Facial Contour Research Articles

A Study on the Correlation of Big 5 Personality Traits in Asians With Facial Contour Surgery.

The purpose of this study is to explore the present situation and related factors of big 5 personality in Asian patients with facial contour surgery and to provide experience for clinical individualized medical care. Total 235 patients with facial contour surgery were selected in this study. The Neo Five-factor Inventory was used to investigate them. The scores of conscientiousness and openness in the Neo Five-factor Inventory were higher than others, whereas neuroticism score was lowest in patients with facial contour surgery. The scores of extroversion and agreeableness were in the middle level. Among the big 5 personality the age, educational background, self-rated personality, the only child in a family and other cosmetic surgery history had significant differences in patients. Patients with facial contour surgery for different sex, different marital status, different body mass index, there is no significant difference in the big 5 personality through this study. However, older patients had higher score for conscientiousness, patients with higher educational background had higher scores in openness and patients with introverted personality had higher neuroticism score. The authors should take individualized personality traits during perioperative care to help the patients to establish a correct and healthy esthetic concept, as well as postoperative body image concept, to build their self-confidence and social competitiveness.

Surgical Correction of Tear Trough Deformity (TTD) with Orbicularis Retaining Ligament Release and Volume Augmentation for Periorbital Rejuvenation: Review of the Literature.

Tear trough deformity is a hallmark of periorbital aging. It is not, however, an exclusive feature of old age. While protruding orbital fat results in lower lid bags that are traditionally corrected by excision, correction of TTD can constitute a real challenge requiring volume enhancement in addition to addressing prolapse of orbital fat and descent of cheek tissues. Described therapeutic options include minimally invasive soft tissue augmentation with fillers or structural autologous fat transfer as well as invasive surgical procedures concomitantly with lower lid blepharoplasty or other facial rejuvenation procedures. Six eponyms have been used in the literature to describe the condition: (1) naso-jugal fold, (2) naso-jugal groove, (3) naso-jugal ditch, (4) tear trough, (5) tear trough deformity, and (6) tear trough depression. A separate PubMed database search of each of the 6 terms was conducted in addition to an advanced literature and systematic PICO searches to identify all described clinical retrospective or prospective, comparative or simple cohort studies related to surgical correction of TTD. An additional screening of references of retrieved clinical studies was performed to identify any missed reports. A total of 435 publications were identified with the initial search. After excluding all none relevant studies, 44 papers were selected for review. 6 additional studies were identified by screening relevant references. Almost all authors agree on the necessity to release the tear trough retaining ligament together with volume enhancement. Transconjunctival and transcutaneous incisions are reported. Most recommend repositioning of the protruding orbital fat for volume enhancement to mostly subperiosteal, or pre-periosteal pockets. Other reported options include pedicled buccal fat pad transposition, segmental fat grafting, and minced micrografts. Internal as well as external fixation of repositioned fat flaps have been described. Despite lack of solid objective evidence, several of these techniques when properly executed for the proper indication in selected patients are reported to result in a rewarding and long-lasting outcome. Unfortunately, it is difficult to determine the most appropriate technique that would universally yield the most pleasant and harmonious facial contour without creating an unnatural puffy appearance. It remains for the surgeon to identify the safe surgical approach that does not compromise lower eyelid function and achieves the most pleasing aesthetic outcome with the least complications and downtime. 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 .

50. Infection rates of facial implants within a cleft population

Hypoplasia and asymmetry of the midface are recognised features of the cleft population. One technique employed for midface contouring is the placement of facial implants. However these carry a lifelong risk of infection.

Predicting 60–4 visual field tests using 3D facial reconstruction

BackgroundDespite, the potential clinical utility of 60–4 visual fields, they are not frequently used in clinical practice partly, due to the purported impact of facial contour on field defects. The...

Advances in Robot-Assisted Surgery for Facial Bone Contouring Surgery.

Since our team reported the application of robot-assisted surgery in facial contouring surgery in 2020, further clinical trials with large samples have been conducted. This paper will report the interim results of a single-center, large-sample randomized controlled trial of the first robot developed by our team for facial contouring surgery. Meanwhile, this research field will be systematically reviewed and prospected.

Esthetic restoration of progressive hemifacial atrophy (Parry-Romberg disease) by free fat grafting using computerized-assisted mapping.

This study aimed to evaluate the use of fat grafting enriched with platelet-rich plasma through a computerized-assisted mapping for esthetic restoration in progressive hemifacial atrophy (Parry-Romberg disease). This prospective study was conducted on 53 patients presented by Parry-Romberg disease and was corrected by facial fat grafting (FFG) enriched with platelet-rich plasma (PRP). A computerized software program was used to design a detailed map to achieve clinical symmetry with fat grafting application, as the anatomical subunits direct 3-dimensional volumetric symmetric, and compartments direct isolated recipient-specific grafting. Also, volumetric asymmetry was assessed through outlines of facial contour, projection, and proportions for both sides and comparing the mirror image of unaffected side as a template. Objective ultrasound and photogrammetric measurements showed a significant improvement in facial symmetry postoperatively compared to preoperative (P < 0.05), with no significant differences between 12 and 18months after surgery. The FACE-Q score regarding comparison before surgery and 18months after surgery showed a statistically significant improvement in all modules (P < 0.001) with overall satisfaction concerning outcome of 82.7 ± 0.8. Enriched fat grafting with platelet-rich plasma (PRP) is a good alternative to reconstruct soft tissue defects for patients with progressive hemifacial atrophy (Parry-Romberg disease) with a minimally invasive approach and low complications. It provides volumetric replacement, enhancement of skin texture, and improvement of hyperpigmentation with restoration of facial contour for an esthetic pleasing appearance. Isolated replacement in accordance with the anatomical facial subunits and fat compartments allows three-dimensional reconstruction and maximizes fat retention.

Custom Endoprosthesis: A Versatile Surgical Technique for Optimizing Pediatric Mandibular Reconstruction and Dental Restoration

Goals of pediatric mandibular reconstruction are restoring form, function, and esthetics while providing platforms for dental restoration. Though many techniques recreate the inferior mandibular border, most fail to address form and function in a manner that optimizes dental rehabilitation. We describe a surgical technique using a novel custom endoprosthesis that recapitulates the native mandibular contour while supporting the bone construct in a cephalad direction with a medial ledge facilitating implant placement and oral rehabilitation. This multi-institutional retrospective review at high-volume pediatric craniofacial surgery departments features patients with large mandibular resections warranting custom constructs. Thirteen patients underwent mandibular resection and endoprosthesis reconstruction with either free fibula osteocutaneous flaps (n = 9), soft tissue free flaps without bone graft (n = 2), rib graft (n = 1), or iliac crest bone graft (n = 1). Five patients required revisions for distal flap necrosis, intraoral granuloma, and orocutaneous fistulas; one endoprosthesis required removal. Excellent esthetic and reconstructive outcomes were achieved; however, only 2 patients completed dental restoration given financial constraints. A custom endoprosthesis represents an untapped avenue toward comprehensive pediatric mandibular reconstruction. It shows compatibility with microvascular flaps while optimizing facial contour and bone height for implant placement. Given these advantages, substantial financial barriers to dental restoration should be addressed.

Surgical Anatomy for Asian facial Contouring: A Personal Perspective.

This paper introduces my personal perspective on anatomic structures for reduction malarplasty, mandibular contouring surgery, and masseter muscle resection. The zygomaticofacial nerve innervates a rectangular area, and each side measures 18.8±4 and 15.8±3.4mm. The center of the rectangle is located laterally, at 17.3±5.5mm from the lateral canthus, and then inferiorly, at 18.1±3.1mm. The point of the zygomaticotemporal nerve appears at the margin of the zygomatic bone, 11.29±2.65mm below the zygomaticofrontal suture and 21.76±2.76mm from the superior border of the zygomatic arch. The inferior alveolar nerve in the mandibular canal runs above the lower one-third of the mandibular body. The terminal mandibular canal is located at an average of 4.5mm under the mental foramen, advances 5.0mm anteriorly, loops, and ends at the foramen. The facial nerve trunk is located 11 to 14mm medial to the posterior border of the mandible. The trunk emerges out of the stylomastoid foramen and runs anteroinferiorly at an angle of 45°. The deep branch of the middle masseteric artery travels deep in the muscle, close to the periosteum of the mandible in 94% of cases. The average diameter is 1.23±0.26mm. The masseteric nerve runs anteriorly and inferiorly between the deep and the middle layers of the masseter. It is observed at 33±5.6mm from the inferior border of the muscle on the anterior third vertical line of the masseter muscle and at 47±5.5mm in the posterior third.

The Accuracy of 3D Surgical Design and Simulation in Prefabricated Fibula Free Flaps for Jaw Reconstruction

The ideal jaw reconstruction involves the restoration and maintenance of jaw continuity, jaw relations, joint alignment, and facial contour, and, most importantly, dental occlusal reconstruction. One of the essential requirements of achieving a consistent functional outcome is to place the bony reconstruction in the correct three-dimensional position as it relates to the other jaw segments and dentition. A protocol of occlusion-driven reconstruction of prefabricated fibular free flaps that are customized to the patient with surgical design and simulation (SDS)-planned osseointegrated implant installation was developed by our institution. This innovation introduced significant flexibility and efficiency to jaw reconstructions, but functional and cosmetic outcomes were dependent on the accuracy of the final reconstructions when compared to the SDS plan. The purpose of this study was to examine the accuracy of the SDS-planned fibular flap prefabrication in a cohort of patients undergoing jaw reconstruction. All patients that had undergone primary jaw reconstruction with prefabricated fibular free flaps were reviewed. The primary outcome of this study was the accuracy of the postoperative implant positions as compared to the SDS plan. A total of 23 implants were included in the analysis. All flaps survived, there was no implant loss postoperatively, and all the patients underwent all stages of the reconstruction. SDS planning of fibular flap prefabrication resulted in better than 2 mm accuracy of osteointegrated implant placement in a cohort of patients undergoing jaw reconstruction. This accuracy could potentially result in improved functional and cosmetic outcomes.

Fat Grafting in Facial Palsy: A Secondary Revision Technique to Improve the Facial Aesthetics.

Summary:We report our experience of using autologous fat grafting (AFG) as an adjunct to dynamic and static facial reanimation surgical techniques in patients with facial palsy. A consecutive series of patients with facial palsy (congenital or acquired) treated by AFG between September 2007 and October 2017 were reviewed. Multiple strategies for initial dynamic facial reanimation have been utilized. Indications for AFG included asymmetry, volume deficiency, and visible muscle tethering. Standard AFG technique was used with fat harvested from the lower abdomen or thigh and injected into multiple affected areas. Fat grafting was repeated as necessary. Two-dimensional analysis was performed using standardized pre- and postoperative photographs to assess facial symmetry. Patient, surgeon, and independent evaluator satisfaction was recorded using a five-point Likert scale (0–4). Thirty-two patients with a mean age of 43 ± 15.5 years were treated with AFG following facial reanimation. A mean of 1.7 ± 1.4 secondary procedures were performed following initial dynamic reanimation before fat grafting. The average number of AFG episodes was 2.2 ± 1.4 with a mean volume of 12.9 ± 6.0 ml. Minimal complications were seen in either the donor or the recipient sites. There was significant improvement (P ≤ 0.001) of postoperative quantitative facial symmetry following fat grafting. At one-year follow-up, surgeon, patient, and independent evaluator were mostly satisfied (3.06 ± 0.62, 3.31 ± 0.59, and 3.16 ± 0.57, respectively). We report a positive experience of correction of facial asymmetry, contour abnormality and visible muscle pull with fat transplantation following dynamic facial reanimation. The procedure has been shown to be quick and simple, with few complications.

Reconstruction of Dentomaxillofacial Deformity Secondary to Mandibular Defect Using Concomitant Orthognathic Surgery and Fibula Free Flap.

The reconstruction of mandibular defects may be delayed or compromised for many reasons, especially in pediatric patients. With the growth of the remaining mandible and the maxilla in the malocclusion status, secondary dentomaxillofacial deformity is plausible. To treat the concomitant mandibular defect and secondary dentomaxillofacial deformity, a hierarchical algorithm using orthodontics, orthognathic surgery, and fibula free flap was developed. This retrospective case series included six patients with long-term mandibular defects caused by tumor resection without repair or with compromised costochondral reconstruction. All patients were treated using the same staged protocol, but with minor changes: (1) presurgical orthodontics, (2) virtual surgical planning, (3) fabrication of the guides and splints, (4) sequenced operations, and (5) postoperative care. The sequence of surgery included the Le Fort I osteotomy, mandibular sagittal split ramus osteotomy of the remaining ramus, final occlusion registration, repositioning of the distal segment of the mandible, segmented fibula reconstruction, and finally, the fixation of mandibular sagittal split ramus osteotomy. The operations and wound healing were uneventful in all patients, and no flap failure or severe complications were detected. Also, the patients exhibited no signs of temporomandibular joint ankylosis during the follow-up. The subspinale-nasion-supramental angle was significantly reduced after surgery. A significant improvement was detected in the facial contour symmetry measurements postoperatively. This proposed workflow of concomitant orthognathic surgery and the fibula free flap is effective and reliable for the reconstruction of dentomaxillofacial deformity secondary to the long-term mandibular defect.

Mandibular Reconstruction with a Custom Endoprosthesis: Optimizing Bone Height and Border Contour

INTRODUCTION: The primary goals of mandibular reconstruction are to restore form, function, and aesthetics while providing a platform suitable for implant placement and oral rehabilitation. We used a novel custom endoprosthesis with complementary cutting guides and predrilled holes to mirror the angle and slope of the native mandible; the upper portion conforms to the bone graft and a medial titanium ledge supports the bone in a cephalad position to optimize distance from the occlusal plane. METHODS: This is an IRB-approved, retrospective chart review at high-volume plastic and maxillofacial surgery departments at pediatric tertiary-care referral centers between January 2018 and June 2021. Patient demographics, comorbidities, mandibular pathology, lesion size, endoprosthesis specifications, postoperative complications, and follow-up time were collected. RESULTS: Eleven patients underwent mandibular resection and custom endoprosthesis reconstruction with free fibula bone osteocutaneous flaps (n = 9), rib graft (n = 1), and iliac crest bone graft (n = 1). Immediate postoperative CT scans confirmed endoprosthesis placement. Five patients (45%) required revisional surgery for distal flap necrosis (n = 1), a small intraoral granuloma (n = 1), and orocutaneous fistulas (n = 3), of which one resulted in endoprosthesis removal. One patient experienced transient foot drop. Excellent cosmetic outcomes were achieved in all patients. Thus far, two patients (18%) have completed dental restoration. CONCLUSION: This custom endoprosthesis represents an untapped avenue toward more comprehensive mandibular reconstruction. It shows compatibility with microvascular flaps as well as skeletally immature and mature patients alike. By optimizing facial contour and bone height, this novel endoprosthesis is an attractive option for patients whose ultimate goal is dental restoration.

InMode Evoke radiofrequency hands-free facial remodeling for skin rejuvenation.

Demand for facial contouring procedures has increased dramatically in recent years. Common regions of concern for patients seeking a rejuvenated, more youthful appearance include the cheeks, jawline, submental area, and neck. Radiofrequency technology offers a non-invasive and effective method of improving skin laxity and subcutaneous fat in these areas. The Evoke system from InMode Aesthetics is a radiofrequency modality designed to address the lower face and neck that stimulates collagen remodeling for skin tightening and thermal lipolysis for improved facial contour. While alternate technologies for radiofrequency facial remodeling are commercially available, Evoke is the first of its kind in introducing a reliable, operator-independent hands-free device developed based on InMode's proprietary Acquire, Control, and Extend technology targeting the deep fibro-septal network to provide optimal and consistent outcomes.

BDC-GAN: Bidirectional Conversion Between Computer-Generated and Natural Facial Images for Anti-Forensics

Aiming at degrading the capability of the existing forensic methods in discriminating computer generated and natural facial images, a bidirectional conversion between computer-generated and natural facial images based on generative adversarial network (BDC-GAN) is proposed for anti-forensics in this paper. The generator of BDC-GAN is composed of noise encoding and content encoding. In the noise encoding, three high-pass filters are first utilized to extract the sensor pattern noise of the image, and then the stacked convolution layer is combined to continue encoding. In the content encoding, VGG-19 is truncated and fine-tuned to encode the content of the image. Some stacked convolution layers and adaptive instance normalization layer are used in the decoder. The discriminator uses multi-scale image discriminator. Furthermore, content loss and noise loss are well designed, and hyperparameters are reasonably set to accomplish the bidirectional conversion between two domain images meanwhile retaining the original facial contour. Experimental results and analysis demonstrate that the proposed anti-forensic method can achieve better visual quality and stronger deception ability compared with the existing unidirectional CG facial image anti-forensic methods and bidirectional domain adaptive methods, and its effectiveness is verified by the tests on the existing 9 forensic methods. It reveals that the existing forensic techniques can be bypassed by using adversarial learning, and it will eventually push the performance improvement of the discrimination of computer generated and natural facial images.

Extended Superficial Musculoaponeurotic System Face-Lift With Vertical Vector for Asian Patients: A 3-Dimensional Analysis of Facial Contour.

In this study, the authors report the experience of extended superficial musculoaponeurotic system (SMAS) face-lift with the vertical vector in Asian ethnicity and investigate the 3-dimensional change of facial contour. A total of 32 patients with Korean ethnicity underwent extended SMAS face-lift with vertical vector from 2015 to 2018. Patients with aging face were included for the study subjects, whereas those who were diagnosed with any craniofacial deformity were excluded. Using 3-dimensional photogrammetry, surface contour analysis was performed in the cheek region to calculate the mean, maximal, and minimal difference of surface projection and global root mean square error between the preoperative and 1-year postoperative period. The change of horizontal facial widths and jawline angle was evaluated. In contour analysis, the mean difference of surface contour was highest in anterior, followed by lateral cheek and lower face, sequentially. The maximal difference of surface contour was highest in anterior cheek, followed by lateral cheek and lower face, whereas the minimal difference of surface contour was lowest in lower face, followed by anterior cheek and lateral cheek, sequentially. No significant differences in the midfacial and lower facial distances were observed between the preoperative and postoperative periods. There was significant increase of jawline angle, from 20.78 to 23.14 degree of mean value ( P =0.001). In conclusion, the extended SMAS face-lift with vertical vector can be an optimal option for Asian subjects in terms of the midfacial volumetric shift, sharpening of jawline and avoidance of midfacial widening.

Partial Extraction Therapy with Early Implant Placement in the Esthetic Zone: A Clinical Case Report

Immediate replacement of teeth designated for extraction is an appealing treatment rationale for both the patient and the operator. However, it has been associated with a greater risk of facial recession and compromised soft-tissue esthetics. Partial extraction therapy (PET) or synonymously socket shield technique (SST) or root membrane technique (RMT) has been proposed to conserve the facial alveolar contour and soft-tissue esthetics. In this article, a special case is described where a root membrane was used to prevent the modeling of the facial aspect of the extraction socket. Partial extraction was performed allowing the socket with the facial root membrane in situ to partially heal for 8 weeks before implant placement. Successful integration and restoration were achieved with very minimal hard- and soft-tissue changes, accentuating satisfactory esthetic results as dictated by objective esthetic assessment. PET with early implant placement may be considered a viable treatment option for selected cases.

Classification of facial phenotypes in Asian patients with obstructive sleep apnea

Backgroud The facial phenotypes of Asian obstructive sleep apnea (OSA) patients remain unclear. Objectives (1) To describe the facial features of OSA patients. (2) To develop a model based on facial contour indicators to predict OSA. (3) To classify the facial phenotypes of Asian OSA patients. Materials and methods 110 patients with OSA (apnea-hypopnea index [AHI] ≥ 10/h) and 50 controls (AHI< 10/h) were selected to measure facial contour indicators. Indicators were compared between OSA patients and the control group. We used multivariable linear regression analysis to predict OSA severity and K-means cluster analysis to classify OSA patients into different phenotypes. Results We built a model to predict OSA which explained 49.1% of its variance and classified OSA patients into four categories. Cluster 1 (Skeletal type) had the narrowest facial width indicators with narrowing of the retroglossal airway. Cluster 2 (Obese type) had the widest face, and narrowest hard palate, retropalatal, and hypopharyngeal airways. Cluster 3 (Nose type) had the narrowest nasal cavity. Cluster 4 (Long type) had the longest airway length. Conclusions and significance Patients with OSA were classified into four categories, each of which identified different anatomic risk factors that can be used to select the treatment.

Design and Optimization of Combined-Function Quadrupole-Sextupole Magnets

A lightweight superconducting (SC) gantry with large momentum acceptance is under development at Huazhong University of Science and Technology (HUST). Three types of combined-function quadrupole-sextupole (QS) magnets are used to suppress the chromatic dispersion for the large momentum acceptance. This paper introduces the design and optimization of the QS magnets with adjustable sextupole to quadrupole (S/Q) field ratio. The pole shaping method and asymmetric excitation method are discussed in detail for the design. Considering the magnetic field quality deterioration caused by the asymmetry of the pole face, the contour of the pole face and the pole end chamfer are optimized to minimize the harmonics field. After several iterations, the maximum harmonics of the QS2 magnet can be limited within 1E-03. In addition, we investigate the magnetic center shift, when the S/Q ratio changes.

Rhinoplasty with Simultaneous Autologous Full-Face Fat Transfer for Asian Facial Contouring Balance: A Retrospective Study.

The aesthetic facial contouring procedures have gained an increasing popularity in the Asian population. Nevertheless, currently, there are few specific literature assessments and studies on the outcomes of rhinoplasty combined with full-face fat graft contouring. To conduct an objective evaluation of the efficacy of Asian rhinoplasty combined with autologous facial fat transfer in terms of 3-dimensional measurement and patient-reported outcomes. Patients who underwent rhinoplasty combined with full-face fat transfer for facial contouring between January 2016 and July 2019 were recruited in the study. The preoperative and postoperative clinical variables and 3-dimensional measurement of patients were also collected. The satisfaction outcome of surgeons and patients was assessed. Twenty patients completed rhinoplasty with full-face fat transfer. The average postoperative follow-up was 10.2 months (range 6-24 months). The nasal length, and the nasal protrusion rate were significantly increased (p<0.05) after surgery, and the median number of nasolabial angles decreased from 106° to 101°, which was closer to the aesthetic standard of 90°-100°. The topographical projection images of whole face indicated that the volume of frontal, temporal, inner cheek and chin regions were increased obviously. All cases received satisfaction outcome based on surgeons' satisfaction scale, ROE scale, FACE-Q overall facial satisfaction scale, and FACE-Q Rhinoplasty scale. Additionally, no patients had intraoperative or postoperative complications. Rhinoplasty combined with full-face fat transfer is a reliable and effective method of augmenting and contouring the facial convexity in the Asian populations. 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 .

Major clinical evidence of cervicofacial liposculpture: a concise systematic review

Introduction: Liposculpture (LS) can complement cervicofacial aging surgery. Modern trends in face sculpting are expanding and adipose tissue transfer can result in optimal esthetic effects with minimally invasive techniques. Facial LS focuses on repositioning adipose tissue and increasing facial transition zones. This is accomplished using internal suspension sutures as well as with autologous fat grafting. Objective: To carry out a concise systematic review of the main clinical considerations and advances in facial and cervical liposculpture as an important aesthetic tool for dental surgeons. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The search was carried out from November 2021 to February 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: Fifty articles were found involving facial liposculpture. A total of 30 articles were fully evaluated and 16 were included and developed in the present study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies at high risk of bias and 4 studies that did not meet the GRADE. Most patients who were involved in the studies showed improvements in facial augmentation and contouring. In patients with loss of facial volume, high-density fat transfer with SVF-gel facial injection resulted in significantly higher improvement scores and better patient satisfaction, with an improved/much improved esthetic appearance being observed. As a follow-up analysis of the studies, at an average of six months after completion, most patients were satisfied with the results. All procedures were well tolerated. Conclusion: According to the main clinical studies selected in the present study, cervicofacial liposculpture proved to be advantageous, with safety and efficacy.