Aging Process of Lateral Facial Fat Compartments: A Retrospective Study

[The submalar hiatus]

The submalar hiatus is a furrow located below the lower orbital arch; it is oblique downwards and outwards; it divides the cheek in two in some patients; it has been well individualized by artists since Antiquity, notably sculptors; some anatomists have called it the midjugal groove; its anatomical structure is very precise, however its origin is debated; some authors attribute to it the melting of the fat located between the external malar fat compartment and the fatty rim parallel to the nasolabial fold; other authors including myself rather invoke localized fat loss associated with a rotation of the nasolabial fat pad downwards and inwards. In fact, there is a center of rotation at the level of each nostril which has a fixed vascular hilum at depth. The submalar hiatus does not in itself constitute a marked ugliness but it can become a concern for certain patients, both women and men. The surgical correction of the submalar hiatus involves the repositioning of the fatty rim by a facelift, the technique of which can vary between a biplane skin+Smas facelift, with re-tensioning of the Smas upwards and outwards; another solution is the medio-facial lifting described by Le Louarn; finally, there is a non-operative solution thanks to aesthetic medicine using a specific injection technique that we describe.

Combining Deep Plane Face and Neck Lift with Periorbital Rejuvenation and Ancillary Surgical Procedures of the Face: A Critical Evaluation of Over 434 Consecutive Cases

BACKGROUND

Over time, all the face structures inevitably undergo the effects of chrono-aging with changes in their intrinsic characteristics, position and volume. Keeping in mind that all the possible aging defects may be concomitant, in the authors' vision, a careful preoperative evaluation of the patient's aging signs should take consideration of the face as a whole. This study reported the senior author's experience and complications on over 400 patients who consecutively underwent deep plane face and neck lifting combined with periorbital rejuvenation procedures.

MATERIALS AND METHODS

434 consecutive patients who underwent deep plane face and neck lifting combined with periorbital rejuvenation procedures were enrolled in this study. Administration of a subjective/patient-specific and objective surgeon/specific questionnaire allowed to investigate satisfaction level at 12 and 18 months after surgery. Statistical analysis was conducted with Prism9. Surgical drawings, techniques and complications were described.

RESULTS

Data deriving from patients' and surgeons' questionnaires evidenced a high level of satisfaction with the combined surgery. The patients' satisfaction tended to increase, even if with a no statistically significant manner, from 12 to 18 months.

DISCUSSION

Authors outlined the importance of focus the attention also on the correction of the cranial part of the middle third soft tissues aging signs, often "neglected" during facelift, and on the periorbital area.

CONCLUSION

A satisfactory total and harmonious rejuvenation of the face and neck should include a combo surgery combining periorbital rejuvenation procedures with a more "traditional" extended deep plane face and neck lift depending on the aging signs.

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 .

Anatomy-Based Filler Injection: Treatment Techniques for Supraorbital Hollowness and Charming Roll

Supraorbital hollowness and pretarsal fullness, commonly known as the sunken eyelid and charming roll, respectively, are significant anatomical features that impact the aesthetic appearance of the periorbital region. Supraorbital hollowness is characterized by a recessed appearance of the upper eyelid, often attributed to genetic factors, aging, or surgical alterations, such as excessive fat removal during blepharoplasty. This condition is particularly prevalent among East Asians due to anatomical differences, such as weaker levator muscles and unique fat distribution patterns. Pretarsal fullness, also known as aegyo-sal, enhances the youthful and expressive appearance of the lower eyelid, forming a roll above the lash line that is considered aesthetically desirable in East Asian culture. Anatomical-based filler injection techniques are critical for correcting these features, involving precise placement within the correct tissue planes to avoid complications and achieve natural-looking results. This approach not only improves the aesthetic appeal of the eyelid but also enhances the overall facial harmony, emphasizing the importance of tailored procedures based on individual anatomy and cultural preferences.

Tracking Fat Grafts by Magnetic Resonance Imaging: A Comparative Study of Adolescent and Adult Patients with Stable Localized Scleroderma

BACKGROUND

The optimal timing of reconstruction for patients with facial localized scleroderma is uncertain. The purpose of this study was to compare the outcomes of autologous fat transplantation in adolescent and adult patients with stable localized scleroderma.

METHODS

Adolescent (age 10 to 19 years) and adult (age >19 years) patients with no previous surgery were enrolled ( n = 10, each group). Preoperative magnetic resonance imaging, blood tests, and dermatological assessments were used to assess disease activity. All patients underwent autologous fat transplantation for anatomic facial fat restoration with preoperative magnetic resonance imaging planning. Preoperative, immediate, and 1-year postoperative 3-dimensional Dixon magnetic resonance imaging scans, with image registration and fusion techniques, were used to track fat grafts. Patient satisfaction was assessed with a 5-point Likert scale.

RESULTS

There was no significant difference in sex, body mass index, disease severity, or volume of injected fat between the 2 groups ( P > 0.05), except for age ( P < 0.05). The 1-year postoperative fat graft retention rate was not significantly different, with 36.6% ± 2.4% (range, 25.3% to 49.3%) in the adolescent group and 32.9% ± 1.7% (range, 27.3% to 40.1%) in the adult group ( P > 0.05). Surgical outcomes were favorable in all patients, with satisfaction scores of 3.8 ± 0.2 points in the adolescent group and 3.6 ± 0.2 points in the adult group ( P > 0.05).

CONCLUSION

In patients with stable localized scleroderma, the initial autologous fat transplantation was equally effective in improving facial contour deformity, with no significant difference in fat graft retention or patient satisfaction.

Evaluation and Treatment Planning for the Aging Face Patient

Facial aging is a multifactorial process that occurs due to alterations in the skin, soft tissue, and bony skeleton. When considering treatments for the aging face and neck, a multifaceted approach targeting each of these areas should be considered. Although surgical intervention remains a key component to the holistic care of the aging face patient, a multitude of minimally invasive techniques is now available to optimize the care of the patient seeking rejuvenation. Proper patient evaluation and counseling on realistic expectations are critical and will be discussed here. A brief overview of common minimally invasive treatments will be presented.

Effectiveness of bandage in the incidence of major complications on bichectomy: literature review and case series of 643 bichectomies

Buccal fat pad removal or bichectomy is an esthetic surgical procedure that is gaining notoriety and increasing number worldwide. This paper aims to discuss the effectiveness of bandage in bichectomy postoperative concerning major complications like bleeding and subcutaneous emphysema. This is a retrospective case series according to PROCESS guidelines of 643 bichectomy surgeries performed by two different surgeons with the same technique from January 2018 until December 2020. Effectiveness of bandage is evaluated in complications rate decrease with statistical tests (p < 0.05). A literature review was performed to sediment knowledge about this theme. Female patients search for buccal fat pad removal more for esthetic reasons and male patients for functional purposes. Bichectomy has a low incidence of major complications, and this incidence decreases more with a bandage use (95%CI). Bandages are effective in the decrease of major complications related to bichectomy.

Unified Anatomical Explanation of Diagonal Earlobe Creases, Preauricular Creases, and Paired Creases of the Helix

Three types of ear creases have been described in the medical literature in association with several cardiovascular and metabolic disorders: diagonal earlobe creases (DELCs) (Frank’s sign), preauricular vertical creases, and paired ear creases of the helix (PECH). The exact mechanism of development of such creases, as well as an explanation of their association with cardiometabolic disorders, remains unclear. Herein, the author provides a suggested unified mechanism of development of all three types of auricular creases. In addition, an anatomical explanation linking the associated cardiometabolic disorders and the three types of ear creases to the common culprit of facial visceral adiposity will be given.

Bitemporal Obesity: An Overlooked Sign of Visceral Obesity?

With increasing rates of morbidity and mortality associated with visceral obesity, as well as its related cardiometabolic disorders, physical findings that aid in diagnosing patients at risk for such conditions are extremely useful. This brief report introduces the novel facial physical sign of bitemporal obesity, which the author observed in a patient and suggests to be associated with visceral obesity.