The mobility of the superficial and deep midfacial fat compartments: An ultrasound‐based investigation

Background: Ultrasound (US) has been used for many years in the field of medicine.Many specialties have embraced US as a quick, painless, and relatively inexpensive tool to assist the clinician in determining anatomy, pathology, and aid in diagnostic or therapeutic procedures. US allows for precise mapping of cutaneous and subcutaneous structures in the face, in particular vascular structures. The use of US leads to reduced chances of complications and clinical failures, rendering more safety and high quality.Methods: US is considered the first-imaging technique for dealing with fillers and managing their potential complications. US can be deployed for vascular mapping, safe placement of fillers, and directed low-dose hyaluronidase reversal of vascular adverse events. It is a noninvasive imaging modality that provides a good definition for studying the skin, deeper layers, and blood flow in real time. In other words, we go from static to dynamic anatomy. In addition, US can guide with the application of botulinum toxin, in order to define the muscular planes. US may contribute to a more personalized procedure, better cosmetic results, and help to avoid complications. In general, physicians tend to use it for prevention. Last, for research purposes, US examination provides valuable information on the behavior, longevity, and interaction of the filler within the tissues. Conclusion:This new approach for US-guided treatments is a very practical and an effective method in cosmetic dermatology. As doctors, we owe it to our patients to do our best to prevent any harm. We feel that in near future, US will be an essential diagnostic tool in any dermatology or cosmetic doctor's office to both ensure safety and provide legal protection for the professional.

Section: Ultrasound In Cosmetic Dermatology: Why?mentioning

confidence: 99%

The growing importance of ultrasonography in cosmetic dermatology: An update after the 23rd IMCAS Annual World Congress (2022)

Haykal

Cartier

Benzaquen

et al. 2022

“…Interestingly, a recent ultrasound imaging-based study revealed that the mobility of the deep facial fat compartments is significantly reduced when compared to the mobility of the superficial fat compartments, most probably due to their connection to stable and immobile deep facial structures like nerves and ligaments. 9 The superficial fat compartments, on the contrary, display significant movement during facial animation which explains the formation of apple cheeks in conjunction with the transverse facial septum. 10 Injectors, therefore, favor treating deep facial structures when trying to restructure and recontour the midface or when trying to provide structural support for overlying soft tissues.…”

Section: Introductionmentioning

confidence: 99%

Clinical validation of the upper face first principle—A clinical, prospective, interventional split‐face study

Hernandez¹,

Zapata²,

Bermudez

et al. 2022

Self Cite

Background Previous clinical and anatomic investigations have identified the clinical relevance of facial biomechanics. Based on this new understanding, principles for facial aesthetic procedures were established: Lateral Face First, Deep Layers First, and Upper Face First. Objective To test the upper face first principle by showing that an injection sequence, starting in the upper face is superior to an injection sequence starting in the lower face. Methods This study was designed as an interventional split‐face study administering the same amount and type of soft tissue filler for the upper, middle, and lower face but in a different sequence: upper, middle, lower face versus lower, middle, and upper face. A total of 15 patients (5 males and 10 females) with a mean age of 39.4 years (9.6) and a mean BMI of 23.4 kg/m2 (1.7) were studied. Follow‐up at D0, D30, and D90 was conducted utilizing semiquantitative scores and objective 3D imaging. Results Despite not reaching statistical significance, midfacial volume and jawline contouring were rated better at every follow‐up visit (D0, D30, D90) when treated with the upper versus the lower face first injection algorithm. The global aesthetic improvement scale showed statistically significantly better values for the upper face first algorithm when compared to the lower face first algorithm at all evaluated time points with all p < 0.001. Conclusion Applying the upper face first injection algorithm seems to result in better aesthetic outcomes when directly compared to the lower face first algorithm. Semiquantitative and objective outcome measurements confirm its clinical effectiveness.

“…This segmented, overfilled look can be avoided by injecting small amounts of filler and asking the patient to smile periodically between intermittent injections 23 . Deeper injections can also prevent this effect, as the deeper fat compartments are less mobile than more superficial compartments 24 …”

Section: Resultsmentioning

confidence: 99%

Aesthetic considerations for treating the North American multi‐ethnic patient: Thriving in diversity international roundtable series

Fabi

Callender

Lee

et al. 2022

Background The United States is becoming increasingly diverse, and between 2016 and 2019, an increase of 945 832 aesthetic procedures was recorded for Hispanic, African American, and Asian American patients combined. In aesthetics, where outcomes are technique dependent and tied to the clinician's ability to tailor treatment to the needs of individual patients, a knowledge of ethnic differences in anatomy and how aesthetic issues can be safely and effectively addressed in different groups is paramount. Aims To discuss similarities and difference in anatomy and treatment preferences of patients from a variety of ethnic and racial backgrounds and how these differences may influence the products or techniques utilized to achieve natural‐looking results and minimize side effects. Patients/Methods In support of clinicians who wish to serve a diverse patient population, a 6‐part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022. Results The results of the first roundtable in the series, the North American Multiethnic Patient, are described here. Conclusions A diverse range of patients can benefit from the tailored use of fillers, fat transfer, neuromodulators, lasers, and energy‐based devices, as long as differences in structural support, skin, and aging patterns, are appreciated.