Improvement Of Facial Contour Research Articles

RELAX and FIRMNESS: The Combination of Muscle Relaxation with Botulinum Toxin and Collagen Biostimulation with Calcium Hydroxyapatite for the Treatment of the Cervical Region.

There are several therapeutic modalities for neck rejuvenation, especially calcium hydroxylapatite. Botulinum toxin, by relaxing the mm. platysma, also provides improvement in facial contour. Combination treatments for this region are usually recommended as they offer better results. This study evaluated the efficacy and safety of the joint dilution of both products (Relax and Firmness - RF), applied in the same device, based on the treatment in the topography of the platysma muscle, ie, starting from the lower third of the face and extending to the neck. Prospective, blinded, controlled study with 10 participants randomly assigned to RF and 5 in the control group (treated with CaHA only). Results were recorded through the Vectra platform and subjectively evaluated through the GAIS scale by participants and blinded evaluators. Objective analysis was performed using corneometry. Times evaluated: pre-treatment, 30 and 90 days. Considered statistically significant when p<0.1. 100% of the RF group reported "excellent improvement" at D30 and 30% at D90. In the control group, 100% reported "very improved" at D30 and 20% rated "excellent improvement" at D90. A higher and earlier satisfaction rate was observed in the RF group. No difference in corneometry was found between the groups at D30. At D90, the control group had a mean increase of 0.24 versus 5.17 in the RF group (p-value=0.089*). When we analyzed the percentage variation from baseline, the control group was stable, while the RF showed a mean increase of 8.89% (p-value=0.062*). We demonstrated the safety and effectiveness of the association of both products, diluted and applied together through microcannulas. Minimization of punctures, patient comfort, and technique based on the anatomy of the platysma muscle underlie the technique. High rates of early satisfaction due to botulinum toxin (Relaxation) and late satisfaction due to CaHA (Firmness).

Effect of the Use of a Cream with Leucine and Lactic Acid Associated with Electrostimulation in Contouring and Facial Tonus: A Randomized Clinical Controlled Trial

Evidence has supported the use of leucine as a promising agent for the maintenance of muscle tone. This study aimed to assess the combined effect of leucine and cream-based lactic acid (novel cosmetic product), associated with the use of surface electrical stimulation to improve contour and facial tonus in women. A total of 23 women were randomly allocated into two groups: Experimental (EG)—use of the leucine-based cream and lactic acid + electrostimulation for facial toning (mean intensity 13 Hz and protocol in progression); and placebo (GP)—use of the placebo cream (without the addition of leucine and lactic acid) + stimulation with the same protocol as the EG. Each group used their cream daily and underwent the intervention protocol three x/week with stimulation for 40 min, for a total of 8 weeks. Three main outcomes were reported: angular variation of facial contour by means of photogrammetry, muscle tone through the electromyographic activity of the masseter and zygomatic muscles during rest and functional tasks of biting and smiling. A significant effect of the intervention and between the groups was obtained for the experimental group against the placebo group for facial contour and muscle tone. An increased muscular activity of the masseter (average 28%) when smiling, and a reduction of zygomatic activity (in average 41%) when biting were found. The use of cream containing leucine and lactic acid combined with electrostimulation contributes to the improvement of facial contour and muscle tone when biting and smiling.

An innovative approach of treating acne scars using bipolar rotational stamping and monopolar criss-cross technique with insulated microneedling radiofrequency in Asians

Introduction:Microneedling radiofrequency (MNRF) using insulated microneedles offers a great advantage to overcome the limitations of fractional lasers such as achieving greater depth, long downtime, and high risk of postinflammatory hyperpigmentation (PIH).Aims:The aim of this study was to assess the efficacy and safety of a novel multiple depth bipolar rotational stamping and monopolar criss-cross method (Wosyet vital technique) with MNRF using insulated needles for the improvement of facial acne scars in Asians.Materials and Methods:Thirty-two patients (20 females, 12 males, average age 30.3 years) with facial atrophic acne scars were treated with insulated MNRF by applying Wosyet vital technique. Most of the patients started noticing improvement in 4–6 weeks after the first session. All patients underwent four sessions at 1-month interval. Outcome assessments included subjective and physician evaluation of acne scars, pores, smoothness, tightness, and overall appearance. Objective assessment was determined by Goodman and Baron’s quantitative and qualitative analysis of the acne scars.Results:All subjects noticed at least 30%–90% (mean––62.50%) improvement in acne scars, whereas unbiased physicians graded 40%–80% (mean––58.44%) at a 6-month follow-up visit. The mean Goodman and Baron’s score decreased significantly from pre- to posttreatment. All patients reported 30%–90% (mean––61.88%) improvement in facial contour and skin tightening. Many patients observe improvement in the open pores as well.Conclusion:The possible explanation of improvement in the global appearance of skin and acne scars is the application of both monopolar and bipolar RF in the dermis through insulated microneedles. We did not find PIH after this technique in Asian patients despite of more aggressive treatment parameters and several treatment sessions.Statistical Analysis Used:The results were analyzed using chi-square test, Wilcoxon sign rank test, Pearson’s correlation test, Spearman’s correlation test, and paired t test.

Cherubism in a 4-year-old boy managed with tumor curettage, mandibular osteotomies and repositioning

Cherubism is a rare disease characterized by significant loss of medullary bone which is replaced by excessive amounts of fibrous tissue growth within the mandible and maxilla. We present a case of a 4-year-old boy with a rapidly enlarging mandible and maxilla, causing significant change in the facial contour, malocclusion and phonation difficulties. He was treated with aggressive tumor curettage, lateral mandibular cortex osteotomies with medial repositioning. This allowed obliteration of the enlarged medullary space and restoration of the normal mandibular anatomy. At 12 months postoperatively, the patient had significant improvement in facial contour, normal outward appearance, and stable dentition.

Effects of Multipolar Radiofrequency and Pulsed Electromagnetic Field Treatment for Face and Neck Rejuvenation.

Skin aging is a gradual process that leads to wrinkle formation, laxity, and overall changes in skin appearance. In recent years, the demands to noninvasive treatments for facial rejuvenation increased, along with a variety of technologies and devices, such as radiofrequency. The present study aimed to evaluate the clinical effects of a multipolar radiofrequency and pulsed electromagnetic field treatment for face and neck rejuvenation. Eleven patients with mild to moderate grades of photoaging underwent eight radiofrequency and pulsed electromagnetic field treatment sessions, once a week. Clinical photographs were taken before and a week after the end of the treatment, and improvement of facial skin parameters was evaluated by two different investigators. Significant improvement in skin laxity was observed in all eleven patients (100%). Improvement in facial contour was noted in 73% and 100% of patients when analyzed by investigators A and B, respectively. The score for overall improvement in skin condition was 3 ± 0.78 for investigator A and 3.6 ± 0.67 for investigator B. All patients were satisfied with the procedure and noted significant improvement in the skin. The combined multipolar radiofrequency and pulsed electromagnetic field device is effective and safe for treatment of aged skin in Brazilian patients.

Bimaxillary Orthognathic Approach to Correct Skeletal Facial Asymmetry of Hemifacial Microsomia in Adults.

Hemifacial microsomia (HFM) is the second most common congenital craniofacial deformity after cleft lip and palate. Distraction osteogenesis (DO) is regarded as an alternative and efficient treatment option for patients with HFM. However, DO was not proven effective for all cases, and the results of long-term follow-up were not satisfactory as expected. Compared with DO, the orthognathic surgery approach may offer more stable clinical outcomes for this kind of disease. The purpose of this study is to evaluate the long-term clinical and radiographic outcome of bimaxillary orthognathic surgery in the treatment of adult HFM. Eight patients with HFM who had undergone bimaxillary orthognathic surgery between 2008 and 2012 were included in the study. The surgical procedures included Le Fort I osteotomy, inverted-L osteotomy, sagittal split ramus osteotomy, genioplasty, and iliac bone grafting. Pre- and postoperative orthodontic treatments were performed, respectively. Clinical and radiographic examinations were carried out to assess postoperative outcomes. No obvious complications appeared postoperatively and no recurrences occurred during follow-up. All patients obtained satisfactory aesthetic results. Marked improvement in facial contour and occlusion were observed. Plain radiographs showed that the height ratios between the affected and unaffected ramus were ameliorated significantly. The bimaxillary orthognathic approach to correct the deformity of adult HFM can obtain stable results in the long-term follow-up, and should be considered as a priority method for the treatment of adult patients with dentofacial deformity. 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 .

The Role of Microfat Grafting in Facial Contouring.

Congenital hypoplasia of facial bones has traditionally been treated by orthognathic surgery. However, the inherent invasiveness of orthognathic surgery often leads to a high complication rate. Facial fat grafting could be a less invasive method to correct facial deformities. The aim of this study was to evaluate the results of microfat grafting for facial contouring. This retrospective chart review evaluated 166 patients who were treated with microfat grafting for maxillary and/or mandibular hypoplasia. Pretreatment and posttreatment photographs were compared regarding improvement of facial contour, and complications were recorded. The follow-up period ranged from 4 months to 10 years (mean, 2 years 7 months). Thirty-eight percent of the patients had a refill procedure 6 or more months after the first procedure. A majority of the evaluated patients stated that they benefited from the microfat grafting, with ratings of excellent (50%), sufficient (48%), and poor (2%). Complications included visible fat lobules under the lower eyelid skin (7%), which was seen during the first 4 years and was resolved by changing the injection cannulae and technique, and fat resorption, which was seen in all patients, with a clinical range from ±15% in the immobile malar area and chin region to ±50% in the mobile lip area. Facial microfat grafting is a valuable alternative to more complicated advancement osetotomies being performed in patients solely for aesthetic reasons. The low morbidity and rapid recovery make facial microfat grafting a welcome tool in the armamentarium of the modern facial aesthetic surgeon.

High-density Hyaluronic Acid for the Treatment of HIV-related Facial Lipoatrophy

Facial lipoatrophy is a stigmatizing hallmark of HIV. The injection of facial fillers has an essential role in the treatment of this condition. The objective of our study was to verify the safety and efficacy of a new formulation of high-density hyaluronic acid for the injectable treatment of HIV-related facial lipoatrophy. We treated with high-density hyaluronic acid injections HIV patients affected by moderate to severe facial lipoatrophy and evaluated them at last follow-up, at a minimum of 36 weeks. Physician-related outcomes included pre-and post-treatment ultrasound measurement of the soft-tissue thickness of the cheeks and qualitative assessment of aesthetic results by means of the Global Aesthetic Improvement Scale using pre- and post-treatment photos of the patients. Patient satisfaction outcomes were evaluated with the VAS-face scale and Freiburg test. Fifty-four patients were studied. The median number of treatment sessions was 3 and the median length of treatment was 5.5 months. The thickness of the soft tissues of the cheek increased significantly from 9.45 to 13.12 mm (p<0.0001). On the basis of the Global Aesthetic Improvement Scale, 87.5% of the patients were judged as "much improved" or "improved." Patient satisfaction at 1 year from the end of treatment was proven (VAS-face: 77.9; Freiburg questionnaire: 93.6% of patients were satisfied or very satisfied). Complications were limited to mild redness and swelling in the early postoperative period. Long-term improvement of facial contour and excellent patient satisfaction, in the absence of severe side effects, were obtained by the injection of high-density hyaluronic acid (STYLAGE® XL) in HIV patients with facial lipoatrophy.

Cherubism - A case report with long term follow up

Cherubism is a rare non-neoplastic disease of the bone characterized by bilateral painless enlargement of the jaws giving a cherubic appearance to the patient. It is an autosomal dominant disorder but may occur sporadically. In this paper, we have tried to explain about the clinical, radiological and histopathologic features of cherubism by presenting a case study. A case study of a 7 year old male patient, who first presented with mandibular bilateral swellings to our department in 1998, has been presented. In-depth clinical, radiological and histopathologic examination was done. An extensive long-term follow-up till 11 years was maintained. When presented for the first time, radiological investigation showed characteristic multilocular lytic lesions of the mandible bilaterally. Histopathological examination of the biopsy specimen showed proliferating fibrous connective tissue interspersed by multinucleated giant cells. It was diagnosed as a case nonfamilial cherubism. Follow-up after 5 years showed involvement of the maxilla as well, which was then corrected by surgical methods. Upon follow up 11 years after the first presentation, it was seen that the lesion was regressing by itself and there was improvement in facial contour. The natural course of Cherubism through its progression, stabilization and involution of the disease after puberty, has been highlighted in this case. More, in-depth studies to understand the nature and the pathogenesis of this condition better are required.

Long-term results of high-density porous polyethylene implants in facial skeletal augmentation: An Indian perspective

ABSTRACT Context: With the increasing emphasis on well-sculpted facial features, today there is a growing need for tools to augment the facial skeleton; either for cosmetic reasons or to re-contour deformities—congenital, post-traumatic and post-ablative. The limitations of autogenous materials has lead to evolution of numerous ‘alloplasts’, of which, high-density porous polyethylene (HDPE) seems to be a promising alternative. Aims: To evaluate the long term results of HDPE in facial skeletal augmentation in terms of achieving desired facial contour, patient satisfaction and complications. Settings: A tertiary care referral centre in a metropolitan set-up. Design: Case Series Materials and Methods: All patients undergoing HDPE implant insertion for facial skeletal augmentation between July 2001 and November 2009 were included in the study. A total of 70 HDPE implants were inserted in 44 patients. All procedures were performed by a single surgeon following standardized pre, intra and post-operative protocols. The results were evaluated with respect to improvement in facial contour desired and achieved, overall patient satisfaction and complications encountered. Results: The study included 44 patients with a male:female ratio of 1:1, a mean age of 25.09 years (14 to 58 years) and a mean follow-up of 45.34 months (0.5 to 100 months). HDPE implants were used to augment the nasal dorsum, maxilla, malar eminence, chin, mandibular body and angle, orbital rim and frontal region. The overall recontouring afforded by the HDPE implants was good, with most patients reporting satisfactory results. There were seven complications (10%), including three cases of deviation (4.29%), three cases of exposure (4.29%) and one case of sub-clinical infection (1.43%). None however necessitated implant removal. Nasal dorsal HDPE implants, especially those involving secondary surgery, suffered a much higher complication rate compared to other implants. Conclusions: HDPE is an alternative to autogenous grafts for facial skeletal augmentation with good long-term results and a low incidence of complications, provided there is adequate vascular soft tissue cover.

Long-term results of high-density porous polyethylene implants in facial skeletal augmentation: An Indian perspective.

Context:With the increasing emphasis on well-sculpted facial features, today there is a growing need for tools to augment the facial skeleton; either for cosmetic reasons or to re-contour deformities-congenital, post-traumatic and post-ablative. The limitations of autogenous materials has lead to evolution of numerous 'alloplasts', of which, high-density porous polyethylene (HDPE) seems to be a promising alternative.Aims:To evaluate the long term results of HDPE in facial skeletal augmentation in terms of achieving desired facial contour, patient satisfaction and complications.Settings:A tertiary care referral centre in a metropolitan set-up.Design:Case SeriesMaterials and Methods:All patients undergoing HDPE implant insertion for facial skeletal augmentation between July 2001 and November 2009 were included in the study. A total of 70 HDPE implants were inserted in 44 patients. All procedures were performed by a single surgeon following standardized pre, intra and post-operative protocols. The results were evaluated with respect to improvement in facial contour desired and achieved, overall patient satisfaction and complications encountered.Results:The study included 44 patients with a male:female ratio of 1:1, a mean age of 25.09 years (14 to 58 years) and a mean follow-up of 45.34 months (0.5 to 100 months). HDPE implants were used to augment the nasal dorsum, maxilla, malar eminence, chin, mandibular body and angle, orbital rim and frontal region. The overall recontouring afforded by the HDPE implants was good, with most patients reporting satisfactory results. There were seven complications (10%), including three cases of deviation (4.29%), three cases of exposure (4.29%) and one case of sub-clinical infection (1.43%). None however necessitated implant removal. Nasal dorsal HDPE implants, especially those involving secondary surgery, suffered a much higher complication rate compared to other implants.Conclusions:HDPE is an alternative to autogenous grafts for facial skeletal augmentation with good long-term results and a low incidence of complications, provided there is adequate vascular soft tissue cover.

Repair of facial soft tissues for improvement of facial contour

Objective To investigate the plastic surgery of facial soft tissue for improvement of facial contour. Methods Botulinum toxin type A was injected into hypertrophied masseter to make it atrophy and attenuation; meanwhile, buccal fat lining was partly resected by intra-oral approach. Buc-cal liposuction was performed if necessary. Results 36 cases got satisfactory face thinning results af-ter treatment. The facial contour of all patients was markedly improved. Following up for 6 - 12 months showed that the effect was stable. Conclusion Plastic repair of facial soft tissue for improve-ment of facial contour is a simple approach, with mild injury, quick recovery, safe and effective. Key words: Buccal fat lining; Usculus masseter; Type A botulinum toxin; Liposuction

Cell-Assisted Lipotransfer for Facial Lipoatrophy: Efficacy of Clinical Use of Adipose-Derived Stem Cells

Lipoinjection is a promising treatment, but its efficacy in recontouring facial lipoatrophy remains to be established. The objective was to evaluate the efficacy and adverse effects of lipoinjection and supplementation of adipose-derived stem/stromal cells (ASCs) to adipose grafts. To overcome drawbacks of autologous lipoinjection, we have developed a novel strategy called cell-assisted lipotransfer (CAL). In CAL, stromal vascular fraction containing ASCs was freshly isolated from half of an aspirated fat sample and attached to the other half of aspirated fat sample with the fat acting as a scaffold. This process converts relatively ASC-poor aspirated fat into ASC-rich fat. We performed conventional lipoinjection (non-CAL; n=3) or CAL (n=3) on six patients with facial lipoatrophy due to lupus profundus or Parry-Romberg syndrome. All patients obtained improvement in facial contour, but the CAL group had a better clinical improvement score than did the non-CAL patients, although the difference did not reach statistical significance (p=.11). Adipose necrosis was found in one non-CAL case who took perioperative oral corticosteroids. Our results suggest that CAL is both effective and safe and potentially superior to conventional lipoinjection for facial recontouring. The authors have indicated no significant interest with commercial supporters.

The facial rejuvenation algorithm

The cosmetic dermatology approach to facial rejuvenation incorporates both medical and surgical approaches. Medical considerations include the use of pharmaceuticals, nutraceuticals, and cosmeceuticals in combination with surgery designed to resurface, redistribute, and reshape. While the scientific cause of aging is the shortening of the telomere following numerous cell divisions, the dermatology patient characterizes aging as the appearance of wrinkles. Yet wrinkles are eliminated or minimized through corrections to the eroding bony architecture, decreased cartilaginous support, redistributed subcutaneous fat, thinning dermal collagen, decreased epidermal turnover, and the failure of exfoliation to occur in the stratum corneum. Only by considering each of these age-related changes can facial rejuvenation optimally occur. Discrete rounded features formed by the structure of the underlying facial bone characterize a universally beautiful face. Bone demineralization begins around age 25 in females and increases throughout life with less bony support creating the appearance of wrinkled excess facial skin. Dermatologists should master the art of bone loss prevention through the use of estrogen hormone replacement, biphosphenates, and vitamin D and calcium carbonate supplements. There is no logic to implanting expensive fillers to expand deep folds of the face without preserving the underlying bone from facial osteoporosis. Once the issues of bone loss have been addressed, then the subcutaneous compartment requires attention. There is no explanation for the observation that fat redistribution with age leads to loss of subcutaneous fat, especially on the face, and increased deposition intra-abdominally. Autologous fat transfer with fat placement on the bone, within the muscle, and beneath the skin can lead to a long-lasting improvement in facial contour, restoring the gentle curves associated with youth and eliminating the facial angularity seen with advancing age. Once the bone and subcutaneous fat compartments have been considered, the draping of the skin over this framework is the next focus. Fillers, deep chemical peeling, and ablative laser resurfacing can be used to replace or encourage regeneration of lost dermal collagen. Botulinum toxin can be used to minimize the effect of hyperkinetic facial muscles on the thinning skin. Medium depth chemical peeling and intense pulsed light can be used to improve pigmentation. Generally, a combination of techniques is required to achieve the best result. Lastly, attention should be paid to the epidermis and the stratum corneum. Microdermabrasion and superficial glycolic or salicylic acid chemical peels can be used to enhance exfoliation while 5-fluorouracil or diclofenac can be used to remove damaged epidermal cells forming actinic keratoses. The appearance of the stratum corneum may also benefit from the use of a moisturizer containing emollients to smooth the skin surface and sunscreens to prevent further photodamage. Thus, the dermatologic approach to facial rejuvenation crosses many disciplines. We must be skilled at using pharmaceutical preparations, such as tretinoin, 5-fluorouracil, diclofenac, etc. to rejuvenate ill-behaved aging cells. We must be skilled at recommending the use of nutraceuticals, such as oral antioxidants, vitamin D, calcium, etc., to provide the necessary raw materials for the skin and underlying bone to form properly. Lastly, we must understand the world of topical cosmeceuticals, to include moisturizers and sunscreens, such that the skin surface can be protected from damaging UV radiation and the effects of the external environment. Cosmetic dermatology combines pharmaceutic, nutraceutic, and cosmeceutic modalities to achieve state-of-the-art facial rejuvenation.

Safety and Efficacy of Midface-lifts With an Absorbable Soft Tissue Suspension Device

To evaluate the safety and efficacy of midface-lifting using an absorbable suspension device (Endotine ST). Prospective cohort of 10 consecutive adult female patients seen in a private practice who underwent isolated midface-lift without accompanying eyelid surgery or volume augmentation procedures in the setting of an accredited ambulatory surgical center. All patients underwent endoscopic-assisted midface-lifts with general anesthesia or intravenous sedation. Subperiosteal dissections of the midface were performed with fixation of the Endotine ST device to temporalis fascia. Objective and subjective criteria were recorded and photodocumented during the postoperative period at 1 week and 1, 3, and 6 months. Patient characteristics of erythema, tenderness, and pain were recorded with a visual analog scale. The patients and surgeon rated changes from the baseline condition and overall satisfaction with the procedure at 1, 3, and 6 months. All 10 patients completed the 6-month postoperative follow-up. Nine of the 10 patients had significant improvements in their aesthetic outcome. The most common objective symptom of malar sensitivity diminished significantly between the 1- and 3-month visits. One patient experienced a temporary paresis of the zygomaticofacial nerve that resolved at 3 months. There were no major complications of infection, extrusion, skin irregularities, or device removals. Midface-lifting with the Endotine ST device provided significant elevation of the malar fat pad with improvement in facial contour. Safety of this surgical technique was comparable to that of midface-lifts in other published studies. Patient acceptance of the midface-lift using the Endotine ST device was favorable. Temporary tenderness over the malar area can be expected during the early postoperative period.

Rotation advancement of the midface by distraction osteogenesis.

A wide variety of disease processes produce alteration of midfacial skeletal growth, resulting in moderate-to-severe midface deficiency presenting as retrusion associated with Angle's class III malocclusion. Le Fort III osteotomies with advancement can provide an excellent tool for correction of this deformity. Recently, the corrective procedure of choice for advancement of midfacial segments has been distraction osteogenesis after osteotomy. Straight linear advancement is the most common choice for corrective movement of the midfacial segment, whether accomplished through acute surgical advancement or through the progressive distraction technique. Unfortunately, linear advancement can produce abnormal configurations, both at the nasal root and lateral orbits, regardless of the technique used. Enophthalmos, caused by orbital enlargement, may limit the advancement necessary to achieve class I occlusion. The authors have extended the utility of the Le Fort III procedure and have improved the final outcome by creating a controlled rotation advancement of the midfacial segment using distraction. The application of an existing internal distraction device is modified to control the movement of the midfacial segment in a rotation advancement path. Included in the series were 10 patients with severe midface retrusion secondary to multiple congenital syndromes, along with cleft lip and palate. The ages of the patients ranged from 6 to 14 years. An internal distraction system was used in all cases. Application of the distractor was substantially modified to simplify both fixation and removal and to produce controlled rotation advancement. The team orthodontist determined the final occlusal relationship. Percutaneous distractor drive rods were removed 4 to 6 weeks after active distraction to increase patient comfort. The distractors and all associated hardware were removed after 12 to 16 weeks of consolidation; follow-up periods ranged from 1 to 3 years. By using the modified distractor application to produce rotation advancement, the contour abnormalities at the nasal root and lateral orbit and the enophthalmos produced by linear advancement were eliminated. Significant improvement in facial contour and class I occlusion was obtained in all cases. Complications consisted of near exposure of the device in one patient. Stability has been excellent, with no relapse reported by the orthodontist. Rotational advancement of facial segments by distraction allows successful early intervention in patients with significant midface retrusion. The abnormal nasal root and lateral orbital configurations produced by direct linear advancement are avoided, and a stable and normalized facial configuration is produced.

A Prospective Study of the Effect of Botulinum Toxin A on Masseteric Muscle Hypertrophy-Preliminary Report

This is a prospective study of effect of botulinum toxin A (BOTOX) on masseteric muscle hypertrophy. Six patients (Four bilateral and two unilateral masseteric muscle hypertrophy) were evaluated. Each patient was recorded using subjective and objective scoring system one month, two months, and three months after injection of botulinum toxin A. All six patients showed remarkable improvement of facial contour for the first three months after treatment. There was no complaining of any side effect after the treatment except for one patient who experienced mild weakness on chewing for the first two weeks. This study shows that botulinum toxin A is a safe and effective method in treating masseteric muscle hypertrophy.

Simplified Procedure for Aesthetic Improvement of Facial Contour by Maxillary Augmentation Using a Porous Hydroxyapatite Graft for Maxillofacial Deformity

A simplified procedure of maxillary augmentation with a porous hydroxyapatite block graft in the anterior aspect of the maxillary parapiriformis area is described. This procedure is an alternative for maxillary advancement osteotomy and is simple to perform for maxillofacial deformity of cleft lip and palate and other deformities. It is effective for facial aesthetics in association with mandibular surgery, such as mandibular setback by sagittal splitting osteotomy, mandibular segmental osteotomy with premolar extraction, bimaxillary osteotomy, and/or genioplasty. We used this procedure on 21 patients (15 for cleft lip and palate jaw deformity and 6 for aesthetic reasons). Although postoperative infection requiring removal of the hydroxyapatite block occurred in one cleft deformity patient, satisfactory results were obtained in all patients.