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Casabona G, Frank K, Zeng R, Cotofana S, Alfertshofer M, Weinmann C, Moellhoff N, Kaye KO. Investigating Facial Muscle Physiology Following Soft Tissue Filler Injections-A Surface-derived Electromyographic and Skin Vector Displacement Analytic Study. Facial Plast Surg 2025; 41:352-358. [PMID: 38834176 DOI: 10.1055/a-2338-0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
The use of hyaluronic acid-based soft tissue fillers has often been reported to modulate the muscle, that is, to cause myomodulation. To our knowledge, there has been so far no scientific study investigating the potential of hyaluronic acid-based soft tissue fillers to modulate or actually alter the function of facial muscles. To further assess this three-dimensional (3D) surface imaging and electromyography (EMG)-based prospective study investigated the changes of facial muscle contraction after injection of strategically placed hyaluronic acid-based soft tissue fillers to assess the actual validity of the term myomodulation. A total of 13 subjects with a mean age of 37.8 years (12 females, 1 male) were injected according to a predefined injection protocol. Surface EMG and 3D surface imaging were performed prior to the injection and 5 days after the injection. The results showed no significant change in the strength of the muscles (measured in μV) after injection of hyaluronic acid-based soft tissue fillers. However, horizontal and vertical skin displacement upon contraction of the zygomaticus major muscle changed significantly between baseline and follow-up, with a mean horizontal skin displacement increase from 3.2 to 4.1 mm. Upon contraction of the depressor anguli oris muscle, the horizontal skin displacement did not change significantly (2.15 vs. 2.05 mm), while vertical skin displacement increased significantly from 2.9 to 4.3 mm. The modification of the surrounding tissue caused an alteration of the vectorial skin displacement upon contraction of the muscle. A potential explanation could be the increased distance between the origin and insertion of the muscle due to the material deposition in the proximity of the relevant facial muscles, leading to a change of contraction vector.
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Affiliation(s)
- Gabriela Casabona
- Department of Plastic Aesthetic Surgery, Ocean Clinic Marbella, Marbella, Spain
| | - Konstantin Frank
- Department of Plastic Aesthetic Surgery, Ocean Clinic Marbella, Marbella, Spain
| | - Rui Zeng
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Sebastian Cotofana
- Department of Dermatology, Erasmus Hospital, Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Charlotte Weinmann
- Klinik für Plastische, Ästhetische, Hand und Wiederherstellungschirurgie des Universitären Medizincampus Niederbayern, Passau, Germany
| | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Kai O Kaye
- Department of Plastic Aesthetic Surgery, Ocean Clinic Marbella, Marbella, Spain
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Valladares J, Lopez-Valdes DA, Farrera A. Technical Note: Reliability of Pöch's facial shape classification system: A morphometric approach. Forensic Sci Int 2025; 369:112435. [PMID: 40043498 DOI: 10.1016/j.forsciint.2025.112435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 02/09/2025] [Accepted: 02/27/2025] [Indexed: 03/14/2025]
Abstract
A standardized vocabulary of facial characteristics is essential in forensic anthropology for identifying both living and deceased individuals. Pöch's facial shape classification system is widely used for this purpose, but its reliability has not been critically evaluated. This is particularly important as the system was originally developed based on European male populations, and prior research suggests that classification systems can be prone to observer inconsistencies. In this study, we evaluate the representativeness and reliability of Pöch's system in describing face shape variation within a Mexican sample (n = 973). First, using geometric morphometrics and principal component analysis, we evaluated how well the system's categories capture the observed facial diversity. Sixteen observers then classified 60 randomly selected faces twice using Pöch's system, and we computed Fleiss' Kappa and Cohen's Kappa to assess intra- and inter-observer agreement. The level of consensus among observers was also measured by calculating the proportion of agreement for each facial shape. Our findings revealed significant morphological redundancy among most of Pöch's categories, poor agreement within (mean Cohen's Kappa = 0.203) and between (mean Fleiss' Kappa = 0.112) observers, and only the round and oval categories showed high levels of consensus. Given the system's poor performance, we conducted a post-hoc k-means clustering analysis of the Procrustes coordinates to explore a more representative classification scheme. The resulting four facial shape categories could inform the development of more representative and reliable classification systems.
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Affiliation(s)
- Jocelyn Valladares
- Facultad de Ciencias Políticas y Sociales, Universidad Nacional Autónoma de México, Cto. Exterior, C.U., Coyoacán, Ciudad de México 04510, Mexico
| | - Daniel Antonio Lopez-Valdes
- Facultad de Ciencias Políticas y Sociales, Universidad Nacional Autónoma de México, Cto. Exterior, C.U., Coyoacán, Ciudad de México 04510, Mexico
| | - Arodi Farrera
- Instituto de Investigaciones Antropológicas, Universidad Nacional Autónoma de México, Cto. Exterior, C.U., Coyoacán, Ciudad de México 04510, Mexico.
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Fezza JP, Barbarino S, Woodward J, Fezza R, Tijerina JD, Lee W. A.S.S.E.S.S. for Facial Fillers. J Cosmet Dermatol 2025; 24:e16633. [PMID: 39462247 PMCID: PMC11743322 DOI: 10.1111/jocd.16633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/25/2024] [Accepted: 09/30/2024] [Indexed: 10/29/2024]
Abstract
BACKGROUND An in-depth and detailed facial assessment is critical in treating and achieving desirable dermal filler and neurotoxin results. METHODS An acronym called A.S.S.E.S.S. simplifies an often complex and overwhelming amount of data needed to assimilate when performing facial filler and neurotoxin injections. Applying this method to patients in six simple steps provides a starting point and offers a guideline to capture key details for a more comprehensive facial assessment. The A.S.S.E.S.S. acronym stands for animate, shape, side, external, symmetry, and shadows and is helpful in following a methodical approach in analyzing facial shape, profile, and natural facial curves in both static and dynamic states. RESULTS Following a regimented A.S.S.E.S.S. approach prior to treating filler and neurotoxin patients allows providers a straightforward guide to achieve a desirable facial shape and profile. CONCLUSION This stepwise facial assessment establishes a logical and detailed approach to ensure the important aspects of facial details are appreciated in creating reliable and pleasing filler and neurotoxin results.
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Affiliation(s)
| | | | | | | | - Jonathan D. Tijerina
- Bascom Palmer Eye InstituteUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Wendy Lee
- Bascom Palmer Eye InstituteUniversity of Miami Miller School of MedicineMiamiFloridaUSA
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Alenezi BT, Hamayun R, Agarwal A, Alanazi DAJ, Alruwaili AMA, Alenezi WAA, Alanazi AKM. Knowledge and Attitude Towards Botulinum Toxin Use in Cosmetic Injections Among the Arar Population in Saudi Arabia: A Cross-Sectional Study. Cureus 2024; 16:e70694. [PMID: 39493111 PMCID: PMC11529696 DOI: 10.7759/cureus.70694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2024] [Indexed: 11/05/2024] Open
Abstract
Background The use of botulinum toxin (BT), commonly known as Botox, has become increasingly popular for cosmetic purposes, particularly in treating wrinkles and facial rejuvenation. While the efficacy of botulinum toxin in achieving desired aesthetic outcomes is well-established, it is also important to consider the level of public knowledge and awareness regarding this potent neurotoxin. This study investigates the knowledge and attitude towards botulinum toxin use in cosmetic injections in the Arar population. Methods This cross-sectional study utilized a self-report questionnaire distributed via social media platforms, employing randomized sampling from May to July 2024. The target population included adults aged 18 and older, regardless of gender, living in the city of Arar, Saudi Arabia. The data were collected through an online self-administered survey using a Google Forms questionnaire template, which was translated into the appropriate language. The collected data was analyzed using descriptive and inferential statistics. Results A total of four hundred and ten (410) participants responded to this study. The maximum number of participants, 149 (36.3%), were in the age group of 20-25 years, while the minimum number of participants, 6 (1.5%), was in the age group of 50-55 years. The results also showed that 341 (83.2%) of participants were females and 69 (16.8%) were males; 262 (63.9%) participants were aware of Botox treatment used in cosmetic clinics. Concerning the most prevalent non-surgical cosmetic treatments, 29 (7%) answered dental procedures, and 19 (4.6%) mentioned its use in pain. Conclusion This study found that 262 (63.9%) of the study population showed knowledge about botulinum toxins used in cosmetic injections. The majority of them were young individuals, females, or unmarried people. Only 83 (20%) were aware of the adverse effects of botulinum toxin. This low level of awareness about the potential risks associated with the use of botulinum toxins for cosmetic purposes is concerning and suggests the need for improved education and information dissemination.
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Affiliation(s)
- Bandar T Alenezi
- Department of Pharmacology, Faculty of Medicine, Northern Border University, Arar, SAU
- Center for Health Research, Northern Border University, Arar, SAU
| | - Rahma Hamayun
- Department of Pharmacology, Faculty of Medicine, Northern Border University, Arar, SAU
| | - Anshoo Agarwal
- Department of Pathology, Faculty of Medicine, Northern Border University, Arar, SAU
| | | | | | - Wateen Ali A Alenezi
- Department of Medicine, Faculty of Medicine, Northern Border University, Arar, SAU
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Farollch-Prats L, Braz A, Urdiales-Gálvez F, de la Guardia C, Nazari A. Profiloplasty and facial contouring with injectables: A holistic, practical, and user-friendly approach. J Cosmet Dermatol 2024; 23:3158-3172. [PMID: 38769652 DOI: 10.1111/jocd.16375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/18/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Expansion of the aesthetic treatment armamentarium with novel injectable products has greatly improved our ability to reshape and enhance the facial profile. However, full-face "profiloplasty" with injectables remain a nascent concept and is insufficiently considered in daily practice. While techniques have been widely published for treating the individual facial areas that constitute an attractive profile-including the forehead, nose, lips, jawline, and chin-the literature remains fragmented on more universal methods for profile improvement. AIMS To collate disparate knowledge on profile optimization with injectables, and define a holistic, practical, and user-friendly approach to profiloplasty and facial contouring. METHODS Consideration is given to key anatomical aspects and the changes that occur with age; patient assessment parameters for planning profiloplasty; and the technical specifications, product selection, and essential safety considerations for minimizing the risk of complications and optimizing the effectiveness of treatment. RESULTS Relevant case studies are presented. CONCLUSIONS Holistic approaches of this type are essential if we are to maximize the potential of full-face treatment with injectables-both now and in the future.
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Affiliation(s)
| | - André Braz
- Dermatología Láser Cosmiatria Clinic, Rio de Janeiro, Brazil
| | | | - Carola de la Guardia
- Global Aesthetics Medical Affairs, Allergan Aesthetics, an AbbVie Company, Madrid, Spain
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Díaz-Aguayo I, Urdiales-Gálvez F, Benítez PA, Carvajal-Larrate A, Farollch-Prats L, Hospido A, Mira M, Uva L, Zuluaga L. Aesthetic management of lips and perioral region with Hylacross® and Vycross® hyaluronic-acid based fillers: A document of recommendations. J Cosmet Dermatol 2024; 23:2843-2856. [PMID: 38751134 DOI: 10.1111/jocd.16358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/20/2024] [Accepted: 04/22/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Lip volumization and perioral rejuvenation with hyaluronic-acid (HA) based dermal fillers are generating increasing interest and demand. However, this topic is still having many unmet needs nowadays. This document aimed to provide tips and recommendations that may help clinicians to achieve optimal and more predictable aesthetic outcomes. METHODS A multidisciplinary group of aesthetic medicine doctors from Spain and Portugal reviewed the tools used for assessing the patient and aesthetic outcomes, as well as the different techniques and products used in lips/perioral rejuvenation. RESULTS The consensus panel provided specific recommendations focusing on the basic information to collect before performing the aesthetic procedure; comprehensive approach to lips/perioral region rejuvenation; clinical and aesthetic assessment tools; product and technique selection; patient profile and needs; and safety issues (complications/adverse-events). CONCLUSIONS The rapid evolution of techniques and tools for assessing the patient and aesthetic outcomes, as well as the development of new HA-based fillers makes it necessary to update the clinical recommendations that guide the daily practice of clinicians, particularly those who have less experience with these procedures. This document addressed relevant subjects related to lip/perioral-region rejuvenation to perform the correct procedure, with the appropriate HA-based, on the right patient; to help specialists to obtain optimal and predictable aesthetic outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Mar Mira
- Clínica Mira + Cueto, Madrid, Spain
| | - Luís Uva
- Clinica Personal Derma, Lisbon, Portugal
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7
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Ding H, Li S, Fu Q, Zhou G, Wang Y, Zheng C, Wu Q, Bai R, Xv X, Chen M. Facial cosmetic injection: A bibliometric analysis of research status and hotspots. J Cosmet Dermatol 2024; 23:746-757. [PMID: 38009307 DOI: 10.1111/jocd.16071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/06/2023] [Accepted: 10/27/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND The increasing popularity of cosmetic injections using various fillers and neuromodulators for facial rejuvenation has brought both new opportunities and challenges to this field. AIM Our study was designed to employ bibliometric and visual analysis for a qualitative and quantitative evaluation of facial cosmetic injections, as well as to identify research trends and hotspots in this field. METHODS All publications covering facial cosmetic injection during 2002-2023 were retrieved and extracted from the Web of Science database. The VOSviewer 1.6.18 software and the online tool (http://bibliometric.com/) were applied to analyze the publication trend. RESULTS A total of 3797 articles related to facial cosmetic injection were identified during the period 2002-2023. The United States had the largest volume of publications (1520, 40.0%), followed by China (333, 8.8%) and Germany (282, 7.3%). Among the institutions and journals, the University of California system and Plastic and Reconstructive Surgery accounted for the most papers related to facial cosmetic injection, respectively. Facial anatomy and injection techniques, prevention and management of complications, regenerative medicine, efficacy and safety of various soft-tissue fillers, as well as botulinum toxin injections for facial rejuvenation were identified as hotspots for facial cosmetic injections. CONCLUSIONS Facial cosmetic injections are showing an increasing trend in terms of both the number of published papers and operations performed. Despite the notable advancements in this field, numerous challenges persist, including safety concerns and the level of research evidence. With the emergence of novel technologies and materials, scholars from diverse countries and institutions should engage in more extensive collaboration, thereby directly expediting the progress of this field.
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Affiliation(s)
- Hongfan Ding
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Shiyi Li
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Qiang Fu
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Guiwen Zhou
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yichen Wang
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Can Zheng
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Qian Wu
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Ruiqi Bai
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Xiao Xv
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Minliang Chen
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
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8
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Expert Opinion on Non-Surgical Eyebrow Lifting and Shaping Procedures. COSMETICS 2022. [DOI: 10.3390/cosmetics9060116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Eyebrow elevation and reshaping are common concerns that we handle in everyday practice, and we have noticed that the trend is shifting from a medical concern to a cosmetic one. Several eyebrow lift methods are available, both invasive and non-surgical. The method of choice depends on several factors, such as patient expectations and beliefs, financial budget, acceptance of downtime and the available tools in the practice. In this article, we review the recent literature on non-surgical eyebrow lift methods to provide an overview of the current state of this field. We discuss seven different methods for eyebrow lift and reshaping, including botulinum toxin, dermal fillers, fractional radiofrequency, high-intensity focused ultrasound, thermo-mechanical ablation, lasers, and threads. Moreover, we provide practical insight into the procedure, injection techniques, expected results, and patient satisfaction rate.
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9
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Talwar AA, Shulkin JM, Hitchner M, McAuliffe PB, Desai AA, Broach RB, Percec I. Use of Cosmetic Facial Injectables After Facial Aesthetic Surgery. Aesthet Surg J 2022; 42:1194-1204. [PMID: 35764098 DOI: 10.1093/asj/sjac171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Over the last two decades, both invasive and minimally-invasive aesthetic procedures have proliferated. Aesthetic surgeons often recommend injectable treatments after cosmetic facial surgery for multiple reasons. Yet, literature is lacking on how cosmetic surgery affects post-operative facial injectable use. OBJECTIVES The authors aim to identify predictors of facial injectable use after cosmetic facial surgery. METHODS All adult patients operated on by a single surgeon between 2013 and 2021 were retrospectively reviewed. Patients who had any of the following cosmetic facial surgeries were included: rhytidectomy, blepharoplasty, rhinoplasty, or genioplasty. Patient demographics, clinical history, intraoperative factors, and use of cosmetic facial injectables (neurotoxin, facial fillers, deoxycholic acid, poly-L-lactic acid) were recorded. RESULTS A total of 227 patients who underwent facial cosmetic surgery were reviewed, of which 158 were included. 89 patients had rhytidectomy (56.3%), 112 had blepharoplasty (70.9%), 28 had rhinoplasty (17.7%), and 7 had genioplasty (4.4%). 44.3% patients received injectables after their surgery (n=73), compared to only 17.7% before surgery (n=28) (p<0.001). The most common post-operative injectables were neurotoxins (48.5%) and facial fillers (46.0%), followed by deoxycholic acid (2.7%) and poly-L-lactic acid (2.7%). Multivariate regression revealed factors positively correlated with future injectable use were index blepharoplasty or rhinoplasty, and history of pre-operative neurotoxin injection (p<0.05). CONCLUSIONS Cosmetic facial injectables are an important consideration in achieving and maintaining optimal facial aesthetics. Their use, especially neurotoxins and facial fillers, increases among patients post-operatively. These results highlight the contribution of injectable procedures in the context of multidimensional care for augmenting facial aesthetics.
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Affiliation(s)
- Ankoor A Talwar
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jared M Shulkin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michaela Hitchner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phoebe B McAuliffe
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Abhishek A Desai
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ivona Percec
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
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10
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Resection of Bilateral Masseter Hypertrophy and Buccal Fat Pad Associated with Genioplasty to Correct Aesthetic–Functional Disturbances in the Face. J Maxillofac Oral Surg 2022; 21:515-520. [DOI: 10.1007/s12663-022-01707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 03/02/2022] [Indexed: 11/26/2022] Open
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Application of Three-Dimensional Technology in Evaluating the Lower Face Lifting by Regional Platysma Injection with Botulinum Toxin-A. Aesthetic Plast Surg 2022; 46:2480-2487. [PMID: 34993595 DOI: 10.1007/s00266-021-02743-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/18/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Botulinum toxin-A (BTX-A) injection of regional platysma has been utilized in the lower-part elevation and mandibular contour sculpture. However, the relative research, especially in quantitative assessment appears very spare. Our aim is to investigate the efficacy of three-dimensional (3D) technology as a method for regional platysma injection with BTX-A. MATERIALS AND METHODS From October 2019 to September 2020, patients with mild or moderate degrees of facial sagging on the lower face were recruited to regional platysma BTX-A injection, and 3D scanning and measurement technology was used to evaluate the difference of curved distances and angels. Patients' improvement was assessed by the global aesthetic improvement scale (GAIS). RESULTS A total of 57 patients underwent regional platysma BTX-A injection and 32 patients were followed up successfully. Compared with Pre-operative, postoperative facial reference curves distance and cervico-mental angles had statistical differences (p < 0.05). GAIS suggested that the 3D imaging measurement technology could improve satisfaction. CONCLUSION 3D technology can evaluate the improvement of the lower face with BTX-A. It provides effective measurement methods and raises satisfaction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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12
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Goel A, Rai K. Midface Rejuvenation Using Juvederm Fillers in Male Patients. J Cutan Aesthet Surg 2022; 15:209-215. [PMID: 36561415 PMCID: PMC9764947 DOI: 10.4103/jcas.jcas_149_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background In the recent years, there has been a significant rise in the number of men seeking rejuvenating procedures. The development of minimally invasive, non-surgical, office-based procedures without minimal downtime has stimulated a fresh interest among men who may seek cosmetic treatment to increase competitiveness and appear youthful in the workplace. It is important to understanding the differences in facial features in men and women to achieve more natural results and to reduce the risk of feminizing the male's face. Aim The purpose of this study was to present our experience of midface rejuvenation using hyaluronic acid (HA) fillers in men. Materials and Methods The authors discuss the anatomical considerations, pathophysiology of aging, gender considerations, and their injection technique for midface rejuvenation in male patients. Results Midface rejuvenation was successful in male patients using HA dermal fillers while maintaining the masculine features. The treatment was well tolerated and resulted in high level of satisfaction. Conclusion Use of injectable HA dermal fillers is a safe, effective, and well-tolerated non-surgical treatment modality for midface rejuvenation in men. A thorough knowledge of the midface anatomy, injection techniques, and properties of individual fillers along with an understanding of the considerations in facial features of men can make injectable dermal fillers a rewarding treatment even in male patients.
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Affiliation(s)
- Anupriya Goel
- Berkowits Hair and Skin Clinic, New Delhi 110048, India
| | - Kritika Rai
- Berkowits Hair and Skin Clinic, New Delhi 110048, India,Address for correspondence: Dr. Kritika Rai, Berkowits Hair and Skin Clinic, J-1, Kailash Colony, New Delhi 110048, India. E-mail:
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13
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Peng YP, Lin YW, Yang YY. System strategy to achieve full-face aesthetic with hyaluronic acid fillers: Yes-lifting and pyramid-volumized approaches. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2021.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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14
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Lorenc ZP, Jones D, Kim J, Gwak HM, Batham S, Vachon G. Validating a Series of Photonumeric Rating Scales for Use in Facial Aesthetics Using Statistical Analysis of Intra- and Inter-rater Reliability. Aesthet Surg J Open Forum 2021; 3:ojab039. [PMID: 35350387 PMCID: PMC8958901 DOI: 10.1093/asjof/ojab039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Growing demand for minimally invasive aesthetic procedures to correct age-related facial changes and optimize facial proportions has been met with innovation but has created an unmet need for objective assessment tools to evaluate results empirically. Objectives The purpose of this study is to establish the intra- and inter-rater reliability of ordinal, photonumeric, 4-, or 5-point rating scales for clinical use to assess facial aesthetics. Methods Board-certified plastic surgeons and dermatologists (3 raters) performed live validation of jawline contour, temple volume, chin retrusion, nasolabial folds, vertical perioral lip lines, midface volume loss, lip fullness, and crow's feet dynamic- and at rest-rating scales over 2 rounds, 2 weeks apart. Subjects selected for live validation represented the range of scores and included 54 to 83 subjects for each scale. Test-retest reliability was quantitated through intra- and inter-rater reliability, determined from the mean weighted kappa and round 2 intraclass correlation coefficients, respectively. The clinical significance of a 1-grade difference was assessed through rater comparison of 31 pairs of side-by-side photographs of subjects with the same grade or a different grade on the developed scales. Results The study demonstrated substantial to near-perfect intra- and inter-rater reliability of all scales when utilized by trained raters to assess a diverse group of live subjects. Furthermore, the clinical significance of a 1-point difference on all the developed scales was established. Conclusions The high test-retest reliability and intuitive layout of these scales provide an objective approach with standardized ratings for clinical assessment of various facial features.
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Affiliation(s)
- Z Paul Lorenc
- Corresponding Author: Dr Z. Paul Lorenc, 983 Park Avenue, New York, NY 10028, USA. E-mail:
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Segurado MA, Urdiales-Gálvez F, Benítez PA, Carrasco S, Díaz I, Escoda N, Farollch-Prats L, Figueiredo V, Ortíz F, Sebastián MC, Uva L. An expert consensus report on the clinical use of the Vycross ® hyaluronic acid VYC-25 L filler. J Cosmet Dermatol 2021; 20:3155-3164. [PMID: 34460984 PMCID: PMC9292743 DOI: 10.1111/jocd.14398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/06/2021] [Indexed: 01/19/2023]
Abstract
Background The portfolio of hyaluronic acid (HA) fillers and the techniques of administration have evolved in recent years. The latest innovation in the Vycross® range was the introduction of VYC‐25L (Juvéderm Volux®; Allergan plc), a first‐in‐class filler effective for chin and facial lower third remodeling. The aim here was to provide clinicians who are starting to use VYC‐25L with key advice, and to standardize procedures so that optimal and predictable outcomes can be obtained. Methods A multidisciplinary group of experts in esthetic medicine from Spain and Portugal reviewed the properties, treatment paradigms, administration techniques, and potential complications of VYC‐25L, on the basis of which they drafted consensus recommendations for its clinical use. Results The consensus panel provided specific recommendations focusing on the patient profile, dose, administration techniques, and the complications of VYC‐25L and their management. The panel identified five different profiles of patients who may benefit from VYC‐25L, and they drafted recommendations aimed to facilitate the treatment of these patients, namely, microgenia (women/men), masculinization (men), rejuvenation (women/men), facial laxity (women/men), and submental convexity (women/men). In terms of their safety, no specific recommendations were made beyond those established for other HA fillers. Conclusions The evolution of esthetic medicine makes it necessary to update the clinical recommendations that guide patient assessment and treatment with the new HA fillers developed. The current consensus document addresses relevant issues related to the use of VYC‐25L on different types of patient, in an attempt to standardize procedures and help specialists obtain predictable results.
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Affiliation(s)
- María A Segurado
- SClinic, Madrid, Spain.,Francisco Vitoria University, Madrid, Spain
| | | | | | - Sara Carrasco
- Grupo Dra. Sara Carrasco - Dermatología Integral, Bilbao, Vizcaya, Spain
| | | | | | | | | | | | | | - Luís Uva
- Clínica Personal Derma, Lisbon, Portugal
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Oh H, Lee S, Na J, Kim BJ, Kim JH. Comparative Evaluation of Physical Characteristics and Preclinical Data of a Novel Monodisperse Polycaprolactone Microspheres Filler. Aesthetic Plast Surg 2021; 46:429-436. [PMID: 34302203 DOI: 10.1007/s00266-021-02470-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Demand for dermal fillers has been increasing gradually over the past decade. Polycaprolactone (PCL) fillers, a biodegradable polymer, not only naturally maintain the volume of the skin, but also stimulate collagen production by microsphere. However, inflammation can be caused by several factors such as large diameters, non-uniformity, uneven surfaces and non-spherical shapes of microspheres in use. Thus, a filler using microspheres with a uniform diameter of more than 20 μm and spherical shape was developed. OBJECTIVE The main purpose of this study was to evaluate the efficacy and safety of newly monodisperse polycaprolactone microspheres fillers, IVL-F001 with smaller microsphere size and better morphology against a conventional commercial PCL filler. MATERIALS AND METHODS The morphology and diameters of microsphere included in IVL-F001 and the PCL filler were analyzed, and the viscoelasticity and inject ability of both fillers were examined. After intradermal injection to hairless mice, the durability and efficacy of both fillers were evaluated through PRIMOSLITE and Folliscope for 24 weeks. Histology was performed to assess the biocompatibility, inflammation, and collagen synthesis. RESULTS Microspheres of IVL-F001 demonstrated a narrow size distribution with average diameter of 34.16 μm and distribution of 4.11. The level of injection force was low and the elasticity (G') was high compared to the licensed PCL filler. In the histopathological evaluation, IVL-F001 had significantly lower inflammatory reactions and higher collagen synthesis compared to the licensed PCL filler. CONCLUSION These data indicated that IVL-F001 has lower inflammatory reaction and improved persistence compared with commercial PCL filler. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Hyunsuk Oh
- R&D Research team, Inventage Lab Inc, Jungwon-gu, Seongnam, 13438, Gyeonggi, Korea
| | - Sangno Lee
- R&D Research team, Inventage Lab Inc, Jungwon-gu, Seongnam, 13438, Gyeonggi, Korea
| | - Jungtae Na
- Department of Life Science, Sogang University, Seoul, 04107, Korea
| | - Beom Joon Kim
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, 06974, Korea
| | - Ju Hee Kim
- R&D Research team, Inventage Lab Inc, Jungwon-gu, Seongnam, 13438, Gyeonggi, Korea.
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17
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Cong LY, Kong XX, Luo CE, Luo SK. Three-Dimensional Computed Tomography of the Detoured Facial Artery: Variations and Implications for Nasojugal Groove Correction. Dermatol Surg 2021; 47:785-790. [PMID: 33941736 DOI: 10.1097/dss.0000000000003000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND When performing filler injection procedures to the nasojugal groove, there is the risk of iatrogenic damage to the detoured facial artery. OBJECTIVE To determine the 3-dimensional location of the detoured facial artery. MATERIALS AND METHODS The branches of the facial arteries from 118 cadaveric hemifaces were scanned using computed tomography and reconstructed using the Mimics software program. RESULTS Detoured facial arteries were found in 47 of the 118 hemifaces (39.8%). Two main arterial patterns were identified: in Type I (29 of 47 cases), there were both detoured and nasolabial trunks where the facial artery originated, whereas in Type II (18 of 47 cases), there was only a detoured trunk. The detoured trunk originated 32.0 ± 5.3 mm from the midsagittal line, 5.0 ± 2.8 mm from the occlusion plane, and 5.9 ± 3.5 mm below the skin layer; the inflection of the detoured trunk was located 30.0 ± 5.6 mm laterally, 26.2 ± 4.4 mm superiorly, and 5.7 ± 2.6 mm deep. The meeting point with the inferior orbital rim plane was located 17.1 ± 3.4 mm laterally, 43.4 ± 3.1 mm superiorly, and 2.8 ± 1.7 mm deep. CONCLUSION The 3-dimensional location of the detoured facial artery as reported here will help clinicians to avoid iatrogenic damage when they are performing filler injection procedures.
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Affiliation(s)
- Li-Yao Cong
- All authors are affiliated with the Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
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18
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de Maio M, Chatrath V, Hart S, Hoo AJS, Marchac A, Sykianakis D, Lee ILI. Multi-Dimensional Aesthetic Scan Assessment (MD ASA™): Initial experience with a novel consultation, facial assessment, and treatment planning tool. J Cosmet Dermatol 2021; 20:2069-2082. [PMID: 33977669 DOI: 10.1111/jocd.14216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Comprehensive patient assessment and planning are central to esthetic treatment with injectables. MD ASA™ (Multi-Dimensional Aesthetic Scan Assessment) is a novel tool developed for this purpose. AIMS To describe the MD ASA technique and present its preliminary application. METHODS MD ASA breaks down the face into five hierarchies (H1-H5). H1 shifts patients' focus from "distractions" (individual lines and folds) toward the overall messages their face portrays, based on eight Emotional Attributes: four negative (tired, sad, angry, and saggy); four positive (youthful, attractive, contoured, and feminine/masculine). Three priority Emotional Attributes are selected for each patient. This is followed by a process of narrowing down through facial thirds (H2), periorbital and perioral dynamics (H3), facial units (H4), and subunits (H5), to arrive at a final assessment. Based on the key facial signs identified, this can be translated into MD Codes equations and thus a treatment formula. A retrospective analysis was performed based on 12 female patients injected by expert clinicians at an educational event. All patients were selected for, and treated using, a single MD Codes formula derived from a common MD ASA work-up. RESULTS There were substantial differences between patients and clinicians in their views of which anatomical areas needed treatment-but good alignment on priority Emotional Attributes. Patients were treated only for three negative Emotional Attributes, but improvements were observed across all eight attributes. CONCLUSIONS MD ASA provides a practical method for translating facial messages into actionable injectable treatment plans and facilitates greater patient-clinician alignment. Prospective studies are warranted.
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Affiliation(s)
| | | | | | | | | | | | - Izzy Lung I Lee
- Shang-Ho Aesthetic Medical Clinic, Kaohsiung City, Taiwan ROC
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19
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Dall'Magro AK, Dogenski LC, Dall'Magro E, Figur NS, Trentin MS, De Carli JP. Orthognathic surgery and orthodontics associated with orofacial harmonization: Case report. Int J Surg Case Rep 2021; 83:106013. [PMID: 34058459 PMCID: PMC8178104 DOI: 10.1016/j.ijscr.2021.106013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction and importance Orthognathic surgery aims to restore the functional and esthetic standards of the face and non-surgical or minimally invasive procedures have been optimizing the results of facial orthosurgical treatments. This case report aimed to show the use of minimally invasive techniques that, associated with orthognathic surgery, represent a trend in current oral and maxillofacial rehabilitation. Case presentation A female patient, 28 years old, white, sought care from the Dentistry team of the São Vicente de Paulo Hospital, in Passo Fundo, Brazil, complaining of mandibular prognathism, anteroposterior maxillary deficiency, dental crowding, malocclusion, functional and esthetic changes that negatively affected her psychosocial interactions and stomatognathic function. The treatment involved orthodontics, orthognathic surgery, and orofacial harmonization with dermal fillers. Clinical discussion The multidisciplinarity among the specialties of Oral and Maxillofacial Surgery and Traumatology, Orthodontics, and Orofacial Harmonization add and contribute to the process of planning and implementing the treatment proposed, as well as the prognosis toward patient satisfaction. Conclusion The surgical procedure associated with minimally invasive facial harmonization not only corrected the functional complaint of the patient but also played an important role in improving facial harmony, contributing significantly to self-esteem. Minimally invasive facial harmonization refines orthognathic surgery techniques. The integration of several disciplines helps to improve facial harmony. Injectable fillers represent important allies in orthosurgical treatments.
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Affiliation(s)
| | - Letícia Copatti Dogenski
- Post-graduation Program in Oral Diagnosis, Faculty of Dentistry, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Eduardo Dall'Magro
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade de Passo Fundo, Passo Fundo, Brazil
| | | | | | - João Paulo De Carli
- Departament of Oral Medicine and Prosthodontics, Faculty of Dentistry, Universidade de Passo Fundo, Passo Fundo, Brazil.
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20
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Hormazabal-Peralta A, Lee KW, Lee HJ, Choi YJ, Hu KS, Kim HJ. Clinical anatomy considerations on the muscular and vascular components of the midface by ultrasonographic imaging. Clin Anat 2021; 34:1142-1149. [PMID: 33982323 DOI: 10.1002/ca.23754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/07/2021] [Accepted: 05/01/2021] [Indexed: 11/07/2022]
Abstract
The first signs of face aging appear in the midface, so procedures such as botulinum toxin and filler injections are performed there. However, no guidelines based on clinical anatomy describing the muscular and vascular components in vivo have been published. The aim of this research was to describe the depths of the midface muscles and the locations of vessels using ultrasonographic (US) imaging. US was applied at 12 landmarks on the midface in 88 volunteers (49 males and 39 females; 19-36 years) to detect sex differences in the depths of muscles and the locations of the vessels. The depths of the orbicularis oculi (OOc), levator labii superioris alaeque nasi (LLSAN), and zygomaticus minor (Zmi) differed significantly with sex at P7 (p = 0.001) and P8 (p = 0.017), P1 (p = 0.028), and P4 (p = 0.035), respectively. The facial artery, facial vein, angular artery, angular vein, and perforator vessels were found at P9, P2 and P10, P1, P1 and P5, and P8, P11 and P12, respectively. The findings indicate that the depths of the OOc, LLSAN, and Zmi muscles differ between the sexes and that the vessels appear at specific landmarks. This information could help in developing anatomical guidelines for several procedures.
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Affiliation(s)
- Alonso Hormazabal-Peralta
- Division in 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 in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Hyung-Jin Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - You-Jin Choi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kyung-Seok Hu
- Division in 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 in 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, South Korea
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21
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de Maio M. MD Codes™: A Methodological Approach to Facial Aesthetic Treatment with Injectable Hyaluronic Acid Fillers. Aesthetic Plast Surg 2021; 45:690-709. [PMID: 32445044 PMCID: PMC8012343 DOI: 10.1007/s00266-020-01762-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/30/2020] [Indexed: 01/02/2023]
Abstract
Background Patients often seek aesthetic correction of facial deficiencies (e.g., lines and folds) that are rarely the underlying cause of dissatisfaction with their appearance. Use of a more holistic approach focused on improving the emotional messages of the face (e.g., looking less sad) may improve patient satisfaction with treatment outcomes. The MD Codes™ system was developed to increase clinician success rates by reducing variability in the technical aspects of hyaluronic acid (HA) filler treatment and focusing on addressing unfavorable emotional attributes of the face. Methods The MD Codes, or medical codes, represent specific anatomical subunits for injection of HA fillers. Each MD Code includes information regarding the target depth of injection, the proper delivery tool (needle or cannula) and delivery technique (e.g., aliquot, bolus, fanning), and the minimum product volume recommended to achieve visible, reproducible results (active number). During treatment planning, the appropriate MD Codes are selected using algorithms focused on lessening unfavorable facial attributes (a saggy, tired, sad, or angry look) and enhancing positive attributes (an attractive, younger, more contoured, or feminine [soft] or masculine look). Results Three case studies are presented to illustrate how the MD Codes and their algorithms were used to address sagginess, tiredness, and sadness in two women and one man. Conclusions MD Codes provide a universal symbolic language for reducing variability in injection technique. The platform provides user-friendly algorithms to help clinicians increase patient satisfaction by going beyond treatment of lines and folds and to focus on reducing unfavorable facial attributes. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Electronic supplementary material The online version of this article (10.1007/s00266-020-01762-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maurício de Maio
- MD Codes Institute, Rua Santa Justina, 660 - cjs 121 e 124, Via Olímpia, Sao Paulo, SP, Brazil.
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22
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Histological and Quantitative Appraisal of the Intradermal and Subcutaneous Distribution of the Hyaluronic Acid Injected into the Nasolabial Fold. Aesthetic Plast Surg 2021; 45:710-717. [PMID: 32198637 DOI: 10.1007/s00266-020-01681-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Histological analysis of hyaluronic acid (HA) applied in the nasolabial fold (NLF) studied gel distribution into the dermis and subcutaneous fat, correlating density of NLF tissues, with cohesivity, concentration and degradation of HA. METHOD Ten patients received two injection points on each NLF. They were intradermal near the nasal ala and subcutaneous near the oral commissure. Injection points received 0.1 ml of 24 mg/ml HA cross-linked by BDDE 2.0 ppm through a bolus technique injection without retrograde backflow. Biopsies were taken 72 h and 9 months after application to histological analysis. RESULTS Dermis density fragmented the gel into small nodules, spreading it into the reticular dermis. Seventy-two hours after application, average diameter of the small nodules was 0.30 mm and at month nine 0.05 mm. Softness of the subcutaneous fat and high concentration of HA created a single and compact nodule. Seventy-two hours after application, average of nodule diameters was 1.05 mm and at month nine 0.49 mm. HA biodegradation occurred on the external surface of the gel. The single nodule offered small contact surface to enzymes, slowing gel degradation. The sum average of the diameters of the small nodules offered a large contact surface to enzymes, accelerating gel degradation. CONCLUSION Permanence of the HA into the tissues depended on the relationship between the gel distribution and its degradation. Due to the small contact surface of the single nodule to enzymes, permanence of the HA into the subcutaneous fat was more extended than into the dermis. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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23
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Auada Souto MP, Souto LRM. An unusual adverse event of botulinum toxin injection in the lower face. J Cosmet Dermatol 2020; 20:1381-1384. [PMID: 33249739 DOI: 10.1111/jocd.13869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/12/2020] [Accepted: 11/12/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND In the lower third of the face, botulinum toxin A is used to obtain a more harmonious contour. The anatomical complexity of the face requires a more precise application of botulinum toxin. AIM Describe the treatment of an unexpected effect after botulinum toxin A application in the lower third of the face. PATIENT/METHODS A 51-year-old female patient presented to our clinic for application of botulin toxin aiming to improve facial wrinkles and contour. 50 U of botulinum toxin type A were applied to the upper third and 20 U to the lower third of the face. The patient returned after 10 days with a smile asymmetry and an excessive and unconscious lowering on the right side of the lower lip while laughing. So, 3 U of botulinum toxin were applied to the center of the depressor labii inferioris muscle on the right side. RESULTS The patient returned with a satisfactory correction of the smile asymmetry. CONCLUSION Although treatments with botulinum toxin A are considered safe, unexpected results can occur. In our case, it probably occurred due to medial injection or diffusion of botulinum toxin A into depressor anguli oris muscle on the left side that may lead to paralysis of the left depressor labii inferioris muscle and downward hyperfunction of the unaffected right lower lip. The correction was made with a new injection of botulinum toxin A in the depressor labii inferioris hyperactive muscle at the right side.
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Farollch Prats L, Mirada Donisa E, Villanueva C. "WAY": A practical means to identify and treat the aging process. J Cosmet Dermatol 2020; 20:1837-1845. [PMID: 33047492 PMCID: PMC8246969 DOI: 10.1111/jocd.13782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 01/22/2023]
Abstract
Background Many patients consult a specialist in esthetics to improve certain aspects of their face that are altered by aging. To ensure optimal results and to define the best approach for such interventions, it is important that specialists have a comprehensive understanding of facial anatomy and of the aging process in the regions of interest. Aims The main purpose of this article was to provide a practical approach for managing aging process in the mid‐ and lower face. Additionally, this paper also aimed to describe the processes associated with aging that may affect the morphology and the appearance of jaw contour (“W”); prejowl (“A”); tear trough, palpebromalar area, and nasojugal groove (“Y”) (“WAY”) signs. Methods The Current paper combined the authors experience with the currently available scientific evidence. Results In this study, the anatomy and the changes associated with aging of the mandibular line and that of the tear trough, palpebromalar area, and nasojugal groove was described. The important anatomical changes in these facial regions can be considered through the “WAY” paradigm, signs of aging that can be treated through a variety of surgical and nonsurgical approaches. Although surgical procedures may obtain good results, patients generally prefer less invasive treatments, which have a good efficacy profile, but are safer and have a shorter recovery time. Conclusions The “WAY” signs identify anatomical changes in the mandibular line and tear trough, palpebromalar area, and nasojugal groove associated with aging that can be corrected by different procedures, preferably minimally invasive ones.
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Braz A, Eduardo CCDP. The Facial Shapes in Planning the Treatment with Injectable Fillers. Indian J Plast Surg 2020; 53:230-243. [PMID: 32884189 PMCID: PMC7458834 DOI: 10.1055/s-0040-1715554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Introduction The facial beauty is not easy to define, yet it is paramount to assess the needs of each patient to propose an appropriate treatment plan that will provide beautification or rejuvenation in a natural-looking fashion. One of the beauty aspects easily recognized is the face shape, which can give a perception of age, gender, and attractiveness, and reflects the facial anatomical structure. Because addressing the structure of the face is the basis for the aesthetic approach with dermal fillers, we find the identification of the patient's face shape to be a very good starting point in the facial assessment. Objective To discuss important aspects of facial beauty, the characteristics of the different facial shapes (oval, heart, round, and angular), and a method of planning the aesthetic treatment with injectable fillers based on the strengths and weaknesses of each morphology of the face, that is called the AB face technique. Methods In this study, we describe seven clinical cases: two cases each of oval, heart, and round, and one case of angular shape. Results The evaluation of the face shape can help us define the priorities of the aesthetic approach, determining the areas that need to be restored in the aging face, as well as which areas could be enhanced in the younger patient. Conclusion This approach can be helpful in proposing the aesthetic treatment plan with injectable fillers to provide beautification, rejuvenation, and enhancement of the facial structure, which may benefit facial contours through aging.
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Affiliation(s)
- André Braz
- Dermatologia Laser Cosmiatria Clinic, Rio de Janeiro, RJ, Brazil
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