The shape of the jawline from the mandibular angle to its most forward point at the chin has a profound effect on an individual's appearance and is an area of concern for many seeking esthetic procedures. Dermal filler injections alone or in combination with other modalities, such as skin tightening energy devices, allow enhancement of the jawline while avoiding the need for surgical procedures. The authors introduce new anatomical zones and nomenclature to enhance safety and outcome when enhancing the jawline. Cadaver dissections were performed to better understand landmarks and potential risks and a topographic guide proposed to assist clinicians to create an esthetically pleasing jawline. Techniques for jawline rejuvenation with calcium hydroxylapatite (CaHA) and high G prime hyaluronic acid (HA) fillers are described. When considered as an esthetic unit, the jawline can be broken down into masseteric, buccal, and mental zones, each with their own injection protocols and safety considerations. Dermal fillers suitable for jawline rejuvenation include either CaHA with or without integral lidocaine, a high G prime HA filler, or a hybrid mixture of CaHA and HA, depending on the desired esthetic outcome and the individual's needs. Small volumes of product per injection point achieve the most natural esthetic outcome and minimize serious adverse events. With these techniques, the angle of the mandible is better defined, the pre- and postjowl hollows are filled, and as a result the jawline appears visibly straighter. CaHA and high G prime HA fillers are effective nonsurgical treatments for redefining the mandibular angle and straightening the contour of the jaw. For optimal results, the jawline should be considered as an esthetic unit and careful consideration paid to anatomical landmarks that influence efficacy and safety.
Inflammation plays an important role in the pathophysiology of atherosclerotic disease. We have previously shown that the targeted photosensitizer chlorin (e(6)) conjugated with maleylated albumin (MA-ce6) is taken up by macrophages via the scavenger receptor with high selectivity. In a rabbit model of inflamed plaque in New Zealand white rabbits via balloon injury of the aorto-iliac arteries and high cholesterol diet we showed that the targeted conjugate showed specificity towards plaques compared to free ce6. We now show that an intravascular fiber-based spectrofluorimeter advanced along the -iliac vessel through blood detects 24-fold higher fluorescence in atherosclerotic vessels compared to control rabbits (p < 0.001 ANOVA). Within the same animals, signal derived from the injured iliac artery was 16-fold higher than the contralateral uninjured iliac (p < 0.001). Arteries were removed and selective accumulation of MA-ce6 in plaques was confirmed using: (1) surface spectrofluorimetry, (2) fluorescence extraction of ce6 from aortic segments, and (3) confocal microscopy. Immunohistochemical analysis of the specimens showed a significant correlation between MA-ce6 uptake and RAM-11 macrophage staining (R = 0.83, p < 0.001) and an inverse correlation between MA-ce6 uptake and smooth muscle cell staining (R = -0.74, p < 0.001). MA-ce6 may function as a molecular imaging agent to detect and/or photodynamically treat inflamed plaques.
No significant difference was found in bruising or pain in patients treated with BEL, BEL-L, and BEL-LE. Studies with a considerably larger sample size are warranted to determine statistically significant and clinically meaningful differences between and among the various formulations.
Summary:
The depressor anguli oris acts to lower the lateral corners of the mouth and can cause an individual to appear sad or angry and contribute to the development of the labiomental folds. Many patients can benefit from the injection of small amounts of botulinum neurotoxin into the depressor anguli oris to enable the lip elevators to reposition the corners of the mouth. Although effective, the procedure is off-label, and the proximity of the depressor anguli oris to the depressor labii inferioris, particularly inferiorly, can lead to inadvertent treatment of the latter, resulting in lip asymmetry. The authors have taken a threefold approach to establish a depressor anguli oris injection technique that provides optimal aesthetic outcomes with a low incidence of adverse events. This involved, first, reviewing the limited existing literature for studies discussing depressor anguli oris anatomy and botulinum neurotoxin treatment technique; second, supplementing information from the published literature with information from cadaver dissections to demonstrate the relationship between the depressor anguli oris and surrounding anatomical structures; and third, performing a retrospective chart review of 275 patients treated with the authors’ three-point injection technique. Combining data from published studies, cadaver dissections, and clinical experience, the authors demonstrate that a three-point technique performed in the upper half of the depressor anguli oris is associated with good clinical outcome and avoids common side effects related to injection or spread of neurotoxin to adjacent muscles.
CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
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