Harmonized Profiloplasty Using Balanced Angular Profile Analysis

To evaluate outcomes of aesthetic facial plastic surgery objectively the authors developed a photogrammetric profile analysis method, which they call balanced angular profile analysis (BAPA). To develop standards and ways to determine the conformation of various soft tissue segments analytically, 19 mean angular values acquired from the photographs of 71 famous female models (53 Eastern models and 18 Western models) were standardized to provide reference data (recommended aesthetic mean angles [RAMA]), which contain some of the common features and differences between ethnic groups and races. On the basis of the data prepared from angular profile analyses of these photographs, the authors apply their developed method in a practical way to the pre- and postoperative photographs of patients. By using the data provided by BAPA, the clinician can identify delicate profile problems correctly, perform appropriate aesthetic operations, and thus produce better aesthetic results. The authors harmonized and balanced angular profile analysis can provide surgeons with a way of determining the conformational problems associated with various soft tissue segments of the face. It also offers aesthetic plastic surgeons reference information concerning the creation of an attractive face during the first patient consultation. The authors hope that their straightforward method of profile analysis will provide facial plastic surgeons with a simple tool for profile analysis and surgical planning designed to create an attractive face.     

Sagittal back contour and craniofacial morphology in preadolescents

The aim of this study was to analyze the correlation ratios between the sagittal back contour (flèche cervicale and lombaire, trunk inclination) and selected parameters of craniofacial morphology in children. The patient sample consisted of 66 healthy children with a mean age of 11.2 years (SD 1.6 years), of which 34 were male (mean age 11.5 years, SD 1.3 years) and 32 were females (mean age 10.9 years, SD 1.9 years). The children were recruited during the preparation of the initial orthodontic treatment records. Craniofacial morphology was analyzed by six angular measurements: facial axis, mandibular plane angle, inner gonial angle, lower facial height, facial depth and maxilla position. Rasterstereography was used for reconstruction of the spinal back sagittal profile. From the profile flèche cervicale, flèche lombaire and trunk inclination were determined and the correlations with the craniofacial morphology were calculated (Pearson and Mann–Whitney U test). Significant correlations were found with respect to the inner gonial angle and the flèche cervicale, the mandibular plane angle and the flèche lombaire, the inner gonial angle and the flèche lombaire, and the angular lower facial height and the flèche lombaire, as well as the inner gonial angle and the trunk inclination. The craniofacial vertical growth pattern, presented by mandibular plane angle, inner gonial angle and the angular lower facial height, and the correlation to flèche cervicale and lombaire as well as trunk inclination reveal correlations between growth pattern and sagittal back contour.     

Profiloplasty of the lower face by maxillary and mandibular anterior segmental osteotomies

Maxillary and mandibular anterior segmental osteotomies (ASO) are ways to correct disharmony in the lip (contour, lip seal, and profile) and occasional dentoalveolar malocclusion. We performed 23 maxillary setback ASO, three maxillary advancement ASO, 21 mandibular setback ASO, and six mandibular advancement ASO in 28 patients to improve their lower facial profile. Other combined operative procedures include nine LeFort 1 osteotomies, four bilateral mandibular ramus osteotomies, two genioplasties, four mandibular angle contouring procedures, two reduction malar plasties, two piriform augmentations with bone graft, and a facelift for correcting of long faces, asymmetric faces, severe malocclusions, microgenias, prominent mandibular angles, prominent malar eminences, piriform recessions, and an aging face. Twenty five patients were satisfied with the results. Two patients complained of an over-recessed lip region, and one of septal deviation. There were no other significant complications or relapses throughout the followup period (9–30 months). Maxillary and mandibular ASO are effective, selective, relatively safe, and simple methods for correcting lower facial profile disharmony to attain a satisfactory aesthetic facial contour.This paper was presented at the 60th annual meeting of American Society of Plastic and Reconstructive Surgery, Seattle, WA, USA, September 24, 1991     

The Korean American woman's face: anthropometric measurements and quantitative analysis of facial aesthetics

OBJECTIVES: To assess the differences in facial proportions between Korean American (KA) women and North American white (NAW) women and to quantitatively describe aesthetic facial features in the KA women. DESIGN: Anthropometric survey and facial aesthetic evaluation. PARTICIPANTS: Volunteer sample of KA women (n = 72) who served as models for part 1 of the study and a different sample of KA women (n = 5) and men (n = 5) who served as judges for part 2 of the study. All subjects were between ages 18 and 35 years and had Korean parents and no previous facial surgery or trauma.Intervention For part 1 of the study, standardized and referenced frontal and lateral photographs were taken of the models, and 26 standard anthropometric measurements were determined. Results were compared with published NAW standards. For part 2 of the study, 10 judges evaluated frontal views of the models for facial aesthetics using a visual analog scale. Quantitative analysis was done of the faces of attractive KA women (>90th percentile in aesthetic scores) and comparisons were made with the faces of NAW women and average KA women. RESULTS: The KA woman's face did not fit the neoclassical facial canons. Compared with NAW women, 24 of the 26 facial measurements in KA women were significantly different. Only 9 of the 26 facial measurements were significantly different when the attractive KA women were compared with the NAW women. Nine of the 17 nonsignificant facial measurements were very similar to those of the NAW women; many of these facial features centered around the midface. CONCLUSIONS: Although the average KA woman's facial anthropometric measurements were very different from those of the NAW woman, attractive KA women reflected many of the facial features of NAW women. These findings support the need for ethnically sensitive facial canons and further research into transcultural aesthetics.     

Single stage aesthetic and functional reconstruction of composite facial gunshot wound with a chimeric functioning muscle and fibular osseous flap. Case report and review of the literature

The current concepts in the aesthetic and functional reconstruction of complex oromandibular defects are presented with a case of a patient with self‐inflicted gunshot wound to the face. The patient presented with a 6 cm composite mandibular defect; the buccomandibular and suborbital aesthetic zones of the cheek along with the mucosa lining, and the ipsilateral facial musculature were missing. A rapid prototyping model of the facial skeleton was used to assist in preoperative planning. A single stage reconstruction with two free flaps was planned; a free fibula osseous flap to reconstruct the mandibular defect, and a free chimeric ALT/functioning vastus lateralis muscle. The one skin paddle of the chimeric flap reconstructed the buccomandibular/suborbital zones of the cheek, and the other the lining of the mouth. The functional muscle provided reanimation of the corner of the mouth by coapting the muscle's motor nerve to the ipsilateral marginal mandibular nerve. A good facial contour and reanimation of the mouth with oral continence was achieved, and the patient presented with good social and emotional smile. This first report of combined use of a fibula osseous flap with a chimeric functional ALT/Vastus Lateralis flap suggests that the chimeric flap principle may be used in complex aesthetic and functional challenges of severe facial trauma.     

“三面两角一拐点”美学标准的提出及在精致下颌缘打造领域的临床应用

医疗美容的属性与特征要求医生在进行医美治疗的过程中需要美学的加入和指导，目前大众审 美对于下颌缘美观度的评价标准难以有效指导临床治疗，为了给精致下颌缘打造提供一个更加科学、规 范、高效的美学标准，在充分考虑到下颌缘问题适应症的多样性与成因的复杂性基础上，引入轮廓美学与 立体打造两个新理念，本文提出“三面两角一拐点”这一美学标准，借助这个标准，以期提升下颌缘的美 观度，在精致下颌缘打造以及面部整体轮廓改善的临床治疗中发挥积极指导意义与参考价值。     

下颌支矢劈后退术后近心骨段位置变化及对面型的影响

目的:分析下颌支矢劈后退术后下颌角间宽度(i nt ergoni al wi dt h,IGW)和近心骨段两者变化的规律及其变化对面型的影响。方法:选择天津医科大学口腔医院颌面外科收治的骨性下颌前突患者20例,进行头影测量,采用SPSS15.0软件包进行统计分析。结果:20例患者的IGW在术后均增加,其变化与下颌后退量呈显著正相关(r=0.917,P<0.01),而与右升支外展角、升支切线角、后面高并无相关性;术后1周与术前相比,Go至坐标原点的距离显著增加(P<0.01),而∠Ar-Go-Me及升支-Y轴夹角呈显著减小(P<0.01);两侧下颌支下段间宽度明显增宽,由下至上下颌支间宽度的变化值存在递减趋势。结论:近心骨段在冠状面上发生了下颌角外展、髁突内旋的转动,矢状面上发生了自身旋转及整体后移,此变化可能会改变患者的面型。研究近心骨段位置的变化规律对临床有重要指导意义。     

利用面部软组织比例定位坐标借鉴明星脸型美学数据的面部轮廓重塑术

目的：运用面部软组织比例定位坐标,探讨借鉴明星脸型美学数据的面部轮廓重塑术的可行性。方法：根据明星脸型的美学指标及以往方脸形患者手术前后宽度变化的研究结论,利用面部软组织比例定位坐标,确定手术方案。术后半年的脸型与参考的明星脸型进行比较。结果：根据术前的方案成功施术,并做出对比。结论：应用面部软组织比例定位坐标,可以参考明星脸型具体的美学指标,是指导面部轮廓重塑术的可行方法。     

Photogrammetric Analysis of Soft Tissue Facial Profile in Turkish Rhinoplasty Population

Background  

The aim of this study was to compare the facial photogrammetric analysis results of the Turkish population who are pleased with their facial appearance with the facial analysis data of patients who underwent rhinoplasty in order to find the most prominent objective facial measurements that lead patients to surgical correction of the nose.     

面部本体感成像运动在面部轮廓及功能重塑中的应用效果

目的 分析面部本体感成像运动在面部轮廓及功能重塑中的应用效果。方法 选取2020年3月-6月 于我中心报名本体感成像运动面部课程学员209名作为研究对象，运用面部本体感成像运动激活、重塑面 部（左右）上颌骨、（左右）颧骨、下颌骨、（左右）颞骨、枕骨、额骨、（左右）顶骨、（左右）鼻骨、 筛骨、蝶骨，比较练习前后下颌关节（耳垂-嘴角）、颞颌关节（耳屏-鼻翼）、上颌骨关节（上耳角-鼻 梁颧骨）、上下颌骨关节（黑眼球正下方-下颌线）距离变化。结果 209名学员完成有效面部本体感成像 运动后，同一练习对象下颌关节、颞颌关节、上颌骨关节都达到左右对称；上下颌骨关节达到上下提升 及左右对称。结论 运用面部本体感成像运动激活、修复和矫正面部骨骼关节结构，能达面部轮廓重塑正 位、功能恢复正常，有效解决面部松弛、下垂、不对称空间，面部呈现年轻化，面部本体感成像运动可作 为抗衰、变美和逆生长的理想选择。     

下颌矢状劈开后退术及其矢状截骨线对面部轮廓的美学影响

目的：分析下颌矢状劈开后退术及其矢状截骨线对下颌骨近心骨段横向位移的改变，探讨手术设计和操作对面部轮廓的美学考虑。方法：20例行SSRO后退术的下颌前突患者，手术前1周（T1）、术后1周（T2）和6月（T3）分别拍摄头颅定位正侧位片，对相关软硬组织变化进行测量及统计学分析。结果：术后下颌升支上段间宽度改变不明显，升支外展角有所增大，1～3月内下颌角间距增加较明显（平均3．59mm），6～12月后恢复较大，总体上有一定增加（1．5lmm）；且增加量与下颌骨矢状截骨线在冠状面上所成角度负相关，与下颌后退量无关。结论：SSRO后退术对近心骨段和髁突造成一定移位，面下宽度有所增加，不规则的矢状截骨线会加大这种改变。手术操作应尽可能减少这种不利影响，并可结合患者的审美要求和容貌特征进行面部轮廓的手术设计。     

Mandible Changes Evaluated by Computed Tomography Following Botulinum Toxin A Injections in Square-faced Patients

Background  

A facial contour that is oval is more pleasing in Asian women. Patients with a square face often seek facial contouring procedures to improve their appearance. Treatment often involves various combinations of Botulinum NeuroToxin A (BoNTA) injections into the masseters and/or mandibular angle resection. Many physicians claim that muscle paralysis with injections alone will decrease pulling on the underlying bone and also treat underlying bony flaring when present. Muscular changes after BoNTA injections have been well documented. However, the effect of BoNTA injections on the underlying mandibular bone morphology has not been studied to the best of the authors’ knowledge. The goal of this study was to determine whether there are mandibular changes after masseter injection with botulinum toxin.     

Mandibular contour reconstruction with three-dimensional computer-assisted models

Facial contours are thought to depend on the appropriate balance of hard and soft tissue. To obtain aesthetically good results in head and neck reconstruction, surgeons should know the exact three-dimensional shape and volume of both hard and soft tissue to be reconstructed. The authors used computer-assisted three-dimensional solid models of the mandible in 7 patients (4 women and 3 men) who underwent mandibular contour reconstruction. Scapular osteocutaneous flaps were used in all 7 patients. The follow-up periods ranged from 7 to 57 months (mean follow-up, 29 months). No flap was lost. One patient died of metastatic cancer. In 2 patients the aesthetic results were excellent and in 4 patients they were good. Computer-assisted three-dimensional models for mandibular contour reconstruction in head and neck reconstruction are quite useful.     

下颌骨角全层截骨加下颌骨外板劈除行方形脸改型术

目的 寻求一种新的更有效的方形脸改型术式.方法 对68例(年龄21～40岁,女65例,男3例)方形脸求术者用高速涡轮气钻和骨凿实施了口内入路下颌角全层三角形截骨加下颌外板劈除术,咬肌肥大者同时行咬肌内层切除术,颊部丰满者则行部分颊脂垫摘除.结果 使用高速涡轮气钻和骨凿截除全层下颌角和劈除下颌外板极为容易.56例3～24个月术后随访,双下颌角间距明显缩小,脸型呈椭圆.无下颌不对称、下颌意外骨折.侧方轮廓自然.结论 下颌角全层截骨加下颌外板劈除不仅可有效缩小下颌正面宽度,而且还能改善下颌侧方轮廓,是方形脸改型的一种有效术式.     

三维CT重建与测量技术在下颌角铣骨成形术中的应用

目的 探讨口内入路下颌角铣骨成形术矫正下颌角肥大的疗效及三维CT重建技术在术前设计及术后效果评价中的应用.方法 局部麻醉下应用口内切口下颌角铣骨成形术对43例下颌角肥大者进行矫正.分别于术前、术后行头颅三维CT重建,测量相关数据,将铣骨术前、术后的下颌角角度和咬肌厚度的三维数据进行比较,观察面部轮廓改善情况.结果 43例中33例获得4～24个月随访,大部分受术者对术后效果满意,面下部正面观和侧面观均有明显改善,下颌角部曲线圆滑、形态自然,无1例发生神经损伤、骨折等严重并发症.结论 下颌角铣骨成形术是一种安全有效、操作简便、恢复较快、并发症少的好方法,三维CT重建对术前设计及术后效果评价均有积极作用.     

Aesthetic reconstruction of deep facial burns

Summary The authors present the case of a young woman aged 21 who benefitt modern procedures of facial reconstruction after deep facial burns: early excision and grafting paying attention to regional aesthetic units, full-thickness skin grafting after expansion of the donor area, surgical modification of underlying bony structures, reconstitution of the contour of the mouth. This lengthy repair process, which can truly be referred to as aesthetic, is an example of what can be done to make social rehabilitation easier for patients severely disfigured due to facial burns.     

Sliding Osteotomy Genioplasty for Facial Aesthetic Balance: 10 Years of Experience

The chin, one of the most obvious facial structures, plays an important role in the perception of the face as an instrument of communication. To alter the chin contour in a reliable manner, horizontal sliding osteotomy of the mandibular symphysis with advancement of the mobilized segment is the technique of choice for correction of the anterior posterior deficiency. This study describes surgical techniques used in aesthetic and functional surgery of the chin as well as the outcomes. Over a 10-year period, 474 patients underwent orthognathic surgery for correction of their malocclusion. Of these 474 patients, 155 were treated in combination with a sliding genioplasty (SGP) and 37 (29 women and 8 men; average age, 32 years; range, 18–47 years) had an isolated SGP. Of these patients, 33 had chin advancement and 4 had chin reduction. The mean chin advancement was a modest 4.5 mm (range, 2–7 mm), and the mean chin vertical displacement was 3.9 mm (range, 2.5–4.1 mm). All the patients in the mandibular deficiency group had a residual sagittal disproportion of the progonion relative to the subnasale (mean, –7.6 mm) and a newly created vertical disproportion, with mean lower face heights of 67.8 mm compared with mean midface heights of 65.3 mm. The surgical outcome was evaluated by analysis of pre- and postoperative photographs, analysis of pre- and postoperative measurements, and patients’ self judgment. All the patients healed uneventfully without any major postoperative problems. Paraesthesia of the mental nerves occurs to some degree in almost all patients measured by the Simmon Weinstein diagnostic device. In the single sliding chin osteotomy group, no major branches of the mental nerves were transacted. Paraesthesia was only transient, usually lasting for only a few weeks. At least 1 year after the operation, normal sensitivity of the lower lip and both sides of the chin was reported by almost all of the patients (93.1%). All who had only a single genioplasty recovered totally from a neurosensory deficit. The level of satisfaction was significantly high for all the patients. The results were judged to be excellent in 73.2% and good in 23.6% of the cases. Only in 3.2% of the cases was it considered to be poor (bimaxillary surgery combined with SGP). The current findings strongly suggest that SGP is a reliable procedure for achieving harmony of the lower face. In addition, it permits a simplification of facial reconstruction and rejuvenation. The combination of chin advancement and submental recontouring can have a positive effect on facial appearance, provided the increased chin projection is appropriate.     

Aesthetic Improvements of Skin Grafts in Nasal Tip Reconstruction

Defect closure on the nasal tip subunit still remains challenging. Full-thickness skin transplantation still is used despite its poor outcome in terms of the nasal tip contour caused by lack of dermal tissue. To avoid subsidence deformities associated with nasal tip reconstruction with skin transplants, this study analyzed methods using combined epidermal and dermal replacement. For 30 consecutive patients with a nasal tip defect, a retrospective comparison was made between conventional full-thickness skin transplantation, retroauricular perichondrodermal composite grafts, and skin transplantation supplemented with the collagen-elastin matrix, Matriderm, used as a dermal substitute (n = 10 per study group).The postoperative results were evaluated in a randomized and blind manner by external facial surgeons using the Manchester Scar Scale. The findings showed a marked improvement in nasal tip contour with combined epidermal/dermal replacement without any deterioration in other graft qualities, justifying the additional effort involved in this procedure. Two patients developed fistulae after Matriderm-aided skin transplantation. Therefore, the authors do not consider this a suitable method for nasal tip reconstruction.     

Botulinum Toxin A for Lower Facial Contouring: A Prospective Study

Background A prominent mandibular angle is a common reason for aesthetic treatment among Asian women. Such women usually present with hypertrophic masseteric muscles, and one treatment for this uses botulinum toxin A (BoNTA). Detailed effectiveness and physiologic influences of this therapy are still under investigation. Methods The authors report a prospective study of 10 female volunteers with hypertrophic masseteric muscles who received a single treatment comprising intramuscular injection of BoNTA. The facial change and the discomfort of the injection were self-rated using a visual analog scale, and the patients were regularly inspected up to 1 year. Bite forces also were measured for chronological documentation. Volume changes of masticating muscles were evaluated by three-dimensional computed tomography (CT) scans before and 3 months after injection of BoNTA. Results The serial photographs and patient subjective evaluation showed an obvious facial change 3 to 6 months after injection. Bite forces decreased from the first day after injection, but started to recover during week 3 and were normal 3 months after injection. Three-dimensional CT evaluation showed a statistically significant mean masseter reduction of about 30%, but no change in the volume of other masticating muscles. There were no serious complications during this study. Conclusions Injection of BoNTA is an effective alternative for contouring of the lower facial profile by reducing the bulkiness of masseteric muscles. Its effectiveness was noticed as early as 2 weeks after injection and reached a peak effect in month 3. The facial contour gradually returned 6 months after injection. The reduction in bite force was temporary and caused no daily life interference.