The Anatomy behind Adverse Events in Hand Volumizing Procedures: Retrospective Evaluations of 11 Years of Experience

Frank, Konstantin; Koban, Konstantin Christoph; Targosinski, Stefan; Erlbacher, Katharina; Schenck, Thilo L.; Casabona, Gabriela; Braz, André; Pavicic, Tatjana; Cotofana, Sebastian

doi:10.1097/prs.0000000000004211

Cited by 39 publications

(33 citation statements)

References 22 publications

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“…[2][3][4][5][6] In contrast, it is thought that needles deliver product more precisely and accurately despite creating more trauma to tissue. Having a device with a blunt tip is thought to reduce the risk of perforating and/or penetrating nerves and blood vessels during the injection procedure.…”

Section: Introductionmentioning

confidence: 99%

“…This purportedly reduces the risk of nerve injuries and the risk of intra-arterial injection of the product. [2][3][4][5][6] In contrast, it is thought that needles deliver product more precisely and accurately despite creating more trauma to tissue. 7 However, recent studies have shown that using a needle results in less precise product placement, if precision is defined as the filler material remaining in the plane of intended implantation.…”

Section: Introductionmentioning

confidence: 99%

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Subperiosteal injections during facial soft tissue filler injections—Is it possible?

Pavicic

Yankova

Schenck

et al. 2019

J of Cosmetic Dermatology

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Background It can be hypothesized that safety during soft tissue filler injection could be enhanced if the product could be positioned between the periosteum and the bone surface i.e. subperiosteal. Aim This study investigated the feasibilityof subperiosteal injections. Patients/Methods We analysed 126 injection procedures performed in seven Caucasian body donors (4 males, 3 females) with a mean age of 75.29 ± 4.95 years [range: 70 – 87] and a mean body mass index of 23.53 ± 3.96 kg/m2 [range: 16.46 – 32.23]. The injection procedures were performed in the forehead, scalp, zygomatic arch and the mandible bilaterally. Injection procedures were conducted using 25G, 27G and 30G sharp‐tip needles (TSK Laboratory, Tochigi, Japan) and at various angles from the bone surface measured with a goniometer: 90 degrees (perpendicular), 45 degrees and 10 degrees (as tangential as possible to bone surface). Results Cadaveric dissections of the injection sites showed that no product was located deep to the periosteum in any of the investigated regions. This indicates that all performed injection procedures positioned the product superficial to the periosteum (100%) with a zero‐success rate of subperiosteal injections. Conclusion In the setting of this cadaveric investigation, despite varying needle size and injection angle, subperiosteal injection could not be achieved. This indicates that the product can spread uncontrolled into more superficial layers yielding an increased risk for adverse aesthetic and vascular events.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Subperiosteal injections during facial soft tissue filler injections—Is it possible?

Pavicic

Yankova

Schenck

et al. 2019

J of Cosmetic Dermatology

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“…Despite failing to reach statistical significance, volume reduction was greater for the PCL suspension threads at the nasolabial and at the labiomandibular sulcus but not when measured along the A strength of the present study is that study outcomes were objectively assessed using 3D surface scanning, which identifies skin movement and surface-volume projection changes between two 3D images. [26][27][28][29][30][31][32] Measurements were conducted using an objective mathematic algorithm, eliminating observer bias. Calculations yielded changes in skin displacement in a 2D Cartesian coordinate system (x-and y-values; representative for vertical lifting (y-value) and horizontal lifting (x-value) given in mm) and changes in surface volume (given in mL).…”

Section: Discussionmentioning

confidence: 99%

The Influence of the Insertion Angle on Middle and Lower Face Tissue-Mechanics When Treating the Nasolabial Folds with Facial Suspension Threads—An Experimental Split-Face Cadaveric Study

Braun¹,

Frank

Freytag

et al. 2020

Facial Plast Surg

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A novel treatment approach to address the nasolabial fold is the insertion facial suspension threads. However, there is a paucity of data available to guide insertion techniques and material selection. Three female and two male cephalic specimens of Caucasian ethnicity (73.6 ± 6.5 years; 21.41 ± 2.2 kg/m2) were included into this experimental split-face study. One facial side was treated with polycaprolactone (PCL) thread: 180 mm, bidirectional, 18G 100 mm cannula, 20 degrees trajectory, preauricular approach whereas the contralateral side was treated with polydioxanone (PDO) thread: 100 mm, bidirectional, 19G, 60 mm cannula, 50 degrees trajectory, infraorbital approach. Three-dimensional imaging outcome measures included vertical and horizontal skin displacement and volume changes at the nasolabial sulcus, at the labiomandibular sulcus, and along the jawline. Comparing PCL 180 mm 20 degrees to PDO 100 mm 50 degrees: vertical lifting effect 1.42 ± 2.63 mm versus 1.24 ± 1.88 mm (p = 0.906); horizontal lifting effect 3.42 ± 1.44 mm versus –2.02 ± 1.84 mm (p = 0.001); nasolabial volume change –0.80 ± 0.65 mL versus –0.52 ± 0.17 mL (p = 0.367); labiomandibular volume change –0.45 ± 0.42 mL versus –0.16 ± 0.16 mL (p = 0.191); jawline volume change 0.02 ± 0.43 mL versus –0.01 ± 0.21 mL (p = 0.892). The study provides objective evidence for the short-term effectiveness of facial suspension threads in treating the nasolabial folds. The results point toward a better aesthetic outcome when utilizing long facial suspension threads that can effect full-face changes as compared with short facial suspension threads.

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“…The superficial lamina begins less than 1 mm deep to the skin surface and contains no important structures. 16,18 The fat distribution is uneven in this layer. The layer has 8 to 12 spanning fascial septae, which contain small vessels.…”

mentioning

confidence: 99%

“…The layer has 8 to 12 spanning fascial septae, which contain small vessels. 16,18 The intermediate lamina contains the veins and nerves of the dorsum of the hand. Dorsal veins have an average diameter of 1.27 mm.…”

mentioning

confidence: 99%

Fat Grafting for Hand Rejuvenation

Conlon

Abu‐Ghname

Davis

et al. 2020

Seminars in Plastic Surgery

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The hands are one of the most visible parts of the body, and prominent dorsal veins and extensor tendons are the most readily recognized signs of the aging process. Fat grafting has been demonstrated to be a safe and effective method of hand rejuvenation by restoration of subcutaneous fat. Despite some variability in the technical approach, fat grafting techniques are consistent in their use of low-pressure injection with standard cannula sizes, small aliquots of graft, and a total volume of graft greater than or equal to 15 mL per hand. While distribution of the fat is an area of debate and a topic of active research, published studies have shown high patient satisfaction rates, suggesting that perhaps the restoration of volume alone is paramount. In this article, we will review the applications of fat grafting to the hand, focusing primarily on its role in hand rejuvenation.

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The Anatomy behind Adverse Events in Hand Volumizing Procedures: Retrospective Evaluations of 11 Years of Experience

Cited by 39 publications

References 22 publications

Subperiosteal injections during facial soft tissue filler injections—Is it possible?

Subperiosteal injections during facial soft tissue filler injections—Is it possible?

The Influence of the Insertion Angle on Middle and Lower Face Tissue-Mechanics When Treating the Nasolabial Folds with Facial Suspension Threads—An Experimental Split-Face Cadaveric Study

Fat Grafting for Hand Rejuvenation

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