Investigation of the presence and variation of the ascending mental artery: Conventional dissections and ultrasonographic study

Lower Lip Reconstruction With the New Ascending Mental Artery Perforator Flap

Full-thickness defects of the lower lip pose a considerable challenge for reconstructive surgeons. The primary objective should be the restoration of oral sphincter competence, achieving both functionally and aesthetically favorable outcomes. For defects involving more than one-third of the lower lip, multiple locoregional flaps have been described as the optimal solution due to their color and texture match. Unfortunately, complications such as reduction of buccal circumference or microstomia have been reported, impacting patients' quality of life. For defects exceeding 80% of the lower lip, free flaps are required. In this study, we propose the new ascending mental artery perforator flap, based on the superficial perforating branches of the ascending mental artery. We applied this technique to 11 patients undergoing lower lip cancer excisions with defects involving 30%-70%. Our primary objective was to maintain oral continence, avoiding reduction of mouth circumference or various grades of buccal microstomia. All patients were satisfied with the functional and aesthetic final outcomes checked by long-term follow-up through clinical examination and photographs/videos (from 14 to 50 mo, with an average follow-up of 26.2 mo). This surgical procedure allows us to raise a safe and easy-to-harvest locoregional flap within a relatively short operative time, bringing a great amount of similar tissue to what is required for reconstruction. Finally, the AMAP flap has been demonstrated to fulfill the main goals of lower lip reconstruction, avoiding the most frequent complications described in the literature, especially the reduction of the circumference of the mouth.

Comparative Trial Evaluating a High- Versus Low-Integration Hyaluronic Acid Filler for Contouring the Jawline

BACKGROUND

Contour deficits of the jawline are an area of concern for many aesthetic patients. While the use of hyaluronic acid (HA) for jawline enhancement has been described previously, comparative investigations of HA fillers manufactured with different technologies are limited. Therefore, the aim of the current investigation was to evaluate the safety and efficacy of Restylane Lyft (HA-L) and Restylane Defyne (HA-D) for contouring of the jawline.

METHODS

This prospective clinical trial enrolled forty (40) participants. Twenty (20) participants with thin skin were treated with HA-D, and twenty (20) participants with thick skin were treated with HA-L. Visits occurred at Screening/Baseline (treatment), Week 2 (touch-up), and Months 1, 3, and 6. At each visit, a blinded evaluator rated 3-dimensional participant imagery according to the Jawline Volume Loss Scale and participants completed the Jawline Subject Satisfaction Scale. Frequency of treatment-emergent adverse events was collected via participant diaries, and product integration characteristics were evaluated via ultrasound.

RESULTS

Chi-square tests of independence revealed statistically significant improvements in severities of jawline volume loss, which were maximal at Month 1 (100%) and maintained until Month 6 (82.05%). At Month 1, 92.10% of participants reported being satisfied with overall treatment effects. Adverse events were expected per the product monographs and did not vary per group. On ultrasound, HA-L displayed targeted product integration and HA-D displayed diffuse product integration.

CONCLUSIONS

Results support the use of HA-L and HA-D for the contouring of the jawline with each product capable of providing distinct advantages depending on patient attributes (e.g., skin thickness, underlying bone structure, desired outcomes).

LEVEL III

Evidence obtained from well-designed cohort or case-control analytic studies.

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 .

Case series of tongue necrosis from vascular complications after chin augmentation with hyaluronic acid: Potential pathophysiology and management

BACKGROUND

Even though the chin is considered a safe injection area for facial filler augmentation, tongue necrosis is a rare complication in this area.

OBJECTIVE

Our aim was to present case series of rare complications from chin filler augmentation with possible pathophysiology and management.

METHODS

From our thorough literature search found only one case report of tongue necrosis from chin filler augmentation. We present case series of unilateral tongue necrosis from vascular occlusion following hyaluronic acid injection in the chin, which was successfully treated with a high-dose hyaluronidase injection resulting in complete recovery in all patients.

RESULTS

Variation in vascular anastomosis leads to a possible cause of vascular occlusion. The lingual artery is the primary arterial supply for the tongue, which is an exclusive target for embolism. Two main responsible arteries and branches are the deep lingual and sublingual arteries. The submental artery variation was previously described as the cause of this event. We proposed potential pathophysiology of the occlusion, not only the variation of vasculature but bone. The midline lingual foramen, an anatomical bone variation on the surface of the midline inferior jaw, was found to be another possible cause. This foramen contains a branch of the submental and sublingual artery, which includes the perforating artery, median perforating artery, or both. Filler injection with a sharp needle on the bone can potentially increase the risk of this vascular incident. A high dose of hyaluronidase administered with multiplane injections was accomplished with complete recovery.

CONCLUSIONS

Tongue necrosis from vascular complications after hyaluronic acid filler injection can occur. Not only vessels but bone variation pathology were possible causes.

Clinical Anatomy of the Chin Evaluated by 3-Dimensional Tomography and Cadaveric Dissection: Implications for Safety and Optimal Injection Techniques in Chinese

BACKGROUND

Soft tissue fillers have been widely used for the correction of chin volume loss because of congenital conditions and aging.

OBJECTIVE

This study aimed to discuss anatomical concerns for chin filler injections, which may help to reduce the incidence of severe intravascular embolization complications and improve patient satisfaction.

METHODS AND MATERIALS

We scanned 40 cadaveric heads with a contrast agent using a 64-row spiral computed tomography scanner. The scan was visualized by a Philips IntelliSpace workstation and analyzed by Materialise's interactive m image control system software to measure and quantify the arterial data. Twenty of 40 cadavers were dissected to define the layers of tissue.

RESULTS

In total, 221 arteries passed through the sagittal plane of 40 specimens. The number of superficial arteries (163 of 221) was much greater than the number of deep arteries (58 of 221). The number of arteries gradually decreased with distance from the lower lip vermilion border plane, which formed the lower third of the face.

CONCLUSION

This study introduces a safe and effective technique for administering chin filler injections that minimizes risks and improves patient satisfaction.

Expert Consensus on Hyaluronic Acid Filler Facial Injection for Chinese Patients

Supplemental Digital Content is available in the text.

Background:

Beauty standards vary by race and region, which must be accounted for in creating beauty. Chinese have unique features, including a depressed nose, flat midface, and small chin, and have different cosmetic concerns. We performed a consensus study on filler injections based on the Chinese standard of beauty due to a lack of such study.

Methods:

We organized the YVOIRE Consensus Group, including 5 plastic surgeons. We discussed common problematic areas seen in Chinese and described techniques based on our experience with hyaluronic acid fillers, while considering peer-reviewed articles, followed by multiple consensus-developing sessions.

Results:

Chinese faces are characterized by retruded forehead, chin, and low nasal bridge, with certain features believed to bring good fortune. Therefore, profiles of the forehead, nose, lip, and chin have substantial effects on attractiveness. The demand for cosmetic procedures is high among the young generation who particularly desire nose and chin augmentation. Attractive Chinese facial shapes are characterized by a long, slender facial shape and pointed chin. Lips are narrow and thick. When injecting fillers for Chinese, it is necessary to apply special methods that produce results consistent with these characteristics.

Conclusions:

Understanding the concept and demand of beauty depending on race and region is important. Patients should be evaluated before aesthetic procedures. Maintaining hygiene during the procedure is crucial. Moreover, methods for preventing pain are essential. Fillers should be injected into the correct anatomical site and layer to minimize side effects and maximize effectiveness.