Jawline Aesthetic Definition: Enhancement with Masseteric Augmentation Using Ultrasound-Guided Fat Transfer.

Background: The rejuvenation and restoration of a well-defined jawline contour are crucial for enhancing facial aesthetics in both men and women. Within the jawline aesthetic unit (mandibular angle), the masseter muscle plays a significant role, as it is responsible for mandibular masticatory movements. We propose a new approach using ultrasound-guided intramuscular fat transfer to enhance the mandibular angle and jawline. Methods: The multicenter study included 20 patients from three countries (Peru, Brazil, and Mexico). After fat harvesting, the ultrasound-guided masseteric fat transfer was performed with a 1.5-mm Viaro cannula from an incision beneath the ear lobule. The fat was then injected intramuscularly into the masseter at each side of the mandibular angle. Results: Masseter ultrasound-guided fat transfer was performed on 10 men and 10 women between 2021 and 2022. The patients had a mean age of 34.4 ±â€…6.39 years and a mean body mass index of 22.39 ±â€…2.59 kg per m2. The mean injected volume was 5.83 mL and 5.58 mL on the right and left sides, respectively. Muscle thickness increased in patients immediately postsurgery, but decreased after 1 month. The muscle remained significantly thicker on each side than the presurgery measurements in patients regardless of gender (both P < 0.0001). Conclusions: Ultrasound-guided intramuscular fat transfer is a safe and reproducible technique for enhancing the jawline contour at the mandibular angle. We believe that it could be a more durable solution than other procedures, although further evaluation of long-term results is necessary.

Intervenciones quirúrgicas mínimamente invasivas complementarias a la ortodoncia quirúrgicamente asistida: Resumen estructurado de evidencia

Introducción: Existen procedimientos quirúrgicos que pueden generar una disminución en la duración de los tratamientos de ortodoncia (TO) mediante una aceleración del movimiento dental. La técnica más estudiada corresponde a la corticotomía clásica, la cual muchas veces es desechada por los pacientes debido a su invasividad. Es por esto que nacen las intervenciones quirúrgicas mínimamente invasivas (IQMI), tales como las micro osteoperforaciones (MOP) y la piezocisión, que buscan el mismo resultado, pero sin realizar colgajos de espesor total, otorgándole al paciente nuevas alternativas terapéuticas para acortar el tratamiento de ortodoncia. La evidencia al respecto aún es controversial, debido a que la certeza de la evidencia es baja o muy baja con relación a estos procedimientos. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 39 revisiones sistemáticas que en conjunto incluyeron 43 estudios primarios, de los cuales, 31 corresponden a ensayos aleatorizados. Concluimos que las intervenciones quirúrgicas mínimamente invasivas podrían aumentar la tasa de movimiento dental a las 12 semanas, la distancia total acumulada, la tasa de movimiento dental y reducir la duración total de tratamiento, pero la certeza de la evidencia es incierta. Además, podrían resultar en poca o ninguna diferencia sobre el índice gingival, la profundidad de sondaje y el índice de placa.

Introduction: There are surgical procedures that can generate a decrease in the orthodontic (OT) treatments duration through a Acceleration of tooth movement. The most studied technique corresponds to classical corticotomy, which is often discarded by patients due to its invasiveness. This is why minimally invasive surgical interventions (MISI) are born, such as micro osteoperforations (MOP) and piezocision, which seek the same result, but without making total thickness flaps, giving the patient new therapeutic alternatives to shorten orthodontic treatment. The evidence on this is still controversial, because the certainty of the evidence is low or very low in relation to these procedures. Methods: A search was performed using Epistemonikos, the biggest database for systematic reviews in health, which is maintained by screening of multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. Data from systematic reviews were extracted, and analysis of the primary studies was performed, including a meta-analysis and a summary of findings table using GRADE approach. Results and conclusions: We identified 39 systematic reviews that together included 43 primary studies, of which 31 correspond to randomized clinical trials. We conclude that minimally invasive surgical interventions could increase the rate of tooth movement at 12 weeks, distance total accumulated, the rate of tooth movement and reduce the total duration of treatment, but the certainty of the evidence is uncertain. In addition, they could result in little or no difference in gingival index, probing depth and plaque index.