The anatomy of the human face has received intensive attention during the last decade, as procedures of facial rejuvenation are being performed with increasing frequency and in numerous varieties. Several new anatomic structures have been identified, which help to understand one of the most complex areas of the human body (►Fig. 1). A plethora of invasive and noninvasive procedures have been introduced to reduce the signs of aging and to restore the youthful appearance of the face. As each of the different procedures is based on the underlying facial anatomy, the understanding of its three-dimensional composition and layered concept is crucial for safe, natural, and long-lasting applications. 1The trend in facial rejuvenative procedures points toward a more natural look compared with the previous empiric approaches, which resulted in a "pulled back" look.2 Today's rejuvenative options try to restore the natural balance between the different facial structures and facial layers and thus to give back to face what is lost during aging processes. 1Aging is the result of the interplay of changes occurring in the facial skeleton, facial ligaments, facial muscles, facial adipose tissue, and skin. These changes befall each mentioned structure at a different pace, start in each individual at a different age, and differ between ethnic background.3 Therefore, it is hard to estimate which structure is mainly causative Keywords ► facial bones ► fat compartments ► facial muscles ► facial ligaments ► aging AbstractRejuvenative procedures of the face are increasing in numbers, and a plethora of different therapeutic options are available today. Every procedure should aim for the patient's safety first and then for natural and long-lasting results. The face is one of the most complex regions in the human body and research continuously reveals new insights into the complex interplay of the different participating structures. Bone, ligaments, muscles, fat, and skin are the key players in the layered arrangement of the face. Aging occurs in all involved facial structures but the onset and the speed of age-related changes differ between each specific structure, between each individual, and between different ethnic groups. Therefore, knowledge of age-related anatomy is crucial for a physician's work when trying to restore a youthful face. This review focuses on the current understanding of the anatomy of the human face and tries to elucidate the morphological changes during aging of bone, ligaments, muscles, and fat, and their role in rejuvenative procedures.

No abstract

BACKGROUND Topical application, oral and IV injection of Tranexamic acid (TXA) have been used to reduce surgical bleeding.OBJECTIVE To evaluate the safety and efficacy of TXA injected subcutaneously to reduce bleeding during dermatologic surgery.METHODS In this double-blinded, placebo controlled, randomized prospective study, 131 patients were randomized to subcutaneous injection of lidocaine 2% diluted 1:1 with either saline (placebo) or TXA 100mg/1ml prior to surgery. Before the second stage or closure, size measurements of bloodstain impregnation on Telfa and surgical wound size were recorded and analyzed using mixed-effects linear regression. Subjective evaluation of hemostasis was performed using 4-point scale grading and analyzed using Fischer's exact test.RESULTS 127 patients completed the study. The bloodstain to surgical wound size ratio was smaller in the TXA group (1.77) compared to the placebo group (2.49) (p<0.001). An improved effect of TXA on bleeding was observed in the subgroup of patients receiving anticoagulants (MD; 95% CI; -0.83; -1.20 to -0.46 p<0.001). The subjective hemostasis assessment was significantly better in the TXA group overall (p=0.043) and anticoagulant subgroup (p=0.001) compared to the placebo group. CONCLUSION Subcutaneous injection of TXA was safe, reduced bleeding during dermatologic surgery and particularly effective for patients receiving anticoagulation treatment.