Pertinent Anatomy and Analysis for Midface Volumizing Procedures

Surek, Christopher C.; Beut, Javier; Stephens, Robert E.; Jelks, Glenn W.; Lamb, Jerome

doi:10.1097/prs.0000000000001226

Cited by 30 publications

(25 citation statements)

References 1 publication

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“…The contour of the anteromedial cheek region has been considered as an important determinant of the overall aesthetics and youthfulness of the face [1][2][3]. For young and aesthetically pleasant faces, the position of the most convex point of the anteromedial cheek region, i.e., cheek mass position, is 1.6-2.1 mm in front of the cornea perpendicular line [1,[4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Effect of Le Fort I Maxillary Advancement and Clockwise Rotation on the Anteromedial Cheek Soft Tissue Change in Patients with Skeletal Class III Pattern and Midface Deficiency: A 3D Imaging-Based Prediction Study

Lai

Denadai

et al. 2020

JCM

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Patients with a skeletal Class III deformity may present with a concave contour of the anteromedial cheek region. Le Fort I maxillary advancement and rotational movements correct the problem but information on the impact on the anteromedial cheek soft tissue change has been insufficient to date. This three-dimensional (3D) imaging-assisted study assessed the effect of surgical maxillary advancement and clockwise rotational movements on the anteromedial cheek soft tissue change. Two-week preoperative and 6-month postoperative cone-beam computed tomography scans were obtained from 48 consecutive patients who received 3D-guided two-jaw orthognathic surgery for the correction of Class III malocclusion associated with a midface deficiency and concave facial profile. Postoperative 3D facial bone and soft tissue models were superimposed on the corresponding preoperative models. The region of interest at the anteromedial cheek area was defined. The 3D cheek volumetric change (mm3; postoperative minus preoperative models) and the preoperative surface area (mm2) were computed to estimate the average sagittal movement (mm). The 3D cheek mass position from orthognathic surgery-treated patients was compared with published 3D normative data. Surgical maxillary advancement (all p < 0.001) and maxillary rotation (all p < 0.006) had a significant effect on the 3D anteromedial cheek soft tissue change. In total, 78.9%, 78.8%, and 78.8% of the variation in the cheek soft tissue sagittal movement was explained by the variation in the maxillary advancement and rotation movements for the right, left, and total cheek regions, respectively. The multiple linear regression models defined ratio values (relationship) between the 3D cheek soft tissue sagittal movement and maxillary bone advancement and rotational movements of 0.627 and 0.070, respectively. Maxillary advancements of 3–4 mm and >4 mm resulted in a 3D cheek mass position (1.91 ± 0.53 mm and 2.36 ± 0.72 mm, respectively) similar (all p > 0.05) to the 3D norm value (2.15 ± 1.2 mm). This study showed that both Le Fort I maxillary advancement and rotational movements affect the anteromedial cheek soft tissue change, with the maxillary advancement movement presenting a larger effect on the cheek soft tissue movement than the maxillary rotational movement. These findings can be applied in future multidisciplinary-based decision-making processes for planning and executing orthognathic surgery.

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Section: Introductionmentioning

confidence: 99%

Effect of Le Fort I Maxillary Advancement and Clockwise Rotation on the Anteromedial Cheek Soft Tissue Change in Patients with Skeletal Class III Pattern and Midface Deficiency: A 3D Imaging-Based Prediction Study

Lai

Denadai

et al. 2020

JCM

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“…Systematic assessment and site-specific nonsurgical rejuvenation of the face with fillers may lead to increased safety, accuracy, and technique reproducibility in this commonly performed procedure. Although out of the scope of this article, several publications referenced herein offer excellent detailed descriptions of techniques (often accompanied by anatomical dissections) used to access some of these areas safely, effectively, and reproducibly (Fitzgerald and Vleggaar, 2011, Pessa and Rohrich, 2012, Lamb and Surek, 2018, Scheuer III et al, 2017, Sieber et al, 2016, Surek et al, 2015b, Wang et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

An approach to structural facial rejuvenation with fillers in women

Fitzgerald¹,

Carqueville

Yang

2019

International Journal of Women's Dermatology

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Newer understanding of volume loss as a critical component of facial aging and the integration of volume replacement into the surgical and nonsurgical therapeutic algorithm is arguably the most significant recent development in the field of facial rejuvenation. As all structural tissues play a role in the aging face, restoring youthful characteristics (or establishing them where they are congenitally absent) starts from the skeletal framework and builds progressively to the canvas of the face. The purpose of this article is to provide an introduction and brief summary of some of the current concepts concerning facial anatomy and the anatomy of facial aging, which serve as the basis for predictable and reproducible results with the use of injectable fillers. This article does not include the various types of fillers or techniques of filler injection, but covers how to decide where to use the filler and why, in different faces, as a result of the recognition and targeted correction of currently recognized specific anatomic deficiencies.

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“…2 The fat repositioning technique fulfills Loeb's criteria because the technique involves the use of vascularized pedicles of orbital fat and positions the fat pedicles anatomically adjacent to the recently defined deep fat compartments, or more precisely, within the overlying prezygomatic and premaxillary spaces that have been theorized to offer the best plane for augmenting and rejuvenating the periorbital and malar areas. 8,10,13 Techniques based on removing orbital fat during lower blepharoplasty do not provide this benefit. Although the fat repositioning technique requires a more thorough grasp of anatomic knowledge, surgical proficiency, and operating time, the results have been shown in the current study to be aesthetically beneficial and the results long lasting.…”

Section: Discussionmentioning

confidence: 99%

“…The area selected for volume analysis was based on the areas typically affected by fat repositioning and by a recent cadaver study confirming reproducible target zones for augmentation in the malar area. 8 The area of evaluation for each patient included the tear trough (and eyelid-cheek junction) as the superior border; the medial and lateral borders were based on perpendicular lines originating from the medial and lateral canthi that intersect a horizontal line originating from the alar crease that served as the inferior border. The area was selected on the preoperative 3D photograph using the untextured view, which offers more precise recognition and inclusion of the entire tear trough (and eyelid cheek junction).…”

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confidence: 99%

Long-term 3-Dimensional Volume Assessment After Fat Repositioning Lower Blepharoplasty

Miller¹

2016

JAMA Facial Plast Surg

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ower eyelid blepharoplasty is a commonly requested aesthetic procedure. 1 The primary reason is pseudofat herniation in the lower eyelid area that can impart an unwanted tired or sad appearance. Surgical techniques that are commonly used to correct pseudofat herniation can typically be categorized as fat preservation or fat subtractive. Fat repositioning lower blepharoplasty is a fat preservation technique that offers distinct advantages, namely effacing the tear trough by releasing the tethering orbicularis retaining ligament with the subsequent addition of volume to the tear trough and upper malar area (Figure 1). 2-5 Prior to 3-dimensional (3D) imaging, evaluation of the effectiveness of the fat repositioning lower blepharoplasty technique was difficult to quantify. Specifically, standard photography relied on shadows and tight camera angles to illustrate qualitative results (Figure 1 and Figure 2). Moreover, patients would commonly have adjunctive procedures performed during or after the procedures, thereby confounding the results of the fat repositioning technique alone. The current study used a standardized 3D camera system and a cohort of patients having only fat repositioning lower blepharoplasty performed to quantify the long-term effectiveness of this fat preservation lower blepharoplasty technique. Methods A retrospective electronic medical record review was performed to identify patients who underwent primary lower IMPORTANCE First reported 3-dimensional quantitative study of the lower periorbital area after lower blepharoplasty using the fat repositioning technique. OBJECTIVE To determine the volumetric effects lower blepharoplasty with fat repositioning provides to the tear trough and deep fat compartments of the upper cheek. DESIGN, SETTING, AND PARTICIPANTS A retrospective electronic medical chart review (16-month study with a minimum of 10-month postoperative evaluation) was performed on 12 initial patients recruited to a private practice; 2 patients were lost to long-term follow-up. Patients were recruited between May 2014 and November 2014. To fulfill recruitment criteria, patients must have undergone a lower blepharoplasty performed using the fat repositioning technique with a minimum of 10 months follow-up. Patients who had undergone additional procedures or had a history of filler to the tear trough or cheek area before or during the study period were excluded. MAIN OUTCOMES AND MEASURES Volume (mL) measurement of a defined anatomical area in postoperative patients. RESULTS Overall, 10 patients (mean [range] age, 56 [37-66] years) who had undergone a lower blepharoplasty performed using the fat repositioning technique had volume gain in the areas evaluated. The mean (range) follow-up time was 12 (10-16) months. The average volume gain was 0.64 mL (left side, 0.61 mL; right side, 0.67 mL). There was no statistical difference when the 2 sides were compared (P = .49). CONCLUSIONS AND RELEVANCE The fat repositioning technique in lower blepharoplasty improves pseudofat herniation while simultaneo...

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Pertinent Anatomy and Analysis for Midface Volumizing Procedures

Cited by 30 publications

References 1 publication

Effect of Le Fort I Maxillary Advancement and Clockwise Rotation on the Anteromedial Cheek Soft Tissue Change in Patients with Skeletal Class III Pattern and Midface Deficiency: A 3D Imaging-Based Prediction Study

Effect of Le Fort I Maxillary Advancement and Clockwise Rotation on the Anteromedial Cheek Soft Tissue Change in Patients with Skeletal Class III Pattern and Midface Deficiency: A 3D Imaging-Based Prediction Study

An approach to structural facial rejuvenation with fillers in women

Long-term 3-Dimensional Volume Assessment After Fat Repositioning Lower Blepharoplasty

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