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Adapting Injection Techniques to Different Regions
Published in Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh, Adapting Dermal Fillers in Clinical Practice, 2022
Yates Yen-Yu Chao, Sebastian Cotofana, Nicholas Moellhoff
The glabella is a critical area connecting the forehead to the brows, nose, and eyelids. It is a highly mobile structure with muscles of frontalis, corrugator, procerus, and orbicularis oculi interacting here. Additionally, many important vessels connecting the external carotid system and the internal one are distributed here, which makes the injection of filler more challenging and full of risks.
Anatomical Considerations to Improve Aesthetic Treatments Using Neuromodulators
Published in Yates Yen-Yu Chao, Optimizing Aesthetic Toxin Results, 2022
Nicholas Moellhoff, Sebastian Cotofana
Glabella lines result from contraction of the corrugator supercilii, the orbicularis oculi (depressor supercilii) and the procerus muscle. Vertical and horizontal glabellar lines are differentiated, depending on the axis of movement. As a rule of principle, the orientation of the rhytids is perpendicular to the muscle fascicle contraction. Thus, horizontal lines are caused by procerus muscle contraction, while vertical lines are predominantly caused by contraction of the corrugator supercilii muscle (pulling horizontally on the skin of the middle eyebrow), in combination with contraction of the medial component of the orbicularis oculi muscle, with lateral fibers of the procerus muscle also contributing to their formation.
The upper third of the face
Published in Jani van Loghem, Calcium Hydroxylapatite Soft Tissue Fillers, 2020
Yates Yen-Yu Chao, Jani van Loghem
The glabella area is also covered by the aponeurosis of procerus muscle, with only the most lateral border attached by the corrugator muscle. Contouring of this area can be achieved more easily using a similar hydrodissection technique, but the cannula has to pass through a more critical area near the medial brow. Thus, injectors have to be much more careful in this area.
Second intention healing of nasal ala and dorsum defects in Asians
Published in Journal of Dermatological Treatment, 2021
Wenyan Jin, Shan Jin, Zhouna Li, Zhehu Jin, Chenglong Jin
Maintaining the aesthetic subunits of the nose is an important factor to consider when repairing defects involving the nasal ala and dorsum. The nasal ala is a paired structural subunit of the nose that consists of three anatomically distinct layers: the external skin, the internal nasal lining, and the fibrofatty middle portion. Each layer is important in the reconstruction to integrate seamlessly with the nose, prevent scar contracture, and maintain nasal patency (10). The surface of each ala is separated from the nasal sidewalls by the alar groove. The ala is covered with thick, sebaceous skin that differs in color, texture, and mobility from the dorsum. The dorsum of the nose extends from the supratip depression to the glabella superiorly, where a transverse wrinkle perpendicular to the procerus muscle may mark its upper limit (11).
Specific complications associated with non-surgical rhinoplasty
Published in Journal of Cosmetic and Laser Therapy, 2020
Tuyet A. Nguyen, Shivani Reddy, Nima Gharavi
Skin and soft tissue necrosis are rare but serious complications of filler injection. It is thought that necrosis from filler injections can be caused by two mechanisms: 1) intravascular embolization through direct injection into a vessel or 2) vascular compromise from external pressure from the filler material (8). The angular, dorsal nasal, and supratrochlear arteries are particularly vulnerable to this complication, and are all possible targets in the application of filler for non-surgical rhinoplasty (9). The glabella is also a watershed area with minimal collateral circulation and small caliber vessels making it susceptible to external pressure and tamponade (10). Signs of impending necrosis include severe pain, blanching, edema, and violaceous discoloration (11–13). However, it is important to distinguish arterial from venous occlusion. While arterial occlusion is often immediately accompanied by pain and blanching, venous occlusion may not present with significant pain but demonstrates venous mottling or a livedo-like phenomenon (13). It is important to recognize features of impending necrosis to allow for early intervention and prevention of further complications.
A superficial nasal dermoid cyst excised through a novel horizontal zig-zag incision in a 49-year-old man
Published in Acta Oto-Laryngologica Case Reports, 2020
Jeremy Wales, Babak Alinasab, Ola Fridman-Bengtsson
A dermoid cyst of the nose is an uncommon midline anomaly that can present as a lump or draining sinus/fistula. The incidence is estimated between 1:20,000 and 1:40,000 [1]. The abnormality presents at the glabella, dorsum, tip or base of the columella of the nose. This can also present intra-nasally. If there is a sinus opening, a ‘cheesy material’ or hairs protruding through the punctum can be indicative of the diagnosis [2]. Nasal dermoid cysts (NDCs) account for 1% of all dermoid cysts of the body [3]. NDCs are unique in comparison to other dermoid cysts in the body as there is a potential for the involvement of deeper structures or to extend intracranially. This extension can put the patient at risk of meningitis, intracranial or orbital abscess, convulsions or cavernous sinus thrombosis with infection [4,5]. As this is a congenital lesion, the usual age of presentation is during childhood (mean age 14–34 months [2]). While presentation of NDCs in adults is rarer than in children, it does occur and Vaghela and Bradley collated 44 patients, aged 16 and over, from the previous 50 years of literature [4].