Surgical Anatomy of the Midcheek: Facial Layers, Spaces, and the Midcheek Segments

Mendelson, Bryan C.; Jacobson, Steven R.

doi:10.1016/j.cps.2008.02.003

Cited by 169 publications

(104 citation statements)

References 29 publications

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“…With respect of the midface, flattening and furrowing of the central area of the midcheek is observed, with displacement medially exaggerating the depth of the nasolabial folds 4–7. In addition, the lower eyelid lengthens and the upper border of the malar fat pad becomes visible, leading to tear trough formation 4–6,8. Therefore, appropriate replacement of lost volume and provision of structure should correct these signs of aging, creating a more youthful appearance.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of a hyaluronic acid filler in subjects treated for correction of midface volume deficiency: a 24 month study

Callan¹,

Goodman²,

Carlisle³

et al. 2013

CCID

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BackgroundHyaluronic acid (HA) fillers are an established intervention for correcting facial volume deficiency. Few studies have evaluated treatment outcomes for longer than 6 months. The purpose of this study was to determine the durability of an HA filler in the correction of midface volume deficiency over 24 months, as independently evaluated by physician investigators and subjects.MethodsSubjects received treatment with Juvéderm™ Voluma™ to the malar area, based on the investigators’ determination of baseline severity and aesthetic goals. The treatment was administered in one or two sessions over an initial 4-week period. Supplementary treatment was permissible at week 78, based on protocol-defined criteria. A clinically meaningful response was predefined as at least a one-point improvement on the MidFace Volume Deficit Scale (MFVDS) and on the Global Aesthetic Improvement Scale (GAIS).ResultsOf the 103 subjects enrolled, 84% had moderate or significant volume deficiency at baseline. At the first post-treatment evaluation (week 8), 96% were documented to be MFVDS responders, with 98% and 100% graded as GAIS responders when assessed by the subjects and investigators, respectively. At week 78, 81.7% of subjects were still MFVDS responders, with 73.2% and 78.1% being GAIS responders, respectively. Seventy-two subjects completed the 24-month study, of whom 45 did not receive supplementary Voluma™ at week 78. Forty-three of the 45 (95.6%) subjects were MFVDS responders, with 82.2% and 91.1% being GAIS responders, respectively. At end of the study, 66/72 subjects were either satisfied or very satisfied with Voluma™, with 70/72 indicating that they would recommend the product to others. Adverse events were transient and infrequent, with injection site bruising and swelling being the most commonly reported.ConclusionVoluma™ is safe and effective in the correction of mild to severe facial volume deficiency, achieving long-term clinically meaningful results. There was a high degree of satisfaction with the treatment outcome over the 24 months of the study.

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Section: Introductionmentioning

confidence: 99%

Efficacy and safety of a hyaluronic acid filler in subjects treated for correction of midface volume deficiency: a 24 month study

Callan¹,

Goodman²,

Carlisle³

et al. 2013

CCID

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“…Numerous theories have been proposed and previously described to explain the orbitomalar sulcus [12–15]. Various anatomic factors were related to tear trough deformities.…”

Section: Discussionmentioning

confidence: 99%

Tear trough deformity: different types of anatomy and treatment options

Jiang¹,

Wang²,

Chen³

et al. 2016

pdia

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AimTo explore the efficacy of tear trough deformity treatment with the use of hyaluronic acid gel or autologous fat for soft tissue augmentation and fat repositioning via arcus marginalis release.Material and methodsSeventy-eight patients with the tear trough were divided into three groups. Class I has tear trough without bulging orbital fat or excess of the lower eyelid skin. Class II is associated with mild to moderate orbital fat bulging, without excess of the lower eyelid skin. Class III is associated with severe orbital fat bulging and excess of the lower eyelid skin. Class I or II was treated using hyaluronic acid gel or autologous fat injections. Class III was treated with fat repositioning via arcus marginalis release. The patients with a deep nasojugal groove of class III were treated with injecting autologous fat into the tear trough during fat repositioning lower blepharoplasty as a way of supplementing the volume added by the repositioned fat.ResultsSeventy-eight patients with tear trough deformity were confirmed from photographs taken before and after surgery. There were some complications, but all had complete resolution.ConclusionsPatients with mild to moderate peri-orbital volume loss without severe orbital fat bulging may be good candidates for hyaluronic acid filler or fat grafting alone. However, patients with more pronounced deformities, severe orbital fat bulging and excess of the lower eyelid skin are often better served by fat repositioning via arcus marginalis release and fat grafting.

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“…Loss of bone and soft tissue volume, redistribution of fat, and decreased dermal elasticity and thickness contribute to the formation of wrinkles and folds, which commonly characterize the aging process 3. In the case of the mid-face, an age-related decline in tensile strength of tissues supporting the nasolabial segment results in flattening and furrowing of the central area of the mid-cheek while displacement medially exaggerates the volume and depth of the nasolabial fold (NLF) 4–6. Correction of facial lines and wrinkles, as well as restoration and alteration in facial shape, are key approaches to the rejuvenation and enhancement of facial appearance 4,7.…”

Section: Introductionmentioning

confidence: 99%

A comparison of the efficacy, safety, and longevity of two different hyaluronic acid dermal fillers in the treatment of severe nasolabial folds: a multicenter, prospective, randomized, controlled, single-blind, within-subject study

Goodman¹,

Bekhor²,

Rich³

et al. 2011

CCID

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BackgroundCommercially available hyaluronic acid (HA)-based fillers have distinct physicochemical properties related to their specific manufacturing technology, including HA concentration, cross-linking percentage, and particle size. These factors may determine treatment effectiveness, safety, and longevity; however, this requires confirmation in the clinic.MethodsTo compare the efficacy, safety, and longevity of two distinct HA-based dermal fillers in the correction of severe nasolabial folds (NLFs), a 24 mg/mL smooth gel (Juvederm ULTRA PLUS™ [JUP]) and a 20 mg/mL particulate gel (Perlane® [PER]) were injected in a total of 80 normal, healthy subjects using a split face design and were followed for 12 months in this prospective, randomized, controlled, multicenter study.ResultsBoth fillers achieved a clinically relevant NLF correction (one point or more improvement, based on a validated NLF severity scale). However, JUP displayed greater longevity, with this correction maintained in a significantly larger percentage of NLFs after 6 months (physician’s evaluation) or 9 months (subject’s evaluation) and thereafter for the remainder of the study (70% vs 45%; P = 0.0002 and 62.5% vs 46.3%; P = 0.01 at month 12, based on physician and subject assessments, respectively). At month 12, 71.4% of the subjects nominated a preference for the NLF injected with JUP (P < 0.0001). Both treatments were well tolerated.ConclusionThese results suggest that different physicochemical properties of HA-based fillers, associated with distinct manufacturing technologies, may influence treatment longevity in the correction of volume deficits. This may relate to a differential resistance to hyaluronidase and/or free radical degradation as previously documented in vitro.

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Surgical Anatomy of the Midcheek: Facial Layers, Spaces, and the Midcheek Segments

Cited by 169 publications

References 29 publications

Efficacy and safety of a hyaluronic acid filler in subjects treated for correction of midface volume deficiency: a 24 month study

Efficacy and safety of a hyaluronic acid filler in subjects treated for correction of midface volume deficiency: a 24 month study

Tear trough deformity: different types of anatomy and treatment options

A comparison of the efficacy, safety, and longevity of two different hyaluronic acid dermal fillers in the treatment of severe nasolabial folds: a multicenter, prospective, randomized, controlled, single-blind, within-subject study

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