Facial Anatomy Research Articles

REKONSTRUKSI WAJAH FORENSIK : MEMBANGUN WAJAH DARI TENGKORAK

Forensic facial reconstruction is an attempt to recreate the face of a deceased person from their skull remains. Forensic facial reconstruction is an alternative identification method that is widely used in the field of forensics to identify the unidentified remains. It also popular in the field of archeology to bring back the appearance of people in the past. Unfortunately, in Indonesia forensic facial reconstruction is not yet popular. In fact, forensic facial reconstruction can be quite cheap and accurate methods, as well as can be applied when other methods are not possible. There are several techniques using antemortem photos to three-dimensional techniques including manual and computerized. The two-dimensional technique using antemortem photo usually used for very fragile skull that is impossible to reconstruct manually in three-dimensional. The manual three-dimensional techniques make it possible to see the realistic face but time consuming to make. However, technological developments have been able to create computerized three-dimensional techniques that are faster and cheaper. This review will discuss forensic facial reconstruction in general and the role of the skull and soft tissue in the final results. By involving knowledge in the field of facial bone and soft tissue anatomy, then equipped with anthropometric data corresponding to the skull, the final results will vary personally depend on the shape of the skull bones. Meanwhile, a touch of art will complete the appearance to make it more real. Ultimately, the results of forensic facial reconstruction are a synergy between science and art.

Anatomic-Based Diagnosis and Filler Injection Techniques: Chin Augmentation and Jawline Contouring.

Chin augmentation and jawline contouring have emerged as significant procedures in aesthetic medicine, addressing both structural and age-related changes in the lower face. This review explores anatomic-based diagnosis and filler injection techniques for these treatments. Ethnic variations in facial structure necessitate different approaches, with Western patients often seeking jawline definition, while Asian patients frequently require chin projection. The evolution of beauty standards and widespread orthodontic treatments have influenced treatment goals, emphasizing overall facial harmony. Successful outcomes rely on a thorough understanding of facial anatomy, including the complex interplay of muscles, fat layers, and soft tissue landmarks. The distinction between bony and soft tissue landmarks is crucial for optimal filler placement. Treatment techniques involve careful selection of filler consistency and injection depth, with high-viscosity fillers used for deep structural support and softer fillers for surface refinement. The use of cannulas in jawline treatments offers advantages in reducing complications and ensuring even distribution. Vascular anatomy knowledge is essential to avoid complications, particularly regarding the facial artery and its branches. Post-treatment management, including massage and follow-up assessments, is vital for achieving and maintaining desired results. This comprehensive approach ensures safe, effective, and aesthetically pleasing outcomes in chin and jawline enhancement procedures.

Injection Techniques for Filler Procedures With Illustration: Narrative Review.

This narrative review explores the various injection techniques utilized in facial filler procedures, emphasizing their applications, benefits, and potential complications. The increasing demand for total facial contouring and rejuvenation has led to a rise in the use of volumizing fillers and the integration of these procedures with other treatments such as toxins, threads, lasers, radiofrequency, and ultrasound. Achieving satisfactory results necessitates a comprehensive understanding of facial anatomy and the effects of aging on skin tissue. Key injection techniques discussed include retrograde and anterograde injections, linear and serial threading, serial puncture, fanning, cross-hatching, bolus, towering, sandwich, tenting, and specialized methods like fern leaf and duck walk injections. Each technique offers unique advantages, such as the retrograde technique's ability to minimize vascular complications and the dual plane technique's effectiveness in achieving optimal volumization and contouring by layering different types of fillers at varying depths. The dual-plane injection technique, in particular, is highlighted for its ability to provide natural and lasting results by combining firm fillers in deep layers with softer fillers superficially, minimizing surface irregularities and filler migration. The review also underscores the importance of preprocedure planning, including the marking of injection points to ensure precision, especially in patients with facial asymmetry. This comprehensive review aims to equip practitioners with the knowledge to select and master appropriate injection techniques, tailored to the specific needs of different facial areas, thereby enhancing treatment outcomes and patient satisfaction while minimizing risks.

Decoding Periorbital Aging: A Multilayered Analysis of Anatomical Changes.

Periorbital aging is a complex phenomenon that involves multiple layers of facial anatomy, including bone, fat, and globe. While previous studies have predominantly focused on age-related changes in facial fat compartments, this research aims to provide a comprehensive understanding of all periorbital components, including upper and lower orbital fat, orbital cavity volume, globe volume, and globe position, in the context of aging. We conducted a retrospective study involving 118 patients (236 subjects) aged 18-99years who underwent brain MRI using a 3 Tesla MR system. Baseline demographics and various parameters pertaining to periorbital aging were collected, and comprehensive measurements were obtained through meticulous radiological analysis. Our findings revealed distinct patterns of age-related changes in the periorbital region. Upper orbital fat remained stable with age, while lower orbital fat exhibited a substantial increase in both anterior and posterior compartments. Notably, orbital cavity volume expanded with bony resorption, while eye globe volume decreased, contributing to an enophthalmic appearance. We observed no vertical displacement of the globe with aging. This study provides a comprehensive overview of the multifaceted anatomical changes that occur in the periorbital region with aging. The insights gained from this research offer important clinical implications for addressing the signs of periorbital aging, guiding surgical interventions, and ultimately enhancing patient outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Automated landmark-based cat facial analysis and its applications

Facial landmarks, widely studied in human affective computing, are beginning to gain interest in the animal domain. Specifically, landmark-based geometric morphometric methods have been used to objectively assess facial expressions in cats, focusing on pain recognition and the impact of breed-specific morphology on facial signaling. These methods employed a 48-landmark scheme grounded in cat facial anatomy. Manually annotating these landmarks, however, is a labor-intensive process, deeming it impractical for generating sufficiently large amounts of data for machine learning purposes and for use in applied real-time contexts with cats. Our previous work introduced an AI pipeline for automated landmark detection, which showed good performance in standard machine learning metrics. Nonetheless, the effectiveness of fully automated, end-to-end landmark-based systems for practical cat facial analysis tasks remained underexplored. In this paper we develop AI pipelines for three benchmark tasks using two previously collected datasets of cat faces. The tasks include automated cat breed recognition, cephalic type recognition and pain recognition. Our fully automated end-to-end pipelines reached accuracy of 75% and 66% in cephalic type and pain recognition respectively, suggesting that landmark-based approaches hold promise for automated pain assessment and morphological explorations.

Temporal Incision Super-high Superficial Musculoaponeurotic System Face Lift for Chinese Patients.

This investigation assessed patient satisfaction with a temporal incision technique using a super-high superficial musculoaponeurotic system (SMAS) flap for midface lifting in a Chinese patient cohort. From July 2019 to July 2023, 95 patients underwent midface lifts via a temporal incision approach at our institution. The extent of SMAS flap dissection spanned 2 cm above the outer canthus, to the lower margin of the zygomatic arch inferiorly, and medially to the zygomaticus major muscle. The technique involved anchoring the elevated SMAS flap to the deep temporal fascia to elevate the malar fat pads, correct sagging tissues, and ameliorate the appearance of nasolabial folds. Among the 95 patients, 61 completed a follow-up ranging from 6 months to 2 years postsurgery, with a majority reporting satisfaction with the aesthetic results of their midface lift. No significant complications, including permanent facial nerve injury, were reported. The temporal incision super-high SMAS face lift technique demonstrated high patient satisfaction and clinical effectiveness in improving the appearance of nasolabial fold and midface aesthetics. However, the success of this technique hinges on a comprehensive understanding of facial anatomy due to the confined operative field, highlighting its technical demands and the need for surgical expertise.

Facial high-pressure injection injury with air in a child

BackgroundHigh-pressure injection injuries are rare injuries and are frequently underestimated due to the limited external damage. Because of their association with occupational activities, these injuries are predominantly seen in hands. Facial involvement in such traumas is extremely rare. The difference in facial anatomy compared to the extremities demands careful consideration of both associated complications and treatment options.CaseA 6-year-old girl with no significant medical history was presented to the Emergency Department with a high-pressure injection injury to her right eye with a high-pressure cleaner. This resulted in injection of air at a pressure of 8 bar into the eye. She developed significant subcutaneous emphysema in the facial and neck regions. Additionally, intraorbital and intracranial emphysema were identified without any fractures. Treatment consisted of inpatient observation and antibiotic treatment. The patient was discharged after one day of observation for continued antibiotic treatment at home. Two weeks later, the patient had no residual symptoms and there were no signs of secondary infection.ConclusionHigh-pressure injection injuries to the face are rare and demand a different approach compared to the most common high-pressure injection injuries to the extremities. The nature of the injected material is paramount in choosing the appropriate treatment. This case illustrates that a high-pressure injection injury with air in the facial region, leading to extensive emphysema, can be managed conservatively with antibiotic therapy and inpatient observation.

A Facial Motion Retargeting Pipeline for Appearance Agnostic 3D Characters.

3D facial motion retargeting has the advantage of capturing and recreating the nuances of human facial motions and speeding up the time-consuming 3D facial animation process. However, the facial motion retargeting pipeline is limited in reflecting the facial motion's semantic information (i.e., meaning and intensity), especially when applied to nonhuman characters. The retargeting quality heavily relies on the target face rig, which requires time-consuming preparation such as 3D scanning of human faces and modeling of blendshapes. In this paper, we propose a facial motion retargeting pipeline aiming to provide fast and semantically accurate retargeting results for diverse characters. The new framework comprises a target face parameterization module based on face anatomy and a compatible source motion interpretation module. From the quantitative and qualitative evaluations, we found that the proposed retargeting pipeline can naturally recreate the expressions performed by a motion capture subject in equivalent meanings and intensities, such semantic accuracy extends to the faces of nonhuman characters without labor-demanding preparations.

The Dangers of Oversimplifying Facial Anatomy in Aesthetic Education.

The Dangers of Oversimplifying Facial Anatomy in Aesthetic Education.

Role of Artificial Intelligence in Determining Ideal Nasal Tip Projection in Diverse Populations.

Nasal tip projection ideals have been based on the Caucasian nose; however, many racial groups have underprojected tips. Several methodologies have been described to measure ideal nasal tip projection. This study aimed to compare various methods to racially diverse groups to elucidate those best suited for race-specific facial morphology. An openly accessible artificial intelligence image generator was used to generate images of Caucasian, Middle Eastern, and African American noses. Tip projection was manually measured using 5 different ideal tip projection methods. One-way analysis of variance with post hoc Tukey honest significant difference test evaluated differences between racial cohorts. One-sample t tests were used for comparisons to previously described aesthetic ideals, and a P value of less than 0.05 was considered statistically significant. Twenty lateral images were analyzed per racial cohort (10 men and 10 women). All racial groups-except for male Middle Eastern noses (P = 0.01)-were measured as ideal using the Byrd nasal length proportion method. Caucasian and Middle Eastern noses measured ideal using the nasolabial tip projection method. African American female noses measured ideal using the nasofacial tip projection method. Only Caucasian noses were ideal using the lip tangent method. This study suggests that the ideal nasal length to tip length ratio of two-thirds (67%) has generalizability across these racial groups; the lip tangent is an excellent method for evaluating tip projection in Caucasians; and assessment of ideal tip projection in Middle Eastern and African American groups should use regional midface and lower face anatomy to account for differences in facial morphology.

Secondary Reconstruction of Panfacial Fractures With Virtual Reality Surgical Planning Using Both Pre and Postreconstruction Scans.

Late secondary reconstruction is sometimes required in patients with suboptimal primary panfacial fracture repair. At this stage, it can be difficult to discern original facial architecture due to malunion and bony remodeling. By utilizing the original postinjury CT scan to complete fracture reduction in the virtual reality (VR) planning environment, the surgeon may attempt to recreate an "ideal" facial bony anatomy for patients. This technique was completed in 2 patients presenting with facial deformity secondary to malunited panfacial fracture. Each had a cone-beam CT (CBCT) scan taken at presentation and the initial postinjury CT scans were obtained. Fracture reductions were completed in VR to recreate the preinjury anatomy. The resulting model was overlaid with current anatomy to create surgical aids. The first patient, a 23-year-old man, presented with malunion of all bones of the midface. Cutting guides were designed for the Lefort 1 segment, left zygomaticomaxillary complex (ZMC), and naso-orbito-ethmoid (NOE) osteotomies. The second patient, a 30-year-old woman, had bilateral ZMC and subcondylar fractures, midface retrusion, and malunion of parasymphyseal fracture. A 2-stage procedure was planned, including an initial Lefort I and bilateral sagittal split osteotomy with midline wedge excision. To address malar projection, a second surgery was planned using custom MEDPOR midface implants for the NOE and zygomatic regions. Both patients were discharged home, and all surgical goals and esthetic objectives were achieved.

Enhanced Understanding of Facial Nerve Anatomy and Arborization in the Indian Population: Implications for Surgical Procedures.

The anatomy and arborization patterns of the extraparotid facial nerve show considerable variation among different populations, impacting surgical approaches in plastic, head and neck, and ENT surgeries. This study focuses on the Indian population to provide a detailed understanding of these variations, specifically highlighting the Davis type IV arborization pattern's prevalence and its clinical relevance. We conducted a comprehensive dissection of 16 formalin-preserved Indian cadaveric hemifaces. The study meticulously mapped the facial nerve trunk (FNT), its furcation points, and branches. Key anatomical landmarks for locating these nerve structures were identified, including the tip of the mastoid process, the angle of the mandible, and a novel line between the lateral palpebral fissure and otobasion superioris. The most common arborization pattern observed was Davis type IV (31.3%). The study provided precise measurements for locating the FNT and its branches, using identifiable landmarks. These findings facilitate more accurate surgical planning, crucial for procedures involving nerve repair or grafting. This research offers vital insights into the facial nerve anatomy specific to the Indian population, with significant implications for surgical precision and patient outcomes. By establishing reliable anatomical landmarks and elucidating the predominant arborization pattern, the study enhances the understanding of facial nerve behavior during surgical interventions, particularly in the context of facial paralysis treatment and reconstructive surgeries. Due to the small sample size, however, this study only acts as a pilot for further research.

Anatomical Considerations for Thread Lifting Procedure.

Thread lifting is a minimally invasive procedure that enhances facial aesthetics by repositioning sagging tissues with absorbable threads. It requires a comprehensive understanding of facial anatomy for safe and effective results. This study aims to highlight the critical anatomical considerations in thread lifting, including the navigation of facial vascular structures, the protection of facial nerves, manipulation of fat compartments, and engagement of retaining ligaments. These factors are essential for minimizing complications and achieving optimal outcomes. A review was conducted focusing on the anatomical elements critical to thread lifting. The study analyzed clinical outcomes related to vascular structures, nerve pathways, fat compartments, and ligaments in patients undergoing the procedure. The review revealed that careful navigation of facial blood vessels is crucial to avoid complications such as bleeding and bruising. Knowledge of facial nerve pathways is essential to prevent nerve damage, which could result in facial weakness or paralysis. Proper manipulation of facial fat compartments helps address aging-related changes, and engaging retaining ligaments is vital for a sustainable lift without tissue distortion. Thread lifting demands not only technical skill but also a deep understanding of facial anatomy to ensure patient safety and desired aesthetic results. Expertise in these anatomical considerations is essential for minimizing complications and preserving the natural function of facial structures.

Virtual Reality Surgical Planning of a Complex Two-Jaw Defect

Head and neck reconstruction poses challenges requiring stable coverage and optimal appearance and functionality. In complex cases, and beyond the right choice of flap, Virtual Reality (VR) surgical software and preoperative planning, are needed to optimize outcomes. Our patient is a 16-year-old with a history of rhabdomyosarcoma necessitating maxillary-mandibular defect reconstruction. VR-based preoperative planning facilitated the intervention by creating 3D-VR models of facial anatomy and fibula, simulating resection margins, and creating surgical guides for intraoperative use. Our 2-team surgeons opted for a single-staged reconstruction using a vascularized fibula free flap. This case demonstrates successful single-flap reconstruction of a maxillary-mandibular defect, addressing challenges of recipient vessel scarcity, fibrotic scarring, and poor tissue quality. It also underscores the efficacy of a 2-team approach and VR-based preoperative planning in achieving successful outcomes in complex maxillary-mandibular reconstruction. The use of a single fibula flap minimized possible complications and operative time, and the 2-team approach helped by combining the expertise and training of craniofacial and microsurgical trained surgeons. Acknowledging limitations in imaging quality and real-time adaptability, we advocate for continued exploration of VR technologies in enhancing surgical precision in challenging cases.

Botulinum toxin-related blepharoptosis in emergency department admissions

The use of Botulinum Toxin Type A (BoNT-A) has become prevalent not only for therapeutic purposes but also for cosmetic applications. Among healthcare professionals, there has been an increase in BoNT-A administration within familial or friend circles. This rise has corresponded with a notable increase in cases of unilateral blepharoptosis presenting in emergency department admissions. This trend may be attributed to insufficient knowledge and experience regarding the proper dosing of BoNT-A, inadequate understanding of facial anatomy, or anatomical variations of the supraorbital foramen or neurovascular pedicle. While BoNT-A administration for reducing facial wrinkles may appear straightforward for a healthcare professional, a thorough understanding of anatomy and the causes and treatment of blepharoptosis is essential.

Landmark-in-facial-component: Towards occlusion-robust facial landmark localization

Despite great efforts in recent years to research robust facial landmark localization methods, occlusion remains a challenge. To tackle this challenge, we propose a model called the Landmark-in-Facial-Component Network (LFCNet). Unlike mainstream models that focus on boundary information, LFCNet utilizes the strong structural constraints inherent in facial anatomy to address occlusion. Specifically, two key modules are designed, a component localization module and an offset localization module. After grouping landmarks based on facial components, the component localization module accomplishes coarse localization of facial components. Offset localization module performs fine localization of landmarks based on the coarse localization results, which can also be seen as delineating the shape of facial components. These two modules form a coarse-to-fine localization pipeline and can also enable LFCNet to better learn the shape constraint of human faces, thereby enhancing LFCNet's robustness to occlusion. LFCNet achieves 4.82% normalized mean error on occlusion subset of WFLW dataset and 6.33% normalized mean error on Masked 300W dataset. The results demonstrate that LFCNet achieves excellent performance in comparison to state-of-the-art methods, especially on occlusion datasets.

Understanding clinical meaningfulness when targeting the depressor anguli oris muscle (DAO) with neuromodulators: a clinical prospective interventional study.

Neuromodulator injections in the US increased by 24% from 2021 to 2022. This rise is attributed to new products and growing acceptance of minimally invasive aesthetic treatments. Recent studies emphasize the importance of facial anatomy for precision and, consequently, a higher efficacy of neuromodulator treatments. This study aims to evaluate the clinical efficacy of a novel previously proposed injection technique targeting the depressor anguli oris (DAO) muscle to improve oral commissure position. This clinical, prospective study included 34 volunteers from the Shinobu Clinic, São Paulo, Brazil. Patients received 3 units of onabotulinumtoxinA per side, injected mid-distance between the oral commissure and jawline, following the labiomandibular sulcus (LMS). Standardized photographs and assessments using the Oral Commissure Severity Scale (OCSS) and Global Aesthetic Improvement Scale (GAIS) were conducted before and 30days post-treatment. Statistical analyses included t-tests, Wilcoxon Signed Rank test, and generalized linear models. The average increase in commissural height was 5.22% (p < 0.001). OCSS ratings improved significantly from baseline (clinician: 1.21 to 0.72, p < 0.001; patient: 0.93 to 0.69, p < 0.001). However, GAIS scores indicated no significant change (patient: 0.32, observer: 0.38; p = 0.491). The proposed injection technique improves perioral aesthetics objectively and subjectively. However, the lack of significant change in GAIS scores suggests that perceived improvements may not be clinically meaningful to patients. Future studies should focus on patient-centered evaluation methods to better assess aesthetic outcomes.

The role of oculoplastic surgeons in minimally invasive cosmetic injectables.

In recent years, the field of aesthetic medicine has witnessed a paradigm shift with an increasing demand for minimally invasive cosmetic procedures, including cosmetic injectables. This review aims to delineate the distinctive role played by oculoplastic surgeons in the administration of cosmetic injectables, comparing their expertise to that of nonphysician practitioners. Complications arising from cosmetic injections are discussed, including skin discoloration, inflammation, necrosis, vision loss, retinal pathology, and central nervous system adverse effects. Injector expertise, patient factors, type of filler, location of injection, and management strategies are reviewed. Findings highlight diverse practitioner involvement, common adverse effects like skin necrosis and vision loss, with hyaluronic acid fillers being prominent. Areas at the highest risk for ocular complication include the glabella and nose with potential management involving dissolving fillers and reducing pressure. Emphasis is placed on expert injector selection and patient awareness. The administration of cosmetic injectables requires a profound understanding of facial anatomy, vasculature, and potential complications. In contrast to nonphysician practitioners, oculoplastic and aesthetic surgeons bring a level of anatomical precision and clinical acumen that is essential for navigating the complexities of cosmetic injectables. Emphasis on training and collaboration among practitioners will be essential in advancing the field while prioritizing patient safety and satisfaction.

The effect of the golden ratio in facial anatomy on beauty perception

Objectives: This study explores the influence of the golden ratio on aesthetic perception, focusing on facial features such as the nasal index, nasooral ratio, and upper-to-lower lip thickness ratio. The aim is to identify patterns in individuals’ aesthetic preferences and examine correlations with demographic factors such as gender, educational background, and interest in visual arts. Methods: Facial images, both digitally altered and hand-drawn, were manipulated to create variations in anthropometric measurements. A questionnaire featuring these images was distributed among adults in various social settings. Statistical analyses included chi-squared tests to compare aesthetic preferences across demographic groups and correlation coefficients to assess the relationships between binary aesthetic choices and demographic factors. Results: Significant differences in aesthetic preferences were found based on respondents’ educational background and interest in visual arts. Males exhibited a stronger preference for golden ratio proportions in nasal and nasooral features, while females demonstrated more variable preferences depending on the specific facial feature. Higher education levels and greater interest in visual arts were consistently associated with a stronger inclination towards selecting golden ratio proportions. Conclusion: Education and exposure to the arts significantly influence aesthetic preferences, highlighting the impact of social factors on beauty perception. The use of digitally manipulated and hand-drawn images provided a controlled setting for testing the golden ratio and other proportions, ensuring consistency in the study. Future research incorporating real-life images may further enhance our understanding of the mechanisms behind aesthetic perception.

3D 4K Exo-Endoscopic Temporal Bone Dissection: A Novel Approach for Sharing the Anatomy.

Temporal bone dissection is overwide recognized as an ideal training method for otologic surgeons. The knowledge of temporal bone anatomy and especially of the course of infratemporal facial nerve is pivotal in practice. The 3D exoscope is an innovative and promising tool, that was recently introduced in ear surgery. A high-definition 3D exoscope (3D VITOM®) mounted on the VERSACRANETM holding system (Karl Storz) was used to perform two temporal bone dissection, with the aim to study the anatomy of infratemporal facial nerve. The 3D endoscope (TIPCAM®1 S 3D ORL, Karl Storz) was used in combination to provide a close-up high-quality view and to provide a different angle of view on fine anatomical relationships. The high-definition 3D exoscope allowed to conduct the dissection with high quality visualization and to share the same surgical field with trainees. Moreover, it showed a high interchangeability with the 3D endoscope. 3D 4K Exo-endoscopic temporal bone dissection seems to have benefits in terms of educational purpose, especially concerning anatomy understanding. The superiority in teaching value of this tool should be further investigated in cohort studies.