Influence of botulinum toxin type A esthetic injections on facial expressions.

BACKGROUND: Botulinum toxin type A (BoNT-A) injection remains the leading medical cosmetic procedure worldwide, with a high rate of patient satisfaction. However, it still suffers from patients' fear of being unable to transmit their emotions and of looking frozen from unnatural results. AIM: This study aimed to determine whether BoNT-A can decrease the intensity of emotions in facial expressions. PATIENTS/METHODS: In this single-center prospective study, 42 patient investigators assessed four patients' facial expressions for six emotions and neutral faces, before and after injection of 36 IU or 48 IU of onabotulinumtoxinA, using photographs. Photographs were presented on a tablet to the investigators. RESULTS: There were no statistical differences between the before and after photographs for the intensity of emotions for all expressions (P > .05) except for the expression of surprise in the group of patients that received 48 IU of the injection (protocol with injection of the frontalis muscle). All patient investigators answered negatively to the question "Do you think that this patient has a 'frozen face'?". CONCLUSION: This study shows that esthetic injection of BoNT-A in the upper face has no negative effects on facial expressions and does not lead to the feared "frozen face" when it is injected with respect for best practice guidelines. This study can be used as an example for patients who have some reticences against BoNT-A injection.

High-Resolution Magnetic Resonance Imaging of Aging Upper Face Fat Compartments.

BACKGROUND: Age-related changes in fat compartments have yet to be fully characterized. Uncertainty remains in terms of volume gains/losses or shape fluctuations over time. The authors' aim was to determine the evolution of subcutaneous fat in the aging upper face, focusing on shifts in volume and dimension. METHODS: Over the course of 4.5 years, 100 faces of living female Caucasian patients were prospectively studied using high-resolution magnetic resonance imaging. Subjects were stratified by age as follows: group 1, 18 to 30 years; group 2, 30 to 60 years; and group 3, older than 60 years. Superficial temporal and central forehead compartments were delimited, analyzing respective volumes and dimensions by group. RESULTS: In 85 patients studied, superficial temporal fat (mean volume, 5.14 cm) increased 35.48 percent in total volume between youth and old age (p = 0.046). Overall height and magnitude of the lower one-third also increased with aging. Central forehead fat (mean volume, 2.56 cm), studied in 83 patients, showed a 209.75 percent volume gain in group 2 (versus group 1) and a 17.59 percent volume loss in group 3 (versus group 2) (p = 0.001). CONCLUSION: Subcutaneous facial fat fluctuates with aging, increasing in the upper face and promoting ptosis through basal compartmental expansion.

Coverage of Tendon Exposure after Radial Forearm Free Flap by the Dorsoulnar Artery Perforator Flap.

Objective This study was designed to assess the effectiveness of an alternative technique using a perforator flap to manage secondary tendon exposure after a radial forearm free flap in head and neck oncologic surgery. Study Design Prospective cohort study. Setting Plastic Reconstructive Surgery Unit, Nice University Hospital, Pasteur 2 Hospital, France. Subjects and Methods Despite its numerous advantages, the radial forearm free flap is associated with significant donor site morbidity and the risk of secondary tendon exposure. Conventional skin grafts for secondary tendon exposure can lead to diminished wrist range of motion and grip strength, with residual pain and cold intolerance. Between 2012 and 2015, we prospectively studied 20 patients with secondary tendon exposure after a forearm radial free flap for head and neck reconstruction. Two techniques of secondary coverage were compared: a reference technique with a secondary full skin graft (10 patients) and a dorsoulnar artery perforator (DUAP) flap (10 patients). Results Maximum wrist extension (100%) was observed for the DUAP group compared with only 87% for the skin graft (SG) group ( P = .001). An improvement in grip strength (+14 kg) ( P = .028) and a decrease in pain or cold intolerance ( P = .002) were also observed in the DUAP group, in addition to a better aesthetic appearance. Conclusion The perforator flap procedure is an interesting tool in reconstructive surgery. The DUAP flap is a reliable, useful flap for secondary tendon exposure coverage after a radial forearm free flap. Level of Evidence III (case-control analytic studies of 1 center).

A Cadaveric Study of the Arterial Blood Supply of the Labia Minora.

BACKGROUND: Labiaplasty has become a rather common operation. The main complication of the different surgical techniques is the dehiscence of the suture line. The dehiscence rate varies among the different techniques, and this may imply that the vascular anatomy is not respected in some cases. The detailed arterial anatomy of labia minora is not well described, so the aim of the authors was to describe this anatomy with a cadaveric study. METHODS: Eleven fresh cadavers were dissected, and arterial study was made with injected computed tomography scans and rotational angiography. At the end, a cast of the arterial network was made and chemically exposed to verify the radiological findings. RESULTS: The findings of this study allowed identification of a dominant central artery that was named "C" artery, two posterior arteries named "P1" and "P2," and one small anterior artery, "A." Furthermore, a connection between the anterior system of the external pudendal artery and the posterior system of the internal pudendal artery was confirmed. CONCLUSIONS: The arterial network of the labia minora was identified with this study. This may help surgeons orientate the wedge excision when they perform labiaplasties. More precisely, when this wedge is placed at the most anterior part of the labia minora, the least perfused area is removed, and a posterior flap is created that will preserve a robust blood perfusion.