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Zhou LC, Cao MB, Peng T, Yu H, Li JY, Zeng MQ, Li T, Luo SK. Clinical Relevance of the Variability of the Infraorbital Arterial Anatomy Evaluated by Three-Dimensional Computed Tomography. Aesthetic Plast Surg 2024; 48:1698-1705. [PMID: 38480656 DOI: 10.1007/s00266-024-03929-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/09/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Knowledge of the anatomy of the infraorbital artery (IOA) is crucial for the rejuvenation of the anterior medial aspect of the midface; however, studies adequately describing the anatomy of the IOA branches are lacking, and their connection with the ophthalmic artery branches remains unclear. OBJECTIVES This study aims to elucidate the anatomical characteristics of the IOA in its deployment within the lower eyelid using three-dimensional (3D) technology, thereby offering an anatomical foundation for clinical surgical procedures. METHODS An analysis was conducted on computed tomography scans of 132 cadaveric head sides post-contrast injection, utilizing the Mimics software for reconstruction. The study focused on examining the anastomosis of the IOA, its principal branches, and the branches emanating from the ophthalmic artery. RESULTS The prevalence of type I IOA was observed at 38.6% (51/132), while Type II IOA was found in 61.4% (81/132) of cases. A 7.6% incidence (10/132) of IOA directly anastomosing with the angular artery was noted. The presence of palpebral branches (PIOA) was identified in 57.6% (76/132) of instances. In the lower eyelid, four distinct distribution patterns of IOA were discerned: The likelihood of Type I PIOA was 5.3%, whereas for Types IIA, IIB, and IIC PIOA, the probabilities were 8.3%, 32.6%, and 11.4%, respectively. The occurrence of the orbital branch of IOA was recorded at 41.7% (55/132). CONCLUSIONS 3D technology can map IOA variants and identify the deployment patterns of IOA branches in the lower eyelid vascular vesicles at high resolution as a guide in clinical practice. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ling-Cong Zhou
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
- Department of Plastic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Mi-Bu Cao
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Tong Peng
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Hao Yu
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jun-Yu Li
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Mai-Qiu Zeng
- Department of Plastic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Ting Li
- Department of Plastic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Sheng-Kang Luo
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China.
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, China.
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Zhou LC, Dong YX, Cao MB, Li JY, Peng T, Zhang SY, Zhou YW, Shu HN, Luo SK. The Safety of Injections in the Infraorbital Region. Aesthetic Plast Surg 2024:10.1007/s00266-024-03976-5. [PMID: 38528128 DOI: 10.1007/s00266-024-03976-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Infraorbital filler injection is a commonly used minimally invasive cosmetic procedure on the face, which can cause vascular complications. OBJECTIVE In this study, we aimed to explore the anatomical structure of the infraorbital vasculature and to establish an accurate protocol for infraorbital filler injection. METHODS The vascular structure of the infraorbital region was evaluated in 84 hemifacial specimens using computed tomography. Four segments (P1-P4) and five sections (C1-C5) were considered. We recorded the number of identified arteries in each slice and at each location and the number of deep arteries. Furthermore, we also measured the infraorbital artery (IOA) distribution. RESULTS At P1-P4, the lowest number of arteries was detected in segment P4, with a 317/1727 (18.4%) and 65/338 (2.3%) probability of total and deep arterial identification, respectively. The probabilities of encountering an identified artery at the five designated locations (C1-C5) were 277/1727 (16%), 318/1727 (18.4%), 410/1727 (23.7%), 397/1727 (23%), and 325/1727 (18.8%), respectively. The probability of an IOA being identified at C2 was 68/84 (81%). CONCLUSION We described an effective filler injection technique in the infraorbital region to minimize the associated risks. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ling-Cong Zhou
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
- Department of Plastic and Cosmetic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Yun-Xian Dong
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Mi-Bu Cao
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Jun-Yu Li
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Tong Peng
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Si-Yi Zhang
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Yang-Wu Zhou
- Department of Plastic and Cosmetic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Hai-Ning Shu
- Department of Plastic and Cosmetic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
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Huang YL, Chi CC, Chang SL, Hu S, Lee MC, Lu CW, Chung WH, Lin TM, Cheng CY. A structured approach with Swiss cheese model to reduce vascular adverse events of filler injections. J Cosmet Dermatol 2024; 23:737-745. [PMID: 37864302 DOI: 10.1111/jocd.16038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Filler injection is among the most popular nonsurgical aesthetic procedures worldwide. Though relatively noninvasive, filler injection can lead to severe vascular adverse events. Even though the incidence is rare, it may cause devastating and irreversible outcomes. A Swiss cheese model has been widely applied for risk analysis and management approach in medical field. AIMS In this review article, we adopt the Swiss cheese model and create a structured approach to prevent severe vascular complications caused by filler injections. METHODS We reviewed the current literature regarding the knowledge and techniques of preventing vascular adverse events in the filler injection. RESULTS We propose four structured strategies in this model to reduce the risk of severe vascular adverse events of filler injections, including clinical facial anatomy, safe filler injection principles, real time imaging and auxiliary instruments, and implication of checklist. CONCLUSION This review provides clinicians a structured approach before and during the filler injection procedure to reduce the risk of vascular adverse events and improve its safety and outcome.
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Affiliation(s)
- Yau-Li Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Ching-Chi Chi
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Shyue-Luen Chang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Sindy Hu
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Mei-Ching Lee
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chun-Wei Lu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Hung Chung
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsai-Ming Lin
- Charming Institute of Aesthetic and Regenerative Surgery (CIARS), Kaohsiung, Taiwan
| | - Chun-Yu Cheng
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Center of Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Zhu C, Li F, Tang X, Cai L, Yin B, Zhang X, Jiang C, Han X. Buccal Fat Pad Augmentation for Midfacial Rejuvenation: Modified Fat Grafting Technique and Ogee Line Remodeling. Aesthet Surg J 2024; 44:117-130. [PMID: 37418635 DOI: 10.1093/asj/sjad214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The volume and position of the buccal fat pad (BFP) change with age, which manifests as a hollow midface. Previous studies showed that autologous fat grafting for BFP augmentation could effectively ameliorate midfacial hollowing. OBJECTIVES The aim of this study was to introduce a modified fat grafting technique for female patients with midfacial hollowing to restore the volume of BFP, and to evaluate the safety and effectiveness of this approach. METHODS Two cadavers were used for the dissection of the BFP and to demonstrate the surgical procedures. Forty-eight patients were treated for midfacial hollowing with the modified grafting strategy. The BFP was filled through a percutaneous zygomatic incision and an immediate amelioration in the hollow area was observed. Improvements were evaluated from measurements of the ogee line and ogee angle, FACE-Q questionnaires, and 3-party satisfaction ratings. Clinical profiles were reviewed and statistically analysed. RESULTS The mean [standard deviation] ogee angle was 6.6° [1.9°] preoperatively and 3.9° [1.4°] postoperatively (average reduction, 2.7°). Patients' ogee lines were smoother postoperatively, with marked improvements in overall appearance, psychological well-being, and social confidence. Patients reported high satisfaction with decision-making and postoperative outcomes and felt 6.61 [2.21] years younger. Overall, 88%, 76%, and 83% of the cases were graded as good or excellent in improvement by surgeon, patient, and the third party, respectively. CONCLUSIONS For age-dependent midfacial hollowing in female patients, the modified percutaneous grafting technique described here was safe and efficacious in restoring BFP volume. This technique produced a smoother ogee line and a natural, younger midfacial contour. LEVEL OF EVIDENCE: 4
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Desai RN, Batra N. Evaluation of Infraorbital Foramen Position Using Cone-Beam Computed Tomography in a Cohort of Central Gujarat, Indian Population. Cureus 2024; 16:e51722. [PMID: 38318592 PMCID: PMC10840040 DOI: 10.7759/cureus.51722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE The location of infraorbital foramen varies between geographic locations. Thus, population-specific information is required to facilitate the prediction of its exact location. METHODS A cross-sectional study was conducted on 100 cone beam computed tomography (CBCT) sections to evaluate the distance between the infraorbital foramen and incisal edge of the maxillary central incisor, the occlusal plane of the maxillary second premolar, and the alveolar crest over the maxillary second premolar using CBCT in Central Gujarat, Indian population. Descriptive statistical analysis was performed to calculate means and standard deviations for each measured parameter. The statistical significance level was defined at p<0.05. RESULTS The distance between the infraorbital foramen and incisal surface of the maxillary central incisor was (mean ± standard deviation) R=49.39 ± 3.12 mm and L=49.49 ± 3.29 mm, the occlusal plane of the maxillary second premolar was R=39.02 ± 2.65 mm and L=39.49 ± 2.53 mm, and the alveolar crest over the maxillary second premolar was R=32.64 ± 2.67 mm and L=31.64 ± 2.33 mm. There was no significant difference in the mean values of all variables between genders and age groups (p>0.05). The distance between the infraorbital foramen and the alveolar crest over the maxillary second premolar was greater on the right side (p<0.05). CONCLUSION The results of this study were analogous to those observed in a cohort of the Turkish population but varied from those observed in a cohort of the Sri Lankan population. Hence, more population-specific studies are required.
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Affiliation(s)
- Ritvi N Desai
- Oral and Maxillofacial Surgery, Manubhai Patel Dental College and Hospital, Vadodara, IND
| | - Namish Batra
- Oral and Maxillofacial Surgery, Manubhai Patel Dental College and Hospital, Vadodara, IND
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6
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Sun Y, Wu G, Dai T, Li S, Cao W, Dai T. Stromal Vascular Fraction Gel (SVF-Gel) Combined with Nanofat for Tear Trough Deformity. Aesthetic Plast Surg 2024; 48:213-220. [PMID: 37957391 DOI: 10.1007/s00266-023-03698-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/20/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Tear trough deformity makes patients appear tired. Patients with less severe tear trough deformity prefer a less invasive method to correct the deformity. The infraorbital area is a multilayered tissue, and the aging of various components leads to tear trough deformity. To this end, we utilized the different characteristics of different fat derivatives to correct tear trough deformity. METHODS Thirty-two patients with Barton Grade I/II tear trough deformity were enrolled in this study between September 2020 and March 2021. We injected Stromal Vascular Fraction Gel (SVF-Gel) into the suborbicularis oculi fat layer and Nanofat into the subcutaneous. After 12 months of follow-up, we evaluated the changes using standardized clinical photogrammetric techniques, volume, global aesthetic improvement scale, and patient self-evaluation. RESULTS There were no major complications in any of the 32 patients. The measured data points demonstrated improvements in all aesthetic parameters. The width of the tear trough and the distance from the pupil to the tear trough improved. The Global Aesthetic Improvement Scale (GAIS) showed a high score (2.45±0.64 points), with patient self-assessment showing satisfactory results. CONCLUSION SVF-Gel combined with Nanofat injection can effectively correct tear trough deformities. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yiyu Sun
- Department of Wound Reconstructive Surgery, Tongji Hospital, Tongji University, Shanghai, China
| | - Gaoyang Wu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, China
| | - Tao Dai
- Department of Wound Reconstructive Surgery, Tongji Hospital, Tongji University, Shanghai, China
| | - Shengli Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, China
| | - Weigang Cao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, China.
| | - Tingting Dai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, China.
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Dong R, Jin Q, Zhi J, Jin M, Gao Y, Nan M, Jin Z, Jin C. Analysis of the efficacy of blunt separation combined with uncrosslinked sodium hyaluronate composite solution for the treatment of tear trough deformity in Asians. J Cosmet Dermatol 2023. [PMID: 38130178 DOI: 10.1111/jocd.16151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Filling therapy is becoming increasingly popular for correcting tear trough deformities (TTD). However, its therapeutic effect and retention time are limited. AIMS To improve the clinical efficacy and safety of TTD treatment in Asians, we used a blunt separation technique to break the adhesion site of periorbital subcutaneous tissue, and while repairing skin dermis after injury, it was combined with uncrosslinked hyaluronic acid compound solution to promote collagen regeneration and treat TTDs. PATIENTS/METHODS Twenty-six Chinese patients (21 women and 5 men) with TTD, with a mean age of 34.54 ± 9.21 (range, 20-56) years, were enrolled. Symptom improvement, recurrence rates, treatment safety, and patient satisfaction were evaluated. RESULTS All patients' tear trough rating scale (TTRS) scores decreased significantly immediately after treatment. The TTRS scores at 1, 3, and 6 months, and 1 year after treatment demonstrated significant differences from those before treatment (all p < 0.05). All patients' experienced mild pain, erythema, and swelling during the treatment. Three patients developed postinjection bruising after treatment, which lasted for 6-7 days and subsequently disappeared. No other adverse reactions were observed during the follow-up. There were no recurrent cases, and patient satisfaction was very high. CONCLUSIONS Blunt separation combined with an uncrosslinked sodium hyaluronate composite solution is safe and effective for treating TTDs in Asians with few side effects and has good clinical application prospects.
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Affiliation(s)
- Richeng Dong
- Department of Dermatology, Suzhou Mylike Cosmetic Hospital, Suzhou, Jiangsu, China
| | - Qingmei Jin
- Department of Dermatology, Suzhou Mylike Cosmetic Hospital, Suzhou, Jiangsu, China
| | - Jiahui Zhi
- Department of Dermatology, Suzhou Mylike Cosmetic Hospital, Suzhou, Jiangsu, China
| | - Meilin Jin
- Department of Medical Cosmetology, Yanbian University Hospital, Jilin, China
| | - Yang Gao
- Department of Medical Cosmetology, Yanbian University Hospital, Jilin, China
| | - Meilan Nan
- Department of Medical Cosmetology, Yanbian University Hospital, Jilin, China
| | - Zhehu Jin
- Department of Medical Cosmetology, Yanbian University Hospital, Jilin, China
| | - Chenglong Jin
- Department of Dermatology, Suzhou Mylike Cosmetic Hospital, Suzhou, Jiangsu, China
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Wang R, Li Y, Li Z, Yao H, Zhai Z. Hyaluronic acid filler-induced vascular occlusion-Three case reports and overview of prevention and treatment. J Cosmet Dermatol 2023. [PMID: 38131127 DOI: 10.1111/jocd.16147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Vascular occlusion induced by hyaluronic acid injections is rare, but can lead to severe adverse events, including necrosis, blindness, and cerebral infarction. OBJECTIVE This study aims to explore methods of reducing the risk of complications such as embolism induced by hyaluronic acid injection, and to study the impact of comprehensive systematic treatment on the prognosis of patients with hyaluronic acid embolism. METHODS The clinical data of three female patients with vascular occlusion due to hyaluronic acid injection was analyzed. Their median age was 26 years, with symptoms presenting 1-6 h postinjection. Hospital stays averaged 6 days. Two patients had ptosis, diplopia, and severe pain after injection of eyebrows. The other, who had a nose enhancement, experienced facial skin color changes and intense pain. RESULTS Two patients received comprehensive, systematic treatment based on injectable hyaluronidase. One patient self-discharged after receiving injectable hyaluronidase, antispasmodic, and vasodilator treatment on the night of embolism and returned to the hospital 3 days later with worsening embolism symptoms and received symptomatic treatment again. Two patients who received comprehensive, systematic treatment based on injectable hyaluronidase showed significant improvement, while the patient who did not undergo systematic treatment left scars on the face. CONCLUSION Vascular occlusion caused by hyaluronic acid facial filling is a severe adverse event, and timely, comprehensive, systematic treatment can effectively improve irreversible damage caused by thrombosis, and even cure it.
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Affiliation(s)
- Rong Wang
- Plastic Surgery Institute of Weifang Medical University, Weifang, China
| | - Yukun Li
- School of Qingdao University, Qingdao, China
| | - Zhaoxin Li
- Affiliated Traditional Chinese Medicine Hospital of Weifang Medical University, Weifang, China
| | - Haifeng Yao
- Plastic Surgery Institute of Weifang Medical University, Weifang, China
| | - Zhaohui Zhai
- Plastic Surgery Institute of Weifang Medical University, Weifang, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nikolis A, Enright KM, Berros P, Sampalis JS. Safety of infraorbital hyaluronic acid injections: Outcomes of a meta-analysis on prospective clinical trials. J Cosmet Dermatol 2023; 22:2382-2390. [PMID: 37424173 DOI: 10.1111/jocd.15925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/11/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Hollowing of the infraorbital region represents a common concern among aesthetic patients. In the past decade, an increasing number of patients have resorted to noninvasive aesthetic procedures to treat these concerns. The objective of this study was to evaluate the safety profile of infraorbital hyaluronic acid injections for aesthetic rejuvenation. METHODS Through a systematic review and meta-analysis of prospective clinical trials, investigators sought to answer the research question "Does the use of needle versus cannula during infraorbital HA injections result in the same incidence rate of adverse events?" The primary outcomes of interest were the incidence rates of ecchymosis and edema in subject groups treated with a needle or cannula. RESULTS Subjects treated with needles had a statistically significant greater incidence rate of ecchymosis, compared to those treated with cannula. Conversely, subjects treated with cannula had a statistically significant greater incidence rate of edema, compared to those treated with needles. CONCLUSIONS The incidence rates of adverse events following the administration of hyaluronic acid injections in the infraorbital region vary depending on whether a needle or cannula is used; with needles being associated with a greater risk of ecchymosis and cannulas being associated with a greater risk of edema. These findings should be discussed with patients prior to treatment consultation. Finally, as with most techniques, it is usually prudent to develop expertise with one technique before using a second, especially in cases where both approaches can be used and have different adverse event profiles.
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Affiliation(s)
- Andreas Nikolis
- Clinical Research Unit, Erevna Innovations Inc, Westmount (Montreal), Quebec, Canada
- Department of Plastic Surgery, McGill University, Montreal General Hospital Montreal, Montreal, Quebec, Canada
| | - Kaitlyn M Enright
- Clinical Research Unit, Erevna Innovations Inc, Westmount (Montreal), Quebec, Canada
| | - Philippe Berros
- Medical International Center Monaco (CMIM), Montreal, Monaco
| | - John S Sampalis
- JSS Medical Research, Saint-Laurent (Montreal), Quebec, Canada
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Cheng Y, Yan G, Li C, Han X, Shang J, Shang S, Han J, Luo G, Liu F. Case report and literature review: fatal cerebral fat embolism following facial autologous fat graft. Front Neurol 2023; 14:1180333. [PMID: 37602257 PMCID: PMC10436317 DOI: 10.3389/fneur.2023.1180333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/06/2023] [Indexed: 08/22/2023] Open
Abstract
Background Severe cerebral artery embolism is a rare complication of facial autologous fat injection. However, its incidence has markedly increased with the recent rise in facial cosmetic procedures. Case presentation We report a 31-year-old Chinese woman who presented with unconsciousness 6 h after having undergone a facial autologous fat injection. A neurological examination revealed stupor, bilaterally diminished pupillary light reflexes, right-sided central facial palsy, and no reaction to pain stimulation of right limbs. Diffusion-weighted imaging displayed patchy hyperintense lesions in the left frontal, parietal, and temporal lobes. Magnetic resonance angiography demonstrated fat embolism in the left internal carotid artery, anterior cerebral artery, and middle cerebral artery. We immediately performed mechanical thrombectomy under sufficient preoperative preparations but failed to achieve complete recanalization. Pathological examination of the embolus confirmed the presence of adipocytes. Although we actively administered symptomatic and supportive treatments, the patient eventually died due to the progression of cerebral herniation and systemic infection. Conclusion Due to the ineffectiveness of current treatment and the inferior prognosis, fat embolism, a severe complication of autologous fat graft, should draw the attention of both plastic surgeons and neurologists so that actions may be taken for both its prevention and treatment.
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Affiliation(s)
- Yawen Cheng
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Gezhi Yan
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chenyang Li
- Department of Neurology, HanCheng People's Hospital, Han Cheng, China
| | - Xiangning Han
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jing Shang
- The Diagnostic Center, Shannxi People's Hospital, Xi'an, China
| | - Suhang Shang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianfeng Han
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guogang Luo
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fude Liu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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12
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Turan A. The versatility of the reverse superior labial artery flap. J Plast Reconstr Aesthet Surg 2023; 82:71-80. [PMID: 37149912 DOI: 10.1016/j.bjps.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND The reverse superior labial artery flap was introduced in 2015 as a reconstructive option for medial cheek defects. Notably, this flap can be redesigned as a more effective repair tool for large facial defect reconstruction. In this study, we redesigned the reverse superior labial artery flap to include the vascular territories of the infraorbital and transverse facial arteries in larger sizes for the repair of large facial defects. METHODS A reverse superior labial artery flap was used to repair large facial defects in 17 patients with a mean age of 74 years. The defects were located in the orbital region and entirely nasal sidewall in patient two, buccal region in patient three, and in lower lip and malar areas in patient five. The flap sizes ranged from 3.5 × 10 to 7 × 15 cm. A sensory examination was performed on the flaps at 6 and 12 months postoperatively. The mean follow-up period was 12 months. RESULTS All flaps survived without partial or total loss. In a small number of flaps minor complications such as venous congestion, epidermolysis, and dehiscence were seen. No functional disability was observed in the lower eyelid or lower lip, and the esthetic appearance was evaluated as satisfactory by the patients. In all the flaps, the protective sensation was recovered in the postoperative 12th month. CONCLUSIONS The reverse superior labial artery flap has an extensive arc of rotation, a reliable vascular pedicle, and a large cutaneous paddle. Therefore, this flap may be a versatile surgical repair tool for large cheek defects.
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Affiliation(s)
- Aydın Turan
- Head of the Plastic, Reconstructive, and Aesthetic Surgery Department, Turkey.
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13
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Huang R, Yang J, Fan J, Jiao H. Tear Trough Ligament Release and Autologous Fat Injection as a New Method for Tear Trough Deformity Correction. Aesthetic Plast Surg 2022; 46:2814-22. [PMID: 35857083 DOI: 10.1007/s00266-022-03002-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/20/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Even though the tear trough (TT) deformity is only 2 cm in length, it can give a worn, even haggard appearance on the face. The authors developed a novel approach and presented findings from the clinical effect. METHODS Between February 2018 and January 2021, the medical records of patients treated with autologous fat injection for TT deformity were researched. The fat was placed under the orbicularis oculi muscle with a sharp cannula. During that period, the TT ligament was also released with the cannula. After the fat was injected entirely, we still needed to repeatedly puncture this ligament to release it until there was no puncture resistance. Improvement was evaluated by measuring patients' and investigators' global aesthetic improvement scale. RESULTS 152 of 173 patients completed the follow-up plan and were enrolled in this study. The most common complications reported were temporary swelling and lumpiness. At 1 month, 3 months, 6 months, 12 months, and 24 months, the satisfaction rate of patient self-assessment was 93.4%, 89.5%, 86.8%, 84.3%, and 82.4%, respectively. The Investigator Global Aesthetic Improvement Scale showed 94.1% of patients' improvement after one month, 83.6% after three months, 78.3% after six months, 75% after 12 months, and 71.8% after 24 months. CONCLUSION Fat injection based on TT ligament release to correct TT deformity is a novel, easy and effective treatment that deserves to be further used. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Isaac J, Walker L, Ali SR, Whitaker IS. An illustrated anatomical approach to reducing vascular risk during facial soft tissue filler administration – a review. JPRAS Open 2022; 36:27-45. [PMID: 37064503 PMCID: PMC10102405 DOI: 10.1016/j.jpra.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022] Open
Abstract
Vascular complications from soft tissue fillers can have catastrophic consequences for patients. Adverse events are rare, but they are increasing, and their appearance may be the result of intravascular injection. A comprehensive understanding of the 2-dimensional anatomy (distribution) and 3-dimensional anatomy (depth) of the facial vasculature is fundamental for the safe delivery of nonsurgical cosmetic procedures. The purpose of this review is to provide an illustrated approach to examine surgical anatomy specific to the facial vascular system and the anatomical considerations clinicians need to give in specific danger during injectable cosmetic procedures. A grounding in safety and anatomy will help the new injector to mitigate the risk of vascular complications.
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Affiliation(s)
| | - Lee Walker
- B City Clinic, Liverpool, United Kingdom
| | - Stephen R Ali
- Reconstructive Surgery and Regenerative Medicine Research Centre. Institute of Life Sciences, Swansea University Medical School. Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Centre. Institute of Life Sciences, Swansea University Medical School. Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
- Corresponding author: Professor Iain S. Whitaker MA Cantab PhD FRCS Plast FAcadTM, Reconstructive Surgery & Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea SA2 8PP, United Kingdom, Tel: 01792205678.
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Ting M, Ezra DG. Unravelling the Complex Anatomy of the Tear Trough and Lower Eyelid Folds: A Review of Cadaveric Studies in the Literature. J Craniofac Surg 2022. [PMID: 35946827 DOI: 10.1097/SCS.0000000000008756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 04/02/2022] [Indexed: 11/26/2022] Open
Abstract
The lower eyelid tear trough deformity is a common cosmetic concern which is the result of multiple anatomic changes in the lower eyelid, usually resulting from age. A sound understanding of the underlying anatomy is vital to inform surgeons about the ideal treatment options for rejuvenation of this region and to minimize the risk of complications. Cadaveric studies provide unique insight into underlying anatomic changes. Here we review the relevant published cadaveric studies relating to the tear trough deformity and its treatment.
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Soares DJ, Blevins LW. Distal Internal Maxillary Artery Occlusion with Palatal Necrosis following Cheek Injection with Calcium Hydroxylapatite. Plast Reconstr Surg Glob Open 2022; 10:e4164. [PMID: 35265444 PMCID: PMC8901201 DOI: 10.1097/gox.0000000000004164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/10/2022] [Indexed: 12/02/2022]
Abstract
Accidental intravascular injection of cosmetic fillers resulting in dermal infarction represents one of the most feared complications in aesthetic medicine. Despite the infrequency of these injuries, the rapid rise in filler use has caused a sudden increase in the incidence of filler-induced skin necrosis. Because the complex vascular anatomy of the face subserves a wide range of cutaneous and mucosal tissues, it has been surmised that occult injuries affecting the oronasal cavities could occur as a result of accidental intravascular injection of dermal fillers. We report an instance of ischemic skin injury of the infraorbital territory of the face with hemi-palatal mucosal necrosis secondary to vascular occlusion with calcium hydroxylapatite.
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Abstract
ABSTRACT With the sudden emergence of new medical aesthetic fillers, the number of fillers injected worldwide has exploded, but there are also worrying risks in the pursuit of beauty. At present, many cases of blindness caused by injection of aesthetic fillers have been reported. Most of the cases are caused by irreversible vascular embolism. This is a rare yet greatly feared complication of using facial cosmetic fillers. This article reviewed and analyzed the literature and summarized the changes in the anatomical structure of facial blood vessels related to blindness during facial injection.
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Affiliation(s)
- Dan Li
- From the Department of Plastic and Burn Surgery, the First Affiliated Hospital Chongqing Medical University, Chongqing, China
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18
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Siperstein R. Infraorbital Hyaluronic Acid Filler: Common Aesthetic Side Effects with Treatment and Prevention Options. Aesthet Surg J Open Forum 2022; 4:ojac001. [PMID: 35386936 PMCID: PMC8982019 DOI: 10.1093/asjof/ojac001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Infraorbital hollows can give a fatigued or aged appearance, which can be treated by volumizing the segmented transition from the tear trough to the cheek with hyaluronic acid filler. Due to thin skin and the complex anatomy of the infraorbital area, both short- and long-term side effects (SEs) from this treatment are very common. While some patients are clear surgical candidates vs filler candidates, in real-world practice, many, if not most, patients are on a continuum where either procedure is appropriate, and the treatment decision is individualized based on each person’s risk vs benefit profile. Objectives Common aesthetic SEs from hyaluronic acid filler treatment in the infraorbital area will be reviewed, including their etiology, prevention, detection, and treatment. Methods The author’s experience from injecting the infraorbital areas of more than 800 patients in private clinical practice and observations from both short- and long-term follow-ups over 8 years is leveraged to provide detailed guidance. Results Recommendations on injection techniques, patient selection, and patient education are presented along with algorithms for the prevention and management of bruising, short- and long-term swelling, bumps, and blue discoloration (which is usually secondary to swelling from the filler rather than just the filler alone placed or migrating too superficially). Conclusions For nearly all patients, complete dissolution of filler with hyaluronidase is not required to address the issue, and the guidelines provided here will assist clinicians in the management of SEs to increase patient satisfaction with their treatment and aesthetic outcome. Level of Evidence: 5
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20
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Fabi S, Zoumalan C, Fagien S, Yoelin S, Sartor M, Chawla S. A Prospective, Multicenter, Single-Blind, Randomized, Controlled Study of VYC-15L, a Hyaluronic Acid Filler, in Adults for Correction of Infraorbital Hollowing. Aesthet Surg J 2021; 41:NP1675-NP1685. [PMID: 34351386 PMCID: PMC8520027 DOI: 10.1093/asj/sjab308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rejuvenation of the under-eye area is a popular facial aesthetic treatment option. OBJECTIVES This study evaluated the safety and effectiveness of VYC-15L for the correction of moderate or severe infraorbital hollowing. METHODS This was a randomized, controlled, single-blind study with a primary endpoint defined as the proportion of participants with ≥1-grade improvement at Month 3 assessed by an evaluating investigator employing the Allergan Infraorbital Hollow Scale. Three-dimensional imaging was conducted to assess infraorbital volume up to Month 12. Procedure pain and injection-site responses (ISRs) were documented, and safety was monitored throughout the study. RESULTS At Month 3, the difference between treatment (83.1%) and control (15.6%) was 67.5% (95% CI = 52.9 to 82.0, P < 0.0001). 3D imaging showed a mean volume increase from baseline of 0.733 mL (left) and 0.777 mL (right) at Month 12. Mean pain scores were ≤1.7 (scale of 0 to 10). Most ISRs with initial treatment were mild/moderate and resolved in ≤1 week, including tenderness (49.5%), bruising (42.7%), and swelling (41.7%). Thirty-four participants had treatment-emergent adverse events (TEAEs), of which 14 (10.3%) had treatment-related TEAEs, including bruising (3.8%) and swelling/edema (2.9%), which resolved in ≤2 weeks. Three participants had swelling/edema starting >30 days posttreatment; 2 resolved in ≤4 days, 1 by 45 days. No treatment-related serious AEs were reported. CONCLUSIONS VYC-15L was safe and effective for the correction of moderate or severe infraorbital hollowing and lasted through 1 year. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Sabrina Fabi
- Corresponding Author: Dr Sabrina Fabi, 9339 Genesee Avenue, Suite 300, San Diego, CA 92121, USA. E-mail: ; Instagram: @sabrina.fabi
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Vadera S, Shome D, Kumar V, Doshi K, Kapoor R. Innovative approach for tear trough deformity correction using higher G prime fillers for safe, efficacious, and long-lasting results: A prospective interventional study. J Cosmet Dermatol 2021; 20:3147-3154. [PMID: 34450687 DOI: 10.1111/jocd.14407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND One of the most challenging areas for facial rejuvenation is the lower eyelid. Apart from the protruding orbital fat causing lower lid bags, a discrete entity called the "tear trough deformity" is distinguishable in this area. AIM The objective of this study is to compare and evaluate the standard technique of tear trough deformity correction with the lateral injection technique using a high G prime filler to establish a guideline for the safe and effective correction of tear trough deformity. METHODS A prospective, double-blind, study was carried out from Dec 2017 to 2019 including 30 participants in the age range of 35-60 years. The participants were divided into two groups of 15 patients each. In group A patients, conventional technique with a low G Prime filler was used, whereas in group B, lateral injection technique with a high G Prime filler was used. RESULTS Marked improvement was seen in appearance and skin quality on both the sides in all the patients. As compared to our technique (lateral injections) where a mean of 0.5 ml of filler was used to lift the cheek and reduce the tear trough, the standard technique (Mauricio de Maio's 3-point tear trough reshape technique) required a mean of 1.2 ml of filler for the same. Post-procedure complications including bruising and Tyndall effect were much higher (statistically significant) using the standard medial technique for the correction tear trough. CONCLUSION Aesthetically satisfying results for the tear trough correction are possible, without actually injecting the tear trough directly, based on the knowledge of the underlying anatomy.
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Affiliation(s)
- Sapna Vadera
- Department of Facial Plastic Surgery and Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | - Debraj Shome
- Department of Facial Plastic Surgery and Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | - Vaibhav Kumar
- Clinical Research Coordinator, The Esthetic Clinics, Navi Mumbai, India
| | - Komal Doshi
- Department of Facial Plastic Surgery and Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | - Rinky Kapoor
- Department of Dermatology, Cosmetic Dermatology & Dermato-Surgery & Director, The Esthetic Clinics, Mumbai, India
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22
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Wollina U, Goldman A. Facial vascular danger zones for filler injections. Dermatol Ther 2020; 33:e14285. [PMID: 32902108 DOI: 10.1111/dth.14285] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 01/03/2023]
Abstract
Filler injections are widely used for facial rejuvenation. The technique is safe as long as some precautions are respected. In this review we will focus on vascular anatomy in the upper, middle and lower face. We performed a PUBMED research on "facial danger zones" and "filler injections" and "hyaluronic acid" and "vascular compromise" with a focus on the last decade. This is of particular importance since vascular compromise is one of the most severe adverse events possibly leading to tissue necrosis and in rare cases to loss of vision. We describe the danger zones in these esthetic units and provide recommendations how to avoid severe adverse events. We report on temporal region, glabella and nose, infraorbital region, nasolabial folds and nasal triangle, lips, and chin. Although we focus on hyaluronic acid fillers, our recommendations will also scope other filler types and autologous adipose tissue transfer. We also take a closer look on innovations to improve the safety of facial filler injections. Facial rejuvenation with hyaluronic acid fillers is a popular method. It is safe if the facial danger zones are recognized and proper injection techniques and fillers are used.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | - Alberto Goldman
- Department of Plastic Surgery, Hospital São Lucas da PUCS, Porto Alegre, Brazil
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Allepot K, Mojallal A, Gerenton B. Self-injection: Inescapable DIY and real danger? A case study and literature review. ANN CHIR PLAST ESTH 2020; 66:93-99. [PMID: 32919811 DOI: 10.1016/j.anplas.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
Aesthetic medicine is booming, and expanding Internet delivery is not controlled by health authorities. More than ever, conditions are thus favorable for patient self-injection. We present the case of a 45-year-old woman self-injected in breast with hyaluronic acid purchased on the Internet. She developed a bilateral breast infection treated with antibiotic treatment. Despite the ban on the use of filler in the breast by our health authorities since 2011, we will talk about the management of this type of patient. In light of this complication, we will discuss the public health issue raised by the development of the injectable products market. We wish to emphasize in France the emergency of establishing a strict legal framework for the use of fillers.
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Affiliation(s)
- K Allepot
- Chirurgie plastique reconstructrice et esthétique, hôpital de la Croix-Rousse, 103, Grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - A Mojallal
- Chirurgie plastique reconstructrice et esthétique, hôpital de la Croix-Rousse, 103, Grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - B Gerenton
- Chirurgie plastique reconstructrice et esthétique, clinique du Parc Lyon, 155, boulevard de Stalingrad, 69006 Lyon, France.
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Anido J, Fernández JM, Genol I, Ribé N, Pérez Sevilla G. Recommendations for the treatment of tear trough deformity with cross-linked hyaluronic acid filler. J Cosmet Dermatol 2020; 20:6-17. [PMID: 32844581 PMCID: PMC7818415 DOI: 10.1111/jocd.13475] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
Background Recent years have seen a growing interest in the appearance of the eyes among the concerns expressed by patients in cosmetic clinics. This has led to an increase in the frequency of diagnosis of tear trough deformity, and, as a result, the number of treatments performed by specialized professionals has also risen. Hyaluronic acid filler injection is a rapid, nonsurgical technique that gives good long‐lasting, but not permanent, results. However, to achieve optimal results, the attending physician must have good anatomical knowledge of the area and involvement of the structures in the tear trough, carry out proper clinical assessment of the patient, and use an appropriate injection technique with the right product. Aims To support good practice among the professionals who carry out these procedures, this interdisciplinary consensus document describes the relevant issues and recommendations, in order to improve safety standards and to help successfully resolve this aesthetic problem.
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Affiliation(s)
- Javier Anido
- Medicina Estética, Clínica Anido Health & Beauty, Madrid, Spain
| | | | - Ignacio Genol
- Oftalmología y Cirugía Oculoplástica, Clínica Dr. Ignacio Genol, Madrid, Spain
| | - Natalia Ribé
- Institut Dra Natalia Ribé, Andrología y Medicina Estética, Barcelona, Spain
| | - Gema Pérez Sevilla
- Hospital La Milagrosa, Unidad de Medicina y Cirugía Estética Facial Avanzada, Madrid, Spain
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Agorgianitis L, Panagouli E, Tsakotos G, Tsoucalas G, Filippou D. The Supratrochlear Artery Revisited: An Anatomic Review in Favor of Modern Cosmetic Applications in the Area. Cureus 2020; 12:e7141. [PMID: 32257686 PMCID: PMC7105260 DOI: 10.7759/cureus.7141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The supratrochlear artery represents a terminal branch of the ophthalmic artery. Cosmetic interventions may traumatize it, resulting in a circulation in the lesion in glabellar region and in the medial aspect of the forehead. This review article aims to synopsise the existing knowledge of the anatomy of the supratrochlear artery in close correlation with minimally invasive cosmetic procedures in the facial area such as soft-tissue filler injections. Their possible adverse effects and their safe application based on the topographic anatomy were included. A literature review was performed in PubMed/Medline online medical database. The superficial course of the supratrochlear artery, as well as the rich, variable anastomotic network that it forms with the supraorbital, angular and dorsal nasal artery raise clinical questions in the case of soft-tissue filler injections in the nasoglabellar and central forehead area. Accidental cannulation of the supratrochlear artery and ultimately, the risk of embolization of the central retinal artery in a retrograde fashion might lead to injury with questionable cosmetic results. Although the risk of complications from the use of soft tissue fillers is considered rare, once happen, the results could be devastating for the quality of life. Thus, the comprehension of the anatomy of the supratrochlear artery is paramount for the health practitioners.
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Affiliation(s)
- Loukas Agorgianitis
- Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Eleni Panagouli
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - George Tsakotos
- Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Gregory Tsoucalas
- Anatomy, School of Medicine-Democritus University of Thrace, Alexandroupolis, GRC
| | - Dimitrios Filippou
- Surgery, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
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Rusu MC, Săndulescu M, Cârstocea L. False and true accessory infraorbital foramina, and the infraorbital lamina cribriformis. Morphologie 2020; 104:51-8. [PMID: 31924470 DOI: 10.1016/j.morpho.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 11/23/2022]
Abstract
The infraorbital nerve (ION) and artery (IOA) course in the infraorbital canal (IOC) to exit through the infraorbital foramen (IOF). Few previous studies brought evidence of accessory IOF. Evaluation of the IOF in Cone Beam Computed Tomography (CBCT) is more accurate to determine whether or not foramina of maxilla are supplied by canaliculi deriving from the IOC. We performed a retrospective anatomical study of the CBCT files of 200 patients. An accessory infraorbital foramen located inferior to the infraorbital margin (AIOF) was found in 18/200 right maxillae and in 13/200 left ones. Canaliculi deriving from the IOC supplied accessory foramina in the sutura notha- AIOF(SN) - in 15 maxillae. Noteworthy, the AIOF(SN)-negative maxillae displayed the SN and the vascular foramina of Macalister. In 94% of cases the AIOF were unique. A single maxilla (3%) had a double AIOF. In a different case (3%) were found three accessory infraorbital foraminules transforming the anterior wall of the antrum into a veritable lamina cribriformis infraorbitalis. A single prior study distinguished AIOF from AIOF(SN), while most of different other ones were performed on dry bones. Therefore, the reports of prevalence for the number and location of AIOF should be regarded with caution. Foramina of the SN could equally get intraosseous and extraosseous supply, this distinction being accurately made in CBCT.
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Sokhn S, Challita R, Challita A, Challita R. The Infraorbital Foramen in a Sample of the Lebanese Population: A Radiographic Study. Cureus 2019; 11:e6381. [PMID: 31938659 PMCID: PMC6957048 DOI: 10.7759/cureus.6381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose The infraorbital foramen (IOF) is an important structure in the maxillofacial region through which important structures pass. Wide variability in the shape and location of the infraorbital foramen among different populations and ethnic groups is present. So we conducted this study to specify the IOF shape, the presence of accessory foramina, and the IOF location with respect to anatomic landmarks in the Lebanese population. Patients and method A cross-sectional retrospective study was conducted on cone-beam computed tomography (CBCT) scans of 105 Lebanese adult patients. Images were reviewed and the shape, diameter, and location of the IOF were recorded. The presence of an accessory foramen was also noted. Then, SPSS version 21 (IBM Corp., Armonk, NY, US) was used for the statistical analysis. Results Concerning the distances from the IOF to the anatomic landmarks, the distance from the IOF to the infraorbital margin measured 7.98 ± 1.41 mm, to the lateral nasal wall 10.61 ± 2.39 mm, and to the midline 24.71 ± 2.09 mm. When distances were compared, a statistical difference was only identified in the distance between the IOF and the lateral nasal wall (p=0.00), and the distance between the IOF and the middle of the face (p=0.016) between genders. For the shape of the IOF, 54.8% of the IOF were circular in shape, and this shape was the most common shape in females. An accessory foramen was present in 8.6% of the cases. Finally, the mean diameter of the foramina measured 3.71 ± 0.63 mm. Conclusion The IOF shows a lot of variability between different populations. Thus, the exact location should always be remembered during an infraorbital nerve (ION) block, during maxillofacial surgeries, and during esthetic procedures involving the facial region in order to prevent unnecessary complications.
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Affiliation(s)
- Sayde Sokhn
- Oral and Maxillofacial Imaging, Lebanese University, Beirut, LBN
| | - Ronald Challita
- Obstetrics and Gynecology, Faculty of Medicine, Lebanese University, Beirut, LBN
| | - Anthony Challita
- Periodontology and Implantology, Lebanese University, Beirut, LBN
| | - Raymond Challita
- Plastic and Reconstructive Surgery, Faculty of Medicine, Lebanese University, Beirut, LBN
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Delorenzi C. Discussion: Assessing Retrobulbar Hyaluronidase as a Treatment for Filler-Induced Blindness in a Cadaver Model. Plast Reconstr Surg 2019; 144:321-4. [DOI: 10.1097/prs.0000000000005861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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