Infraorbital Area Research Articles

Multimodal Pilot Evaluation of a Hyaluronic Acid Infraorbital Filler Using Precise, Multi-Positional, 3D Imaging Quantification, Patient Reported Outcomes, and Anatomic Cadaveric Assessments

Abstract Background Despite the high demand of filler in the infraorbital area, there remains debate on injection practices, precise anatomical placement, and hyaluronic acid (HA) filler behavior. Objectives We aimed to contribute to the clinical and anatomic understanding of infraorbital HA injection via a prospective patient injection study in combination with a cadaveric analysis. Methods Patients were injected with Volbella XC into the tear trough region by a single experienced aesthetic plastic surgeon. Over a 90-day period, precise undereye volumetric measurements using 3D photogrammetry (VECTRA-M3) and patient reported outcomes (FACE-Q) were collected and analyzed relative to two pretreatment severity scales. Juvéderm Vycross and Restylane NASHA products were injected into the infraorbital and malar region in six cephalus specimens and evaluated with regards to the anatomic injection location with and without common clinical physical manipulations. Results Eleven patients participated with a 100% retention rate. Infraorbital HA volume maintenance was 70-81% at 30 days and 50-70% at 90 days. Significant improvement was noted in the eyes, overall facial appearance, and cheekbones (p<0.05) with FACE-Q outcomes, irrespective of pretreatment severity. In the cadaver examination, we observed differences in the anatomic locations occupied by Juvéderm and Restylane products as well as in behavior after physical manipulation between gel types. Conclusions Volbella XC effectively augments undereye volume to diminish infraorbital hollowing as measured over a 90-day period with significantly improved PROs. Enhanced knowledge of the behavior of Volbella XC and other HA fillers in this sensitive anatomic region will lead to improved patient outcomes.

Minimizing Narcotic Use in Rhinoplasty: An Updated Narrative Review and Protocol

Opioids are commonly used to reduce pain after surgery; however, there are severe side effects and complications associated with opioid use, with addiction being of particular concern. Recent practice has shifted to reduce opioid consumption in surgery, although a specific protocol for rhinoplasty is still in progress. This paper aims to expand on the protocol previously established by the senior author based on updated evidence and details. This was accomplished by first high-lighting and summarizing analgesic agents with known opioid-reducing effects in the surgical field, with a particular focus on rhinoplasty, then compiling these analgesic options into a recommended protocol based on the most effective timing of administration (preoperative, intraoperative, postoperative). The senior author’s previous article on the subject was referenced to compile a list of analgesic agents of importance. Each analgesic agent was then searched in PubMed in conjunction with “rhinoplasty” or “opioid sparing” to find relevant primary sources and systematic reviews. The preferred analgesic agents included, as follows: preoperative, 1000 mg oral acetaminophen, 200 mg of oral celecoxib twice daily for 5 days, and 1200 mg oral gabapentin; intraoperative, 0.75 μg/kg of intravenous dexmedetomidine and 1–2 mg/kg injected lidocaine with additional 2–4 mg/kg per hour or 1.5 cc total bupivacaine nerve block injected along the infraorbital area bilaterally and in the subnasal region; and postoperatively, 5 mg oral acetaminophen and 400 mg of oral celecoxib. When choosing specific analgesic agents, considerations include potential side effects, contraindications, and the drug-specific mode of administration.

A full-face contouring using micro-autologous fat transplantation (MAFT)-gun technique in Vietnamese population

IntroductionMicro-autologous fat transplantation (MAFT)-gun technique is applied to accurately deliver small fat parcels to multiple fat layers in varied facial sites. Our study presented surgical and clinical outcomes of the MAFT-gun technique for full face contouring. MethodsFrom 01/2021 to 06/2023, 31 healthy participants undergoing fat grafting by MAFT-gun technique for volumization of their full face at our hospital were included. Data on fat volume grafted in different facial sites, complications, and satisfaction rate (%) were collected and analyzed. ResultsThe fat volumes grafted over the left and right cheek were 10.3 ± 0.31ml and 10.2 ± 0.30ml. The forehead and temples demanded lower fat volume by 9.8 ± 0.23ml and 4.5 ± 0.21ml. A small fat volume was required for the nasolabial fold, the tear trough, and the infraorbital areas, by 2.2 ± 0.11ml, 1.9 ± 0.10ml, and 1.4 ± 0.11ml. The fat volumes for the nasolabial fold and the tear trough were significantly different between young and old people. No complications including infection, necrosis, or vascular injury were noted. At the end of the follow-up, 26 patients (83.9%) expressed their satisfaction after the procedure. ConclusionThe MAFT-gun technique is safe and effective for full-face autologous fat grafting. Commercial closed-system processors could be an effective alternative to centrifugation for fat processing. The procedure contributed to the improvement of facial hollowness and brought a more attractive and satisfied appearance to people even after 12 months postoperatively.

An Inflammatory Myofibroblastic Tumour Presenting with Limited Mouth-Opening, Hypoesthaesia of The Left Chin and Infraorbital Area, Intermittent Left Eye Ptosis and Converging Strabismus.

An inflammatory myofibroblastic tumour (IMT) is a challenging disease.Given the variable clinical and radiological presentation of the disease, it is of paramount importance to know it, to be swiftly recognised so diagnosis can be promptly made.The adapted treatment should be immediately started to prevent possible life-threatening outcomes.

Beneath the surface: a case of subcutaneous human dirofilariasis.

A female in her 60s, a resident of Kerala, India, presented with a painless cystic swelling in the left infraorbital area for 15 days, with a preceding history of insect bite.

Principles and Clinical Application of Free-Style Capillary Perforator-Based Flap for Coverage of Facial Skin Cancer Defects.

This study introduces a free-style perforator based island flap (PBIF) for the reconstruction of skin defects. From March 2012 to December 2022, a retrospective investigation was conducted on patients who underwent reconstruction for facial defects due to skin cancer. Data on the patients' gender, age, anesthesia method, diagnosis, defect location, flap size, complications, and follow-up periods were collected. There are several principles for designing the PBIF: finger-pinching method, alignment with the direction of wrinkles, the smaller width and longer length of the flap, and proximal attachment to the muscle. A total of 32 patients were included, with an average age of 63.6 years. Surgeries were performed in various regions, such as the infraorbital area, nose, cheek, philtrum, and the anterior/posterior/inferior auricular regions, with an average flap size of 7.63 cm2. There were no complications, such as venous congestion or vascular insufficiency in the skin flaps, although one case required revisional closure due to flap disruption. The PBIF is a useful and effective method for the restoration of facial defects. This method can provide simple yet aesthetically satisfying results, showing stable outcomes without complex surgeries or complications. This study indicates the potential for this method to be more widely employed in reconstructive surgeries in the future.

Infraorbital nerve block for pain management in pediatric cleft lip surgery in resource-limited areas of Indonesia: A case series

Introduction and importanceCleft lip and palate (CLP) are congenital anomalies of the craniofacial region, commonly found in low- and middle-income countries, including Indonesia. Surgical correction of clefts typically begins at around three months of age to support infant growth. An infraorbital nerve block is an option for regional anesthesia in CLP surgery. This case series aims to determine the effectiveness of infraorbital nerve block in pain management for pediatric CLP surgery. Case presentationThis case series includes five patients who fulfilled the Millard criteria for CLP surgery. All patients received general anesthesia followed by an infraorbital nerve block with 0.2 % ropivacaine in the infraorbital foramen area using the intraoral approach. Data were collected preoperatively, intraoperatively, and postoperatively. DiscussionThe combination of general anesthesia and infraorbital nerve block resulted in stable hemodynamics, low delirium scores, low pain intensity, and adequate oral intake postoperatively. ConclusionInfraorbital nerve block with ropivacaine provides intraoperative hemodynamic stability, decreased delirium, and effective postoperative pain management in pediatric patients undergoing CLP surgery.

Randomized self-controlled study comparing open-face vs. closed immobilization masks in fractionated cranial radiotherapy

PurposeTo compare patient discomfort and immobilisation performance of open-face and closed immobilization masks in cranial radiotherapy. Material and methodsThis was a single-center randomized self-controlled clinical trial. At CT simulation, an open-face and closed mask was made for each patient and treatment plans with identical dose prescription were generated for each mask. Patients were randomised to start treatment with an open-face or closed mask. Masks were switched halfway through the treatment course; every patient was their own control. Patients self-reported discomfort, anxiety and pain using the visual analogue scale (VAS). Inter- and intrafraction set-up variability was measured with planar kV imaging and a surface guided radiotherapy (SGRT) system for the open-face masks. Results30 patients with primary or metastatic brain tumors were randomized − 29 completed radiotherapy to a median total dose of 54 Gy (range 30–60 Gy). Mean discomfort VAS score was significantly lower with open-face masks (0.5, standard deviation 1.0) vs. closed masks (3.3, standard deviation 2.9), P < 0.0001. Anxiety and pain VAS scores were significantly lower with open-face masks (P < 0.0001). Closed masks caused more discomfort in infraorbital (P < 0.001) and maxillary (P = 0.02) areas. Two patients and 27 patients preferred closed or open-face masks, respectively. Interfraction longitudinal shifts and roll and yaw rotations were significantly smaller and lateral shifts were significantly larger with closed masks in combination with the laser system (P < 0.05) compared to open masks in combination with a SGRT system. Intrafraction variability did not differ between the masks. ConclusionsOpen-face masks are associated with decreased patient discomfort without compromising patient positioning and immobilisation accuracy.

Peculiarities of the clinical picture and diagnosis of dirofilariasis in the maxillofacial area: a series of cases from practice

Dirofilariasis is a helminthiasis that occurs in carnivorous animals (dogs, cats, foxes, wolves, etc.) and less often in humans, although according to some authors it is believed that the number of infected animals approximately corresponds to the number of infected people. Dirofilariasis of the maxillofacial area is not a widespread condition, its cases are described in short series, therefore, the aim of this work is to share our own experience of managing patients with this rare condition.The work presents our own experience in the management of 14 dirofilariasis patients with lesions of the maxillofacial area, of them there are 3 men and 11 women aged 29 to 54. Most patients sought help in the late autumn, winter and spring periods and only 2 people in the summer period. All patients were examined by a dentist, and an ultrasound examination of the area with a formation was performed. According to the clinical manifestations, the disease began acutely in nine patients and had a picture of inflamed atheroma (2 – in the zygomatic area, 1 – in the parotid, 2 – in the infraorbital area, 2 – in the temporal area, and 2 – in the area of the nasal bridge). All patients were operated on and tumor-like formations in dense membranes were removed, inside which one live nematode 11-18 cm long was found. In 3 observations, fragments of dead, partially lysed nematodes were removed from the oral cavity, the capsules of which imitated a migrating granuloma. According to the location – 5 capsules with dirofilaria were located in the subcutaneous fatty tissue, 3 – in the submucosal layer of the gums fused to the periosteum of the upper jaw, 1 – in the submucous layer of the lower jaw, 2 – in the fibers of the temporalis muscle and 1 – in the fibers of the buccal muscle. In each case, the localization of the nematode was close to the places of accumulation of adipose tissue or large blood vessels. In the postoperative period complex therapy was prescribed, including symptomatic anti-inflammatory and desensitizing agents, and consultation with infectionist was recommended. Thus, according to our observations, dirofilariasis most often affects areas of the face in which there are large vessels and accumulation of fatty tissue. In connection with the prevalence of dirofilariosis in humans and the predominant localization of parasitic infection in the face area, dentists, ophthalmologists and otolaryngologists need to be familiar with this pathology and show definite vigilance. Treatment dirofilariosis patients should be carried out comprehensively, together with parasitologists, with surgical excision of the lesion and appropriate drug therapy.

Lichen sclerosus of the eyelid involving the eyelash margin

AbstractLichen sclerosus is a debilitating and chronic disease that typically affects the anogenital area, although it can also be found on extragenital locations such as the shoulders, neck, trunk, breasts, and arms. Facial involvement is rare, but there have been a few reported cases of extragenital lichen sclerosus affecting the infraorbital area. To our knowledge, there are 7 documented cases of extragenital lichen sclerosus affecting the eyelid in medical literature. This is a novel case and documented report of a patient with extragenital lichen sclerosus located on the eyelid with eyelash margin involvement.

A Periorbital Treatment Option Using a Polycaprolactone-based Dermal Filler for Infraorbital Volume Restoration: Case Series

Background: The polycaprolactone-based filler, (PCL-1, Ellansé-M) has been widely used for the treatment of various facial regions, both for volume enhancement and skin rejuvenation. Thus far, reports on the outcomes of PCL-based dermal fillers for the infraorbital area are limited. Objective: To assess the aesthetic outcomes related to the infraorbital area using a PCL-based dermal filler over a one-year post-treatment period. Materials and Methods: The study population consisted of 10 patients (100% women) aged between 45 and 65 years, undergoing infraorbital treatment with a PCL-based dermal filler in a private clinic. The authors employed the grading system based on the volume difference between pre- and post-injection photographs to evaluate its efficacy at 1- and 12-months post-procedure. Results: The average evaluation scores at 1 and 12 months were 1.5 and 1.8, respectively. The mean improvement on the clinical GAIS scale was observed in all participants one year after the procedure. A clear increase in volume of the infraorbital area were observed in all patients at one year.

P14 Midface Toddler Excoriation Syndrome (MiTES): a new mimic of non-accidental injury

Abstract Background Midface Toddler Excoriation Syndrome (MiTES) is a rare genetic condition first described in 2017. Commencing in the first year of life, it is characterised by intense mid-­facial itch with persistent scratching and skin breakdown. Symptoms improve later in childhood, leaving atrophic scarring. Disbelief that infants can damage themselves in this way can lead to an erroneous and damaging misdiagnosis of non-accidental injury (NAI). Cases A boy now aged 11 years presented at 6 months with recurrent scratching of the face, leading to ulceration of the nasal bridge, sides of the nose, infraorbital areas and central forehead. Extensive investigations were unhelpful and NAI was suspected with significant psychosocial sequelae for the family. When his sister, now aged 4 years, presented with strikingly similar lesions MiTES was suspected and confirmed by genetic testing which showed homozygosity for 18 alanine repeats in the PRDM12 gene. Testing of sibling and parents is planned. Both children are now asymptomatic but have significant facial scarring. Discussion Biallelic variants in PRDM12 usually cause hereditary sensory and motor neuropathy type 8 with widespread damage to distal appendages due to pain insensitivity. The specific variant found here and in all reported MiTES cases causes highly localised lesions with rarely any extra-facial ­involvement. Due to its novelty and rarity, MiTES may be misdiagnosed and safeguarding concerns raised, leading to distress for affected families and breakdown of parent-­provider relationships. This case, which for the first time provides longitudinal data on affected siblings, highlights the need for early recognition and diagnosis.

Brushed Aside: Unusual Lodgment of a Toothbrush in the Infraorbital Region - A Case Report

Foreign objects found in the oral and maxillofacial region a common encounter for surgeons specializing in oral and maxillofacial surgery OMFS often result from incidents of assault trauma or insufficient postoperative assessment. Identifying these objects can pose a diagnostic challenge for trauma surgeons. It mainly depends on factors such as the size of the object difficulty of access and its anatomical proximity to vital structures. Dealing with such injuries requires a sequential and multidisciplinary approach beginning with the trauma unit responsible for ensuring airway maintenance and hemodynamic stabilization and if deemed necessary conducting evaluations related to neurology ophthalmology and vascular concerns. The given case report describes an injury in which a 7 cm long piece of toothbrush was lodged in the left infraorbital area as a result of an accident. The patient presented with signs of local inflammation periorbital edema and paresthesia of the concerned region. The patient was treated under general anesthesia and made a full recovery post-operatively.

A novel description of the supporting system of the orbicularis oculi muscle in the infraorbital area: Tear trough muscle fiber.

The aim of this study was to elucidate the anatomical structures of supporting system of the infraorbital area. Forty-four hemifaces from eleven Korean and eleven Thai cadavers were used to dissect the infraorbital area. Based on the dissection and previous histologic results, they were analyzed. The orbicularis oculi muscle (OOc) had two portions (palpebral and orbital portion) and four subparts (pretarsal, preseptal, prezygomatic, and premaxillary part). The elliptical muscle fiber of OOc was supported by circumferential connective tissue including skin ligament, orbicularis retaining ligament, zygomatic ligament, and zygomatic cutaneous ligament. The vertical muscle fiber, the tear trough muscle fiber, and medial muscular band directly attached to the skin. Full of subcutaneous tissue in the tear trough groove, strong attachment to the bone by tear trough ligament and to the skin by tear trough muscle fiber would multiply result in the tear trough on the face.

Stromal Vascular Fraction Gel (SVF-Gel) Combined with Nanofat for Tear Trough Deformity.

Tear trough deformity makes patients appear tired. Patients with less severe tear trough deformity prefer a less invasive method to correct the deformity. The infraorbital area is a multilayered tissue, and the aging of various components leads to tear trough deformity. To this end, we utilized the different characteristics of different fat derivatives to correct tear trough deformity. Thirty-two patients with Barton Grade I/II tear trough deformity were enrolled in this study between September 2020 and March 2021. We injected Stromal Vascular Fraction Gel (SVF-Gel) into the suborbicularis oculi fat layer and Nanofat into the subcutaneous. After 12 months of follow-up, we evaluated the changes using standardized clinical photogrammetric techniques, volume, global aesthetic improvement scale, and patient self-evaluation. There were no major complications in any of the 32 patients. The measured data points demonstrated improvements in all aesthetic parameters. The width of the tear trough and the distance from the pupil to the tear trough improved. The Global Aesthetic Improvement Scale (GAIS) showed a high score (2.45±0.64 points), with patient self-assessment showing satisfactory results. SVF-Gel combined with Nanofat injection can effectively correct tear trough deformities. 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 effect of Salix alba L. bark extract on dark circles in vitro and in vivo.

Dark circles in the infraorbital area are a common cosmetic concern among individuals because they exhibit fatigue and are undesirable across all ages. Of the dark circle etiologies, blood stasis by poor vascular integrity can cause darkening of the lower eyelid skin, which might be alleviated by reduced endothelial permeability. In this study, we investigated the effects of Salix alba bark extract (SABE) on the synthesis of hyaluronic acid (HA) in fibroblasts and vascular integrity protection from inflammatory cytokine. We also performed a clinical trial investigating the effect of SABE on dark circles. To confirm the effect of SABE on HA synthesis in human dermal fibroblasts (HDF), we performed ELISA and real-time PCR. We investigated interaction HDF-secreted substance with vascular integrity, and human dermal microvascular endothelial cells (HMEC-1) were treated with conditioned medium (CM) from HDF treated with or without SABE. Subsequently, we conducted a clinical study on 29 subjects by having them apply SABE containing cream for 8 weeks. SABE treatment increased HA synthesis and regulated HMW-HA related gene expressions in HDF. CM from SABE-treated HDF alleviated endothelial permeability and led to improved vascular integrity in HMEC-1 cells. Treatment with the cream containing 2% SABE for 8 weeks improved the parameters measuring dark circles, skin microcirculation, and elasticity. Our results showed that SABE could protect against dark circles in vitro, and that topical treatment of SABE improved the clinical indexes of dark circles in a clinical study. Therefore, SABE can be used as an active ingredient for improving dark circles.

Filler in the Tear Trough and Lid-Cheek Junction: A Cadaveric Evaluation of Filler Type and Manipulation Technique

Abstract Goals/Purpose The tear trough and lid-cheek junction demonstrate among the earliest and most noticeable signs of aging as a result of thin periorbital skin and loss of volume causing shadowing and darkness of the infraorbital region. Thus, rejuvenation of this area is commonly requested by patients. Soft tissue filler injections are the second most common non-surgical cosmetic procedure performed in the U.S, with over 2.6 million procedures reported in the 2020 Plastic Surgery Statistics Report. As such, there is a high demand for filler injection in the infraorbital area. However, there is currently only one FDA-approved filler for the tear trough, Juvéderm Volbella XC, although many practitioners also use Restylane-L. Interestingly, these two products differ significantly in their rheology (G’, cohesivity, and flexibility), and the Juvéderm Vycross is smooth gel while the Restylane NASHA is particulate. Despite the high demand of filler in the infraorbital area, there remains debate on injection practices and precise anatomical placement leading to several prior cadaveric examinations of the region. We herein aimed to contribute to the anatomic understanding of infraorbital filler injection via a cadaveric study using Juvéderm and Restylane products with different constitutions and manipulation techniques. Methods/Technique Institutional approval for cadaveric study was obtained. Six cadaveric cephalus specimens were used for filler injection and dissection. All fillers were dyed with food coloring. The Juvéderm products Volbella XC (tear trough, red) and Voluma XC (malar, blue) were used together in hemi-faces (Juvéderm pair), and Restylane products Restylane-L (tear trough, purple) and Restylane-LYFT (malar, green) were used together in separate sets of hemi-faces (Restylane pair). All filler injections were performed by the senior author as follows: 0.5 cc of filler was injected into the malar region in the deep fat compartment above the maxilla both medial and lateral to the infraorbital foramen. In the tear trough region, the orbit was protected with the nondominant hand and 0.3 cc of filler injected just superficial to the infraorbital rim. One hemi-face was injected with the original constitution of filler product and the other was injected with filler blended with 0.2 cc of saline. In two cadavers, after injection the hemifaces were massaged and compared to those which remained unmanipulated. All hemi-faces were then dissected from medial to lateral in the subcutaneous plane and between the superficial and deep facial fat compartments by a single author. All photographs and videography were taken by a single author. All hemi-faces were subjectively analyzed by all authors. Results/Complications All cadavers were in excellent condition, and the subcutaneous tissue, superficial fat, and deep fat compartments were dissected in clear planes. Volbella was found on the periosteum of the infraorbital rim and along the orbicularis retaining ligament (ORL) and crossed into the sub-orbicularis oculi fat (SOOF) and the subcutaneous fat while the Restylane-L did not leech into the fat and remained as a distinct mass on the rim and ORL. Voluma was found in the deep medial cheek compartment and crossed into the superficial medial cheek and superficial nasolabial compartments and subcutaneous fat. In contrast, Restylane-LYFT remained mostly within the deep medial cheek compartment without spreading into the superficial fat pads (Figure). Dilutional manipulation by blending with saline and physical manipulation by massaging both increased spread of all products within the anatomical planes. However, Restylane products appeared to remain distinctly within the anatomical planes they were injected in despite the manipulations. Conclusion This cadaveric study was successful in demonstrating the behavior of different hyaluronic acid fillers injected in the infraorbital region. Tear trough and malar region filler injections just above the periosteum resulted in precise anatomical placement along the infraorbital rim/ORL and in the deep medial cheek fat compartment, respectively. The Juvéderm products appeared to spread across anatomical planes more freely than Restylane products. This may be explained by the lower elastic modulus (G’) of the Juvéderm fillers. Manipulation of the filler product including blending and post-injection massage appeared to spread the fillers medially and laterally within the injected anatomical planes compared to unmanipulated filler. Of note, there are limitations to this study including the cadaver model as this does not allow for hydrophilic swelling of the filler nor spread and integration of the products as in live patients. The results of this study provide information about filler products commonly used in the infraorbital region and the effects of manipulation using blending or massage. Confirmation of precise anatomical placement of the fillers and improved knowledge of their behavior in situ through this cadaver study may assist clinical practitioners’ selection of rheological properties of fillers, method of constitution, and manipulation technique depending on patient-specific anatomy.

Effectiveness and Safety of Radiofrequency Thermocoagulation Treatment Guided by Computed Tomography for Infraorbital Neuralgia Following Failed Conservative Treatment: A Retrospective Study.

To evaluate the effectiveness and safety of CT-guided radiofrequency thermocoagulation (RFT) for the treatment of infraorbital neuralgia following the failure of conservative management. This was a single center, retrospective study which included 196 patients between the ages of 37 to 90 years, who suffered from infraorbital neuralgia, and had undergone CT-guided RFT treatment. The medical records of these patients were retrieved between January 7, 2015 and February 5, 2020, and the patients were followed up for 2 years. Follow-up outcomes included Numerical Rating Scale (NRS) scores, dosage of carbamazepine, time to take effect, status of recurrence and side effects. The effective rate was defined as the percentage of patients with postoperative NRS score reduction of >50%. The effective rates were 92.9%, 100%, 100%, 100%, 93.4% and 85.7% onthesame day, week 1, month 1, month 6, year 1 and year 2 after RFT, respectively. After RFT, the postoperative NRS scores and dosage of carbamazepine were significantly reduced than those preoperatively (P < 0.05). The median time to take effect was zero day. Twenty-eight patients with recurrence underwent RFT again and achieved complete pain relief. All patients experienced numbness in the infraorbital nerve innervation area and the numbness scores gradually decreased over time. CT-guided RFT treatment may be an effective and safe technique for pain relief in patients with infraorbital neuralgia following failed results from conservative treatment.

Aesthetic considerations for treating the Middle Eastern patient: Thriving in Diversity international roundtable series.

The Middle East has a significant influence on the global aesthetic market. Within the United States and globally, patients with Middle Eastern heritage have a wide range of ethnic and cultural backgrounds that affect their perceptions of beauty and motivations to seek cosmetic treatment. The aim of this roundtable was to discuss similarities and differences in anatomy and treatment preferences of Middle Eastern patients and explore how these differences may influence aesthetic practices. In support of clinicians who wish to serve a diverse patient population, a 6-part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022. The results of the fourth roundtable in the series, the Middle Eastern Patient, are described here. A discussion of treatment preferences is included, and specific procedural information is provided for commonly treated areas in this population (forehead, infraorbital area, and jawline). Middle Eastern patients have a variety of aesthetic preferences, which are influenced by a wide range of cultural backgrounds, making it difficult to develop general statements about this demographic. There is an unmet need for research into this diverse group of patients to help physicians understand and incorporate their unique needs and desires into clinical practice.

Infraorbital mass long after dermal filler injection: A report of two cases.

Hyaluronic acid fillers have been increasingly used throughout the world in the management of aging skin in the periocular region and other areas. To evaluate very late-term orbital mass formation secondary to Hyaluronic acid filler injection into the inferior eyelid. We report two cases that presented with a subcutaneous palpable mass localized at the right medial lower infraorbital area. Following clinical and radiological examination, surgical excision was required for the differential diagnosis of tumor. After pathologic examination and the finding of a foreign-body granulomatous reaction, both patients recalled that hyaluronic acid filler had once been injected into their lower eyelids approximately 10 years prior. This is consistent with the fact that dermal-filler-related granuloma formation may occur even years later in the differential diagnosis of mass lesions. It is suggested that patients be informed about the possible but rare mass effect in the infraorbital region. Clinicians should also attend to delayed hypersensitivity reactions, since patients may not recall details due to the length of time since injection.