Facial Contour Research Articles

Male-to-female transgenders demonstrated unique perspectives on perceived facial attractiveness and orthognathic surgery need

The esthetic preference and decision concerning undergoing orthognathic surgery in the transgender population have not been reported. The aims of this study were to examine the influence of the sagittal mandibular position on the esthetic perception and perceived surgery need in male-to-female transgenders (MTFTs) compared with male and female laypeople. A questionnaire study was performed by male-to-female transgender, male and female laypeople. Three-dimensional black & white male and female facial images with facial contour angle (FCA) of 3°, 1°, 5°, 9°,13°, 17°, and 21° were shown to the participants. The participants scored the images' perceived facial attractiveness using visual analog scales (VAS) and indicated whether orthognathic surgery was needed. The participants included 85 MTFTs, 85 males, and 85 females. The results revealed that there were significant differences in the VAS scores between the MTFT and male participants. The MTFTs rated the male images with prognathism of 1° and -3°FCA in significantly lower scores compared with the males (P = 0.033, P = 0.010). Female images with prognathism 1°FCA was rated by the MTFTs in significantly lower scores compared with the males (P = 0.041). A significantly higher number of surgery needs was found in the MTFTs compared with the other groups. Gender influences esthetic perception and the decision to undergo orthognathic surgery. MTFTs have a unique perspective on facial esthetics, being more desirous of surgery than males and females. Clinicians should be aware of the ideal expectation in facial esthetics in MTFTs.

Lip prosthesis as a palliative care modality for a head and neck cancer patient—A case report

The present case report describes the prosthetic management following partial loss of free-fibular osteocutaneous flap in an irradiated patient diagnosed with recurrent head and neck cancer. The patient presented with constant drooling of oral fluids due to an anatomically deficient lower lip. Salvage reconstructive surgery was not considered feasible due to past history of recurrence, multiple surgeries and radiotherapy, and financial constraints. An adhesive-retained interim silicone prosthesis was fabricated to alleviate the functional and psychosocial morbidity. The prosthesis served to restore the oro-facial seal to prevent constant drooling of oral fluids. It also aided in providing an excellent aesthetic solution to palliate the psychological suffering experienced by the patient due to lost facial contours.

Tracking Fat Grafts by Magnetic Resonance Imaging: A Comparative Study of Adolescent and Adult Patients with Stable Localized Scleroderma.

The optimal timing of reconstruction for patients with facial localized scleroderma is uncertain. The purpose of this study was to compare the outcomes of autologous fat transplantation in adolescent and adult patients with stable localized scleroderma. Adolescent (age 10-19 years) and adult (age >19 years) patients with no previous surgery were enrolled (n = 10, each group). Preoperative magnetic resonance imaging (MRI), blood tests and dermatological assessments were used for disease activity assessment. All patients underwent autologous fat transplantation for anatomic facial fat restoration with preoperative MRI planning. Preoperative, immediate and one-year postoperative 3D Dixon MRI scans with image registration and fusion techniques were used for fat graft tracking. Patient satisfaction was assessed with a 5-point Likert scale. There was no significant difference in sex, body mass index, disease severity, or volume of injected fat between the two groups (p > 0.05), except for age (p < 0.05). The one-year postoperative fat graft retention rate was not significantly different, with 36.6 ± 2.4% (ranging from 25.3 to 49.3%) in the adolescent group and 32.9 ± 1.7% (ranging from 27.3 to 40.1%) in the adult group (p > 0.05). Surgical outcomes were favorable in all patients, with satisfaction scores of 3.8 ± 0.2 points in the adolescent group and 3.6 ± 0.2 points in the adult group (p > 0.05). In stable localized scleroderma, the initial autologous fat transplantation was equally effective for facial contour deformity improvement, with no significant difference in fat graft retention or satisfaction.

Real-World Study of Definisse Threads for Facial Reshaping in Indian Patients: REDEFINE FACE Study.

In recent years, thread lifting has gained popularity as a less invasive cosmetic surgery. It helps raise and realign sagging tissue. The newest thread type for thread lifting procedure is poly-lactic acid-polycaprolactone (PLCL) Definisse threads (RELIFE S.r.l., Florence, Italy). These are fourth-generation absorbable suspended barbed threads. Their double action involves an immediate elevating impact through mechanical action and, over time, the promotion of histological rejuvenating activity through inducing fibroblasts and the synthesis of elastin, hyaluronic acid, and collagen. The REDEFINE FACE study assessed the effectiveness and tolerance of Definisse threads in a real-world setting for facial reshaping in patients in India. This multicenter, retrospective observational research included patients treated with Definisse threads for face contouring. Three hundred seventeen patients with a mean follow-up of 4.9 months and an average age of 48.6 years participated in the study. All patients underwent thread lifts using either a single or a combination of Definisse thread reshaping techniques. The Global Aesthetic Improvement Scale for Physicians and Subjects (PGAIS and SGAIS) reported improvement instantly following the treatment (mean score- 3.23 and 3.18, respectively). Improvements continued to enhance during the follow-up visits (mean score- 4.09 and 4.03, respectively). Following the procedure, 96% of patients on the PGAIS and SGAIS exhibited enhancement. Most procedure-related side effects were minor and went away on their own in a few days without the need for proactive care. The results of this real-world analysis showed that the latest Definisse threads effectively achieve facial reshaping on patients in India and have both immediate and long-term effects. Treatment was generally well tolerated, and no patient experienced serious adverse events.

A Stage-Wise Residual Attention Generation Adversarial Network for Mandibular Defect Repairing and Reconstruction.

Surgical reconstruction of mandibular defects is a clinical routine manner for the rehabilitation of patients with deformities. The mandible plays a crucial role in maintaining the facial contour and ensuring the speech and mastication functions. The repairing and reconstruction of mandible defects is a significant yet challenging task in oral-maxillofacial surgery. Currently, the mainly available methods are traditional digitalized design methods that suffer from substantial artificial operations, limited applicability and high reconstruction error rates. An automated, precise, and individualized method is imperative for maxillofacial surgeons. In this paper, we propose a Stage-wise Residual Attention Generative Adversarial Network (SRA-GAN) for mandibular defect reconstruction. Specifically, we design a stage-wise residual attention mechanism for generator to enhance the extraction capability of mandibular remote spatial information, making it adaptable to various defects. For the discriminator, we propose a multi-field perceptual network, consisting of two parallel discriminators with different perceptual fields, to reduce the cumulative reconstruction errors. Furthermore, we design a self-encoder perceptual loss function to ensure the correctness of mandibular anatomical structures. The experimental results on a novel custom-built mandibular defect dataset demonstrate that our method has a promising prospect in clinical application, achieving the best Dice Similarity Coefficient (DSC) of 94.238% and 95% Hausdorff Distance (HD95) of 4.787.

Visualization Mapping and Current Trends of Facial Contouring Procedures: A Bibliometric Analysis Based on Web of Science.

Facial contouring procedures become popular in recent years, but there has been no bibliometric analysis focused on this field. Construct visualization maps and analyze the hotspots and current trends in this field using bibliometric analysis. Publications on facial contouring procedures were extracted from the Web of Science Core Collection database from 2003 to 2022. VOSviewer, CiteSpace, and "Bibliometrix" R package were used to analyze data. Seven hundred and twenty-one publications on facial contouring procedures between 2003 and 2022 were included. The United States was the leading country both in publications (206) and citations (3941). Shanghai Jiao Tong University was the institution with the greatest contribution (35 publications with 379 citations). Hu J (17 publications) from China had the most outputs, while the most cited author was Rohrich RJ (321 citations) from the United States. The Journal of Craniofacial Surgery (135 documents) published the most research, and Plastic and Reconstructive Surgery was the most cited journal (2755 citations). The most cited article focused on virtual surgical planning in mandibular reconstruction. Keywords co-occurrence analysis identified five clusters centered on "reconstruction," "augmentation," "reduction malarplasty," "face rejuvenation," and "orthognathic surgery," separately. "Hyaluronic acid," "facial feminization," and "orthognathic surgery" might be related to trend topics. The research on facial contouring procedures is booming. In the past 2 decades, hotspots in this field included: facial defects reconstruction, facial augmentation cosmetology, facial skeletal contour plasty, and facial rejuvenation surgery. The following aspects may be trend frontiers: precision and personalization, combined treatments, transgender facial contour, and facial contour shaping with fat and hyaluronic acid.

Orthosurgical treatment to obtain facial aesthetics

In the present case report, a 24-year-old male underwent a combined surgical and orthodontic treatment to enhance facial aesthetics. The treatment consisted of the use of an Edgewise fixed appliance (0.022 x 0.028-in), and was complemented by a mini Wing osteotomy. The results of the treatment improved facial contours, defining and elongating the submental area, and eliminating the adipose tissue. Orthodontically, the preservation of the canines and molars Class I relationship, and the maintenance of the compensatory projection of the lower incisors were observed. Satisfactory overbite and overjet were achieved, along with a levelled curve of Spee. The combined treatment modalities led to the achievement of functional occlusion and facial aesthetics.

A Prospective Investigation of Patient Satisfaction and Psychosocial Status Following Facial Bone Contouring Surgery using the Face-Q.

The objective of this study was to assess satisfaction and psychosocial status before and after facial bone contouring surgery using the Face-Q. The Face-Q, a multimodular patient-reported outcome (PRO) instrument, comprises independently functioning scales and checklists designed to assess outcomes in facial aesthetic patients. A prospective cohort study was conducted from November 2020 to May 2022. Participants undergoing facial bone contouring surgery (reduction mandibuloplasty and/or malarplasty) were asked to complete the Face-Q preoperatively and 12months postoperatively. Comparative analyses were conducted using normative Face-Q data from 534 matched normal individuals. Face-Q scores were evaluated for each domain on a scale of 0 to 100, with higher scores indicating greater satisfaction with appearance or a superior quality of life. A total of 284 patients (274 female and 10 male) completed the Face-Q preoperatively and 12 months postoperatively. Of these, 146 underwent reduction mandibuloplasty, 18 underwent malarplasty, and 120 underwent both procedures. Post-surgery, patients experienced significant improvements in overall appearance, features altered by surgery, and quality of life, excluding the patient-perceived age. Preoperatively, patients demonstrated significantly lower scores compared to normative data, with scores significantly increasing postoperatively to levels representative of the general population. Satisfaction with outcome was significantly correlated with postoperative Face-Q measurements but not preoperatively. Facial bone contouring surgery significantly improves the satisfaction and quality of life in patients with square faces, reaching a level at least equivalent to the normative population. The use of Face-Q should be highlighted in the clinic practice. 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 IMPORTANCE OF THE TOTAL EDENTULOUS PROSTHETIC FIELD MORPHOLOGY IN THE DESIGN OF CONVENTIONAL COMPLETE DENTURES

The complete denture has the role of reproducing the missing dental and maxillary structures: teeth, gums and facial contours, ensuring a harmonious integration with the patient’s remaining features. The main objective of this study aims to evaluate the knowledge of dental students and dentists regarding complete denture. Material and method. The evaluation of the knowledge among students and dentists regarding the prosthetics of the complete edentulism was carried out by the questionnaire method. The study was attended by students of the Faculty of Dental Medicine of the University of Medicine and Pharmacy, Craiova and dentists, from the urban environment. Results. Regarding the sources of information, 26% of the participants mentioned that the main source of information was represented by specialized books, 86% of the participants believed that the patient’s general state of health influences the morphology of the total edentulous prosthetic field. 74 of the participants stated that the installation of the “suction cup” phenomenon between the mucosal face of the prosthesis and the fully edentulous prosthetic field is the main factor for achieving the suction of the complete denture. 44% of the respondents considered that the main factor contributing to the stability of a complete denture is the anatomical retentiveness Conclusions. The complete denture plays an essential role in the restoration of the dento-maxillary system by ensuring the morphological and functional rehabilitation of totally edentulous arches.

A New Peptide Skin-Brightening Facial Cream Demonstrated Clinical Improvement in Jawline Sagging, Discoloration and Overall Photodamage

Besides fine lines and wrinkles, chronological aging leads to discoloration, age spots, and more importantly, sagging and loss of elasticity on facial skin. There are ample consumer needs to reduce age spots and skin sagging with an increasing desire for effective topical solutions that can provide meaningful benefits in these areas. A new microdipeptide (acetyl dipeptide) technology was developed that demonstrated the potential to reduce skin inflammation and stimulate the skin’s supporting matrix. This clinical study was designed to test the effectiveness of a facial cream with a unique blend of microdipeptide technology along with brightening and firming ingredients to reduce the key signs of facial aging with twice daily use. The 16-week study included 43 healthy female subjects, ages 40-70 with diverse skin tones, and having mild to moderate jawline sagging with fine lines and/or hyperpigmentation by expert visual grading (3 to 6 on a 0 to 9 scale). Visual grading exhibited statistically significant reduction in all targeted skin aging signs starting at week 8, and continuing improvement to week 16, including jawline sagging (19%), laxity (19%), lift/ firmness (15%), as well as improved evenness of skin tone (16%), hyperpigmentation (14%) and overall photodamage (23%) (mean percent change, p&lt; 0.05). Consumer perception questionnaires also revealed improvement after 16 weeks of use with tighter/tauter jawlines (88%), increased firmness (93%), skin elasticity (93%), refined facial contour (88%), less sagging (95%), and more lifted (91%) and volumized appearance (98%). Furthermore, subjects also indicated brighter skin (95%), increased radiance (93%), less discoloration (86%), fading dark spots (77%), reduced fine lines (93%) and wrinkles (95%), skin looks younger (95%), and overall less noticeable aging signs (95%). Clinical photography supported both the clinical grading and consumer perception of benefits. In addition, these clinical outcomes are further supported by in vitro and ex vivo investigations showing the microdipeptide activity on inhibiting the expression of inflammatory cytokines and inducing multiple matrix building biomarkers, beyond elastin, pro-collagen and hyaluronic acid to include decorin and fibronectin. Gene expression profiling showed changes associated with skin barrier and extracellular matrix organizations, therefore mimicking a younger-looking skin. These results demonstrated that this peptide facial cream was well-tolerated and effective in improving jawline sagging, facial skin firmness, skin brightening, and reducing the overall signs of aging.

What Are the Factors That Enable Thread Lifting to Last Longer?

Thread-lifting traditionally addressed aging-related skin laxity by leveraging precise thread placement and traction. However, recent advancements, notably cog threads, expanded its application to younger patients seeking facial contour refinement. These newer threads effectively lift sagging areas and refine facial contours, broadening the procedure’s appeal. Challenges arise in selecting threads due to variable physician preferences and patient needs. Clear indications for thread efficacy are vital for credibility and tailored selection. Thread choice depends on tissue laxity, necessitating lighter threads for minimal laxity and stronger ones for significant sagging. However, no single thread universally suits all cases. Combining different threads is favored for optimal outcomes and minimizing side effects. Excessive traction post-procedure may lead to prolonged discomfort and skin irregularities. Post-procedural tension adjustments through massage remain debated, potentially conflicting with minimally invasive principles. Understanding thread characteristics guides tailored selection, considering patient conditions and procedural goals. This comprehensive understanding extends beyond specific products, aiming for optimal outcomes in thread-lifting procedures. Key factors influencing outcomes encompass thread materials, thickness, cog shapes, insertion depth, lifting vectors, and absorbable thread expiration dates.

Autologous Fat Transfer in Craniofacial Surgery

Over the past two decades, autologous fat transfer has garnered significant recognition and widespread adoption within esthetic and reconstructive surgical domains. In craniofacial surgery, fat transplantation is frequently employed to address soft tissue volumetric deficiencies and asymmetries that influence facial contours. While adipose tissue (AT) is widely regarded as an optimal choice for augmentation due to its abundant availability and biocompatibility, the unpredictability and heightened resorption rates observed with traditional lipofilling techniques present a challenge for clinicians. Adipose-derived stem cells (ASCs) housed within the grafted tissue play a pivotal role in graft survival and offer avenues for tissue repair due to their angiogenic, anti-inflammatory, and immunosuppressive properties. Micro Fragmentation of Adipose Tissue (MFAT), utilized in several FDA-approved processing devices, has demonstrated promising outcomes in treating osteoarthritic joints, with success primarily attributed to enhanced paracrine function of ASCs via preservation of the perivascular niche. Currently, its application for treating bone or articular defects in the craniofacial region, including abnormalities of the temporomandibular joint, remains limited. This scarcity underscores the need for further investigation prior to its widespread integration into clinical practice.

Combining Liposuction and Thread-Lifting for Middle-Lower Facial Rejuvenation.

Thread-lifting (TL) is a minimally-invasive technique for facial rejuvenation, whereas liposuction is commonly used for facial contouring. This retrospective cohort study aims to introduce and evaluate a novel technique that combines liposuction and thread-lifting for mid-lower facial rejuvenation. Consecutive patients who underwent TL for mid-lower facial rejuvenation from May 2016 to May 2021 were divided into thread-lifting group (TL group) or thread-lifting plus liposuction group (TLL group) according to whether liposuction was performed adjunctively. The co-primary outcomes were the changes between the preoperative and 6-month postoperative Wrinkle Severity Rating Scale (WSRS) and Facial Aging Evaluation Scale (FAES). A total of 185 patients (184 females) with an average age of 34.5±5.5 years were included. There were no significant differences in patients' age, number of threads, and preoperative WSRS and FAES between the two groups. The TLL group (n = 128) had significantly lower postoperative WSRS (1.5±0.6 vs. 1.8±0.8, p<0.001) and FAES (2.5±1.4 vs. 3.8±2.1, p<0.001) than the TL group (n = 57). The decrease in WSRS (0.8±0.6 vs. 0.2±0.7, p<0.001) and FAES (2.7±1.3 vs. 1.6±1.6, p<0.001) were greater in the TLL group. Only 3.8% patients experienced slight side effects and totally recovered. The combination of TL and liposuction is an effective and safe technique for simultaneous contour improvement and facial rejuvenation in middle-aged East Asian females. 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 https://www.springer.com/00266 .

East Asia Superciliary Arch Augmentation With Silicone Implant.

A flat superciliary arch is relatively common in East Asian women. Superciliary arch augmentation aims to increase the facial three-dimensionality of the upper face. However, there are few reports in the literature specifically introducing the surgery. In this study, the authors present the clinical outcomes after a series of superciliary arch augmentation with silicone implants. From May 2020 to December 2022, 54 patients underwent superciliary arch augmentation with silicone implants. Silicone implants generally have a length of 50 to 60 mm, a width of 13 to 14 mm, and an arc of 170 degrees. The thickness was 2 to 7 mm. The implant was placed subperiosteal at the lower edges of the eyebrows through a 7 mm incision below the brow tail. All patients evaluated the outcome according to the Global Esthetic Improvement Scale. Four plastic surgeons evaluated postsurgery results with a 5-point Likert Scale (5 = excellent, 4 = good, 3 = fair, 2 = no change, and 1 = worse). Fifty-four patients were successfully enrolled. The mean follow-up period was 12.02 ± 3.38 months. The mean thickness was 4.55 ± 0.67 mm for the thickest part of the implant. The minor complication rate was 44.44%. They all subsided within 1 month without treatment. Patients' outcome ratings were 4.45 ± 0.55 (3 mo), 4.51 ± 0.48 (6 mo), and 4.51 ± 0.45 (1 y). The surgeons' outcome scoring was 4.49 ± 0.31. Superciliary arch augmentation with silicone implants is a quite simple, effective, inexpensive, and safe strategy to improve the three-dimensionality and contour of the upper face in East Asians.

What are filling (volumizing) threads?

Facial aging prompts a shift in the demands for lifting procedures, transitioning from targeted improvements in younger individuals to overall facial contour enhancements as skin elasticity declines in later years. This paper examines the evolution of PDO volumizing threads, delineating their development from initial limitations to contemporary innovations aimed at addressing tissue deformation and maintaining thread integrity post-insertion. Categorizing these threads based on elasticity, shape, and functionality underscores their versatility and application nuances, catering to specific wrinkle correction, contour sculpting, and facial volume restoration. The discussion emphasizes the pivotal role of thread characteristics in achieving optimal outcomes while minimizing potential complications. By delving into historical contexts, mechanisms, effectiveness, and thread classification, this paper equips practitioners with a comprehensive understanding to make informed decisions in selecting threads for volumizing thread procedures. Recommendations for future research directions, including long-term safety assessments and patient-specific outcomes, seek to enhance the clinical utility and applicability of this analysis.

Microstructural and micromechanical characteristics of composite osteoconductive coatings deposited by the atmospheric pressure plasma technique.

Long-term placement of facial implants requires avoiding the formation of fibrous tissue capsules around the artificial material by creating osteoconductive properties of the surface. Most promising approach is the deposition coatings made of materials very similar to bone mineral components, that is, calcium phosphates such as hydroxyapatite (HAp). As part of the research work, an innovative, cost-effective atmospheric pressure plasma deposition (APPD) system was used as a low-temperature coating technology for generating the HAp coatings deposition. Full microstructural characterisation of the coatings using SEM and TEM techniques was carried out in the work. It has been shown that the fully crystalline HAp powder undergoes a transformation during the coatings deposition and the material had a quasi-sintered structure after deposition. The crystalline phase content increased at the coating/substrate interface, while the surface of the HAp was amorphous. This is a very beneficial phenomenon due to the process of bioresorption. The amorphous phase undergoes much faster biodegradation than the crystalline one. In order to increase the bioactivity of the HAp, Zn particles were introduced on the surface of the coating. The TEM microstructural analysis in conjunction with the qualitative analysis of the EDS chemical composition showed that the binding of the Zn particles within the HAp matrix had diffusive character, which is very favourable from the point of view of the quality of the adhesion and the bioactivity of the coating. In the case of such a complex structure and due to its very porous nature, micromechanical analysis was carried out in situ in SEM, that is, by microhardness measurements of both the HAp matrix and the Zn particle. It was shown that the average value of HAp microhardness was 4.395GPa ± 0.08, while the average value of Zn microhardness was 1.142GPa ± 0.02.

Application of 3D printed titanium mesh and digital guide plate in the repair of mandibular defects using double-layer folded fibula combined with simultaneous implantation.

Fibula transplantation plays an irreplaceable role in restoring the function and morphology of the defected mandible. However, the complex load-bearing environment of the mandible makes it urgent to accurately reconstruct the mandible, ensure the position of the condyle after surgery, and restore the patient's occlusal function and contour. The intervention of digital design and three-dimensional (3D) printed titanium mesh provides a more efficient method and idea to solve this problem. Digital design guides the accurate positioning, osteotomy, and simultaneous implant placement during surgery, and 3D printed titanium mesh ensures stable condyle position after surgery, restoring good mandibular function. The double-layer folded fibula maintains the vertical height of the mandible and a good facial contour, and simultaneous implant placement can establish a good occlusal relationship. This study conducted a retrospective analysis of five patients with jaw defects who underwent digital fibula reconstruction over the past 3years. It was found that the surgical protocol combining digital design, 3D printed intraoperative guides, 3D printed titanium mesh, free fibula flap, immediate implant, and occlusal reconstruction to repair jaw defects had more ideal facial appearance and biological function. It will provide a more reliable surgical protocol for clinical management of large mandibular defects.

Face De-Identification Using Convolutional Neural Network (CNN) Models for Visual-Copy Detection

The proliferation of media-sharing platforms has led to issues with illegally edited content and the distribution of pornography. To protect personal information, de-identification technologies are being developed to prevent facial identification. Existing de-identification methods directly alter the pixel values in the face region, leading to reduced feature representation and identification accuracy. This study aims to develop a method that minimizes the possibility of personal identification while effectively preserving important features for image- and video-copy-detection tasks, proposing a new deep-learning-based de-identification approach that surpasses traditional pixel-based alteration methods. We introduce two de-identification models using different approaches: one emphasizing the contours of the original face through feature inversion and the other generating a blurred version of the face using D2GAN (Dual Discriminator Generative Adversarial Network). Both models were evaluated on their performance in image- and video-copy-detection tasks before and after de-identification, demonstrating effective feature preservation. This research presents new possibilities for personal-information protection and digital-content security, contributing to digital-rights management and law enforcement.

Surgical management of severe cherubism persisting into early adulthood: a case report and literature review.

Cherubism is a rare fibro-osseous condition characterized by bilateral expansion of the mandible and maxilla. Due to its rarity, treatment guidelines for cherubism have not been clearly established. Observation without surgical intervention is typically recommended, as cherubism often regresses spontaneously after puberty. However, a surgical intervention may be necessary if aggressive lesions lead to severe complications. In this report, we present a case involving surgical management of cherubism that did not spontaneously regress until early adulthood. An 18-year-old man was diagnosed with cherubism, presenting characteristic upward-looking eyes and a swollen face. He strongly desired surgical management. Gross contouring of the mandible was performed using an osteotome. Subsequently, delicate contouring was performed by bone burring and curettage. The remaining multiple locular bony defects were filled with demineralized bone matrix. No major complications, including infection and hematoma, occurred during the 8-month follow-up period. The facial contour remained stable without the aggravation of cherubism. The patient was satisfied with the cosmetic results. Considering that cherubism is a rare disease globally, with few reported cases in Korea, and that treatment guidelines are not clearly established, we anticipate that the results of this case will contribute to the development of future protocols for treating cherubism.

Sonographic observation of the paradoxical masseteric bulging and clinical implication of functional compartment.

Masseter are commonly botulinum neurotoxin targeted muscle for facial contouring in aesthetic field. However, paradoxical masseteric bulging is common adverse effect that has not been discussed with ultrasonographic observations. Retrospective study has been conducted from October, 2021 to January, 2023, out of 324 patients have done blinded botulinum neurotoxin injection in the masseter at the middle and lower portion of the masseter with each side of 25 units (letibotulinum neurotoxin type A), 3 patients demonstrated paradoxical masseteric bulging has been reported and the image observed by ultrasonography by physician. Based on the observations made, we can infer that the function of the moving muscle involves twisting of the muscle fibers during contraction, along with the twisting of the deep inferior tendon, which causes the muscle to be divided into anterior and posterior compartments rather than into superficial and deep compartments of masseter. In ultrasonographic observe the skin surface of a patient with paradoxical masseteric bulging, it is observable that either the anterior or posterior part contracts significantly. The functional units of anterior and posterior compartment are observable as muscular contraction of inward movement of the muscle from either the anterior or posterior functional unit.