3D Stereophotogrammetry Quantitative Lip Analysis

Background  Reduction in lip volume is a stigmata of the aging face. There are many lip augmentation techniques but very few studies analyzing how these techniques change the three-dimensional structure of the lips. Furthermore, there is no consensus about whether the lip position should be standardized to either the lips closed or parted. The aim of this study was first to obtain a three-dimensional quantitative analysis of the lips in adults and to look for sexual dimorphism and, second, to compare whether more consistent measurements of the oral region can be obtained with the mouth open compared with it closed. Methods  Seventy young Caucasian volunteers underwent lip dimension analysis using 3D stereophotogrammetry with lips parted and closed. Parameters measured for consistency of results were linear distances (e.g., mouth width, total lip height, upper lip height), surface distances (e.g., upper vermilion), areas (e.g., vermilion upper and lower lip, total vermilion), and volumes (upper and lower lip volume, total lip volume). Analysis also compared lip dimensions between male and female subjects. Results  Consistent and reproducible results were seen with the lips closed compared with lips apart. All lip parameters (distances, areas, and volumes) were larger in men than in women. The following measurements had significant differences between males and females: mouth width, upper lip height median, upper white lip height median, upper white lip height lateral, lower vermilion surface distance, and area of vermilion (p < 0.05). Conclusion  We present a novel technique for aesthetic assessment of the lips that is objective and achieves consistency with the lips in the closed position. Males have greater lip dimensions compared with females.     

Facial soft tissue augmentation with Artecoll?: A review of eight years of clinical experience in 153 patients

OBJECTIVE:

Artecoll (Canderm Pharma Inc, Canada) is a semipermanent, injectable, soft tissue filler composed of uniform polymethylmethacrylate microspheres in a bovine collagen gel, which has been used in Europe over the past decade. The authors review their experience using Artecoll as an injectable material for the correction of deep static folds of the face, improvement of nasal asymmetries following rhinoplasty, depressed acne scars and augmentation of the lip.

METHOD:

A retrospective chart review, subjective patient satisfaction feedback and objective findings noted by the senior author were performed over an eight-year period. A total of 153 patients were treated with Artecoll injections; 74 underwent lip augmentation, 21 underwent deep nasolabial fold augmentation, eight underwent glabellar fold augmentation, 26 were treated for minor nasal dorsal irregularities and 24 were treated for depressed acne scars.

RESULTS:

No early or delayed allergic responses were reported. Complications occurred most commonly with lip augmentation, in which 13.5% of patients noted significant noticeable bruising postinjection that resolved completely within one week, 51.3% had detectable implant on palpation, and 13.1% required further intervention with massage, steroid injection and/or local excision to correct for lumpiness. Sixty per cent of patients requiring further intervention responded successfully, while local excision was performed on the two patients who failed to respond after six months of massage and steroid therapy. Overall, a total of 11 patients (14.9%) had minor asymmetries or less than optimal results within the lip augmentation study group. Among other sites, the most common complaint was undercorrection of the fold or wrinkle.

CONCLUSION:

Based on the authors’ experience, Artecoll is a safe, viable option for long-term treatment of deep facial wrinkles, nasal asymmetry, hypoplastic or atrophic lips, and depressed acne scars, and the results have been accompanied by a high degree of patient satisfaction. Although the implant is often palpable, rarely does it cause significant visible lumps. Its use and applications as a semipermanent injectable agent certainly warrant further investigation.     

Augmentation cheiloplasty by using mucomuscular flaps

If one excludes the controversial use of silicone injections and the not fully researched new biomaterials for implant (e.g., Gore-Tex), there are no lip augmentation techniques that give stable and lasting results. Collagen and dermal or fascial grafts are almost always reabsorbed. Local flaps (either W or V/Y) give only a slight outward protrusion of the lips and do not increase volume and therefore have negligible cosmetic impact. In plastic surgery flap rotation is standard practice when the objective is stable tissue reconstruction. We feel that this technique achieves lasting increases in lip volume. Therefore, we propose the rotation of a mucous-muscle flap obtained from the inner cheek wall or from the other lip, the fulcrum of which is the labial commissure. The surgical technique is given in detail here together with the results and complications of 28 cases.Presented at the 12th International ISAPS Congress, Paris, France, September 7, 1993     

A New ePTFE Soft Tissue Implant for Natural-Looking Augmentation of Lips and Wrinkles

BACKGROUND: Expanded polytetrafluoroethylene (ePTFE) implants have been used for augmentation of thinning lips and wrinkles due to aging for more than 10 years. The aesthetic results have often been excellent, but complications such as infection, extrusion, migration, shrinkage, and hardening have occurred in some patients. OBJECTIVE: To assess short-term results and complications in patients undergoing augmentation of the lips, nasolabial folds, and marionette lines with a newly designed ePTFE implant. METHODS: Thirty patients received 60 Advanta ePTFE implants for augmentation of the lips, nasolabial folds, or marionette lines. RESULTS: All patients received a natural-looking augmentation following 3-4 days of noticeable swelling. The only significant complications involved two upper lip implants that were removed for suspected infection. CONCLUSION: In a preliminary series, Advanta ePTFE implants provided effective, natural-looking augmentation of the lips and nasolabial folds with minimal complications.     

Lip Rejuvenation

BACKGROUND . The management of the senile lip remains a dilemma. Allogenic fillers often feel unnatural, lip resurfacing is not adequate, and fat transfers may disappear.
OBJECTIVE . To develop a more reliable step-by-step approach to lip augmentation.
METHOD . Lips were divided into types: (1) the simple senile lip that had lost its fullness—treated with fat augmentation; (2) the lip with rhagades—treated with fat augmentation and laser resurfacing; and (3) the duckbill lip—treated with lip advancement, fat augmentation, and laser resurfacing. Tattooing to increase the degree of redness was performed on all types of lips.
RESULT . If there had been a previously full lip, it was possible to rejuvenate the lip by simple augmentation with autologous fat transfer. The average number of fat transfer sessions to generate this pleasing lip was two to three. The lip with rhagades required fat filling, with laser resurfacing to achieve a new contour. The duckbill lip required a lip advancement along with lipofilling and laser resurfacing. All types benefited from lip tattooing.
CONCLUSIONS . It was possible with fat augmentation and/or laser resurfacing to generate a pleasing lip in type 1 and 2 lips. Lip type 3 required a lip advancement along with fat augmentation and laser resurfacing. Lip tattooing accentuated all the lip types.     

Use of expanded polytetrafluoroethylene in aesthetic surgery of the face

Aesthetic surgery procedures and materials available to improve the appearance of various subunits of the face have been evolving for the past several decades. Initially, techniques such as direct excision or placement of autogenous tissue grafts (e.g., fat, fascia, tendon, and dermal fat grafts) were used. Additional options became available with the development of silicone, injectable collagen, and ePTFE. These options for facial augmentation can be done rapidly in an office setting and as an outpatient. An important aspect of treatment is discussing clearly all pertinent options with the patient, and recommending the appropriate option based on the patient's anatomic findings and personal needs. For example, patients desiring lip augmentation but unsure about the result may be best treated with collagen injection, which gives temporary results and lets the patient consider a long-term result provided by ePTFE or autogenous grafts. Use of ePTFE in facial aesthetic surgery gradually has increased over the past two decades. Its use in augmentation of lips, nasolabial creases, and nose is becoming an important treatment modality for aesthetic surgeons.     

Restoration of the Lip Roll with Gore-Tex

Gore-Tex has been used by the author for the past 2 years to enhance the vermillion border of the lips by emphasizing that a natural pocket exists between the skin and the orbicularis muscle all along the white roll where a Gore-Tex implant can be easily placed. The overlying skin is thick providing a good protection of this material, and such a thickness necessitates that this protection is provided. If a complication occurs from its use, then the implant can be easily removed without any damage to the adjacent tissues.     

Gore-Tex chin implants: a review of 324 cases

Augmentation of the chin is a long-standing and effective technique for facial enhancement. We have used preformed expanded polytetrafluoroethylene (Gore-Tex) implants for chin augmentation for several years. For this study, we collectively pooled data detailing our experiences with this material. From January 1, 1998, to March 30, 2001, a total of 324 Gore-Tex chin implants were placed. No resorption or visible movement of any implant occurred. Two (0.62%) of the 324 implants became infected and were ultimately removed. No other complications occurred. This complication rate compares favorably to other reports. Five implants (1.5%) were removed or changed in size due to patient requests. All remaining patients (97.8%) were satisfied with their result. We also describe technical points and procedure modifications that have helped us achieve beneficial results for our patients. Gore-Tex is a reliable implant material that helps the surgeon to achieve a high degree of patient satisfaction in chin augmentation.     

A new classification of lip zones to customize injectable lip augmentation

OBJECTIVES: To present a new classification of 15 anatomical lip zones used to direct placement of injectable fillers during lip augmentation and to evaluate the new classification's ability to customize lip contour and size. METHODS: Study participants were consecutive patients presenting to a facial plastic and reconstructive surgery practice for injectable lip augmentation with a nonanimal-sourced stabilized hyaluronic acid (Restylane; Medicis Aesthetic Inc, Scottsdale, Arizona). A nonrandomized, prospective case series. RESULTS: A total of 137 treatments were performed on lips of 66 patients. The mean (SD) satisfaction score was 4.5 (0.6) on an integral scale of 1 (dissatisfied) to 5 (most satisfied). The mean (SD) persistence until lips returned to preoperative appearance based on patient subjective evaluation was 4.9 (1.5) months. Patients were free of adverse effects. CONCLUSIONS: Using a new classification of lip anatomical zones to direct the injection of a nonanimal-sourced stabilized hyaluronic acid has increased my ability to better control lip shape and size in lip augmentation. This technique was met with high patient satisfaction and no adverse effects. Persistence of injected nonanimal-sourced stabilized hyaluronic acid was similar to that seen in other studies.     

汉族青年女性口唇形态与面型的相关性研究

目的:测量汉族青年女性唇部软组织正常值,探讨唇部软组织正常值间相关性以及与面型的关系。方法:选择2012~2013级在校女学生(共70名,年龄18~19岁;均为汉族),采用面部软组织直接测量口唇各部高度均值、口列宽度均值、正面三庭均值、面宽均值、形态面高和容貌面高均值、内眦距离均值。结果:面部软组织直接测量获得口唇各部高度均值(唇高:3.45±0.608、上唇高:1.95±0.317、上白唇高:1.29±0.326、上红唇高:0.67±0.201、下唇高:1.55±0.349、下白唇高:0.79±0.336、下红唇高:0.77±0.199、上下红唇高:1.48±0.297)cm、口列宽度均值(4.37±0.341)cm、正面三庭均值(上庭:5.92±0.770、中庭:5.75±0.427、下庭6.07±0.607)cm、面宽均值(14.40±1.174)cm、形态面高(11.85±1.144)cm和容貌面高(18.59±1.234)cm均值、内眦距离均值(3.32±0.339)cm。结论:1建立青年女性口唇形态测量相关指标的正常参考值;2口裂宽与内眦距离(P=0.005)、上唇高(P=0.000)、唇高(P=0.007)有正相关(P0.01),唇形态改变的趋势是越厚越宽,越窄越薄;3上唇高(P=0.043)、下唇高(P=0.004)和唇高(P=0.011)与上庭有正相关;4唇高与唇各部高度(除下红唇高无相关)均呈正相关,且与上唇高和下唇高相关性显著(P=0.000);上唇高与唇各部高度(除下白唇高无相关)均呈正相关,且与上红唇高、上下红唇高、上白唇高及唇高相关性显著(P=0.000),而与下红唇高有相关性(P=0.002),且上红唇高对上唇高影响较上白唇高影响大;下唇高与下白唇高(P=0.000)、唇高(P=0.000)相关性显著,颏唇沟位置对下唇高度影响大;上红唇高与上下红唇高相关性显著(P=0.000);(P0.01);5唇各部高度和宽度与容貌面高、形态面高和面宽无相关性(P0.05)。6以上唇形态正常参考值及相关性对整形外科提供形态学基础。     

Evaluation of the Radiance FN soft tissue filler for facial soft tissue augmentation

OBJECTIVE: To evaluate the clinical efficacy and patient satisfaction of Radiance FN (fine needle) (BioForm Inc, Franksville, Wis), a highly biocompatible, calcium hydroxylapatite-based implant, when used for facial soft tissue augmentation. METHODS: Ninety patients aged between 25 and 85 years underwent subdermal injection with Radiance FN. The primary areas treated were lips, nasolabial folds, glabellar rhytids, marionette lines, prejowl depressions, acne scars, and surgical soft tissue defects. Patients were surveyed after treatment and for up to 6 months for pain, ecchymosis, skin erythema, nodules, softness, appearance, and satisfaction. RESULTS: In terms of efficacy, at 6 months, appearance, softness, and overall patient satisfaction were rated good or excellent in 74%, 80%, and 88% of patients, respectively. Moderate or severe pain occurred with injection in 59% of patients but disappeared 2 to 5 minutes after injection. Erythema, edema, and ecchymosis were common immediately after treatment but resolved in all patients within 2 weeks. Seven patients had persistent visible mucosal lip nodules, 4 of whom required intervention. CONCLUSIONS: Radiance FN is highly effective and well tolerated when used for facial soft tissue augmentation. Additional experience with longer follow-up will help determine the most appropriate use and long-term safety for the implant.     

Advanta implants

Advanta is a new expanded polytetrafluoroethylene implant with dual porosity that can be used to enhance facial features. It is marketed for use in the areas of the nasolabial folds, marionette lines, and glabella and also to augment lips. Advanta implants provide a quick and effective method for facial augmentation. The implants feel soft and natural and the complication rate is low.     

The use of Gore-Tex Soft Tissue Patch to assist temporal muscle transfer in the treatment of facial nerve palsy.

Temporal muscle transfer remains one of the most widely practiced procedures in dynamic correction of paralysis of facial nerves. In case of shortage of temporal muscle volume, length, and strength, some type of autogenous tissue or implant is required to achieve great stretching and excursion. Several artificial materials have been used in the past, each with its own limitations or problems. We used Gore-Tex Soft Tissue Patch to lengthen and strengthen the muscle-fascia strip. This material is very successful as an implant; it shows excellent tissue tolerance, the porous microstructure encourages tissue attachment and infiltration, and it also resists infection. As a result, reasonable suspension and restoration of orbital and oral sphincters were achieved.     

Cement augmentation of implants—no general cure in osteoporotic fracture treatment. A biomechanical study on non‐displaced femoral neck fractures

Femoral neck fractures in the elderly are a common problem in orthopedics. Augmentation of screw fixation with bone cement can provide better stability of implants and lower the risk of secondary displacement. This study aimed to investigate whether cement augmentation of three cannulated screws in non‐displaced femoral neck fractures could increase implant fixation. A femoral neck fracture was simulated in six paired human cadaveric femora and stabilized with three 7.3 mm cannulated screws. Pairs were divided into two groups: conventional instrumentation versus additional cement augmentation of screw tips with 2 ml TraumacemV+ each. Biomechanical testing was performed by applying cyclic axial load until failure. Failure cycles, axial head displacement, screw angle changes, telescoping and screw cut‐out were evaluated. Failure (15 mm actuator displacement) occurred in the augmented group at 12,500 cycles (± 2,480) compared to 15,625 cycles (± 4,215) in the non‐augmented group (p = 0.041). When comparing 3 mm vertical displacement of the head no significant difference (p = 0.72) was detected between the survival curves of the two groups. At 8,500 load‐cycles (early onset failure) the augmented group demonstrated a change in screw angle of 2.85° (± 0.84) compared to 1.15° (± 0.93) in the non‐augmented group (p = 0.013). The results showed no biomechanical advantage with respect to secondary displacement following augmentation of three cannulated screws in a non‐displaced femoral neck fracture. Consequently, the indication for cement augmentation to enhance implant anchorage in osteoporotic bone has to be considered carefully taking into account fracture type, implant selection and biomechanical surrounding. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:314–319, 2016.     

Cardiovascular action of calcitonin gene-related peptide in humans

Summary Calcitonin gene-related peptide (CGRP) has been localized in cardiac nerve fibers and blood vessels from which it may be released as neurotransmitter or neuromodulator. Acute cardiovascular effects of i.v. administered CGRP have been studied in human subjects. CGRP (25.3 nmol) caused a mean maximal increase of the heart rate of 41 beats per min (P<0.01) and lowered arterial systolic and diastolic pressures by 26 mm Hg and 20 mm Hg, respectively (P<0.01) (n=6 subjects). These effects were associated with facial flushing, and a rise of plasma levels of norepinephrine and epinephrine of 257 pg/ml and 9 pg/ml, respectively (P<0.01). Administration of equimolar amounts of human calcitonin caused no cardiovascular effects except for minor facial flushing. Serum calcium was marginally lowered with both CGRP (0.2 mg/100 ml) and calcitonin (0.4 mg/100 ml) (P<0.05). Further-more, CGRP (12.7 nmol) reduced the preejection period and duration of the electromechanical systole by 26 msec and 66 msec, respectively (P<0.001 andP<0.01), presumably acting as positive inotropic agent. Labetalol, blocking adrenergic receptors, obliterated these inotropic effects, whereas the positve chronotropic and hypotensive actions of CGRP remained unchanged.     

Nasal base, maxillary, and infraorbital implants--alloplastic

The aesthetic surgery of the facial skeletal contour requires either the performance of ostectomies of excessively prominent segments or the augmentation of retruded segments with organic or synthetic material, in order to achieve balanced tridimensional relations of each segment with regard to the total facial unit. Craniomaxillofacial surgeries are necessary in major malformations or in those combined with malocclusion. In the nasal dorsum or tip, the author prefers the use of cartilage, because synthetic materials need adequate soft-tissue bulk for cover to be inserted without tension and absence of passive mobility of the reception site. For malar augmentation, first proposed by the author and independently by Spadafora in 1971, for chin augmentation up to 8 mm, and for augmentation of the mandibular angle, the author prefers silicone implants because they do not change in shape or volume, may be premanufactured or custom-made, have a similar consistency to that of bone, and do not support bacterial growth. On the other hand, autologous bone grafts adapt less to curved bony surfaces, have an erratic rate of resorption, and need an additional surgical step for removal with the corresponding morbidity and scar. Subperiosteal insertion is preferred because it confers greater stability and the cavity is easier to dissect without soft-tissue damage. Although bone erosion may occur, with over 1200 implants clinically no major change in the soft-tissue contour has been observed, nor has the author been consulted for late complication. In the malar region this may be due to the large surface of the implant and absence of muscular pressure. In the chin, an insertion over the site of the dental roots is avoided. For midface augmentation the following implants are used: (1) The premaxillary lower nasal base implant, proposed in 1971, is indicated to correct a concave midfacial profile, frequent in Asian, black, and Mestizo patients from Latin America and in Caucasian patients with maxillonasal dysplasia or Binder's syndrome, after trauma, with excessive septum and nasal spine resections, and in nasal-maxillary sequels in cleft patients. In case of dental malocclusion, orthognathic surgery is the technique of choice. A prototype implant is available in two sizes, to be inserted through a lateral incision at the base of the columella. In 108 patients two implants have been partially removed. After the first month the patient is usually well adapted to the foreign body.(ABSTRACT TRUNCATED AT 400 WORDS)     

假体隆颏术后骨吸收的原因分析及治疗

目的探讨假体隆颏术后颏部骨吸收的可能原因及治疗。方法分析假体隆颏术后因骨吸收进一步治疗患者i2例,通过临床于术所见和放射学检查结果,观察局部颏骨吸收情况。结果发生轻度或无骨吸收者7例骨吸收（≤2mm）,其中硅橡胶假体5例,膨体聚四氟乙烯假体2例。发生中度骨吸收者3例（骨吸收〉2mm,而≤4mm）,均为硅橡胶假体。发生重度骨吸收者2例（骨吸收〉4mm）,硅橡胶假体1例,膨体聚四氟乙烯假体1例。所有患者均接受假体取出术,其中8例行颏成形术．2例行高密度多孔聚乙烯隆颏术进一步治疗,效果满意。结论颏肌假体一骨之间的平衡失调是引起骨吸收的最主要原因之一。因此,对于轻度和中度小颏畸形可以选用合适的假体进行隆颏术,但需长期随访观察,对于重度的小颏畸形,或伴有黯颌面畸形和颏肌功能亢进的小颏或者小下颌患者不应选用假体隆颏术。否则,会发生严重骨吸收,需要采用截骨成形术进行矫正。     

Lip augmentation with porcine small intestinal submucosa

OBJECTIVE: To relate our initial experience using an acellular, soft tissue matrix derived from porcine small intestinal submucosa (Surgisis; Cook Biotech Inc, West Lafayette, Indiana) for lip augmentation. DESIGN: A prospective, uncontrolled case series examining the results of lip augmentation using Surgisis in patients presenting to an academic otolaryngology/facial plastic surgery office. RESULTS: Nineteen Surgisis implants were placed in 8 patients. All patients tolerated the procedure and denied unnatural sensations or complications at any interval. Adverse events included transient erythema and 1 case of local cellulitis treated effectively with oral antibiotics. Four patients were satisfied with the procedure and 4 patients requested greater augmentation. Six-month follow-up was reported, and preoperative and postoperative photography was used in all cases. CONCLUSIONS: Short-term lip augmentation was achieved in all 8 patients (4 patients had multiple strands placed). This study demonstrates technical ease and early safety. Surgisis should serve as scaffolding for ingrowth of striated muscle of the lip, potentially providing long-term augmentation. This study introduces Surgisis as a novel implant for lip augmentation.     

广东成年女性安氏Ⅰ类开唇露齿拔牙矫正前后软组织侧位变化的比较

目的了解广东成年女性安氏Ⅰ类开唇露齿患者拔除4个第1双尖牙矫正后软组织侧貌变化情况，评价该类患者矫正后软组织变化的意义。方法回顾性研究15例广东成年女性安氏Ⅰ类开唇露齿患者，用头颅侧位分析法分析拔牙矫正前后软组织X线片，再将同一测量值于矫正前后做配对t检验，了解有无显著性差异，分析判断矫正后唇组织变化的意义。结果在角度方面：鼻唇角、上下唇角、Z角增加；线距方面：上下唇长和上下唇厚加大，而上下唇审美平面距和上下唇突距皆缩小，且变化有统计学意义；面凸角、面角、上下唇基角和颏厚等变化无统计学意义。结论该类患者拔除4个第1双尖牙的矫正可以使患者面部严重不协调关系有明显改善；但唇厚较治疗前加大，唇间距仅部分缩小，上前牙仍有部分外露，患者仍然有开唇露齿的面像，其进一步好转依赖于患者唇肌功能的改善。     

Lip Augmentation with AlloDerm Acellular Allogenic Dermal Graft and Fat Autograft: A Comparison with Autologous Fat Injection Alone

Many surgical options exist for lip augmentation, none of which consistently provide safe, lasting, and predictable volume gains. We describe and evaluate the use of AlloDerm acellular allogenic dermal graft in combination with fat autograft and compare the postoperative results with those of autologous fat injection alone. Analysis of the preoperative and 1- and 3-month postoperative photographs was done using digital imaging software. Outcome measures included vermilion show and horizontal lip projection from the soft tissue pogonion–subnasale plane. A 61% mean increase in vermilion show was observed in lips augmented with AlloDerm/fat injection, in comparison to a mean increase of 13% in lips augmented with fat injection alone. Lip projection demonstrated a mean increase of 1 mm in AlloDerm/fat lips at 3 months. Postoperatively, no evidence of resorption was seen in lips augmented with AlloDerm/fat between the 1- and the 3-month follow-ups, however, a 9% decrease in vermilion show occurred in lips augmented with fat injection over the same period. No complications occurred in either group. We conclude that AlloDerm in conjunction with autologous fat injection constitutes a safe, reliable, and lasting method of lip augmentation providing increased vermilion show compared to that with autologous fat injection alone.