Medicine › Dermatology

Facial Rejuvenation and Surgery Techniques

Works Count: 29550

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This cluster of papers focuses on the use of hyaluronic acid and other dermal fillers for facial rejuvenation, including their anatomical implications, clinical applications, complications, and adverse reactions. It covers topics such as soft tissue augmentation, aging face, and the safety and efficacy of various filler materials.

Keywords

Hyaluronic Acid; Dermal Fillers; Facial Rejuvenation; Soft Tissue Augmentation; Complications; Aging Face; Cosmetic Surgery; Adverse Reactions; Anatomy; Clinical Implications

Hyaluronic acid gel (Juv&eacute;derm&trade;) preparations in the treatment of facial wrinkles and folds

2008-12-01

Leslie Baumann

Hyaluronic acid gel (Juvéderm™) preparations in the treatment of facial wrinkles and folds Inja Bogdan Allemann, Leslie BaumannUniversity of Miami Cosmetic Group, Leonard M. Miller School of Medicine, Miami Heart … Hyaluronic acid gel (Juvéderm™) preparations in the treatment of facial wrinkles and folds Inja Bogdan Allemann, Leslie BaumannUniversity of Miami Cosmetic Group, Leonard M. Miller School of Medicine, Miami Heart Institute, Miami Beach, Florida, USAAbstract: Soft tissue augmentation with temporary dermal fillers is a continuously growing field, supported by the ongoing development and advances in technology and biocompatibility of the products marketed. The longer lasting, less immunogenic and thus more convenient hyaluronic acid (HA) fillers are encompassing by far the biggest share of the temporary dermal filler market. Since the approval of the first HA filler, Restylane®, there are at least 10 HA fillers that have been approved by the FDA. Not all of the approved HA fillers are available on the market, and many more are coming. The Juvéderm™ product line (Allergan, Irvine, CA), consisting of Juvéderm™ Plus and Juvéderm™ Ultra Plus, was approved by the FDA in 2006. Juvéderm™ is a bacterium-derived nonanimal stabilized HA. Juvéderm™ Ultra and Ultra Plus are smooth, malleable gels with a homologous consistency that use a new technology called "Hylacross™ technology". They have a high concentration of cross-linked HAs, which accounts for its longevity. Juvéderm™ Ultra Plus is used for volumizing and correcting deeper folds, whereas Juvéderm™ Ultra is best for contouring and volumizing medium depth facial wrinkles and lip augmentation. Various studies have shown the superiority of the HA filler products compared with collagen fillers for duration, volume needed, and patient satisfaction. Restylane®, Perlane®, and Juvéderm™ are currently the most popular dermal fillers used in the United States.Keywords: hyaluronic acid gel, Juvéderm™, facial wrinkles, facial folds

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Changes in the Facial Skeleton With Aging: Implications and Clinical Applications in Facial Rejuvenation

2012-05-11

Bryan C. Mendelson , Chin-Ho Wong

In principle, to achieve the most natural and harmonious rejuvenation of the face, all changes that result from the aging process should be corrected. Traditionally, soft tissue lifting and redraping … In principle, to achieve the most natural and harmonious rejuvenation of the face, all changes that result from the aging process should be corrected. Traditionally, soft tissue lifting and redraping have constituted the cornerstone of most facial rejuvenation procedures. Changes in the facial skeleton that occur with aging and their impact on facial appearance have not been well appreciated. Accordingly, failure to address changes in the skeletal foundation of the face may limit the potential benefit of any rejuvenation procedure. Correction of the skeletal framework is increasingly viewed as the new frontier in facial rejuvenation. It currently is clear that certain areas of the facial skeleton undergo resorption with aging. Areas with a strong predisposition to resorption include the midface skeleton, particularly the maxilla including the pyriform region of the nose, the superomedial and inferolateral aspects of the orbital rim, and the prejowl area of the mandible. These areas resorb in a specific and predictable manner with aging. The resultant deficiencies of the skeletal foundation contribute to the stigmata of the aging face. In patients with a congenitally weak skeletal structure, the skeleton may be the primary cause for the manifestations of premature aging. These areas should be specifically examined in patients undergoing facial rejuvenation and addressed to obtain superior aesthetic results.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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Comparison of Smooth-Gel Hyaluronic Acid Dermal Fillers with Cross-linked Bovine Collagen: A Multicenter, Double-Masked, Randomized, Within-Subject Study

2007-12-07

Leslie Baumann , Ava Shamban , Mary P. Lupo +4 more

BACKGROUND A new family of next-generation non-animal hyaluronic acid (HA) dermal fillers was approved by the FDA in June 2006. Compared with other HA fillers available in the United States … BACKGROUND A new family of next-generation non-animal hyaluronic acid (HA) dermal fillers was approved by the FDA in June 2006. Compared with other HA fillers available in the United States at the time of writing, these new fillers have a higher concentration of HA, higher concentration of cross-linked HA, and a smooth consistency—which should promote long-lasting corrections and a smooth, natural look and feel postinjection. OBJECTIVE The objective was to compare the effectiveness and safety of these smooth-gel HA dermal fillers with bovine collagen for nasolabial fold (NLF) correction. METHODS AND MATERIALS A total of 439 subjects with moderate or severe NLFs received one of three types of smooth-gel HA dermal filler (in one NLF) and cross-linked bovine collagen (in the other NLF) and were evaluated for ≤24 weeks. RESULTS All three HA dermal fillers achieved considerably longer-lasting clinical correction than bovine collagen; 81% to 90% of HA dermal filler–treated NLFs maintained a clinically significant improvement from baseline for ≥6 months. Up to 88% of subjects preferred the HA dermal fillers over bovine collagen. All fillers were similarly well tolerated. CONCLUSION The smooth-gel HA dermal fillers offer longer-lasting correction than bovine collagen—which may lessen the frequency that repeat treatments are needed. Also, they were preferred by the vast majority of subjects—which should promote patient satisfaction.

Advances in Facial Rejuvenation: Botulinum Toxin Type A, Hyaluronic Acid Dermal Fillers, and Combination Therapies???-Consensus Recommendations

2008-04-22

Jean Carruthers , Richard G. Glogau , Andrew Blitzer

Facial aesthetics and rejuvenation are evolving rapidly due to changes in products, procedures, and patient demographics. Clinicians can benefit from ongoing guidance on products, tailoring treatments to individual patients, treating … Facial aesthetics and rejuvenation are evolving rapidly due to changes in products, procedures, and patient demographics. Clinicians can benefit from ongoing guidance on products, tailoring treatments to individual patients, treating multiple facial areas, and using combinations of products and ways to optimize outcomes.A multidisciplinary group of aesthetic treatment experts convened to review the properties and uses of botulinum toxin type A (BoNTA) and hyaluronic acid fillers and to update consensus recommendations for facial rejuvenation using these two types of products. The group considered paradigm shifts in facial aesthetics; optimal techniques for using BoNTA and hyaluronic acid fillers alone and in combination; the influence of patient sex, ethnicity, cultural ideals, and skin color on treatment; general techniques; patient education and counseling; and emerging trends and needs in facial rejuvenation.The group provided specific recommendations by facial area, focusing on relaxing musculature, restoring volume, and recontouring using BoNTA and hyaluronic acid fillers alone and in combination. For the upper face, BoNTA remains the cornerstone of treatment, with hyaluronic acid fillers used to augment results. These fillers are central to the midface because of the need to restore volume. BoNTA and hyaluronic acid in combination can improve outcomes in the lower face.Optimal outcomes in facial aesthetics require in-depth knowledge of facial aging and anatomy, an appreciation that rejuvenation is a three-dimensional process involving muscle control, volume restoration, and recontouring, and thorough knowledge of properties and techniques specific to each product in the armamentarium.

Adverse reactions to injectable soft tissue fillers

2010-12-16

Luís Requena , Celia Requena , Lise Christensen +3 more

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Endoscopic facial rejuvenation: Endoforehead, the functional lift. Case reports

1994-01-01

Nicanor G. Isse

Human Histology and Persistence of Various Injectable Filler Substances for Soft Tissue Augmentation

2003-10-01

Gottfried Lemperle , Vera B. Morhenn , Ulrich Charrier

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Crosslinked hyaluronic acid dermal fillers: A comparison of rheological properties

2008-01-15

Samuel J. Falcone , Richard A. Berg

Temporary dermal fillers composed of crosslinked hyaluronic acid (XLHA) are space filling gels that are readily available in the United States and Europe. Several families of dermal fillers based on … Temporary dermal fillers composed of crosslinked hyaluronic acid (XLHA) are space filling gels that are readily available in the United States and Europe. Several families of dermal fillers based on XLHA are now available and here we compare the physical and rheological properties of these fillers to the clinical effectiveness. The XLHA fillers are prepared with different crosslinkers, using HA isolated from different sources, have different particle sizes, and differ substantially in rheological properties. For these fillers, the magnitude of the complex viscosity, |eta*|, varies by a factor of 20, the magnitude of the complex rigidity modulus, |G*|, and the magnitude of the complex compliance, |J*| vary by a factor of 10, the percent elasticity varies from 58% to 89.9%, and the tan delta varies from 0.11 to 0.70. The available clinical data cannot be correlated with either the oscillatory dynamic or steady flow rotational rheological properties of the various fillers. However, the clinical data appear to correlate strongly with the total concentration of XLHA in the products and to a lesser extent with percent elasticity. Hence, our data suggest the following correlation: dermal filler persistence = [polymer] x [% elasticity] and the clinical persistence of a dermal filler composed of XLHA is dominated by the mass and elasticity of the material implanted. This work predicts that the development of future XLHA dermal filler formulations should focus on increasing the polymer concentration and elasticity to improve the clinical persistence.

Changes in ocular globe-to-orbital rim position with age: Implications for aesthetic blepharoplasty of the lower eyelids

1999-09-01

Joel E. Pessa , Lisa D. Desvigne , Val Lambros +3 more

Levator Resection for Minimal Ptosis: Another Simplified Operation

1961-04-01

R.M. Fasanella , Javier Servat

In cases of ptosis demonstrating a fair to good levator action, some procedure utilizing the principals described by Blascovic<sup>1</sup>is still considered the operation of choice. In an attempt to shorten … In cases of ptosis demonstrating a fair to good levator action, some procedure utilizing the principals described by Blascovic<sup>1</sup>is still considered the operation of choice. In an attempt to shorten the operative time and simplify the technical difficulties often encountered especially by the ophthalmic surgeon who does ptosis surgery only "occasionally," many modifications of this procedure have been devised and described. In this paper we are presenting another modification of Blascovic's original levator resection intended only for cases of minimal ptosis (3 to 4 mm.) with some function of the levator showing a fair lid fold and in the absence of the "jaw-winking" phenomenon of Marcus Gunn. In our last 4 cases of minimal ptosis we have utilized a simplified and fast procedure (10 min.). Essentially the operation consists of a resection of the levator (or better Müller's and levator), tarsus, and conjunctiva. For this reason, it may

The Tarsal Strip Procedure

1979-11-01

Richard L. Anderson , Dennis D. Gordy

We have developed a procedure that is particularly useful for (1) paralytic or senile upper and lower eyelid laxity, (2) lateral canthal tendon laxity or malposition, and (3) iatrogenic phimosis … We have developed a procedure that is particularly useful for (1) paralytic or senile upper and lower eyelid laxity, (2) lateral canthal tendon laxity or malposition, and (3) iatrogenic phimosis associated with recurrent entropion or ectropion after traditional lid-shortening procedures. Lateral canthal tendon laxity or elongation is the primary problem in the majority of these cases, and eyelid tightening with use of lateral tarsal strips corrects this deformity. The midtarsal portion of the eyelid, which is usually resected in traditional lid-shortening procedures, is seldom elongated, and recurrences of laxity are common secondary to further stretching of lax tendons. The technique involves a lateral canthotomy and transection of the appropriate crus of the lateral canthal tendon. The eyelid is then split into anterior and posterior lamellae, and tarsal strips are fashioned from the posterior lamella. The tarsal strips are sutured to periosteum at the lateral orbital wall, adjusting the height and tension of the lateral canthus. This technique gives a normal appearance to the lateral canthal angle and has yielded good results in 51 cases.

Safety Data of Injectable Nonanimal Stabilized Hyaluronic Acid Gel for Soft Tissue Augmentation

2002-06-01

Paul M. Friedman , Erick A. Mafong , Arielle N.B. Kauvar +1 more

Nonanimal hyaluronic acid gel was recently developed for soft tissue augmentation and volume expansion and has been shown to offer several advantages in comparison to other augmentation materials. There are … Nonanimal hyaluronic acid gel was recently developed for soft tissue augmentation and volume expansion and has been shown to offer several advantages in comparison to other augmentation materials. There are rare reports of adverse events believed to be secondary to trace amounts of proteins in the hyaluronic acid raw material.To determine the safety profile of nonanimal stabilized hyaluronic acid gel (Restylane, Perlane, Restylane Fine Lines, Q-Med AB, Uppsala, Sweden) for soft tissue augmentation using a retrospective review of all adverse events data from Europe, Canada, Australia, South American, and Asia from 1999 and 2000.Data from an estimated 144,000 patients treated in 1999 indicated the major reaction to injectable hyaluronic acid was localized hypersensitivity reactions, occurring in approximately 1 of every 1400 patients treated. In 1999 there was an adverse event reported for 1 of every 650 patients (0.15%) treated. These were temporary events that included redness, swelling, localized granulomatous reactions, bacterial infection, as well as acneiform and cystic lesions. For 2000 there was an estimated 262,000 patients treated with hyaluronic acid gel. The total number of adverse events was 144, corresponding to one adverse event for every 1800 patients (0.06%) treated. The major adverse event was again hypersensitivity, occurring in 1 of every 5000 patients treated.According to the reported worldwide adverse events data, hypersensitivity to nonanimal hyaluronic acid gel is the major adverse event and is most likely secondary to impurities of bacterial fermentation. According to data from 2000, the incidence of hypersensitivity appears to be declining after the introduction of a more purified hyaluronic acid raw material.

Filling the Periorbital Hollows With Hyaluronic Acid Gel: Initial Experience With 244 Injections

2006-09-01

Robert A. Goldberg , Danica Fiaschetti

In Brief Purpose: To review our initial experience using hyaluronic acid gel (Restylane) as a filler to treat the periorbital hollows. Methods: This is a retrospective, anecdotal case review of … In Brief Purpose: To review our initial experience using hyaluronic acid gel (Restylane) as a filler to treat the periorbital hollows. Methods: This is a retrospective, anecdotal case review of 244 cosmetic hyaluronic acid gel injections in 155 patients. An average volume of 0.9 ml per injection session was used in an individualized pattern that variably included the orbital rim hollow, zygomatic hollow, septal confluence hollow, and eyebrow and cheek fat pad. To achieve smooth contours, a layered, feathered threading technique was used, placing the filler deep to the orbicularis. Hyaluronidase injections were used in 11% of patients at follow-up visits to "dissolve" some of the filler to reduce contour irregularities. Results: One hundred eight of 121 (89%) patients with follow-up visits were satisfied with the cosmetic improvement after hyaluronic acid gel injections. For maintenance, the interval to second injection averaged 6.5 months. Side effects included lumps or contour irregularities (11%), bruising (10%), color change (7%), and fluid (15%). Twelve patients were unsatisfied and were not interested in additional injections: 5 with malar fluid, 3 with lumpy irregularity, and 3 with color change. Conclusions: Complex 3-dimensional contours and thin skin over bone render periorbital filling difficult. However, with individualized planning and with care taken to create smooth, feathered contours, it is possible to achieve acceptable improvement. We found that most patients considered themselves improved cosmetically, despite occasional side effects including contour irregularity or lumps, bruising, color change, and fluid accumulation. Patients with very thin skin, preexisting color problems, or preexisting eyelid fluid may not be good candidates for periorbital filling with hyaluronic acid gel. The effect of the filler is temporary, of course, and we counsel patients to anticipate maintenance injections at 6- to 12-month intervals. Hyaluronic acid gel injections can be successfully used for aesthetic improvement of the periorbital hollows.

Dermal fillers in aesthetics: an overview of adverse events and treatment approaches

2013-12-01

Tatjana Pavicic , David K. Funt

Background: The ever-expanding range of dermal filler products for aesthetic soft tissue augmentation is of benefit for patients and physicians, but as indications and the number of procedures performed increase, … Background: The ever-expanding range of dermal filler products for aesthetic soft tissue augmentation is of benefit for patients and physicians, but as indications and the number of procedures performed increase, the number of complications will likely also increase. Objective: To describe potential adverse events associated with dermal fillers and to provide structured and clear guidance on their treatment and avoidance. Methods: Reports of dermal filler complications in the medical literature were reviewed and, based on the publications retrieved and the authors' extensive experience, recommendations for avoiding and managing complications are provided. Results: Different dermal fillers have widely varying properties, associated risks, and injection requirements. All dermal fillers have the potential to cause complications. Most are related to volume and technique, though some are associated with the material itself. The majority of adverse reactions are mild and transient, such as bruising and trauma-related edema. Serious adverse events are rare, and most are avoidable with proper planning and technique. Conclusion: For optimum outcomes, aesthetic physicians should have a detailed understanding of facial anatomy; the individual characteristics of available fillers; their indications, contraindications, benefits, and drawbacks; and ways to prevent and avoid potential complications. Keywords: aesthetic medicine, complications

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Hyaluronic acid skin fillers: Adverse reactions and skin testing

2001-12-01

Nicholas J. Lowe , C. Anne Maxwell , Philippa Lowe +2 more

Consensus Recommendations for Soft-Tissue Augmentation with Nonanimal Stabilized Hyaluronic Acid (Restylane)

2006-03-01

Seth L. Matarasso , Jean Carruthers , Mark L. Jewell

Summary: The American Society for Aesthetic Plastic Surgery recently reported that there were nearly 12 million cosmetic procedures (2.1 million surgical and 9.7 million nonsurgical) performed in the United States … Summary: The American Society for Aesthetic Plastic Surgery recently reported that there were nearly 12 million cosmetic procedures (2.1 million surgical and 9.7 million nonsurgical) performed in the United States in 2004. Almost 900,000 of the nonsurgical procedures were soft-tissue augmentation procedures using hyaluronic acid fillers. Restylane (Medicis Aesthetics, Inc., Scottsdale, Ariz.), nonanimal stabilized hyaluronic acid, was approved for use in the United States in December of 2003. Although the use of all fillers increased from 2003 to 2004, use of hyaluronic acid fillers increased nearly 700 percent. The dramatic increase in all cosmetic procedures reflects the growing trend, especially with increasing job competition, to maintain a youthful lifestyle and appearance. Basic recommendations for aesthetic use of Restylane were established based on short- and long-term efficacy and safety studies (Medicis Aesthetics, package insert). With the widespread and growing use of Restylane, a cross-sectional panel of experts with extensive clinical experience, including cosmetic dermatologists and surgical specialists (cosmetic, plastic, and ocular), convened to develop consensus guidelines for the use of Restylane. This supplement reviews the aesthetic affects of aging on the face, the role of fillers in facial soft-tissue volume replacement, and general principles for the use of Restylane, including patient comfort and assessment techniques. Specific recommendations for Restylane use in each potential target area, including type of anesthesia, injection techniques, volume for injection, use in combination with other procedures, and expected longevity of corrections, are provided. Techniques for optimizing patient outcomes and satisfaction and for minimizing and managing expected problems and potential complications are described.

The Youthful Cheek and the Deep Medial Fat Compartment

2008-05-23

Rod J. Rohrich , Joel E. Pessa , Brunno Ristow

Purpose: This article introduces the concept of pseudoptosis as a mechanism of midfacial aging: diminished volume of a specific deep fat compartment leads to an excess skin envelope and the … Purpose: This article introduces the concept of pseudoptosis as a mechanism of midfacial aging: diminished volume of a specific deep fat compartment leads to an excess skin envelope and the illusion of a more prominent nasolabial fold. Tha anatomy of this deep fat compartment, and of two others, is described. Methods: Fourteen hemifacial cadaver dissections were performed using the dye injection technique to identify deep medial cheek, submentalis, and sub–orbicularis oris fat compartments. Latex injection was used to investigate the arterial supply. Results: The deep medial fat compartment was defined in each subject. Two separate areas of deep medial fat exist. The more medial compartment abuts the pyriform membrane. The lateral component lies directly on the maxilla. The anatomy of submentalis and suborbicularis fat was defined. Conclusions: Loss of volume of deep medial cheek fat leads to pseudoptosis and is an additional determinant of the nasolabial fold. Augmentation of deep medial fat has four effects: it increases anterior projection (not addressed by lateral redraping alone); it diminishes the nasolabial fold; the V-deformity is corrected; and a youthful cheek with natural boundaries is recreated. The term “malar fat” is probably a misnomer: this region is composed of both distinct superficial and deep fat compartments. Submentalis and sub–orbicularis oris fat play a role is the formation of the labiomental hollow and aging lip respectively. Understanding the anatomy of this area lends greater precision to our ability to rejuvenate the aging face.

The anatomy of the aging face: Volume loss and changes in 3-dimensional topography

2006-01-01

Sydney R. Coleman , R GROVER

Journal Article The Anatomy of the Aging Face: Volume Loss and Changes in 3-Dimensional Topography Get access Sydney R. Coleman, MD, Sydney R. Coleman, MD Dr. Coleman is Assistant Professor … Journal Article The Anatomy of the Aging Face: Volume Loss and Changes in 3-Dimensional Topography Get access Sydney R. Coleman, MD, Sydney R. Coleman, MD Dr. Coleman is Assistant Professor of Plastic Surgery in the Department of Surgery at New York University School of Medicine, New York, NY. Sydney Coleman, MD, 44 Hudson Street, New York, NY 10013. Search for other works by this author on: Oxford Academic PubMed Google Scholar Rajiv Grover, BSc, MB BS, MD, FRCS (Plast) Rajiv Grover, BSc, MB BS, MD, FRCS (Plast) Dr. Grover is Consultant Plastic and Aesthetic Surgeon, King Edward VII Hospital, London, UK. Search for other works by this author on: Oxford Academic PubMed Google Scholar Aesthetic Surgery Journal, Volume 26, Issue 1_Supplement, January 2006, Pages S4–S9, https://doi.org/10.1016/j.asj.2005.09.012 Published: 01 January 2006

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Evaluation of the safety of a non‐animal stabilized hyaluronic acid (NASHA – Q‐Medical, Sweden) in European countries: a retrospective study from 1997 to 2001

2004-06-11

P. André

ABSTRACT Background In Europe, several filler devices are currently on the market for use in aesthetic dermatology and some of them cause severe, permanent, adverse reactions. Since 1996 a non‐animal … ABSTRACT Background In Europe, several filler devices are currently on the market for use in aesthetic dermatology and some of them cause severe, permanent, adverse reactions. Since 1996 a non‐animal stabilized hyaluronic acid (NASHA) from Q‐Medical, Sweden, has been introduced and is becoming a leading product in aesthetic dermatology. Hyaluronic acid has no species specificity and skin testing is not recommended before treatment. Objective Our purpose was to evaluate the incidence of adverse reactions from 1997 to 2001 and the safety of NASHA after injections into the skin for aesthetic reasons. Method Surveys were sent to physicians in European countries that agreed to participate. This is a retrospective study. A total of 12 344 syringes were sold by the Q‐Medical to these physicians and we evaluated the total number of patients treated to 35% of this number (4320). We separated immediate hypersensitivity reactions from delayed reactions and analysed infectious and other types of reactions. Results From 1997 until 2001, 34 cases of hypersensitivity were reported: 16 cases of immediate hypersensitivity and 18 cases of delayed. The global risk of sensitivity is 0.8%. Since 2000, the amount of protein in the raw product has decreased and the incidence of hypersensitivity reactions is around 0.6%. As 50% of these reactions are immediate and resolved within less than 3 weeks, the risk of strong but transient, delayed reaction is around 0.3%. Four cases of abscess were reported. They were all sterile. No bacterial infection was found. Herpetic recurrence is possible after lip augmentation according to the technique of injection. No systemic reactions were reported. Conclusion NASHA is a very useful and safe filler product. Skin testing does not seem to be necessary.

Training the Generation X Plastic Surgeon: Dispelling the Myths?

2001-11-01

Rod J. Rohrich

An increasing number of injectable filler materials for facial wrinkles and folds points to the need for objective measurements of their effectiveness. Patient satisfaction is the goal, but proof of … An increasing number of injectable filler materials for facial wrinkles and folds points to the need for objective measurements of their effectiveness. Patient satisfaction is the goal, but proof of the value of a particular product requires objective measurement. A wrinkle assessment scale was developed as a simple tool for use by plastic surgeons, dermatologists, and aesthetic surgeons who want to assess the changes resulting from injecting filler materials in their patients. By correlating the grade of the wrinkle in the reference photographs with the wrinkle in a patient's face, a classification of 0 to 5 is assigned. Reliability of the scale was assessed by "live" judgment of 76 wrinkles by nine observers. The same rating was given to 92.7 percent of all wrinkles. In a second trial, photographs from 130 wrinkles were presented to eight observers who rated 89.4 percent of all wrinkles equally. A significant correlation of 87 percent was found between subjective ratings and objective wrinkle depth measured by profilometry on 40 silicone impressions. Manufacturers, monitors of clinical trials, health authorities, and most important, patients will benefit from objective data on current and new injectable materials.

Subcutaneous Incisionless (Subcision) Surgery for the Correction of Depressed Scars and Wrinkles

1995-06-01

David S. Orentreich , Norman Orentreich∥

BACKGROUND A new method of subcuticular underming for the treatment of depressed cutaneous scars and wrinkles is introduced. OBJECTIVE To define the newly coined term “Subcision” and to describe this … BACKGROUND A new method of subcuticular underming for the treatment of depressed cutaneous scars and wrinkles is introduced. OBJECTIVE To define the newly coined term “Subcision” and to describe this minor surgical procedure for treating depressed scars and wrinkles. METHODS A tri-beveled hypodermic needle is inserted through a puncture in the skin surface (hence, “incisionless” surgery), and its sharp edges are maneuvered under the defect to make subcuticular cuts or “-cisions.” RESULTS The depression is lifted by the releasing action of the procedure, as well as from connective tissue that forms in the course of normal wound healing. CONCLUSION This technique is useful in treating a variety of cutaneous depressions, including scars and wrinkles.

Blindness following Cosmetic Injections of the Face

2012-03-29

Davide Lazzeri , Tommaso Agostini , Michele Figus +3 more

Complications following facial cosmetic injections have recently heightened awareness of the possibility of iatrogenic blindness. The authors conducted a systematic review of the available literature to provide the best evidence … Complications following facial cosmetic injections have recently heightened awareness of the possibility of iatrogenic blindness. The authors conducted a systematic review of the available literature to provide the best evidence for the prevention and treatment of this serious eye injury.The authors included in the study only the cases in which blindness was a direct consequence of a cosmetic injection procedure of the face.Twenty-nine articles describing 32 patients were identified. In 15 patients, blindness occurred after injections of adipose tissue; in the other 17, it followed injections of various materials, including corticosteroids, paraffin, silicone oil, bovine collagen, polymethylmethacrylate, hyaluronic acid, and calcium hydroxyapatite.Some precautions may minimize the risk of embolization of filler into the ophthalmic artery following facial cosmetic injections. Intravascular placement of the needle or cannula should be demonstrated by aspiration before injection and should be further prevented by application of local vasoconstrictor. Needles, syringes, and cannulas of small size should be preferred to larger ones and be replaced with blunt flexible needles and microcannulas when possible. Low-pressure injections with the release of the least amount of substance possible should be considered safer than bolus injections. The total volume of filler injected during the entire treatment session should be limited, and injections into pretraumatized tissues should be avoided. Actually, no safe, feasible, and reliable treatment exists for iatrogenic retinal embolism. Nonetheless, therapy should theoretically be directed to lowering intraocular pressure to dislodge the embolus into more peripheral vessels of the retinal circulation, increasing retinal perfusion and oxygen delivery to hypoxic tissues.Risk, V.

Comparative Physical Properties of Hyaluronic Acid Dermal Fillers

2009-02-01

Jeffrey Kablik , Gary D. Monheit , Liping Yu +2 more

BACKGROUND Hyaluronic acid (HA) fillers are becoming the material of choice for use in cosmetic soft tissue and dermal correction. HA fillers appear to be similar, but their physical characteristics … BACKGROUND Hyaluronic acid (HA) fillers are becoming the material of choice for use in cosmetic soft tissue and dermal correction. HA fillers appear to be similar, but their physical characteristics can be quite different. These differences have the potential to affect the ability of the physician to provide the patient with a natural and enduring result. OBJECTIVE The objective of this article is to discuss the key physical properties and methods used in characterizing dermal fillers. These methods were then used to analyze several well-known commercially available fillers. METHODS AND MATERIALS Analytical methods were employed to generate data on the properties of various fillers. The measured physical properties were concentration, gel-to-fluid ratio, HA gel concentration, degree of HA modification, percentage of cross-linking, swelling, modulus, and particle size. RESULTS The results demonstrated that commercial fillers exhibit a wide variety of properties. CONCLUSION Combining the objective factors that influence filler performance with clinical experience will provide the patient with the optimal product for achieving the best cosmetic result. A careful review of these gel characteristics is essential in determining filler selection, performance, and patient expectations. Jeffrey Kablik, LiPing Yu, Grace Chang, and Julia Gershkovich are employees of Genzyme Corporation. The materials used in this study were provided by Genzyme.

Adverse Reactions to Injectable Soft Tissue Permanent Fillers

2005-01-01

Lise Christensen , Vibeke Breiting , Martin Janssen +2 more

Observations on Periorbital and Midface Aging

2007-10-01

Val Lambros

Background: Many of the anatomical changes of facial aging are still poorly understood. This study looked at the aging process in individuals linearly over time, focusing on aspects of periorbital … Background: Many of the anatomical changes of facial aging are still poorly understood. This study looked at the aging process in individuals linearly over time, focusing on aspects of periorbital aging and the upper midface. Methods: The author compared photographs of patients’ friends and relatives taken 10 to 50 years before with closely matched recent follow-up pictures. The best-matching old and recent pictures were equally sized and superimposed in the computer. The images were then assembled into GIF animations, which automate the fading of one image into the other and back again indefinitely. Results: The following findings were new to the author: (1) the border of the pigmented lid skin and thicker cheek skin (the lid-cheek junction) is remarkably stable in position over time, becoming more visible by contrast, not by vertical descent as is commonly assumed. (2) Orbicularis wrinkles on the cheek and moles and other markers on the upper midface were also stable over decades. (3) With aging, there can be a distinct change in the shape of the upper eyelid. The young upper lid frequently has a medially biased peak. The upper lid peak becomes more central in the older lid. This article addresses these three issues. No evidence was seen here for descent of the globe in the orbit. Conclusions: There seems to be very little ptosis (inferior descent) of the lid-cheek junction or of the upper midface. These findings suggest that vertical descent of skin, and by association, subcutaneous tissue, is not necessarily a major component of aging in those areas. In addition, the arc of the upper lid changes shape in a characteristic way in some patients. Other known changes of the periorbital area are visualized.

Injectable Skin Fillers

2005-04-01

Rhoda S. Narins , Paul H. Bowman

An Anatomically Based Study of the Mechanism of Eyebrow Ptosis

1996-06-01

David M. Knize

The development of eyebrow ptosis with aging is commonly attributed to progressive laxity of scalp and forehead soft tissues. If the change in eyebrow position with aging resulted entirely from … The development of eyebrow ptosis with aging is commonly attributed to progressive laxity of scalp and forehead soft tissues. If the change in eyebrow position with aging resulted entirely from this basic mechanism of tissue stretching, uniform lowering of the medial and lateral eyebrow segments should occur. Clinical observations show, however, that the lateral eyebrow segment usually becomes ptotic earlier than the medial segment, indicating that a more complex mechanism exists. To clarify this process, anatomic studies were done on 20 (40 half-head) fresh cadaver specimens. Histologic studies also were performed to complement the gross anatomic findings. These studies confirm that the mechanism producing eyebrow ptosis has a relatively greater effect on the lateral eyebrow segment. The lateral eyebrow has less support from deeper structures than the medial eyebrow, and the balance of forces acting on the eyebrow selectively depresses the lateral segment. Structures that may promote mobility and gravitational descent of the eyebrow, especially the lateral eyebrow segment, are (1) the galea fat pad, (2) the preseptal fat pad, and (3) the subgalea fat pad glide plane space. Three forces that act on the lateral eyebrow are (1) frontalis muscle resting tone, which suspends that eyebrow segment medial to the temporal fusion line of the skull, (2) gravity, which causes the softtissue mass lateral to the temporal line to slide over the temporalis fascia plane and push the lateral eyebrow segment downward, and (3) corrugator supercilii muscle hyperactivity in conjunction with action of the lateral orbicularis oculi muscle, which can antagonize frontalis muscle activity and directly facilitate descent of the lateral eyebrow. The axis point for these forces is the temporal fusion line of the skull near the superior orbital rim. The interaction of those structures and forces contributing to the mechanism producing eyebrow ptosis is discussed. Derived concepts are applied to the execution of the forehead lift procedure. (Plast. Reconstr. Surg. 97: 1321, 1996.)

Simulating facial surgery using finite element models

1996-08-01

R Koch , Markus Groß , Friedrich R. Carls +3 more

Article Free Access Share on Simulating facial surgery using finite element models Authors: Rolf M. Koch Swiss Federal Institute of Technology, Institute for Information Systems, Department of Computer Science, ETH … Article Free Access Share on Simulating facial surgery using finite element models Authors: Rolf M. Koch Swiss Federal Institute of Technology, Institute for Information Systems, Department of Computer Science, ETH Zentrum, CH-8092 Zürich, Switzerland Swiss Federal Institute of Technology, Institute for Information Systems, Department of Computer Science, ETH Zentrum, CH-8092 Zürich, SwitzerlandView Profile , Markus H. Gross Swiss Federal Institute of Technology, Institute for Information Systems, Department of Computer Science, ETH Zentrum, CH-8092 Zürich, Switzerland Swiss Federal Institute of Technology, Institute for Information Systems, Department of Computer Science, ETH Zentrum, CH-8092 Zürich, SwitzerlandView Profile , Friedrich R. Carls Dept. of Maxillofacial Surgery, University Hospital, Zürich Dept. of Maxillofacial Surgery, University Hospital, ZürichView Profile , Daniel F. von Büren Swiss Federal Institute of Technology, Institute for Information Systems, Department of Computer Science, ETH Zentrum, CH-8092 Zürich, Switzerland Swiss Federal Institute of Technology, Institute for Information Systems, Department of Computer Science, ETH Zentrum, CH-8092 Zürich, SwitzerlandView Profile , George Fankhauser Swiss Federal Institute of Technology, Institute for Information Systems, Department of Computer Science, ETH Zentrum, CH-8092 Zürich, Switzerland Swiss Federal Institute of Technology, Institute for Information Systems, Department of Computer Science, ETH Zentrum, CH-8092 Zürich, SwitzerlandView Profile , Yoav I. H. Parish Swiss Federal Institute of Technology, Institute for Information Systems, Department of Computer Science, ETH Zentrum, CH-8092 Zürich, Switzerland Swiss Federal Institute of Technology, Institute for Information Systems, Department of Computer Science, ETH Zentrum, CH-8092 Zürich, SwitzerlandView Profile Authors Info & Claims SIGGRAPH '96: Proceedings of the 23rd annual conference on Computer graphics and interactive techniquesAugust 1996 Pages 421–428https://doi.org/10.1145/237170.237281Online:01 August 1996Publication History 205citation1,657DownloadsMetricsTotal Citations205Total Downloads1,657Last 12 Months59Last 6 weeks13 Get Citation AlertsNew Citation Alert added!This alert has been successfully added and will be sent to:You will be notified whenever a record that you have chosen has been cited.To manage your alert preferences, click on the button below.Manage my Alerts New Citation Alert!Please log in to your account Save to BinderSave to BinderCreate a New BinderNameCancelCreateExport CitationPublisher SiteeReaderPDF

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Arcus Marginalis Release and Orbital Fat Preservation in Midface Rejuvenation

1995-08-01

Sam T. Hamra

With aging, the periorbital area reveals progressive exposure of underlying skeletal anatomy as compared with the lower areas of the face, whose thicker soft tissues continue to cover underlying bony … With aging, the periorbital area reveals progressive exposure of underlying skeletal anatomy as compared with the lower areas of the face, whose thicker soft tissues continue to cover underlying bony landmarks. With recent techniques in cheek fat repositioning and orbicularis muscle repositioning, rejuvenation results of the midface have been markedly improved. Conventional lower blepharoplasty techniques that remove lower eyelid fat can create a concave contour deformity of the lower eyelids that causes the "operated" appearance. This paper describes a new technique to preserve the lower eyelid fat and to advance it beyond the infraorbital rim. An arcus marginalis release is accomplished, and the subseptal fat is advanced and sutured beyond the entire infraorbital rim and under the repositioned orbicularis muscle. By camouflaging the lower orbital rim anatomy, rejuvenation of the midface is more complete. A total of 152 cases have been done over a 3-year period with impressive results and minimal complications. This procedure is done in all composite rhytidectomies and in isolated blepharoplasty patients without advanced facial aging. It is particularly indicated in secondary procedures correcting overresection of orbital fat or deformities resulting from malar augmentation.

The Fat Compartments of the Face: Anatomy and Clinical Implications for Cosmetic Surgery

2007-05-23

Rod J. Rohrich , Joel E. Pessa

Background: Observation suggests that the subcutaneous fat of the face is partitioned as distinct anatomical compartments. Methods: Thirty hemifacial cadaver dissections were performed after methylene blue had been injected into … Background: Observation suggests that the subcutaneous fat of the face is partitioned as distinct anatomical compartments. Methods: Thirty hemifacial cadaver dissections were performed after methylene blue had been injected into specified regions. Initial work focused on the nasolabial fat. Dye was allowed to set for a minimum of 24 hours to achieve consistent diffusion. Dissection was performed in the cadaver laboratory using microscopic and loupe magnification. Results: The subcutaneous fat of the face is partitioned into multiple, independent anatomical compartments. The nasolabial fold is a discrete unit with distinct anatomical boundaries. What has been referred to as malar fat is composed of three separate compartments: medial, middle, and lateral temporal-cheek fat. The forehead is similarly composed of three anatomical units including central, middle, and lateral temporal-cheek fat. Orbital fat is noted in three compartments determined by septal borders. Jowl fat is the most inferior of the subcutaneous fat compartments. Some of the structures referred to as “retaining ligaments” are formed simply by fusion points of abutting septal barriers of these compartments. Conclusions: The subcutaneous fat of the face is partitioned into discrete anatomic compartments. Facial aging is, in part, characterized by how these compartments change with age. The concept of separate compartments of fat suggests that the face does not age as a confluent or composite mass. Shearing between adjacent compartments may be an additional factor in the etiology of soft-tissue malposition. Knowledge of this anatomy will lead to better understanding and greater precision in the preoperative analysis and surgical treatment of the aging face.

Aging of the Bony Orbit: A Three-Dimensional Computed Tomographic Study

2008-05-01

Daniel Kahn , R SHAWJR

Background: Facial aging is a dynamic process involving the aging of soft tissue and bony structures. The shape, size, and volume of the bony orbit have all been shown to … Background: Facial aging is a dynamic process involving the aging of soft tissue and bony structures. The shape, size, and volume of the bony orbit have all been shown to change with increasing age.

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Dermal filler agents: a practical review

2006-08-24

Sukhjit S Johl , Richard A. Burgett

Purpose of review Facial aging results from multiple microscopic (histopathologic) and macroscopic (anatomic) changes. Whereas skin care and traditional surgery have much to offer patients desiring cosmetic improvement, they can … Purpose of review Facial aging results from multiple microscopic (histopathologic) and macroscopic (anatomic) changes. Whereas skin care and traditional surgery have much to offer patients desiring cosmetic improvement, they can fail to adequately address certain signs of facial aging. Soft-tissue augmentation with dermal fillers can successfully address these signs of aging by filling soft-tissue defects caused by age, scar formation, or disease. All dermal fillers aim to achieve the same goal: long-lasting soft-tissue augmentation without side effects. Each dermal filler preparation available for patient use has unique compositions and characteristics that impact its proper handling, therapeutic results, potential complications, and, ultimately, its ideal use. This review surveys the currently available preparations for soft-tissue augmentation. Recent findings A review of the medical literature and manufacturers' information are included for dermal fillers currently approved for use by the US Food and Drug Administration. The composition, use, and potential limitation of each available preparation are reviewed. Summary Dermal filling agents offer an excellent option for management of certain facial cosmetic changes. Since a wide range of products with significantly different characteristics is available, the treating physician should have sound knowledge of them all.

Surgical Anatomy of the Midcheek and Malar Mounds

2002-09-01

Bryan C. Mendelson , Arshad R. Muzaffar , William P. Adams

The anatomy of the midcheek has not been satisfactorily described to adequately explain midcheek aging and malar mounds, nor has it suggested a logical approach to their correction or provided … The anatomy of the midcheek has not been satisfactorily described to adequately explain midcheek aging and malar mounds, nor has it suggested a logical approach to their correction or provided sufficient detail for safe surgery in this area. This cadaver study, which was complemented by many operative dissections, located a missing link: a glide plane space overlying the body of the zygoma. The space functions to allow mobility of the orbicularis oculi, where it overlies the zygoma and the origins of the elevator muscles to the upper lip. The space is a cleft between the sub-orbicularis oculi fat and the preperiosteal fat and is lined by a fine membrane. The anatomic boundaries are clearly defined by retaining ligaments, which correlate with the triangularity of the space. Several anatomic features provide the functional characteristics of the prezygomatic space, including the (1) absence of direct attachments between the orbicularis in the roof to the floor, (2) more rigid inferior boundary formed by the zygomatic ligaments, and (3) more mobile upper ligamentous boundary formed by the orbicularis retaining ligament (separating from the preseptal space of the lower lid). These components determine the characteristic aging changes that occur in this region and explain much about malar mounds. An appreciation of this anatomy has several surgical implications. The prezygomatic space is a junction area that can be approached from the temple, lower lid, and cheek. The zygomatic branches of the facial nerve to the orbicularis do not cross the space; rather, they course in the walls and in the sub-orbicularis fat within the roof of the space.

Injection Necrosis of the Glabella: Protocol for Prevention and Treatment After Use of Dermal Fillers

2006-03-15

Adrienne S. Glaich , Joel L. Cohen , Leonard H. Goldberg

BACKGROUND Injection of filler materials into the dermis is well tolerated with few mild and transient side effects. Injection necrosis is a rare but clinically important potential complication caused by … BACKGROUND Injection of filler materials into the dermis is well tolerated with few mild and transient side effects. Injection necrosis is a rare but clinically important potential complication caused by interruption of the vascular supply to the area by compression, injury, and/or obstruction of the vessel(s). The glabella is a particular danger zone for injection necrosis regardless of the type of filler used. OBJECTIVE We recommend a protocol that may be used to help prevent and treat injection necrosis of the glabella after injection with dermal fillers. CONCLUSION Injection necrosis in the glabellar region may be prevented by a knowledge of the local anatomy and an understanding of its pathophysiology and treated by a suggested protocol.

The science of hyaluronic acid dermal fillers

2008-01-01

Ahmet Tezel , Glenn H. Fredrickson

Background: The use of injectable materials for soft‐tissue augmentation has been increasing in the United States, reflecting the introduction of new hyaluronic acid (HA)‐based dermal fillers. HA dermal fillers vary … Background: The use of injectable materials for soft‐tissue augmentation has been increasing in the United States, reflecting the introduction of new hyaluronic acid (HA)‐based dermal fillers. HA dermal fillers vary widely in their physical and chemical characteristics and many variables contribute to their overall performance. This article explains the basic science of HA and describes how the physical properties of HA dermal fillers may influence clinical outcomes. Hyaluronic acid: The chemical composition of disaccharide HA monomers, and how they form polymer chains and are crosslinked into gels for dermal fillers are described. Hyaluronic acid dermal fillers: Key concepts and properties relevant to the production and performance of HA dermal fillers, such as the degree of crosslinking, gel hardness, gel consistency, viscosity, extrusion force, HA concentration, and extent of hydration are explained. New formulations of HA dermal fillers that have recently been approved by the US Food and Drug Administration differ from currently available HA fillers and may provide enhanced ease of extrusion and persistence over previous fillers. Conclusion: Knowledge of the chemical and physical blueprint of HA dermal fillers may help physicians in choosing the appropriate HA dermal filler for facial enhancements. This, together with appropriate injector training and injection experience, should lead to results that ultimately will benefit patients.

The dynamic anatomy and patterning of skin

2015-08-18

Richard Wong , Stefan H. Geyer , Wolfgang J. Weninger +2 more

The skin is often viewed as a static barrier that protects the body from the outside world. Emphasis on studying the skin's architecture and biomechanics in the context of restoring … The skin is often viewed as a static barrier that protects the body from the outside world. Emphasis on studying the skin's architecture and biomechanics in the context of restoring skin movement and function is often ignored. It is fundamentally important that if skin is to be modelled or developed, we do not only focus on the biology of skin but also aim to understand its mechanical properties and structure in living dynamic tissue. In this review, we describe the architecture of skin and patterning seen in skin as viewed from a surgical perspective and highlight aspects of the microanatomy that have never fully been realized and provide evidence or concepts that support the importance of studying living skin's dynamic behaviour. We highlight how the structure of the skin has evolved to allow the body dynamic form and function, and how injury, disease or ageing results in a dramatic changes to the microarchitecture and changes physical characteristics of skin. Therefore, appreciating the dynamic microanatomy of skin from the deep fascia through to the skin surface is vitally important from a dermatological and surgical perspective. This focus provides an alternative perspective and approach to addressing skin pathologies and skin ageing.

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Adverse Reactions to Dermal Fillers

2005-11-01

Nicholas J. Lowe , C. Anne Maxwell , Rickie Patnaik

For many patients, injectable filling agents offer the promise of facial rejuvenation while offering reduced risks compared with more invasive surgery. With the increase in products available and the rise … For many patients, injectable filling agents offer the promise of facial rejuvenation while offering reduced risks compared with more invasive surgery. With the increase in products available and the rise in the number of patients seeking this type of intervention, it is crucial that both the physician and the patient are fully cognizant of the risks involved with each product.To review the incidences and types of reaction to various commonly used injectable products.A literature review and personal experiences (gained largely in Europe over the past 8 years) of dermal fillers from 1996 to the present, including illustrative case reviews.Reactions can be attributed to the procedure itself, the procedural technique, and the agent injected. Some of these reactions are preventable, whereas others are inevitable; most are mild and transient. Improving product formulations, altering the concentration of product injected, or changing the injection technique can dramatically reduce the incidence of adverse reactions. Since its reformulation in mid-1999, the biologically engineered hyaluronic acid filler Restylane (Medicis Pharmaceuticals, Scottsdale, AZ, USA) elicits less than one allergic reaction in 1600 treatments. Skin reactions with poly-L-lactic acid (New-Fill/Sculptra, Dermik Laboratories, Berwyn, PA, USA) are considerably less likely if a greater dilution and deeper injection technique are employed.Different injectable products have highly divergent properties, associated risks, and injection requirements. The dermasurgeon should be suitably experienced to select and use these products correctly.

A Randomized, Double-Blind, Multicenter Comparison of the Efficacy and Tolerability of Restylane Versus Zyplast for the Correction of Nasolabial Folds

2003-06-01

Rhoda S. Narins , Fredric S Brandt , William D. James +3 more

Bovine collagen is extensively used for facial soft tissue augmentation but provides only temporary correction and can cause hypersensitivity reactions. Hyaluronic acid derivatives potentially offer improved longevity of correction and … Bovine collagen is extensively used for facial soft tissue augmentation but provides only temporary correction and can cause hypersensitivity reactions. Hyaluronic acid derivatives potentially offer improved longevity of correction and a reduced risk of immunogenicity and hypersensitivity.To compare the efficacy and safety of nonanimal stabilized hyaluronic acid gel (Restylane; Q-Med, Uppsala, Sweden) with that of bovine collagen (Zyplast) for treatment of nasolabial folds.One hundred thirty-eight patients with prominent nasolabial folds were randomized to treatment with hyaluronic acid gel and bovine collagen on contralateral sides of the face. Treatments were repeated at 2-week intervals, as required, to achieve "optimal cosmetic result" (baseline). Outcomes were evaluated by a blinded investigator at 2, 4, and 6 months after baseline.Less injection volume was required for "optimal cosmetic result" with hyaluronic acid gel than with bovine collagen, and patients and investigators judged hyaluronic acid gel to be more effective in maintaining cosmetic correction. The investigator-based Wrinkle Severity Rating Scale and Global Aesthetic Improvement Scale assessments at 6 months after baseline indicated that hyaluronic acid gel was superior in 56.9% and 62.0% of patients, respectively, whereas bovine collagen was superior in 9.5% and 8.0% of patients, respectively. The frequency, intensity, and duration of local injection-site reactions were similar for the two products.Nonanimal stabilized hyaluronic acid provides a more durable aesthetic improvement than bovine collagen and is well tolerated.

Müller Muscle-Conjunctiva Resection

1975-08-01

Allen M. Putterman , Martin J. Urist

A new technique for resecting the Müller muscle and the conjunctiva for correction of blepharoptosis has been developed. The operation is performed on all patients in whom a 10% phenylephrine … A new technique for resecting the Müller muscle and the conjunctiva for correction of blepharoptosis has been developed. The operation is performed on all patients in whom a 10% phenylephrine hydrochloride solution instilled in the conjunctival cul-de-sac will elevate the blepharoptotic eyelid to a cosmetically acceptable level. The results of the surgery have been satisfactory in 27 of 28 operated eyelids.

Arterial embolization caused by injection of hyaluronic acid (RestylaneR)

2002-05-01

Stefan Schanz , Wilfried Schippert , Anja Ulmer +2 more

Journal Article Arterial embolization caused by injection of hyaluronic acid (Restylane®) Get access S. Schanz, S. Schanz Department of Dermatology, University Hospital Tübingen, Liebermeisterstraße 25, D‐72076 Tübingen, Germany Search for … Journal Article Arterial embolization caused by injection of hyaluronic acid (Restylane®) Get access S. Schanz, S. Schanz Department of Dermatology, University Hospital Tübingen, Liebermeisterstraße 25, D‐72076 Tübingen, Germany Search for other works by this author on: Oxford Academic Google Scholar W. Schippert, W. Schippert Department of Dermatology, University Hospital Tübingen, Liebermeisterstraße 25, D‐72076 Tübingen, Germany Search for other works by this author on: Oxford Academic Google Scholar A. Ulmer, A. Ulmer Department of Dermatology, University Hospital Tübingen, Liebermeisterstraße 25, D‐72076 Tübingen, Germany Search for other works by this author on: Oxford Academic Google Scholar G. Rassner, G. Rassner Department of Dermatology, University Hospital Tübingen, Liebermeisterstraße 25, D‐72076 Tübingen, Germany Search for other works by this author on: Oxford Academic Google Scholar G. Fierlbeck G. Fierlbeck Department of Dermatology, University Hospital Tübingen, Liebermeisterstraße 25, D‐72076 Tübingen, Germany Correspondence: Prof. Dr Gerhard Fierlbeck. E‐mail: [email protected]‐tuebingen.de Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 146, Issue 5, 1 May 2002, Pages 928–929, https://doi.org/10.1046/j.1365-2133.2002.04707.x Published: 01 May 2002

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In Vivo Stimulation of De Novo Collagen Production Caused by Cross-linked Hyaluronic Acid Dermal Filler Injections in Photodamaged Human Skin

2007-02-01

Frank Wang , Luis A. Garza , Sewon Kang +4 more

<h3>Objective</h3> To determine whether endogenous synthesis of new extracellular matrix may contribute to the degree and duration of clinical benefits derived from cross-linked hyaluronic acid dermal filler injections. <h3>Design</h3> In … <h3>Objective</h3> To determine whether endogenous synthesis of new extracellular matrix may contribute to the degree and duration of clinical benefits derived from cross-linked hyaluronic acid dermal filler injections. <h3>Design</h3> In vivo biochemical analyses after filler injections. <h3>Setting</h3> Academic referral center. <h3>Participants</h3> Eleven healthy volunteers (mean age, 74 years) with photodamaged forearm skin. <h3>Interventions</h3> Filler and vehicle (isotonic sodium chloride) injected into forearm skin and skin biopsy specimens taken 4 and 13 weeks later. <h3>Main Outcome Measures</h3> De novo synthesis of collagen, the major structural protein of dermal extracellular matrix, was assessed using immunohistochemical analysis, quantitative polymerase chain reaction, and electron microscopy. <h3>Results</h3> Compared with controls, immunostaining in skin receiving cross-linked hyaluronic acid injections revealed increased collagen deposition around the filler. Staining for prolyl-4-hydroxylase and the C-terminal and N-terminal epitopes of type I procollagen was enhanced at 4 and 13 weeks after treatment (<i>P</i><.05). Gene expression for types I and III procollagen as well as several profibrotic growth factors was also up-regulated at 4 and 13 weeks compared with controls (<i>P</i><.05). Fibroblasts in filler-injected skin demonstrated a mechanically stretched appearance and a biosynthetic phenotype. In vitro, fibroblasts did not bind the filler, suggesting that cross-linked hyaluronic acid is not directly stimulatory. <h3>Conclusions</h3> Injection of cross-linked hyaluronic acid stimulates collagen synthesis, partially restoring dermal matrix components that are lost in photodamaged skin. We hypothesize that this stimulatory effect may be induced by mechanical stretching of the dermis, which in turn leads to stretching and activation of dermal fibroblasts. These findings imply that cross-linked hyaluronic acid may be useful for stimulating collagen production therapeutically, particularly in the setting of atrophic skin conditions.

Hyaluronic acid fillers

2006-05-01

Gary D. Monheit , Kyle Coleman

ABSTRACT: Although hyaluronic acids are a relatively new treatment for facial lines and wrinkles, they have provided numerous advances in the area of cosmetic surgery. This article discusses the inherent … ABSTRACT: Although hyaluronic acids are a relatively new treatment for facial lines and wrinkles, they have provided numerous advances in the area of cosmetic surgery. This article discusses the inherent properties of hyaluronic acid fillers that make them ideal for treatment of facial lines. It encompasses a review of the current literature on U.S. Food and Drug Administration-approved hyaluronic acid fillers and the role that each of these fillers currently has in facial cosmetics. This article also discusses the potential pitfalls and adverse effects that can be associated with using hyaluronic acids for filling facial lines. Finally, it serves as an overview of current techniques for clinical assessment of patients as well as administration and treatment of facial lines and wrinkles.

Complications of Injectable Fillers, Part 2: Vascular Complications

2014-04-02

Claudio DeLorenzi

Accidental intra-arterial filler injection may cause significant tissue injury and necrosis. Hyaluronic acid (HA) fillers, currently the most popular, are the focus of this article, which highlights complications and their … Accidental intra-arterial filler injection may cause significant tissue injury and necrosis. Hyaluronic acid (HA) fillers, currently the most popular, are the focus of this article, which highlights complications and their symptoms, risk factors, and possible treatment strategies. Although ischemic events do happen and are therefore important to discuss, they seem to be exceptionally rare and represent a small percentage of complications in individual clinical practices. However, the true incidence of this complication is unknown because of underreporting by clinicians. Typical clinical findings include skin blanching, livedo reticularis, slow capillary refill, and dusky blue-red discoloration, followed a few days later by blister formation and finally tissue slough. Mainstays of treatment (apart from avoidance by meticulous technique) are prompt recognition, immediate treatment with hyaluronidase, topical nitropaste under occlusion, oral acetylsalicylic acid (aspirin), warm compresses, and vigorous massage. Secondary lines of treatment may involve intra-arterial hyaluronidase, hyperbaric oxygen therapy, and ancillary vasodilating agents such as prostaglandin E1. Emergency preparedness (a “filler crash cart”) is emphasized, since early intervention is likely to significantly reduce morbidity. A clinical summary chart is provided, organized by complication presentation.

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Use of Hyaluronidase in the Treatment of Granulomatous Hyaluronic Acid Reactions or Unwanted Hyaluronic Acid Misplacement

2005-08-01

Harold J. Brody

Background In the past, reactions or misplacement of soft tissue fillers has been fraught with anxiety because time has been the main thrust for improvement in spite of ancillary treatments. … Background In the past, reactions or misplacement of soft tissue fillers has been fraught with anxiety because time has been the main thrust for improvement in spite of ancillary treatments. Hyaluronidase is an enzyme that dissolves hyaluronic acid in the skin and also assists in the management of granulomatous foreign-body reactions to hyaluronic acid. These reactions may be caused by allergy to the material or immunologic response to the protein contaminants in the hyaluronic acid preparations. Dissolution of material in erroneous placement of material and in allergic reactions can be a time saver and a deterrent to patient dissatisfaction. Objective To evaluate the use of hyaluronidase in the treatment of both allergic reactions and the erroneous misplacement of hyaluronic acid in the skin. Methods A case of persistent granulomatous reaction to injectable hyaluronic acid and a case of hyaluronic acid erroneous misplacement with their successful subsequent treatments using intracutaneous hyaluronidase are reported, along with illustrative examples of hyaluronidase use. Results The use of hyaluronidase reduced the patient discomfort within 24 to 48 hours, deterring any patient anxiety or patient dissatisfaction. Conclusions Hyaluronidase has a place in the treatment of allergic reactions to hyaluronidase and in the erroneous misplacement of the material.

Avoiding and Treating Blindness From Fillers

2015-09-10

Katie Beleznay , Jean Carruthers , Shannon Humphrey +1 more

BACKGROUND As the popularity of soft tissue fillers increases, so do the reports of adverse events. The most serious complications are vascular in nature and include blindness. OBJECTIVE To review … BACKGROUND As the popularity of soft tissue fillers increases, so do the reports of adverse events. The most serious complications are vascular in nature and include blindness. OBJECTIVE To review the cases of blindness after filler injection, to highlight key aspects of the vascular anatomy, and to discuss prevention and management strategies. METHODS A literature review was performed to identify all the cases of vision changes from filler in the world literature. RESULTS Ninety-eight cases of vision changes from filler were identified. The sites that were high risk for complications were the glabella (38.8%), nasal region (25.5%), nasolabial fold (13.3%), and forehead (12.2%). Autologous fat (47.9%) was the most common filler type to cause this complication, followed by hyaluronic acid (23.5%). The most common symptoms were immediate vision loss and pain. Most cases of vision loss did not recover. Central nervous system complications were seen in 23.5% of the cases. No treatments were found to be consistently successful in treating blindness. CONCLUSION Although the risk of blindness from fillers is rare, it is critical for injecting physicians to have a firm knowledge of the vascular anatomy and to understand key prevention and management strategies.

Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations

2018-01-05

Fernando Urdiales‐Gálvez , Nuria Escoda Delgado , Vitor Figueiredo +7 more

Dermal fillers have been increasingly used in minimally invasive facial esthetic procedures. This widespread use has led to a rise in reports of associated complications. The aim of this expert … Dermal fillers have been increasingly used in minimally invasive facial esthetic procedures. This widespread use has led to a rise in reports of associated complications. The aim of this expert consensus report is to describe potential adverse events associated with dermal fillers and to provide guidance on their treatment and avoidance. A multidisciplinary group of experts in esthetic treatments convened to discuss the management of the complications associated with dermal fillers use. A search was performed for English, French, and Spanish language articles in MEDLINE, the Cochrane Database, and Google Scholar using the search terms "complications" OR "soft filler complications" OR "injectable complications" AND "dermal fillers" AND "Therapy". An initial document was drafted by the Coordinating Committee, and it was reviewed and modified by the experts, until a final text was agreed upon and validated. The panel addressed consensus recommendations about the classification of filler complications according to the time of onset and about the clinical management of different complications including bruising, swelling, edema, infections, lumps and bumps, skin discoloration, and biofilm formation. Special attention was paid to vascular compromise and retinal artery occlusion. Clinicians should be fully aware of the signs and symptoms related to complications and be prepared to confidently treat them. Establishing action protocols for emergencies, with agents readily available in the office, would reduce the severity of adverse outcomes associated with injection of hyaluronic acid fillers in the cosmetic setting. This document seeks to lay down a set of recommendations and to identify key issues that may be useful for clinicians who are starting to use dermal fillers. Additionally, this document provides a better understanding about the diagnoses and management of complications if they do occur. 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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Hyaluronic acid, a promising skin rejuvenating biomedicine: A review of recent updates and pre-clinical and clinical investigations on cosmetic and nutricosmetic effects

2018-10-01

Syed Nasir Abbas Bukhari , Nur Liyana Roswandi , Muhammad Waqas +7 more

Phaco-Emulsification and Aspiration

1967-07-01

Charles D. Kelman

Pretreatment with corticosteroids to alleviate reactions to intravenous contrast material

1988-05-01

Composite Rhytidectomy

1992-07-01

Sam T. Hamra

Signs of aging in the face reflect the change in position of deep anatomic elements, which are the platysma muscle, cheek fat, and the orbicularis oculi muscle. These changes occur … Signs of aging in the face reflect the change in position of deep anatomic elements, which are the platysma muscle, cheek fat, and the orbicularis oculi muscle. These changes occur from progressive ptosis of these elements, which continue to keep their intimate relationship with each other throughout the aging process. Conventional face lift procedures disrupt this normal relationship by separating the skin from these elements. All SMAS techniques reposition only the platysma muscle without repositioning the cheek fat and orbicularis muscle. This composite rhytidectomy allows elevation of a composite musculocutaneous flap containing all three elements for repositioning while maintaining their intimate relationship with each other and with the skin. One-hundred and sixty-seven composite rhytidectomies have been done with impressive results and minimal complications.

Discussion: A Conservative Crease-Height–Adjustable Asian Double-Eyelid Surgery Technique Based on Live Anatomical Studies

2025-06-25

Chin‐Ho Wong , Michael Ku Hung Hsieh | Plastic & Reconstructive Surgery

Validation of the Asian Midface Volume Deficit Severity Scale

2025-06-25

Jingyu Li , Lei Pan , Qing Yun +7 more | Aesthetic Plastic Surgery

Abstract Background Anatomical differences in facial aging and aesthetic needs of Asian and Caucasian individuals have led to disparate clinical rejuvenation strategies using filler augmentation for midface volume deficits. Therefore, … Abstract Background Anatomical differences in facial aging and aesthetic needs of Asian and Caucasian individuals have led to disparate clinical rejuvenation strategies using filler augmentation for midface volume deficits. Therefore, the Asian Midface Volume Deficit Severity Scale (AMVDSS) by LBTD (Lanzhou Biotechnique Development Co, Ltd) was developed to objectively assess midface volume deficits and clinical outcomes of Asian individuals. Methods Four observers independently rated randomized photographs (front, left and right 45°, left and right 90°) of 65 patients during two sessions with a 2-week interval using the AMVDSS. Results All participants were Asian (18 male and 47 female participants; mean age, 40.9 years; range, 20–76 years). Interobserver agreement was substantial to almost perfect for the left (weighted κ, 0.778–0.907) and right (weighted κ, 0.774–0.938) during the first session; it was almost perfect for the left (weighted κ, 0.844–0.907) and right (weighted κ, 0.805–0.876) during the second session. Interobserver agreement was 76.9% to 90.8% and 76.9% to 93.9% for the left and right, respectively, during the first session; it was 84.6% to 90.8% and 81.5% to 87.7% for the left and right, respectively, during the second session. Intraobserver agreement was “almost perfect” for both the left (weighted κ, 0.950; 95% confidence interval [CI] 0.923–0.977) and right (weighted κ, 0.954; 95% CI 0.928–0.980). Exact intraobserver agreement was 95.0% (range, 90.8–100.0%) for the left; it was 95.4% (range, 94.9–96.9%) for the right. Conclusions The AMVDSS by LBTD could be used to reliably assess midface volume deficits or volume changes after dermal filler injections. Level of Evidence II 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

Arterial Anatomy of the Tear Trough Region in Chinese Cadavers: Implications for Injection Safety

2025-06-25

Ling-cong Zhou , Weidong Zhao , Yunong Wu +3 more | Aesthetic Plastic Surgery

Aesthetic Management of the Lips, Chin and Submentum

2025-06-25

Jessyka G. Lighthall , Jason D. Bloom | Facial Plastic Surgery

Dimple Creation Surgery

2025-06-24

Kimberly J. Lee , Raffaello M. Cutri | Facial Plastic Surgery

Abstract Dimple creation surgery, or dimpleplasty, recreates the dynamic cheek indentations found in approximately 30% of faces. This review highlights current evidence and provides surgical insights for predictable, natural outcomes. … Abstract Dimple creation surgery, or dimpleplasty, recreates the dynamic cheek indentations found in approximately 30% of faces. This review highlights current evidence and provides surgical insights for predictable, natural outcomes. Since 1962, successive refinements of the technique have focused on smaller incisions and precise dermomuscular fixation. Awareness of zygomaticus major variants, orbicularis oculi bands, Stenson's duct, and buccal branches of the facial nerve underpins safe practice. Bipolar cautery may assist with hemostasis. Healthy adults with realistic expectations benefit most. Those with keloid tendency warrant caution. A 5-mm intraoral incision, selective muscle fenestration, and dermomuscular plication produce an immediate dimple that softens with healing. Brief oral antibiotics support recovery. AI-assisted 3D smile simulation is being conducted and refined to boost dimple creation precision and predictability. With surgical precision and careful patient selection, dimpleplasty remains a low-risk procedure that can deliver high patient satisfaction.

Nuances in Genioplasty

2025-06-24

Bailey R. Minehart , José E. Barrera | Facial Plastic Surgery

Abstract The goal of the article is to help surgeons understand the anatomy and surgical technique of alloplastic and osseous genioplasty. The article provides a brief history of cosmetic osseous … Abstract The goal of the article is to help surgeons understand the anatomy and surgical technique of alloplastic and osseous genioplasty. The article provides a brief history of cosmetic osseous genioplasty and the rise of alloplastic genioplasty after the 1950s. This study describes the vertical thirds of the face with anatomic landmarks and the zero meridian assessment for chin deficiencies. Use of virtual surgical planning for custom genioplasty advancements and hardware and the ultrasonic bone saw for bony cuts. This article also describes how to evaluate patients for genioplasty and determine if alloplastic or osseous genioplasty will result in the best patient desired outcome, including the degree of advancement desired, any change in vertical height, correction in horizontal asymmetry, or reduction of the chin. The surgical technique is described for both osseous and alloplastic genioplasty. An intraoral approach is described for osseous genioplasty, while external and intraoral is described for alloplastic. Brief discussion of postoperative care, including compressive dressings, postoperative edema, and duration of liquid diet. Improvement of custom planning with virtual surgical plans as well as development of implants with low risk of infection and extrusion. This study summarizes the anatomic importance of genioplasty with the advantages and disadvantages of osseous and alloplastic genioplasty.

Delayed Iatrogenic Nasal Hump Induced by Hyaluronic Acid Filler: A Rare Long-Term Complication

2025-06-24

Sae Bin Lee , Hyun Jin Min | Journal of Craniofacial Surgery

Rhinoplasty is frequently performed in Asian populations, with nonsurgical rhinoplasty using hyaluronic acid (HA) fillers becoming an increasingly popular alternative for patients seeking subtle corrections, those with contraindications to surgery, … Rhinoplasty is frequently performed in Asian populations, with nonsurgical rhinoplasty using hyaluronic acid (HA) fillers becoming an increasingly popular alternative for patients seeking subtle corrections, those with contraindications to surgery, or individuals preferring temporary, less-invasive solutions. HA fillers are often combined with other minimally invasive procedures, such as barbed thread insertion, to enhance aesthetic outcomes and overcome individual limitations. Although these procedures are generally considered safe, most complications are reported within a short treatment period, allowing for timely management. Here, the authors present a rare case of a patient who underwent nonsurgical rhinoplasty using HA fillers and barbed threads 4 years prior and later sought revision surgery due to a nasal dorsal hump. Medical management failed to improve the condition, prompting revision surgery. Intraoperatively, the hump was found to be a firm, fixed capsule of granulation tissue formed around the previously injected HA filler, rather than a true bony prominence. This case highlights the potential for delayed complications after nonsurgical rhinoplasty and underscores the importance of considering long-term tissue responses, particularly when multiple techniques are combined.

Maintaining the Integrity of Midface During Le Fort III Distraction with the Use of 'Glasgow Handlebar Plate' Technique

2025-06-24

Dieta Brandsma , G. Zotos , R. Sangra +2 more | International Journal of Oral and Maxillofacial Surgery

Risk Factors for Facial Swelling at 1 Week After Bimaxillary Surgery in Class III Patients

2025-06-24

Stefania A. Mari , Namiaki Takahara , Nobuyoshi Tomomatsu +2 more | International Journal of Oral and Maxillofacial Surgery

Adjunctive Aesthetic Procedures in Orthognathic Surgery: A Case Series

2025-06-24

Ezgi Yüceer Çetiner , S. Basa | International Journal of Oral and Maxillofacial Surgery

Orthofacial Surgery: Orthognathic Surgery With Facial Prosthesis and Cervical Liposuction

2025-06-24

P. Gallardo Suazo , Alejandro Bustos , Ferdane Melike Duran | International Journal of Oral and Maxillofacial Surgery

Functional vs Cosmetic Eyelid Surgery: Techniques Review & Caucasian Blephroplasty

2025-06-24

Futoon Jomman Ali Alomari | International Journal of Oral and Maxillofacial Surgery

Deep neck lift associated with orthognathic surgery as an option to improve cervical aesthetic results

2025-06-24

F. Carnevale | International Journal of Oral and Maxillofacial Surgery

Migrated Lip Filler: A new Differential Diagnosis?

2025-06-24

Z. Khalaf | International Journal of Oral and Maxillofacial Surgery

Insurance Coverage for Facial Masculinization Surgery Will Promote Gender-Affirming Health Equity

2025-06-23

Matteo Laspro , Erika Thys , Alexandra Verzella +4 more | Transgender Health

The patho-anatomy of facial or fallopian canal dehiscence: a systematic review with meta-analysis of observational studies

2025-06-23

Adil Asghar , Ravi Kant Narayan , Ananya Priya +3 more | Indian Journal of Otolaryngology and Head & Neck Surgery

Effect of Poly-D,L-Lactic Acid (PDLLA) Biostimulator on Facial Rejuvenation Markers in Late Middle-Aged Thai Women: A Quasi-Experimental Study

2025-06-23

| Journal of the Medical Association of Thailand

Background: The quality of skin, especially its elasticity, hydration, and collagen, diminishes with age, contributing to visible signs of aging. Poly-D,L-lactic acid (PDLLA) has emerged as a biostimulator that can … Background: The quality of skin, especially its elasticity, hydration, and collagen, diminishes with age, contributing to visible signs of aging. Poly-D,L-lactic acid (PDLLA) has emerged as a biostimulator that can potentially improve facial skin quality through collagen stimulation. Objective: To assess the efficacy of PDLLA in improving facial rejuvenation markers in late middle age Thai women. Materials and Methods: A quasi-experimental design was conducted for a before-and-after design. Fifteen eligible participants, aged between 45 and 60 years old, were recruited from Mae Fah Luang University Hospital Asoke, Bangkok, Thailand. Two sessions of subdermal PDLLA injections were administered to each participant. Eight skin quality parameters were assessed at baseline, two, four, and six months using the Cutometer MPA580 for skin elasticity, Sebumeter SM815 for sebum level, Corneometer CM825 for skin hydration or skin capacitance, Tewameter TM300 for transepidermal water loss or TEWL, and Visia CR system for spots, pores, wrinkles, and texture. Results: Significant improvements were noted in skin elasticity, hydration, TEWL, pores, and wrinkles compared to baseline. Skin elasticity increased by 0.11±0.02 at six months (p<0.001), and skin hydration improved, with skin capacitance rising by 6.19±0.86 at four months (p<0.001). TEWL dropped by 6.49±0.68 g/m²/hour at four months (p<0.001), pores reduced by 3.04±0.51 at four months (p<0.001), and wrinkles decreased by 7.62±1.13 at six months (p<0.001). In contrast, the remaining three parameters, sebum level, spots, and texture, showed no statistically significant changes in the time series measurement. No severe adverse effects were reported. Conclusion: PDLLA is an effective and safe biostimulator for enhancing facial skin quality in the late middle age Thai women.

The Role of Toxins and Fillers in Optimizing Perioral Rejuvenation

2025-06-23

F. Jeffrey Lorenz , Heather K. Schopper , Scott G. Walen | Facial Plastic Surgery

Neurotoxins and fillers have become increasingly popular for restoring age-related changes in the perioral region. This review examines their roles in optimizing perioral rejuvenation.The perioral region composes the lower third … Neurotoxins and fillers have become increasingly popular for restoring age-related changes in the perioral region. This review examines their roles in optimizing perioral rejuvenation.The perioral region composes the lower third and middle three-fifths of the face. It includes the lips, surrounding perioral skin, chin, muscles of facial expression, maxilla, and mandible. Changes in the perioral region are significant contributors to the visible signs of aging.Ideal candidates for perioral rejuvenation with toxin and filler are individuals experiencing age-related rhytids or volume loss who are interested in minimally invasive, nonsurgical interventions.Neurotoxins like Botox, Xeomin, Dysport, Jeuveau, and Daxxify are used to relax muscles that contribute to rhytids. Common treatment areas and techniques include perioral rhytids, lip flip, oral commissure elevation, dimpled chin, and gummy smile. Dermal fillers such as hyaluronic acid, calcium hydroxyapatite, and poly-L-lactic acid restore volume in areas like the nasolabial folds, lips, marionette lines, chin, prejowl sulcus, and perioral rhytids.Neurotoxins and dermal fillers offer effective, minimally invasive solutions for perioral rejuvenation. With an understanding of underlying anatomy, proper patient selection, and precise injection techniques, facial plastic surgeons can achieve natural, youthful results with minimal downtime.

The Effect of a Collagen-Elastin Implantation on Infraorbital Hallowing in Lower Lid Surgery for Aging Patients

2025-06-23

Hyunwoo Kyoung , JuYoung Park , Byungchul Lee +7 more | Journal of Craniofacial Surgery

This study investigates the efficacy of integrating a collagen-elastin matrix (MatriDerm) with lower blepharoplasty to address infraorbital hollowness and fine wrinkles in aging patients, conditions often inadequately treated with conventional … This study investigates the efficacy of integrating a collagen-elastin matrix (MatriDerm) with lower blepharoplasty to address infraorbital hollowness and fine wrinkles in aging patients, conditions often inadequately treated with conventional techniques. Twenty patients (40 eyelids) aged 40 to 70 years with Barton's grade II to III periorbital hollowness were included. Lower blepharoplasty was performed using a subciliary approach, and the collagen-elastin matrix was implanted in two submuscular layers along the lid-cheek groove. Seven patients received additional subdermal implantation to further address fine wrinkles. Outcomes were evaluated three months postoperatively using Barton's grading system and digital photography. The results demonstrated significant improvements in both volume restoration and wrinkle reduction. Among Grade III cases, 60% improved to grade 0, and 25% improved to grade I. No major complications were observed, and patient satisfaction was universally high. The collagen-elastin matrix served as an effective adjunct to lower blepharoplasty, enhancing structural support and promoting tissue regeneration. By providing a scaffold for neocollagenesis and maintaining skin elasticity, the matrix addressed volume deficiencies and fine wrinkles more comprehensively than traditional methods alone. This study highlights the collagen-elastin matrix as a promising solution for improving outcomes in lower eyelid rejuvenation. Its integration into lower blepharoplasty procedures offers a dual benefit of volume enhancement and wrinkle improvement in a single operation. Further research with larger sample sizes and extended follow-ups is necessary to confirm these findings and explore broader applications in aesthetic surgery.

Correction of High Eyelid Folds Using Three-Plane Dissection and Fat Repositioning/Grafting in Revisional Blepharoplasty

2025-06-23

Chuanbo Liu , Qinyuan Zhao , Shibai Zhu +3 more | Aesthetic Plastic Surgery

Analysis of classifications of the facial «danger zones»

2025-06-23

Т. С. Жарикова , Vladimir N. Nikolenko , Valentin I. Sharobaro +4 more | Operativnaâ hirurgiâ i kliničeskaâ anatomiâ (Pirogovskij naučnyj žurnal)

Background. In parallel with the increase in the number of aesthetic procedures in the face and neck, the likelihood of complications associated with individual and typological variability of the topographic … Background. In parallel with the increase in the number of aesthetic procedures in the face and neck, the likelihood of complications associated with individual and typological variability of the topographic anatomy of structures in this area increases. The concept of «danger zones» of the face has taken root in the world, and depending on the course and spatial location of the branches of the vessels and nerves of the facial region, up to 20 classifications of such «danger zones» are distinguished by various authors. Objective. The study and generalization of classifications of facial «danger zones». Material and methods. More than 100 sources of modern scientific literature have been studied. The search for sources of modern scientific literature was carried out using the databases PubMed, Google Scholar, elibrary.ru and CyberLeninka for the last 10 years. The literature was searched by keywords. The selection methodology was based on the recommendations of Prisma and included the stages of identification, screening and inclusion. 42 works were selected. Results. Based on the analysis of scientific literature data, the review summarizes information reflecting the modern understanding of the «danger zones» of a person. Generalization and combination of information presented in various classifications of «danger zones» has not yet been carried out. The systematization of information about the anatomy and topography of the structures of «danger zones» allows us to identify areas of the face with a high risk of complications, such as infectious processes, tissue necrosis, circulatory disorders, etc. Conclusion. Research in this area contributes to the development of a unified classification of «danger areas» of the face and a unified approach to the diagnosis of complications arising after surgical and cosmetic interventions in the facial area.

Conhecimento anatômico das estruturas faciais como pilar da harmonização: Revisão de literatura

2025-06-22

J. Mira , S. Pereira , Wagner Costa Rossi +1 more | Research Society and Development

A harmonização facial compreende a realização de diversos procedimentos utilizados como coadjuvantes em tratamentos que promovam uma melhora estética da face bem como auxiliam no rejuvenescimento. Tais procedimentos variam desde … A harmonização facial compreende a realização de diversos procedimentos utilizados como coadjuvantes em tratamentos que promovam uma melhora estética da face bem como auxiliam no rejuvenescimento. Tais procedimentos variam desde a aplicação de substâncias como a toxina botulínica, ácido hialurônico e colágeno, até a aplicação dérmica de fios, como lifting, com o intuito de amenizar rugas e linhas de expressão. Para que os profissionais da saúde estejam habilitados nestes tipos de procedimentos e tenham sucesso em seus tratamentos é importante que estes conheçam a anatomia, posição, localização dos músculos faciais bem como suas relações topográficas com outras estruturas como artérias, veias e nervos. O objetivo do presente estudo é apresentar um levantamento bibliográfico de artigos que demonstram a importância do conhecimento anatômico facial para a realização de procedimentos estéticos. Realizou-se uma revisão sistemática nas bases PubMed e MedLine. Através de descritores como: “músculos faciais”, “estética”, “ácido hialurônico”, “toxina botulínica”, “colágeno” e “harmonização”, combinados entre si com conectores “AND” e “OR”, na língua inglesa e portuguesa, do Brasil, chegou-se ao total de 32 artigos finais; que mostram a relevância do conhecimento anatômico dos músculos faciais por parte dos profissionais e o quanto é imprescindível para a realização de procedimentos seguros e precisos, pois a aplicação inadequada de substâncias podem gerar efeitos adversos, desde os mais leves até os mais severos. É unânime entre os artigos consultados à importância da capacitação dos profissionais que atuam realizando esses procedimentos.

Leukotriene Receptor Antagonists for the Prevention and Treatment of Capsular Contracture: A Systematic Review and Meta-analysis

2025-06-22

Omer Bin Abdul Aziz , Mudassar Jalil , Sheikh Bilal Ahmad +2 more | Cureus

Tear Trough Deformity Correction With Autologous Fat Grafting Evidenced by Linear Gray Scale Analysis

2025-06-20

Xuanchen Liu , Jie Li , Jiguang Ma | Journal of Craniofacial Surgery

Linear gray scale (LGS) analysis was an objective and reproducible approach for evaluating nasolabial folds and baggy lower eyelids. This study aimed to assess the aesthetic outcome of tear trough … Linear gray scale (LGS) analysis was an objective and reproducible approach for evaluating nasolabial folds and baggy lower eyelids. This study aimed to assess the aesthetic outcome of tear trough rejuvenation with fat grafting with patient satisfaction, Barton grading system and LGS analysis. Patients who underwent fat grafting for tear trough correction at the authors' department from January 1, 2020 to December 31, 2024 were included in this study. The purified adipose tissue was injected supraperiosteally into the lower eyelid region using a retrograde linear threading method. The aesthetic results were analyzed by patient satisfaction and Barton grading system. LGS analysis was conducted as an objective assessment based on preoperative and postoperative photographs. The postoperative complications of tear trough correction were also recorded. Seventy-nine patients underwent autologous fat grafting for tear trough correction. The follow-up period varied from 3 to 9 months, with a median time of 3 months. No major complications occurred. 51.5% of patients rated themselves as very satisfied, whereas 22.2% expressed satisfaction. The tear trough deformity was rejuvenated after autologous fat grafting. Barton grades improved from 1.67±0.79 to 0.51±0.48 postoperatively (t=5.932, P<0.001). The medial orbital gray scale (OGS) score decreased from 47.23±26.63 to 27.77±18.56 postoperatively (t=3.90, P=0.002). The central OGS score decreased from 40.23±16.67 to 24.77±13.61 postoperatively (t=4.66, P=0.001). The medial and central OGS scores were positively correlated with Barton grades (medial: r=0.817, P<0.001; central: r=0.813, P<0.001). Autologous fat grafting was effective in tear trough rejuvenation without major complications. A strong correlation was observed between the results of LGS analysis and Barton grading system. The LGS analysis was a standardized, objective, and quantitative method to evaluate the aesthetic results of tear trough correction.

A Simplified Algorithm for Corner Lip Lifting

2025-06-20

Benjamin Talei , Arman Danielian | Facial Plastic Surgery

Abstract This study presents a simplified guideline for corner lip lifting (cheiloplasty), a procedure aimed at enhancing the lateral lip's appearance by addressing vermilion deficiency, philtral hooding, and angular depression. … Abstract This study presents a simplified guideline for corner lip lifting (cheiloplasty), a procedure aimed at enhancing the lateral lip's appearance by addressing vermilion deficiency, philtral hooding, and angular depression. Despite the evolution of cosmetic cheiloplasty, with numerous techniques developed to enhance lip aesthetics, tailoring the procedure to individual patients and selecting suitable candidates remain significant challenges for surgeons. Utilizing detailed anatomical mapping based on relaxed skin tension lines and the Diagonal (“D”) line, we outline precise surgical techniques to optimize vermilion exposure, elevate the chelion, and improve facial character. Key considerations include dental influences and aging-related ptosis, with specific endpoints and pitfalls highlighted to ensure reproducible outcomes. We introduce three types of corner lip lifts—1, 2a, and 2b—designed to treat varying degrees of lateral lip deficiencies in both younger and older patients, either alone or in combination with subnasal lip lifts using the Cupid Lift® algorithm. Sutures are removed at days 3 and 5, and incisions are lasered with a low-energy CO2 at 6 and 12 weeks. Our findings demonstrate that these procedures effectively restore lateral lip aesthetics, balance stomion and chelion positions, and ameliorate aging-related changes, offering a versatile approach for practitioners. This work advances cosmetic surgery by providing a streamlined framework for corner lip lifting, enhancing patient outcomes in facial rejuvenation and aesthetic harmony.

Correction: Safety and Efficacy of Poly-L-Lactic Acid Filler (Gana V vs. Sculptra) Injection for Correction of the Nasolabial Fold: A Double-Blind, Non-inferiority, Randomized, Split-Face Controlled Trial

2025-06-19

Woo Yeon Han , Hyeon Jin Kim , Rosie Kwon +2 more | Aesthetic Plastic Surgery

Assessing the contribution of orthodontic profiles in predicting facial soft tissue thickness for forensic facial approximation

2025-06-18

Muhammad Fadli Hanafi , Hajime Utsuno , Shuuji Namiki +7 more | International Journal of Legal Medicine

Abstract Background Facial soft tissue thickness (FSTT) is essential for forensic facial approximation. Although its correlations with age, sex, and body mass index (BMI) are well documented, the potential correlations … Abstract Background Facial soft tissue thickness (FSTT) is essential for forensic facial approximation. Although its correlations with age, sex, and body mass index (BMI) are well documented, the potential correlations between FSTT and various orthodontic profiles—such as cephalic index (CI), skeletal class (SC), Tweed and Northwestern analyses—remain unexplored collectively. This study examined these correlations and their impact on FSTT prediction accuracy. Methods We analyzed 103 postmortem computed tomography datasets from Japanese cadavers aged 18–86 years. Moderate-to-high multicollinearity was identified among orthodontic profile variables (SC, Tweed, and Northwestern) and addressed using principal component analysis (PCA), yielding two principal components (PC1 and PC2). Predictive formulas were constructed incorporating age, sex, BMI, CI, PC1, and PC2. To evaluate model performance, we conducted two comparative approaches: (1) comparing root mean squared error (RMSE) and mean absolute error (MAE) from the PCA-based regression model with those derived from holdout dataset’s BMI-based mean estimates, and (2) with primary dataset’s baseline regression model including only age, sex, and BMI, across all landmarks. Results and discussion PCA reduced multicollinearity, retaining 77% of total data variability. Based on the two comparative approaches, the PCA-based regression model demonstrated marginal improvements in predictive accuracy, as indicated by slightly lower RMSE and MAE across most landmarks. It indicates a limited yet consistent benefit of using orthodontic profiles for enhancing model accuracy beyond basic demographic predictors. Conclusion The inclusion of orthodontic profiles demonstrated modest improvements in predictive accuracy and may enhance the interpretive value of FSTT predictive models in forensic contexts. Clinical trial number Not applicable.

Conjuntivite lenhosa: aspectos clínicos, diagnóstico e manejo

2025-06-18

Rafael Leite de Oliveira , Pablo Sousa de Oliveira , Vanessa Dib Salge +4 more | Brazilian Journal of Health Review

A conjuntivite lenhosa é uma condição rara e crônica da superfície ocular, caracterizada pela formação de pseudomembranas espessas na conjuntiva, geralmente associada à deficiência de plasminogênio, o que compromete a … A conjuntivite lenhosa é uma condição rara e crônica da superfície ocular, caracterizada pela formação de pseudomembranas espessas na conjuntiva, geralmente associada à deficiência de plasminogênio, o que compromete a fibrinólise e favorece a recorrência das lesões. Objetiva-se relatar um caso clínico de paciente idosa com quadro típico da doença, destacando aspectos diagnósticos e terapêuticos. Para tanto, procede-se à descrição de um estudo de caso envolvendo avaliação oftalmológica, exames laboratoriais e histopatológicos, além do acompanhamento multidisciplinar. Desse modo, observa-se que a paciente apresentava membranas volumosas aderidas à conjuntiva, com confirmação histológica e laboratorial da deficiência de plasminogênio, sendo tratada com colírios anti-inflamatórios e imunossupressores tópicos, com resposta parcial. O que permite concluir que o diagnóstico precoce e o manejo individualizado, com envolvimento conjunto de oftalmologia e hematologia, são essenciais para controlar a inflamação e prevenir complicações visuais graves. Ainda assim, a recorrência das lesões e a ausência de protocolos consolidados reforçam a necessidade de estudos adicionais e seguimento contínuo.

Evolution of Thread Lifting: Advancing Toward Bioactive Polymers and Sustained Hyaluronic Acid Delivery

2025-06-18

Pavel Burko , Ilia Miltykh | Cosmetics

Facial aging is a multifactorial and stratified biological process characterized by progressive morphological and biochemical alterations affecting both cutaneous (Layer I) and subcutaneous (Layer II) tissues. These age-related changes manifest … Facial aging is a multifactorial and stratified biological process characterized by progressive morphological and biochemical alterations affecting both cutaneous (Layer I) and subcutaneous (Layer II) tissues. These age-related changes manifest clinically as volume depletion, tissue ptosis, and a decline in overall skin quality. In response to these phenomena, thread lifting techniques have evolved significantly—from simple mechanical suspension methods to sophisticated bioactive platforms. Contemporary threads now incorporate biocompatible polymers and hyaluronic acid (HA), aiming not only to reposition soft tissues but also to promote dermal regeneration. This review provides a comprehensive classification and critical assessment of thread lifting materials, focusing on their chemical composition, mechanical performance, degradation kinetics, and biostimulatory potential. Particular emphasis has been given to the surface integration of HA into monofilament threads, especially with the emergence of advanced delivery systems such as NAMICA, which facilitate sustained HA release. Advanced thread materials, especially those fabricated from poly(L-lactide-co-ε-caprolactone) [P(LA/CL)], demonstrate both tensile support and regenerative efficacy. Emerging HA-covered threads exhibit synergistic bioactivity, stimulating skin remodeling. NAMICA technology represents an advancement in the field, in which HA is encapsulated within biodegradable polymer fibers to enable gradual release and enhanced dermal integration. Nonetheless, well-designed human studies are still needed to substantiate its therapeutic efficacy. Consequently, the paradigm of thread lifting is shifting from purely mechanical interventions toward biologically active systems that promote comprehensive ECM regeneration. The integration of HA into resorbable threads, especially when combined with sustained-release technologies, represents a meaningful innovation in aesthetic dermatology, meriting further preclinical and clinical evaluation.

Hilos PDO vs Ultra V desde una perspectiva científica y de innovación es clave para entender sus beneficios y diferencias

2025-06-18

Paula Jessenia Idrovo Campoverde , Andrea Mendoza , Carla Emilia Parra Moran +2 more | Arandu-UTIC.

El lifting facial sin cirugía ha evolucionado gracias a los avances en hilos tensores, con dos opciones principales: Hilos PDO (polidioxanona) y Ultra V. Cada tecnología ofrece beneficios específicos en … El lifting facial sin cirugía ha evolucionado gracias a los avances en hilos tensores, con dos opciones principales: Hilos PDO (polidioxanona) y Ultra V. Cada tecnología ofrece beneficios específicos en términos de estímulo de colágeno, efecto tensor y duración. Esta revisión narrativa analiza las características de cada tipo de hilo, comparando su mecanismo de acción, aplicaciones clínicas y resultados en dermatología estética. Se presentan estudios recientes que respaldan su uso y eficacia. Este estudio sigue un enfoque de revisión narrativa, basándose en literatura reciente sobre hilos tensores en dermatología estética. Se consultaron investigaciones sobre seguridad, eficacia y evolución tecnológica de los hilos PDO y Ultra V. Para garantizar un análisis amplio, se revisaron estudios en bases de datos científicas como: - “PubMed”,- “SciELO”, - “Journal of Cosmetic Dermatology”, - “Revista Latinoamericana de Dermatología Estética”. . Criterios de inclusión - Estudios sobre seguridad y eficacia de hilos PDO y Ultra V. - Ensayos clínicos que comparan diferentes métodos de lifting facial sin cirugía. La principal limitación es la variabilidad en los resultados debido a diferencias en protocolos de aplicación y el tipo de piel del paciente.

A simplified sutureless Müllerectomy for ptosis repair: a case series

2025-06-18

Henry Bair , Narmien Murdock , Karine Shebaclo +2 more | Orbit

Müller's muscle-conjunctival resection (MMCR) is a well-established posterior approach to correct mild to moderate ptosis. Traditional methods involve resection of a measured segment of Müller's muscle and conjunctiva, followed by … Müller's muscle-conjunctival resection (MMCR) is a well-established posterior approach to correct mild to moderate ptosis. Traditional methods involve resection of a measured segment of Müller's muscle and conjunctiva, followed by the approximation of resected edges with sutures. In recent years, various sutureless MMCR techniques have been reported. Here, we describe and evaluate a modified sutureless approach that eliminates the need for specialized instruments. A retrospective case series was conducted to evaluate outcomes of patients who underwent sutureless MMCR ptosis repair. All surgeries were performed by one surgeon. For the procedure itself, curved hemostats were used to delineate and clamp the measured amount of Müller's muscle and conjunctiva, which were then resected and cauterized. Surgical outcomes, including margin reflex distance (MRD1) improvement, symmetry, and complications, were analyzed. A total of 105 eyelids from 66 adult patients who underwent sutureless MMCR were included in this study. Fifty eyelids (47.6%) underwent concurrent procedures such as blepharoplasty and internal browpexy. The mean increase in MRD1 was 3.31 mm in the entire cohort and 2.76 mm in the MMCR-alone cohort. Symmetry within 1 mm was achieved in 96% of bilateral cases. Post-operative complications were limited to foreign body sensation in five patients and pyogenic granuloma in one patient. One patient required revision with external ptosis repair. The modified sutureless MMCR described here is a simple, effective, and safe technique for ptosis repair, either in isolation or with concomitant eyelid and brow procedures, providing excellent outcomes with minimal potential complications.

Hypodense Middle Cerebral Artery Sign of Cerebral Embolism after Facial Filler

2025-06-18

Y B Wang , Xi Chen , Chi Shen +2 more | Neurology India

Endoscopic Gliding Forehead Lift: A Brow Shaping Method to Lift the Medial and Lateral Brow

2025-06-17

Apinut Wongkietkachorn , Nuttapone Wongkietkachorn | Aesthetic Plastic Surgery

Abstract Introduction The gliding browlift has gained popularity as a technique to elevate the lateral brow. However, in many Asian patients, achieving the desired brow shape often necessitates lifting both … Abstract Introduction The gliding browlift has gained popularity as a technique to elevate the lateral brow. However, in many Asian patients, achieving the desired brow shape often necessitates lifting both the medial and lateral aspects. The endoscopic gliding forehead lift represents an evolution of the gliding browlift, tailored to address these specific anatomical and aesthetic considerations. This study aims to describe the surgical technique and evaluate objective outcomes of brow reshaping six months postoperatively. Methods A retrospective study was performed on patients who underwent endoscopic gliding forehead lifts between July 2022 and June 2024. The surgical technique for the endoscopic gliding forehead lift is outlined in detail. Objective outcomes were assessed using measurements of the brow-to-pupil distance (BPD), brow-to-lateral canthus distance (BLCD) and brow-to-medial canthus distance (BMCD) preoperatively and at six months post-surgery. Results A total of 100 patients (200 eyebrows) were included in the study. The BPD increased from 19.0 [17.0, 21.0] mm preoperatively to 24.0 [22.0, 26.0] mm at six months postoperatively ( p < 0.001). The BLCD increased from 21.0 [20.0, 23.0] mm preoperatively to 28.0 [27.0, 29.0] mm at six months postoperatively ( p < 0.001). The BMCD increased from 18.0 [16.0, 20.0] mm to 21.0 [19.0, 23.0] mm at six months postoperatively ( p < 0.001). No cases of hematoma or frontal branch of facial nerve palsy were observed in this study. Conclusion The endoscopic gliding forehead lift is an effective technique for shaping and lifting both the medial and lateral brows. 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 .

Poly-l-Lactic Acid Palpable Nodules: Ultrasound Role in the Discrimination of Accumulation of Product Versus Granulomatous Reactions

2025-06-17

Rosa Sigrist , Natacha Quezada , Miguel Villaseca +1 more | Dermatologic Surgery

A fast and easy-to-perform noninvasive Muller’s muscle sublimation technique using plasma technology for treatment of mild-to-moderate ptosis: a case report

2025-06-17

Nasrin Raffati | Journal of Medical Case Reports

Abstract Background Currently, most surgeons favor Muller’s muscle conjunctival resection as a treatment for mild-to-moderate ptosis, as this method is associated with fewer post-surgical complications. Case presentation This case series … Abstract Background Currently, most surgeons favor Muller’s muscle conjunctival resection as a treatment for mild-to-moderate ptosis, as this method is associated with fewer post-surgical complications. Case presentation This case series of six Iranian women aged between 15 and 65 (mean 43) years with mild-to-moderate ptosis treated at Negah Eye Hospital used a plasma scalpel (PLEXR™) for conjunctivo-Muller sublimation. A 1–4 area management strategy was applied, and margin reflex distance 1 measurements showed improvement from 1.58 mm pre-treatment to 3.66 mm after 6 months. Conclusion Seemingly, applying plasma technology to treat mild-to-moderate ptosis via conjunctivo-Muller muscle sublimation might be a promising alternative to more invasive surgical methods.

Current Trends in Facelift and Necklift Procedures

2025-06-16

Carter J. Boyd , Daniel J. Ceradini | Journal of Clinical Medicine

Many surgical and nonsurgical options are available to patients seeking facial rejuvenation. In this review, we aim to provide an overview of the current trends in facelift and necklift procedures … Many surgical and nonsurgical options are available to patients seeking facial rejuvenation. In this review, we aim to provide an overview of the current trends in facelift and necklift procedures while simultaneously highlighting the utility of nonsurgical treatments. A comprehensive literature review was performed using the PubMed, Google Scholar, and Cochrane Library databases, with the objective of including recent literature published on facelift and necklift procedures from 2015 to 2025. Articles were selected based on relevance, with a specific focus on including a wide breadth of techniques. A considerable body of literature has been published to further classify the soft-tissue anatomy of the face and neck. In particular, these studies focus on the characterization of the three-dimensional anatomy of the facial nerve with emphasis on safe planes of dissection to avoid inadvertent facial nerve injury. The current literature continues to debate both the theoretical and practical advantages and disadvantages of various facelift techniques. Broadly speaking, facelift techniques can be divided into those that manipulate the superficial musculoaponeurotic system (SMAS) layer on its superficial surface and those that undermine the SMAS to varying extents. Numerous approaches are available to improve the contour of the neck and jawline, including manipulation of the platysma muscle and subplatysmal volume reduction. Other surgical procedures and nonsurgical treatments should be considered to optimize and enhance facelift and necklift results. Advancements in patient safety include a focus on minimizing complications while reducing the length of recovery. Facelift and necklift procedures remain the foundational pillars for facial rejuvenation. With attention to patient-specific anatomy, surgeons can work collaboratively with patients to provide global facial optimization by choosing appropriate facelift and necklift techniques in combination with other ancillary procedures. Doing so will deliver enduring, elegant results.

Risk of reoperation for recurrent ptosis following intraocular surgery

2025-06-16

Itay Nitzan , Tehila Shalmov , Shoham Kubovsky +3 more | Eye

Larger Vertical Ridge Augmentation: A Retrospective Multicenter Comparative Analysis of Seven Surgical Techniques

2025-06-16

Andreas Pabst , Abdulmonem Alshihri , Philipp Becker +7 more | Journal of Clinical Medicine

Background: Vertical alveolar ridge augmentation (ARA) > 3 mm is associated with increased surgical complexity and higher complication rates. Despite the availability of various ARA techniques and graft materials, robust … Background: Vertical alveolar ridge augmentation (ARA) > 3 mm is associated with increased surgical complexity and higher complication rates. Despite the availability of various ARA techniques and graft materials, robust comparative clinical data remain limited. This retrospective multicenter study aimed to evaluate and compare surgical and patient-relevant outcomes across seven established vertical ARA techniques. Methods: This retrospective multicenter study included 70 cases of vertical ARA > 3 mm using seven different techniques (10 cases each): an iliac crest graft (ICG), intraoral autogenous bone block (IBB), allogeneic bone block (ABB), CAD/CAM ABB, CAD/CAM titanium mesh (CAD/CAM TM), magnesium scaffold (MS), and the allogeneic shell technique (ST). The outcome parameters included harvesting and insertion time, bone gain (vertical and horizontal, after a minimum of one year), graft resorption (after one year), donor site morbidity, dehiscence rate, need for material removal, and biological and general financial costs. Results: Harvesting time significantly varied among the different ARA techniques (p = 0.0025), with the longest mean durations in ICGs (51.6 ± 5.8 min) and IBBs (36.5 ± 10.8 min), and no harvesting was required for the other techniques. Insertion times also significantly differed between the different ARA techniques (p < 0.0001) and were longest in IBBs (50.1 ± 7.5 min) and the ST (47.3 ± 13.9 min). ICGs achieved the highest vertical and horizontal bone gain (5.6 ± 0.4 mm), while ABBs and CAD/CAM ABBs showed the lowest (~3.0 mm). Resorption rates significantly differed between the different ARA techniques (p < 0.0001) and were highest for ICGs (25.9 ± 3.9%) and lowest for MSs (5.1 ± 1.5%). Donor site morbidity was 100% in ICGs and 50% in IBBs, with no morbidity in the other groups. Dehiscence rates were 10% in most techniques but 30% in CAD/CAM TMs. Removals were required in all techniques except MSs. Biological and financial costs were high for ICGs and CAD/CAM ABBs and low for MSs. Conclusions: Vertical ARA techniques significantly differ regarding harvesting and insertion time, bone gain, graft resorption, donor site morbidity, dehiscence rates, removals, and costs. While ICGs achieved the highest bone volume, less invasive techniques, such as CAD/CAM-based or resorbable scaffolds, reduced biological costs and complication risks. Technique selection should be individualized based on defects, patients, and reconstructive goals.

Müller Muscle-Conjunctival Resection With Tarsectomy in Chronic Progressive External Ophthalmoplegia

2025-06-16

Mehmet Serhat Mangan , Emin Özkul , Ceyhun Arıcı +1 more | Journal of Craniofacial Surgery

This report presents 2 cases of chronic progressive external ophthalmoplegia (CPEO) with progressive bilateral ptosis, managed successfully using Müller muscle-conjunctival resection with tarsectomy (MMCRT). The first case involved a 59-year-old … This report presents 2 cases of chronic progressive external ophthalmoplegia (CPEO) with progressive bilateral ptosis, managed successfully using Müller muscle-conjunctival resection with tarsectomy (MMCRT). The first case involved a 59-year-old female, and the second a 45-year-old male, both presenting with longstanding histories of worsening ptosis and significant limitations in extraocular motility. Postoperatively, both patients exhibited substantial improvements in eyelid elevation without complications such as lagophthalmos or exposure keratopathy, commonly seen in alternative surgical approaches. These cases demonstrate MMCRT as a promising technique for managing CPEO-related ptosis, highlighting its potential advantages and the need for further studies to confirm its efficacy and safety in broader clinical applications.

Biopolymers in Facial Aesthetics: Gel-Based Applications, Safety, Effectiveness, and Future Prospects. A Systematic Review of the Literature

2025-06-13

Gonzalo Ruiz-de-León , Daniela Cortés-Eslava , Esther Hernández-Pacheco +3 more | Gels

Biopolymer-based dermal fillers have gained attention in facial aesthetics due to their biocompatibility, gel-forming properties, and capacity to stimulate tissue regeneration. However, evidence regarding their clinical performance remains scattered and … Biopolymer-based dermal fillers have gained attention in facial aesthetics due to their biocompatibility, gel-forming properties, and capacity to stimulate tissue regeneration. However, evidence regarding their clinical performance remains scattered and inconsistent. This systematic review evaluates the current scientific literature on the effectiveness and safety of injectable biopolymers used in facial aesthetic procedures. A systematic search was conducted in PubMed, MEDLINE, and Embase databases for studies published between 2016 and 2024. Only human studies in English assessing clinical efficacy, safety, adverse events, and patient satisfaction were included. Of the 280 articles initially identified, 9 met the inclusion criteria. The selected studies showed improvements in facial volume and wrinkle reduction with gel-based biopolymers such as poly-L-lactic acid (PLLA), polycaprolactone (PCL), and polymethylmethacrylate (PMMA). Most studies reported high patient satisfaction and a low incidence of serious adverse effects. However, methodological heterogeneity and limited long-term data reduced the strength of the evidence. While injectable biopolymers appear to be effective and generally safe, current evidence is limited and variable. Further multicenter randomized trials with standardized protocols and longer follow-up periods are needed. Clinicians should apply these materials with caution, ensuring individualized treatment planning and careful risk assessment.

Artificial intelligence in patient care: evaluating artificial intelligence’s accuracy and accessibility in addressing blepharoplasty concerns

2025-06-12

Olivia Ayad , Arsany Yassa , Aman M. Patel +3 more | International Ophthalmology

Tranexamic Acid in Body Contouring Surgery: A Systematic Review and Meta-Analysis

2025-06-12

Arman Fijany , Cole Holan , Thomas Troia +7 more | Aesthetic Surgery Journal

Abstract Breast and body contouring procedures are plastic surgery's most popular and effective interventions. Though these procedures are generally safe, they are not without risks and complications. Antifibrinolytic drugs like … Abstract Breast and body contouring procedures are plastic surgery's most popular and effective interventions. Though these procedures are generally safe, they are not without risks and complications. Antifibrinolytic drugs like tranexamic acid (TXA) have been used as an adjunct to improve outcomes. This meta-analysis explores the impact of TXA on complications in breast and body contouring procedures. We searched PubMed (US National Library of Medicine, Bethesda, MD) for studies that used TXA in standard breast reconstruction and body contouring procedures. We then performed a meta-analysis on the following complications: hematoma, seroma, infection, and wound healing complications. A Mantel-Haenszel method random effects model was used to calculate the odds ratio (OR) within and a 95% confidence interval (CI) for dichotomous outcomes. Subgroups were created for studies that utilized systemic (IV), topical or concurrent IV and topical TXA administration. A total of thirteen studies were selected and included in the analysis. There was a significant lower risk of hematoma (OR = 0.37; 95% CI = 0.18 to 077; P = 0.008) in the TXA cohort. There were no significant differences observed in terms of wound healing issues or seroma formation. Our subgroup analysis demonstrated significantly decreased risks of infection (OR = 0.41; 95% CI = 0.22 to 077; P = 0.005) in the topical TXA cohort. In breast and body contouring procedures, the risk of hematoma and wound healing complications can potentially be reduced by IV TXA administration. The infection risk can be potentially reduced by topical TXA administration.

Quality of Life after Facial Feminization Surgery: A Systematic Review of Current Evaluations and Call for Standardization

2025-06-12

Jasmina Abdalla , Matteo Laspro , Ogechukwu C. Onuh +4 more | Transgender Health

OPTIMIZED (LATERAL TARSAL STRIT — LTS) SURGICAL CORRECTION OF THE LOWER EYELID ECTROPION

2025-06-10

K.V. Кlimenko , K.V. Artamonova , N.T. Grishina +1 more | Bulletin of the Medical Institute of Continuing Education

Background. One of the problems of the lower eyelids in elderly patients in ophthalmic and plastic surgery is ectropion, eversion of the lower eyelid of atonic etiology. The occurrence of … Background. One of the problems of the lower eyelids in elderly patients in ophthalmic and plastic surgery is ectropion, eversion of the lower eyelid of atonic etiology. The occurrence of atonic lower eyelid ectropion is connected with impaired innervation of the zygomatic branch of the facial nerve or is formed due to involutional changes in the tarsal plate of the lower eyelid during its degenerative changes. In addition to the aesthetic and cosmetic defect of the lower eyelid, there is a risk of developing keratitis on the part of the cornea of the eyeball. The most effective and radical method of treating ectropion of atrophic origin is surgical. Various methods of surgical treatment of atonic lower eyelid ectropion have been published in a scientific literature review. An optimized, effective method of surgical correction of lower eyelid ectropion is shortening the lower eyelid lamella and suspending it to the lateral wall of the orbit, which creates a stable and long-term result. Observations in the long-term postoperative period with positive clinical results have been analyzed, but they require further study and possible improvement. Purpose. To analyze and provide the aesthetic and therapeutic effectiveness of surgical correction of atonic lower eyelid eversion, by shortening the lamella of the tarsal plate of the lower eyelid and suspension (suturing) to the lateral wall of the orbit. Materials and methods. The clinical study involved 15 patients who underwent a corrective operation between 2023 and 2024, shortening the overstretched tarsal plate of the lower eyelid and fixing it with separate sutures to the lateral surface of the orbit (Lateral Tarsal Strip-LTS). The study involved female and male patients, their age ranged from 70 to 75 years. The main motivation for contacting an aesthetic surgeon for all patients was complaints of lower eyelid sagging, incomplete closure of the palpebral fissure, lacrimation, conjunctivitis, and keratitis. Results. After the corrective operation, on the 3rd day, the most of the patients (94.7%) noted satisfaction with the aesthetic and cosmetic result. During a follow-up examination of all operated patients after three months, 98.3% of patients noted complete satisfaction with the functional and aesthetic result of the corrective operation performed (Lateral Tarsal Strip-LTS). Conclusion. The functional and aesthetic efficiency of the corrective surgery aimed at shortening the tarsal plate and fixing it with separate sutures to the lateral surface of the orbit (Lateral Tarsal Strip-LTS). More than 96% of operated patients noted a pronounced positive functional and aesthetic result after surgical correction of atonic lower eyelid ectropion.

THE USE OF THE POLYNUCLEOTIDE-BASED SKINBOOSTER POLYPHIL FOR THE AESTHETIC CORRECTION OF THE PERIORBITAL AREA

2025-06-10

V.V. Gladko , I.V. Izmaylova | Bulletin of the Medical Institute of Continuing Education

Background. The study is dedicated to evaluating the effectiveness of aesthetic correction of age-related changes in the soft tissues of the periorbital area using intradermal injections of a polynucleotide-based skin … Background. The study is dedicated to evaluating the effectiveness of aesthetic correction of age-related changes in the soft tissues of the periorbital area using intradermal injections of a polynucleotide-based skin booster. Purpose. To develop an algorithm for the use of skin boosters based on PolyPhil polynucleotides (Croma, Austria) for the correction of age-related changes in the soft tissues of the periorbital region and to evaluate the aesthetic result of the correction using skin profilometry. Materials and methods. The proposed method of aesthetic correction was tested on 23 patients. The group included 18 women and 5 men aged from 18 to 55 years with a skin phototype according to the Fitzpatrick scale types 1-5. All patients underwent a course of intradermal administration of the PoliPhil skin booster (Croma, Austria) using a blunt 22 G cannula 7 cm long (SoftFill, Switzerland), 0.01-0.02 ml microbolus technique, total volume of 2 ml, distributed on both sides of the periorbital areas of the face. Results. The effectiveness of the treatment was assessed 2 months after the end of the course of aesthetic correction as part of the follow-up program. On average, the depth of the nasolacrimal groove decreased from 0.1mm to 2 mm. Conclusion. The minimally invasive method of aesthetic correction of age-related changes in the soft tissues of the periorbital region using intradermal injection of the polynucleotide-based skin booster is an effective and safe procedure that can be successfully carried out by cosmetologists and plastic surgeons.