Dual real-time imaging of vein detector and ultrasound for a safe volumetric rejuvenation and skin surgery of the dorsal hand

A structured approach with Swiss cheese model to reduce vascular adverse events of filler injections

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.

Ultrasound Analyses of the Dorsal Hands for Volumetric Rejuvenation

BACKGROUND

Volumetric hand rejuvenation of the dorsal hands is increasingly applied for aged, skeletonized dorsal hand skin, with prominent veins, tendons, and joints due to volumetric loss of subcutaneous fat. However, the aging process of the fatty laminae remains unexplored.

OBJECTIVES

We aim to investigate the impact of aging and potential determinants on the fatty laminae to improve the therapeutic effect of volumetric injection.

METHODS

This cross-sectional study enrolled 105 Taiwanese participants aged ≥20 years, divided into five age groups per decade. Thicknesses of the dorsal superficial lamina (DSL), dorsal intermediate lamina (DIL), and dorsal deep lamina (DDL) were measured via ultrasonography by a single-blinded practitioner. The potential determining factors of the laminae thickness (age, sex, body mass index, and hand dominance) were analyzed.

RESULTS

The thicknesses of the three laminae decreased with aging, with the mean decrease in thickness from the 20s to >60 years in DSL, DIL, and DDL being 0.21 mm (30.0%), 1.38 mm (63.89%), and 0.31 mm (20.95%), respectively. DIL thickness decrease was the greatest and most significant since the 30s. Multiple linear regression analysis showed age as the only determinant for thicknesses of the 3 laminae (all P<0.001), whereas DIL was significantly thicker in men (P<0.001).

CONCLUSIONS

Volumetric fat loss was noted in the three fatty laminae of dorsal hands during aging; DIL has the greatest progressive fat loss since the 30s. Volumetric rejuvenation of the 3 laminae may result in the most esthetic appearance, especially in women.