Displacement of facial soft tissues in upright versus supine positions

Quantitative Mobility Analysis of the Face and its Relevance for Surgical and Non-surgical Aesthetic Facial Procedures

BACKGROUND

Understanding the degree of facial mobility upon postural changes is of great clinical relevance especially if facial assessment, facial measurements and/or facial markings are done in an upright position, but facial procedures are performed in a supine position.

OBJECTIVE

The objective of this study is to investigate regional facial skin displacement and facial volume changes in individuals between upright and supine positions.

METHODS

This multi-center study analyzed a total of 175 study participants with a mean age of 35.0 (10.2) years and a mean body mass index of 24.71 (3.5) kg/m². 3D surface scanning technology with automated registration and alignment was utilized, and multivariate analyses were performed with adjustment for age, gender, body mass index, facial skin sagging and laxity.

RESULTS

The medial face displaced less than the lateral face in both cranial (0.88 mm) and in lateral (0.76 mm) directions, and the lower face displaced more than the middle face in both cranial (1.17 mm) and lateral directions (1.37 mm). Additionally, the medial face lost, on average, 3.00cc whereas the lateral face increased by 5.86cc in volume; the middle face increased by 2.95cc, whereas the lower face decreased by 0.98cc in volume. All p < 0.001.

CONCLUSION

Practitioners should be mindful that there is a statistically significant change in facial soft tissues between the upright and supine positions and that the magnitude of the change does not necessarily reflect on the aging process alone but is a multi-factorial process which should be individualized for each patient's needs.

LEVEL OF EVIDENCE IV

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Three-dimensional prediction of nose morphology in Chinese young adults: a pilot study combining cone-beam computed tomography and 3dMD photogrammetry system

The nose is the most prominent part of the face and is a crucial factor for facial esthetics as well as facial reconstruction. Although some studies have explored the features of external nose and predicted the relationships between skeletal structures and soft tissues in the nasal region, the reliability and applicability of methods used in previous studies have not been reproduced. In addition, the majority of previous studies have focused on the sagittal direction, whereas the thickness of the soft tissues was rarely analyzed in three dimensions. A few studies have explained the specific characteristics of the nose of Chinese individuals. The aim of this study was to investigate the relationship between the hard nasal structures and soft external nose in three dimensions and to predict the morphology of the nose based on hard-tissue measurements. To eliminate the influence of low resolution of CBCT and increase the accuracy of measurement, three-dimensional (3D) images captured by cone-beam computed tomography (CBCT) and 3dMD photogrammetry system were used in this study. Twenty-six measurements (15 measurements for hard tissue and 11 measurements for soft tissue) based on 5 craniometric and 5 capulometric landmarks of the nose of 120 males and 120 females were obtained. All of the subjects were randomly divided into an experimental group (180 subjects consisting of 90 males and 90 females) and a test group (60 subjects consisting of 30 males and 30 females). Correlation coefficients between hard- and soft-tissue measurements were analyzed, and regression equations were obtained based on the experimental group and served as predictors to estimate nasal morphology in the test group. Most hard- and soft-tissue measurements appeared significantly different between genders. The strongest correlation was found between basis nasi protrusion and nasospinale protrusion (0.499) in males, and nasal height and nTr-nsTr (0.593) in females. For the regression equations, the highest value of R² was observed in the nasal bridge length in males (0.257) and nasal tip protrusion in females (0.389). The proportion of subjects with predicted errors < 10% was over 86.7% in males and 70.0% in females. Our study proved that a combined CBCT and 3dMD photogrammetry system is a reliable method for nasal morphology estimation. Further research should investigate other influencing factors such as age, skeletal types, facial proportions, or population variance in nasal morphology estimation.

Skeletal dimensions as predictors for the shape of the nose in a South African sample: A cone-beam computed tomography (CBCT) study

The profile of the nose is an important feature for facial approximations. Although several manual and semi-automated prediction guidelines exist for estimating the shape of the nose, the reliability and applicability of these methods to South Africans groups are unknown. The aim of this study was to predict the displacements of capulometric landmarks from hard-tissue planes to facilitate nasal soft-tissue reconstruction in a South African sample. Cone beam computed tomography (CBCT) scans of 120 adult South Africans were selected from the Oral and Dental Hospital, University of Pretoria, South Africa. Measurements involving craniometric and capulometric landmarks of the nose were obtained as plane-to-plane distances. Correlation coefficients between hard- and soft-tissue measurements were determined, and regression equations computed to assist in the prediction of the most probable shape and size of the nose. All hard- and soft-tissue measurements appeared significantly different between groups, except for the distance between the pronasale and nasion in the transverse plane and for the distance between the alare and the nasion in the coronal plane. The nasal height, nasal bone length and the nasal bone projection were significant predictors of the pronasale, subnasale and alare positions. More precisely, the nasal height and the nasal bone length were significant predictors of the pronasale position in both groups. Nasal bone projection was only useful for predicting shape in white South Africans. The variation in the skeletal predictors of the external shape of the nose noted between black and white South Africans and the results of the cross-validation testing emphasize the need for population specific guidelines.