.org/0000-0003-0010-5948
| |
Collapse
|
5
|
Yuan L, Zhuang J, Chai H, Wu Y, Su X, Jiang L, Jia Y, Hu J, Wang Y. An Exploration of the Anatomy of the Forehead of Asians and Its Relationship With Forehead Lines Based on Ultrasound Imaging. Aesthet Surg J 2023; 43:NP956-NP961. [PMID: 37154084 DOI: 10.1093/asj/sjad133] [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: 03/31/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND A profound understanding of the various frontal tissues' morphology and their relationship with forehead lines can efficiently guide clinical treatment. OBJECTIVES The authors explored the relationship between frontal anatomy and frontal lines. METHODS We measured the thickness and shape of tissues in different regions of the forehead of 241 Asians. Then, we analyzed the relationship between the types of frontalis muscle and frontal lines, as well as the relationship between the frontal anatomical structures and the production of frontal lines. RESULTS We classified the types of frontalis muscle into 3 categories comprising 10 subtypes. The skin (0.78 mm vs 0.90 mm, P < .05), superficial subcutaneous tissue (0.66 mm vs 0.75 mm, P < .05), and frontalis muscle thickness (0.29 mm vs 0.37 mm, P < .05) of people with obvious dynamic forehead lines were significantly thicker than those of people without significant dynamic forehead lines. However, no significant difference in the deep subcutaneous tissue thickness was found between people with and without static forehead lines (1.36 mm vs 1.34 mm, P < .05). CONCLUSIONS This study shows the relationship between the frontal structure and frontal lines. Therefore, these results can provide references for treating frontal lines, to a certain extent. LEVEL OF EVIDENCE: 3
Collapse
|
6
|
Choi YJ, Lee KW, Gil YC, Hu KS, Kim HJ. Ultrasonographic Analyses of the Forehead Region for Injectable Treatments. Ultrasound Med Biol 2019; 45:2641-2648. [PMID: 31311686 DOI: 10.1016/j.ultrasmedbio.2019.06.414] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 06/10/2019] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
Botulinum toxin type A (BoNT-A) injections in the forehead region should only target the frontalis. This study applied ultrasonography with the aim of providing guidelines for predicting the layered structure and soft-tissue thickness of the forehead. We performed ultrasound scanning at 7 facial landmarks in 40 Korean adults. Allowing for the error range, the minimum depth from the skin to exclude the muscle layer was 2.3 mm, and the maximum depth from the skin to include the muscle layer was 2.8 mm. Of the total 7 points from the skin to muscle surface, significant differences between the males and females were found in 6 points (p < 0.05). Clinicians can use ultrasonography to identify the structural layers of the scalp. Even if ultrasound-guided injections are not performed, it is possible to target only muscle layers in BoNT-A injections by maintaining a needle depth of around 2.5 mm.
Collapse
Affiliation(s)
- You-Jin Choi
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kang-Woo Lee
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Young-Chun Gil
- Department of Anatomy, Chungbuk National University School of Medicine, Cheongju, Republic of Korea
| | - Kyung-Seok Hu
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Hee-Jin Kim
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea; Department of Materials Science & Engineering, College of Engineering, Yonsei University, Seoul, Republic of Korea.
| |
Collapse
|
7
|
Gidaly MP, Tremont T, Lin CP, Kau CH, Souccar NM. Optimal antero-posterior position of the maxillary central incisors and its relationship to the forehead in adult African American females. Angle Orthod 2018; 89:123-128. [PMID: 30183324 DOI: 10.2319/120517-833.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To determine an optimal anteroposterior (AP) position of the maxillary central incisors and their relationship to the forehead in adult African American (AA) females. MATERIALS AND METHODS Smile profile photographs of 150 AA females were acquired and divided into an optimal control group (N = 48) and a study group (N = 102) based on the position of the maxillary central incisors, as judged by a panel of orthodontists and orthodontic residents. The AP position of the maxillary central incisors and the forehead inclination (FI) were measured relative to Glabella vertical (GV). A two-sample t-test was used to compare the incisor AP position and the FI between the two groups. Linear regression was used to quantify the relationship between the incisor AP position and the FI. RESULTS In all groups, the maxillary incisors were anterior to GV. However, a significant difference was found in the incisor AP position between the groups (8.58 ± 3.96 mm for the control group and 11.2 ± 4.48 mm for the study group; P = .001). Furthermore, the control group demonstrated a positive association between the optimal AP position of the maxillary central incisors and FI ( P < .0001). CONCLUSIONS GV is a reliable landmark with which to access the AP maxillary incisor position in AA females. The optimal AP position of the maxillary central incisors is significantly associated with FI; the greater the FI, the more anterior the optimal maxillary incisor position. A prediction equation to determine the optimal position of the maxillary incisors relative to GV for AA females is proposed.
Collapse
|
8
|
Abstract
BACKGROUND The principle of dynamic muscular activity affecting eyebrow height and shape is well known. We postulate that similarly, dynamics of the fronto-galea-occipital muscles affect forehead height. OBJECTIVES To present a forehead lift technique using Botulinum toxin injection and evaluate its clinical efficacy and safety. METHODS Twenty-nine female patients comprised the study group. Forty units of prepared abobutolinumtoxinA (Dysport, 10 U/0.05 mL) were injected into 4 points in the hair-bearing scalp, simulating the points of frontalis origin. The glabella and forehead regions were treated with 50 U each. Standard photographs and measurements were taken before and at 2 weeks following treatment. Forehead height was measured bilaterally drawing a vertical line from mid-pupil to frontal hairline (MPFH) and from medial canthus to frontal hairline (MCFH). We assessed outcome differences in patients with low vs high forehead (cutoff value 5.5 cm forehead height). RESULTS Mean age was 48 years (range, 29-66 years). Two weeks following treatment, mean frontal height had increased significantly in all measurement points (MCFH right: 4.1 ± 1.8 mm, MCFH left 4.4 ± 1.8 mm, MPFH right 4.4 ± 2.0 mm, MPFH left 4.7 ± 2.3 mm; P <0.001). Low forehead subgroup achieved significantly higher forehead lift compared with high forehead subgroup both in MCFH (6.9% ± 2.0% vs 5.3% ± 2.2%, P = 0.043) and MPFH (8.6% ± 2.5% vs 5.7% ± 2.6%, P = 0.008). No adverse events were documented in any participant. CONCLUSIONS Botulinum toxin type A injection into frontalis origin can effectively and safely extend forehead height in selected patients. The effect of this technique is greater on patients with low foreheads. LEVEL OF EVIDENCE 4
Collapse
Affiliation(s)
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lior Heller
- Department of Plastic and Reconstructive Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| |
Collapse
|
9
|
Abstract
The goal of this article is to provide a systemic approach to forehead rejuvenation. Fillers, botulinic toxin injections, transpalpebral, endoscopic or bicoronal brow lift must be usual techniques for every plastic surgeon in overall facial rejuvenation. Achieving a long lasting and aesthetically pleasing forehead is possible only with surgical techniques when aging is obvious.
Collapse
Affiliation(s)
- M Prevot
- 34, avenue Eugène-Pittard, 1206 Genève, Suisse; 11, chaussée de la Muette, 75016 Paris, France.
| | - C Thomet
- Service de chirurgie plastique, reconstructive et esthétique, HUG, Genève, Suisse.
| | | | - A Marchac
- 68bis, rue Spontini, 75116 Paris, France.
| | - E Delay
- 50, rue de la République, 69002 Lyon, France.
| |
Collapse
|
10
|
Abramo AC, Do Amaral TPA, Lessio BP, De Lima GA. Anatomy of Forehead, Glabellar, Nasal and Orbital Muscles, and Their Correlation with Distinctive Patterns of Skin Lines on the Upper Third of the Face: Reviewing Concepts. Aesthetic Plast Surg 2016; 40:962-971. [PMID: 27743084 DOI: 10.1007/s00266-016-0712-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 07/21/2016] [Accepted: 09/23/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study is to establish a relationship between the skin lines on the upper third of the face in cadavers, which represent the muscle activity in life and the skin lines achieved by voluntary contraction of the forehead, glabellar, and orbital muscles in patients. METHODS Anatomical dissection of fresh cadavers was performed in 20 fresh cadavers, 11 females and 9 males, with ages ranging from 53 to 77 years. Subcutaneous dissection identified the muscle shape and the continuity of the fibers of the eyebrow elevator and depress muscles. Subgaleal dissection identified the cutaneous insertions of the muscles. They were correlated with skin lines on the upper third of the face of the cadavers that represent the muscle activity in life. Voluntary contraction was performed by 20 voluntary patients, 13 females and 7 males, with ages ranging from 35 to 62 years. Distinct patterns of skin lines on the forehead, glabellar and orbital areas, and eyebrow displacement were identified. RESULTS The frontalis exhibited four anatomical shapes with four different patterns of horizontal parallel lines on the forehead skin. The corrugator supercilii showed three shapes of muscles creating six patterns of vertical glabellar lines, three symmetrical and three asymmetrical. The orbicularis oculi and procerus had single patterns. The skin lines exhibited in voluntary contraction of the upper third of the face in patients showed the same patterns of the skin lines achieved in cadavers. CONCLUSIONS Skin lines in cadavers, which are the expression of the muscle activity in life, were similar to those achieved in the voluntary contraction of patients, allowing us to assert that the muscle patterns of patients were similar to those identified in cadavers. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .
Collapse
Affiliation(s)
- Antonio Carlos Abramo
- Division of Plastic Surgery at the General Hospital São Luiz, ACA - Institute of Assistance in Plastic Surgery of São Paulo, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil.
| | - Thiago Paoliello Alves Do Amaral
- Division of Plastic Surgery at the General Hospital São Luiz, ACA - Institute of Assistance in Plastic Surgery of São Paulo, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil
| | - Bruno Pierotti Lessio
- Division of Plastic Surgery at the General Hospital São Luiz, ACA - Institute of Assistance in Plastic Surgery of São Paulo, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil
| | - Germano Andrighetto De Lima
- Division of Plastic Surgery at the General Hospital São Luiz, ACA - Institute of Assistance in Plastic Surgery of São Paulo, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil
| |
Collapse
|
11
|
Seo K, Tsai TF, Chao YYY, Goodman GJ. Efficacy and Safety of IncobotulinumtoxinA in Asian Subjects: A Pooled Analysis of Clinical Trials in the Treatment of Glabellar Frown Lines. J Drugs Dermatol 2016; 15:1084-1087. [PMID: 27602970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Owing to differences in facial anatomy and cultural beauty ideals, dose adaptations are often necessary when administering botulinum toxin type A to Asians and non-Asians. OBJECTIVE To assess potential differences in the efficacy and safety of incobotulinumtoxinA in Asian and non-Asians.<br/> METHODS Efficacy data were pooled from several Phase II/III trials that used 20 U incobotulinumtoxinA to treat glabellar frown lines in Asian subjects. The variable of interest was investigator-assessed improvement in scores on the 4-point Facial Wrinkle Scale from baseline to days 30, 60, 90, and 120. Subjects with a 1-point improvement were considered 'responders'. Data were also assessed for treatment-emergent adverse events, treatment-emergent serious adverse events, and adverse events of special interest among a pool of incobotulinumtoxinA safety studies.<br/> RESULTS Four trials were pooled, comprising 19 Asian and 563 non-Asian subjects. At maximum frown on day 30, 100% of Asians and 87% of non-Asians were responders; by day 120, values were 37% and 40%, respectively. At rest on day 30, 63% of Asians and 56% of non-Asians were responders. Corresponding values for day 120 were 11% and 25%. The mean change in score on the Facial Wrinkle Scale from baseline over time was similar in both groups. Very few adverse events occurred. Overall, treatment-emergent adverse events were lower amongst Asians than non-Asians.<br/> CONCLUSIONS Compared with non-Asians, a trend towards slightly higher responses was observed in Asians at maximum frown. There were no clinically relevant differences in the safety of incobotulinumtoxinA when administered to Asian and non-Asian subjects. <br /><br /> <em>J Drugs Dermatol.</em> 2016;15(9):1084-1087.
Collapse
|
12
|
Choi YJ, Won SY, Lee JG, Hu KS, Kim ST, Tansatit T, Kim HJ. Characterizing the Lateral Border of the Frontalis for Safe and Effective Injection of Botulinum Toxin. Aesthet Surg J 2016; 36:344-8. [PMID: 26507959 DOI: 10.1093/asj/sjv190] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The forehead is a common site for injection of botulinum neurotoxin type A (BoNT-A) to treat hyperactive facial muscles. Unexpected side effects of BoNT-A injection may occur because the anatomy of the forehead musculature is not fully characterized. OBJECTIVES The authors described the lateral border of the frontalis in terms of facial landmarks and reference lines to determine the safest and most effective forehead injection sites for BoNT-A. METHODS The hemifaces of 49 embalmed adult Korean cadavers were dissected in a morphometric analysis of the frontalis. L2 was defined in terms of FT (the most protruding point of the frontotemporal region), L0 (the line connecting the infraorbital margin with the tragus), and L1 (the line parallel to L0 and passing through FT) such that L2 was positioned 45° from L1 and passed through FT. RESULTS The distance from FT to the superior margin of the orbicularis oculi was 12.3 ± 3.3 mm. The frontalis extended more than 5 cm along L2 in 49 of 49 cases (100%), more than 6 cm in 47 cases (95.9%), more than 7 cm in 34 cases (69.4%), more than 8 cm in 11 cases (22.4%), and more than 9 cm in 3 cases (6.1%). The lateral border of the frontalis ran parallel to and within 1 cm of the medial side of L2. CONCLUSIONS Surface anatomy mapping can assist with predicting the lateral border of the frontalis to minimize the side effects and maximize the efficiency of BoNT-A injections into the forehead.
Collapse
Affiliation(s)
- You-Jin Choi
- Mr Choi is a Graduate Student, Dr Hu is an Associate Professor, and Dr H-J Kim is a Professor, Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institution, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea. Dr Won is an Assistant Professor, Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea. Dr Lee is an Assistant Professor, Department of Dental Hygiene, School of Health and Medicine, Namseoul University, Choenan, Republic of Korea. Dr S-T Kim is a Professor, Department of Oral Medicine, TMJ and Orofacial Pain Clinic, College of Dentistry, Yonsei University, Seoul, Republic of Korea. Dr Tansatit is a Professor, Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sung-Yoon Won
- Mr Choi is a Graduate Student, Dr Hu is an Associate Professor, and Dr H-J Kim is a Professor, Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institution, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea. Dr Won is an Assistant Professor, Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea. Dr Lee is an Assistant Professor, Department of Dental Hygiene, School of Health and Medicine, Namseoul University, Choenan, Republic of Korea. Dr S-T Kim is a Professor, Department of Oral Medicine, TMJ and Orofacial Pain Clinic, College of Dentistry, Yonsei University, Seoul, Republic of Korea. Dr Tansatit is a Professor, Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jae-Gi Lee
- Mr Choi is a Graduate Student, Dr Hu is an Associate Professor, and Dr H-J Kim is a Professor, Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institution, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea. Dr Won is an Assistant Professor, Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea. Dr Lee is an Assistant Professor, Department of Dental Hygiene, School of Health and Medicine, Namseoul University, Choenan, Republic of Korea. Dr S-T Kim is a Professor, Department of Oral Medicine, TMJ and Orofacial Pain Clinic, College of Dentistry, Yonsei University, Seoul, Republic of Korea. Dr Tansatit is a Professor, Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kyung-Seok Hu
- Mr Choi is a Graduate Student, Dr Hu is an Associate Professor, and Dr H-J Kim is a Professor, Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institution, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea. Dr Won is an Assistant Professor, Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea. Dr Lee is an Assistant Professor, Department of Dental Hygiene, School of Health and Medicine, Namseoul University, Choenan, Republic of Korea. Dr S-T Kim is a Professor, Department of Oral Medicine, TMJ and Orofacial Pain Clinic, College of Dentistry, Yonsei University, Seoul, Republic of Korea. Dr Tansatit is a Professor, Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sung-Taek Kim
- Mr Choi is a Graduate Student, Dr Hu is an Associate Professor, and Dr H-J Kim is a Professor, Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institution, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea. Dr Won is an Assistant Professor, Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea. Dr Lee is an Assistant Professor, Department of Dental Hygiene, School of Health and Medicine, Namseoul University, Choenan, Republic of Korea. Dr S-T Kim is a Professor, Department of Oral Medicine, TMJ and Orofacial Pain Clinic, College of Dentistry, Yonsei University, Seoul, Republic of Korea. Dr Tansatit is a Professor, Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanvaa Tansatit
- Mr Choi is a Graduate Student, Dr Hu is an Associate Professor, and Dr H-J Kim is a Professor, Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institution, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea. Dr Won is an Assistant Professor, Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea. Dr Lee is an Assistant Professor, Department of Dental Hygiene, School of Health and Medicine, Namseoul University, Choenan, Republic of Korea. Dr S-T Kim is a Professor, Department of Oral Medicine, TMJ and Orofacial Pain Clinic, College of Dentistry, Yonsei University, Seoul, Republic of Korea. Dr Tansatit is a Professor, Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hee-Jin Kim
- Mr Choi is a Graduate Student, Dr Hu is an Associate Professor, and Dr H-J Kim is a Professor, Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institution, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea. Dr Won is an Assistant Professor, Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea. Dr Lee is an Assistant Professor, Department of Dental Hygiene, School of Health and Medicine, Namseoul University, Choenan, Republic of Korea. Dr S-T Kim is a Professor, Department of Oral Medicine, TMJ and Orofacial Pain Clinic, College of Dentistry, Yonsei University, Seoul, Republic of Korea. Dr Tansatit is a Professor, Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
13
|
Darby LJ, Millett DT, Kelly N, McIntyre GT, Cronin MS. The effect of smiling on facial asymmetry in adults: a 3D evaluation. Aust Orthod J 2015; 31:132-137. [PMID: 26999885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND/AIMS Mild resting facial asymmetry exists in clinically symmetrical faces, but the effect of smiling on the magnitude of overall facial asymmetry in adults has not been assessed. The aim of the present study was to use stereophotogrammetry to quantify the effect of smiling on overall facial asymmetry in Caucasian adults who presented with Class I incisor relationships and no history of orthodontic treatment. METHODS Twenty male and 20 female Caucasians aged 1 8-30 years with no history of orthodontic treatment, a clinically symmetrical face and a Class I incisor relationship had 3D stereophotogrammetric images captured at rest and on natural and maximal smile (T1). The images were repeated 2-4 weeks later (T2) to assess expression reproducibility. Overall facial asymmetry scores were produced from 27 landmarks using partial Ordinary Procrustes Analysis (OPA) and assessed by an Analysis of Covariance (ANCOVA) model. A random sample of the images was re-examined two months later to calculate intraobserver landmark reproducibility. RESULTS Mean landmark error was low (0.41 ± 0.07 mm). Mean overall facial asymmetry scores were not significantly gender different (p = 0.5300); therefore, the male and female data were pooled. Mean overall facial asymmetry scores for maximal (0.91 ± 0.16) and natural smile (0.88 ± 0.18) were higher than at rest (0.80 ± 0.17) (p < 0.0001) and were reproducible across (T1-T2) sessions (p = 0.3204). CONCLUSIONS/IMPLICATIONS Overall 3D facial asymmetry scores for the sampled Caucasian adults with clinically symmetrical faces increased in magnitude from rest to natural and to maximal smile. Clinicians should assess overall facial asymmetry at rest and on natural and maximal smile at baseline, during treatment and as part of a core outcome assessment, particularly for cases with unilateral posterior crossbite, unilateral cleft lip and palate or skeletal asymmetry.
Collapse
|
14
|
Affiliation(s)
- Umbareen Mahmood
- Dr Mahmood is a Resident, Department of Surgery, Division of Plastic Surgery, University of South Florida, Morsani College of Medicine, Tampa, Florida. Dr Baker is a Professor of Surgery, University of Central Florida, Orlando, Florida; Clinical Professor of Plastic Surgery, University of South Florida, Tampa, Florida; Immediate Past Chairman of the Florida Hospital System; and Past President of the Florida Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery
| | - James L Baker
- Dr Mahmood is a Resident, Department of Surgery, Division of Plastic Surgery, University of South Florida, Morsani College of Medicine, Tampa, Florida. Dr Baker is a Professor of Surgery, University of Central Florida, Orlando, Florida; Clinical Professor of Plastic Surgery, University of South Florida, Tampa, Florida; Immediate Past Chairman of the Florida Hospital System; and Past President of the Florida Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery
| |
Collapse
|
15
|
Ikävalko T, Närhi M, Lakka T, Myllykangas R, Tuomilehto H, Vierola A, Pahkala R. Lateral facial profile may reveal the risk for sleep disordered breathing in children--the PANIC-study. Acta Odontol Scand 2015; 73:550-5. [PMID: 25892581 DOI: 10.3109/00016357.2014.997795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the lateral view photography of the face as a tool for assessing morphological properties (i.e. facial convexity) as a risk factor for sleep disordered breathing (SDB) in children and to test how reliably oral health and non-oral healthcare professionals can visually discern the lateral profile of the face from the photographs. MATERIALS AND METHODS The present study sample consisted of 382 children 6-8 years of age who were participants in the Physical Activity and Nutrition in Children (PANIC) Study. Sleep was assessed by a sleep questionnaire administered by the parents. SDB was defined as apnoeas, frequent or loud snoring or nocturnal mouth breathing observed by the parents. The facial convexity was assessed with three different methods. First, it was clinically evaluated by the reference orthodontist (T.I.). Second, lateral view photographs were taken to visually sub-divide the facial profile into convex, normal or concave. The photos were examined by a reference orthodontist and seven different healthcare professionals who work with children and also by a dental student. The inter- and intra-examiner consistencies were calculated by Kappa statistics. Three soft tissue landmarks of the facial profile, soft tissue Glabella (G`), Subnasale (Sn) and soft tissue Pogonion (Pg`) were digitally identified to analyze convexity of the face and the intra-examiner reproducibility of the reference orthodontist was determined by calculating intra-class correlation coefficients (ICCs). The third way to express the convexity of the face was to calculate the angle of facial convexity (G`-Sn-Pg`) and to group it into quintiles. For analysis the lowest quintile (≤164.2°) was set to represent the most convex facial profile. RESULTS The prevalence of the SDB in children with the most convex profiles expressed with the lowest quintile of the angle G`-Sn-Pg` (≤164.2°) was almost 2-fold (14.5%) compared to those with normal profile (8.1%) (p = 0.084). The inter-examiner Kappa values between the reference orthodontist and the other examiners for visually assessing the facial profile with the photographs ranged from poor-to-moderate (0.000-0.579). The best Kappa values were achieved between the two orthodontists (0.579). The intra-examiner Kappa value of the reference orthodontist for assessing the profiles was 0.920, with the agreement of 93.3%. In the ICC and its 95% CI between the two digital measurements, the angles of convexity of the facial profile (G`-Sn-Pg`) of the reference orthodontist were 0.980 and 0.951-0.992. CONCLUSION In addition to orthodontists, it would be advantageous if also other healthcare professionals could play a key role in identifying certain risk features for SDB. However, the present results indicate that, in order to recognize the morphological risk for SDB, one would need to be trained for the purpose and, as well, needs sufficient knowledge of the growth and development of the face.
Collapse
Affiliation(s)
- Tiina Ikävalko
- Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland , Kuopio , Finland
| | | | | | | | | | | | | |
Collapse
|
16
|
Salehi P, Oshagh M, Aleyasin ZS, Pakshir HR. The effects of forehead and neck position on esthetics of class I, II and III profiles. Int J Esthet Dent 2014; 9:412-425. [PMID: 25126620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION All parts of the face, other than jaw relationships, should be considered in orthodontic treatment planning. The role of forehead and neck in facial esthetics is well known; however, the majority of conventional facial analysis methods have not considered them. Neck and forehead may confer mutual effects on equilibrium and on esthetics of other facial components, and may change the overall convexity/concavity view of the profile. Therefore, the aim of this study was to assess the effect of anteroposterior position of the forehead and neck on the esthetics of skeletal class I, II and III jaw relationships using profile silhouettes. METHODS Class II and III jaw relationships were constructed on the silhouette of a class I normal profile by altering the mandibular position. Retruded, normal and protruded positions were also applied for the forehead and neck. Three hundred Iranian laypeople (150 men, 150 women) scored the esthetics of profile silhouettes from 1 to 7. Half of the participants were told to consider the profiles as a man, and the other half were told to consider them as a woman. Data were analyzed using non-parametric methods. RESULTS Class I jaw relation was found to be the most beautiful profile followed by class II and III respectively. Esthetics of different positions of the neck and forehead were significantly different (P < 0.05). In subjects with a normal neck and forehead position, and those with a retruded neck, the best esthetic relationship was class I, and the worst was class III. For protruded foreheads, the best jaw relationship was class II for females and class I for males, and the worst was class III for both. In a retruded forehead position, the most preferred jaw relationship was class I, and the worst was class II. For profiles with a protruded neck, the best esthetics was found to be in class III jaw relationship, and the worst was in class II. There was a small difference in scoring for male and female profiles (P < 0.05); there were also small differences in scoring trends of men and women (P < 0.05). CONCLUSION This study showed that the anteroposterior position of the forehead and neck affects the esthetics of jaw relationships in profile view. In laypeople's opinions, in a normal profile, the overall appearance is more important compared to the independent position of the neck and forehead; however, having jaw abnormalities, the neck plays an important independent role. The preferred jaw relation for profiles with each forehead or neck position was introduced.
Collapse
|
17
|
Affiliation(s)
- Phillip R Langsdon
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | | | | |
Collapse
|
18
|
Abstract
The open brow lift procedure is discussed in terms of relevant surgical anatomy, preoperative evaluation, and detailed surgical technique for pretrichial coronal forehead lift with hair-bearing temporal lift, direct incisional brow lift, and coronal brow lift. Complications are discussed, and information is presented on patient evaluation and expectations, with a discussion of what patients can expect before and after brow lift surgery.
Collapse
|
19
|
Velemínská J, Bigoni L, Krajíček V, Borský J, Šmahelová D, Cagáňová V, Peterka M. Surface facial modelling and allometry in relation to sexual dimorphism. Homo 2012; 63:81-93. [PMID: 22425585 DOI: 10.1016/j.jchb.2012.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 01/27/2012] [Indexed: 11/18/2022]
Abstract
Sexual dimorphism is responsible for a substantial part of human facial variability, the study of which is essential for many scientific fields ranging from evolution to special biomedical topics. Our aim was to analyse the relationship between size variability and shape facial variability of sexual traits in the young adult Central European population and to construct average surface models of adult males and females. The method of geometric morphometrics allowed not only the identification of dimorphic traits, but also the evaluation of static allometry and the visualisation of sexual facial differences. Facial variability in the studied sample was characterised by a strong relationship between facial size and shape of sexual dimorphic traits. Large size of face was associated with facial elongation and vice versa. Regarding shape sexual dimorphic traits, a wide, vaulted and high forehead in combination with a narrow and gracile lower face were typical for females. Variability in shape dimorphic traits was smaller in females compared to males. For female classification, shape sexual dimorphic traits are more important, while for males the stronger association is with face size. Males generally had a closer inter-orbital distance and a deeper position of the eyes in relation to the facial plane, a larger and wider straight nose and nostrils, and more massive lower face. Using pseudo-colour maps to provide a detailed schematic representation of the geometrical differences between the sexes, we attempted to clarify the reasons underlying the development of such differences.
Collapse
Affiliation(s)
- J Velemínská
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University in Prague, Czech Republic.
| | | | | | | | | | | | | |
Collapse
|
20
|
Oshagh M, Aleyasin ZS, Roeinpeikar M. The effects of forehead and neck positions on profile esthetics. Eur J Esthet Dent 2012; 7:454-466. [PMID: 23150873] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Each facial feature might affect the perception of the balance of the other features so the whole of the face must be considered in facial evaluation. There are no studies that have examined the effect of forehead and neck position on profile esthetics. The objective of this study was to evaluate the effects of forehead and neck positions on profile esthetics judged by lay people, dental students and art students. MATERIALS AND METHODS A straight silhouette (black right-facing profile in white background) was digitally manipulated to make variations of profiles. The positions of all compartments of face were similar except for anteroposterior position of forehead and neck. The 310 raters (100 dental students, 100 art students and 110 lay people) were asked to rate profiles with a Likert scale. The nonparametric Mann-Whitney test, chisquare tests, Spearman rank correlation coefficients, one-way analysis of variance (ANOVA) and Kruskal-Wallis analyses were used in data analysis. RESULTS The scores given to profiles with straight, retruded and protruded necks and foreheads were significantly different. (P < 0.05). In three groups, the most and least attractive profiles judged by raters were comparable (P > 0.05). CONCLUSION This study showed that the position of the forehead and the neck has an effect on the beauty of profile silhouettes and this effect is so noticeable that all of the raters could perceive the differences. It is necessary to evaluate the whole of the face, including the forehead and neck, in a facial evaluation.
Collapse
Affiliation(s)
- Morteza Oshagh
- Department of Orthodontics, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | | |
Collapse
|
21
|
Zhao R, Gao J, Cao HR. [A clinical study of the male anterior hairline]. Zhonghua Zheng Xing Wai Ke Za Zhi 2011; 27:355-358. [PMID: 22259986] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To measure the male anterior hairline (AH) and provide data for hair transplantation. METHODS 205 males were randomly involved and divided into different age groups, as the young group( age 18-29), the middle-aged group (age 30-49) and the old group (age 50+). Their AH shape and height were measured. The data was then analyzed. RESULTS According to the morphological classification of AH, the linear type was most common in the young and middle-aged groups (48.40% and 37.33%), the anterior protrusion type was most common in the old group (34.80%). The mean height of AH was 6.42 cm (5.00-8.50 cm)for the median line, and there was no statistical difference between groups (P > 0.05); the mean ratio of median line AH height to facial length was 0.30 (0.22-0.37), there were significant differences between the old group against the young, or the middle-aged group (P < 0.05), and no difference between the young group and the middle-aged group (P > 0.05); the mean height of AH was 5.83 cm (3.5-8.0 cm) for the paramedian line, and there was no statistical difference between groups (P > 0.05); the mean height of AH was 8.34 cm (5.5-10.5 cm) for the lateral line, there were significant differences between the young group against the middle-aged, or the old group (P < 0.05), and no difference between the middle-aged group and the old group (P > 0.05). CONCLUSIONS The shape and height of AH were age-associated. The linear type is most common in the young and middle-aged groups, the anterior protrusion type is most common in the old group. The change first occurs on the lateral lines since the age of 30, and the central portion is involved since the age of 50. The older the age gets, the higher the hairline is.
Collapse
Affiliation(s)
- Ru Zhao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijin 100032, China
| | | | | |
Collapse
|
22
|
Au WWL, Houser DS, Finneran JJ, Lee WJ, Talmadge LA, Moore PW. The acoustic field on the forehead of echolocating Atlantic bottlenose dolphins (Tursiops truncatus). J Acoust Soc Am 2010; 128:1426-1434. [PMID: 20815476 DOI: 10.1121/1.3372643] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Arrays of up to six broadband suction cup hydrophones were placed on the forehead of two bottlenose dolphins to determine the location where the beam axis emerges and to examine how signals in the acoustic near-field relate to signals in the far-field. Four different array geometries were used; a linear one with hydrophones arranged along the midline of the forehead, and two around the front of the melon at 1.4 and 4.2 cm above the rostrum insertion, and one across the melon in certain locations not measured by other configurations. The beam axis was found to be close to the midline of the melon, approximately 5.4 cm above the rostrum insert for both animals. The signal path coincided with the low-density, low-velocity core of the melon; however, the data suggest that the signals are focused mainly by the air sacs. Slight asymmetry in the signals were found with higher amplitudes on the right side of the forehead. Although the signal waveform measured on the melon appeared distorted, when they are mathematically summed in the far-field, taking into account the relative time of arrival of the signals, the resultant waveform matched that measured by the hydrophone located at 1 m.
Collapse
Affiliation(s)
- Whitlow W L Au
- Hawaii Institute of Marine Biology, PO Box 1106 Kailua, Hawaii 96734, USA
| | | | | | | | | | | |
Collapse
|
23
|
Pancherz H, Knapp V, Erbe C, Heiss AM. Divine proportions in attractive and nonattractive faces. World J Orthod 2010; 11:27-36. [PMID: 20209174] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM To test Ricketts' 1982 hypothesis that facial beauty is measurable by comparing attractive and nonattractive faces of females and males with respect to the presence of the divine proportions. METHODS The analysis of frontal view facial photos of 90 cover models (50 females, 40 males) from famous fashion magazines and of 34 attractive (29 females, five males) and 34 nonattractive (13 females, 21 males) persons selected from a group of former orthodontic patients was carried out in this study. Based on Ricketts' method, five transverse and seven vertical facial reference distances were measured and compared with the corresponding calculated divine distances expressed in phi-relationships (f=1.618). Furthermore, transverse and vertical facial disproportion indices were created. RESULTS For both the models and patients, all the reference distances varied largely from respective divine values. The average deviations ranged from 0.3% to 7.8% in the female groups of models and attractive patients with no difference between them. In the male groups of models and attractive patients, the average deviations ranged from 0.2% to 11.2%. When comparing attractive and nonattractive female, as well as male, patients, deviations from the divine values for all variables were larger in the nonattractive sample. CONCLUSION Attractive individuals have facial proportions closer to the divine values than nonattractive ones. In accordance with the hypothesis of Ricketts, facial beauty is measurable to some degree.
Collapse
Affiliation(s)
- Hans Pancherz
- Department of Orthodontics, University of Giessen, Giessen, Germany.
| | | | | | | |
Collapse
|
24
|
Cai XY, Li ZM, Xu YB, Cheng G, Luo P. [The anatomic features of supratrochlear artery]. Zhonghua Zheng Xing Wai Ke Za Zhi 2009; 25:456-459. [PMID: 20209940] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To explore the anatomical features of supratrochlear artery which is related to the blood supply of paramedian frontal flap in nasal reconstruction. METHODS 10 adult head specimens (20 sides) were used for observation of the course, layer and anastomosis of the supratrochlear artery. The horizontal line of supraorbital rim and the frontal middle line were used as X and Y axis to locate the position of supratrochlear artery. RESULTS Supratrochlear artery is directed medially and upward after it gets out from orbit. Some arteries (9/20) have one sharp bend at the beginning. The frontal muscle penetration point of the artery is (15.2 +/- 2.6) mm above the X axis and (12. 1 +/- 1 .4) nun lateral to the Y axis. The artery goes subcutaneously after muscle penetration point. It goes more superficially and is anastomosed to the supraorbital artery and frontal branches of the superficial temporal artery at the same side, and also the contra-lateral supratrochlear artery. CONCLUSION The pedicle of the paramedian frontal flap should not be too narrow. The dissection of the pedicle should not be too near to the artery, so as to protect the bend at the beginning. The flap elevation must be performed beneath the frontal muscle, when it is 2-3 cm above the supraorbital rim.
Collapse
Affiliation(s)
- Xiao-yan Cai
- Department of Burn and Plastic Surgery, the First People's Hospital of Shunde , Southern Medical University, Foshan 528300, China
| | | | | | | | | |
Collapse
|
25
|
Sykes JM. Applied anatomy of the temporal region and forehead for injectable fillers. J Drugs Dermatol 2009; 8:s24-s27. [PMID: 19891119] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Injectable fillers allow for augmentation of soft tissue deficiencies caused by aging, trauma or other scarring. Placement of injectable fillers can be performed in the office, safely and with minimal patient downtime. In order to avoid complications from injection of filler substances, the injector must have a thorough knowledge of the applied anatomy. The temple and forehead are often associated with aging changes. This article describes the anatomic layers of the forehead and temple, and discusses the various planes for safe injection of fillers.
Collapse
Affiliation(s)
- Jonathan M Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, CA, USA.
| |
Collapse
|
26
|
Friedman T, Golan J, Shalom A, Westreich M. The "Brown sisters": photogrammetric analysis of brow and cheek descent. Isr Med Assoc J 2009; 11:470-473. [PMID: 19891234] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Due to the absence of accurate tools and appropriate photographic material there is a paucity of objective studies on facial aging in the modern literature. OBJECTIVES To measure changes in two elements of the face: brow ptosis and cheek mass migration, using an objective tool that we developed which we then used to evaluate facial aging in two subjects studying serial professional photographs over a 25 year period. METHODS We studied the photographic atlas of the "Brown Sisters," a record of the yearly group photograph of four sisters taken by the photographer Nicolas Nixon. For technical reasons only two of the sisters fulfilled the criteria we set for the study. We used the interpupillary distance of each photograph studied to standardize the brow height and cheek mass distance from the interpupillary line. RESULTS We observed progressive medial brow descent occurring at about the age of 30, with apparent stabilization thereafter. In contrast, there was a continuous process of lateral brow descent through the years. A process of gradual cheek mass descent was noted in the second half of the third decade. CONCLUSIONS Our results indicate that the dynamic brow changes start in the second half of the third decade, with more significant lateral brow descent than medial brow descent. The cheek mass reflective point moves in an inferior-lateral direction. The tool we developed can be used to follow aging changes and postoperative results, thereby helping the surgeon achieve true rejuvenation surgery.
Collapse
Affiliation(s)
- Tal Friedman
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | | | | | | |
Collapse
|
27
|
Cai X, Li Z. [Applied anatomy study of supratrochlear vein in reconstruction of nasal defect]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009; 23:219-221. [PMID: 19275108] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To investigate the variation of supratrochlear vein and its relationship with supratrochlear artery and to provide anatomical basis for the reduction of congestive necrosis of paramedian forehead flap in the reconstruction of nasal defect. METHODS Twenty sides of 10 antiseptic head specimens were anatomized macroscopically and microscopically. Using the horizontal and anterior median line of supraorbital rim as X and Y axis to locate supratrochlear vein and artery, the angles between the supratrochlear artery and vein and the supraorbital rim were detected, and the distances from the supratrochlear artery and vein to the anterior median line on the horizontal line of supraorbital rim were measured. RESULTS The distance from the supratrochlear artery and supratrochlear vein to the anterior median line on the horizontal line of the supraorbital rim was (16.2 +/- 2.1) mm and (9.7 +/- 3.1) mm, respectively, indicating there was a significant difference (P < 0.05). The angle between the supratrochlear vein and artery and the supraorbital rim was (83.3 +/- 6.4) degrees and (80.5 +/- 4.2) degrees, respectively, indicating there was no significant difference (P > 0.05). Two asymmetric supratrochlear veins were observed around the area of anterior median line in every specimen, one was far from the anterior median line (group A) and the other was close to or even on the line (group B). The distance from the supratrochlear veins to the anterior median line on the horizontal line of the supraorbital rim was (11.0 +/- 1.9) mm in group A and (7.9 +/- 3.2) mm in group B, showing there was a significant difference between two groups (P < 0.05). For all the specimens, the supratrochlear vein ran laterally along the medial anterior median line of the supratrochlear artery (one side was just on the anterior median line). The distance from the supratrochlear veins to the supratrochlear arteries on the horizontal line of the supraorbital rim was (6.6 +/- 3.2) mm, (5.5 +/- 2.0) mm in group A and (7.9 +/- 3.9) mm in group B, indicating the difference between two groups was significant (P < 0.05). CONCLUSION The pedicle of the paramedian forehead flap should be wide enough (1.5-2.0 cm), the lateral boundary of the pedicle should be the supratrochlear artery while the medial boundary should be the supratrochlear vein.
Collapse
Affiliation(s)
- Xiaoyan Cai
- Department of Burn and Plastic Surgery, the First People's Hospital of Shunde, Southern Medical University, Foshan Guangdong, 528300, P.R. China
| | | |
Collapse
|
28
|
Abstract
Corrugator supercilii is a facial, forehead and supra-orbital muscle. The frown glabellar wrinkles are mainly formed by repeated contractions of this muscle. These wrinkles will produce the picture of premature ageing even in a young person. Many treatments reduce or abolish the action of this muscle, enhancing the appearance of the glabellar area. We propose to review the recent material related to the anatomical characteristics of this muscle in order to build the necessary knowledge to optimize the result of these different treatments.
Collapse
Affiliation(s)
- C Bartolin
- Service de chirurgie plastique et reconstructrice, hôpital Roger-Salengro, CHRU de Lille, boulevard du Professeur-Emile-Laine, 59037 Lille cedex, France.
| | | |
Collapse
|
29
|
Abstract
OBJECTIVE The aim of this study was to evaluate the accuracy of facial plaster casts and their suitability for 3-D mapping. MATERIALS AND METHODS All measurements were carried out on 15 adult probands (seven female and eight male; age range 19-31 years, mean 24.7 years). A plaster cast of the facial surface was prepared for all probands using alginate impressions. The plaster casts and the probands faces were digitized using a three-dimensional laser-scanner operating with structured light. The resulting point clouds were matched in a virtual environment to analyze the deviations between the cast and the facial surfaces, both qualitatively and quantitatively. RESULTS The average deviations depended on the facial area and lay between 0.95 and 3.55 mm. Marked differences between the plaster cast and the facial surface were found, particularly in the area of the lips, at the roof of the nose, at the cheeks, and in the entire lower facial area. CONCLUSIONS The regionally exacerbated soft tissue deformations that occur during impression of the facial surface lead to inaccuracies in the resulting plaster cast that forbids any use for morphometric analysis. Documentation of pathological findings in cleft lip and palate using facial plaster casts does appear to be justifiable.
Collapse
Affiliation(s)
- Christof Holberg
- Department of Orthodontics, University of Munich, Bavaria, Germany.
| | | | | | | |
Collapse
|
30
|
Weinberg SM, Naidoo S, Govier DP, Martin RA, Kane AA, Marazita ML. Anthropometric precision and accuracy of digital three-dimensional photogrammetry: comparing the Genex and 3dMD imaging systems with one another and with direct anthropometry. J Craniofac Surg 2006; 17:477-83. [PMID: 16770184 DOI: 10.1097/00001665-200605000-00015] [Citation(s) in RCA: 245] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A variety of commercially available three-dimensional (3D) surface imaging systems are currently in use by craniofacial specialists. Little is known, however, about how measurement data generated from alternative 3D systems compare, specifically in terms of accuracy and precision. The purpose of this study was to compare anthropometric measurements obtained by way of two different digital 3D photogrammetry systems (Genex and 3dMD) as well as direct anthropometry and to evaluate intraobserver precision across these three methods. On a sample of 18 mannequin heads, 12 linear distances were measured twice by each method. A two-factor repeated measures analysis of variance was used to test simultaneously for mean differences in precision across methods. Additional descriptive statistics (e.g., technical error of measurement [TEM]) were used to quantify measurement error magnitude. Statistically significant (P < 0.05) mean differences were observed across methods for nine anthropometric variables; however, the magnitude of these differences was consistently at the submillimeter level. No significant differences were noted for precision. Moreover, the magnitude of imprecision was determined to be very small, with TEM scores well under 1 mm, and intraclass correlation coefficients ranging from 0.98 to 1. Results indicate that overall mean differences across these three methods were small enough to be of little practical importance. In terms of intraobserver precision, all methods fared equally well. This study is the first attempt to simultaneously compare 3D surface imaging systems directly with one another and with traditional anthropometry. Results suggest that craniofacial surface data obtained by way of alternative 3D photogrammetric systems can be combined or compared statistically.
Collapse
Affiliation(s)
- Seth M Weinberg
- Center for Craniofacial and Dental Genetics, Department of Oral Medicine and Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, USA.
| | | | | | | | | | | |
Collapse
|
31
|
Affiliation(s)
- Jonathan M Morgan
- Department of Otolaryngology, Division of Facial Plastic Surgery, University of South Florida, 12901 Bruce B. Downs Boulevard, Tampa, FL 33621, USA
| | | |
Collapse
|
32
|
Abstract
All students of beauty agree upon the overwhelming contribution of the eyes to the beautiful face. It is not at all surprising, therefore, that since antiquity, the search for personal beauty has centered on enhancement and beautification of the eyes. The precise sources of the beauty of this region are ultimately intuitive, but various common features seem to span racial differences and can be loosely (but certainly not rigidly) defined. The anatomic characteristics that contribute to beautiful eyes are described, and application of this knowledge to multiracial aesthetic surgery of the periorbital region is discussed.
Collapse
|
33
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide the latest findings in the constantly changing field of brow and forehead lifting. Significant articles published in the last 24 months are reviewed and discussed based on the personal experience of the senior author (F.P.). RECENT FINDINGS Important anatomical findings have been made over the last few years which will have an impact on plastic surgery of the upper third of the face, with new ligamentous structures of the forehead and more precise landmarks of the supraorbital neurovascular bundle being described. The short-term efficacy of a new device for periosteal fixation has been evaluated and new data have been collated about the time required for forehead periosteal readhesion. SUMMARY In the last few years there have been important anatomical findings which will allow the development of more detailed and safe techniques for forehead lift surgery. New absorbable materials are available that allow efficient mechanical fixation of the soft tissues. The senior author of this review has extensive personal experience involving more than 400 cases. In addition to commenting on recent articles, we detail the methods we have used over the last 8 years, especially regarding the fixation technique.
Collapse
|
34
|
Abstract
The goal of this article is to explain both the options and the techniques that are available when considering the rejuvenation of the eyelid and brow complex. We first explain the relevant anatomy. We then list and explain the different techniques with both the brow lift and the blepharoplasty. During this discussion we also explain a newer technique that we have been using. This combines the endoscopic technique with a trichophytic incision. The selection of patients is discussed in reference to which technique is appropriate given each patient's particular anatomy and desired effects. We also highlight the unique differences that the male patient presents.
Collapse
Affiliation(s)
- Jonathan M Morgan
- Department of Otolaryngology, Division of Facial Plastic Surgery, University of South Florida, Tampa, Florida 33606, USA
| | | | | |
Collapse
|
35
|
Abstract
BACKGROUND Elimination of glabellar frown lines by direct denervation of the corrugator and procerus muscles has proven elusive. Furrows often persist after the frontal branch of the facial nerve has been divided. In order to find an explanation for these observations and to provide an anatomic basis for future surgical strategies, the pattern of innervation of these muscles was studied. METHODS Two separate investigations were performed: (1) cadaveric anatomical dissection in 18 fresh cadaver hemi-faces utilizing loupe magnification, operating microscope, and template tracings; and (2) electrophysiologic testing performed in 12 healthy volunteers utilizing a Viking Ile nerve stimulator (Nicolet, Madison, WI). RESULTS The corrugator was found to have a dual nerve supply with contributions from branches of the frontal, zygomatic and buccal branches of the facial nerve. The frontal branch passes deep to the orbicularis at the level of the eyebrow; and the buccal branch, after receiving a contribution from the zygomatic, forms the angular nerve, which then passes superiorly in front of the medial canthus to supply both corrugator and procerus. The procerus muscle was found to receive contributions from the angular nerve exclusively. CONCLUSIONS Procedures designed to denervate the corrugator should be directed at both components of its redundant nerve supply, the frontal branch as well as the angular nerve. Division of the angular nerve will also denervate the procerus muscle. Both frontal nerve branches and angular nerve components are accessible through an upper blepharoplasty incision.
Collapse
Affiliation(s)
- D M Caminer
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
| | | | | |
Collapse
|
36
|
Sullivan PK, Salomon JA, Woo AS, Freeman MB. The Importance of the Retaining Ligamentous Attachments of the Forehead for Selective Eyebrow Reshaping and Forehead Rejuvenation. Plast Reconstr Surg 2006; 117:95-104. [PMID: 16404255 DOI: 10.1097/01.prs.0000185862.37301.32] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Forehead rejuvenation procedures can lead to excessive elevation of the medial brow, resulting in the "surprised look." Differential treatment of the medial and lateral brow allows more precise positioning. The purpose of this study was to determine whether retaining structures exist in the forehead that would permit this differential elevation. METHODS Anatomical dissections were performed in the foreheads of 12 cadavers. Multiplanar dissections at the subperiosteal, subgaleal, and subcutaneous levels were performed on eight hemiforeheads. Clinical correlation for these findings was obtained during endoscopic and open brow-lift surgery. RESULTS Four retaining structures of the brow were identified: three medial and one lateral. The superomedial attachment begins 13 mm from the midline and 10.8 mm above the supraorbital rim. The superolateral attachment begins 23 mm from the midline and 10.3 mm above the supraorbital rim. The inferomedial attachment begins 12.6 mm from the midline at the level of the supraorbital rim, just medial to the supraorbital nerve. These three structures were found to control the position of the medial brow. Laterally, brow position was controlled by a broad ligamentous attachment extending across the lateral aspect of the supraorbital rim. CONCLUSIONS Medial retaining structures have been found to extend from the cranium into the forehead musculature. Release of the lateral broad ligamentous attachment was performed, followed by selective preservation of medial retaining structures. With this approach, we were able to gain control of the position of the medial brow and prevent overelevation and lateral spreading.
Collapse
Affiliation(s)
- Patrick K Sullivan
- Division of Plastic and Reconstructive Surgery, Brown University, Providence, RI, USA.
| | | | | | | |
Collapse
|
37
|
Abstract
The aim of the study is to elucidate the precise anatomy and histologic structure of frontalis muscle relating to blepharoptosis repair. Five Korean adult cadavers were used. The soft tissues of the lower forehead, including muscle and periosteum, were dissected at different sagittal planes and then observed histologically and photographed. Masson's trichrome was used for staining the section specimens. The frontalis muscle passed through and inserted into the bundles of the orbicularis oculi muscle on the superior border of the eyebrow at middle and medial side of the upper eyelid. However, at the lateral side it inserted about 0.5 cm below the superior border of eyebrow. At the medial side of the eyelid, the most distal frontalis muscle was located deep to the procerus muscle and superficial to the corrugator muscle. A knowledge of the distal insertion of the frontalis muscle is referred to the muscle transfer procedure for blepharoptosis repair.
Collapse
Affiliation(s)
- Kun Hwang
- Department of Plastic Surgery, College of Medicine, Inha University, Incheon, Korea.
| | | | | |
Collapse
|
38
|
Abstract
The use of botulinum toxin is becoming increasingly popular, and application details are being examined in an effort to achieve more satisfactory results with fewer side effects. In the forehead area, the main considerations are the effacement of forehead wrinkles to a desirable extent and the prevention of complications such as ptosis of the eyebrow and upper eyelid. The frontalis muscle necessitates chemodenervation by botulinum toxin at multiple points for the desired effect. The dimensions of foreheads, and thus the frontalis muscle, differ from patient to patient. The effectiveness and side effects change according to whether the forehead is narrow or a wide. Therefore, no single application technique is best for all patients. For this study, the glabella-hairline distance was measured in 90 healthy adults. Patients with a vertical forehead length exceeding 70 mm were regarded as having a wide forehead, and the botulinum toxin was applied in three vertical lines in two split doses. On the other hand, individuals with a vertical forehead length of less than 60 mm were regarded as having a narrow forehead, and the toxin was applied in two split doses in three horizontal lines. The authors have found that in cases of wide or narrow foreheads, the effectiveness of the toxin increased, whereas the side effects such as brow asymmetry and ptosis were not encountered. Thus, they recommend the use of this technique for patients with wide or narrow foreheads.
Collapse
|
39
|
Abstract
OBJECTIVE The transpalpebral resection of the corrugator and depressor supercilii muscles is a new treatment option for migraine headaches. Hyperactive contractility of these muscles can provoke the peripheral compression of the supratrochlear nerve and induce a neurogenic inflammation triggering the symptoms of migraine. In order to gather detailed knowledge of the respective anatomy in the eyebrow region, a macroscopic cadaver study was conducted. MATERIALS AND METHODS The relevant muscles of the forehead, glabella and eyebrow were dissected in five fresh, non-preserved heads. The supracanthal origins and dermal points of insertion were marked. Following the preparation of the neurovascular structures, the muscles were measured and weighed. The course of the supraorbital and supratrochlear nerves was demonstrated from the forehead to the orbital cavity. RESULTS There are three, paired groups of muscles in the superomedial region of the orbital rim. They can be divided into the superficial frontalis and procerus muscle, the orbicularis muscle in a middle layer and the corrugator and depressor supercilii in a deeper layer. The corrugator measured approximately 4.5 cm, whose origin is superior and posterior to the depressor origin situated cranial to the medial canthus. The corrugator inserts lateral to the exit of the supraorbital nerve in the dermis above the eyebrow after penetrating the orbicularis and frontalis muscles and a subgaleal fat pad. The length and weight of the muscles is highly variable. The muscle is penetrated by the supratrochlear nerve whereas the supraorbital nerve runs underneath it. The corrugator is innervated medially and laterally by branches of the facial nerve. CONCLUSION A detailed knowledge of the complex arrangement of the muscles acting upon the glabella and the different communicating subgaleal and preseptal fat pads allow the identification and resection of the corrugator and depressor muscles without damaging the supratrochlear nerve. The course of the specific nerves is variable. The double-innervation of the corrugator suggests its complete resection instead of the selective denervation of the muscle.
Collapse
Affiliation(s)
- T Muehlberger
- Abteilung für Plastische- und Handchirurgie, Park-Klinik Weissensee, Berlin.
| | | | | |
Collapse
|
40
|
Abstract
The reconstruction of defects that involve the scalp and forehead presents unique aesthetic and functional challenges. This article reviews the surgical anatomy of these regions and presents an algorithm for decision making in reconstructive surgery. Nonmicrosurgical techniques are briefly reviewed. The microsurgical reconstruction of scalp and forehead defects differs from the more common oropharyngeal reconstructions in several ways, including flap choices, choices for recipient vessels, and the opportunity to use conventional and microsurgical techniques simultaneously to improve outcomes. Each of these considerations is reviewed and the authors' preferred techniques presented.
Collapse
Affiliation(s)
- Claire L F Temple
- Division of Plastic Surgery, University of Western Ontario, Hand and Upper Limb Centre, London, Ontario, Canada.
| | | |
Collapse
|
41
|
Abstract
Interpolation flaps provide an excellent method for reconstruction of large or deep defects where adjacent local tissue cannot supply sufficient donor tissue for repair. These flaps use tissue imported from nonadjacent sites with an inherent blood supply (vascular pedicle) to support the flap while attached to the recipient defect until neovascularization has been ensured between the flap and recipient bed. Hence, they can supply the thickness or bulk needed for large or deep defects and can survive on exposed bone or cartilage. The main disadvantage of these flaps is that they require two stages to complete because the delayed second stage releases the pedicle after inosculation and neovascularization render the tissue independent of the pedicle. This article describes three major interpolation flaps useful in repair of the nose and ear. The forehead, melolabial, and postauricular interpolation flaps are excellent methods that will add to the dermatologic surgeon's reconstructive armamentarium for the repair of large or deep defects.
Collapse
Affiliation(s)
- J Ramsey Mellette
- Department of Dermatology, University of Colorado Health Sciences Center, P.O. Box 6510, Mail Stop F703, Aurora, CO 80045-0510, USA.
| | | |
Collapse
|
42
|
Naini FB, Moss JP. Three-dimensional assessment of the relative contribution of genetics and environment to various facial parameters with the twin method. Am J Orthod Dentofacial Orthop 2005; 126:655-65. [PMID: 15592212 DOI: 10.1016/j.ajodo.2003.08.034] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The purpose of this prospective study was to help distinguish the relative contributions of heredity and environment to the external facial features and to assess the relative strength of the genetic influence on anteroposterior and vertical facial parameters, by using 3-dimensional optical surface scanning and the inferential twin method. The subject group consisted of 10 pairs of monozygotic twins (5 male, 5 female, mean age 11.9 years), 10 pairs of same-sex dizygotic twins (3 male, 7 female, mean age 12.1 years), and 6 mixed-sex dizygotic twin pairs. Two methods of analysis were used on the 3-dimensional scans. Interlandmark measurements of 28 facial parameters were recorded, and the mean intrapair differences for each parameter were compared between the monozygotic and dizygotic groups. The second method used the analysis of surface shape for all twin pairs. This technique characterizes the face by using 9 surface shapes distinguished visually by color, allowing a qualitative description of the differences between monozygotic and dizygotic twin pairs. Analysis of the 28 facial parameters showed significant ( P< .05) genetic determination for midfacial parameters, especially left eye width, intercanthal width, nose height, and nose width. Analysis of surface shape showed the strongest genetic determination for a triangular area of the midface encompassing the orbital rims, intercanthal area, and nose. The concordance for vertical and anteroposterior facial parameters was found to be greater in monozygotic twins than in dizygotic twins. The concordance for vertical facial dimensions of the middle and lower anterior parts of the face was found to be greater than that for anteroposterior facial dimensions in monozygotic twins.
Collapse
|
43
|
Abstract
The article focuses on forehead reconstruction of surgical wounds following skin cancer resection. Reconstruction options are presented for three forehead subunits. Preserving motor and, when possible, sensory nerve function, maintaining eyebrow position, and camouflaging incisions are priorities for successful reconstruction. Most forehead defects that cannot be closed primarily are usually reconstructed with laterally based advancement flaps.
Collapse
Affiliation(s)
- Peter C Seline
- Center for Surgical Dermatology, 1080 Polaris Parkway, Suite 200, Columbus, OH 43240, USA
| | | |
Collapse
|
44
|
Abstract
The introduction of endoscopes is responsible for the surge in many of the aesthetic facial plastic surgeries in the past decade. This relatively new technology is widely used in upper-third facial rejuvenation and created a natural evolution into the rejuvenation of the central midthird of the face. After careful patient selection and evaluation, several key maneuvers are accomplished to achieve forehead and midface rejuvenation: (1) a subperiosteal dissection of the scalp to the level of the superior and lateral orbital rims and zygomatic arch, (2) incision and release of orbital periosteum, (3) selective myectomies of the glabella muscles, (4) subperiosteal dissection of the midface (from infraorbital rim to the inferior aspect of the maxilla and laterally over the entire zygomatic arch to the gonial angle beneath the masseteric aponeurosis), and (5) suspension and reposition of the malar fat pad, suborbicularis oculi fat, and soft tissue overlying the angle of the mandible. Endobrow-midface lift is a safe and reliable method to rejuvenate the upper two thirds of the face with excellent results while minimizing the morbidities and complications associated with the traditional open procedures.
Collapse
Affiliation(s)
- Vito C Quatela
- The Lindsay House Center for Plastic Surgery, Rochester, New York, USA
| | | |
Collapse
|
45
|
|
46
|
Affiliation(s)
- Jonathan M Sykes
- Department of Otolaryngology/Head and Neck Surgery, University of California-Davis, 2521 Stockton Blvd, Suite 7200, Sacramento, CA 95817, USA.
| | | |
Collapse
|
47
|
Bozkir MG, Karakas P, Oguz O. Vertical and horizontal neoclassical facial canons in Turkish young adults. Surg Radiol Anat 2003; 26:212-9. [PMID: 14625792 DOI: 10.1007/s00276-003-0202-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [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: 01/22/2003] [Accepted: 09/20/2003] [Indexed: 11/24/2022]
Abstract
Four vertical and three horizontal measurements were taken to assess the validity of neoclassical facial canons in 500 (272 female, 228 male) healthy, young adults between the ages of 18 and 25 years from Turkey and to compare them with a different population. The measurements were made by a millimetric compass. The special head height was longer than the special face height in the majority of our group (women/men: 97.8%/91.7%). The three-section facial profile canon was equal in only one male subject (women/men: 0/0.4%). Faces with four equal profile sections were not seen in either of the sexes. The nose length was longer than the ear length in the minority of our population (women/men: 1.5%/1.3%). The intercanthal distance was shorter than the nose width and left eye fissure length in the majority of our subjects (women/men: 50.4%/78.9% and 50.0%/52.2% respectively). The mouth width was greater than 1.5 times the nose width in the majority of this study (women/men: 66.9% vs 49.1%).
Collapse
Affiliation(s)
- M G Bozkir
- Department of Anatomy, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey.
| | | | | |
Collapse
|
48
|
Farkas LG, Hreczko TM, Katic MJ, Forrest CR. Proportion indices in the craniofacial regions of 284 healthy North American white children between 1 and 5 years of age. J Craniofac Surg 2003; 14:13-28. [PMID: 12544216 DOI: 10.1097/00001665-200301000-00004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The study's aim was to provide the normal range data on 81 anthropometric proportion indices of the craniofacial complex, separately in boys and girls between 1 and 5 years of age, supplementary to the previously published normal proportion values of the North American white population from 6 to 18 years of age. In the first age group, 17 or 18 boys and 18 or 22 girls were measured. In each age group between 2 and 5 years old, 30 boys and 30 or 31 girls were examined. The normal values of the 81 proportion indices were established with the help of 45 measurements (7 cranial, 13 facial, 4 orbital, 12 nasal, 7 labio-oral, and 2 auricular) taken from 287 healthy children. The data on the normal indices were reported in two groups: areal and interareal. The areal proportions are formed by taking measurements from one particular craniofacial region. Proportions indicating the quality of relation of measurements taken from two craniofacial regions were classified as interareal (N = 36). The basic proportions (N = 13) of the areal one show the relation between the measurements influencing the general view of each craniofacial region. The detailed analysis of the proportionality in the individual regions, carried out with the help of the other measurements within the regions, established 36 additional areal proportion indices. The recommended method of examination is to start with the basic proportions, which offers the determination of the most and least disproportionate craniofacial region, followed by a more comprehensive search for other disproportions with the help of the additional areal proportions (N = 36) and interareal proportions (N = 32).
Collapse
Affiliation(s)
- Leslie G Farkas
- Center for Craniofacial Care and Research, The Hospital for Sick Children, and Division of Plastic Surgery, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|
49
|
Pejović-Milić A, Brito JA, Gyorffy J, Chettle DR. Ultrasound measurements of overlying soft tissue thickness at four skeletal sites suitable for in vivo x-ray fluorescence. Med Phys 2002; 29:2687-91. [PMID: 12462736 DOI: 10.1118/1.1513569] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Due to signal attenuation in overlying soft tissue, development of x-ray fluorescence systems to measure low atomic number elements, such as strontium, in human bone required a search for a skeletal site with thin overlying tissue. This paper reports ultrasound measurements of overlying tissue on 10 subjects, at four anatomical sites. The average tissue thickness at the finger was (2.9+/-0.7) mm. The average tissue thicknesses were (3.6+/-0.7) mm, (4.8+/-2.0) mm, and (8.4+/-1.7) mm at forehead, tibia and heel, respectively. Additionally, both parametric and nonparametric approaches to the relationship between body mass index (BMI) and tissue thickness suggest that there is a significant linear correlation between the subject's BMI and overlying tissue at the finger and heel bone. These correlations might be used as a criterion to perform XRF measurements, however a larger data set is required to address these correlations more clearly.
Collapse
|
50
|
Abstract
Six hundred and seventy seven radiographs were selected from the logs of films taken in a major hospital in Metro Manila, Philippines over the course of the previous year. Two hundred and eighty-eight female and 389 male, healthy Filipinos between the ages of birth and twenty years were selected based on the availability of a modified Waters' projection and lateral skull film taken at the same time. Measurements for the lateral orbital wall were made at the site of the suture on the medial surface of the zygomatic bone. The medial orbital wall measurement was the distance between the dacrya using a correction factor formula of CF = D-d/D where D is the target film distance and d is the object film distance (1). The actual bony measurements were calculated. The data was gathered and plotted according to sex and in age in years. Graphs were generated using SAS over a graph software. Lines were smooth using cubic spline technique developed by Reinsch with the smoothest value of 75 (2). The mean plus two, four, and six standard deviations were included in each of the curves.
Collapse
Affiliation(s)
- Constance M Barone
- University of Missouri-Columbia, Division of Plastic Surger, Department of Child Health, One Hospital Drive, Columbia, MO 65212, USA
| | | | | | | | | |
Collapse
|