A Guide to Cheek Augmentation: Single-Point Deep Injection of Hyaluronic Acid Filler at Midface in Close Proximity to Medial Suborbicularis Oculi Fat (SOOF) Area

Loss of volume in midface can result in an aged, wasted appearance. Osseous and fat atrophy with aging may further contribute to the loss of soft tissue support and midface ptosis. In the aging of periorbital area and midface, fat atrophy occurs mostly in the suborbicularis oculi fat (SOOF) area. The authors proposed that injection of hyaluronic acid (HA) filler to support the SOOF area could counteract the aging sign due to fat atrophy, restore volume loss and achieve a more youthful appearance. The authors described the treatment of 10 female patients who received CHAP®-particle hyaluronic acid (CHAP®-HA) injections for cheek augmentation, using single-point deep injection technique at midface in close proximity to SOOF area. Such approach provides satisfactory cheek augmentation results without significant complications. The authors discussed a rationale for their choice of dermal filler and provided an injection technique for restoring volume in the midface region with CHAP®-HA. Such technique is relatively quick to perform, have little down time, and result in a high rate of patient satisfaction.

Presentation of multiple midface fractures combined with intracranial injury treated conservatively

Midface injuries are normally the result of high forces impacted on the face, that can bypass the power of the connection buttresses, which are thick and strong, base of skull is also a rigid and toughstructure which requires significant forces to break. In our case, multiple midface and cranial base fractures are presented, which reflect injury caused by high forces and normally, these result in instability in the facial skeleton, or cause CSF rhinorrhea, or sharp spicules to endanger the orbit or the anterior cranial fossa, or the presence of any other indication of surgery. It is unusual to find such an extent of facial trauma and such a multiplication of fractures on the midface and cranial base levels, yet they were stable enough and without a real indication to require surgical interference.

Use of High-Resolution Ultrasound (HRU) in the Assessment of Deep Injections of CHAP-Hyaluronic Acid (CHAP-HA) Fillers for Midface Lift

High-resolution ultrasound (HRU) imaging is a useful tool to study hyaluronic acid (HA) filler injection in the face. It is noninvasive, quick, well-tolerated, and can provide in vivo and dynamic information. The formations of pools or pearls in HA fillers could be observed real time during injection. The plane of injection could be determined accurately, and there were no specimen manipulation artifacts. It was observed that HA gel fillers with differing production technologies showed distinct spread and distribution patterns in the periocular tissues on HRU examination. The authors used HRU to assess deep injections of CHAP-Hyaluronic Acid (CHAP-HA) fillers for midface lift. 10 patients who underwent bilateral midface deep injections using CHAP-HA filler were examined with HRU before and immediately after treatment, and in 2 weeks and one month later. The CHAP-HA appeared as hypoechoic densities within the preperiosteal plane in HRU. CHAP-HA adopted variable morphology within the tissue depending on individual tissue densities and the compliance of the tissues in the plane of injection. CHAP-HA was unidentifiable with surrounding tissue after one month in 13 of the 20 injection sites. HRU allows in vivo study of CHAP-HA injection behavior and could be a tool for further studies of HA-tissue reactions.

Three-dimensional finite element analysls for external midface distraction after different osteotomy in patients with cleft lip and palate

Objective To study three - dimensional finite element analysis for external midface distraction after different osteotomy in patients with cleft lip and palate ( Clp) . Methods Three - dimensional Fem models of Le Fort Ⅰ,Ⅱand Ⅲ,osteotomy in Clp patients were estabolished. External midface distraction were simulated. An anteriorly and inferiorly directed 900 g force was

The temporal endoscopic midface lift-centrofacial rejuvenation without facial scars

Aim:The author describes a new endoscopic midface lifting technique using solely temporal access and evaluates its advantages and perspectives.Methods:This is a single-surgeon case study.Through a short temporal incision,dissection is performed along a single plane connecting the superficial surfaces of both the facial and temporal superficial musculoaponeurotic system(SMAS)layers.Subsequent midface dissection divides the malar fat pad into the deeper and superficial parts.A new concept of a combination high malar SMAS lift and internal skin flap anchorage that provides long-term stability is described.Results:The temporal endoscopic midface(TEM)lift technique resulted in good objective results with high patient satisfaction.The temporal access allowed proper vertical vector correction of the sagging centro-facial structures.The resulting scar was inconspicuous and hidden in the hair bearing skin,and its length was measured between 5-6 cm.A conversion to the conventional long facial scar approach was completely avoided.Conclusion:The TEM lift is a new and effective procedure for facial rejuvenation,especially the midface and cheek.The results illustrate the importance of internal anchorage of both the midface SMAS and skin flap.These are the keys to long-lasting and pleasing results.The procedure is best suited for younger men and women with little or no neck skin laxity.

A minimally invasive midface suspension

Aim:With the normal aging process,the malar fat pad descends vertically,causing a number of characteristic changes to the face.Various techniques have been used to correct ptosis of the malar fat pad.Methods:The authors describe a technique that is minimally invasive and can be used to correct malar fat pad ptosis.This technique uses a suspension suture to elevate the malar fat pad to a more youthful position.The technique has been successfully used in 71 patients.Results:All of the cases were performed in the office setting under local anesthesia.There were no complications,and,by patient self-report and physician exam,results have been lasting and satisfactory.Conclusion:The minimally invasive midface suspension is a safe and successful approach to midface rejuvenation in properly selected patients.

Review of cost and surgical time implications using virtual patient specific planning and patient specific implants in midface reconstruction

Aim:Summarize the available data on midfacial virtual patient specific planning and patient specific implants,highlighting the financial costs and savings,and additionally emphasize the potential cost implications of transitioning to“in-house”virtual 3D modeling and printing.Methods:Review of current literature.Results:Current literature suggests cost benefits of virtual patient specific planning and patient specific implants in the form of improved ischemia time,better boney apposition between flaps,and reduced patient complications.This reduction of complications includes a reduction in blood loss and time spent in the intensive care unit from flap failure.Improved boney apposition results in a higher likelihood of boney union and a further reduction in failure and complications.Subjective benefits of virtual patient specific planning and patient specific implants are shown in the form of improved reconstructive surgeon mental energy.In-house production of 3D models and presurgical planning provides additional cost benefits for providers as they can produce viable models at a fraction of the price of that which is produced by industrial companies.Providers can also construct and use models in an expedient manner compared to industrial models,allowing for the opportunity to be utilized in more acute settings.The foundation of developing an in-house workflow is adequate funding,resources,and clinical volume.Facilities also must focus on appropriate quality and safety measures,as well as appropriate workflow development for adequate production of models.Conclusion:Virtual patient specific planning and patient specific implants show benefits in midfacial reconstructive outcomes,resulting in realized financial and temporal gains for both patient and provider.These gains may be enhanced by moving to in-house planning and printing.

A protocol used to manage maxillary hypoplasia in cleft lip and palate patients

Objectives: We report our experience and the protocol we used in managing maxillary hypoplasia in cleft lip and palate patients. Patients and methods: 14 adult cleft lip and palate patients with maxillary hypoplasia were evaluated clinically. Dental models and radiographs including (lateral cephalograms and orthopantographs) were obtained at the initial visit and upon completion of the presurgical orthodontic treatment. Patients with occlusal discrepancies larger than 6 mm and severe palatal scaring underwent Distraction osteogenesis (DO) to advance the maxilla. Patients with an occlusal discrepancy of 6 mm or less, underwent traditional orthognathic surgery including le fort I advancement and Bilateral sagittal split osteotomy (BSSO) to seat the mandible in occlusion. Results: Five patients underwent orthognathic surgery. Two of them underwent double jaw surgery. Three underwent single jaw conventional le fort l advancement. Four patients required bone grafting to repair the residual alveolar defect and to augment the midface deficiency. Nine patients with severe maxillary hypoplasia underwent maxillary advancement using distraction osteogenesis. Conclusion: Patients with a severe maxillary hypoplasia of 6 mm or more and excessive palatal scaring are successfully treated with DO. Conventional le fort I is reserved for patients with less severe maxillary hypoplasia. Both techniques gave promising results providing having followed the proper selection criteria.

Kicked in the Face by a Fish

Facial trauma caused by animals is a well known aetiology for maxillofacial injuries. Our case is an injury to the midface and upper face, caused by an unusual animal in the world of maxillofacial trauma, in circumstances not very commonly seen, and certainly only exists in few parts of the world. This assault results in a fracture in one of the stronger corners of the orbital cavity rather than the commonly seen floor fractures which is partly likely to break first with blunt external trauma.

Global facial rejuvenation, new technique

Facial aging is the combination of multiple effects such as sun exposure, tobacco, environmental stress and smog, reflecting the cumulative and dynamic effects of time on the skin, soft tissues and the deep structural components of the face that show an important change structural features of the skin and loss of facial volume. There are many different techniques currently used to perform face lifting, the ultimate goal is to get good results with respect for patient safety. This article describes a new approach to facial rejuvenation combining superficial musculoaponeurotic system (SMAS) plication elements on four vectors, with a blepharoplasty to achieve a lasting improvement in facial aging. The plication of the SMAS on the suture provides three vectors of elevation under the skin in the middle rhytidectomy, linked to the Lorè fascia and to the third platys elevation vector behind the ear. The blepharoplasty technique is often unavoidable in the execution of the global facial rejuvenation. This allows obtaining excellent results both in terms of aesthetic and of a good patient empowerment. This new surgical technique, called 'KORU technique', was used on 31 patients between October 2010 and October 2012, producing lasting results, reducing injuries and respecting anatomical planes. This approach can be safely and easily performed under local anesthesia as an isolated midface procedure, respecting and safeguarding the facial nerve. This type of chiropractic technique can be used by young surgeons.

Endoscopic assisted facial rejuvenation: a 35 year personal journey

Aim:Traditional facelift techniques rely on pulling.They approach the superficial or intermediate layers where the facial nerves and muscles are located,increasing the risk of facial nerve injury.They approach the central oval from the periphery and produce unnatural vectors of pull and aesthetic results.Alternative techniques that work on the subperiosteal plane using endoscopic techniques are described.Modern concepts of volume augmentation,beautification and rejuvenation of the facial expression are an inherent part of such techniques,or can be easily integrated.Methods:The central oval is approached via four small scalp incisions and additional intraoral,upper gingivo-buccal incisions.The interconnected frontal subperiosteal,temporal subfascial and midface subperiosteal areas are lifted,imbricated and suspended sequentially.The brow/forehead is suspended to the skull using cortical screws.The midface and lower periorbita are suspended to the fascia of the temporal muscle.The buccal fat pad is used to enhance the ogee line of the midface.Other three-dimensional volumetric maneuvers can easily be applied.In this setting,upper and lower lid blepharoplasties become more straightforward,skin only procedures.Actinic or nicotine damaged skin can be treated with lasers,peels or fluidified fat grafting in the same setting.The excess skin on the lower face and neck can be redrapped with standard cervicofacial techniques.Deep subplatysmal cervicoplasty can be done concomitantly,or at another time to complete comprehensive rejuvenation.Results:The procedures described herein has been performed in 824 patients with excellent aesthetic results and low complication rate.The average rate of rejuvenation was 18 years. ;Conclusion:These combination techniques are called Biplanar Endoscopic Assisted Mask and Triplanar Endoscopic Assisted Mask facial rejuvenation.They are advanced techniques of facial rejuvenation that provide comprehensive,natural,long lasting results.