Facial Creases Research Articles

AESTHETIC AND FUNCTIONAL PARAMETERS OF THE MENTOLABIAL GROOVE IN THE OROFACIAL HARMONIZATION OF THE MENTAL REGION

There have been many techniques and approaches in the treatment of orofacial harmonization of the lower third of the face, however, in many cases, the mentolabial sulcus area does not receive due attention in this process. Therefore, the objective of this study is to carry out a case report that analyzes the aesthetic and functional parameters of the mentolabial sulcus in the orofacial harmonization of the chin region for a more complete and efficient facial rejuvenation. In order to reach the proposed objective, a clinical case report was made with a female patient, with no history of alcoholism and smoking, in good health. The patient underwent anamnesis, clinical examination and proposed, for her case, the use of three syringes of hyaluronic acid of a known brand, in the middle and lower thirds of the face. At the end of the treatment, the patient presented greater luminosity in the filled areas, a good reduction of facial creases and an expressive rejuvenation of the chin region, where a decrease in shadows and an increase in the mentolabial angle can be observed. From that case, a detailed study of the aesthetic and functional parameters of the mentolabial sulcus in orofacial harmonization was carried out, from which important conclusions can be drawn.

Facial preservation following extreme mummification: Shrunken heads

Shrunken heads are a mummification phenomenon unique to South America. Ceremonial tsantsa are ritually reduced heads from enemy victims of the Shuar, Achuar, Awajún (Aguaruna), Wampís (Huambisa), and Candoshi-Shapra cultures. Commercial shrunken heads are comparatively modern and fraudulently produced for the curio-market, often using stolen bodies from hospital mortuaries and graves. To achieve shrinkage and desiccation, heads undergo skinning, simmering (in water) and drying. Considering the intensive treatments applied, this research aims to identify how the facial structure can alter and impact identification using post-mortem depiction.Sixty-five human shrunken heads were assessed: 6 ceremonial, 36 commercial, and 23 ambiguous. Investigations included manual inspection, multi-detector computerised tomography, infrared reflectography, ultraviolet fluorescence and microscopic hair analysis.The mummification process disfigures the outer face, cheeks, nasal root and bridge form, including brow ridge, eyes, ears, mouth, and nose projection. Melanin depletion, epidermal degeneration, and any applied staining changes the natural skin complexion. Papillary and reticular dermis separation is possible. Normal hair structure (cuticle, cortex, medulla) is retained. Hair appears longer (unless cut) and more profuse following shrinkage. Significant features retained include skin defects, facial creases, hairlines and earlobe form. Hair conditions that only affect living scalps are preserved (e.g. nits, hair casts). Ear and nose cartilage helps to retain some morphological information. Commercial heads appear less distorted than ceremonial tsantsa, often presenting a definable eyebrow shape, vermillion lip shape, lip thickness (if mouth is open), philtrum form, and palpebral slit angle. Facial identification capabilities are considered limited, and only perceived possible for commercial heads.

Categorizing facial creases: A review.

Ensuring uniformity in the nomenclature standardization of facial creases is important to enable the scholarly community to follow and debate the advancements in research. This review highlights the prevailing disparity in the nomenclature that refers to the same facial crease by researchers and laypeople, and suggests uniform names for the facial creases based on available literature. The previous and current trends in facial crease classification are also discussed. The nomenclature of the facial creases considered for this review include the following: the nasolabial fold, corner of the mouth lines, upper and lower lip creases around the mouth region, the mandibular folds, the bifid nose, the transverse nasal line, the vertical glabellar line, chin crease, the mental crease, four type of creases around the eyes, forehead creases, and periauricular creases. A figure illustrating the above facial creases is included as reference. It is hoped that the proposed standardization of nomenclature would ensure a more scientific referencing of facial creases enabling more effective scientific interaction among the scholarly community as well as the laypeople interested in the research and application of facial creases.

Estimation and reconstruction of facial creases based on skull crease morphology

This research explores the relationships between the facial creases and the morphology of the underlying skull for supplementary use during forensic facial reconstruction. The correlation between skull morphology and the patterns of facial creases was obtained using the three-dimensional (3D) skull surface scans from the William Bass skeletal collection at the University of Tennessee, USA, which also provided the related ante-mortem face photographs. Superimposition of the facial crease patterns seen in a face photograph with the related skull image enabled the visual analysis of the correlation between the crease and the skull morphology. Qualitative analysis indicated that the infraorbital crease follows the outline of the orbit in 52% of the subjects, while the nasolabial fold (NLF) relates to the canine fossa in 95% of the subjects. The infraorbital crease and NLF were reconstructed in a blind study using ten 3D surface scan skull models and related face photographs from the Helmer collection available in the Centre for Anatomy and Human Identification, the University of Dundee, UK. Correct prediction was obtained in six specimens (60%). One inconclusive result was due to poor photograph quality and three inaccurate results showed an overestimation of the NLF strength although the location of the crease manifestation was correct.

Barber-Say syndrome and Ablepharon-Macrostomia syndrome: An overview.

Barber-Say syndrome (BSS) and Ablepharon-Macrostomia syndrome (AMS) are congenital malformation syndromes caused by heterozygous mutations in TWIST2. Here we provide a critical review of all patients published with these syndromes. We excluded several earlier reports due to misdiagnosis or insufficient data for reliable confirmation of the diagnosis. There remain 16 reliably diagnosed individuals with BSS and 16 with AMS. Major facial characteristics present in both entities, albeit often in differing frequencies, are excessive facial creases, hypertelorism, underdevelopment of the anterior part of the eyelids (anterior lamella), ectropion, broad nasal ridge and tip, thick and flaring alae nasi, protruding maxilla, wide mouth, thin upper vermillion, and attached ear lobes. In BSS a remarkable extension of the columella on the philtrum can be seen, and in both the medial parts of the cheeks bulge towards the corners of the mouth (cheek pads). Scalp hair is sparse in AMS only, but sparse eyebrows and eyelashes occur in both entities, and general hypertrichosis occurs in BSS. We compare these characteristics with those in Setleis syndrome which can also be caused by TWIST2 mutations. The resemblance between the three syndromes is considerable, and likely differences seem larger than they actually are due to insufficiently complete evaluation for all characteristics of the three entities in the past. It is likely that with time it can be concluded that BSS. AMS and Setleis syndrome form a continuum. © 2016 Wiley Periodicals, Inc.

Six Month Clinical Evaluation of Interdental Papilla Reconstruction with Injectable Hyaluronic Acid Gel Using an Image Analysis System.

Obtaining predictable and aesthetically pleasing interdental papilla is challenging in dental reconstruction. Hyaluronic acid gel has been successfully used to reduce facial creases and similar abnormalities. The purpose of this study was to clinically assess the efficiency of interdental papilla reconstruction with injectable hyaluronic acid gel. Ten patients with 43 treated sites in the maxillary anterior region were studied. Photographic standardization devices were designed for image analysis before treatment. This treatment was repeated up to five times during 3-week intervals. Patients were followed 6 months after initial gel application. Twenty-nine sites had complete papilla reconstruction and 14 sites improved from 39 to 96% of interdental papilla reconstruction rate. Complete interdental papilla reconstruction was performed when black triangle at initial examination had area of ≤0.25 mm(2) , height of ≤1mm, or width of ≤0.5mm. Injectable hyaluronic acid gel may be a promising treatment for enhancing papillary esthetics. Interdental papilla reconstruction with injectable hyaluronic acid gel can be suggested as a minimally invasive treatment option for interdental papilla deficiencies in small areas. However, long-term results of this treatment beyond 6 months are not yet known. (J Esthet Restor Dent 28:221-230, 2016).

Description of a Novel Anatomic Venous Structure in the Nasoglabellar Area

Injectable dermal fillers are frequently used to reduce the appearance of various facial creases and rhytids. However, venous complications can develop while injecting dermal filler, especially in the nasoglabellar area. The aims of this study were to determine the anatomic patterns of the veins in the nasoglabellar area and to elucidate their detailed location with reference to various facial landmarks. Forty-one heads from Korean and Thai cadavers were dissected. When the anastomosing vein between the bilateral angular veins (AVs) was located in the nasoglabellar area, it was designated the intercanthal vein (ICV). The bilateral AVs continued as the facial vein without any communicating branches in 12 cases (29.3%). At the radix of the nose, the AV communicated with the ICV, connecting them bilaterally. The ICV was found above (type IIA) and below (type IIB) the intercanthal line in 26 (63.4%) and 3 (7.3%) cases, respectively. The ICV can be regarded as a candidate causative site for the frequent complications associated with dermal filler injection in the nasoglabellar area, and utmost care should be taken when injecting in this area, such as when performing radix augmentation and softening wrinkles in the glabellar area.

The post-mortem resilience of facial creases and the possibility for use in identification of the dead

The post-mortem resilience of facial creases was studied using donated bodies in order to establish the efficacy of crease analysis for identification of the dead. Creases were studied on normal (pre-embalmed) and bloated (embalmed) cadavers at the Centre for Anatomy and Human Identification (CAHID) to establish whether facial bloating would affect facial crease visibility. Embalming was chosen to simulate the effects produced by post-mortem bloating. The results suggested that creases are resilient and changes were only detected for creases located on the periphery of the face, particularly at areas where the skin is thick, such as at the cheeks. Two new creases not previously classified were identified; these creases were called the vertical superciliary arch line and the lateral nose crease. This research suggests that facial creases may be resilient enough after death to be utilised for human identification.

Lower Lip Reconstruction Using Unilateral Nasolabial Gate Flap (Fujimori Technique)

Abstract Background: In the medical literature there are multiple reconstructive procedures for small and medium size defects of the lower lip, but only a few methods for larger defects involving the whole lower lip. Choosing the repairing procedure for larger lower lip defects must take into account two aspects: flap or flaps used should be local flaps, and suture lines should correspond to the natural facial creases or follow the functional lines of different facial aesthetic units. Finally, the flap or flaps should be large enough to restore the entire postexcisional defect. However, the more tissue is lost from the lower lip, the more challenging the reconstruction is from a functional and cosmetic point of view. Material and methods: During the last 2 years in the Oral and Maxillofacial Surgery Department of the County Emergency Clinical Hospital in Tîrgu Mureș, the unilateral Fujimori technique has been successfully used for the reconstruction of large lower lip defects in 4 patients with extended, neglected squamous cell carcinomas involving almost the whole lower lip tissue. These patients underwent complex surgical and oncological treatment. Surgery was performed in two stages: first, excision of the tumor and immediate lip reconstruction, and then removal of submandibular lymph nodes (level I), in the second stage. Results: The aesthetic and functional recovery of these patients was very good, with no need of other subsequent surgical corrections. Conclusions: The postoperative reconstruction of large defects of the lower lip is far from optimal, but it is very important to restore an adequate muscle function, the lip continence and a satisfactory facial appearance.

Clinical Experience With Polymethylmethacrylate Microspheres (Artecoll) for Soft-Tissue Augmentation

To evaluate patient satisfaction and clinical outcomes with soft-tissue augmentation using an injectable alloplast composed of polymethylmethacrylate microspheres 30 to 40 microm in diameter suspended in atelocollagen (3.5% collagen solution) (Artecoll; Artes Medical Inc, San Diego, California). A retrospective review of the literature and an evaluation of our clinical experience with Artecoll implantation for facial soft-tissue augmentation were performed. In a large private metropolitan clinical facial plastic surgery practice, 72 patients (62 females and 10 males) underwent Artecoll implantation between January 1, 1997, and June 30, 2002. Artecoll was implanted into different facial sites, including the philtrum, acne scars, corners of the mouth, upper and lower lips, melolabial folds (also known as nasolabial folds), and other facial creases to attain permanent soft-tissue augmentation. Via completion of an anonymous survey, patients performed subjective evaluation of the aesthetic results. Subjective evaluation of aesthetic results by the surgeon was based on review of photographic documentation. Objective variables, including complications, sites most often treated, total number of treatments, and volume of implant material injected, were obtained by reviewing patient medical records. Among 72 patients, 40 returned a completed patient satisfaction survey (56% response rate). The most common reason cited by patients (35 of 40) for selecting Artecoll implantation was that the implantation offered permanent correction. Five of 40 patients reported persistent problems with Artecoll (firmness of the lip in 1 patient, increased sensitivity of the lip for 6 months in 1 patient, and lumps in their lips in 3 patients). Eighty-five percent of patients (34 of 40) reported that the treatment met or exceeded their expectations, 13% (5 of 40) reported that the treatment was less satisfying than expected, and 3% (1 of 40) reported that the treatment was much less satisfying than expected. Ninety-five percent (38 of 40) reported that they would recommend Artecoll implantation to a friend or relative, and 90% (36 of 40) reported that they would undergo Artecoll implantation again. The retrospective medical record review revealed that the most commonly requested facial areas for augmentation were (in order of frequency) upper lip, lower lip, melolabial folds, corners of the mouth, and other facial creases. Seventy-two patients underwent 177 Artecoll implantation procedures. The mean number of treatments required to obtain favorable soft-tissue augmentation was 2.4. The medical record review confirmed that 5 of 72 patients had complications after Artecoll implantation (nodule formation in 4 patients and persistent lip pain in 1 patient). Sixty-two of 72 patients (86%) achieved favorable soft-tissue augmentation with a total Artecoll implant volume of 3.0 mL or less. Artecoll is a satisfying treatment for lip augmentation or for treatment of facial creases and furrows among patients seeking permanent correction. However, implantation success is technique sensitive. Conservative gradual implantation provides favorable results and few complications. Implantation in the subdermal plane is critical to obtain favorable outcomes using this injectable alloplast.

Complications With the Use of Botulinum Toxin Type A for Cosmetic Applications and Hyperhidrosis

In dermatology, botulinum toxin is now most often used to reduce dynamic facial creases and treat primary focal hyperhidrosis. The exemplary safety record of this medication is such that after nearly 2 decades, it is not known to have any long-term adverse events. Transient adverse events, such as mild injection pain, are typically minor and spontaneously remitting. Headache, nausea and flu-like symptoms, lid and brow ptosis after upper face injection, lower face asymmetry after perioral injection, and fine motor impairment after palmar injection are uncommon to rare. Understanding of anatomic landmarks and site-specific precautions can further mitigate the incidence of unwanted effects. Patients who do experience uncommon, transient effects can be reassured that these are not dangerous and will resolve completely without intervention.

Delayed speech development with facial asymmetry

We report on four unrelated children with delayed speech development associated with mild facial asymmetry and transverse ear lobe creases. The combination of these features proved to be familial in one case. Our findings seem to confirm the existence of a syndrome described by Mehes [(1993) J Med Genet 30:76-77].

Beauty in Later Life: Older Women's Perceptions of Physical Attractiveness

ABSTRACTUsing data from 96 hours of semi-structured interviews with women aged 61 to 92, this paper explores the meanings that older women attribute to beauty and aging. The women in my study tend to equate physical attractiveness with youthfulness and slimness. However, they reject the extremes of thinness embodied in today's fashion models and actresses. Even as they disparage obese individuals, the women argue that thin older women appear scrawny. The women express a preference for more rounded female bodies than current beauty standards allow and emphasize the importance of inner beauty. While some women view their wrinkles negatively, others suggest that their facial creases are badges of honour. I argue that older women do not simply internalize beauty ideals to the detriment of their sense of self. Rather, older women resist and challenge current ideals of feminine attractiveness and suggest alternative beauty ideals and definitions of personal desirability.

Three-Dimensional Caricatures of Human Heads: Distinctiveness and the Perception of Facial Age

A standard facial-caricaturing algorithm was applied to a three-dimensional representation of human heads. This algorithm sometimes produced heads that appeared 'caricatured'. More commonly, however, exaggerating the distinctive three-dimensional information in a face seemed to produce an increase in the apparent age of the face--both at a local level, by exaggerating small facial creases into wrinkles, and at a more global level via changes that seemed to make the underlying structure of the skull more evident. Concomitantly, de-emphasis of the distinctive three-dimensional information in a face made it appear relatively younger than the veridical and caricatured faces. More formally, face-age judgments made by human observers were ordered according to the level of caricature, with anticaricatures judged younger than veridical faces, and veridical faces judged younger than caricatured faces. These results are discussed in terms of the importance of the nature of the features made more distinct by a caricaturing algorithm and the nature of human representation(s) of faces.

Age‐Related Changes in Facial Skin Contours and Rheology

To evaluate the age effect on both the mechanical properties and wrinkling of facial skin. This topic has not previously been addressed in the literature. A total of 180 white women aged 18 to 67 years participated in the study. Each of the 5 decades of age was represented by 30 subjects, with the exception of menopausal women aged 48 to 57 years who were allocated to two groups of 30 according to the use or non-use of hormone replacement therapy (HRT). A University medical center, Belgian SSTC Research Unit 5596. Mechanical properties of the skin were measured on the face using a computerized suction device. Skin contours were assessed using optical profilometry and computerized image analysis. Skin aging of the face is characterized by a progressive increase in extensibility associated with a decreased elasticity. The loss of tonicity is accompanied by a progressive deepening of facial creases. HRT appears to limit the age-related rheological changes without showing a preventive effect on wrinkling of facial skin. Aging of facial skin resembles, in some ways, the features previously reported on sun-protected areas of the forearms. HRT has a beneficial effect that may slow the overall process of aging without, however, limiting the number and depth of wrinkles.

Aesthetic considerations in facial reconstructive surgery: the V-Y flap revisited.

The subcutaneous pedicled V-Y advancement flap (also known as the "kite flap" of Dufourmentel) has been described by many authors. Its versatility in reconstructive surgery is well known, both in facial reconstructive surgery as well as surgery of the trunk and extremities. Its advantages in achieving aesthetic reconstruction in specific facial regions have been less well emphasized in the literature. The flap can be designed within natural facial creases and heals inconspicuously because of its widely based subcutaneous or muscle pedicle which incorporates venous and lymphatic drainage over most of its length. The undesirable "biscuiting" or flap edema frequently observed with other conventional transposition flaps is avoided. We have found the V-Y flap particularly useful in reconstructing the lower eyelid/medial canthus, supra-alar, and nasolabial regions. Our experience with over 40 such flaps is described, and technical considerations in designing and elevating the flap are discussed.

Facial and Neck Contouring Using Liposuction and Lipoinjection

Speaking at the annual meeting of the Triological Society in Palm Beach, Fla, Dr John Dmytryshyn, Vancouver, British Columbia, Canada, discussed his techniques for contouring five major facial zones using liposuction or lipoinjection. Those zones include the submental, submandibular, midlateral neck, preparotid, and nasolabial zones. Depending on the area to be contoured, he recommended the submental and nasolabial stab-incision approach and the open-facelift approach. Liposuction was performed before rhytidectomy. Pinch testing was advocated before operation and after suctioning to determine the need for and the result of liposuction, respectively. Dr Dmytryshyn did not advocate the use of liposuction in the lateral mandibular area, and he cautioned that the technique was not a substitute for weight loss. Lipoinjection was much less predictable than liposuction, due to the 50% resorption of injected material. Lipoinjection was advocated only for placement under facial creases, wrinkles, and scars, not as augmentation for chin and cheek