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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 infraorbital region is extremely delicate. It is subdivided into a medial and lateral part in relation to the medial margin of the pupil, which differ in their layered arrangement. Medially, the infraorbital region is made up of only three fascial layers, including skin (layer 1), orbicularis oculi muscle (layer 2), and periosteum (layer 3) (Mojallal et al., 2017). The angular vein is located in the depth of the nasojugal groove approximately 4 mm inferior to the inferior orbital rim and travels within the orbicularis oculi muscle from inferolateral to superomedial (Calomeni et al., 2022). The angular artery travels in a vertical orientation medial and parallel to the angular vein. Laterally, the infraorbital region is composed of seven fascial layers, including skin (layer 1), subcutaneous fat (layer 2), orbicularis oculi muscle (layer 3) (Figure 6.36), suborbicularis oculi fat (SOOF, layer 4), deep fascia (layer 5), preperiosteal fat within the prezygomatic space (layer 6), and periosteum (layer 7). The zygomatico-cutaneous ligament borders the SOOF inferiorly, while superiorly the orbicularis retaining ligament can be found (Figure 6.37). The zygomatico-cutaneous and orbicularis retaining ligaments fuse at the medial end of the SOOF, forming the tear trough ligament (Figure 6.38).
Facial anatomy
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
This vein is best understood by first appreciating its originating branches. The most distal supply of this vein arguably comes from the superficial temporal vein. This vein is which is situated on the lateral aspect of the top of the skull and forms a venous plexus with the frontal vein from the contralateral side of the skull. It proceeds to travel inferiorly along the anterior skull before joining the frontal and superior orbital veins which drain the forehead, eyelids and glabellar complex. Proximal to these anastomoses it is referred to as the angular vein, which then travels obliquely in an inferolateral direction on the lateral aspect of the nasal bone, draining tiny perforators from the skin overlying the nasal bridge before being joined by the vein of the nasal alar, otherwise known as the nasal arch. It is worth noting that the angular vein communicates with the ophthalmic vein and subsequently through these vessels blood can drain directly into the cavernous sinus, which can allow infections or emboli from the angular vein or its tributaries to easily cause complications such as intracerebral abscesses, infarction or encephalitis.
Periorbital Region and Tear Trough
Published in Ali Pirayesh, Dario Bertossi, Izolda Heydenrych, Aesthetic Facial Anatomy Essentials for Injections, 2020
Colin M. Morrison, Ruth Tevlin, Steven Liew, Vitaly Zholtikov, Haideh Hirmand, Steven Fagien
The facial vein gives rise to the angular vein. The latter may sometimes be accompanied by the cephalic branch of the infraorbital artery, by a duplexed angular artery, or by a detoured facial artery, which all travel in the TT channel.
Surgical success of ‘W’ shaped incision versus Tear Trough incision in External Dacryocystorhinostomy
Published in Orbit, 2022
Isha Acharya, Jolly Rohatgi, Pramod Kumar Sahu
Nevertheless, there were certain limitations of W incision encountered in our study as well. Surgical time was prolonged possibly due to time taken for fashioning, passing traction sutures, and suturing of the skin incision. Mild darkening of apices of the flaps was noticed at the end of surgery in 67.7% of patients. This complication was also mentioned by Ekinci et al. who postulated that it was due to vascular compromise to the tips of the triangular skin flaps.14 However, the darkening of skin flaps was temporary and had disappeared on the first postoperative day in all our cases. Superficial bleeding was more common in cases of ‘W’ incision as compared to tear trough incision, though the difference between our two groups was insignificant (p = 0.06). This could be due to the location of the W incision corresponding with the anatomical location of the angular vein and its branches.
An effective technique for managing vascular diameter discrepancies in microsurgery: tapering with a hemoclip
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Zulfukar Ulas Bali, Mustafa Kursat Evrenos, Berrak Karatan, Yavuz Kececi, Levent Yoleri
Of the 12 patients, the tapering technique with a hemoclip was applied in seven patients simultaneously, for both the vein and artery, and only for vein anastomosis in five patients (Table 1). All the patients underwent a single-vein anastomosis. Reconstruction of the patients’ veins was performed with ten free ALT flaps (Figures 5 and 6) and two free osteocutaneous iliac flaps. Six superficial temporal arteries (STA) and one frontal branch of the STA were used as a recipient artery in the seven patients who underwent head and neck vein reconstruction. The recipient vein was the superficial temporal vein (STV) in four cases and the angular vein (AV) in the other three cases. In the five patients who underwent lower extremity reconstruction, this technique was used only in vein anastomosis. The diameters of the vessels were measured with a micrometer. The luminal diameters of the arteries and veins of the flap and recipient differed by 1.6- to 3-fold and 1.5- to 2.6-fold, respectively. None of the cases required re-exploration. The patients were followed up for a median of 8.4 months. No complications occurred during the follow-up period.
Severe Intraoperative Orbital Venous Congestion during Resection of a Frontal Meningioma Presenting with Post-operative Vision Loss and Ophthalmoplegia: A Case Report
Published in Neuro-Ophthalmology, 2019
Victoria Leung, Ari Aharon Shemesh, Laila Al Shafai, Timo Krings, Taufik Valiante, Edward Margolin
Detailed review of pre-operative imaging revealed two plausible pathways of venous outflow from the meningioma: anterior and posterior. We believe that when the craniotomy was performed, transdural coagulation of the adjacent diploic venous plexus obliterated the posterior drainage pathway from the meningioma. This resulted in redirection of venous flow through the less dominant anterior pathway into the orbit via the angular vein. The anterior pathway became the sole channel for venous drainage from the highly vascular meningioma until it was entirely resected. As it took a few hours for the meningioma to be resected, excess inflow of venous blood resulted in a significant and sustained rise in right intraorbital venous pressure. This manifested in several ways, including: extraocular muscle congestion, ischemic optic neuropathy, central retinal artery occlusion, and large exudative retinal detachment.