The aging process occurs in all anatomical layers of the face; therefore, rejuvenation should not be limited to the dermic signs of aging. 1,2 Regardless of the beauty concept, a search for rejuvenation through aesthetic procedures is universal, which makes the number of these procedures increase each year. 2 The treatment with fillers in strategic points can reconstruct young anatomy, providing natural results.. 1 There are two instruments used for facial application of hyaluronic acid: cannula and needle. Both of them have advantages and disadvantages. Needles often come together with the products.However, there are some problems associated with its use, including pain, tissue damage from the use of a sharp instrument, a greater chance of ecchymosis, laceration of vessels, and the need for multiple punctures. 3,4 Positioning the needle tip in the periosteum is assumed to be relatively easy and results in accurate placement of the filler. This assumption still represents the view of the majority, as shown in our survey of expert injectors. 1 In some applications, the use of cannulas offers advantages and the main one is related to safety. 5 Cannulas are instruments with
Background The tear trough is one of the most challenging facial regions for soft-tissue filler injections. A thorough understanding of the underlying fascial, muscular, and vascular anatomy is crucial to perform safe and effective tear trough injectable treatments. Objectives To evaluate the location and function of the angular vein in the tear trough in three different facial expressions: repose, smiling, and max. orbicularis oculi contraction. Methods Twenty study participants with a mean age of 48.3 years and mean BMI of 24.5 kg/m 2 were investigated via functional ultrasound imaging. The diameter of the angular vein, the velocity, and direction of venous blood flow were analyzed in repose, smiling and during max. orbicularis oculi contraction. Results The angular vein was identified in 100% of the cases to travel inside the orbicularis oculi muscle (= intra-muscular course) within the tear trough whereas the angular artery was not identified in this location. The distance between the angular vein the inferior orbital rim was (lateral to medial): 4.6 mm, 4.5 mm, 3.9 mm, and 3.8 mm. The caudally directed blood flow was in repose 10.2 cm/sec and was 7.3 cm/sec at max. orbicularis oculi muscle contraction; however, no blood flow was detectable during smiling. Conclusions The diameter and the venous blood flow of the angular vein varied between the three tested facial expressions. Based on these anatomical findings, the deep injection approach to the tear trough is recommended due to the intramuscular course of the angular vein
Background Uncontrolled product spread is an important issue to consider in facial soft-tissue filler injections. Lack of precision can result in a reduction of effectiveness and surface projection, as well as irregularities, and product visibility. Objectives To assess the precision of soft-tissue filler injections in the face using a cannula. Methods This single-center observational study investigated soft-tissue filler distribution in a total of 100 facial injection procedures using real-time non-invasive ultrasound imaging. Outcome parameters included (1) the tissue plane of product distribution, (2) the extent of horizontal as well as vertical product spread at the injection site, and (3) the product surface area taking into account the multifactorial influence of several independent variables. Subjects were followed up to 30 days post-injection. Results 100 facial regions were injected in 8 patients (2 males, 6 females) with a mean age of 37.20 (6.34) years and a mean BMI of 22.21 (1.39) kg/m2. The plane of product distribution remained constant in ~ 90% of cases at day 0 (d0), d14 and d30. Mean horizontal product spread was higher compared to vertical spread, while both significantly decreased over all respective time points with p<0.001. Mean product surface area was 22.51 +/- 16.34 mm2 at d0, 15.97 +/- 11.28 mm2 at d14 and 12.9 +/- 9.15 mm2 at d30. Analysis using generalized linear models revealed that injection volume and injection depth significantly influenced product surface area. Conclusions Injection of soft-tissue filler using a cannula allows precise application of the product within the intended tissue plane. Precision can be improved by injecting less product into deeper tissue layers.
Background Addressing neck contouring with surgical and non-surgical aesthetic procedures includes understanding the origin of platysmal banding. A theory was postulated to explain this phenomenon via isometric vs isotonic muscular contraction patterns. However, no scientific proof was provided to date for its correctness. Objectives To confirm the correctness of the platysmal banding theory based on isometric vs isotonic muscular contractions. Methods 80 platysma muscles from 40 volunteers (15 males/25 females) were investigated (mean age 41.8 (15.2) years; mean BMI of 22.2 (2.3) kg/m2). Real-time ultrasound imaging was utilized to measure the increase in local muscle thickness inside and outside of a platysmal band as well as platysma mobility. Results Within a platysmal band, the local thickness of the muscle increases during muscular contractions by 0.33 mm (37.9%; p < 0.001). Outside of a platysmal band the thickness of the platysma muscle decreased by 0.13 mm (20.3%; p < 0.001). It was identified that within a platysmal band no gliding was detectable whereas outside of a band an average muscle gliding of 2.76 mm was observed. Conclusions The results confirm the correctness of the isometric vs isotonic platysma muscle contraction pattern theory: isotonic muscle contraction (gliding without increase in tension and therefore in muscle thickness) versus isometric muscle contraction (no gliding but increase in tension and therefore in muscle thickness). These two types of contraction patterns occur within the platysma simultaneously and are an indicator for zones of adhesion in the neck to guide surgical and non-surgical aesthetic procedures.
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