Temporal Hollowing Research Articles

Clinical Application of Stromal Vascular Fraction Gel in Temple Augmentation Using Deep Injection and Shallow Pave Filling.

Temporal hollowing is an early sign of aging, and many techniques comprising the injection of fillers into the temporal fossa to correct this hollowing have been described. To assess the safety of a new technique in which stromal vascular fraction gel is used for temporal hollowing. Thirty-three patients with temporal hollowing were corrected with the aforementioned gel using deep injection and shallow pave filling at the Department of Plastic and Reconstructive Surgery, Guangdong Women and Children Hospital, China, between January 2017 and April 2021. This gel was injected into the double plane via a needle and cannula by the same cutaneous access points to prevent severe vascular injury. Improvement was evaluated by self-assessment, the Hollowness Severity Rating Scale (grade range, 0-3; lower grades represent minimal hollowness), and a satisfaction survey. Self-assessment questionnaire (6questions) results were satisfactory; 44temples (67%) demonstrated more than 2grades of magnitude of clinical improvement. Thirty-one patients (94%) were satisfied with their outcomes; the complaint ratio was low. The high satisfaction rate of patients treated using the stromal vascular fraction gel by deep injection and shallow pave filling suggests that this technique is simple, effective, and safe. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

A Comprehensive Approach To Alloplastic Cranioplasty: Novel Implant Design And Refinement of Soft Tissue Management

Background: Large scale craniectomy defects are commonly reconstructed with alloplastic implants, which can restore brain protection and promote cosmesis. However, esthetic outcomes can be subpar due to skin contour abnormalities and temporal hollowing. Herein we describe a senior craniofacial surgeon’s experience using a custom composite polyetheretherketone (PEEK) and porous polyethylene (Medpor) implant for alloplastic cranioplasty. Methods: A retrospective review was conducted of all PEEK-Medpor cranioplasty cases performed over the past 2 years. Patient characteristics, intraoperative information, surgical outcomes, and cosmetic outcomes were reviewed. Results: Sixteen patients (18-70 years of age) underwent surgery. Indications for cranioplasty included craniectomy due to trauma, stroke, or tumor, and bone resorption after a prior autologous cranioplasty. Augmentation of the temporalis area using alloderm or a muscle graft was performed in 7 cases. There were no intraoperative complications. Ultimately, all implants were maintained. One implant was temporarily removed due to infection, but successfully replaced. Three minor complications occurred. At an average follow-up of 9 months, 93.8% of surgical sites showed no significant temporal hollow. Conclusion: We describe a series of 16 implants using a composite PEEK Medpor implant for alloplastic cranioplasty, which resulted in a low infection rate and improved postoperative regional contour. Use of this implant with suspension of the temporalis muscle is a new technique that may allow for better adherence of the temporalis muscle to its anatomic position, while still providing good brain protection.

Suprafascial dissection for pterional craniotomy to preserve the frontotemporal branch of the facial nerve with less temporal hollowing.

Background: To protect the frontotemporal branch of the facial nerve (FTFN) when performing pterional craniotomy, several reports suggest the subfascial or interfascial dissection technique. However, the reports of postoperative frontalis paralysis and temporal hollowing, which are common complications, were relatively limited. This study reports the incidence of postoperative frontalis paralysis and temporal hollowing after pterional craniotomy using the suprafascial and interfascial techniques.Methods: Patients who underwent pterional craniotomy, using the suprafascial technique (leaving the muscle cuff and not leaving the muscle cuff) and the interfascial technique, between November 2015 and September 2018 were retrospectively evaluated for postoperative frontalis paralysis and temporal hollowing using Chi-squared/ Fisher exact test.Results: Seventy-two patients underwent pterional craniotomy, using the suprafascial technique in 54 patients (leaving the muscle cuff in 21 patients and not leaving the muscle cuff in 33 patients) and the interfascial technique in 18 patients. Eleven patients (20.4%) in the suprafascial group and 1 patient (5.6%) in the interfascial group developed transient frontalis paralysis (P = 0.272). No permanent frontalis paralysis was observed. Obvious temporal hollowing occurred in 18.2% of patients in the suprafascial group without the muscle cuff, in 64.3% of patients in the suprafascial group with the muscle cuff, and in 72.7% of patients in the interfascial group (P = 0.003).Conclusion: The suprafascial dissection technique does not cause permanent injury of the FTFN, and this approach results in a significantly lower incidence of postoperative temporal hollowing than interfascial dissection, especially without leaving a temporalis muscle cuff.

Pre-injection ultrasound scanning for treating temporal hollowing.

Hyaluronic acid filler injection is commonly administered to correct temple hollowness, typically through deep temporal injection. Since the vascular distribution at the injection site can be diverse, studies on avoiding damage to the corresponding blood vessels are needed. To assess the commonly used hyaluronic acid filler injection site in the temple region, 1cm lateral and 1 cm above from the end of eyebrow, using a Doppler ultrasound to detect any anatomic variations in the blood vessels. Thirty patients (60 temples, right and left) were examined using Doppler ultrasonography. An 8-17 MHz ultrasound probe was used to discriminate between the anatomic layers of the temple. Blood vessels found in each anatomical layer were subsequently investigated. Among the 30 patients included in this study, we found temporal region arteries 1 cm above and 1 cm lateral to the distal end of the eyebrow in 9 patients; However, no arteries were detected in the temples of 21 patients. The presence or absence of arteries was bilateral in all patients. The anatomical layers with blood vessels varied among patients. The variability could give rise to complications. Possible anatomic variations at the temple should be carefully identified using pre-injection ultrasonography, and harming blood vessels should be avoided while injecting hyaluronic acid filler for temple augmentation.

Esthetics outcomes in patients submitted to pterional craniotomy and its variants: A scoping review.

Background: Highly performed nowadays, the pterional craniotomy (PC) has several widespread variants. However, these procedures are associated with complications such as temporalis muscle atrophy, facial nerve frontal branch damage, and masticatory difficulties. The postoperative cranial aesthetic is, nonetheless, the main setback according to patients. This review aims to map different pterional approaches focusing on final aesthetics.Methods: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies were classified through the Oxford method. We searched PubMed/MEDLINE, EMBASE, and Cochrane Library from January 1969 to February 2021 for cohorts and randomized clinical trials that met our inclusion criteria.Results: 1484 articles were initially retrieved from the databases. 1328 articles did not fit the inclusion criteria. 118 duplicates were found. 38 studies were found eligible for the established criteria. 27 (71.05%) were retrospective cohorts, with low evidence level. Only 5 (13.15%) clinical trials were found eligible to the criteria. The majority of the studies (36/38) had the 2B OXFORD evidence level. A limited number of studies addressed cosmetic outcomes and patient satisfaction. The temporal muscle atrophy or temporal hollowing seems to be the patient’s main complaint. Only 17 (44.73%) studies addressed patient satisfaction regarding the aesthetics, and only 10 (26.31%) of the studies reported the cosmetic outcome as a primary outcome. Nevertheless, minimally invasive approaches appear to overcome most cosmetic complaints and should be performed whenever possible.Conclusion: There are several variants of the classic PC. The esthetic outcomes are poorly evaluated. The majority of the studies were low evidence articles.

Endoscopic Transconjunctival Deep Lateral Wall Decompression for Thyroid-associated Orbitopathy: A Minimally Invasive Alternative: Transconjunctival Endoscopic with Wall Decompression for TAO

To investigate the feasibility, efficacy, and safety of endoscopic transconjunctival transorbital deep lateral wall decompression for thyroid-associated orbitopathy (TAO). Prospective single-surgeon interventional case series. Twenty-two patients (39 orbits) diagnosed with thyroid-associated orbitopathy without dysthyroid optic neuropathy were enrolled in this study. All patients underwent endoscopic transconjunctival transorbital deep lateral wall decompression for proptosis reduction. The data, including measurement on exophthalmometry, volumetric change on computed tomography, and surgery-related complications, were analyzed. We observed a proptosis reduction (mean, 3.42 ± 0.87 mm; range, 2.10-5.52 mm) and a corresponding decrease in the bony volume of the greater wing of the sphenoid bone (mean, 1.89 ± 0.81 cm3; range, 0.56-3.79 cm3) postoperatively. Preexisting diplopia improved in 5 patients (22.73%). Transient zygomaticotemporal hypoesthesia developed in all patients, and cerebrospinal fluid leakage occurred in 1 orbit (2.56%). No patient complained of temporal hollowing, oscillopsia, or new-onset or worsening diplopia during follow-up. Endoscopic transconjunctival transorbital deep lateral wall decompression is an effective and minimally invasive treatment for proptosis reduction in patients with thyroid-associated orbitopathy. The surgery-related complications with this technique were fewer compared with traditional approaches.

Single Segment Neo-Bandeau Fronto-Orbital Advancement in Children With Craniosynostosis: Technique Adaptation and Craniometric Analysis.

Fronto-orbital advancement (FOA) of the anterior skull and orbital bandeau is standard of care for craniosynostosis with anterior morphology. Fronto-orbital retrusion, temporal hollowing, and bony contour irregularities are commonly seen in long-term follow-up. In this study, we report several technical adaptations of a new FOA technique described in Fearon et al that help facilitate adaptation of the single-segment neo-bandeau FOA technique in preparation of use in younger patients, and perform a craniometric analysis of the technique. Five consecutive patients who underwent the single-segment neo-bandeau FOA in 2020 with available pre- and post-operative three-dimensional head computed tomography scans were studied. Using Materialise Mimics (Materialise, Ghent, Belgium), cranial length, cranial height, cranial widths, and intracranial volume were measured. Two (40%) patients were male and all were non-Hispanic White with a median age at surgery of 18.6 months (interquartile range 10.4-45.7). Three patients (60%) had bicoronal or other multi-suture craniosynostosis, and 1 each had metopic and sagittal craniosynostosis. Intraoperatively measured intracranial pressure decreased from 17.8 mmHg (R 13.0-20.0) before craniectomy to 4.8 mmHg (R 2.0-11.0; P = 0.038) after craniectomy. Anterior cranial width increased postoperatively (mean 92.6 mm; R 74.9-111.5 versus 117.6 mm; R 109.8-135.2, P = 0.005). Intracranial volume increased from preoperative (mean 1211 cm3; R 782-1949 cm3) to postoperative (1387 cm3; R 1022-2108 cm3; P = 0.009). The authors find in this small sample that a single-segment neo-bandeau FOA demonstrates volumetric expansion similar to conventional FOA techniques and is feasible in infants under 1 year of age.

How Safe and Effective Is Shifting from Pterional to Supraorbital Keyhole Approach for Clipping Ruptured Anterior Circulation Aneurysms? A Surgeon's Transition Phase Comparative Study.

Background Comparative studies between standard pterional and supraorbital keyhole approaches for aneurysms had potential biases with the heterogeneity of patient selection, differences among surgeons, or varying expertise across the surgeon’s learning curve. This is a study of a surgeon’s transition from pterional to keyhole approach for early clipping of selected consecutive ruptured anterior circulation aneurysms. Methods Patients more than 18 years, presenting within 72 hours of ictus, in good clinical grades 1 to 3, no midline shift, with saccular aneurysms less than 25 mm at either communicating segment of internal carotid artery, anterior communicating artery, or middle cerebral artery segment till bifurcation were studied between the last 25 cases of pterional and first 25 cases of the keyhole, for the intraoperative and postoperative surgical outcome parameters. Results There was no significant difference among baseline parameters, including the location of aneurysms across both groups. While only four cases of pterional had an intraoperative ventricular puncture, the lumbar drain was electively inserted in all keyhole patients. The intraoperative parameters, such as a dural tear, adequate parent vessel exposure, temporary clipping, and intraoperative rupture, did not show any significant difference. None had immediate postoperative deficits. While delayed cerebral ischemia and wound complaints were similar in both groups, temporal hollowing and chewing difficulty were significantly more in pterional patients( p = 0.01). Conclusion A surgeon experienced in pterional approach can comfortably and safely shift to the keyhole for early clipping of selected ruptured aneurysms less than 25 mm, with a comparable surgical outcome but better cosmesis and mastication.

The Influence of Different Light Angles During Standardized Patient Photographic Assessment on the Aesthetic Perception of the Face

Background2D baseline and follow-up clinical images are potentially subject to inconsistency due to alteration of imaging parameters. However, no study to date has attempted to quantify the magnitude by which such images can be influenced.ObjectiveThe objective of the present study is to identify the magnitude by which images can be influenced by changing the imaging light angle.MethodsThis study is based on the evaluation of 2D frontal images of the face and included a total of 51 subjects of which n = 14 were males and n = 37 were females. Faces were photographed at 0°, 30°, and 60° light angle under identical and standardized conditions. Images were randomized and rated by 27 blinded raters for age, facial attractiveness, body mass index (BMI), temporal hollowing, lower cheek fullness, nasolabial sulcus severity, and jawline contour.ResultsFacial attractiveness decreased, facial unattractiveness increased and the evaluated BMI (based on facial assessment) increased statistically significantly at 60°. The assessment of regional facial scores, i.e., temporal hollowing, lower cheek fullness, and jawline contour, showed no statistically meaningful changes both at 30° and at 60° light angle.ConclusionThe results indicate that there might be an observed blind range in light angle (0°–30°) which does not influence facial assessment. Increasing the light angle past the threshold value to 60° might result in a statistically significant impact on facial perception which should be accounted for when documenting and/or presenting facial 2D images.Level of Evidence V 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.

Temporal augmentation using autologous fat grafting in Chinese women: Effect on temporal hairline.

Temporal hollowing causes an old and gaunt appearance. An inward curve of the temporal hairline adds to the severity of temporal hollowing, which is visually exacerbated by the dark-colored hairline in most Chinese women. Whether temporal augmentation using autologous fat grafting (AFG) is effective for correcting an inwardly curved temporal hairline remains unclear. To assess the effect of temporal augmentation using AFG on the temporal hairline. Forty-six women with an inward-curved temporal hairline, who underwent temporal augmentation using AFG, were recruited. The preoperative and postoperative severity of temporal hollowing was evaluated, and anthropometric measurements regarding the temporal hairline were performed on photographs taken in the frontal and lateral views. Subject satisfaction and incidence of complications were documented. A slight increase in forehead width was observed. The minimal forehead width and minimal forehead width/forehead width ratio were increased. The width, depth, and height of the temporal peak were all increased as well, indicating that the previously inwardly oriented temporal peak was shifted slightly outward, upward, and backward after augmentation. Autologous fat grafting satisfactorily smoothened the temporal hairline without excessively increasing forehead width in subjects with temporal hollowing and an inward-curved temporal hairline.

A rare case of congenital facial nerve palsy with extreme ocular manifestations

A 12-month-old malnourished female child, born by normal vaginal delivery, presented to us with lagophthalmos and healed corneal ulcer with keratinisation. Examination revealed right facial asymmetry, temporal hollowing, loss of...

Volumization of the young and the old temple using a highly cross‐linked HA filler

A plethora of age-related changes contribute to hollowing of the temples, as bone remodeling, atrophy of the temporalis muscle, thinning of the skin, and deflation of the subcutaneous and deep temporal fat create the appearance of a skeletonized face. In addition, previous studies have established a relationship between facial skeletonization, temporal hollowing, and postmenopausal sarcopenia. To compare the volume change, adverse events, and patient satisfaction of soft-tissue filler injections in the temple between young (<51) and old (>51) females. A total of 30 women with a mean age of 53.1±12.1years underwent bilateral temporal volumization. Adverse events and satisfaction were assessed after 3 and 6months. 3-Dimensional surface imaging was performed at baseline and after 2weeks, 3 and 6months to assess volumetric changes. A mean volume of 5.55±1.9cc was injected into the temples. A total of 31 adverse events were observed in 13 patients. The overall satisfaction of the procedure was very high after 3 and 6months in both patient groups, and raters showed a significant agreement in their assessment of the aesthetic improvement, while the self-reported patient satisfaction was also substantially high. The surface-volume coefficient differed significantly between 14days and 3months post-injection only in pre-menopausal patients, while no significant difference was detected between 3 and 6months. Temporal soft-tissue filler injections are safe and provide long-lasting aesthetic improvement both in pre- and postmenopausal women.

Differences in Temporal Volume between Males and Females and the Influence of Age and BMI: A Cross-Sectional CT-Imaging Study

The temple has been identified as one of the most compelling facial regions in which to seek aesthetic improvement-both locally and in the entire face-when injecting soft tissue fillers. The objective of this study is to identify influences of age, gender, and body mass index (BMI) on temporal parameters to better understand clinical observations and to identify optimal treatment strategies for treating temporal hollowing. The sample consisted of 28 male and 30 female individuals with a median age of 53 (34) years and a median BMI of 27.00 (6.94) kg/m2. The surface area of temporal skin, the surface area of temporal bones, and the temporal soft tissue volume were measured utilizing postprocessed computed tomography (CT) images via the Hausdorff minimal distance algorithm. Differences between the investigated participants related to age, BMI, and gender were calculated. Median skin surface area was greater in males compared with females 5,100.5 (708) mm2 versus 4,208.5 (893) mm2 (p < 0.001) as was the median bone surface area 5,329 (690) mm2 versus 4,477 (888) mm2 (p < 0.001). Males had on average 11.04 mL greater temporal soft tissue volume compared with age and BMI-matched females with p < 0.001. Comparing the volume between premenopausal versus postmenopausal females, the median temporal soft tissue volume was 46.63 mL (11.94) versus 40.32 mL (5.69) (p = 0.014). The results of this cross-sectional CT imaging study confirmed previous clinical and anatomical observations and added numerical evidence to those observations for a better clinical integration of the data.

Aging Process of Lateral Facial Fat Compartments: A Retrospective Study.

Since 2007, when the anatomy of facial fat compartment was described, an increasing number of studies on the aging process of the compartment of cadavers has emerged. The authors evaluated the aging changes of lateral facial fat compartments on the same person. Sixty-three patients were included in this retrospective study. All patients had magnetic resonance imaging scans with at least 4 years apart. The authors targeted the fat compartments of the superficial temporal, subcutaneous temporal, and buccal fat pad, comparing the data on different time points. The thickness of the subcutaneous temporal fat did not change significantly. The 3 diameters of the superficial temporal fat compartment all became thinner on the axial view (P < 0.05). On the sagittal view, the superficial temporal fat elongated from 38.89 mm to 43.74 mm (P < 0.05). The buccal fat compartment also lengthened from 68.73 mm to 74.39 mm (P < 0.05) and had a positive correlation with follow-up duration only. The study revealed the fat compartment change on the same person with time. The temporal hollow mainly originates from the thinner part of the superficial temporal fat. The descending of the buccal fat pad aggravates the labiomandibular fold. By understanding the aging process more fully, we can rejuvenate our patients more naturally.

The Use of Split Temporalis Muscle Flap in Maxillofacial Reconstruction

Study Design: Case Report. Objective: The Temporalis muscle (TM) Flap is a reliable, versatile flap with adequate bulk and flexibility. However, temporal hollowing is the most common postoperative complication after harvesting the flap. We describe a surgical modification for harvesting the split TM flap to prevent postoperative temporal hollowing and report 2 cases with up to 18 months of follow-up. Method: This study discusses the posterior ⅔ split temporalis muscle flap in preventing temporal hollowing. We report 2 well-documented cases with up to 18 months of postoperative follow-up. Also, the authors discuss the key points regarding the technique’s indication and limitation. Results: The posterior ⅔ split temporalis muscle flap is reliable in both benign and malignant disease processes. The results demonstrate the flap’s reliability with minimum donor site morbidity. Conclusion: The use of the posterior ⅔ of the TM flap is a viable technique to prevent the flap’s harvest’s temporal hollowing.

Full‐face effects of temporal volumizing and temporal lifting techniques

Most injection techniques utilizing hyaluronic acid-based soft tissue fillers have predictable outcomes at the location injected. However, the temporal region has been identified to have aesthetic effects beyond the temple. To identify and quantify the panfacial aesthetic effects of three different temporal injection techniques. The medical records of nine female and five male Caucasian patients with a mean age of 50.9±11.9years were retrospectively reviewed for the effects of these techniques: supraperiosteal, interfascial, and subdermal. Panfacial effects were evaluated by the semiquantitative assessment of aesthetic scores for the temple volume, the temporal crest visibility, the lateral orbital rim visibility, the position of the eyebrows, the severity of lateral canthal lines, the midfacial volume, and the contour of the jawline. The supraperiosteal injection technique had the greatest influence on improving the temporal volume (25.0%), the temporal crest (33.3%), and the lateral orbital rim visibility (31.0%) scales but had no effects in other facial regions. The interfascial injection technique revealed good effects on improving temporal hollowing (23.3%) but had an even greater effect on the crow's feet (26.8%) and on the position of the eyebrow (33.3%). The subdermal injection technique had its greatest effects in the lower face by improving the contour of the jawline (26.8%) followed by the improvement of the lower cheek fullness scale (14.3%). Future injection algorithms could utilize all three injection techniques together as one multi-layer injection approach with a tailored proportion of each technique based on the aesthetic needs of the patient.

Correction of temporal wasting using calcium hydroxylapatite with integral lidocaine: An underused procedure for enhancing overall facial appearance.

Hollowing of the temple area is an early sign of aging that is often overlooked, but when corrected, can lead to significant subject and physician satisfaction. To assess physician and subject awareness of the impact of temporal hollowing on appearance and to evaluate treatment satisfaction following injection of calcium hydroxylapatite with integral lidocaine (CaHA(+)). Subjects with temporal depression grade ≥2 on a validated Temple Hollowing Scale were recruited. CaHA(+) was injected supraperiosteally using a bolus technique. Photographs were taken prior to treatment and 30 days, and graded by three evaluating physicians using the Global Aesthetic Improvement Scale (GAIS) and Temple Hollowing Scale. The same physicians estimated subjects' age before and after treatment. Photographs were graded by patients as part of a satisfaction questionnaire. The study enrolled 10 subjects aged 32-68years old. Physician GAIS scores of subject appearance at 1month were rated as "very much improved" in 80% and "much improved" in 20% of subjects. Temple hollows were graded as 1 after treatment in 90% of subjects. Following blinded review of patients' true ages, estimates for subjects' perceived age were on average 4years younger than their actual age. Most subjects had not been aware of temple hollowing prior to treatment, but nine out of 10 were very to extremely satisfied with results, and all were willing to repeat treatment. No treatment complications were observed. Treatment of the temple area can have a dramatic aesthetic effect and should not be neglected when addressing facial rejuvenation. CaHA(+) is an effective and well-tolerated product for use in the temple area and is associated with a high degree of subject and physician satisfaction.

Primary Observation of the Causes of Temporal Hypertrophy Secondary to Fat Grafting and the Effect of Liposuction on the Hypertrophy.

In Asia, the temporal hollowing is considered to be a sign of bad fortune and aging. Many people demand to correct the temporal hollowing with fat grafting. Subsequently, the temporal hypertrophy secondary to fat grafting become more and more. This study attempted to preliminarily explore the causes of temporal hypertrophy and observe the safety and effectiveness of liposuction in correcting temporal hypertrophy. A diagnostic criteria for temporal hypertrophy was established, and 55 of 78 patients who complained of temporal swelling were defined as temporal hypertrophy, and filled out a questionnaire which included patients' basic information, preoperative, intraoperative, and postoperative problems related to fat grafting, as well as their acceptance of liposuction. Analyze the results of the questionnaire to explore which factors are associated with hypertrophy. Practice liposuction on patients who are willing to try liposuction. Postoperative complications were observed to determine the safety of liposuction. The patients, doctors, and bystanders were followed up 3 months postoperative to investigate the satisfaction of the operation for analyzing the effectiveness of liposuction for temporal hypertrophy. Before fat grafting, 13 (23.6%) patients without significant temporal hollowing and 42 (76.4%) patients with obvious temporal hollowing; 28 (50.9%) patients with 1 fat grafting, 20 (36.4%) with 2 fat gratings, 7 (12.7%) with 3 fat grafting. The mean time between 2 fat gratings was 4.8 months. The fat donor sites: 50 (90.9%) patients in thigh, 4 (7.3%) in abdomen, and in 1 (1.8%) in waist. The average onset time of hypertrophy in 55 patients was 13.1 months after the last fat grafting. The average onset time of temporal hypertrophy of the weight-gain group (25.7 months) was significant later than that of the weight-invariant group (7 months) (P < 0.01).No irregularities, skin necrosis, hematoma, or infection was found in all patients. One patient showed the damage to temporal branch of facial nerve on right side, which fully recovered at 1 week postoperative. 7 (22.6%) patients, 10 (32.3%) doctors, and 8 (25.8%) laypersons reported satisfactory results; 14 (45.2%) patients, 15 (48.4%) doctors, and 14 (45.2%) laypersons reported mostly satisfactory results; 10 (32.3%) patients, 6 (19.4%) doctors, and 9 (29.0%) laypersons reported dissatisfactory results. To prevent temporal hypertrophy, the following points are important: to rationally choose of indication of temporal fat grafting, to wait 1 to 2 years before next fat grafting, to maintain weight stability after fat grafting, to practice conservative fat grafting, to prudently choose fat donor site. Liposuction is safe for temporal hypertrophy, but it is not easy to operate and difficult to correct all cases. Therefore, a superior treatment plan should be explored.

Temporal Fat Grafting in Children With Craniofacial Anomalies.

Fat grafting is a common adjunct procedure used to treat temporal fat hollowing in children with craniofacial anomalies. The goal of this study was to assess the surgical and aesthetic outcomes of this procedure. We retrospectively reviewed patients who underwent temporal fat grafting at a single tertiary pediatric craniofacial center. The surgical outcome was assessed based on intraoperativeand 30-day postoperative complication rates. The aesthetic outcome was assessed by 3 independent investigators using a 3-point grading scale for preoperative temporal hollowing severity (1 = mild, 2 = moderate, 3 = severe) and a 5-point scale for postoperative improvement (0 = no, 1 = mild, 2 = moderate, 3 = significant, and 4 = complete improvement). Forty-three patients met inclusion criteria. Twenty-seven (63%) were male, 39 (91%) had a history of craniosynostosis, and 18 (42%) had associated syndromes. The mean age at fat grafting was 9.9 years (2.7-20.4, SD = 5.5) with an average follow-up time of 1.6 years (0-5.8, SD = 1.8). The average volume of fat grafted was 8.6 mL (0-30, SD = 5.9) to the right temporal region and 8.6 mL (0-30, SD = 5.8) to the left. There were no intraoperative or postoperative complications. The mean improvement score was 2.9 (1-4, SD = 0.7), demonstrating that most patients experienced moderate to significant improvement. Multiple linear regression analysis demonstrated that syndromic status had a negative impact on the aesthetic outcome (P < 0.001). These findings demonstrate that fat grafting is an effective method to treat temporal hollowing in children with craniofacial anomalies with no perioperative complications.

The mini-temporalis turnover flap for midface reanimation: Photogrammetric and patient-rated outcomes

Mini-temporalis transposition (MTT) flaps, modified from Gillies' technique, have become less popular than temporalis tendon transfers for midface reanimation. MTT involves raising the middle third of the temporalis, transposition over the zygomatic arch and lengthening with deep temporalis fascia which is sutured to the orbicularis oris. This retrospective study assessed subjective and objective outcomes following MTTs by a single surgeon from 2009 to 2019. Operative and surgical details were recorded. Four blinded consultants rated pre- and postoperative videos according to Terzis' scale. Pre- and postoperative resting, Mona Lisa and canine smile photographs were analysed using Emotrics, the software that automatically computes differences in inter-landmark distances. Patients also completed the Glasgow Benefit Inventory (GBI) patient-rated outcome measure. Forty-one patients (mean age 65.8 ± 15.5) underwent MTT, median 3 (0.4-57) years post-paralysis and were followed up for median of 2.2 (0.4-8.8) years. Higher mean postoperative Terzis score demonstrates symmetric and aesthetic improvements (3 ± 1.3 vs. 2 ± 1; p<0.05). Emotrics analysis showed postoperative improvements in resting and dynamic symmetry of all indices, with the majority statistically significant (p<0.003). The mean GBI was 35.19 with 17 (94.4%) patients reporting improvement, whereas one (5.6%) patient reported detriment after surgery. Two (5.4%) patients suffered complications: one haematoma and one infection. Four patients (9.8%) required revisional flap tightening. No patients requested revisional surgery for temporal hollowing or zygomatic fullness. MTT effectively improves both subjective and objective resting and dynamic midface symmetry in a single stage. These results suggest this technique is a good alternative to temporalis tendon transfer techniques.