The Relationship between Bone Remodeling and the Clockwise Rotation of the Facial Skeleton: A Computed Tomographic Imaging–Based Evaluation

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Background The arrangement of the facial soft tissue layers is different with respect to the line of ligaments: medially oblique and laterally in parallel. Aims This split‐face study was designed to investigate the effects on midfacial volumization if the same medial vs lateral injection points are targeted in various sequences. Methods Twelve patients (3 males, 9 females; 46.67 years ± 4.5) were included in this interventional study. On the right side of the face, lateral injection points were performed first, whereas on the left side, medial injection points were executed first. The infraorbital hollowness score, the upper cheek fullness score, the global aesthetic improvement scale, and the injected volume were assessed. Results No side differences were observed after the intervention with P = 1.00 for all scores. When the lateral injection points were performed first, the volume injected into the medially located injection points (0.46 ± 0.26 cc vs 0.73 ± 0.31 cc [P = .037]), into the lateral injection points (0.79 ± 0.40 cc vs 1.15 ± 0.28 cc [P = .017]), and overall (1.26 ± 0.64 cc vs 1.88 ± 0.57 cc [P = .02]) was significantly reduced. Conclusion The results of the present study emphasize the importance of respecting the layered arrangement of the facial soft tissues when performing minimally invasive soft tissue filler injections. Targeting injection points lateral to the line of ligaments first reduces the volume needed to symmetrically and aesthetically appealing manner and volumizes the infraorbital and upper cheek regions.

Section: Introductionmentioning

confidence: 99%

Lifting vs volumizing—The difference in facial minimally invasive procedures when respecting the line of ligaments

Casabona¹,

Frank

Koban

et al. 2019

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“…It could be speculated that in males, a greater effect could be expected as the muscular response might be larger resulting a greater volume increase of the temporal fossa. On the other side, it can be speculated that age might result in a limited effect of temporal volumization, as with increasing age the soft tissue of the temple additionally contributes to temporal hollowing 13‐17 . Future clinical trials should account for various gender‐ and age‐related factors to best elaborate on the results and discussions presented herein.…”

Section: Discussionmentioning

confidence: 92%

“…On the other side, it can be speculated that age might result in a limited effect of temporal volumization, as with increasing age the soft tissue of the temple additionally contributes to temporal hollowing. [13][14][15][16][17] Future clinical trials should account for various gender-and age-related factors to best elaborate on the results and discussions presented herein.…”

Section: Temporal Volume Scalementioning

confidence: 99%

Temporal volume increase after reduction of masseteric hypertrophy utilizing incobotulinumtoxin type A

Nikolis

Enright²,

Rudolph

et al. 2020

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Background:Treating the lower face with neuromodulators and targeting the masseter muscle can reduce masseteric hypertrophy but can also change the facial shape.A novel observation after the treatment of the masseter muscle with incobotulinumtoxin Type A was the increase in temporal volume. Aim:Objectively assess temporal volume increase following treatment of masseteric hypertrophy using incobotulinumtoxin Type A.Methods: Nine female patients with a mean age of 35.11 years ± 9.1 [Asian (11.1%) and Caucasian (88.9%)] were treated with incobotulinumtoxin Type A for masseteric hypertrophy. Masseteric prominence and temporal volume were assessed by two independent raters, and temporal fossa volume was measured via 3-dimensional volumetric imaging.Results: Independent of the neuromodulator injection technique (ie, single-injection versus multi-injection), a reduction in masseteric hypertrophy occurred represented by a decrease in the masseter prominence scale. In addition, the treatment resulted in a significant improvement of the temporal volume scale and an increase in the measured volume of the temporal fossa. None of the presented measurements were statistically significantly different between the two utilized injection techniques. Conclusions:This study supports using a full-face approach when performing aesthetic treatments. Anatomical concepts can help to guide treatments: the compensatory increase in temporalis function after masseter muscle treatment resulted in an increased in temporal fossa volume. The findings presented herein should not be considered as a new concept for treating the temporal fossa but rather as an additional possibility for increasing the temporal volume. K E Y W O R D S facial anatomy, incobotulinumtoxin type A, masseteric hypertrophy, neuromodulator, temporal hollowing, temporal volume | 1295 NIKOLIS et aL.

“…Facial aging is a multifactorial process involving all tissues of the face: bones, muscles, ligaments, fat, and skin. [1][2][3][4][5] Despite the fact that each tissue ages at its own pace and starts at a different time point, the visible signs of facial aging can be observed in each individual. 6 Soft tissue descent, facial volume loss, and alterations in skin texture and color are the main reasons why patients seek esthetic advice and treatment.…”

Section: Introductionmentioning

confidence: 99%

“…esthetic effects, facial anatomy, fascial layers, safety, soft tissue fillers, temple is due to the anthropometric differences between a male and female skull. [2][3][4] In general, the temporal region extends between the zygomatic arch (inferior) and the temporal crest (superior) and between the lateral orbital margin (anterior) and the occipital boundary of the temporalis muscle which is 1-3 cm posterior to a vertical line passing through the external auditory meatus (posterior). The posterior boundary of the temple is of less clinical importance as it is covered by hair.…”

Section: Introductionmentioning

confidence: 99%

The six different injection techniques for the temple relevant for soft tissue filler augmentation procedures – Clinical anatomy and danger zones

Cotofana

Gaete²,

Hernandez

et al. 2020

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Objective The most promising facial region for inducing pan‐facial effects is the temporal region. The temple displays signs of facial aging itself which include temporal volume loss and increased visibility of the temporal crest, the temporal vasculature, the lateral orbital rim, and the upper zygomatic arch. The objective of this article is to provide a detailed review of temple anatomy pertaining to routinely performed temporal injection techniques, their expected esthetic outcomes as well as the intendant advantages, disadvantages, and procedure pearls. Materials and Methods This narrative review is based on the clinical experience of the authors treating the temporal region for esthetic purposes. The postulated outcome of each technique was observed during the routine clinical practice of the authors. Results The temporal region is based on a bony platform consisting of the parietal, frontal, sphenoid, and temporal bones. The overlying soft tissues are arranged in layers which contain the temporal neurovascular structures. The temporal soft tissues consist of 10 parallel layers which vary in their thickness depending on age‐related influences. Six different techniques will be addressed, which include subdermal and interfascial techniques for volumizing, low and high supraperiosteal techniques for volumizing, and supraauricular and temporal lifting techniques. Conclusion This narrative provides a detailed anatomic overview of the temporal region and describes each commonly performed injection technique with respect to anatomy, esthetic outcome, as well as potential pearls and pitfalls. It is hoped that the description contained herein may guide esthetic practitioners toward safer and more natural outcomes when treating the face.