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  • 1
    In: Aesthetic Surgery Journal, Oxford University Press (OUP), Vol. 43, No. 7 ( 2023-06-14), p. 760-770
    Abstract: Multiple muscles contribute to the formation of dorsal nasal lines (DNLs) and affect nasal aesthetics. Few attempts have been made to explore the range of distribution of DNLs in relation to injection planning. Objectives The aim of this study was to classify the distribution types of DNLs and propose a refined injection technique validated by clinical study and cadaver dissection. Methods Patients were classified into 4 types according to their DNL distribution type. Botulinum toxin type A injections were administered at 6 regular points and 2 optional points. The effect on wrinkle reduction was assessed. Patient satisfaction was recorded. Cadaver dissection was conducted to explore the anatomical evidence of DNL variation. Results The study included 349 treatments in 320 patients (269 females and 51 males), whose DNLs were classified into complex type, horizontal type, oblique type, and vertical type. The severity of DNLs was significantly reduced after treatment. Most patients were satisfied. From the cadaver study, connecting muscular fibers were clearly observed among the muscles involved in the formation of DNLs, and these muscles were collectively named the dorsal nasal complex (DNC) by the authors. Four anatomical variations of the DNC were discovered, corroborating the DNL classification system. Conclusions A novel anatomical concept, the DNC, and a classification system for DNLs were proposed. Each of the 4 distribution types of DNLs corresponds to a specific anatomical variation of the DNC. A refined injection technique for DNLs was developed, and its efficacy and safety were demonstrated.
    Type of Medium: Online Resource
    ISSN: 1090-820X , 1527-330X
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 2
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2023
    In:  Aesthetic Surgery Journal ( 2023-08-16)
    In: Aesthetic Surgery Journal, Oxford University Press (OUP), ( 2023-08-16)
    Abstract: Pretarsal rolls are a crucial aesthetic feature. Despite numerous studies conducted on periorbital aesthetics, there remains a dearth of research on the ideal pretarsal rolls. Objectives This study aimed to investigate 4 aesthetic characteristics of ideal pretarsal rolls: presence, width, proportion, and morphology. Methods Respondents (385, including 80 aesthetic specialists) were presented with 7 series of images of pretarsal rolls, including 2 series of pretarsal roll existence, 2 series of varying widths, 2 series of different ratios between pretarsal roll and palpebral fissure height, and 1 series about morphology. Participants were asked to rank each image within a given series from most attractive to least attractive. The rankings were then analyzed according to population demographics. Results The majority of respondents deemed images with pretarsal rolls to be more aesthetically pleasing (P & lt; .001) than those without such features. Additionally, pretarsal rolls with a width of 5 mm (P & lt; .001), a ratio to palpebral fissure height of 0.5:1 (P & lt; .001), and a crescent shape (P & lt; .001) were perceived as the most attractive. Moreover, individuals aged 40 or younger exhibited a significant preference for images with pretarsal rolls compared to older groups (P & lt; .001), and females displayed a greater inclination toward a medium ratio of pretarsal roll to palpebral fissure height than males did (0.5:1 P = .003, 0.618:1 P & lt; .001). Conclusions This study validates the optimal characteristics of pretarsal rolls, which provides insight into pretarsal roll aesthetics and holds significant implications for surgical planning and effect assessment in future periocular procedures involving pretarsal rolls. Level of Evidence: 3
    Type of Medium: Online Resource
    ISSN: 1090-820X , 1527-330X
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 3
    In: Aesthetic Plastic Surgery, Springer Science and Business Media LLC
    Type of Medium: Online Resource
    ISSN: 0364-216X , 1432-5241
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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  • 4
    In: Aesthetic Surgery Journal, Oxford University Press (OUP), ( 2024-04-25)
    Abstract: Three-dimensional facial stereophotogrammetry, a convenient, noninvasive and highly reliable evaluation tool, has in recent years shown great potential in plastic surgery for preoperative planning and evaluating treatment efficacy. However, it requires manual identification of facial landmarks by trained evaluators to obtain anthropometric data, which takes much time and effort. Automatic 3D facial landmark localization has the potential to facilitate fast data acquisition and eliminate evaluator error. Objectives The aim of this work was to describe a novel deep-learning method based on dimension transformation and key-point detection for automated 3D perioral landmark annotation. Methods After transforming a 3D facial model into 2D images, High-Resolution Network is implemented for key-point detection. The 2D coordinates of key points are then mapped back to the 3D model using mathematical methods to obtain the 3D landmark coordinates. This program was trained with 120 facial models and validated in 50 facial models. Results Our approach achieved a satisfactory mean [standard deviation] accuracy of 1.30 [0.68] mm error in landmark detection with a mean processing time of 5.2 [0.21] seconds per model. Subsequent analysis based on these landmarks showed mean errors of 0.87 [1.02] mm for linear measurements and 5.62° [6.61°] for angular measurements. Conclusions This automated 3D perioral landmarking method could serve as an effective tool that enables fast and accurate anthropometric analysis of lip morphology for plastic surgery and aesthetic procedures.
    Type of Medium: Online Resource
    ISSN: 1090-820X , 1527-330X
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2024
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  • 5
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2023
    In:  Aesthetic Surgery Journal Vol. 43, No. 4 ( 2023-03-15), p. NP283-NP292
    In: Aesthetic Surgery Journal, Oxford University Press (OUP), Vol. 43, No. 4 ( 2023-03-15), p. NP283-NP292
    Abstract: Masseter reduction by botulinum neurotoxin A (BoNT-A) injection is a popular procedure in East Asia. Inappropriate injection can result in various complications. Objectives The aim of this study was to develop an approach for comprehensively evaluating the lower facial structure based on the shape of the mandible angle, the thickness of the masseter, and the thickness of subcutaneous fat. Methods Clinical profiles and standard ultrasound images were collected from patients seeking masseter BoNT-A injections. Lower facial structures were evaluated based on 3 aspects: mandible, masseter, and subcutaneous fat and skin. The mandibular angle was classified as extroverted, straight, or introverted. The starting point of the middle part of the masseter was recorded. The thickness of the deep inferior tendon, the superficial and deep belly of the superficial part of the masseter, and their contractility were measured. Overall thickness and the thickness of subcutaneous fat and skin were also measured. Results Eighty-four masseters from 42 patients were included. Straight mandibular angles were the most common type of angle (48.81%), followed by introverted (26.19%) and extroverted angles (25.00%). The middle part of the masseter starts from 2.33 [0.36] cm (mean [standard deviation] ) above the mandible edge, which is above the usual injection points. The superficial belly was thicker than the deep belly in both static and clenching states (P = .048, P = .001) and had greater contractility. The average overall thickness was 1.87 [0.29] cm. Conclusions Comprehensive evaluation of the lower facial contour and structure based on ultrasound examination could be a reliable and replicable assessment approach. Level of Evidence: 4
    Type of Medium: Online Resource
    ISSN: 1090-820X , 1527-330X
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 6
    Online Resource
    Online Resource
    Wiley ; 2022
    In:  Journal of Cosmetic Dermatology Vol. 21, No. 10 ( 2022-10), p. 4301-4306
    In: Journal of Cosmetic Dermatology, Wiley, Vol. 21, No. 10 ( 2022-10), p. 4301-4306
    Abstract: Large calves are considered unattractive. Botulinum toxin type A (BoNT‐A), acting as a neurotoxin that reduces muscle contraction, is widely used in calf contouring. However, there lacks detailed anatomical data to guide clinical injection. Objectives This study aims to use ultrasonography to provide depth information of the calf muscles and determine the morphological types of the gastrocnemius muscle. Methods Ultrasound scanning was performed at six sites on 40 Chinese adults. A real‐time ultrasound scannerwas used to detect the depth of the gastrocnemius muscle and the soleus muscle. Results The thickness of the gastrocnemius muscle and the soleus muscle was measured. The depth from the skin to the surface, the middle, and the bottom of the gastrocnemius muscle was measured. The morphology of gastrocnemius muscle was classified into four different types under ultrasound according to the muscle bulge pattern. Conclusion This study took ultrasonic measurements of Asian calves to guide accurate and effective BoNT‐A injection in real clinical practice.
    Type of Medium: Online Resource
    ISSN: 1473-2130 , 1473-2165
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2075528-4
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  • 7
    In: Aesthetic Plastic Surgery, Springer Science and Business Media LLC
    Type of Medium: Online Resource
    ISSN: 0364-216X , 1432-5241
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 8
    In: Aesthetic Plastic Surgery, Springer Science and Business Media LLC
    Type of Medium: Online Resource
    ISSN: 0364-216X , 1432-5241
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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  • 9
    In: Aesthetic Surgery Journal, Oxford University Press (OUP), ( 2023-08-22)
    Abstract: Establishing facial anthropometric reference values is essential for diagnosis of deformity, assessment of aging, and planning for aesthetic and reconstructive treatment. Objectives This study aimed to provide detailed perioral anthropometric data in relation to sex and age in Chinese persons with a standardized 3-dimensional protocol. Methods Three-dimensional facial photographs were obtained of 60 male and 64 female healthy Chinese participants ages 20 to 35 and 50 to 65 years old, as well as 2 acromegaly patients, with the VECTRA 3D camera. A standardized evaluation was performed to locate 37 perioral landmarks and generate corresponding measurements, including 26 linear distances, 5 ratios, 2 curvatures, 4 areas, and 9 angles. Measurements of different age groups and of different genders were compared, as were measurements of healthy individuals with those of acromegaly patients. Results Sex discrepancy was noted in philtrum length, width, and area, lip width, and vermilion and cutaneous upper lip area; these were larger in Chinese males than females. However, vermilion heights were similar in both genders. With age, philtrum and cutaneous upper lip height and area, lip width, and angles related to cupid's bow significantly increased, whereas vermilion height and mouth corner angles decreased, and philtrum width, vermilion areas, and lip protrusion remained unchanged. Compared to healthy Chinese patients, acromegaly patients had a larger value for most measurements. Perioral rejuvenation based on detailed 3-dimensional anthropometry showed good results. Conclusions Chinese males have wider but not thicker lips than females, and aging features thin, flattened, and wide vermilions with a lengthened philtrum in both genders. These data can serve as a reference standard for disease diagnosis, aesthetic procedures, and reconstructive lip surgeries. Level of Evidence: 4
    Type of Medium: Online Resource
    ISSN: 1090-820X , 1527-330X
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 10
    In: Aesthetic Surgery Journal, Oxford University Press (OUP), ( 2024-02-20)
    Abstract: The depressor anguli oris muscle (DAO) is a pivotal treatment target in creation of harmonic jawline. However, evidence of its live morphology remains scarce. Objectives This study aimed to reevaluate DAO by a facile ultrasound analysis and hereby guide safer and more effective botulinum toxin type A (BTX-A) injection. Methods A prospective ultrasound assessment was conducted in 41 patients. Morphology of DAO and its relative position with neighboring structures were appraised at the ubiquitous facial landmark, labiomandibular fold (LMF). Three-dimensional images were captured before and after receiving BTX-A injection based on sonographic evidence. Results The skin-to-muscle depths of DAO on average (measured from the medial to lateral border) were 5.26, 5.61, and 8.42 mm. DAO becomes thinner and wider from zone 1 to 3 (p & lt; 0.001). Overlapping lengths between DAO and DLI increased from zone 1 to 3: 4.74, 9.68, 14.54 mm (p & lt; 0.001). The medial border of DAO was located at 4.33, 6.12, 8.90 mm medial to LMF (zone 1-3), and no muscle fibers of DAO was observed at zone 1 and 2 in near one-third of patients. Mouth corner downturn angle improvement upon receiving BTX-A injection at zone 2 and 3 were 88.3%, 32.3%, and 14.7% for the neutral, maximum smile, and down-pulling mouth corner expressions. Conclusions This work established an informative ultrasound portrait of the DAO and structures in the perioral region, which suggests LMF as a convenient landmark to locate DAO. Injections at the middle and lower thirds of LMF at a 4-5 mm depth is recommended.
    Type of Medium: Online Resource
    ISSN: 1090-820X , 1527-330X
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2024
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