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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
Nasolabial fold filler injection is a very frequently requested procedure. The nasolabial sulcus is a normal facial contour that exists in almost everyone from childhood to old. Filler treatment of the nasolabial fold should aim to modify its pattern or depth, not to remove it, as what is considered undesirable is its senile appearance, not the fold itself. The anatomic basis for the formation of the nasolabial sulcus is the dermal insertion of the LLSAN, zygomaticus minor, zygomaticus major, and levator anguli oris muscles. These muscles originate from the bone and travel superficially to reach the dermal undersurface. This insertion of muscles forms a natural boundary for the superficial nasolabial fat compartment that is one of the most mobile superficial (subdermal) fat compartments of the face. With increasing age and loss of bony fundament of the midface, the midfacial soft tissues descend. This descent, however, is blocked by the dermal insertion of the facial muscles, which causes the superficial nasolabial fat compartment to bulge above the sulcus, generating the clinical appearance of a deep nasolabial fold.
Dermal fillers
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
Nasolabial folds are skin creases from the nasal alar which extend inferolaterally adjacent to the corners of the mouth. They become more prominent as we age due to the intrinsic loss of volume and elasticity within the cheeks and a lifetime of repeated facial movements. As these creases become more apparent as patients get older, many people seek dermal filler augmentation to smoothen these lines and thus make them less prominent.
The middle third of the face
Published in Jani van Loghem, Calcium Hydroxylapatite Soft Tissue Fillers, 2020
The nasolabial folds are probably the most requested filler indication, and it is often the indication that is treated as a first choice by novel filler injectors. The nasolabial fold is located at the medial border of the nasolabial fat compartment and extends from the lateral ala, where we find the deepest point, to lateral to the oral commissures. At the nasolabial fold, different facial muscles insert into the skin, making it not only a static fold, but also having a dynamic component. The aging process results in descent of soft tissue of the cheeks, and the nasolabial fold is where the superficial nasolabial fat compartment gets stopped in this descent, causing it to fall over the muscle insertions in the skin. Bone resorption at the maxilla adds to a deepened aspect of the superior part of the nasolabial fold, dermal loss of collagen adds to sharpness of the fold, and subcutaneous volume loss adds to deepening of the fold itself [1].
The efficacy and safety of DermalaxTM DEEP in the correction of moderate to severe nasolabial folds: a multicenter, randomized, double-blind clinical study
Published in Journal of Dermatological Treatment, 2021
Ju Qiao, Feng Li, Hong-Zhong Jin, Xiu-Min Yang, Hong Fang, Li Li, Wei Zhang, Xin-Feng Wu, Min Zheng, Qian-Nan Jia
With the aging process, the skin shows loss of soft tissue volume due to a combination of fat and bone absorption, and the maxillofacial region is typically deepened by bilateral nasolabial folds (1). For the past few years, various methods and materials which could help to restore facial volume with injectable devices have been extensively introduced. Hyaluronic acid (HA) is a normal component of human skin, with a low degree of immunogenicity (2) that is due to the quality of chemical identity across all species (3), which has become a favorite choice as temporary filler for facial augmentation agents with less risk. In large part because HA has several advantages over other fillers’ agent. Numerous studies have demonstrated that HA dermal fillers have better persistence than older collagen-containing products (4–6). The favorable physical properties of HA include ease of administration, resistance to deformation after injection (7), acceptable persistence, biocompatibility, and reversibility with hyaluronidase (8). HA can attract water to keep skin elasticity and moisturized (5).
Vascular complications with injection implants: treatment with hyperbaric chamber
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Danuza Dias Alves, Honório Sampaio Menezes, Roberto Chacur, Rodrigo Cadore Mafaldo, Nívea Maria Bordin da Silva Chacur, Leandro Dias Gomes, Raíssa Nardi, Gabriella Andressa Marchesin de Castro, Vanessa Pletsch Brendler Borges, Manuela Guimarães Dias Gomes
A female, 47-year-old patient underwent treatment for nasolabial folds. Polymethylmethacrylate (PMMA) 10% was injected with a 22 G microcannula. Local anesthesia of lidocaine 2% was administered, then the cannula was introduced through the right oral commissure. At that moment, the patient moved abruptly and reported feeling pain. Although the cannula had already been inserted, the filler had not yet been injected. A retrograde injection of 0.4 mL of PMMA in total was administered. As soon as injected, when removing the cannula, the responsible doctor noticed edema in the region of the nasolabial folds, which spread to the malar region, and the patient reported discomfort at the site. Then, the immediate formation of a small hematoma was observed in the cannula path and, after five minutes, the skin presented a livedoid aspect in the entire cheek region. The protocol for treating occlusion, which consists of severe massage in the region, application of hot compresses, prescription of acetylsalicylic acid (ASA) 300 mg, prednisone 20 mg and prophylactic antibiotic, was started at this moment. The doctor massaged vigorously the region and applied hot compresses. After action was taken, the patient remained in the clinic under observation for approximately one hour. As the patient reported that the pain had ceased, and a relative improvement was observed; she was prescribed antibiotics and sent home.
Modified cheek advancement flap for medial lower eyelid, nasal sidewall and infraorbital cheek reconstruction: a case series
Published in Orbit, 2020
Giorgio Albanese, Shivani Kasbekar, Lorraine C. Abercrombie
The MCAF is a one-incision flap. The incision is performed along the nasal sidewall and extended into the nasolabial fold. The length of the incision depends upon the amount of tissue to be recruited. However, crossing the midpoint between nasal ala and lip is usually not necessary and could result in lip deformity. The flap is then raised by undermining the subcutaneous tissue around the infero-lateral edges of the defect within the malar and naso-labial fat pads . The lateral edge of the defect is used as leading edge of the flap. Prolene sutures are used to anchor the flap to the periosteum in order to minimise vertical traction and eyelid distortion. Wound closure is subsequently completed in layers. Subcutaneous tissue is closed with 5–0 polyglactin sutures, whereas skin closure is achieved with vertical mattress 6–0 prolene along the nasolabial fold and interrupted 7–0 polyglactin sutures in the periorbital area. A pressure dressing was applied in all cases and kept in place for 7 days (Figure 2).