The Facial Vein on Computed Tomographic Angiography: Implications for Plastic Surgery and Filler Injection.

BACKGROUND: Knowledge of the anatomy of the facial vein is essential for plastic surgery and filler injection. OBJECTIVES: The authors sought to investigate the variation and 3-dimensional (3D) course of the facial vein utilizing computed tomographic angiography. METHODS: The computed tomographic angiography images of 300 facial veins from 150 Asian patients were included in this study. The distance between each anatomical landmark and the facial vein was measured to position the course. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum were measured at 5 anatomical planes. RESULTS: The facial vein showed a relatively constant course with a frequency of 7.0% variation. The vertical distance between the medial canthus, midpoint of inferior orbital rim, or external canthus and the facial vein was 10.28 ± 2.17 mm, 6.86 ± 2.02 mm, or 48.82 ± 7.26 mm, respectively. The horizontal distance between medial canthus, nasal alar, or oral commissure and the facial vein was 6.04 ± 1.44 mm, 22.34 ± 3.79 mm, or 32.21 ± 4.84 mm, respectively. The distance between the mandibular angle or oral commissure and the facial vein at the inferior of mandible was 24.99 ± 6.23 mm or 53.04 ± 6.56 mm. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum varied from the plane of the medial canthus to the plane of the mandible. CONCLUSIONS: This study revealed the 3D course of the facial vein with reference to anatomical landmarks. Detailed findings of the facial vein will provide a valuable reference for plastic surgery and filler injection.

Facial Arterial Variations in Asians: A Study on Computed Tomographic Angiography.

BACKGROUND: A consensus on facial artery anatomy has not been established due to the discrepancies in previous studies. OBJECTIVES: The authors sought to assess the branches, course, and location of the facial artery in Asians by utilizing computed tomographic angiography. METHODS: The computed tomographic angiography images of 300 facial arteries from 150 Asian patients were evaluated. The FA was classified as follows: type 1, facial artery terminates superior labial or inferior labial artery; type 2, facial artery terminates lateral nasal or inferior alar artery; type 3, facial artery terminates medial canthal artery; or type 4, facial artery is divided into duplex branches with dominant medial canthal artery laterally. The relationship between nasolabial fold and FA was evaluated, and the distances from anatomical landmarks to FA were measured to position the course. RESULTS: Seventy (23.3%), 163 (54.3%), 49 (16.3%), and the other 18 arteries (6.0%) were classified as type 1, 2, 3, and 4, respectively. A total 72.3% of facial arteries were located medially to the nasolabial fold, and only 14.7% of arteries were lateral to the nasolabial fold. The vertical distance between the facial artery and the inner canthus or the midpoint of the inferior orbital rim decreased from type 1 to type 4 facial artery (P < 0.0001). The 4 types did not significantly differ in distance between the mandibular angle (P = 0.1226) or oral commissure (P = 0.1030) and the facial artery at inferior of mandible. CONCLUSIONS: Detailed findings of the facial artery will provide a valuable reference for filler injection in cosmetic procedures and flap design in reconstructive surgery.

The Facial Vein on Computed Tomographic Angiography: Implications for Plastic Surgery and Filler Injection.

BACKGROUND: Knowledge of the anatomy of the facial vein is essential for plastic surgery and filler injection. OBJECTIVES: The authors sought to investigate the variation and 3-dimensional (3D) course of the facial vein utilizing computed tomographic angiography. METHODS: The computed tomographic angiography images of 300 facial veins from 150 Asian patients were included in this study. The distance between each anatomical landmark and the facial vein was measured to position the course. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum were measured at 5 anatomical planes. RESULTS: The facial vein showed a relatively constant course with a frequency of 7.0% variation. The vertical distance between the medial canthus, midpoint of inferior orbital rim, or external canthus and the facial vein was 10.28 ± 2.17 mm, 6.86 ± 2.02 mm, or 48.82 ± 7.26 mm, respectively. The horizontal distance between medial canthus, nasal alar, or oral commissure and the facial vein was 6.04 ± 1.44 mm, 22.34 ± 3.79 mm, or 32.21 ± 4.84 mm, respectively. The distance between the mandibular angle or oral commissure and the facial vein at the inferior of mandible was 24.99 ± 6.23 mm or 53.04 ± 6.56 mm. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum varied from the plane of the medial canthus to the plane of the mandible. CONCLUSIONS: This study revealed the 3D course of the facial vein with reference to anatomical landmarks. Detailed findings of the facial vein will provide a valuable reference for plastic surgery and filler injection.

Imaging of the Silicone Implant with a 3D SPACE MR Sequence: The Accuracy for Estimating Implant Volume and Reconstructing Implant Deformation in Breast Surgery.

OBJECTIVE: The study is to assess the accuracy and reliability of 3D simulated magnetic resonance imaging with SPACE sequence for estimating implant volume and reconstructing implant deformation, which may assist in the diagnosis of implant complications and making individualized surgical plans for these patients. METHODS: MRI examinations of ten silicone implants were performed with T2, H2O-excitation SPACE sequence (T2-spc-H2O) and silicone-excitation SPACE sequence (T2-spc-Silicone) to find the most accurate method to estimate implant volume by ITK-SNAP. The effect of implant deformation and voxel size of silicone-excitation SPACE sequence on volume measurement was investigated. Thirteen normal patients and ten patients with implant complications (Wuhan Tongji Hospital from March 2017 to May 2019) were enrolled for testing the accuracy and reliability of 3D simulated MRI with silicone-excitation SPACE sequences for volume measurement and reconstructing implant deformation in patients. RESULTS: The absolute volume differences of T2-spc-Silicone group were significantly less than T2-spc-H2O and T2 group (6.28 vs. 23.27 vs. 42.19 mL, P < 0.05) in vitro. No significant difference was found between the normality group and the deformation group for estimating the volume of implants. Besides, the voxel size of T2-spc-Silicone from 0.5 × 0.5 × 0.5 mm to 5.0 × 5.0 × 5.0 mm did not significantly affect the accuracy of volume measurement of the implants in deformation state. However, 3D images of the implant became blurred with the voxel size increased. With the voxel size larger than 1.5 × 1.5 × 1.5 mm, the scores of image quality decreased significantly. The number of folds could not be identified accurately with the voxel size larger than 2.0 × 2.0 × 2.0 mm. In normal patients, the measurement errors of T2-spc-Silicone were around 10 mL. In the patients with implant complications, there was no significant difference between measured volume and the actual volume of implants. Moreover, implant deformations were clearly presented by T2-spc-Silicone with the voxel size of 1.0 × 1.0 × 1.0 mm. The results showed excellent intraobserver reliability (ICC = 0.997 > 0.8), and internal consistency ranged from 0.986 to 0.997 (P < 0.001). CONCLUSIONS: The method to measure implant volume by 3D simulated magnetic resonance imaging with T2-spc-Silicone sequence had possessed desirable accuracy and reliability. The deformation of the implant and the voxel size of the T2-spc-Silicone sequence didn't exhibit a significant effect on the accuracy of the measurement. T2-spc-Silicone with voxel size less than 2.0 × 2.0 × 2.0 mm could be used for 3D reconstruction of the implant deformation. The 1.0 × 1.0 × 1.0 mm was a suitable voxel size to reconstruct implant deformation clearly and quickly. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Use of DCE-MRI to Evaluate the Blood Supply to the Nipple-Areola Complex: A Study in 245 Asian Women.

BACKGROUND: Understanding the main blood supply to the nipple-areola complex (NAC) is important for breast plastic surgery. However, previous reports have involved studies of cadavers and small sample sizes. OBJECTIVES: This study aimed to identify and classify the in vivo blood supply to the NAC based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). METHODS: DCE-MRI images of 393 breasts in 245 Asian women obtained from March 2012 to October 2019 were included retrospectively. Axial, coronal, and sagittal maximum-intensity projection images were evaluated to identify all vessels supplying the NAC. Blood supply to the NAC was classified into 9 anatomic zones: superomedial (Ia), medial (Ib), inferomedial (Ic), superolateral (IIa), lateral (IIb), inferolateral (IIc), central (III), inferior (IV), and superior (V). RESULTS: A total of 637 source vessels were identified in 393 breasts. Of the 393 breasts, 211 (53.7%) were supplied by a single zone, 132 (33.6%) by 2 zones, 38 (9.7%) by 3 zones, and 12 (3.1%) by 4 zones. Of the 637 vessels, 269 (42.2%) vessels were in zone Ia, 180 (28.3%) vessels were in zone IIa, and <10% of vessels were in the other zones. The number of NAC perfusion zones (P = 0.093) and the distribution of source vessels (P = 0.602) did not differ significantly between the left and right breasts. CONCLUSIONS: DCE-MRI provides a clear indication of the blood supply to the NAC. Blood vessels from the superomedial and superolateral zones were the predominant sources of blood supplying the NAC.

The Middle Temporal Vein on Computed Tomographic Angiography: Implications for Filler Injection and Reconstructive Surgery.

BACKGROUND: Detailed knowledge of middle temporal vein (MTV) anatomy would benefit health care professionals when performing filler injection and reconstructive surgery. The purpose of this study was to assess the variation and course of the MTV using computed tomographic angiography. METHODS: Computed tomographic angiography images of 300 MTVs from 150 Asian patients were evaluated in this study. The course and branching pattern of the MTVs were evaluated, as well as the relationship between the location of the MTV and the frontal branch of the superficial temporal artery. The diameter of the MTV and the distances between anatomic landmarks and temporal vessels were measured. RESULTS: The MTV was identified in all images, with an average diameter of 2.98 ± 0.80 mm. All MTVs had at least one major trunk; 12.3% had two major trunks. According to the landmarks, the MTV ran 16.3 ± 8.1 mm, 24.8 ± 4.5 mm, and 24.2 ± 4.6 mm above bony lateral canthus, jugale, and zygion point, respectively. Regarding the relationship between the MTV and the frontal branch of the superficial temporal artery, most of the superficial temporal arteries (81.7%) were located above the MTVs, whereas only 9.0% of the superficial temporal arteries crossed the MTVs. The superficial temporal artery was located 43.5 ± 9.6 mm, 44.3 ± 11.9 mm, and 37.0 ± 11.9 mm above the bony lateral canthus, jugale, and zygion point, respectively. CONCLUSION: Detailed knowledge of MTV anatomy will provide a valuable reference for safe filler injection and reconstructive surgery in the temporal region. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Aging of the Nose: A Quantitative Analysis of Nasal Soft Tissue and Bone on Computed Tomography.

BACKGROUND: Morphologic and anatomical changes of the aging nose affect the surgical strategy of rhinoplasty in older patients, but age-related changes in noses have yet to be fully characterized. This study aimed to determine the evolution of nasal soft tissue and bone in aging noses using computed tomography. METHODS: Computed tomographic images of 200 Asian patients were included. The study population was divided into two groups according to age and sex: a younger group (20 to 35 years of age) and an older group (65 to 80 years of age). Measurements of nasal soft tissue and bone on computed tomography were performed using Osirix 9.0 software. RESULTS: With regard to soft-tissue changes, the nasal skin and soft-tissue envelope thickness at rhinion, supratip, and nasal tip increased significantly with aging in both sexes. Increase of nasal depth and decrease of nasolabial angle were significant in both sexes. Nasal length and nasofrontal angle showed significant age-related increases in men; decrease of nasal tip angle and increase of pyramidal angle were significant in women. With regard to nasal bone changes, the bone length decreased significantly in women and the bone thickness decreased significantly in both sexes. Nasofrontal angle in men and pyramidal angle in women increased significantly. CONCLUSION: These results suggest that the aging process leads to drooping of the nasal tip, thickened nasal skin and soft tissue, and resorption of the nasal bone, providing a reference for rhinoplasty in older patients.

3D images of the silicone implants in capsular contracture after breast augmentation using magnetic resonance imaging with SPACE sequence.

BACKGROUND: Capsular contracture is a common complication after breast augmentation. However, no objective methods are available to assess capsular contracture at present. The goal of the present study was to evaluate the correlation between capsular contracture and 3D images of the silicone implants by using magnetic resonance imaging (MRI) with sampling perfection with application optimized contrast using different flip angle evolutions (SPACE) sequence. METHODS: Twenty-one patients (42 breasts) underwent breast augmentation, had postoperative MRI examinations with SPACE sequence, and the evaluation of the Baker grade by two trained plastic surgeons. Capsular thickness was measured on the T2-weighted images. The software ITK-SNAP was used to reconstruct 3D images of the implants. The fold characteristics such as number, depth, direction, and distribution were compared with the Baker grade. RESULTS: Of the 42 breasts, 14, 8, 12, and 8 breasts were classified as Baker grade I, II, III, and IV, respectively. The MRI images of breasts with Baker grade III or IV revealed a thicker capsule (mean of 2.29 mm) as compared to the capsule with the lower Baker grades (mean of 1.58 mm). The 3D images of implants showed no difference in the number of folds between the groups with different Baker grades. The fold direction and fold distribution differed between grade I to II and grade III to IV. CONCLUSION: The 3D image of an implant with pathological folds is a potential and feasible diagnostic indication of capsular contracture. LEVEL OF EVIDENCE: IV.