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Schelke L, Lowrey N, Mojallal A, Rowland-Warmann MJ, Wortsman X, Sigrist RM, Velthuis PJ, Cotofana S. Post-Treatment Displacement of Facial Soft Tissue Fillers-A Retrospective Ultrasound-based Investigation of 382 Zygomatic Regions. Dermatol Surg 2024:00042728-990000000-00828. [PMID: 38833408 DOI: 10.1097/dss.0000000000004257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND Clinical and ultrasound experience has revealed that after soft tissue injections of the lateral cheek, the filler may displace from the zygoma to the caudal temporal area. OBJECTIVE To obtain more data to provide insight into product distribution when soft tissue fillers are injected in the zygomatic region. METHODS Two hundred patients were examined with facial ultrasound imaging of the zygomatic and temporal region. Inclusion criteria were simply a positive response on the screening questionnaire as to whether or not they had filler injections placed in their lateral cheek. Control injections were also performed to the zygomatic regions of a body donor and in 10 patients ultrasound-guided. RESULTS A correlation was found between the layers in which filler was detected on the zygoma and where it was ultimately found in the temples. Four different redistribution patterns were observed: (1) migration of filler within the superficial muscular aponeurotic system (SMAS) on the zygoma into the superficial temporal fascia. Migration of filler from the lateral suborbicularis oculi fat to (2) the deep interfacial plane of the temple or (3) to the superficial temporal fat pad; (4) migration from the supraperiosteal layer of the zygoma to the superficial temporal fat pad. Body donor and patients: filler deposits injected on the zygoma were witnessed to shift during injection into the caudal part of the temple. CONCLUSION Soft tissue filler aliquots may be redistributed into the temples after injections of the lateral side of the zygomatic arch. The displacement follows a distinct pattern depending on the initial layer of injection.
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Affiliation(s)
- Leonie Schelke
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicola Lowrey
- Department of Plastic, Reconstructive, and Aesthetic Surgery, N2 Aesthetics, Manhattan Beach, CA
| | - Ali Mojallal
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospices Civils de Lyon, Lyon, France
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Université Claude Bernard, Lyon, France
| | - M J Rowland-Warmann
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Smileworks Liverpool, Liverpool, UK
| | - Ximena Wortsman
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Institute for Diagnostic Imaging of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Universidad de Chile, Santiago, Chile
| | - Rosa M Sigrist
- Department of Radiology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Peter J Velthuis
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sebastian Cotofana
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong Province, China
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Moellhoff N, Kuhlmann C, Frank K, Kim BS, Conte F, Cotofana S, Piccolo NS, Pallua N. Arterial Embolism After Facial Fat Grafting: A Systematic Literature Review. Aesthetic Plast Surg 2023; 47:2771-2787. [PMID: 37563433 PMCID: PMC10784353 DOI: 10.1007/s00266-023-03511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/30/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND While autologous fat grafting of the face is considered a generally safe procedure, severe complications such as arterial embolism (AE) have been reported. OBJECTIVE To summarize data on injection-related visual compromise, stroke, and death caused by arterial embolism after facial fat transplantation. MATERIALS AND METHODS Plastic surgery societies were contacted for reports on AE after autologous facial fat injection. In addition, a systematic literature review was performed. Data extracted included study design, injection site/technique, symptoms, management, outcome, and etiology. RESULTS 61 patients with a mean age of 33.56 ± 11.45 years were reported. Injections targeted the glabella or multiple facial regions (both n = 16/61, 26.2%) most commonly, followed by injections in the temples (n = 10/61, 16.4%) and the forehead (n = 9/61, 14.8%). The mean volume injected was 21.5 ± 21.5 ml. Visual symptoms were described most frequently (n = 24/58, 41.4%) followed by neurological symptoms (n = 20/58, 34.5%), or both (n = 13/58, 22.4%). Ophthalmic artery (OA, n = 26/60, 43.3%), anterior or middle cerebral artery (CA, n = 11/60, 18.3%) or both (n = 14/60, 23.3%) were most frequently occluded. Outcome analysis revealed permanent vision loss in all patients with OA occlusion (n = 26/26, 100%), neurological impairment in most patients with CA occlusion (n = 8/10, 80%), and vision loss in most patients suffering from both OA and CA occlusion (n = 7/11, 63.6%). Six patients died following embolisms. CONCLUSIONS AE causes severe complications such as blindness, stroke, and death. Due to a lack of high-quality data, no evidence-based treatment algorithms exist. To increase patient safety, a database collecting cases and complications should be established. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany.
| | - Constanze Kuhlmann
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zürich, Switzerland
| | - Francesco Conte
- Medical Faculty Rhenish, Westphalian Technical University, Aachen, Germany
- Pallua-Clinic Duesseldorf, Duesseldorf, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nelson S Piccolo
- Division of Plastic Surgery, Pronto Socorro para Queimaduras, Goiânia, Brazil
- International Society of Plastic Regenerative Surgeons, Arlington Heights, IL, USA
| | - Norbert Pallua
- Medical Faculty Rhenish, Westphalian Technical University, Aachen, Germany
- Pallua-Clinic Duesseldorf, Duesseldorf, Germany
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Zhang L, Zhao Y, Gu Q, Feng X, Li J, Lai F, Pan L, Sun Y, Wu S. A roadmap for safety during facial filler injections: A fresh frozen cadaver study. J Plast Reconstr Aesthet Surg 2023; 86:155-164. [PMID: 37717300 DOI: 10.1016/j.bjps.2023.06.029] [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: 12/20/2022] [Accepted: 06/05/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Filler injections are commonly applied to reshape facial contouring. However, cadaveric injections of filler for facial contouring on the whole face, followed by anatomic analysis and measurement, have rarely been reported. This study aimed to provide comprehensive anatomical information, including topographies and roadmap of injection point entry, penetration depth, filler location, the hierarchy of facial structure, and vital vascular course. METHODS Thirty faces on fresh frozen cadaver heads were used for this anatomic study. The whole face was divided into seven facial zones and 14 injection points for penetration depth measurement and cadaveric injection. Static periosteum injections with a sharp-needle technique were performed. Specimens were then dissected to observe the precise locations of fillers and their relationships with surrounding anatomic structures. RESULTS The topography of penetration depth gradually increased from the upper face to the middle face, lower face, and temporal region. Most of the injected hyaluronic acid filler flowed backward to the loose areolar tissue layer between the superficial musculoaponeurotic system and periosteum or deep fascia. Multilevel layer distributions and anastomosis of the vessels were found in the face, especially in the glabella, dorsum nasi, and temporal regions. CONCLUSIONS This study can provide clinicians with a comprehensive reference for facial contouring injections: topographies of the injection point and penetration depth and the vascular anatomical structure in high-risk facial zones. The static periosteum injection with effective aspiration is recommended as a relatively safe technique. Clinicians are supposed to grasp the anatomy and injection technique to achieve maximum safety during filler injections.
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Affiliation(s)
- Lei Zhang
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Ye Zhao
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Qinghao Gu
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Xiao Feng
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Jingyu Li
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Fangyuan Lai
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Lei Pan
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Yi Sun
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Sufan Wu
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China.
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Chen Q, Li P, Zhao Q, Tu T, Lu H, Zhang W. Occurrence and treatment of peripheral nerve injuries after cosmetic surgeries. Front Neurol 2023; 14:1258759. [PMID: 38020669 PMCID: PMC10659089 DOI: 10.3389/fneur.2023.1258759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Although non-invasive and minimally invasive aesthetic procedures increasingly dominate the cosmetic market, traditional plastic surgery remains the most effective improvement method. One of the most common complications in plastic surgery, peripheral nerve injuries, though has a low incidence but intrigued plastic surgeons globally. In this article, a narrative review was conducted using several databases (PubMed, EMBASE, Scopus, and Web of Science) to identify peripheral nerve injuries following cosmetic surgeries such as blepharoplasty, rhinoplasty, rhytidectomy, breast surgeries, and abdominoplasty. Surgery-related nerve injuries were discussed, respectively. Despite the low incidence, cosmetic plastic surgeries can cause iatrogenic peripheral nerve injuries that require special attention. The postoperative algorithm approaches can be effective, but the waiting and treatment processes can be long and painful. Preventive measures are undoubtedly more effective than postoperative remedies. The best means of preventing disease is having a good understanding of anatomy and conducting a careful dissection.
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Affiliation(s)
- Qiang Chen
- Department of Hand & Reconstructive Surgery, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Pengfei Li
- Department of Plastic and Aesthetic Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - QingFang Zhao
- Department of Plastic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Tian Tu
- Department of Plastic and Aesthetic Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hui Lu
- Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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5
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Zhou YH, Chen CL, Luo CE, Wang HB, Luo SK. Deep Temporal Artery Anatomy: Implications for Improving the Safety of Deep Temporal Injections. Aesthetic Plast Surg 2023; 47:2045-2050. [PMID: 37076704 DOI: 10.1007/s00266-023-03341-y] [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: 12/26/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Knowledge of the anatomy of the deep temporal artery (DTA) is critical to ensure safe filling of the deep temporal region. However, current treatment guidelines still focus on how to avoid the superficial temporal artery and the middle temporal vein, and an understanding of the safety of avoiding DTA injury is lacking. OBJECTIVE The purpose of this study was to determine the positioning and course of the DTA to help clinicians safely perform the injection and filling in the temporal region. METHODS Computed tomography (CT) scans and dissections of the skulls of 34 fresh frozen cadavers perfused with lead oxide were performed. Reconstruction and trajectory analysis of all DTA branches were performed using Mimics and MATLAB software. RESULTS In this study, the DTA was identified in all samples, which originated from the maxillary artery of the external carotid artery system. According to image reconstruction and anatomical observations, the distribution of the anterior and posterior branches of the DTA had two different distribution patterns. The anatomical level of the DTA is located between the temporal muscle and the periosteal layer. Compared with observations in previous studies, the anterior branch of the DTA is slightly different, and we found that its course is closer to the frontal area in Asian specimens. CONCLUSION The anatomical information on the DTA described in this study may help improve awareness of the safety of temporal injection by aesthetic physicians. 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 Table of Contents or online Instructions to Authors www.springer.com/00266. .
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Affiliation(s)
- Yu-Hao Zhou
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China
| | - Chun-Lin Chen
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China
| | - Cheng-En Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China
| | - Hai-Bin Wang
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China.
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6
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Fabi SG, Hernandez C, Montes JR, Cotofana S, Dayan S. Aesthetic considerations when treating the Latin American patient: Thriving in diversity international roundtable series. J Cosmet Dermatol 2023; 22:593-602. [PMID: 36468194 DOI: 10.1111/jocd.15516] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/10/2022] [Accepted: 11/03/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND The Hispanic/Latin American population is the fastest growing non-Caucasian group in the United States. Within this group, demand for aesthetic procedures is on the rise. High ethnic variability among these patients influences treatment approaches and patient priorities. Understanding these ethnic differences is central to providing optimal care. AIMS To discuss similarities and differences in anatomy and treatment preferences of Hispanic/Latin American patients both within the United States and internationally and explore how these differences may influence or inform aesthetic practices. PATIENTS/METHODS In support of clinicians who wish to serve a diverse patient population, a 6-part, international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021 to May 16, 2022. In this roundtable, held in Medellin, Columbia, expert clinicians from across Latin America and the United States were invited to contribute and share best practices. RESULTS The results of the second roundtable in the series, the Latin American Patient, are described here. A special emphasis is placed on procedures that address the most commonly encountered concerns in these patients. CONCLUSIONS Hispanic and Latino patients represent a broad demographic with unique anatomical features, aesthetic preferences, and treatment priorities. Clinicians should consider these differences when treating this patient population.
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Affiliation(s)
| | | | - José Raúl Montes
- Ophthalmology Department, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.,Jose Raul Montes Eyes & Facial Rejuvenation, San Juan, Puerto Rico
| | | | - Steve Dayan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois at Chicago, Chicago, Illinois, USA
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7
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Cotofana S, Lowrey N, Frank K, Ziebart R, Guertler A, Freytag L, Helm S, Alfertshofer MG, Moellhoff N. Vascular Safe Zones for Facial Soft Tissue Filler Injections. PLASTIC AND AESTHETIC NURSING 2022; 42:238-245. [PMID: 36469395 DOI: 10.1097/psn.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The number of soft tissue filler injections performed by aesthetic injectors has continued to increase over the last few years. To provide a high standard of safety and achieve individualized, reproducible, and long-lasting outcomes, aesthetic injectors must have a solid foundation in anatomy, facial biomechanics, rheology, and injection biomechanics. Adverse events associated with soft tissue filler injections can be severe, especially if the aesthetic injector unintentionally injects the soft tissue filler into the patient's arterial vascular circulation and the administered product reaches the arterial bloodstream. Although the face has a rich arterial vascular supply that may seem overwhelmingly complex, it can be broken down systematically according to its internal and external vascular territories. To provide guidance for aesthetic practitioners performing minimally invasive facial injections for aesthetic purposes, this narrative article will discuss the course, depth, and branching pattern of the facial arteries based on the most frequently injected anatomical regions. In this article, we focus on vascular safe zones rather than danger zones .
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Affiliation(s)
- Sebastian Cotofana
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicola Lowrey
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Konstantin Frank
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Rachel Ziebart
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Anne Guertler
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Lysander Freytag
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Sabrina Helm
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael G Alfertshofer
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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Abstract
BACKGROUND Reoperative face lift can be technically more demanding than primary face lift because of altered anatomy and scarred tissue plane. This study was carried out to analyze the outcome of reoperative face lift using sub-superficial musculoaponeurotic system (SMAS) techniques, including facial nerve injury. METHODS Seventy reoperative face lifts using sub-SMAS techniques were studied. Data analysis includes the patients' demographic information, the interval between the previous face lift and the reoperative face lift, intraoperative findings of the SMAS-platysma anatomy, complications, and rate of revision. A separate group of 180 primary face lifts using sub-SMAS techniques during the same period was analyzed for the incidence of facial nerve injury only. RESULTS Intraoperative findings in the reoperative group consist of anatomical changes in the SMAS-platysma in 82.9 percent of the cases, including increased fibrosis, changes in thickness, limited movement, and increased adhesion on the undersurface. Sub-SMAS dissection was completed in 137 hemifaces. Complication consists of seroma (1.4 percent), delayed healing (1.4 percent), and temporary facial nerve injury (7.1 percent), which was not correlated with increased fibrosis or adhesion under the SMAS-platysma. The rate of revision within 18 months was 11.4 percent. There was a 2.2 percent incidence of temporary facial nerve injury in the primary face-lift group. CONCLUSIONS Sub-SMAS techniques, with few exceptions, were successfully used in a series of reoperative face lifts. Temporary facial nerve injury was the most frequent complication. Satisfactory outcome was obtained in all the cases. The incidence of facial nerve injury was higher than in primary face lift using sub-SMAS techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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9
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The Fascias of the Forehead and Temple Aligned—An Anatomic Narrative Review. Facial Plast Surg Clin North Am 2022; 30:215-224. [DOI: 10.1016/j.fsc.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Cotofana S, Lowrey N, Frank K, Ziebart R, Guertler A, Freytag L, Helm S, Alfertshofer MG, Moellhoff N. Vascular Safe Zones for Facial Soft Tissue Filler Injections. PLASTIC AND AESTHETIC NURSING 2022; 42:80-87. [PMID: 36450087 DOI: 10.1097/psn.0000000000000430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The number of soft tissue filler injections performed by aesthetic injectors has continued to increase over the last few years. To provide a high standard of safety and achieve individualized, reproducible, and long-lasting outcomes, aesthetic injectors must have a solid foundation in anatomy, facial biomechanics, rheology, and injection biomechanics. Adverse events associated with soft tissue filler injections can be severe, especially if the aesthetic injector unintentionally injects the soft tissue filler into the patient's arterial vascular circulation and the administered product reaches the arterial bloodstream. Although the face has a rich arterial vascular supply that may seem overwhelmingly complex, it can be broken down systematically according to its internal and external vascular territories. To provide guidance for aesthetic practitioners performing minimally invasive facial injections for aesthetic purposes, this narrative article will discuss the course, depth, and branching pattern of the facial arteries based on the most frequently injected anatomical regions. In this article, we focus on vascular safe zones rather than danger zones.
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Affiliation(s)
- Sebastian Cotofana
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicola Lowrey
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Konstantin Frank
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Rachel Ziebart
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Anne Guertler
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Lysander Freytag
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Sabrina Helm
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael G Alfertshofer
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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Cotofana S. Commentary on: A New Target for Temple Volumization? An Anatomical and Ultrasound-Guided Study of the Intermediate Temporal Fat Pad. Aesthet Surg J 2021; 41:1344-1345. [PMID: 33724338 DOI: 10.1093/asj/sjab022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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12
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Surek CC. A New Target for Temple Volumization? An Anatomical and Ultrasound-Guided Study of the Intermediate Temporal Fat Pad. Aesthet Surg J 2021; 41:1339-1343. [PMID: 33630064 DOI: 10.1093/asj/sjaa425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current techniques for temple volumization primarily focus on deep or superficial targets. Further anatomical exploration of intermediate injection targets is warranted. OBJECTIVES The purpose of this study was to examine the anatomy of the intermediate temporal fat pad (ITFP) as it relates to filler injection procedures and to explore the utilization of ultrasound technology for clinical localization. METHODS Ultrasound technology was utilized to identify and inject red dyed hyaluronic acid filler into the ITFP in 20 hemifacial fresh cadavers. Cross-sectional dissection was performed to confirm injection accuracy and document pertinent anatomical relationships. The same technique was performed in a single clinical patient case employing ultrasound guidance and injectable saline. RESULTS The ITFP is a quadrangular structure located in the anterior-inferior bony trough. The ITFP is supplied by a middle temporal artery branch and encased between the superficial and deep layers of deep temporal fascia. In 18 of 20 (90%) injections performed under ultrasound guidance, the injected product was accurately delivered to the substance of the ITFP, and in 2 of 20 (10%), the product was found immediately below the deep layer of deep temporal fascia within the temporalis muscle. In the single clinical case, saline was successfully injected in the ITFP under ultrasound guidance. CONCLUSIONS The ITFP is a consistent anatomical structure in the anterior-inferior trough of the temporal fossa. Ultrasound technology can be utilized to identify and inject the fat pad. Further clinical evaluation will determine the role of this fat pad as a potential intermediate injection target for temple volumization procedures.
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13
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Alghoul MS, Vaca EE, Bricker JT, Mioton LM. Enhancing the Lateral Orbital "C-Angle" With Calcium Hydroxylapatite: An Anatomic and Clinical Study. Aesthet Surg J 2021; 41:952-966. [PMID: 32719841 DOI: 10.1093/asj/sjaa218] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Deliberate injection of specific facial subunits may improve aesthetic outcomes in facial rejuvenation. We contend that the lateral orbital area (LOA) is a key anatomic subunit in the perception of eye attractiveness, with a C-shaped distribution of fat contributing to the formation of a distinct angle in the lateral orbit. OBJECTIVES The aim of this study was to describe the anatomy of the LOA that constitutes the C-shaped angle and to investigate the safety and cosmetic outcomes of nonsurgical enhancement of that area with calcium hydroxylapatite (CaHA). METHODS Four injected fresh-frozen cadaver heads were dissected. Twenty patients were enrolled in a prospective clinical study. Participants were seen on the day of injection, and at 2 weeks and 3 months postinjection. Two-dimensional and 3D photographs were analyzed to quantify the volumetric changes between pretreatment and postinjection time points. Secondary outcomes included Global Aesthetic Improvement Scale score and subject satisfaction at 3 months. RESULTS Cadaver dissections revealed distinct fat compartments and a zone of adhesion forming the C-shaped area around the lateral orbit. In the clinical study, a mean of 1.88 mL of CaHA was injected into each lateral periorbital region. There was 97% and 76% volume retention at 2 weeks and 3 months, respectively, with 70% of patients being "very satisfied" at 3 months. The average Global Aesthetic Improvement Scale rating at 3 months was 3.95. There were no complications. CONCLUSIONS The LOA is a distinct facial subunit that can be enhanced safely by CaHA injection with good cosmetic outcomes. Focusing on the C-angle can improve periorbital aesthetics. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Elbert E Vaca
- Northwestern Feinberg School of Medicine Plastic Surgery Program, Chicago, IL
| | | | - Lauren M Mioton
- Northwestern Feinberg School of Medicine Plastic Surgery Program, Chicago, IL
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14
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Yang CS, Huang YL, Chen CB, Deng CY, Liu YT, Huang PHP, Chang KC. Aging Process of Lateral Facial Fat Compartments: A Retrospective Study. Aesthet Surg J 2021; 41:NP247-NP254. [PMID: 33649752 DOI: 10.1093/asj/sjaa340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since 2007, when the anatomy of facial fat compartment was described, an increasing number of studies on the aging process of the compartment of cadavers has emerged. OBJECTIVES The authors evaluated the aging changes of lateral facial fat compartments on the same person. METHODS Sixty-three patients were included in this retrospective study. All patients had magnetic resonance imaging scans with at least 4 years apart. The authors targeted the fat compartments of the superficial temporal, subcutaneous temporal, and buccal fat pad, comparing the data on different time points. RESULTS The thickness of the subcutaneous temporal fat did not change significantly. The 3 diameters of the superficial temporal fat compartment all became thinner on the axial view (P < 0.05). On the sagittal view, the superficial temporal fat elongated from 38.89 mm to 43.74 mm (P < 0.05). The buccal fat compartment also lengthened from 68.73 mm to 74.39 mm (P < 0.05) and had a positive correlation with follow-up duration only. CONCLUSIONS The study revealed the fat compartment change on the same person with time. The temporal hollow mainly originates from the thinner part of the superficial temporal fat. The descending of the buccal fat pad aggravates the labiomandibular fold. By understanding the aging process more fully, we can rejuvenate our patients more naturally.
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Affiliation(s)
- Ching-Sheng Yang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yau-Li Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Ying Deng
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taiwan
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15
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Trussler AP. Commentary on: Basic Consideration for Facial Aging: Analyses of the Superficial Musculoaponeurotic System (SMAS) Based on Anatomy. Aesthet Surg J 2021; 41:NP124-NP126. [PMID: 33346338 DOI: 10.1093/asj/sjaa293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Moltoni G, D'Arco F, Rossi-Espagnet MC, James G, Hayward R. Observations on the growth of temporalis muscle: A 3D CT imaging study. J Anat 2020; 238:1218-1224. [PMID: 33280101 PMCID: PMC8053578 DOI: 10.1111/joa.13370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022] Open
Abstract
This study investigates the hypothesis that there is, during childhood, a disproportionate age-related expansion of the origin of temporalis muscle compared to the growth of the underlying skull. Lateral projections of 50 randomly selected 3D reformatted computerized tomographic (CT) scans (yielding 100 temporalis muscles) of children aged >0.6 to 15 years scanned for conditions that did not affect the shape of their head or face were windowed to provide the optimum delineation of temporalis muscle against the underlying bone. Vertical and anterior-posterior measurements of the muscle made independently by two observers were compared with those of the skull along the same planes. The development of the anterior temporal crest was also assessed. The intraclass correlation coefficient for differences in the measurements made by each observer ranged from good to excellent. The muscle and skull measurements were used to produce a ratio of muscle-to-skull lengths in both vertical and horizontal planes. Analysis of these ratios showed a statistically significant increase in the vertical reach of temporalis with age (Pearson correlation coefficient (R) =0.7826; p < 0.05) compared to the growth of the skull along the planes chosen for the study-but less so for its horizontal reach (R = 0.5073. p < .001). There were no significant differences between right/left or male/female measurements. There was also a substantial level of agreement between both observers in their assessment of the development of the temporal crest. The mean age of children in whom a fully formed temporal crest could be identified (10.6 years) was significantly greater (p < 0.001) than that of the 38 remaining subjects (6.0 years). These results confirm that there is, in response to increased masticatory/dietary demands during childhood, a disproportionate increase in the vertical and (to a lesser extent) horizontal reach of temporalis muscle over its origin from the temporal, frontal, sphenoid, and parietal bones compared the growth of the skull. It is proposed that surgical interference with this normal process is responsible for the soft tissue component of late-developing deformity that can occur following early (at 6-18 months of age) operations for the correction of trigonocephalic head shape associated with metopic synostosis.
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Affiliation(s)
- Giulia Moltoni
- Neuroradiology Unit, Department of Neuroscienze, Salute Mentale e Organi di Senso (NESMOS), Sapienza University, Rome, Italy
| | - Felice D'Arco
- Department of Neuroradiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Maria Camilla Rossi-Espagnet
- Neuroradiology Unit, Department of Neuroscienze, Salute Mentale e Organi di Senso (NESMOS), Sapienza University, Rome, Italy.,Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Greg James
- Departments of Craniofacial Surgery and Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Richard Hayward
- Departments of Craniofacial Surgery and Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Schultz JJ, Viviano SL, Ayyala HS, Lee BB, Keith JD. Superficial temporal artery perforator flaps for reconstruction of intraoral defects. Microsurgery 2020; 41:119-123. [PMID: 33230926 DOI: 10.1002/micr.30687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/28/2020] [Accepted: 11/10/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Intraoral defects after tumor resection are often reconstructed with free tissue transfer. However, in patients who are not good candidates for free tissue transfer, regional flaps based on the superficial temporal artery can be utilized. The authors present our technique to reconstruct intraoral defects with the superficial temporal artery perforator (STAP) flap and early outcomes. METHODS Five patients underwent STAP flaps for defects including the hard palate, buccal sulcus, floor of mouth, and retromolar trigone between 2017 and 2019. The mean defect size was 5.6 × 3.4 cm2 (3 × 3 cm2 - 7 × 4 cm2 ). The mean age was 74 (57-88) and all patients had recurrent cancer. External Doppler, indocyanine green laser angiography, and FLIR thermal imaging were used intra-operatively to identify the best perforators and plan for flap design. RESULTS The mean flap size was 7.6 × 3.5 cm2 (6 × 3 cm2 - 10 × 5 cm2 ). Four flaps were based off of the posterior branch of the STA, while the fifth was based off of the anterior branch. Two donor sites were closed primarily, and three required skin grafts. One patient experienced partial flap necrosis. There were no complete flap losses and no donor site complications. Average follow up was 14.6 months (9-20 months). All patients maintained preoperative level of speech, mastication, and oral continence. CONCLUSIONS The STAP flap can be based on the anterior or posterior branch of the superficial temporal artery and is a useful regional flap for intraoral defects after tumor resection.
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Affiliation(s)
- Jerette J Schultz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Stephen L Viviano
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Haripriya S Ayyala
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Bryant B Lee
- Department of Otolaryngology, St. Barnabas Medical Center, Livingston, New Jersey, USA
| | - Jonathan D Keith
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
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Cadaveric study of deep temporal fascia for autologous rhinoplasty grafts: Dimensions of the temporal compartment in Asians. Arch Plast Surg 2020; 47:604-612. [PMID: 33238349 PMCID: PMC7700851 DOI: 10.5999/aps.2020.01165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background Due to the anatomical complexity of the deep temporal fascia (DTF), practical guidelines for its safe harvest are lacking. However, since the upper temporal compartment (UTC) contains no vital structures, it may provide safe access for DTF harvest. This study aimed to identify the anatomical structures of the temporal compartment in Asian cadavers and to measure their dimensions to enable safe DTF harvest. Methods The anatomical structures surrounding the temporal compartment were identified in 27 hemifaces from 15 Korean cadavers. After dissection, digital images were acquired and craniometric landmarks were placed upon them to identify the boundaries of the temporal compartment. The horizontal and vertical lengths of the temporal compartment were measured and their surface areas were computationally assessed. Subsequently, differences in the results by sex were evaluated. Results The five-layer anatomical structure of the UTC was clearly visualized. The UTC was bounded by the temporal septa superiorly and inferiorly, the innominate fascia laterally, and the DTF medially. No vital structures were present within the UTC. The vertical and horizontal lengths of the UTC were 6.41±0.67 cm and 10.44±0.83 cm, respectively, and the surface area of the UTC was 48.52±5.65 cm2. No statistically significant differences were observed in any dimensions between male and female patients. Conclusions During rhinoplasty, DTF can be harvested as an autologous graft material from the UTC. An anatomical understanding of the UTC will aid in the safe and simple harvest of a sufficient amount of DTF.
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Primary Observation of the Causes of Temporal Hypertrophy Secondary to Fat Grafting and the Effect of Liposuction on the Hypertrophy. J Craniofac Surg 2020; 31:2148-2155. [PMID: 33136845 DOI: 10.1097/scs.0000000000006628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE In Asia, the temporal hollowing is considered to be a sign of bad fortune and aging. Many people demand to correct the temporal hollowing with fat grafting. Subsequently, the temporal hypertrophy secondary to fat grafting become more and more. This study attempted to preliminarily explore the causes of temporal hypertrophy and observe the safety and effectiveness of liposuction in correcting temporal hypertrophy. METHODS A diagnostic criteria for temporal hypertrophy was established, and 55 of 78 patients who complained of temporal swelling were defined as temporal hypertrophy, and filled out a questionnaire which included patients' basic information, preoperative, intraoperative, and postoperative problems related to fat grafting, as well as their acceptance of liposuction. Analyze the results of the questionnaire to explore which factors are associated with hypertrophy. Practice liposuction on patients who are willing to try liposuction. Postoperative complications were observed to determine the safety of liposuction. The patients, doctors, and bystanders were followed up 3 months postoperative to investigate the satisfaction of the operation for analyzing the effectiveness of liposuction for temporal hypertrophy. RESULTS Before fat grafting, 13 (23.6%) patients without significant temporal hollowing and 42 (76.4%) patients with obvious temporal hollowing; 28 (50.9%) patients with 1 fat grafting, 20 (36.4%) with 2 fat gratings, 7 (12.7%) with 3 fat grafting. The mean time between 2 fat gratings was 4.8 months. The fat donor sites: 50 (90.9%) patients in thigh, 4 (7.3%) in abdomen, and in 1 (1.8%) in waist. The average onset time of hypertrophy in 55 patients was 13.1 months after the last fat grafting. The average onset time of temporal hypertrophy of the weight-gain group (25.7 months) was significant later than that of the weight-invariant group (7 months) (P < 0.01).No irregularities, skin necrosis, hematoma, or infection was found in all patients. One patient showed the damage to temporal branch of facial nerve on right side, which fully recovered at 1 week postoperative. 7 (22.6%) patients, 10 (32.3%) doctors, and 8 (25.8%) laypersons reported satisfactory results; 14 (45.2%) patients, 15 (48.4%) doctors, and 14 (45.2%) laypersons reported mostly satisfactory results; 10 (32.3%) patients, 6 (19.4%) doctors, and 9 (29.0%) laypersons reported dissatisfactory results. CONCLUSIONS To prevent temporal hypertrophy, the following points are important: to rationally choose of indication of temporal fat grafting, to wait 1 to 2 years before next fat grafting, to maintain weight stability after fat grafting, to practice conservative fat grafting, to prudently choose fat donor site. Liposuction is safe for temporal hypertrophy, but it is not easy to operate and difficult to correct all cases. Therefore, a superior treatment plan should be explored.
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Anatomy and external landmarks of the superficial temporal artery using 3-dimensional computed tomography. Surg Radiol Anat 2020; 43:283-290. [PMID: 33128649 DOI: 10.1007/s00276-020-02589-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/28/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to analyze the anatomical variability of the superficial temporal artery (STA) and to provide an easy visual landmark to find the STA and its branches to facilitate its surgical access. METHODS A retrospective study was conducted on 57 patients who underwent a head and neck computed tomography with contrast injection. A visual landmark running from the tragus to the corner of the eye was used: the "eye-tragus-line" (ETL). On the ETL, the distance between the tragus and the STA was measured. The length of the STA main branch, its parietal and frontal branch and the angle of the STA and its branches with the ETL were measured. The division of the STA was studied as above/at the same level/below the zygomatic arch (ZA) and the ETL. RESULTS The STA division was located above the ZA in 61.54% of cases, at the same level in 26.92% of cases and below in 11.54% of cases. Regarding the ETL, 93.27% of the STA divisions were located above the ETL, 5.77% at the same level and 0.96% below. On the ETL, the STA was located 15.55 ± 4.5 mm in front of the tragus. CONCLUSION This study allowed to define an easy visual landmark: the ETL running from the tragus to the corner of the eye. The STA main branch was located 15.55 ± 4.5 mm of front of the tragus on the ETL. The STA division was nearly always located above the ETL (99.04%). Furthermore, this study provides a statistical representation of the anatomy of the STA and its branches.
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Ahn HS, Kim JS, Lee HJ, Lee JH, Kim HM, Kim HJ. Anatomical Continuation Between the Sub-Superficial Musculoaponeurotic System Fat and Retro-Orbicularis Oculi Fat: The True Nature of the Retro-Orbicularis Oculi Fat. Facial Plast Surg Aesthet Med 2020; 23:362-367. [PMID: 33074722 DOI: 10.1089/fpsam.2020.0398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: This study aims to analyze the anatomical location and continuation between the retro-orbicularis oculi fat (ROOF) and sub-superficial musculoaponeurotic system fat (subSMAS fat; named "innominate fascia") by comparing their layered structures, thereby letting us suggest a safe minimally invasive procedure guideline for the forehead and temple. Methods: Ultrasonographic scanning was performed from the upper medial eyebrow to the lateral side of the superior temporal line in 109 volunteers. Hematoxylin and eosin staining was performed on five specimens at the same area as ultrasonographic scanning. Then, four embalmed cadavers were dissected from the orbicularis oculi, frontalis muscle, superficial temporal fascia, and SMAS to confirm the location and continuation pattern of the ROOF and subSMAS fat. Results: On ultrasonography and histological images, there was a continuous fatty layer from the ROOF to the subSMAS fat. When dissecting, the ROOF, which was located deep below the frontalis muscle, also continued to the subSMAS fat, passing through the superior temporal line in the upper temporal region. Conclusions: This study confirmed that the subSMAS fat is an anatomical fat structure that is continuous with the ROOF. Since the subSMAS fat layer is known as a less vascular area, it is considered a safer layer to avoid serious complications, and injecting accurately into the subSMAS fat layer has been a goal of clinicians. Based on this study, a cannula will safely approach the subSMAS fat through the ROOF injection that named "forehead-downward approach."
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Affiliation(s)
- Hyo-Sang Ahn
- 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
| | - Ji-Soo Kim
- Dr. Youth Clinic, 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
| | - Ji-Hyun 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
| | | | - 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 and Engineering, College of Engineering, Yonsei University, Seoul, Republic of Korea
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Hashem AM, Couto RA, Duraes EFR, Çakmakoğlu Ç, Swanson M, Surek C, Zins JE. Facelift Part I: History, Anatomy, and Clinical Assessment. Aesthet Surg J 2020; 40:1-18. [PMID: 30843042 DOI: 10.1093/asj/sjy326] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In this article, the authors aim to thoroughly describe the critical surgical anatomy of the facial layers, the retaining ligamentous attachments of the face, and the complex three-dimensional course of the pertinent nerves. This is supplemented with clarifying anatomic dissections and artwork figures whenever possible to enable easy, sound, and safe navigation during surgery. The historic milestones that led the evolution of cervicofacial rejuvenation to the art we know today are summarized at the beginning, and the pearls of the relevant facial analysis that permit accurate clinical judgment and hence individualized treatment strategies are highlighted at the end. The facelift operation remains the cornerstone of face and neck rejuvenation. Despite the emergence of numerous less invasive modalities, surgery continues to be the most powerful and more durable technique to modify facial appearance. All other procedures designed to ameliorate facial aging are either built around or serve as adjuncts to this formidable craft.
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Affiliation(s)
- Ahmed M Hashem
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Rafael A Couto
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | | | | | - Marco Swanson
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Chris Surek
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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Koban KC, Cotofana S, Frank K, Green JB, Etzel L, Li Z, Giunta RE, Schenck TL. Precision in 3-Dimensional Surface Imaging of the Face: A Handheld Scanner Comparison Performed in a Cadaveric Model. Aesthet Surg J 2019; 39:NP36-NP44. [PMID: 30239592 DOI: 10.1093/asj/sjy242] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Handheld 3-dimensional surface imaging (3DSI) devices of various precision are becoming more versatile in their applications and more widely accepted by clinicians for documentation. OBJECTIVES The authors sought to compare the precision of facial volumetric change measurements of 3 3DSI devices in the cadaveric model: Eva (Artec 3D Inc., Luxembourg), Sense (3D Systems, Rock Hill, SC), and iSense (3D Systems, Rock Hill, SC). METHODS A total of 336 scanning and analysis procedures were carried out in 4 cephalic specimens (mean age, 77.25 ± 24.3 years; mean BMI, 21.76 ± 6.6 kg/m2). Two superficial and 2 supraperiosteal regions of interest were injected with 0.5-cc aliquots and subsequently scanned using the 3 different scanners. Correlation coefficients between the injected and measured volume were computed. RESULTS The correlation coefficient for the Eva scanner was for subcutaneous regions of interest rp = 0.935 and for the supraperiosteal regions of interest rp = 0.966, compared with rp = 0.760 and rp = 0.364 (superficial vs supraperiosteal) for the Sense and rp = 0.694 and rp = 0.382 (superficial vs supraperiosteal) for the iSense scanner. CONCLUSIONS 3DSI devices are capable of measuring surface volume changes of the face at a level of 0.5-cc surface volume change and can thus be regarded as useful tools in the preinterventional, intrainterventional, and postinterventional phases of a treatment. One of the 3 evaluated scanners provided very high correlation coefficients between the injected and the measured volume (Eva), whereas the other evaluated 3DSI devices provided moderate (Sense) and low (iSense) coefficients.
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Affiliation(s)
- Konstantin C Koban
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University, Munich, Germany
| | | | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University, Munich, Germany
| | | | - Lucas Etzel
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University, Munich, Germany
| | - Zhouxiao Li
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University, Munich, Germany
| | - Riccardo E Giunta
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University, Munich, Germany
| | - Thilo L Schenck
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University, Munich, Germany
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Arteries of the Face and Their Relevance for Minimally Invasive Facial Procedures. Plast Reconstr Surg 2019; 143:416-426. [DOI: 10.1097/prs.0000000000005201] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Cotofana S, Gotkin RH, Ascher B, Morozov SP, Gombolevsky VA, Laipan AS, Pyatintsky IA, Movsisyan TV, Koban KC, Hladik C, Frank K. Calvarial Volume Loss and Facial Aging: A Computed Tomographic (CT)-Based Study. Aesthet Surg J 2018; 38:1043-1051. [PMID: 29635393 DOI: 10.1093/asj/sjy096] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Our understanding of the aging changes involving the cranium and its impact on the overlying soft tissues is limited. OBJECTIVES This study was designed to look at the changes that occur in the cranium with aging and to propose an additional mechanism for loss of support for overlying soft tissues. METHODS One hundred and fifty-seven white individuals (10 males and 10 females in each decade: 20-29 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, 80-89 years, and 8 males and 9 females aged 90-98 years) were investigated. Computed tomographic (CT) multiplanar scans with standardized measurements of cranial thickness were performed for the frontal bone, nasion, vertex, pterion, lambda, calvarial and midfacial height, and sagittal and transverse diameter. RESULTS Increasing age correlated with a decrease in sagittal diameter in both males (rp = -0.201) and females (rp = -0.055) but with an increase in transverse diameter in both males (rp = 0.233) and females (rp = 0.207). Frontal bone thickness decreased in males -1.57mm/-18.14%, whereas it increased slightly in females +0.26mm/+3.04%. At the pterion, bone thickness increased significantly in both genders. Calvarial volume decreased with increased age in both males and females: -70.2 ml/-5.35% and -61.4 ml/-5.10%, respectively. CONCLUSIONS The lateral expansion of the skull may favor a skeletonized appearance of the face in elderly individuals. The computed volume of the calvaria decreased with advancing age in both genders, providing an additional element in the multifactorial model for facial soft-tissue laxity. LEVEL OF EVIDENCE 2
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Affiliation(s)
- Sebastian Cotofana
- Department of Medical Education, Albany Medical College, Albany, NY, USA
| | | | - Benjamin Ascher
- Plastic and Reconstructive Surgeon, Iena Plastic Surgery Clinic, Paris, France
| | - Sergey P Morozov
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Victor A Gombolevsky
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Albina S Laipan
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Ilya A Pyatintsky
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Tigran V Movsisyan
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Konstantin C Koban
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig, Germany and Maximilian University Munich, Munich, Germany
| | - Casey Hladik
- Department of Medical Education, Albany Medical College, Albany, NY, USA
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig, Germany and Maximilian University Munich, Munich, Germany
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Lee SS, Huang YH, Lin TY, Chou CK, Takahashi H, Lai CS, Lin SD, Lin TM. Long-Term Outcome of Microautologous Fat Transplantation to Correct Temporal Depression. J Craniofac Surg 2018; 28:629-634. [PMID: 28468137 PMCID: PMC5421456 DOI: 10.1097/scs.0000000000003410] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Sunken temporal fossa appears oftentimes in Asians and resembles bad fortune that people wish to change. Numerous techniques and materials have been applied clinically for augmenting the sunken temporal fossa with variable results. The microautologous fat transplantation (MAFT) technique proposed by Lin et al in 2006 has demonstrated favorable results in facial rejuvenation. In the present study, the authors applied the MAFT technique with an innovative instrument in sunken temporal fossa and reported its results. METHODS Microautologous fat transplantation was performed on 208 patients during the 4-year period starting in January 2010. Fat was harvested by liposuction, processed and refined by centrifugation at 1200 g for 3 minutes. Then purified fat was microtransplanted to the temporal fossa with the assistance of an instrument, MAFT-Gun. The patients were followed up regularly and photographs were taken for comparison. RESULTS On average, the MAFT procedure took 48 minutes to complete. The average delivered fat was 6.8 ± 0.2 mL/6.5 ± 0.3 mL for the right/left side. The average follow-up period was 18 months. No complication including skin necrosis, vascular compromise, nodulation, fibrosis, and asymmetry was noted. The patient-rated satisfaction 5-point Likert scale demonstrated that 81.3% of all patients had favorable results (38.5% very satisfied and 42.8% satisfied). CONCLUSIONS The concept and technique of MAFT along with the micro- and precise controlling instrument enabled surgeons to perform fat grafting accurately and consistently. In comparison with other strategies for volume restoration, the MAFT procedure demonstrated the patients' high satisfaction with the long-term results. Therefore, the potential of MAFT as an alternative strategy in sunken temporal fossa in Asians was emphasized.
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Affiliation(s)
- Su-Shin Lee
- *Department of Plastic Surgery, Kaohsiung Medical University †Charming Institute of Aesthetic and Regenerative Surgery (CIARS) ‡Division of Traumatology, Department of Emergency, Kaohsiung Medical University §Yuan's General Hospital
- Department of Post Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Anatomical Study of Perfusion of a Periosteal Flap with a Lateral Pedicle. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1476. [PMID: 29062647 PMCID: PMC5640352 DOI: 10.1097/gox.0000000000001476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 07/10/2017] [Indexed: 11/25/2022]
Abstract
Background: Pedicled periosteal flaps are commonly used for tissue defects between the base of the skull and the midfacial area. This study aimed to clarify the 3-dimensional vascular distribution of temporal region flaps. Methods: Ten fresh cadavers were used. Full-thickness cranial flaps were elevated from the cranial bone and each layer was detached separately. Contrast enhancement of the full thickness of the scalp, macroscopic evaluation, and histologic analyses were performed. Radiographs were obtained and image analysis was performed using a 3-dimensional monitor. Results: The mean number of deep vessels extending from the parietal branch of the superficial temporal artery was 68.7, including 14.2 and 54.5 vessels on the proximal and distal sides, respectively. The mean number of deep vessels extending from the frontal branch of the superficial temporal artery was 71.6, including 17.6 and 54.0 vessels on the proximal and distal sides, respectively. There were significantly more perforating branches in the distal area than in the proximal area of both the frontal and parietal branches (P = 0.005). There was no significant difference in the number of perforating branches between the frontal and parietal branches. Conclusions: Contrast-enhanced images of the loose areolar tissue and periosteal layers revealed vessels that extended radially. We successfully identified the 3-dimensional structure of the perforating vessels peripheral to the temporal fossa. Our findings provide a theoretical foundation for the feasibility of elevating a periosteal/loose areolar tissue flap with a reliable blood supply without sacrificing the temporal muscle.
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Aveta A, Brunetti B, Tenna S, Segreto F, Persichetti P. Superficial temporal artery perforator flap: Anatomic study of number and reliability of distal branches of the superficial temporal artery and clinical applications in three cases. Microsurgery 2017; 37:924-929. [PMID: 29034512 DOI: 10.1002/micr.30237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 08/01/2017] [Accepted: 08/25/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Limited information is available about the anatomical feasibility and clinical applications of flaps based on distal divisions of the superficial temporal artery (STA). The aim of this study was to investigate the anatomy of the STA, focusing on the number and reliability of distal branches and to show representative cases for the use of such flaps for zygomatic, parieto-frontal and occipital reconstructions. METHODS Fifty volunteers were examined bilaterally by Doppler to investigate the presence and variability of the distal divisions of STA branches. Dissection was performed on 14 temporal regions of 7 fresh cadavers. Three cases of reconstruction following skin cancer in the zygomatic (7 × 5 cm defect), parieto-frontal (4 × 4 cm defect) and occipital areas (4 × 2 cm defect) are presented. All the flaps were pedicled and based on a single vessel. RESULTS In all the 50 volunteers, the parietal branch split into 2 ± 0 branches (anterior and posterior), bilaterally, while an average of 2.84 ± 0.46 and 2.82 ± 0.48 branches originated from the frontal vessel on the right and left side, respectively. 2 ± 0 parietal and 3 ± 0 frontal (superior, central, and inferior) cutaneous perforator branches were identified in all cadaveric specimens. Flaps (4 × 10 cm, 5 × 7 cm, and 2 × 5 cm, respectively, width × length) healed uneventfully providing stable coverage. CONCLUSIONS STA distal perforator branches proved to be anatomically constant in both the cadaveric and clinical settings. Although a larger series of cases is needed, island flaps based on such vessels may represent a versatile surgical option, allowing a wide range of reconstructions in the different facial subunits.
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Affiliation(s)
- Achille Aveta
- Unit of Plastic Surgery and Dermatology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Rome 00128, Italy
| | - Beniamino Brunetti
- Unit of Plastic Surgery and Dermatology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Rome 00128, Italy
| | - Stefania Tenna
- Unit of Plastic Surgery and Dermatology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Rome 00128, Italy
| | - Francesco Segreto
- Unit of Plastic Surgery and Dermatology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Rome 00128, Italy
| | - Paolo Persichetti
- Unit of Plastic Surgery and Dermatology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Rome 00128, Italy
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Mojallal A, Cotofana S. Anatomy of lower eyelid and eyelid-cheek junction. ANN CHIR PLAST ESTH 2017; 62:365-374. [PMID: 29033216 DOI: 10.1016/j.anplas.2017.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Understanding the anatomy of the lower eyelid and the lid-cheek junction is important for surgical and non-surgical approaches. It is important to understand the correlation between the clinical presentation and the individual anatomy to direct an adequate treatment. METHODS A review of the literature based on the authors experience combined with anatomical dissections was conducted to reveal the current concepts of the surgical and non-surgical anatomy. The various anatomical structures important for the understanding of the symptoms and the proposed treatment are described in this article. RESULTS The anatomy of the lower eyelid and the lid-cheek junction has to be understood as a unit. Structures are continuous from the eyelid to the cheek influencing each other during aging. The concept of superficial, i.e. superficial to the orbicularis oculi muscle and deep facial fat compartments, i.e. deep to the orbicularis oculi muscle has to be applied in order to understand the relevant anatomy regarding the ligaments, fat compartments, muscular and tarsal structures and the vascularization. CONCLUSION The understanding of the layered arrangement of the lower eyelid and eyelid-cheek junction anatomy enables practitioners to perform safe and effective surgical and non-surgical procedures.
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Affiliation(s)
- A Mojallal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Croix-Rousse Hospital, hospices civils de Lyon (HCL), University of Lyon Claude-Bernard 1, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - S Cotofana
- Department of Medical Education, Albany Medical College, 47 New Scotland avenue MC-135, 12208 Albany, NY, USA
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Huang RL, Xie Y, Wang W, Herrler T, Zhou J, Zhao P, Pu LLQ, Li Q. Anatomical Study of Temporal Fat Compartments and its Clinical Application for Temporal Fat Grafting. Aesthet Surg J 2017; 37:855-862. [PMID: 28520850 PMCID: PMC5846703 DOI: 10.1093/asj/sjw257] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Low satisfaction rates and severe complications are two major limitations for temporal hollowing augmentation using autologous fat grafting. Despite fat compartments in temporal region have been reported, its clinical applied anatomy for fat grafting have not been the subject of studies that show its benefits objectively and statistically. OBJECTIVES To investigate temporal fat compartments and relative neurovascular structures in cadavers, developing a safe and effective fat grafting technique for temporal hollowing augmentation. METHODS The study was conducted on 8 cadavers (16 temples). The tissue layers, fat compartments, ligaments, and neurovascular structures in the temporal region were analysed. The variables were the number and location of sentinel veins, perforator vessels of the middle temporal vein. Measurements were taken with a digital calliper. RESULTS Two separate fat compartments, the lateral temporal-cheek fat compartment and lateral orbital fat compartment, were found in the subcutaneous layer, and two separate septum compartments, the upper and lower temporal compartment, were found in the loose areolar tissue layer. One sentinel vein and 1 to 6 perforator vessels were found to travel through the subcutaneous tissue layer, traverse the overlapping tissue layers in the lower temporal septum region, and finally join in the middle temporal vein. CONCLUSIONS The four fat compartments in the temporal region are ideal receipt sites for fat grafting. The medial border of the junction of the hairline and temporal line is a safe and effective cannula entry site for temporal fat grafting. The anterior half of the lower temporal compartment is a "zone of caution" for temporal fat grafting.
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Affiliation(s)
- Ru-Lin Huang
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Yun Xie
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Wenjin Wang
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Tanja Herrler
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Jia Zhou
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Peijuan Zhao
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Lee LQ Pu
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Qingfeng Li
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
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Alghoul M. Commentary on: Bilayered Structure of the Superficial Facial Fascia. Aesthet Surg J 2017; 37:637-639. [PMID: 28333268 DOI: 10.1093/asj/sjx035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mohammed Alghoul
- Dr Alghoul is an Assistant Professor, Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Initial Exploration on Temporal Branch of Facial Nerve Function Preservation in Plexiform Neurofibroma Resection. J Craniofac Surg 2016; 27:1589-92. [PMID: 27526236 PMCID: PMC5023767 DOI: 10.1097/scs.0000000000002842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Large temporal plexiform neurofibroma (PNF) is an irritating problem that causes facial disfigurement. Surgical resection of PNF is the only effective way to remove the tumor as well as to improve the patient's facial appearance. However, temporal branch of the facial nerve (TBFN) in the tumor is prone to be destroyed during PNF removal. Thus, TBFN palsy is the inevitable complication after surgery and might induce other malformation and dysfunction. Therefore, the aim of this study is to reconstruct a nearly normal face contour while preserving the facial nerve function. Purpose: Selective PNF removal technique was designed to protect TBFN during PNF lesions resection in our patients. Methods: From May 2011 to June 2015, the authors had 10 patients who suffered from PNF in the temporal region with facial disfigurement and underwent selective PNF removal to correct the facial disfigurement while preserving TBFN as well. Result: All patients obtained the improvement of facial appearance after surgery. The temporal PNF was removed and the TBFN function successfully maintained. Plexiform neurofibroma recurrence has not been relapsed during 6 to 49 months’ follow-up. Conclusions: In our initial exploration, TBFN function maintenance and facial appearance improvement can be achieved simultaneously by using PNF-selective removal surgery technique.
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Cuzalina A, Bedi M. Management of Complications Associated with Upper Facial Rejuvenation. Atlas Oral Maxillofac Surg Clin North Am 2016; 24:175-80. [PMID: 27499477 DOI: 10.1016/j.cxom.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Angelo Cuzalina
- Private Practice, Tulsa Surgical Arts, 7322 East 91st Street, Tulsa, OK 74133, USA.
| | - Manik Bedi
- Private Practice, 6153 Fort King Road, Zephyrhills, FL 33542, USA
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Kachlik D, Musil V, Baca V. Terminologia Anatomica after 17 years: Inconsistencies, mistakes and new proposals. Ann Anat 2015; 201:8-16. [DOI: 10.1016/j.aanat.2015.04.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 11/30/2022]
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Gascoigne AC, Farhadieh RD. Cheek reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Complications and prevention of complications in brow lift are presented. A discussion of anatomic features of the brow introduces the article in keeping with the focus that a thorough understanding of the anatomy, patient variations, and potential complications is requisite for surgeons performing forehead rejuvenation. The varying approaches to brow lift are discussed. Complications reviewed are bleeding, nerve injury, scarring, alopecia, brow asymmetry, and brow elevation overcorrection or undercorrection.
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Affiliation(s)
- Jessyka G Lighthall
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Mailcode: SJH-01, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
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