Satisfaction with facial profile aesthetics: are norms overrated?

This study aimed to explore to what extent adults perceive deviations from the norm of a balanced profile with normal occlusion as reducing satisfaction with facial appearance and having a psychosocial impact. This cross-sectional study included 225 Caucasian subjects (64% women) aged 18–42 years. Their facial profiles were analyzed photogrammetrically and they were classified into three categories: within, below, or above the standard range for the Croatian population with a normal occlusion. Psychosocial issues were assessed by self-reported satisfaction with facial appearance and domains from the Orthognathic Quality of Life Questionnaire: social aspects of dentofacial aesthetics (SA), facial aesthetics concern (FA), and awareness of dentofacial aesthetics (AW). Men with a concave profile were less satisfied with their faces than those with a flat or convex profile (P < 0.05). A reduced upper lip height in men resulted in a lower level of satisfaction and increased FA score, when compared to men with a normal or increased upper lip height (P < 0.05). In women, a reduced middle third of the face increased AW (P = 0.045). Deviations from a well-balanced facial profile, as well as the morphology of the nose and lip, do not increase psychosocial issues to a great extent. The range of acceptable facial characteristics is evidently much broader than the norms.     

Surgical management of large venous malformations of the lower face

We describe the benefits of an early surgical approach to large (more than 3 cm) venous malformations in the lower face, and discuss the advantages over conservative treatment. Fifty-eight patients with venous malformations of the lower face were treated in this hospital between 2005 and 2010 with sclerotherapy (lipidocanol), or láser, or resection, or all three. Only patients with recurrent malformations and a history of previously ineffective conservative treatment were included in the study (n = 17). Follow-up ranged from 23–65 months (mean 40). Functional and cosmetic outcomes and recurrence were recorded on a single questionnaire. Seventeen patients with a history of recurrent malformations, which had previously been treated ineffectively with conservative treatment and were more than 3 cm in diameter, benefited from early and wide resection. No recurrences were recorded during follow-up. Patients were satisfied with the postoperative cosmetic and functional results. Large malformations are both deforming and functionally disabling. These patients, who initially do not respond to conservative treatment, benefit from early definitive resection.     

Concurrent structural fat grafting and carbon dioxide laser resurfacing for perioral and lower face rejuvenation

Abstract

Objective: To quantitatively evaluate a dual-modality treatment that combines autologous structural fat grafting and carbon dioxide (CO₂) laser resurfacing for perioral and lower face rejuvenation. Method: Retrospective review of patients undergoing rejuvenation by a single surgeon between 2005 and 2009. A blinded expert rated photographs on three scales, each with a range of 1 (no abnormality) to 5 (severe abnormality): (i) perioral fine rhytids; (ii) deep folds; and (iii) pigmentary or cutaneous abnormalities. Within-subject comparisons were generated. Results were correlated with skin type (Fitzpatrick) and baseline photodamage (Glogau). A test for effect of adjunctive procedures was performed. Results: Seventeen patients were included (all female, mean age 61 years). Significant postoperative improvement was noted for perioral fine rhytids (3.1 to 1.7, p < 0.0001); deep folds (3.4 to 2.0, p < 0.00001); and pigmentation (2.5 to 1.9, p = 0.02). Fitzpatrick skin type was inversely correlated with improvement in pigmentation scores (r = ?0.78), while the Glogau score correlated with improvement of fine rhytids (r = 0.76). No significant effect of adjunctive procedures was found. No complications occurred, though fat grafts resorbed in one patient. Conclusions: Concurrent structural fat grafting and CO₂ resurfacing result in quantifiable improvement of perioral and lower face aesthetics in relation to baseline characteristics and independent of adjunctive surgical procedures.     

Case with Brunsting–Perry‐like localized subepidermal blister formations and immunoglobulin G antibodies against unidentified basement membrane zone antigen

Brunsting–Perry type bullous pemphigoid is defined by the blister formation limited to the head and neck, and autoantibodies to type VII collagen are detected in several cases. However, the pathomechanisms and autoantigens in this condition remain unknown. We report a 20‐year‐old female patient with a more than 2‐year history of recurrent tense blisters localized on the face with no distinct atrophic scar formation. The patient had neither extensive sun exposure nor a history suggestive of contact dermatitis. Oral betamethasone was effective on the skin lesions. Histopathology revealed subepidermal blister formation with dermal infiltrates of neutrophils. Although direct and indirect immunofluorescence tests detected immunoglobulin G antibodies to the basement membrane zone (BMZ), no known dermal or epidermal autoantigens were detected in immunoblot analyses. Therefore, this case may be a rare variant of Brunsting–Perry type localized bullous pemphigoid with autoantibodies to an undetermined BMZ antigen.     

Recurrent neutrophilic dermatosis of the face: A report of two cases and review of the published work

Recurrent neutrophilic dermatosis of the face is a disease that is morphologically and histopathologically compatible with Sweet's syndrome, but is distributed on the face without fever, laboratory abnormalities or associated disorders. At present, it is unclear whether our cases belong to the chronic and mild variant of Sweet's syndrome or are independent entities. Here, we present two cases of recurrent neutrophilic dermatosis of the face with good response to systemic corticosteroids or potassium iodine, as well as those of cases reported in the published work.