Periorbital Region Research Articles

Surgeons’ Survey of the Aging Face With a Focus on the Aging Nose

Introduction: The purpose of this study was to evaluate how facial cosmetic surgeons rank different areas of the aging face by comparing those areas for the greatest impact on surgical rejuvenation. It was hypothesized that the nose would be ranked lower than most other areas of the aging face. Materials and Methods: Fifty surveys were included in this study and were completed by surgeons from the following specialties: oral and maxillofacial surgery, oculoplastic surgery, otolaryngology, general surgery, plastic surgery, dermatology, and obstetrics/gynecology. The 12 ranked areas of the face (from 1 to 12) were skin, hair/hairline, brows, periorbital area, nose, ears, cheeks, midface/nasolabial area, dentition, perioral area, lower face/chin/jowls, and neck. Each of these areas of the face was also rated based on the surgeons’ assessment of the level of importance when evaluating and treating the aging face on a 5-level scale, ranging from level 1 (not important) to level 5 (very important). Results: The average rank for the nose was 9.30. The highest average ranking was the periorbital region with 2.74 and the lowest average ranking was the ears at 11.02. The surgeons’ ratings of the nose were 0% for level 1 (not important), 20% for level 2 (slightly important), 30% for level 3 (somewhat important), 26% for level 4 (important), and 16% for level 5 (very important). The average level rating of the nose was 3.413 (somewhat important). In comparison, the highest average rating was for the periorbital region at 4.837 (very important) and the lowest average rating was the ears at 2.957 (somewhat important). Using a significance level of P < .05, the nose is both ranked and rated as less important than 7 out of 11 other areas of the face: the periorbital area, the lower face, the skin, the neck, the midface, the perioral area, and the cheeks. The difference between the ranking and rating of the nose and that of the brows, dentition, hairline, and the ears was not considered significant. Discussion: This study confirmed the hypothesis that when comparing the areas of the aging face that would have the most effect on surgical facial rejuvenation, the nose was ranked lower than most other areas of the face except the ears. The nose undergoes multiple anatomical changes with age that affect both appearance and nasal function. Therefore, the rhinoplasty for the aging nose should not be overlooked as an important contributor to facial rejuvenation and a potential to improve nasal function. Conclusion: The nose is most often considered of lower importance compared with other areas of the face by facial cosmetic surgeons when evaluated for impact on surgical facial rejuvenation.

Facial skin ageing: Key concepts and overview of processes.

IntroductionThe face is a cosmetically sensitive region where the process of ageing is most clearly manifested. With increased focus on anti‐ageing and longevity, more anti‐senescent treatments are being proposed despite limited evidence. This study outlines the pathways and mechanisms underpinning the biological process of ageing in the face.MethodsComprehensive searches of MEDLINE, EMBASE, Cochrane Library and CINAHL from inception to 2020. Inclusion criteria included all empirical human research studies specific to facial ageing features, written in the English language.ResultsA total of 65 papers met inclusion criteria for analysis. Pathways were subdivided into intrinsic and extrinsic senescence mechanisms. Intrinsic pathways included genetics, generation of reactive oxygen species and hormonal changes. Extrinsic pathways included photoageing and damage to skin layers. The combined intrinsic and extrinsic pathway alterations result in wrinkles, higher laxity, slackness and thinning of the skin. Skin functions such as barrier immune function, wound healing, thermoregulation and sensory function are also impaired.ConclusionThe ageing process is unique to the individual and depends on the interplay between an individual's genetics and external environmental factors. Through understanding the molecular and cellular mechanisms, an appreciation of the consequent structural and functional changes can be achieved. Based on this knowledge, further research can focus on how to slow or impede the ageing process and identify specific targets to develop and evolve new treatment strategies.

A Retrospective Study of SVF-gel Compared With Nanofat Combined With High-density Fat in the Treatment of Early Periorbital Aging.

To compare the effectiveness of transplantation with stromal vascular fraction (SVF)-gel or nanofat combined with high-density fat prepared with the Coleman technique (nanofat+high-density fat) to restore volume in the periorbital region or for periorbital rejuvenation in early periorbital aging. This retrospective study included 103 patients who received a transplant of SVF-gel (n = 58) or nanofat+high-density fat (n = 45) to restore volume in the periorbital region (n = 85) or for periorbital rejuvenation (n = 18) in our hospital between January 2016 and January 2020. Patient satisfaction and the reoperation rate were evaluated. All patients had improved periorbital contouring and augmentation. Among the patients that received treatment to restore volume in the periorbital region, 17% and 65.9% of patients administered SVF-gel were very satisfied or satisfied, and 5.3% and 44.7% of patients administered nanofat+high-density fat were very satisfied or satisfied. administered SVF-gel were significantly more satisfied than patients administered nanofat+high-density fat with improvements in periorbital contouring ( p < 0.05). Among the patients that received treatment for periorbital rejuvenation, 54.5% and 27.3% of patients administered SVF-gel were very satisfied or satisfied, and 28.6% and 42.8% of patients administered nanofat+high-density fat were very satisfied or satisfied. There was no significant difference between groups ( p > 0.05). Some patients underwent a second operation after 3 to 8 months. Patients administered SVF-gel to restore volume in the periorbital region had a significantly lower reoperation rate than patients administered nanofat+high-density fat (12.7% [6/47] vs. 34.2% [13/38]; p < 0.05). There was no significant difference in the reoperation rate in patients treated for periorbital rejuvenation (9.1% [1/11] vs. 14.3% [1/7]; p > 0.05). SVF-gel and nanofat+high-density fat are effective for restoring volume in the periorbital region and for periorbital rejuvenation in early periorbital aging. The reoperation rate was significantly lower and patient satisfaction scores were significantly higher in patients administered SVF-gel to restore volume in the periorbital region compared with patients administered nanofat+high-density fat.

Impact of Surgical Rejuvenation on Visual Processing and Character Attribution of Periorbital Aging.

The perceptual response to aging changes in the periorbital region and the effects of surgical rejuvenation on that response have not been elucidated. The authors examined the reflexive visual response to periorbital aging before and after brow lift and upper blepharoplasty surgery and investigated how observers' character attributions of the images were affected by the rejuvenative intervention. Preoperative and postoperative photographs were obtained of patients with brow ptosis and dermatochalasis who underwent brow lift and blepharoplasty. Forty observers examined each image while an infrared eye-tracking camera continuously recorded their eye movements. The observers rated the images with respect to character attributes (attractiveness, trustworthiness, sociability, healthiness, and capability) on a scale of one to seven. Fourteen patients who underwent brow lift and blepharoplasty were identified and studied. The surgical intervention was found to increase observers' attention to the eye and brow region, while decreasing relative attention to the forehead and lower eyelid areas; increase the two-dimensional surface area of the forehead and eye and brow zones in a manner directly associated with the measured changes in visual attention; and significantly increase the ratings for all five positively valanced character attributes compared with preoperative controls. The authors provide an important combination of explicit and implicit data illustrating how surgical rejuvenation unveils the periorbital region to the observer. This change in pattern of inspection was associated with an improvement in the perception of character.

Приобретенная ангиоэдема лица и периорбитальной области. Клинический случай

The purpose of the work was to analyze the features of differential diagnosis of acquired angioedema of the face and periorbital region on the example of a clinical case. Material and methods. A 62-year-old patient with complaints of edema of the upper and lower eyelids, zygomatic region and cheeks, decreased vision of the left eye applied for a consultative appointment at the polyclinic. The patient underwent a comprehensive examination, on the basis of which Waldenstrom's macroglobulinemia was diagnosed. Results. In the presented patient, ocular manifestations of the disease revealed such manifestations of the disease as macroglobulinemic retinopathy, persistent angioedema of the paraorbital region and soft tissues of the face. Conclusion. Non-inflammatory edema of the eyelids is a manifestation of both ophthalmological and systemic pathology, which creates the need for a thorough differential diagnosis and requires an interdisciplinary approach to identify the cause of the disease. Keywords: Waldenstrom's macroglobulinemia, angioedema.

Choroidal flame.

A 31-year-old lady came for routine refractive check-up. Her best corrected visual acuity was 6/6 in both eyes (OU). Intraocular pressure and anterior segment examination were normal in OU. Fundus examination showed clear vitreous, normal disk, retinal vasculature, and fovea. Large ill-defined areas of orange-colored choroidal lesions were noted over superonasal, nasal, and inferonasal quadrants in Right eye (OD) [Fig. 1a]. The rest of the choroidal background appeared normal. Left eye had similar areas of ill-defined orangish choroidal lesions in nasal and inferotemporal periphery [Fig. 1b].Figure 1: (a) Right eye color fundus montage showing orange-colored choroidal lesion occupying nasal half of the fundus. (b) Left eye shows similar lesion in the peripheral quadrantsWhat is Your Next Step? Look for similar pigmentary lesions over ocular adnexa or rest of the body B scan ultrasonography Fundus autofluorescence All of the above. Findings There was no significant previous systemic or ocular history. There was also no history of any topical or systemic medication use in this patient. Thorough examination ruled out cutaneous hypopigmented lesions, poliosis, or white forelock. Ocular examination revealed no evidence of past or present intraocular inflammation. Optical coherence tomography scan through the lesions was normal with no evidence of overlying retinal pigment epithelium (RPE) abnormalities. B scan ultrasonography ruled out mass lesions and revealed normal choroidal thickness throughout. The lesions remained stable in follow-up over a period of 2 years. Diagnosis Primary choroidal vitiligo. Correct Answer D. All of the above. Discussion Primary choroidal vitiligo is an uncommon benign asymptomatic lesion that presents as flat depigmentation of the choroid. It is usually associated with cutaneous vitiligo, often of the lids and periorbital region. Secondary choroidal vitiligo occurs following intraocular inflammation, particularly Vogt–Koyanagi–Harada (VKH) syndrome.[1] Choroidal hypopigmentation with uveitis, poliosis, and hyperacusis also constitutes a rare syndrome called Alezzandrini syndrome.[2] Presence of white forelock and iris hypopigmentation with typical facial features points toward Waardenburg syndrome.[3] Investigations including angiography, autofluorescence, and ultrasonography helps us rule out conditions mimicking choroidal vitiligo, including amelanotic choroidal nevus, choroidal osteoma, diffuse choroidal hemangioma, amelanotic melanomas, and chorioretinal atrophy. Usually, primary choroidal vitiligo is a nonprogressive condition and no treatment is required. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

STEATOCYSTOMA SIMPLEX UNUSUAL BUMP ON UPPER EYE LID - RARE CASE REPORT

A case of steatocystoma simplex keratinized cyst of upper eye lid in 64 years old female is reported as unusual presentation with its clinical pathological diagnosis management and result. steatocystema occurs as cystic lesion containing sebum or fat material. It is condition arises as cutaneous malformation associated with genetic role with intraglandular changes mainly in pilosebaceous ducts in various parts of body steatocystema classied into two forms steatocystema simplex and steatocystema multiplex Single nodule on cyst called simplex, common sites were occur on scalp face neck axilla groin, extesmitres also periorbital region conjunctiva and lower eye lids shows occurrence of multiple or single lesions. Presence of steatocystema simplex in cystic form on upper eye lid is very rare. Due to it's rarity diagnosis of disseased eye lid lesion plays important role in patient care, initial ignorance may result in visual compromisation and facial disgurement with variable discomfort

Some aspects of the clinic, diagnostics, and effectiveness of treatment of solitary, primarily multiple malignant tumors-of skin and surrounding structures of periorbital region (SPMMTSSSPR)

Aim. To study the features of the clinic, diagnostics, and evaluate the effectiveness of the treatment of solitary and primarily multiple malignant tumors of the skin and surrounding structures of the periorbital region (SPMMTLPSSSPR).Materials and methods. A retrospective analysis of clinical data of case histories of 39 patients with various solitary, primarily multiple malignant tumors of the skin and surrounding structures of the periorbital region was performed and the effectiveness of treatment was evaluated in the conditions of the State Institution “Republican Oncological Scientific Center” of the MOH and SPP of the RT 2015 to 2016.Results. Evaluation of the effectiveness of treatment in 39 (100%) patients with solitary and primarily-multiple malignant tumors of the skin of surrounding structures of the periorbital region (SPMMTSSSPR) showed in 20 (51,28%) excellent results, in 13 (33,35%) – good results, in 2 (5,12%) - satisfactory results and in 4 (10,25%) patients unsatisfactory results. The quality of life of 33 patients with SPMMSSSPR assessment by the Karnowsky scale was improved from a minimal of 60% to 100%.Conclusion. Surgical treatment of SPMTLPSSSPR made it possible to achieve а complete treatment in 85% of patients.

Eyelid ectropion: aesthetic and functional issues

Aim to present the results of the author's treatment method for postoperative complications in the lower eyelid after blepharoplasty.&#x0D; Material and methods. Patients in the postoperative period after blepharoplasty were included in the study (n = 11). All patients had age-related changes in the skin of the upper and lower eyelids before the surgery. After surgery, the patients had a complication in the form of an inversion of the lower eyelid. In the early postoperative period (up to 6 months), all patients with ectropion underwent the author's treatment technique using an erbium laser (Er:YAG, 20940 nm).&#x0D; Results. The errors in the diagnosis and planning of the volume of surgical intervention, surgical errors are the main causes of complications after blepharoplasty affecting the function of the eye. In order to avoid the complications, it is necessary to take into account not only the degree of atrophy of the eyelid skin, but also the structural features of the eyelids and the periorbital region. The study proved that the author's method of treatment using an erbium laser (Er:YAG, 20940 nm) gives positive results. Observation of patients during 6 months after the treatment revealed no recurrence of inversion of the lower eyelids and the need for additional therapy.

Facial Soft Tissue Repositioning With Neuromodulators: Lessons Learned From Facial Biomechanics.

Neuromodulators have proven efficacy in reducing facial rhytides and have also been reported to improve jawline contour and the appearance of platysmal bands. Lifting effects of the tail of the eyebrow are expected outcomes when targeting the lateral periorbital region, underscoring the versatility of neuromodulator treatments. The aim of this study was to analyze the clinical effectiveness of a novel neuromodulator-based injection algorithm with regards to its ability to reposition the middle and lower facial soft tissues. Seventy-five study participants (8 males, 67 females) with a mean [standard deviation] age of 37.5 [8.5] years were injected with neuromodulators in the subdermal plane of the mandibular soft tissues following a standardized algorithm. Live rating of clinical appearance was performed, as well as volume change and skin vector displacement measured by 3-dimensional imaging at baseline, Day 14, and Day 30. Three-dimensional volume analysis revealed an increase in midfacial volume by 0.46 mL, and a decrease of the lower facial volume by 0.30 mL compared with baseline. Additionally, an improvement of midfacial fullness (by 0.13) and jawline contour (by 0.44) was reported on clinical rating scales at Day 30 compared with baseline. Facial soft tissues can be repositioned during the 30-day follow-up period following a neuromodulator treatment; this was reflected through an increase in midfacial volume as well as through a decrease in lower facial volume. The novel injection algorithm presented can provide a safe and effective option for patients desiring improvement of midfacial fullness and jawline contour with neuromodulator treatment alone.

Facial Asymmetry in Children With Unilateral Congenital Ptosis.

To analyze facial asymmetry in children with unilateral congenital ptosis. This is a retrospective review of pediatric patients undergoing ptosis repair between January 1, 2017, and December 31, 2020. Charts were reviewed to ensure a diagnosis of idiopathic unilateral congenital ptosis. Sex, age, laterality, margin to reflex distance 1, levator function, and surgical intervention were collected.Clear preoperative photos without head turn were included. Using the ImageJ software ( nih.gov ), landmarks of the periorbital region, midface, and lower face were marked, and measurements between these landmarks were taken.Two-tailed Student t tests were used to compare measurements between the ptotic and non-ptotic sides. Relationships between different measurements on the same side of the face were analyzed using paired-variable regressions. Forty-four patients with unilateral congenital ptosis were included. The surgical management consisted of Mullerectomy in 9 of 44 (20%), levator resection in 15 of 44 (34%), and frontalis suspension in 20 of 44 (46%) patients. The side of the face with blepharoptosis was found to more often have smaller margin to reflex distance 1 ( p &lt; 0.001), smaller margin to reflex distance 2 ( p &lt; 0.005), smaller horizontal palpebral fissure ( p &lt; 0.05), shorter midface height ( p &lt; 0.001), and a more inferiorly displaced lateral canthus (canthal angle, p &lt; 0.001) relative to the non-ptotic side of the face. The mean head tilt of patients with right sided ptosis (1.37° right tilt) was statistically significantly different from those with left sided ptosis (0.85° left tilt; p = 0.04). In children with unilateral congenital ptosis, the ptotic side of the face was found to be the nondominant side of the face. Patients were also found to have ipsilateral head tilt.

Aesthetic Enhancement of the Brow using Hydroxyapatite

BackgroundAn aesthetically pleasing appearance of the ‘eyes’ usually includes good projection of the outer brow. Weak bony projection of the superolateral periorbital region tends to be not only less attractive, but also predisposes to hooding over the temporal part of the upper lid. Congenital lack of skeletal volume is exacerbated by ageing due to lipoatrophy and soft tissue laxity. The rationale and technique for performing skeletal augmentation of the superolateral orbital rim is described, along with long-term results from a series of cases.Material and MethodsA series of patients having augmentation of the superolateral orbital rim, using the technique described, were evaluated. A forehead crease incision was used, then a precise subperiosteal pocket developed in the lateral brow region between the supraorbital foramen and the superior temporal septum. The hydroxyapatite granule mixture was incrementally placed using modified syringes. The patients were followed to assess the long-term results.ResultsTwo hundred and fifty patients, 80% women, mean age = 53 years [range 23–78] underwent supraorbital rim augmentation using subperiosteal hydroxyapatite granules, during a 12-year period, commencing in 2007. The mean follow-up was 41 months (range 1–12 years). The mean volume used for augmentation was 1.0 mL per side (range 0.4–2.3 mL). Projection of the upper lateral periorbital prominence was effectively increased, resulting in enhancement of the brow position and shape. Twenty-seven patients (11%) had an undercorrection, requiring additional volume augmentation, all during the first three years of the experience. Twelve patients (5%) required correction of contour irregularities. There were no infections and no long-term complications. Resorption of the hydroxyapatite volume over time was not noted.ConclusionThe aesthetic significance of superolateral orbital rim projection is introduced. Patients who have a degree of skeletal deficiency of the zygomatic process of the frontal bone should be considered for hydroxyapatite augmentation of the bone as a complement to upper lid blepharoplasty and brow elevation. This procedure should be considered in the spectrum of upper periorbital aesthetic procedures.Level of Evidence IVThis 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 the Treatment by Combining Hyaluronic Acid Filler and Botulinum Toxin A on the Upper Face

Context: Recently, more people have better aesthetic satisfactions with the application of various treatment methods. Especially, development of botulinum toxins and facial fillers provide patients having folds with new hopes. Aims: We studied to clarify the aesthetic effect of the treatment by combining the injectable hyaluronic acid (HA) and botulinum toxin A (BTX-A). Setting and designs: 115 patients complaining about folds in foreheads, glabellars, and lateral periorbital regions were selected. We made two groups; control group was treated only with injectable HA filler and experimental group by combining HA and BTX-A. Both groups were followed for 8 months after injection. Material and methods: HA (Restylane) and BTX-A were together applied to the upper face folds including forehead, glabellar and crow’s feet that were represented by mimetic muscles. We evaluated the correction and the maintenance effects in control and experimental groups at 0 and 8 months after treatments. Statistical analysis used: All the experimental values were analyzed statistically with Student’s t-test of Microsoft Excel 2013. Results: All the patients in both groups had efficient fold corrections, but there was no significant difference of the rate of maintenance between 2 groups. Conclusion: On the upper face, combined treatments with the injectable HA and BTX-A were intended to have better early effects than with only a filler, and the combined procedure didn’t have a significant difference in fold correction maintenance effects after 8 months.

РЕЗУЛЬТАТЫ КОМПЛЕКСНОГО КОНСЕРВАТИВНОГО ЛЕЧЕНИЯ ПАЦИЕНТОВ С ЭНДОКРИННОЙ ОФТАЛЬМОПАТИЕЙ СРЕДНЕЙ СТЕПЕНИ ТЯЖЕСТИ

Background. Pathogenetic therapy of the moderate severity endocrine ophthalmopathy (EOP) is performed by the administration of glucocorticoids (GC), which possess immunosuppressive, anti-inflammatory and anti-edematous effects. Currently, the application of selenium and pentoxifylline medications, as well as treatment with magnetic field over periorbital region are considered as a part of combined therapy for the disease. Purpose of the study. To evaluate the results of combined conservative treatment of patients with moderate severity EOP. Material and methods. The study included 25 patients (50 orbits) with the clinical signs of moderate severity EOP. Depending on the treatment regimen, patients were divided into group A (comparison) and group B (main). Group A (comparison) – 10 patients who received pulse therapy with methylprednisolone. Group B (main) – 15 patients who were prescribed a combination of pulse therapy with methylprednisalone and a new developed treatment regimen additionally: selenium 100 mgq 2 times a day for 6 months, pentoxifylline at a dose of 600 mg 2 times a day for 6 months, a low-frequency pulsed magnetic field generated by the "UniSPOK" apparatus, lasting for 10-20 minutes, up to 8-12 procedures performed daily. Methylprednisolone application in the form of intravenous pulse therapy was prescribed collegially by an endocrinologist and an ophthalmologist individually for each patient and in total did not exceed 4.5 g recommended for the present process intensity (on average, 4.5±0.5 g in both groups). Results. The sequence in decreasing of EOP clinical signs in patients receiving combination therapy was revealed: a decrease in tremor, eyelid edema and palpebral fissure width in comparison with the initial parameters were noted already by the 3rd month of treatment, after 6 months these indicators disappeared. Lacrimation in the studied groups was not recorded by the 6th month, which can be explained by the corticosteroids application. A significant reduction in exophthalmos under developed therapy was found after 6 months, while no reduction was observed in the standard treatment group. Conclusions. The method of EOP complex treatment, including pulse therapy with methylprednisolone in combination with selenium, pentoxifylline and magnetotherapy, was effective in the moderate severity of the disease and led to the reduction of the ophthalmopathy severity symptoms. The positive effect of the combined therapy indicates the necessity for a six-month treatment course.

Burn Scar Ectropion Correction: Surgical Technique for Functional Outcomes.

Eyelid scarring after severe burn injury of the face is a significant complication endangering vision in addition to the burn scar sequelae. Scar contraction leads to asymmetry and malposition of the eyelid axis, resulting in corneal exposure, eyelid retraction, and incomplete eyelid closure. In consequence, dryness and irritation of the cornea can lead to keratitis, corneal opacity, and vision impairment. In this study, we present our surgical technique for lateral canthopexy in combination with full-thickness skin grafting (FTSGing) in patients with eyelid axis distortion after scar contraction of the periorbital region after severe burn injuries of the face. In this retrospective, single-center case study, we present 5 consecutive patients who experienced severe burn injuries to the face between 2014 and 2019. Patients were suffering from ectropion and malposition of the eyelid axis. In all cases, we performed lateral transosseous canthopexy and FTSGing. Improved symmetry and complete eyelid closure were restored in all 5 patients. The following ophthalmological examinations showed resolved corneal erosions, as well as reduction of chemosis and epiphora. Further vision impairment was successfully prohibited. Surgical revision with FTSGing was required in 2 patients because of recurrence of unilateral lower eyelid retraction. Lateral transosseous canthopexy represents a suitable surgical method to durably correct eyelid malposition, ectropion, and incomplete lid closure in patients with severe scarring of the periorbital region after burns of the face. Early detection of patients at risk and timing of surgical intervention are of great importance.

The Anatomy behind Eyebrow Positioning: A Clinical Guide Based on Current Anatomic Concepts.

The position of the eyebrow is known to reflect emotional status and to provide a plethora of nonverbal information. Although the eyebrow has no direct attachment to underlying bone, it is subject to the interplay between the various periorbital muscles, which when acting together, permit important nonverbal cues to be conveyed. Understanding the balance and interplay between these muscles is of crucial importance when targeting the periorbital area with neuromodulators. The authors' aims were to summarize current anatomic and clinical knowledge so as to provide a foundation that physicians can rely on to improve and increase the predictability of patient outcomes when treating the periorbital region with neuromodulators for aesthetic purposes. This narrative review is based on the anatomic and clinical experience of the authors dissecting and treating the periorbital region with specific focus on the glabella and the forehead. This narrative review covers (1) a brief description of the relevant periorbital muscle anatomy, (2) an analysis of each muscle's contribution to various facial expressions, and (3) an anatomic and physiologic simulation of the muscular effects of specific neuromodulator injection sites. By understanding functional anatomy of the periorbital muscles and combining this knowledge with individualized assessment and treatment planning, it is possible to achieve aesthetically pleasing, predictable, and reproducible treatment outcomes that positively impact perception of nonverbal cues when administering neuromodulators.

To the pathogenesis of perioral dermatitis

Perioral dermatitis (PD) is a skin disease of the face characterized by a rash of non-follicular pinkish-red papules and solitary shiny pseudopustules in the perioral and/or periorbital region. It occurs mainly in women of young and middle age, often acquires a torpid course, tolerant to treatment. The study of PD is especially important due to insufficient knowledge of its etiological and pathogenetic mechanisms and the lack of effective methods of therapy.

Reconstruction of Post-Maxillectomy Periorbital Sinocutaneous and Nasocutaneous Fistulas with Double-Layer Local Flaps.

Postoperative wound dehiscence following Weber-Ferguson or lateral rhinotomy incisions can produce sinocutaneous or nasocutaneous fistulas (NC-SCF). We present a technique author in addressing these defects, utilizing a turn-in flap followed by a 2-stage paramedian forehead flap were utilized to close NC-SCF in the periorbital region. NC-SCF present reconstructive challenges following maxillectomy with postoperative wound dehiscence. The utilization of multiple local flaps in a double-layer soft tissue closure obliterate NC-SCF while providing satisfactory cosmetic outcomes.

Informed Consent In Facial Photograph Publishing: A Cross-sectional Pilot Study To Determine The Effectiveness Of Deidentification Methods.

This study determined the effectiveness of three deidentification methods: use of a) a black box to obscure facial landmarks, b) a letterbox view to display restricted facial landmarks and c) a half letterbox view. Facial images of well-known celebrities were used to create a series of decreasingly deidentified images and displayed to participants in a structured interview session. 55.5% were recognised when all facial features were covered using a black box, leaving only the hair and neck exposed. The letterbox view proved more effective, reaching over 50% recognition only once the periorbital region, eyebrows, and forehead were visible. The half letterbox was the most effective, requiring the nose to be revealed before recognition reached over 50%, and should be the option of choice where appropriate. These findings provide valuable information for informed consent discussions, and we recommend consent to publish forms should stipulate the deidentification method that will be used.

Temporal characteristics of astrocytic activation in the TNC in a mice model of pain induced by recurrent dural infusion of inflammatory soup

BackgroundAstrocytic activation might play a significant role in the central sensitization of chronic migraine (CM). However, the temporal characteristics of the astrocytic activation in the trigeminal nucleus caudalis (TNC) and the molecular mechanism under the process remain not fully understood. Therefore, this study aims to investigate the duration and levels change of astrocytic activation and to explore the correlation between astrocytic activation and the levels change of cytokines release.MethodsWe used a mice model induced by recurrent dural infusion of inflammatory soup (IS). The variation with time of IS-induced mechanical thresholds in the periorbital and hind paw plantar regions were evaluated using the von Frey filaments test. We detected the expression profile of glial fibrillary acidic protein (GFAP) in the TNC through immunofluorescence staining and western blot assay. We also investigated the variation with time of the transcriptional levels of GFAP and ionized calcium binding adapter molecule 1 (Iba1) through RNAscope in situ hybridization analysis. Then, we detected the variation with time of cytokines levels in the TNC tissue extraction and serum, including c-c motif chemokine ligand 2 (CCL2), c-c motif chemokine ligand 5 (CCL5), c-c motif chemokine ligand 7 (CCL7), c-c motif chemokine ligand 12 (CCL12), c-x-c motif chemokine ligand 1 (CXCL1), c-x-c motif chemokine ligand 13 (CXCL13), interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), macrophage colony-stimulating factor (M-CSF), interleukin 1beta (IL-1β), interleukin 6 (IL-6), interleukin 10 (IL-10), interleukin 17A (IL-17A).ResultsRecurrent IS infusion resulted in cutaneous allodynia in both the periorbital region and hind paw plantar, ranging from 5 d (after the second IS infusion) to 47 d (28 d after the last infusion) and 5 d to 26 d (7 d after the last infusion), respectively. The protein levels of GFAP and messenger ribonucleic acid (mRNA) levels of GFAP and Iba1 significantly increased and sustained from 20 d to 47 d (1 d to 28 d after the last infusion), which was associated with the temporal characteristics of astrocytic activation in the TNC. The CCL7 levels in the TNC decreased from 20 d to 47 d. But the CCL7 levels in serum only decreased on 20 d (1 d after the last infusion). The CCL12 levels in the TNC decreased on 22 d (3 d after the last infusion) and 33 d (14 d after the last infusion). In serum, the CCL12 levels only decreased on 22 d. The IL-10 levels in the TNC increased on 20 d.ConclusionsOur results indicate that the astrocytic activation generated and sustained in the IS-induced mice model from 1 d to 28 d after the last infusion and may contribute to the pathology through modulating CCL7, CCL12, and IL-10 release.