High-frequency Ultrasound in the Assessment before and after Applying HArmonyCa™.

AIM: To describe a clinical case of ultrasound (US) used to evaluate, before, post-immediately, and after 4 months, the facial application of a volumizing and biostimulating substance. BACKGROUND: Detecting the behavior of injected filler materials with high-frequency US-guided application is the future of natural facial rejuvenation with more predictable and satisfactory results. TECHNIQUE: A patient indicated for orofacial harmonization (OFH) procedures through volumizing and biostimulating material application was invited to participate. The technique was performed by applying HArmonyCa™ (Allergan Aesthetics, Irvine, CA, USA) in the gonial, preauricular, and bilateral lateral zygomatic angle regions. The first evaluations used the US images before and after product application with a Logiq e® high-frequency US device (GE Healthcare, Chicago, IL, USA) with a probe/linear transducer of 18 MHz. About 4 months after the procedure, a new assessment with the same initial acquisition pattern was performed. The first evaluation showed normal-looking anatomical structures without the esthetic material. Immediately after the procedure and 4 months later, the assessments presented semi-permanent esthetic fillers as dispersed lobulated hyperechogenic areas with a cloud aspect. CONCLUSION: High-frequency US was efficient in the static evaluation of HArmonyCa™ behavior on the facial skin. CLINICAL SIGNIFICANCE: The US-guided application of injectable products in specific areas has minimal side effects and contributes to more predictable and satisfactory results. How to cite this article: Gouveia RSA, Tostes LLL, Bezerra FV, et al. High-frequency Ultrasound in the Assessment before and after Applying HArmonyCa™. J Contemp Dent Pract 2024;25(1):10-14.

In vivo assessment of early effects of diamond-tipped microdermabrasion through the lens of line-field confocal optical coherence tomography.

BACKGROUND: Microdermabrasion is a cosmetic procedure that has gained popularity for skin rejuvenation by causing repetitive intraepidermal injury to stimulate the proliferation of fibroblasts and collagen production. Various clinical studies have demonstrated microdermabrasion's effectiveness in skin rejuvenation; however, most of these studies rely on clinical observation and scoring by observers rather than histologic or microscopic analysis. In our single-center prospective study, we used line-field confocal optical coherence tomography (LC-OCT), to non-invasively visualize the early effects of one microdermabrasion treatment on the facial epidermal and dermal structure. AIM: Using LC-OCT, this study aims to elucidate the microscopic and histological effects of microdermabrasion on epidermal and dermal structures, including epidermal thickness, as well as collagen and vascular patterns. PATIENTS/METHODS: Eight volunteers (Fitzpatrick skin types II-V) underwent one treatment of microdermabrasion. LC-OCT and VISIA imaging were performed before and 10 min after microdermabrasion, and at 48-h follow-up. Subjective evaluations of skin texture and adverse reactions were assessed 1 week posttreatment via a telephone call. RESULTS: Compared to LC-OCT images before treatment, images captured after one treatment of microdermabrasion showed a decrease in thickness and number of undulations in the stratum corneum. In the superficial dermis, enhancement in fibrillar collagen, as demonstrated by an increased prominence of crisscrossing hyper-refractile strands, was visualized. This was consistent with subjective and objective improvement in facial rhytids calculated by VISIA skin analysis. CONCLUSIONS: Treatment monitoring with LC-OCT demonstrated consistent histopathological changes with clinical visual improvement. Therefore, LC-OCT, has the potential to enable long-term histopathological monitoring of microdermabrasion and other cosmetic procedures without biopsy.

Skin patch based makeup finish assessment technique by deep neural network.

BACKGROUND: Skin color and texture play a significant role in influencing impressions. To understand the influence of skin appearance and to develop better makeup products, objective evaluation methods for makeup finish have been explored. This study aims to apply machine learning technology, specifically deep neural network (DNN), to accurately analyze and evaluate delicate and complex cosmetic skin textures. METHODS: "Skin patch datasets" were extracted from facial images and used to train a DNN model. The advantages of using skin patches include retaining fine texture, eliminating false correlations from non-skin features, and enabling visualization of the inferred results for the entire face. The DNN was trained in two ways: a classification task to classify skin attributes and a regression task to predict the visual assessment of experts. The trained DNNs were applied for the evaluation of actual makeup conditions. RESULTS: In the classification task training, skin patch-based classifiers for age range, presence or absence of base makeup, formulation type (powder/liquid) of the applied base makeup, and immediate/while after makeup application were developed. The trained DNNs on regression task showed high prediction accuracy for the experts' visual assessment. Application of DNN to the evaluation of actual makeup conditions clearly showed appropriate evaluation results in line with the appearance of the makeup finish. CONCLUSION: The proposed method of using DNNs trained on skin patches effectively evaluates makeup finish. This approach has potential applications in visual science research and cosmetics development. Further studies can explore the analysis of different skin conditions and the development of personalized cosmetics.

Tridimensional assessment of the mandibular angle in patients with different skeletal patterns by cone-beam computed tomography scans: a retrospective study.

BACKGROUND: Since the muscles of chewing are involved in the region of the mandibular angle, important structures in surgical and orthodontic procedures, to study its morphological aspects and the possible influence of different patterns of skeletal development would be of interest. Thus, this study aimed to assess the influence of patient characteristics - such as sex, skeletal malocclusion (Class I, Class II, and Class III) and facial type (brachycephalic, mesocephalic, and dolichocephalic) - on the width, height, thickness, and volume of the mandibular angle, using cone-beam computed tomography (CBCT) scans. METHODS: CBCT scans were assessed - 144 men and 154 women, total of 298 - and classified according to skeletal patterns (skeletal malocclusions and facial types). Width, height, and thickness of the mandibular angle were measured using OnDemand 3D software. The volumetric measures of the mandibular angle were obtained using the ITK-SNAP software. Analysis of Variance (multiway ANOVA) with Tukey's post-hoc test compared the data, with a 5% significance level. RESULTS: Among the factors studied, sex significantly influenced all the analyzed variables (height, width, thickness, and volume of the mandibular angle) (p < 0.05); in general, male individuals presented higher values than females. In some cases, the skeletal malocclusion and facial type factors influenced only the width and height variables (p < 0.05); in general, the Class III and dolichocephalic individuals presented higher values in relation to the other types of skeletal malocclusions and facial types. CONCLUSIONS: Variations in the craniofacial growth pattern, considering the different skeletal malocclusions and facial types, had some influence in the width and height dimensions of the mandibular angle. Furthermore, sex influenced all the studied variables.

Three-dimensional radiographic assessment of the mandibular retromolar donor site in different vertical facial growth types.

PURPOSE: To assess volumetrically, the impact of vertical facial growth types (VGFT) on the retromolar area as a bone donor site MATERIAL AND METHODS: 60 cone beam computed tomography (CBCT) scans of adult individuals were classified in three groups according to their SN-GoGn angle: hypodivergent group (hG) (33.33%), normodivergent group (NG) (30%) and hyperdivergent group (HG) (36.67%). Total harvestable bone volume and surface (TBV and TBS respectively), total cortical and cancellous bone volume (TCBV and TcBV respectively) and the percentage of cortical and cancellous bone volume (CBV and cBV respectively) were evaluated. RESULTS: The whole sample showed a mean TBV of 1220.99±448.81mm³ and a mean TBS of 940.29±259.93mm². Statistically significant differences were found between the different outcome variables and the vertical growth patterns (p<0.001). TBS differs for the different vertical growth patterns with the highest mean of TBS observed in the hG group. TBV also significantly differs between the different vertical growth patterns (p<0.001) with the highest mean observed for the hG individuals. Significant differences in percentages of cBV and CBV were present between the hyper-divergent groups and the other groups (p<0.001) with the hyper-divergent group having the lowest percentage of CBV and the highest percentage of cBV. CONCLUSION: hypodivergent individuals tend to have thicker bone blocks that can be used in onlay technique while thinner bone blocks harvested from hyperdivergent and normodivergent individuals can be used in three-dimensional grafting approach.

Anthropometric Comparison of 3-Dimensional Facial Scan Taken With a Low-Cost Facial Scanner With Cone-Beam Computed Tomography Scan.

OBJECTIVE: The aim of this study was to evaluate the accuracy of 3-dimensional (3D) facial scans taken with a low-cost facial scanner compared with cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Twenty-five patients had their CBCT scan and 3D facial scan taken on the same day. Facial scans were taken with a low-cost facial scanner (Bellus3D, ARC-1 scanner) in an upright position. The facial scans were imported into Invivo5 software and were integrated with the corresponding CBCT scans. Then, 16 soft tissue landmarks were identified on the CBCT scans and the 3D-integrated facial scans. The 6 vertical, 7 horizontal, 10 oblique linear, and 11 angular anthropometric measurements were obtained and compared between the CBCT scans and 3D-integrated facial scans using paired t test and Bland-Altman plots. RESULTS: The differences between CBCT scans and 3D-integrated facial scans showed no statistical significance except for 2 vertical measurements. Bland-Altman plots showed that all anthropometric measurements were within the limit of agreement. The differences between CBCT scans and 3D-integrated facial scans were <1.5 mm or 1.5 degrees except for 2 vertical measurements. CONCLUSIONS: Three-dimensional facial scans taken with facial scanner showed a clinical acceptance when compared with CBCT scans.

Accuracy of low-cost alternative facial scanners: a prospective cohort study.

INTRODUCTION: Three-dimensional facial scans have recently begun to play an increasingly important role in the peri-therapeutic management of oral and maxillofacial and head and neck surgery cases. Face scan images can be generated by optical facial scanners utilizing line-laser, stereophotography, or structured light modalities, as well as from volumetric data: for example, from cone beam computed tomography (CBCT). This study aimed to evaluate whether two low-cost procedures for the creation of three-dimensional face scan images were capable of producing sufficiently accurate data sets for clinical analysis. MATERIALS AND METHODS: Fifty healthy volunteers were included in the study. Two test objects with defined dimensions (Lego bricks) were attached to the forehead and the left cheek of each volunteer. Facial anthropometric values (i.e., the distances between the medial canthi, the lateral canthi, the nasal alae, and the angles of the mouth) were first measured manually. Subsequently, face scans were performed with a smart device and manual photogrammetry and the values obtained were compared with the manually measured data sets. RESULTS: The anthropometric distances deviated, on average, 2.17 mm from the manual measurements (smart device scanning deviation 3.01 mm, photogrammetry deviation 1.34 mm), with seven out of eight deviations being statistically significant. For the Lego brick, from a total of 32 angles, 19 values demonstrated a significant difference from the original 90° angles. The average deviation was 6.5° (smart device scanning deviation 10.1°, photogrammetry deviation 2.8°). CONCLUSION: Manual photogrammetry demonstrated greater accuracy when creating three-dimensional face scan images; however, smart devices are more user-friendly. Dental professionals should monitor camera and smart device technical improvements carefully when choosing and adequate technique for 3D scanning.

Assessment of the Relation Between Craniofacial Tissue Profile-Morphology and Dermatoglyphics.

This study aims to evaluate the relationship between the convexity angle of facial tissue and fingerprint types by analyzing the connection between dermatoglyphic prints and facial structure. A total of 65 adults (24 females, 41 males) participated in the study. Each participant's fingerprint was analyzed using conventional methods of observation upon the index finger of the dominant hand. Fingerprints were classified into 3 fundamental types: arch, whorl, or loop. Craniofacial profiling was performed with measurements of hard tissue (Gl'-A-Pg') and soft tissue facial convexity (Gl-Sn-Pg) and total facial convexity (Gl-Prn-Pg) angles between 3 anthropological points determined on the lateral direct radiographs of the participants. Soft tissue convexity facial angle (Gl-Sn-Pg) values were found to be an average of 166.83° in females and an average of 162.05° in males. (Gl-Prn-Pg) values were found to be an average of 138.54° in females and 135.27° in males. The soft tissue profile of males showed a significantly convex structure compared with females. Also, the "whorl" type of fingerprint was found to be dominant in both sexes. There is no statistically significant difference in terms of soft tissue profile convexity in individuals belonging to the 3 different fingerprint groups. No statistically significant difference in soft tissue profile angular values between right-hand thumb and index fingerprint type groups were found among and between sexes. However, a comprehensive analysis of the relationships between the nose, lips, mouth, ear, and eyes and fingerprints of the same person may prove to be beneficial.

3D surface imaging technology for objective automated assessment of facial interventions: A systematic review.

BACKGROUND: The incidence of facial skin cancer increases worldwide, resulting in more surgical resections and reconstructions. Reconstructive surgery aims to approach a normal facial anatomy to optimize the quality of life. Objective automated assessment of the esthetic outcome of facial reconstructions could provide feedback for the improvement of surgical techniques and preoperative patient expectation management. OBJECTIVE: This systematic literature review aimed to assess whether modern technologies can create automated objective measurements of surgical and non-surgical facial interventions outcomes using 3D surface imaging technology. METHODS: A systematic literature search was conducted in Embase, Medline (Ovid), Web of Science, and Cochrane on May 19, 2021. All English literature was collected on surgical and non-surgical invasive facial interventions in which 3D surface imaging technology was used for objective automated assessment of outcomes. RESULTS: Fourteen articles were included in the systematic review. 3D surface imaging technology and automated assessment techniques were found for skin malignancy, cleft lip repair, rhinoplasty, orthognathic surgery, and injectables. Ten 3D surface imaging technology hardware systems and 12 software systems were described. Four studies compared 3D surface imaging techniques to conventional methods. Ten studies used 3D surface imaging techniques for the evaluation of the surgical outcome, without comparison to 2D photography, validated scores, or a panel. Two studies validated the hardware system. CONCLUSION: This systematic literature review shows that 3D surface imaging technology has the potential for automated objective assessment of facial intervention outcomes. Future studies are necessary to study and validate these tools for standard clinical use in patients with facial interventions.

Introduction of a Low-Cost and Automated Four-Dimensional Assessment System of the Face.

SUMMARY: Existing automated objective grading systems either fail to consider the face's complex three-dimensional morphology or have poor feasibility and usability. Consumer-based red, green, and blue depth sensors or smartphone integrated three-dimensional hardware can inexpensively collect detailed four-dimensional facial data in real time but are yet to be incorporated into a practical system. This study aimed to evaluate the feasibility of a proof-of-concept automated four-dimensional facial assessment system using a red/green/blue depth sensor (OpenFAS) for use in a standard clinical environment. This study was performed on healthy adult volunteers and patients with facial nerve palsy. The setup consists of the Intel (Santa Clara, Calif.) RealSense SR300 connected to a laptop running the OpenFAS application. The subject sequentially mimics the facial expressions shown on screen. Each frame is landmarked and automatic anthropometric calculations are performed. Any errors during each session were noted. Landmarking accuracy was estimated by comparing the ground-truth position of landmarks annotated manually with those placed automatically. Eighteen participants were included in the study, nine healthy participants and nine patients with facial nerve palsy. Each session was standardized at approximately 106 seconds. A total of 61.8 percent of landmarks were automatically annotated within approximately 1.575 mm of their ground-truth locations. The findings support that OpenFAS is usable and feasible in routine settings, laying down the critical groundwork for a facial assessment system that addresses the shortcomings of existing tools. The iteration of OpenFAS presented in this study is nascent; future work, including improvements to landmarking accuracy, analyses components, and red/green/blue depth technology, is required before clinical application.

A semi-automatic three-dimensional technique using a regionalized facial template enables facial growth assessment in healthy children from 1.5 to 5.0 years of age.

Objectives: To develop a semi-automatic technique to evaluate normative facial growth in healthy children between the age of 1.5 and 5.0 years using three-dimensional stereophotogrammetric images. Materials and Methods: Three-dimensional facial images of healthy children at 1.5, 2.0, 2.5, 3.0, 4.0 and 5.0 years of age were collected and positioned based on a reference frame. A general face template was used to extract the face and its separate regions from the full stereophotogrammetric image. Furthermore, this template was used to create a uniform distributed mesh, which could be directly compared to other meshes. Average faces were created for each age group and mean growth was determined between consecutive groups for the full face and its separate regions. Finally, the results were tested for intra- and inter-operator performance. Results: The highest growth velocity was present in the first period between 1.5 and 2.0 years of age with an average of 1.50 mm (±0.54 mm) per six months. After 2.0 years, facial growth velocity declined to only a third at the age of 5.0 years. Intra- and inter-operator variability was small and not significant. Conclusions: The results show that this technique can be used for objective clinical evaluation of facial growth. Example normative facial averages and the corresponding facial growth between the age 1.5 and 5.0 years are shown. Clinical Relevance: This technique can be used to collect and process facial data for objective clinical evaluation of facial growth in the individual patient. Furthermore, these data can be used as normative data in future comparative studies.

Accuracy Assessment of Three-Dimensional Surface Imaging-Based Distance Measurements of the Face: Comparison of a Handheld Facial Scanner and a Stationary Whole-Body Surface Imaging Device.

Three-dimensional surface imaging (3DSI) has been shown to be a useful tool for plastic surgeons in the preoperative, intraoperative, and postoperative setting. The objective of this investigation was to compare the accuracy of facial surface distance measurements using both a handheld facial 3DSI device and a stationary whole-body 3DSI device. Users should be aware of deviations when obtaining 3DSI using the presented imaging devices but should not refrain from using them, as the absolute differences might be too small to play a role in both, clinical and research, settings.

Similarities and disparities between visual analysis and high-resolution electromyography of facial expressions.

Computer vision (CV) is widely used in the investigation of facial expressions. Applications range from psychological evaluation to neurology, to name just two examples. CV for identifying facial expressions may suffer from several shortcomings: CV provides indirect information about muscle activation, it is insensitive to activations that do not involve visible deformations, such as jaw clenching. Moreover, it relies on high-resolution and unobstructed visuals. High density surface electromyography (sEMG) recordings with soft electrode array is an alternative approach which provides direct information about muscle activation, even from freely behaving humans. In this investigation, we compare CV and sEMG analysis of facial muscle activation. We used independent component analysis (ICA) and multiple linear regression (MLR) to quantify the similarity and disparity between the two approaches for posed muscle activations. The comparison reveals similarity in event detection, but discrepancies and inconsistencies in source identification. Specifically, the correspondence between sEMG and action unit (AU)-based analyses, the most widely used basis of CV muscle activation prediction, appears to vary between participants and sessions. We also show a comparison between AU and sEMG data of spontaneous smiles, highlighting the differences between the two approaches. The data presented in this paper suggests that the use of AU-based analysis should consider its limited ability to reliably compare between different sessions and individuals and highlight the advantages of high-resolution sEMG for facial expression analysis.

Facial asymmetry assessment in skeletal Class III patients with spatially-dense geometric morphometrics.

OBJECTIVE: Quantification and visualization of the location and magnitude of facial asymmetry is important for diagnosis and treatment planning. The objective of this study was to analyze the asymmetric features of the face for skeletal Class III patients using spatially-dense geometric morphometrics. METHODS: Three-dimensional facial images were obtained for 86 skeletal Class III patients. About 7160 uniformly sampled quasi-landmarks were automatically identified on each face using template mapping technique. The pointwise surface-to-surface distance between original and mirror face was measured and visualized for the whole face after robust Procrustes superimposition. The degree of overall asymmetry in an individual was scored using a root-mean-squared-error. Automatic partitioning of the face was obtained, and the severity of the asymmetry compared among seven facial regions. RESULTS: Facial asymmetry was mainly located on, but not limited to, the lower two-thirds of the face in skeletal Class III patients. The lower cheek and nose asymmetry were detected to have more extensive and of a greater magnitude of asymmetry than other facial anatomical regions but with various individual variations. The overall facial asymmetry index and the regional facial asymmetry indices were higher in males and patients with chin deviation. CONCLUSIONS: Soft tissue asymmetry is predominately presented in the lower-third of the face in skeletal Class III patients and with various variations on other facial anatomical regions. Morphometric techniques and computer intensive analysis have allowed sophisticated quantification and visualization of the pointwise asymmetry on the full face.

Three-dimensional radiographic assessment of the mandibular interforaminal donor site in different vertical facial growth types.

PURPOSE: To assess volumetrically, the impact of vertical facial growth types (VFGT) on the mandibular interforaminal region as a potential bone donor site. MATERIAL AND METHODS: 60 cone beam computed tomography (CBCT) scans of adult individuals were classified in three groups according to their SN-GoGn angle: hypodivergent group (hG) (N=20), normodivergent group (NG) (N=19) and hyperdivergent group (HG) (N=21). Total harvestable bone volume (TBV), cortico-cancellous bone volume (CBV-cBV), and cortical bone surface (CBS) were evaluated. ANOVA test followed by Tukey post hoc tests were used to compare the mean continuous outcomes according to their VFGT. RESULTS: The whole sample showed a mean TBV of 1376.32±541.01mm3, CBV of 468.52±121.54mm3 and cBV of 908.73±474.71mm3. The mean CBS amounted to 782.58±146.80mm2. The comparison between the groups stated a significantly different mean TBV and cBV (-p-value<0.001). The mean CBS was significantly different (-p-value=0.015): the smallest for the NG, but not significantly different (-p-value<0.001): the highest for the HG, intermediate for the NG and the smallest for the hG. CONCLUSION: Hypodivergent individuals have the thickest cancellous bone suitable for an onlay bone graft, while hyperdivergent individuals have the thinnest bone ideal for a 3D grafting approach.

Assessment of ROI Selection for Facial Video-Based rPPG.

In general, facial image-based remote photoplethysmography (rPPG) methods use color-based and patch-based region-of-interest (ROI) selection methods to estimate the blood volume pulse (BVP) and beats per minute (BPM). Anatomically, the thickness of the skin is not uniform in all areas of the face, so the same diffuse reflection information cannot be obtained in each area. In recent years, various studies have presented experimental results for their ROIs but did not provide a valid rationale for the proposed regions. In this paper, to see the effect of skin thickness on the accuracy of the rPPG algorithm, we conducted an experiment on 39 anatomically divided facial regions. Experiments were performed with seven algorithms (CHROM, GREEN, ICA, PBV, POS, SSR, and LGI) using the UBFC-rPPG and LGI-PPGI datasets considering 29 selected regions and two adjusted regions out of 39 anatomically classified regions. We proposed a BVP similarity evaluation metric to find a region with high accuracy. We conducted additional experiments on the TOP-5 regions and BOT-5 regions and presented the validity of the proposed ROIs. The TOP-5 regions showed relatively high accuracy compared to the previous algorithm's ROI, suggesting that the anatomical characteristics of the ROI should be considered when developing a facial image-based rPPG algorithm.

Billing patterns for in-office computerized tomography scans of the face/sinus by otolaryngologists.

PURPOSE: To evaluate billing trends, Medicare reimbursement, and practice setting for Medicare-billing otolaryngologists (ORLs) performing in-office face computerized tomography (CT) scans. METHODS: This retrospective study included data on Medicare-billing ORLs from Medicare Part B: Provider Utilization and Payment Datafiles (2012-2018). Number of Medicare-billing ORLs performing in-office CT scans, and total sums and medians for Medicare reimbursements, services performed, and number of patients were gathered along with geographic and practice-type distributions. RESULTS: In 2018, roughly 1 in 7 Medicare-billing ORLs was performing in-office CT scans, an increase from 1 in 10 in 2012 (48.2% growth). From 2012 to 2018, there has been near-linear growth in number of in-office CT scans performed (58.2% growth), and number of Medicare fee-for-service (FFS) patients receiving an in-office CT scan (64.8% growth). However, at the median, the number of in-office CT scans performed and number of Medicare FFS patients receiving an in-office CT, per physician, has remained constant, despite a decline of 42.3% (2012: $227.67; 2018: $131.26) in median Medicare reimbursements. CONCLUSION: Though sharp declines have been seen in Medicare reimbursement, a greater proportion of Medicare-billing ORLs have been performing in-office face CT scans, while median number of in-office CT scans per ORL has remained constant. Although further investigation is certainly warranted, this analysis suggests that ORLs, at least in the case of the Medicare FFS population, are utilizing in-office CT imaging for preoperative planning, pathologic diagnosis, and patient convenience, rather than increased revenue streams. Future studies should focus on observing these billing trends among private insurers.

SONOGRAPHY OF THE FACE AND NECK REGION SOFT TISSUES IN ASSESSMENT OF THE COMPLICATIONS CAUSES AFTER FACIAL CONTOURING.

132 women after facial contouring on terms from 2 weeks to 15 years after filler injection were examined by sonography (US). They had complaints of the edema, hypercorrection, asymmetry, discomfort and anxiety about the excess of the terms that filler had spent into the soft tissues. HA fillers were injected in 111 cases (84.1%), silicon agents - in 13 cases (9.8%), CaHA - in 6 (4.5%), PMMA - on 1 (0.8%) and one patient have had non-hyalouronic filler with unknown origin (0.8%). According to the US data, nasolacrimal and palpebromar fissures were the most common location of fillers or the echo signs of fibrotic changes in the projection of their injection - 54 patients, just like the lips region and nasolabial folds - 52 cases. The US of the skin and the soft tissues of the face and neck region prescribed to the patients in order to carry out the differential diagnosis of complaints' causes, to determine the treatment tactics and for planning cosmetic procedures.

Voxel-based superimposition of serial craniofacial cone-beam computed tomographies for facial soft tissue assessment: Reproducibility and segmentation effects.

INTRODUCTION: The aim of this investigation was to evaluate the reproducibility of a voxel-based 3-dimensional superimposition method and the effect of segmentation error on determining soft tissue surface changes. METHODS: A total of 15 pairs of serial cone-beam computed tomography images (interval: 1.69 ± 0.37 years) from growing subjects (initial age: 11.75 ± 0.59 years) were selected from an existing digital database. Each pair was superimposed on the anterior cranial base, in 3 dimensions with Dolphin 3D software (version 2.1.6079.17633; Dolphin Imaging & Management Solutions, Chatsworth, Calif). The reproducibility of superimposition outcomes and surface segmentation were tested with intra- and interoperator comparisons. RESULTS: Median differences in inter- and intrarater measurements at various areas presented a range of 0.08-0.21 mm. In few instances, the differences were larger than 0.5 mm. In areas where T0-T1 changes were increased, the error did not appear to increase. However, the method error increased the farther the measurement area was from the superimposition reference structure. For individual images, the median soft tissue segmentation error ranged from 0.05 to 0.06 at various areas and in no subject exceeded 0.13 mm. CONCLUSIONS: The presented voxel-based superimposition method was efficient and well reproducible. The segmentation process was a minimal source of error; however, there were a few cases in which the total error was more than 0.5 mm and could be considered clinically significant. Therefore, this method can be used clinically to assess 3-dimensional soft tissue changes during orthodontic treatment in growing patients.

A Single-Center Trial to Evaluate the Efficacy and Tolerability of Four Microneedling Treatments on Fine Lines and Wrinkles of Facial and Neck Skin in Subjects With Fitzpatrick Skin Types I-IV: An Objective Assessment Using Noninvasive Devices and 0.33-mm Microbiopsies.

BACKGROUND: Although ablative techniques are the standard of care for the treatment of fine lines and wrinkles, microneedling offers a minimally invasive alternative. OBJECTIVES: The purpose of this study was to assess the efficacy of microneedling on facial and neck fine lines and wrinkles. METHODS: Thirty-five subjects between 44 and 65 years old with Fitzpatrick skin types I to IV received 4 monthly microneedling treatments over the face and neck. Subjects returned 1 and 3 months posttreatment. At every visit, high-resolution ultrasonography and optical coherence tomography were performed, and transepidermal water loss and skin elasticity were measured. Microbiopsies (0.33 mm) were collected pretreatment, before the fourth treatment and 3 months posttreatment. RESULTS: Thirty-two subjects (30 females, 2 males) completed all 7 visits. Facial dermal and epidermal density increased 101.86% and 19.28%, respectively, from baseline at 3 months posttreatment. Facial elasticity increased 28.2% from baseline at 3 months posttreatment. Facial attenuation coefficient increased 15.65% and 17.33% at 1 and 3 months posttreatment, respectively. At study completion, blood flow at a depth of 300 µm decreased 25.8% in the face and 42.3% in the neck. Relative collagen type III and elastin gene expression was statistically higher 3 months posttreatment. However, total elastin protein levels were unchanged from baseline values. Dermal muscle formation was observed in 58% of biopsies extracted 3 months posttreatment compared with 15.3% at baseline. CONCLUSIONS: The results illustrate the effects of microneedling treatments. Noninvasive measurements and biopsy data showed changes in skin architecture and collagen/elastin gene expression, suggesting skin rejuvenation, with new extracellular matrix production and muscle formation.