Facial Volumes Research Articles

Is Beauty a Matter of Volume Distribution? Proposal of a New Aesthetic Three-Dimensional Guide in Orthognathic Surgery.

Orthognathic surgery is a multidisciplinary surgery in which the aesthetic results have become increasingly important, and consequently, also the predictability of the surgical outcomes. In this paper, we analyzed the volumetric distribution of the lower two-thirds of the face, in patients operated by orthognathic surgery and selected for their attractiveness. Our goal was to analyze the aesthetic volumetric distribution for gender and to propose our operating philosophy, that a normative distribution of facial volumes could be used like a new 3D aesthetic guide in orthognathic planning. A group of 46 orthognathic patients (26 females, 20 males) with the best postoperative aesthetic score was selected by a jury of plastic surgeons, orthodontists, and journalists. The mean soft tissue volumes of the malar, maxillary, mandibular, and chin regions were analyzed. Overall, we measured a mean female facial volume distribution of 38.7%, 29%, 27.6%, and 4.7%, respectively, in the malar, maxillary, mandibular, and chin regions, while in males, it was 37%, 26%, 30%, and 6%, respectively. In this paper, the expansion of facial volumes in orthognathic surgery is proposed as a key point for facial harmonization. Beauty could be scientifically interpreted as a balanced distribution of facial volumes, and the virtual study of this distribution can become an important part of the preoperative analysis, such as a "volumetric" 3D cephalometry, where the surgeon could use average values of aesthetic volumetric distribution as preoperative surgical references.

Automatic Pulp and Teeth Three-Dimensional Modeling of Single and Multi-Rooted Teeth Based on Cone-Beam Computed Tomography Imaging: A Promising Approach With Clinical and Therapeutic Outcomes.

Background Cone-beam computed tomography (CBCT) imaging offers high-quality three-dimensional (3D) acquisition with great spatial resolution, given by the use of isometric voxels, when compared with conventional computed tomography (CT). The current literature supports a median reduction of 76% (up to 85% reduction) of patients' radiation exposure when imaged by CBCT versus CT. Clinical applications of CBCT imaging can benefit both medical and dental professions. Because these images are digital, the use of algorithms can facilitate the diagnosis of pathologies and the management of patients. There is pertinence to developing rapid and efficient segmentation of teeth from facial volumes acquired with CBCT. Methodology In this paper, a segmentation algorithm using heuristics based on pulp and teeth anatomy as a pre-personalized model is proposed for both single and multi-rooted teeth. Results A quantitative analysis was performed by comparing the results of the algorithm to a gold standard obtained from manual segmentation using the Dice index, average surface distance (ASD), and Mahalanobis distance (MHD) metrics. Qualitative analysis was also performed between the algorithm and the gold standard of 78 teeth. The Dice index average for all pulp segmentation (n = 78) was 83.82% (SD = 6.54%). ASD for all pulp segmentation (n = 78) was 0.21 mm (SD = 0.34 mm). Pulp segmentation compared with MHD averages was 0.19 mm (SD = 0.21 mm). The results of teeth segmentation metrics were similar to pulp segmentation metrics. For the total teeth (n = 78) included in this study, the Dice index average was 92% (SD = 13.10%), ASD was low at 0.19 mm (SD = 0.15 mm), and MHD was 0.11 mm (SD = 0.09 mm). Despite good quantitative results, the qualitative analysis yielded fair results due to large categories. When compared with existing automatic segmentation methods, our approach enables an effective segmentation for both pulp and teeth. Conclusions Our proposed algorithm for pulp and teeth segmentation yields results that are comparable to those obtained by the state-of-the-art methods in both quantitative and qualitative analysis, thus offering interesting perspectives in many clinical fields of dentistry.

Efficacy and Safety of Stylage XL Lidocaine for the Restoration and/or Augmentation of Facial Volume: The Beauty Volume Study.

Hyaluronic acid (HA)-based gel fillers help correct facial volume deficits through their volumizing effect. This postmarket clinical follow-up study was a single-center prospective cohort study designed to evaluate the efficacy and safety of Stylage XL Lidocaine (Laboratoires VIVACY, Paris, France) for the augmentation and/or restoration of facial volume. Healthy patients aged between 30 and 65 years with a facial volume grade of 3 to 5 according to the facial volume loss scale (FVLS) were considered eligible. Participants were injected subcutaneously in the area of the cheekbones (essential area). If necessary, patients were also injected in the chin, the temples, and the facial oval (optional areas). Outcomes were assessed at 1, 3, 6, 12, and 18 months following the initial treatment. A touch-up was possible at 1 month following the initial injection. The primary endpoint was the variation in the mean FVLS scores at M6 compared to baseline as evaluated by an independent assessor. A total of 40 female patients (mean age of 52.5 years) were recruited between November 2019 and July 2021. There was a significant improvement in the mean FVLS score at 6 months compared to baseline (2.3 [0.6] vs 3.1 [0.6]; P < .0001). Patients were satisfied with the achieved aesthetic improvements and results were still observed at 12 and 18 months. Stylage XL Lidocaine also had a good safety profile and was well tolerated by the study cohort. The results of the 18-month Beauty Volume study confirmed the efficacy and safety of the Stylage XL Lidocaine HA-based gel filler in the augmentation and/or restoration of facial volumes.

Aesthetic Values of the Buccal Fat Pad Excision in Middle-Aged Patients.

BackgroundDespite buccal fat pad (BFP) excision being an effective and established surgery for the reduction of lower facial volume, there are very few reports explaining a systematic and reliable method for this surgery. The author will demonstrate one method for BFP excision surgery with some important tips and information on the procedure.ObjectivesThe author performed BFP excision surgery for patients seeking facial slimming or improvement of the ptotic lower face. To know the true efficacy of this surgery, objective facial scales were compared preoperatively and postoperatively.MethodsPreoperative and postoperative three-dimensional (3D) pictures were taken, and numerical data for cheek volume and horizontal lower facial length were obtained from 3D picture analysis. The data were statistically analyzed to reveal postoperative improvements.ResultsThe average age of the patients was 54.23 ± 10.31 years old. BFP excision surgery took 60.30 ± 5.93 minutes. Preoperative and 12 months postoperative body weight was 52.3 ± 6.84 and 52.3 ± 6.75 kg, respectively. The average weights for excised BFP were 1.74 ± 0.72 g right and 1.59 ± 0.71 g left. The average of preoperative lower facial volumes was 209.36 ± 30.22 mL right and 209.03 ± 30.13 mL left. The average 12 months postoperative lower facial volumes were 205.00 ± 30.37 mL right and 204.43 ± 30.02 mL left. The results showed a significant difference in both sides (P < 0.01). The average of horizontal lower facial lengths was 238.73 ± 10.87 mm preoperatively and 235.06 ± 10.57 mm 12 months postoperatively. The results affirm that there is a significant difference (P < 0.01).ConclusionsA properly executed BFP excision can achieve distinct facial slimming for the capacious face and can also contribute to improving lower face sagging due to BFP ptosis in middle-aged patients.Level of Evidence: 4

Minimal Incision Lower Augmentation Blepharoplasty: 3 Simple Steps to Facial Mid-Term Rejuvenation.

BackgroundThe practice of removing skin and fatty tissue from the lower eyelid does not accommodate the different forms of facial aging. Therefore, techniques that encompass the recovery of facial volumes are common. Currently, when isolated lower blepharoplasty is performed, it does not take into account that mid-face rejuvenation is simultaneously possible. Furthermore, it is not always necessary to make incisions along the entire lash line, because this may be minimal in good candidates.ObjectivesThis article presents a selection of patients who underwent augmentation lower blepharoplasty for the rejuvenation of the middle third of the face associated with the periorbital area, which is a modified traditional lower blepharoplasty technique performed with minimal incisions and fat grafting. MethodsA retrospective study was conducted on 160 patients who underwent lower augmentation blepharoplasty performed by the authors from July 2017 to March 2021. The small incision utilized is approximately 15 to 18 mm and does not reach the ends or edges of the lower eyelid. The procedure is accompanied by fat grafting in the area of the middle third of the face. Finally, a Likert test was conducted to assess satisfaction.ResultsThe patients presented a noticeable improvement, obtaining more attractive and youthful results from the middle third of the face. There were no major complications, and the patient outcomes were satisfactory.ConclusionsAugmentation lower blepharoplasty with minimal incisions can be a useful alternative for selected patients who seek to jointly rejuvenate the middle third of the face.Level of Evidence: 4

Comprehensive Three-Dimensional Technology Strategies for Autologous Free Fat Graft in Parry-Romberg Syndrome

Autologous free fat graft is a widely accepted method of facial contour restoration in Parry-Romberg syndrome (PRS); however, complex and unpredictable facial anatomy can render this surgery extremely challenging. The integration of 3-dimensional (3D) technology strategies as a method to enhance surgical aesthetic outcomes has been demonstrated.A retrospective chart review was performed for PRS with autologous, free fat graft between 2016 and 2017. Based on 3D volumetric facial analysis and presurgical simulation, a 3D printed fat graft guide was produced. Surgical outcomes were analyzed by volumetric measurements of the upper, middle, and lower face segments.A total of 9 patients were included in the study. Their upper and middle facial volumes before and after the procedures showed statistically significant volume augmentation (upper face, P = 0.004; middle face, P = 0.002) 6 months postoperatively (T1). Facial asymmetry was also statistically significantly corrected (middle face P = 0.012; lower face P = 0.025) at 1 year after the procedure (T2).The advantageous application of 3D comprehensive technology for aesthetic improvements in patients with PRS with autologous, free fat graft treatment has been demonstrated. Precise preoperative planning based on simulations and postoperative 3D volumetric analyses can help adequately predict fat graft strategies.

Evaluation of preferred lip position according to different tip rotations of the nose in class I young adult subjects

The mouth plays an important role in the overall aesthetic appearance of the face. The aims of this study were to determine the optimal antero-posterior (AP) lip position relative to various rotations of the nasal tip and assess the impact of the nasolabial angle on facial aesthetics. Three-dimensional facial volumes, in motion, of one Caucasian male and one Caucasian female with a Class I malocclusion and an orthognathic profile were modified to alter the nasal tip rotation (3 rotations) and the AP lips position (6 positions). 72 generated models were created in two and three-dimensions. Generated models were rated online by 60 dentists, 60 orthodontists and 60 laypeople, using a Visual Analogue Scale. Scores were analysed according to lip position, rater's profession and gender. General agreement was found between all groups on the most and least preferred lip positions. No differences between male and female raters were found. All raters were more influenced by the 3-dimensional rotating facial volume than by 2-dimensional angles. Similar angular values for the nasolabial angles were found in the most and least preferred profiles, showing that the most influential factor in facial aesthetics was the lip position, and stressing the need to evaluate each component of the nasolabial angle independently. The lip position was the determinant factor in facial aesthetics with little influence of the nose tip rotation. Three-dimensional evaluation of the nose and lip were needed to establish a soft tissue-based treatment plan.

Local formulas for Ehrhart coefficients from lattice tiles

As shown by McMullen in 1983, the coefficients of the Ehrhart polynomial of a lattice polytope can be written as a weighted sum of facial volumes. The weights in such a local formula depend only on the outer normal cones of faces, but are far from being unique. In this paper, we develop an infinite class of such local formulas. These are based on choices of fundamental domains in sublattices and obtained by polyhedral volume computations. We hereby also give a kind of geometric interpretation for the Ehrhart coefficients. Since our construction gives us a great variety of possible local formulas, these can, for instance, be chosen to fit well with a given polyhedral symmetry group. In contrast to other constructions of local formulas, ours does not rely on triangulations of rational cones into simplicial or even unimodular ones.

Abstract: Volumetric Changes of the Mid and Lower Face with Animation and the Standardization of 3D Facial Imaging

GOALS: 3D photography provides volumetric data and surface topography with sub-millimeter precision, but current methods lack standardization for facial expression and position. For example, smiling can mimic the desired outcomes of a facelift and fat grafting by increasing malar volume while decreasing volume in the jowls. Our goal was to quantify volumetric changes of the mid and lower face caused by facial expression so that we can accurately assess volumetric changes after surgery. Secondarily, we aimed to identify soft tissue landmarks that can be used to detect these changes in facial expression or head position to ensure the standardization of 3D images. METHODS: 3D facial images of 16 subjects performing 22 facial expressions or changes in head position were captured. Variable degrees of animation during smiling and frowning were also evaluated. Volumetric changes of the malar and jowl regions with facial expressions were quantified using a 3D superimposed image subtraction technique. Translation (movement >1 mm) of 14 standard soft tissue surface landmarks was assessed during various facial animations to determine which landmarks can be utilized to standardize 3D images. RESULTS: Sixteen of the 22 facial expression studied had a significant effect on malar and/or jowl volume. Significant volume changes were noted with subtle animation during smiling and frowning. During maximal smile, mean excursion of oral commissures was 13.7mm +/- 3.0 and the malar region demonstrated a 17.2mL +/- 5.7 increase in volume, whereas the jowl region demonstrated a 1.7mL+/- 0.9 decrease in volume. During maximal frowning, mean excursion of oral commissures was 7.4mm +/- 2.3. The malar region demonstrated a 3.7mL +/- 2.3 decrease in volume, whereas the jowl region demonstrated a 5.4mL +/- 0.9 increase in volume. In the act of smiling, there was significant volume augmentation of the malar region with small degrees of oral commissure excursion, such that a quarter smile (excursion = 25% of excursion with maximal smile) could induce a volume change equivalent to 75% of maximum smile. The jowl decreases in volume with smiling, but in a linear fashion (a quarter smile yields a volume change equivalent to 25% of a maximum smile). Frowning exhibited the opposite, but similarly significant changes in mid and lower facial volume. A 1mm commissure excursion during smiling can produce 5-10mL of malar augmentation or 2-4mL of jowl augmentation with frowning. We believe these results are related to isometric contraction of mimetic muscles and their influence on fat compartments. A combination of 5 landmarks (glabella, bilateral cheilion, pogonion and laryngeal prominence) was found to indicate all tested facial expressions which effect mid and facial volumes, with the exception of platysmal straining. CONCLUSION: Most facial expressions will lead to translation of the oral commissures, with even a subtle (1mm) excursion leading to 5-10mL of malar augmentation during smiling or 2-4mL of jowl augmentation during frowning. We identified that the glabella, pogonion, laryngeal prominence, and bilateral cheilion can be used as a referencing system to allow identification of subtle changes in head position and facial expression for standardization of 3D images.

Single Session Facial Lipostructure by Using Autologous Fat Mixed With Platelet-Rich Fibrin Injected by Using Facial Autologous Muscular Injection Technique.

This study was designed to evaluate the role of single session autologous facial fat grafting in correcting facial asymmetries after mixing it with platelet-rich fibrin (PRF) and injecting them into rich vascular facial muscular plane. Fifteen patients (12 females and 3 males) with age ranging from 18 years to 40 years were included in this study and followed up during 6 months, all the patients were treated in the Al-Shaheed Ghazi Al-Hariri for specialized surgeries hospital (Medical City, Baghdad, Iraq).Autologous fat with PRF injected in facial muscular plane was the standardized method in the treatment of acquired and congenital facial defects.Results were evaluated by 2 plastic surgeons using visual analogue scale.Interexaminer and intraexaminer calibration of the visual analogue scale were carried out by using paired t test. This prospective study showed that the majority of patients (73.3%) needed only a single session for creating a noticeable improvement in facial volumes and contours. Mixing fat with PRF and injecting them by using facial autologous muscular injection technique offers better graft survival by utilizing the growth factors and cytokines in PRF clot together with rich vascular plexus in the muscular layer consequently.

Commentary on: Evaluation of Facial Volume Changes after Rejuvenation Surgery Using a 3-Dimensional Camera.

Facial aging has been the object of various facial rejuvenation approaches throughout the years. To obtain a natural and pleasing rejuvenation effect, it is essential to understand and diagnose the underlying anatomic and age-related changes in order to propose the most appropriate treatment. In this sense, three main categories of age-related changes must be analyzed: (1) skin surface breakdown and changes; (2) skin and soft tissue redundancy and ptosis; and (3) deflation of facial volumes by atrophy and hollowing of underlying soft tissue compartments. Skin care and skin resurfacing procedures were developed to treat the first group of problems, while traditional facelifts and necklifts address the skin redundancy and soft tissue ptosis. The growing appreciation of the loss of facial fat and soft tissue volumes in the face over the last 20 years have led to the introduction and widespread use of fillers and filling techniques, including fat grafting.1,2 The latter has been increasingly used in the last 10 years in association with facelift procedures, based on detailed anatomic studies and clinical series.3,4 Fat grafting is the best surgical option for volume restoration because it is natural, biocompatible and allows for skin quality improvement.5 One of the major drawbacks of fat grafting, however, remains the uncertainty of the results due to unpredictable resorption rates. This is especially true for the facial region where …

Construction of a low-cost surface scanner for medical studies: a feasibility study

This article describes the assembly of a cost-efficient system to enable contact-free volumetric measurement of facial volumes. The system was built from low-cost standard equipment, including Lego bricks, standard CCD camera, laser module, USB board, and stepper motor. The total cost was less than 200 €. At different time intervals, depth data were captured with a sweeping laser line to subsequently determine volumetric models of the object under investigation. The obtained volumetric data were imported in the open-source software ParaView (Kitware Inc., New York, NY, USA) as standard comma-separated files. The absolute errors of the obtained depth values increased from 0.5 to 3.52 mm between 30 and 90 cm of defined object distance, respectively. The relative errors increased from 0.3 to 0.76 %, respectively. This study proves that applicable volume scanners can be built using low-cost components.

Inexperienced Sonographers Can Successfully Visualize and Assess a Three-Dimensional Image of the Fetal Face Using a Standardized Ultrasound Protocol

Introduction: A standardized three-dimensional ultrasonographic (3DUS) protocol is described that allows fetal face reconstruction. Ability to identify cleft lip with 3DUS using this protocol was assessed by operators with minimal 3DUS experience. Material and Methods: 260 stored volumes of fetal face were analyzed using a standardized protocol by operators with different levels of competence in 3DUS. The outcomes studied were: (1) the performance of post-processing 3D face volumes for the detection of facial clefts; (2) the ability of a resident with minimal 3DUS experience to reconstruct the acquired facial volumes, and (3) the time needed to reconstruct each plane to allow proper diagnosis of a cleft. Results: The three orthogonal planes of the fetal face (axial, sagittal and coronal) were adequately reconstructed with similar performance when acquired by a maternal-fetal medicine specialist or by residents with minimal experience (72 vs. 76%, p = 0.629). The learning curve for manipulation of 3DUS volumes of the fetal face corresponds to 30 cases and is independent of the operator's level of experience. Discussion: The learning curve for the standardized protocol we describe is short, even for inexperienced sonographers. This technique might decrease the length of anatomy ultrasounds and improve the ability to visualize fetal face anomalies.

Soft Tissue Facial Morphometry Before and After Total Oral Rehabilitation With Implant-Supported Prostheses

The objective of the current study was to assess a low-cost, noninvasive facial morphometric digitizer to assist the practitioner in three-dimensional soft-tissue changes before and after oral rehabilitation. Twenty-two patients aged 45 to 82 years, all with edentulous maxilla and mandible, were assessed both before and after receiving their definitive complete implant-supported prostheses (each received 4-11 implants in each dental arch; full-arch fixed prostheses were made). The three-dimensional coordinates of 50 soft-tissue facial landmarks were collected with a noninvasive digitizer; labial and facial areas, volumes, angles, and distances were compared without and with the prostheses. Dental prostheses induced significant reductions in the nasolabial, mentolabial, and interlabial angles, with increased labial prominence (P < 0.05, Wilcoxon test). Lip vermilion area and volume significantly increased; significant increments were found in the vertical and anteroposterior labial dimensions. The presence of the dental prostheses significantly (P < 0.001) modified the three-dimensional positions of several soft-tissue facial landmarks. In conclusion, the current approach enabled quantitative evaluation of the final soft-tissue results of oral rehabilitation with implant-supported prostheses, without submitting the patients to invasive procedures. The method could assess the three-dimensional appearance of the facial soft tissues of the patient while planning the provisional prosthetic restoration, providing quantitative information to prepare the best definitive prosthesis.

A contact-free volumetric measurement of facial volume after third molar osteotomy: proof of concept

The present study tested the reliability of an optical scanning device for the objective assessment of postoperative facial swelling. Twenty control subjects bearing a defined volume of water (10-30 mL) in an intraorally carried balloon were tested to assess the measurement accuracy of the device. As a proof of concept, facial volumes of 59 surgical cases were recorded before osteotomy and 1 and 7 days after intervention with the use of a structured light scanner. The median difference between the applied and the measured volumes was 0.67 mL for the control test with the artificial swelling simulated using water balloons. For subjects having third molar osteotomy, extraoral volume increased to 5.29 cm(3) 1 day after surgery (95% CI 5.22-8.52) and decreased to 0.00 mL (95% CI 0.85-2.55) after 7 days. Contact-free visible-light 3-dimensional scanning is reliable for the objective assessment of postoperative facial swelling.

A new automatic algorithm to extract craniofacial measurements from fetal three‐dimensional volumes

Three-dimensional (3D) ultrasound is useful in the prenatal evaluation of fetal craniofacial structures, particularly as it provides a multiplanar view. However, an expert must designate the area of interest and the appropriate view, making measurement of fetal structures using 3D ultrasound both time-consuming and subjective. In this study we propose an image analysis system that measures automatically and precisely the fetal craniofacial structures and evaluate its performance in the second trimester of pregnancy using a new 3D volume analysis algorithm. A universal facial surface template model containing the geometric shape information of a fetal craniofacial structure was constructed from a fetal phantom. Using the proposed image analysis system we fitted this stored template model using a model deformation approach to individual fetal 3D facial volumes from 11 mid-trimester fetuses, and extracted automatically the following standard measurements: biparietal diameter (BPD), occipitofrontal diameter (OFD), interorbital diameter (IOD), bilateral orbital diameter (BOD) and distance between vertex and nasion (VN). The same five parameters were measured manually by an expert and the results compared. Comparison of the algorithm-based automatic measurements with manual measurements made by an expert gave correlation coefficients of 0.99 for BPD, 0.98 for OFD, 0.80 for BOD, 0.83 for IOD and 0.99 for VN. There were no significant differences between automatic and manual measurements. Our proposed system measures precisely the fetal craniofacial structures using 3D ultrasound, making it potentially useful for clinical service. This system could also be applied to other clinical fields in future testing.

Triple-Anchoring Sub-SMAS Face-lift

This article presents the senior author's (ARB) 10-year experience with a rhytidectomy technique that incorporates concepts of modern facial shaping and contour using a sub-SMAS repositioning of volumetric units with partial sub-SMAS elevation (tunnel dissection), periosteal anchoring of SMAS and volumetric units, and limited skin undermining. The cases of triple-anchoring sub-SMAS face-lift performed from January 2000 to January 2010 were analyzed retrospectively. Primary and secondary cases were included. All case data and photography were analyzed. Data regarding patient age, sex, and operative time were gathered. Complication rates were also calculated. A total of 626 patients had a face-lift using the author's technique in this period. A total of 484 patients had a primary face-lift and 142 had secondary surgery. Experience with 626 rhytidectomies performed over a 10-year period indicates that this operation can be completed safely with satisfactory results and a low incidence of complications. To alter effectively the facial contour, a system that reliably elevates the facial volumetric units is needed. After adequate release of the retaining ligaments, the thick SMAS is used as a load-bearing layer. All the tension is transferred from the SMAS to a fixed periosteal anchor point. Each volumetric unit of the face (mala, lateral, and cervical) should be independently mobilized and fixed. The author's technique was shown to be effective in repositioning facial volumes. It was a predictable and reliable technique with few complications over the years. 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 at http://www.springer.com/00266.

Three-dimensional facial morphometry in patients rehabilitated with implant-supported prostheses

The aim of the present study was to assess a low-cost, non-invasive facial morphometric digitizer to assist the practitioner in three-dimensional soft-tissue changes before and after oral rehabilitation. The method should provide quantitative data to support an objective assessment of the facial esthetic outcome [1]. Twenty-two patients aged 45-82 years, all with edentulous maxilla and mandible, were assessed both before and after receiving their definitive complete implant-supported prostheses (each received 4-11 implants in each dental arch; full-arch fixed prostheses were made). The three-dimensional coordinates of 50 soft-tissue facial landmarks were collected with a non-invasive digitizer; labial and facial areas, volumes, angles and distances were compared without/ with the prostheses [2]. Dental prostheses induced significant reductions in the nasolabial, mentolabial and interlabial angles, with increased labial prominence (p<0.05, Wilcoxon test). Lip vermilion area and volume significantly increased; significant increments were found in the vertical and anteroposterior labial dimensions. The presence of the dental prostheses significantly (p<0.001) modified the three-dimensional positions of several soft-tissue facial landmarks. The current approach enabled quantitative evaluation of the final soft-tissue results of oral rehabilitation with implant-supported prostheses, without submitting the patients to invasive procedures. The method could assess the three-dimensional appearance of the facial soft tissues of the patient while planning the provisional prosthetic restoration, providing quantitative information to prepare the best definitive prosthesis. Dote ricerca: FSE, Regione Lombardia

The Facial Autologous Muscular Injection (FAMI) Procedure: An Anatomically Targeted Deep Multiplane Autologous Fat-Grafting Technique Using Principles of Facial Fat Injection

As widely described in the medical literature, facial fat grafting has been limited to the subcutaneous plane, with only vague reference to the muscular plane and deeper tissues. Local infiltration, with or without general anesthesia, is commonly used. The challenges of maintaining volumetric correction, symmetry, and predictability have limited practitioners' confidence in obtaining a desirable result when fat grafting the face. The authors describe a technique for facial fat grafting that targets specific anatomic structures and tissue beds, in effect making the patient's underlying anatomy the template for rejuvenation. Engrafting the muscles of facial expression improves graft retention and therefore predictability and symmetry. The ability to target anatomic structures other than muscle lends itself to the prospect of greater therapeutic advances using adipose-derived stem cells (ADSCs). A set of principles guiding the technique intended to promote successful cellular engraftment is presented. Three illustrative cases are presented, each the result of a single session: two from a 10-year experience of 700 patients by the lead author and one by the corresponding author. The majority of cases (80-90%) needed only a single session for creation of permanent improvement in facial volumes and contours. The facial autologous muscular injection (FAMI) technique offers an anatomically based approach to facial fat grafting with greater predictability and efficiency than current techniques. The principles of the technique put forth apply equally to volumetric enhancements obtained through successful fat grafting and to the promise of ADSCs.

Soft tissue facial morphometry in subjects with Moebius syndrome

Moebius syndrome is a congenital facial palsy associated with the impairment of ocular abduction. The three-dimensional characteristics of the facial soft tissues of 12 male and 14 female subjects [3-52 yr of age (mean age + standard deviation: 17 + 14 yr)] were measured using a non-invasive, computerized system; facial volumes, areas, angles, and distances were computed and compared with those obtained in reference subjects of the same age and gender. When compared with reference subjects, patients with Moebius syndrome had a more prominent and hyperdivergent face in the sagittal plane, a smaller and more prominent upper facial third; a smaller middle facial width; a smaller nose; smaller mandibular volume, depth, corpus length, and ramus height; and a more posterior positioned mandible, with a less prominent chin. In conclusion, patients with Moebius syndrome had a tendency towards a skeletal Class II pattern. These morphological variations may be the combined effect of a general alteration of the motor and sensitive facial nerves, including the trigeminal nerve, and of a maldevelopment of the brainstem.