Nasolabial Groove Research Articles

Metachronous Basal Cell Carcinoma and Primary Plasmacytic Leukemia Associated With Dermatomyositis

Dermatomyositis is associated with cancer frequently. However, successive occurrence of two malignancies in one person is rare. In this article, we present a 71-year-old female patient who was diagnosed as dermatomyositis based on skin lesions, muscle weakness, elevated muscle enzymes, electromyography, and muscle biopsy. Two years later, the patient had an ulcer on the left nasolabial groove. A resection was performed after basal cell carcinoma was confirmed by tissue biopsy. Two years after resection, serum M protein, urinary l light chain, and neoplastic plasma cells infiltration in bone marrow biopsy of the patient were evaluated. Findings were compatible with the plasmacytic leukemia. Dermatomyositis patients may suffer from multiple tumors due to carcinogenic susceptibility. Therefore, physicians should continue to monitor dermatomyositis patients after the occurrence of the first tumor since they still have the possibility of developing another malignancy.

Variación intraespecífica en Cryptotis aroensis (Mammalia, Soricomorpha, Soricidae) de Venezuela

Introduction: In Venezuela, the genus Cryptotis Pomel 1848 is represented by four species: C . meridensis Thomas 1898, C . tamensis Woodman 2002, C . aroensis Quiroga-Carmona and Molinari 2012; and C . venezuelensis Quiroga-Carmona 2013 (Quiroga-Carmona and Molinari 2012; Quiroga-Carmona 2013). C . meridensis , and C . tamensis have been documented in the Andes (Cordillera de Merida, El Tama, and Sierra de Perija). On the other hand, C . aroensis , and C . venezuelensis are recorded only in the Cordillera de la Costa (Sierra de Aroa, and Serrania del Litoral). Cryptotis aroensis , was recently described and is known from only three specimens from type locality (Sector Milla, Sierra de Aroa, Yaracuy State), in Northern Venezuela. Based on a new series (45 specimens) from Yurubi National Park, Sierra de Aroa, Yaracuy State, Venezuela, in this article, we evaluated the intraspecifi c variations of Cryptotis aroensis , previously unknown in the literature. Metodology: Specimens studied are preserved in the Museo de la Estacion Biologica de Rancho Grande (EBRG, Aragua State, Venezuela), and the Museo de Zoologia, Universidad de Carabobo (MZUC, Carabobo, State, Venezuela). External measurements (mm) and weight (g) were taken from the colector’s tag. Craniodental terminology follows Woodman (2002, 2003), Quiroga-Carmona and Molinari (2012), and Woodman et al . (2013), and the craniodental measurements were taken with a digital caliper. Finally, for each measure, mean and range were calculated and we used a Student t test with intervals confi dence not less than 95% to explore differences related to sex. Results: Our morphological and metric analysis indicates that specimens of Cryptotis aroensis from Yurubi National Park are smaller and with longer tails, compared with C . meridensis , C. tamensis and C. venezuelensis . There were no signifi cant differences between sexes for the individuals studied, suggesting that there is no sexual dimorphism in C . aroensis . Within this sample there were highly variable morphological characters such as the shape of the wart on the nasolabial groove in the rhinarium, numbers of postnasal warts on the muzzle, hindlimb digits, presence and position of the fourth unicuspid tooth, presence and size of dorsal foramina on the skull, presence and size of foramina on posterior border of tympanic process of petromastoids. The humerus was slightly smaller, less robust and slightly curved in C . aroensis compared with one humerus available for C . meridensis . Discussion: The high intraspecifi c variation in C . aroensis is consistent with previous reports that indicates a high morphological and metric variation among individuals in the groups Cryptotis nigrescens (Woodman and Timm 1993), C . goldmani (Woodman and Timm 1999; Woodman 2011), C . thomasi (Woodman 2002), C . mexicana (Ramirez-Pulido et al . 2004), and C . parva (Ramirez-Pulido et al . 2004). With respect to the characters in the original description of C . aroensis (Quiroga-Carmona and Molinari 2012), there are similarities when the sample increases from three (holotype and two paratypes) to 45 specimens. Such characters include body-head length, and length of mandible, besides the presence of cusps on the third upper molar that defi ne a complex molar. Additionally, the result of this study suggests that tail length (extremely long) can be useful to separate C . aroensis of the different taxa in Venezuela. When we compared the type series of C . venezuelensis , a species known only from three specimens from the Cordillera de la Costa, like C . aroensis (Quiroga-Carmona 2013), there are several similarities in morphology and metrics. Those characters include its size and body coloration, presence and visibility of the fourth unicuspid tooth, shape of the wart and its extension on the nasolabial groove in the rhinarium, the numbers of postnasal warts, size and shape of the angular and coronoid processes, and the average of scales per centimeter on the tail. These characters suggest that C . aroensis and C . venezuelensis might be closely related taxa.

The Premaxillary Space: A Location for Filler Injection?

A four-layer fat structure is found in the anterior cheek region. The deepest of these fat layers is the premaxillary fat. To determine whether the premaxillary fat is located in a closed compartment and whether injection of substances affects the appearance of the face. Filler or arterial mass (0.5-0.8 mL) after Thiel were injected, and gross dissections, horizontal and sagittal sections, and three-dimensional reconstructions with computed tomography were performed. The premaxillary fat is located in a semiopen space, the premaxillary space, with mainly bony and muscular borders. The injected substances spread in lateral and superficial located tissues. Injection of substances into this space leads to discrete improvements in the appearance of the nasolabial groove.

Reconstruction of Upper Lip Muscle System by Anatomy, Magnetic Resonance Imaging, and Serial Histological Sections

Surgeons need references to undertake cleft lip repairs. We aimed to establish a three-dimensional model of upper lip muscles. We examined specimens from 2 adult cadaver heads and 8 adult cadaver lips, obtaining serial sections in the axial, sagittal, and coronal planes. Sections were stained to observe the philtrum, Cupid bow, vermilion, and nostril sill. Reconstruction was done with three-dimensional software (eg, 3D-DOCTOR, MicroMR). Parallel circular muscle fibers existed between modioli. The orbicularis oris deep layer contained fan muscle fibers inclining inward. Some ended at the anterior nasal crest. Others migrated to the depressor septum, crossed the midline, and migrated to the nasalis muscle. At the nostril floor, the depressor septum muscle bundle and ipsilateral orbicularis oris overlapped the nasalis muscle and the contralateral orbicularis oris. This construction shaped the nostril sill. The levator labii superioris alaeque nasi, levator labii superioris, and zygomaticus minor crossed the nasolabial groove and migrated to the superficial orbicularis oris, entering the outer edge of the nasal alar to the upper lip near the vermilion border and philtrum ridge, shaping Cupid bow. Contralateral deep orbicularis oris muscle fibers crossed the philtrum dimple to the lateral philtrum ridge (axial plane). Superficial reticular muscle fibers of the levator labii superioris, zygomaticus minor, zygomaticus major, and orbicularis oris inserted into the medial philtrum ridge (coronal plane). They intersected to form the philtrum ridge. A three-dimensional upper lip muscular system model was established that can be referenced for cleft lip repair and lip operations.

Correction of shortened and broaden prolabium deformity with double flag-shaped flaps following bilateral cleft lip repair

To explore the correction for shortened and broaden prolabium deformity following bilateral cleft lip repair. We designed the upper lip double flag-shaped flaps. The quadrilateral original surgical scar (flap flag pole part) was resected and the incision was made along the direction of nasolabial groove at the nostrils bottom to form two flag-shaped flaps (the section of the flag face). Lip tubercle were tracted and blunt dissection of upper philtrum were performed to form a wound, 4-6 mm in width. The flag-shaped flaps on both sides were rotated to the central, in order to form a new nasal base and new prolabium, followed by V-Y or Z plasty procedure to correct the defect of tubercle and vermilion. 10 cases were enrolled for the clinical application from January 2008 to December 2012. The height of the prolabium was lengthened by 4-6 mm after operation, which fundamentally corrected shortened and broaden prolabium deformity after bilateral cleft lip operation. The procedure can also correct the depression or defect of tubercle, too wide philtrum, philtrum column scar and the deformity of vermilion border continuity. The patients were followed up for a period of 3 months to 3 years with satisfactory results. Double flag-shaped flaps of the upper lip at the nostrils bottom is a simple and good surgery method to correct the shortened and broaden prolabium deformity following bilateral cleft lip repair.

Prevalence of lip and perioral Ephelides in beach workers.

BACKGROUNDEphelides are small hyperpigmented macules common in the skin, presenting as areas with increased melanin production. Ephelides are observed in genetically predisposed individuals, particularly fair-skinned people highly susceptible to sunburn. OBJECTIVESThis study aimed to determine the prevalence of lip and perioral ephelides in 362 beach workers in the city of Natal (Rio Grande do Norte) and to investigate potential associations with sociodemographic, occupational and general health. METHODSFor this purpose clinical tests were performed by calibrated examiners in the epidemiological area around the lips and the area bounded laterally by the nasolabial groove and at the bottom by the chin. A questionnaire was completed and assessed. The possible associations between sociodemographic variables, occupational and general health with the presence of lip and perioral ephelides were evaluated by chi-square test for a significance level of 5%. RESULTSApproximately one third of the workers were affected by perioral ephelides (33.7%) and around a quarter of them by lip ephelides (24.0%). Gender was the only variable significantly associated with the presence of perioral ephelides (p = 0.002), unlike lip ephelides which proved to be significantly associated with habits (p = 0.036) and alcoholism (0.030). CONCLUSIONSThe prevalence of ephelides in lip and perioral region was high in the study population, with gender and certain habits associated with its occurrence.

Seasonal and annual variation in the intensity of facial wrinkles

We studied annual, seasonal and gender-dependent changes in the intensity of facial wrinkles. The study included 32 Japanese subjects (16 men, 16 women, aged 35-47). Wrinkles on the forehead, corner of the eye, lower eyelid and nasolabial groove of each subject were captured in photos and in replicas at 3-month intervals from March, 2009 to March, 2010. At each occasion, skin conductance in the stratum corneum and skin color were measured on the cheek. The photos obtained were used for visual scoring of wrinkle intensity, and the quantitative 3-D data of replicas were obtained. An apparent annual variation in skin conductance, which is supposed to be caused by skin dryness, and in the level of skin brightness, which is supposed to be caused by sun tan, was found for both genders. In contrast, no seasonal changes were determined in wrinkle intensity. Three-D analysis revealed no annual variation in women but revealed annual variation in the depths of eye wrinkles in men. There was a gender-dependent difference in the annual variation of wrinkle depth in subjects around 40years of age. Seasonal environmental changes may affect on the eye wrinkles depth in men within a year.

Angular vessels as a new vascular pedicle of an island nasal chondromucosal flap: Anatomical study and clinical application

Successful eyelid reconstructions have been reported when using an axial nasal chondromucosal flap based on the dorsal nasal artery. The present study aimed to present a detailed anatomical description of the blood supply of the lateral nasal region and the angular artery, in order to propose the angular vessels as a new vascular pedicle for the island nasal chondromucosal flap. A total of 11 cadavers (22 hemi-faces) were examined. Observations with regard to the origin, course and distribution patterns of the angular artery were recorded. Based on the anatomical study findings, the angular vessels were proposed as a vascular source for the island nasal chondromucosal flap. Observations with regard to the varying origins of the angular artery were categorized into four types. The course of the angular artery along the nasojugal fold was constant. The angular artery branched off into the upper two-thirds of the lateral nasal region and anastomosed with the other vascular branches on the nasal dorsum. Clinically, reconstruction of a full-thickness defect of the lower eyelid was successfully performed by using this composite flap based on the angular vessels and an adjacent orbicularis oculi myocutaneous flap. Satisfactory esthetic outcomes were obtained for the donor and recipient sites. The angular artery is a good vascular source for an island nasal chondromucosal flap. The flap may be created safely and successfully in clinic. Island nasal chondromucosal flaps and nasolabial groove skin flaps based on the angular vessels may be designed simultaneously for use on full-thickness defects of the eyelid.

Gonadotropin-Releasing Hormone Modulates Vomeronasal Neuron Response to Male Salamander Pheromone

Electrophysiological studies have shown that gonadotropin-releasing hormone (GnRH) modifies chemosensory neurons responses to odors. We have previously demonstrated that male Plethodon shermani pheromone stimulates vomeronasal neurons in the female conspecific. In the present study we used agmatine uptake as a relative measure of the effects of GnRH on this pheromone-induced neural activation of vomeronasal neurons. Whole male pheromone extract containing 3 millimolar agmatine with or without 10 micromolar GnRH was applied to the nasolabial groove of female salamanders for 45 minutes. Immunocytochemical procedures were conducted to visualize and quantify relative agmatine uptake as measured by labeling density of activated vomeronasal neurons. The relative number of labeled neurons did not differ between the two groups: pheromone alone or pheromone-GnRH. However, vomeronasal neurons exposed to pheromone-GnRH collectively demonstrated higher labeling intensity, as a percentage above background (75%) as compared with neurons exposed to pheromone alone (63%, P < 0.018). Since the labeling intensity of agmatine within neurons signifies the relative activity levels of the neurons, these results suggest that GnRH increases the response of female vomeronasal neurons to male pheromone.

Trigeminal neuralgia surgical treatment using LASER

Trigeminal neuralgia is an extremely painful and difficult condition to treat. Adding LASER is an edge cutting techonology which might help stop drugs and thereby the adverse effects. To describe the experience of using LASER in a patient with trigeminal neuralgia For NEUTECTOMY. A 47-year-old man presented with constant, severe pain in the right side of his face over the nasolabial groove for more than 11 months. The pain had been progressively worse and was usually precipitated by brushing his teeth, shaving, washing his face, eating, and talking. The patient's neurologist treated him with 150 mg/d of carbamazepine; when the pain improved, the dosage was reduced. However, the pain worsened in two months and he was prescribed 1500 mg of oxcarbazepine three times daily. It did not relieve the pain, which had become constant with the severity higher than 10 on a scale of 1-10. The patient was treated with LASER. Relief of neuralgia. The patient's pain level during the 1st day of treatment dropped from 10/10 to 0. On his 2nd visit. The patient continued to improve and could eat and speak without pain. This case report describes a patient who responded well by the use of LASER.

Lipofilling With Minimal Access Cranial Suspension Lifting for Enhanced Rejuvenation

Loss of volume is an important aspect in facial aging, but its relevance is frequently neglected during treatment. The authors discuss lipofilling as an ancillary procedure to improve the impact of facelifting procedures. Fifty patients who underwent minimal access cranial suspension (MACS) lifting alone were retrospectively analyzed, and their results were compared to 42 retrospective cases of MACS lifting with adjuvant lipofilling. The results were evaluated with a photographic ranking system by two panels (five plastic surgeons and five medical students). Combined MACS lifting and lipofilling yielded overall cosmetic results that were significantly better than the results achieved with MACS lifting alone. Photographic evaluations showed that improvements were more pronounced in the tear trough (P < .05) and malar eminence (P < .01) than in the nasolabial groove (P > .05). Volume restoration with lipofilling following MACS lifting procedures produces significantly better postoperative results than MACS lifting alone. This combined procedure produces the most dramatic improvements in the tear trough and malar eminence regions.

Cisto Nasolabial: revisão da literatura e relato de caso clínico

The nasolabial cyst is a rare developmental cyst, non-odontogenic, whose development occur in the lower region of the nasal wing, with pathogenesis rare still uncertain. These cysts are often asymptomatic, promoting the elevation of the nose wing and deletion of nasolabial groove. The objective of this work is to carry a through literature revision on the subject and present a case of nasolabial cyst of a patient of 43 years of gender masculine attended in the Clinic of the Specialization in Surgery and Bucomaxilofacial Traumatology of PUC Minas.

Midfacial degloving approach to myxoid type nodular fasciitis of the maxilla in a 16-month-old female

Nodular fasciitis is a rare, benign tumor of mesenchymal fibroblasts arising from the deep fascia or bony periostium and presents as a mass in the subcutaneous tissues. Due to its rapid growth, it may mimic a malignant lesion. In children, the myxoid type of nodular fasciitis (also termed infiltrative fasciitis, pseudosarcomatous fasciitis, or pseudosarcomatous fibromatosis) is most common with involvement of the head and neck. To date, four cases of nodular fasciitis specifically involving the maxilla have been reported, only one of which includes a description of the surgical approach. This case report describes a 16-month-old female with nodular fasciitis of the nasolabial groove arising from the maxilla. The objective is to discuss and illustrate the imaging appearance of this rare maxillary location of myxoid fasciitis and to describe the successful resection of the mass utilizing the midfacial degloving approach.

Jacques-Louis David and his post-traumatic facial pathology

Jacques-Louis David is regarded as one of France's most recognized painters, who's most famous work—the Death of Marat (1793)—has been subject to medical review, as it was well-known that Marat suffered from an exasperating chronic skin condition.1 It is interesting to note, however, that David's life-story and self-portrait also reveal an underlying pathology, that to date has not received attention in the medical literature. In his youth, David suffered from a deep left peri-oral sword wound after a fencing incident, whereupon he subsequently lost his left nasolabial groove while his left cheek gradually swelled.2 As a result, he found it difficult to make left-sided facial movements, particularly those around his left mouth, which led to a noticeable asymmetry during facial expression. Furthermore, eating or speaking in public became strenuous, which, when added to a longstanding speech impediment whereby he could not pronounce some consonants (such as ‘r’), made him highly and understandably self-conscious. Biographers and art historians over the centuries have defined this post-traumatic pathology as a ‘benign tumour’ or ‘exostosis’.2 Looking at David's self-portrait (Figure 1A), it becomes clear that a discernible scar representing the rapier wound is visible at the left labiomarginal sulcus (painted on the right side in the image as it was based on a mirror's reflection), extending for a short distance laterally into the midface. Anatomically, this corresponds to a path taken by some of the buccal branches of the facial nerve, which have an inconstant origin and variable course from the parotid gland, passing horizontally to a distribution below the orbit, to the nose and mouth. Those branches ending close to the labiomarginal sulcus include the deep lower branches that supply buccinator, orbicularis oris and joint filaments of the buccal branch of the mandibular nerve.3 Furthermore, in view of some of the complex routes taken by the buccal branches of the facial nerve, a number of the divisions that supply the lip elevators and small nasal muscles may also correspond to this area of trauma. This therefore could explain David's facial affliction as a result of a likely injury to the buccal branch of the facial nerve, resulting in the difficulties with left facial movement and the associated loss of the left nasolabial groove. Other differentials include facial asymmetry as a result of a lesion centrally or more proximally in the course of the facial nerve. Figure 1 A: Self-portrait by Jacques-Louis David (painted from a mirror reflection), 1794 (81 × 64 cm). B: Sculpture of Jacques-Louis David by Francois Rude, 1831 (26 × 39 × 21 cm); Musee du Louvre, Paris The subsequent description of a facial ‘growth’ following traumatic injury may therefore be ascribable to recognized complications of midface soft tissue injury, which could include either a post-traumatic rapier wound, a foreign body granuloma,4 or even a post-traumatic neuroma.5 These could have caused the artist significant anxiety regarding self-image, and thus (being a shrewd propagandist), he is reputed to have diminished the extent of his disfigurement from his own self-portrait. This only becomes conspicuously evident when one studies sculptures of Jacques-Louis David produced during his lifetime by other artists, who would have probably presented his facial characteristics with more objectivity (Figure 1B).

Comparison of age-related changes in facial wrinkles and sagging in the skin of Japanese, Chinese and Thai women

Differences in skin aging features between Asians and Caucasians are commonly known, whereas little is known about such differences in various Asian populations. A survey was carried out in Tokyo, Shanghai and Bangkok to identify specific features of skin aging in each population and to evaluate whether our conventional photo scale is an appropriate tool for this type of comparative study. Eighty-seven women residing in Tokyo, 100 women residing in Shanghai, and 90 women residing in Bangkok were examined by a specialist. Facial wrinkles (forehead, glabella, upper eyelid, crow's feet, lower eyelid, cheek, nasolabial groove and mouth corner) and cheek sagging were evaluated using photo scales previously obtained from Japanese subjects. Comparisons were made according to 10-year age groups. Women in Bangkok showed the most severe level of wrinkles, followed by those in Shanghai in the three groups. Significant differences were observed between Thai and Japanese women in the intensity of wrinkles at many facial sites. Chinese women had significantly more severe wrinkles in the area around the eyes compared to Japanese women, while Thai women had significantly more severe wrinkles in the lower halves of their faces compared to Chinese women. In cheek sagging scores, significant differences were observed between Japanese and Thai women in their 30s and 50s, but not between Japanese and Chinese women or between Chinese and Thai women in all age groups. These results indicate variations in skin aging features among women from three Asian cities thereby suggesting the diversity of Asian skin. Our scaling method proved to be appropriate for facial wrinkles, but required modification to compare cheek sagging among Asian populations.

Comparison of age‐related changes in wrinkling and sagging of the skin in Caucasian females and in Japanese females

We compared age-related changes in wrinkles in eight areas of facial skin (forehead, glabella, upper eyelid, corner of the eye, lower eyelid, nasolabial groove, cheek, and corner of the mouth) and sagging in the subzygomatic area of Caucasian females and of Japanese females. The subjects studied included 85 healthy Caucasian females (ages 20-69 years) living in Cincinnati in the U.S. and 70 Japanese females (ages 20-69 years) living in Tokyo. Photos of the face in frontal and in oblique 45 degrees views were analyzed. Wrinkles in the face and sagging in the subzygomatic area were graded on Japanese photoscales, respectively, by the same experienced observer. The wrinkle score increased with age in all eight areas of the face examined in Caucasian females as well as in Japanese females. In the group aged 20-29 years, the wrinkle score in each area was significantly higher in Caucasian females than in Japanese females. The wrinkle scores in the forehead, glabella, upper eyelid, and corner of the eye were similar at advanced ages between the two groups, while the wrinkle scores in lower areas of the face (lower eyelid, nasolabial groove, cheek, and corner of the mouth) were markedly higher in Caucasian females than in Japanese females in each age group, and reached an upper limit at advanced ages in Caucasian females. The sagging score also increased with age in Caucasian females as well as in Japanese females. The sagging score was significantly higher in Caucasian females than in Japanese females in the groups aged 40 years or more. These results suggest more marked wrinkle formation in all areas of the face in younger age groups of Caucasian females living in North America than in Japanese females living in Tokyo. In particular, Caucasian females showed marked age-related wrinkle formation in the lower areas of the face, probably due to sagging in the subzygomatic area, which suggests a higher susceptibility to sagging in the subzygomatic area of Caucasian females.

Spastic paretic hemifacial contracture (SPHC) in a patient with multiple sclerosis. A clinical, EMG and neuroimaging study

We present the case of a 42-year-old woman with a 4-year history of definite multiple sclerosis (MS) and sustained contracture of the left hemiface with marked left deviation of the nose, deepened left nasolabial groove, narrowed palpebral fissure and weakness of the contracting muscles. Needle electromyography showed continuous resting activity of irregularly firing motor unit potentials (MUP) in the left orbicularis oculi (OO) and orbicularis oris, but not in the left frontalis. Simultaneous recording of maximal voluntary contraction of the OO on both sides showed marked preponderance on the right. Blink reflex findings were consistent with an injury in the pons, mainly in the vicinity of the left facial nucleus. A magnetic resonance imaging study showed multiple supra- and infra-tentorial white matter lesions, as well as multiple lesions at the level of the pons. Complete recovery was observed after 3 months. This condition has been described in cases of brainstem tumor as spastic paretic hemifacial contracture (SPHC). Up to now SPHC has not been explicitly associated with MS and, in this case, it could be arguably attributed to hyperexcitability of the facial neurons due to demyelination of the corticofacial fibers.

Minimal access cranial suspension lift: a modified S-lift.

There is a strong trend at hand toward less dramatic facial rejuvenation surgery. Most of the authors' patients want a cosmetic improvement but not at the cost of prolonged disfigurement or a high risk of complications. In 1999, a very simple but effective rhytidectomy technique, termed an S-lift, was described in the literature and was adopted by the authors. Its basic principle is the suspension of sagging facial features by a strong, permanent purse-string suture. The procedure is performed with the patient under local anesthesia. Significant modifications were applied to the incision, to the purse-string suture anchoring site, and to the direction and shape of the skin excision. The authors named the modified procedure the minimal access cranial suspension lift to specifically describe the concept of the technique. Through an inverted L-shaped preauricular incision with extension below the sideburn, a limited skin undermining is performed. Two strong, permanent purse-string sutures are woven into the superficial musculoaponeurotic system tissues in a vertical U and an oblique O shape, initiating from a strong anchorage in the deep temporal fascia at the level of the helical crus. Tying these sutures produces a very powerful vertical correction of descended facial features that acts mainly on the jowls and the upper neck. The procedure can be extended by continuing the dissection over the malar fat pad, placing a third vertical purse-string suture with strong action on the nasolabial groove, and vertically repositioning the midfacial volumes. During 20 months, pleasing results and a very low complication rate were obtained in 88 consecutive patients with a mean age of 551/2 years. In this article, the authors provide a detailed description of the anesthetic and surgical technique, a demonstration of the results in different patient age categories, and a discussion comparing the minimal access cranial suspension lift with other types of facial rejuvenation procedures.

Use of bilateral retroangular flaps for reconstruction of the glabella and nose

We report the use of bilateral retroangular flaps for reconstruction of the glabella and nasal tip following extirpation of a cavernous haemangioma. The vascularity of the flaps was good, and the colour and texture match excellent. Donor-site closure was easy, and the scar in the nasolabial groove was not conspicuous. Our experience demonstrates that this flap is useful for reconstruction of skin defects of not only the nose but also the glabella and forehead. By raising bilateral flaps, a wide skin defect in the centre of the face can be repaired.

Determination of age‐related changes in the morphological structure (sagging) of the human cheek using a photonumeric scale and three‐dimensional surface parameters

The usefulness of the photo standard for evaluating skin sagging in the face, especially in the cheeks, was evaluated. A six-stage photo standard was prepared using photos of women aged 17-83-years-old at three magnification rates (136-188 women in each group). Based on this photo standard, scoring was performed using a six-grade scoring system by two specialists to obtain the consensus score. Scoring was also performed in parallel by five general observers. The degree of agreement between the two scores was evaluated by calculating the Kappa value. In each group, the Kappa value was 0.452-0.563, indicating moderate agreement. Thus, the photo standard may be useful for evaluating sagging. Based on the photo standard, a score of 2, at which sagging becomes detectable appeared at the age of 40 years. In parallel, 3D analysis of replicas around the cheek was performed to morphologically analyse age-related changes in sagging. When the depth parameter was compared between the nasolabial groove and the mouth corners, a higher value was observed in the nasolabial groove until the age of 40 years, but higher values were seen in the mouth corners thereafter. This may have been because sagging in the cheeks descends to the area around the mouth, resulting in reversion in the sWv value. These findings indicated that sagging in the cheeks becomes morphologically distinct in women in their forties.