Platelet-Rich Plasma for Treatment of Hair Loss Improves Patient-Reported Quality of Life.

BACKGROUND: While numerous studies have demonstrated enhanced hair growth following platelet-rich plasma (PRP) treatments in patients with male and female pattern hair loss, no study has demonstrated its impact on quality of life (QoL) using a validated tool. OBJECTIVE: This prospective study aimed to assess the psychological impact of PRP treatment for hair loss. METHODS: PRP scalp injections were repeated monthly for the first 3 months, then quarterly for 1 year, and annually thereafter. HAIRDEX 48, a validated scale assessing QoL for patients with alopecia, was administered before PRP and at each visit. Scores were interpolated on a 0-100 scale: 0 representing highest QoL, 100 lowest, and compared using paired t-tests. RESULTS: Ninety-two patients receiving PRP were analyzed. Mean age was 48.2 ± 17.4 years and 55% were male. Patients had an average of 4 ± 2 treatments; most (60%) had ≥4. Thirty patients (33%) completed both pre- and post-PRP questionnaires. Prior to PRP, 61% tried minoxidil, 16% finasteride, and 1% hair transplant. Total HAIRDEX scores improved from a mean of 23.2 ± 15.4 to 19.7 ± 11.3 after 3-5 months after PRP (p < 0.001). There were also decreases in symptoms (10.0 ± 12.0 vs. 9.6 ± 10.8, p < 0.001), functioning (16.1 ± 18.1 vs. 13.3 ± 12.6, p < 0.001), and emotions domains (37.7 ± 24.1 vs. 32.2 ± 18.9, p < 0001). For stigmatization and self-confidence domains, improvements from pre-PRP were significant at 3-5 months (21.2 ± 16.8 vs. 17.4 ± 12.1; p < 0.001 and 24.8 ± 17.7 vs. 20.9 ± 15.5; p < 0.001, respectively) and >6 months (18.9 ± 13.9; p < 0.001 and19.5 ± 18.6; p = 0.008, respectively). CONCLUSIONS: PRP improves QoL and is an effective part of multimodal therapy for hair loss. 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 .

A Longitudinal, Geographical, and Descriptive Analysis of Political Contributions of Plastic Surgeons.

BACKGROUND: Political contributions from healthcare providers are essential to shaping healthcare policy and allow physicians to expand their influence on a national level. Political Action Committees in particular provide a useful avenue for unifying contributions for the interest of a specific community. This study examined the geographical distribution, temporal pattern, and overall nature of the political contributions made by plastic surgeons. METHODS: The Federal Election Commission was analyzed for political contributions made by plastic surgeons from 2003 to 2021 using the search terms "plastic surgeon," "microsurgeon," and "craniofacial" as well as physician contributions to PlastyPAC. Contributions were categorized based on political parties (Democratic, Republican, and independent parties), and further analyzed based on state distribution and year of contribution. Spatial distribution data were then visualized using heatmaps for each state. RESULTS: The total sum of contributions between 2003 and 2021 from plastic surgeons was $5,306,605, with $1,737,178.51 for the Republican party, $962,773.26 for the Democratic party, and $2,604,149.86 for independent parties. Political funding of PlastyPAC consisted of 47.3% of the overall political contributions. There was no significant trend through the years in the overall contribution amount. The states with the most political contributions were California, New York, Florida, and Texas. CONCLUSIONS: The temporal stagnation of total political contributions and decline in recent PlastyPAC funding from plastic surgeons support an increased political awareness for new plastic surgeons. LEVEL OF EVIDENCE V: 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 .

Labiaplasty: Analysis of the National Surgical Quality Improvement Program Database.

BACKGROUND: Labiaplasty is an increasingly popular procedure performed for both cosmetic and pathologic etiologies. Questions have been raised regarding the efficacy of the procedure, especially for cosmetic etiologies. OBJECTIVES: The aim of this study was to examine the complication profiles of labiaplasties for both cosmetic and pathologic etiologies. METHODS: The 2005 to 2017 National Surgical Quality Improvement Program database was analyzed for patients who, according to the relevant Current Procedural Terminology code, had undergone labiaplasties. Our cohort was further separated into cosmetic and pathologic groups based on International Classification of Diseases codes. Information was collected on patient demographic characteristics, patient comorbidities, and operative variables. Outcomes of interest included surgical complications and delayed length of stay (DLOS). A univariate analysis and multivariate logistic regression were applied to determine statistically significant predictors of our outcomes of interest for both etiologies. RESULTS: There were 640 patients in the cosmetic cohort and 1919 patients in the pathologic cohort. There were no significant differences in rates of surgical complications between the 2 groups, but there was a statistically significant increase in length of stay for the pathologic group. Univariate analysis revealed operative time and plastic surgeon specialty to be predictive of DLOS in the cosmetic cohort. No covariates were implicated with multivariate analysis for either surgical complications or for DLOS in the cosmetic cohort. CONCLUSIONS: Our findings suggest that cosmetic labiaplasty is a safe and efficacious procedure with low complication rates and no predictors of adverse outcomes.

The Positive Patient Experience: A Comprehensive Analysis of Plastic Surgery Online Reviews.

BACKGROUND: Subjective online physician evaluation is an important component of patient decision-making. Understanding reviews may improve satisfaction and build positive online reputation. OBJECTIVES: The aim of this study was to analyze and compare the top predictive factors driving patient satisfaction across the most popular plastic surgery procedures. METHODS: Online reviews were analyzed from RealSelf, Yelp, and Google for the 5 highest-rated plastic surgeons in 6 US metropolitan areas. Blank, non-English, consultation, duplicate, and unrelated reviews were excluded. Data from free-text reviews included physician rating, patient-reported reasons for rating, procedure, and complications. Univariate analysis was performed to compare predictive factors of online ratings. RESULTS: In total, 11,078 reviews were included. RealSelf had the highest average rating (4.77), and Yelp had the lowest (4.66). Reviews in Miami, Philadelphia, New York City, and Chicago were mostly published on RealSelf, whereas Houston and Los Angeles mostly used Google and Yelp, respectively. Reconstructive procedures were rated significantly higher than cosmetic procedures (P = 0.035). Aesthetic appearance was the strongest predictor of rating across all procedures. Buccal fat removal (98.8%) and abdominoplasty (98.1%) had the highest satisfaction, and Brazilian butt lift had the lowest (88.2%) (P < 0.001). Additional significant contributors included staff interaction, bedside manner, health outcomes, complications, and postoperative care (P < 0.001). CONCLUSIONS: Although aesthetic outcome is an important predictor of satisfaction, other aspects of care, such as bedside manner and staff interaction, provide an important foundation of support. Excellent patient-surgeon communication and postoperative care may mitigate patient dissatisfaction and elicit high-satisfaction online patient reviews.

The role of topical probiotics in skin conditions: A systematic review of animal and human studies and implications for future therapies.

There is increasing evidence that the intestinal microbiome plays an important role in modulating systemic inflammation and disease. Oral probiotics can modulate the intestinal microbiome and have demonstrated to be efficacious in treating topical skin conditions, such as atopic dermatitis, acne and rosacea. By proxy, exogenous application to the skin of probiotics should also promote a positive bacterial balance to mitigate or potentially eliminate pathologic conditions. The goal of this article was to provide a systematic review of studies that have investigated the role of topical probiotics in mitigating skin conditions. Additionally, skin conditions where dysbiosis has been identified but topical probiotics have not been investigated are discussed. We hope this review both analyses the evidence for the role that topical probiotics could play in topical skin conditions and highlights additional areas in need of research and exploration.

Perioperative Homeopathic Arnica and Bromelain: Current Results and Future Directions.

INTRODUCTION: Arnica and bromelain, two of the most widely recommended homeopathic medications to improve perioperative outcomes, have yet to be widely adopted by allopathic practitioners. A significant barrier to utilization of herbal medications by allopathic doctors is that the preparations and dosing regimens are not widely known or understood. The goal of this review was to critically analyze studies that have examined the perioperative efficacy of arnica and bromelain with a focus on treatment regimen and outcomes. METHODS: A triple database search was conducted with the keywords "arnica," "bromelain," and "surgery." References for each identified article were analyzed for additional articles. Articles were analyzed for methodology, outcomes, and conclusion. Articles were excluded if they did not involve human subjects, were published before 1990, and if they were not available in English. Level of evidence was determined based on methodology. RESULTS: A total of 29 articles met inclusion criteria, with 20 and 9 in the arnica and bromelain treatment groups, respectively. There was marked heterogeneity with regard to surgical procedure, dosing regimen, outcomes measured, and results. Arnica seems to have a mitigating effect on ecchymosis, most notably following rhinoplasty and facelifts/facial procedures. Bromelain is well supported across numerous studies in reducing trismus, pain, and swelling following molar extractions. However, there was no effect demonstrated when evaluating topical arnica following blepharoplasty procedures. DISCUSSION: A systematic review of the literature demonstrates the potential for arnica and bromelain to improve perioperative outcomes including edema, ecchymosis, and pain control. Future studies are required to determine safety and efficacy of dosing and interactions with other medications. We hope this article stimulates surgeons to consider using these interventions to improve perioperative outcomes in the context of well-done studies with an objective analysis of results.

Revisiting the "July Effect" in Plastic Surgery: New Data to Support Resident Autonomy.

BACKGROUND: The "July Effect" represents a topic of considerable interest across residency programs. This study investigated the frequency of postoperative complications following procedures with plastic surgery resident participation (all postgraduate year [PGY] levels) during the first (quarter 3, July-September) and last academic quarters. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was used to calculate complication rates from 2006 to 2010. Resident involvement was analyzed as a categorical variable consisting of "juniors" (PGY1-PGY3), and "seniors" (PGY4-PGY6). Outcomes from procedures during Q3 were compared with all quarters. Propensity score matching and adjustment enabled logistic regression identifying the effect of resident involvement and admission. RESULTS: Among all cosmetic and reconstructive procedures (n = 6625), mean operative time was not significantly greater in Q3 compared with all other quarters (P = 0.069); no significant differences in complication rates were observed between Q3 and all other quarters, though superficial surgical site infection (SSI) approached significance (3.3% of procedures in Q3 vs 2.5% in all other quarters, P = 0.063). Among reconstructive procedures only (n = 5677), mean operative time was not significantly greater in Q3 compared with all other quarters (P = 0.119); the same held true for cosmetic procedures only (P = 0.275). Surgical site infection, however, was significantly more likely to occur with reconstructive procedures only, in Q3 compared with all other quarters (3.5% of cases vs 2.3%, P = 0.024). When adjusting for PGY status and matching populations, superficial SSI and return to the operating room were not significantly more common in Q3. When adjusting for quarter of admission, however, superficial SSI was significantly more common among the overall and noncosmetic cases with participation by junior residents (P = 0.013 and 0.020, respectively). CONCLUSIONS: This may represent the first fully reproducible, transparent National Surgical Quality Improvement Program study in plastic surgery that demonstrates the absence of a clinically significant "July Effect," and suggests that an appropriate degree of resident autonomy may pose minimal risk during both cosmetic and reconstructive procedures in residency training. Additionally, the findings encourage the development a plastic surgery-specific database to remedy inherent difficulties with larger, more comprehensive surgical databases.

Optimizing Postoperative Pain Control in Autologous Breast Reconstruction: A Systematic Review.

BACKGROUND: Pain management approaches in autologous breast reconstruction have become a topic of great interest in the era of enhanced recovery after surgery protocols, as well as the opioid epidemic. The management of postoperative pain is of critical importance for women undergoing breast reconstruction; however, these protocols have yet to be synthesized and compared in the primary literature. Herein, we present a systematic review of approaches to provide optimal pain control while minimizing narcotic use and its associated potential negative sequelae in autologous breast reconstruction. METHODS: A comprehensive systematic review of the published literature was conducted using Ovid Medline/PubMed database without timeframe limitations, in compliance with the guidelines outlined in the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Inclusion criteria were selected for studies reporting objective outcomes of pain modulation in autologous breast reconstruction. Articles for inclusion were stratified based on intervention. RESULTS: A total of 101 articles were identified on initial search query. After full-text review and final screening of all articles and review of included studies' references, 28 studies met the inclusion criteria and were analyzed. CONCLUSION: There continues to be a substantial need for evidence-based guidelines in the plastic surgery literature. Mitigating postoperative pain can improve health-related quality of life, reduce health care resource utilization and costs, and minimize perioperative opiate use. Given the increasing popularity of and access to autologous approaches to breast reconstruction, we hope this area of study continues to be a top priority for plastic surgeons to allow for optimized postoperative care.

The role of topical probiotics on wound healing: A review of animal and human studies.

Pathogenic, opportunistic, and commensal bacterial coexist in the intestinal tract, and imbalances among these strains have been linked to systemic inflammation and a variety of disease states. Similarly, human skin plays an important role as an interface between the body and the environment with an estimated 1 billion microbes per square centimetres. Skin microbiome fluctuations that cause increases in pathologic bacteria, either because of individual and/or environmental factors, can lead to disease states at the skin level ranging from inflammatory conditions to infections. As wounds are inherently associated with perturbations in the local microflora due to injury and activation of the immune responses, the addition of topical probiotics could be a means to prevent infection, regulate inflammation, and potentially augment healing. The goal of this review is to analyse the impact the skin microbiome has on cutaneous wound healing with a focus on developing proposed treatment algorithms and support for their therapeutic potential.

Anatomic Targets for Breast Reconstruction Neurotization: Past Results and Future Possibilities.

The concept of providing neurotized autologous breast reconstruction is not novel, but the introduction of cadaveric nerve grafts has allowed for the development of new techniques and a resurgence in academic interest. There has been a surge in the number of publications regarding neurotized autologous breast reconstruction. However, recent articles and reviews have focused mainly on autologous, abdominal-based reconstruction. The sensory innervation of the most commonly used autologous tissues has been well described, allowing surgeons to perform accurate and reproducible dissections. However, there are numerous options for autologous breast reconstruction, and not all patients are candidates for abdominally based reconstruction. As more patients inquire to their possible reconstruction options, plastic surgeons will have to be well versed in the different neurotized options and appreciate the technical aspects associated with reconstructive success. In this review, we aim to discuss both established anatomic targets for autologous flap neurotization and future directions.

Microsurgical reconstruction of complex maxillofacial gunshot wounds: Outcomes analysis and algorithm.

BACKGROUND: Satisfaction with appearance, functional outcomes (speech, swallowing), work status after microsurgical reconstruction for maxillofacial gunshot wounds (GSW) remain largely unknown. The purpose of this study is to report these parameters. By investigating these outcomes, we also aimed to provide microsurgical algorithms for complex maxillofacial GSW. METHODS: Forty-two consecutive maxillofacial GSW patients between 2006 and 2014 were analyzed for outcomes. Mean age was 41.3 years ranging 14 to 77 years. There were 33 males and 9 females. RESULTS: Twenty-four patients received 36 free flaps for early reconstruction in 1 to 2 weeks, two patients in a delayed manner. Fifteen fibula flaps for mandible reconstruction, five fibula, there radial forearm (RF), and two scapular osteocutaneous (OC) flaps for maxilla reconstruction, two RF flaps for palate reconstruction, one RF for cheek reconstruction were used. Four patients underwent innervated gracilis flap for total lower lip and one for cheek reconstruction. Rectus abdominis myocutaneous flap was used for mid-face defects in two patients. One anterolateral thigh flap was used for lower lip/chin reconstruction. Nine free flaps were performed to treat a complication and/or to improve function. All flaps survived except for three partial skin paddle loss to fibula flaps. Mean follow-up was 17.2 months. Return to work/school was 70%. Surveys noted 58% "satisfied". All patients but two achieved perceptible speech, the majority had no difficulty with swallowing, all patients had oral competence. CONCLUSIONS: Favorable outcomes were obtained in most maxillofacial GSW. After investigating these outcomes, microsurgical algorithms were developed for clinical practice for reconstruction of composite mandible and total-lower lip defects, and maxilla/mid-face defects.

A literature review and meta-analysis of outcomes in microsurgical reconstruction using vasopressors.

INTRODUCTION: There is a hesitancy to utilize vasopressors in microsurgical reconstruction due to fear of vessel spasm and subsequent flap compromise. Although there are large literature reviews analyzing vasopressor usage in head and neck reconstruction, this has not been extrapolated to all regions of the body. The goal of this study was to perform a meta-analysis examining vasopressor usage and risk of complications in microsurgical reconstruction for all recipient sites. MATERIALS AND METHODS: A meta-analysis was conducted for articles discussing the utilization of vasopressors in microsurgical reconstruction. The primary endpoint was total flap failure. Secondary endpoints were necessity for operative take-back and hematoma requiring intervention. Odds ratios were calculated for each complication and for each study. RESULTS: Four prospective and six retrospective studies were analyzed yielding 6321 patients and 7526 flaps. 67.4% (966/1433) of patients received vasopressors and 80.8% (6080/7526) of flaps received vasopressors. There were 100 failures in the vasopressor group (100/6080 = 15.9%) and 39 failures in the non-vasopressor group (39/1456 = 26.8%) (O.R. 0.73; p = 0.12). There were 177 take-backs in the vasopressor group (177/5916 = 29.9%) and 64 take-backs in the non-vasopressor group (64/1404 = 4.6%) (O.R. 0.65; p < 0.05). There were 73 hematomas in the vasopressor group (73/5099 = 14/3%) and 14 hematomas in the non-vasopressor group (14/979 = 14.3%) (O.R. 1; p = 0.89). The odds ratio for total flaps failures in the breast and head/neck cohorts were 0.788 (p = 0.76) and 1.2761 (p = 0.77), respectively, with neither significantly increased in flaps receiving vasopressors. CONCLUSION: Our results suggest that vasopressor utilization does not directly result in increased complications. Flaps that received vasopressors had a statistically lower rate of take-back and failure. Due to the paucity of data available for analysis and limited reporting relating flap characteristics to outcomes, prospective, well-designed studies are necessary to verify the safety of vasopressor use in microsurgical reconstruction.

Facial Masculinization Surgery and its Role in the Treatment of Gender Dysphoria.

BACKGROUND: Interest in facial masculinization surgery is expected to increase as gender-affirming surgery becomes more widely accepted and available. The purpose of this study is to summarize the current literature describing operative techniques in facial masculinization surgery and provide an algorithmic approach to treating this patient population. METHODS: PubMed, EMBASE, and Medline databases were queried for literature on operative techniques and outcomes of facial masculinization surgery in transgender and cisgender patients, published through July 2018. Data on patient demographics, follow-up, operative techniques, complications, and outcomes were collected. RESULTS: Fifteen of the 24 identified studies met inclusion criteria. Two studies discussed the outcomes of 7 subjects (6 trans-male and 1 cis-male) who underwent facial masculinization procedures. No objective outcomes were reported in either study; however, subjects were generally satisfied and there were no complications. The remaining studies reviewed operative techniques utilized in the cisgender population. CONCLUSION: A summary of considerations for each facial anatomic subunit and respective operative techniques for facial masculinization is presented. Current facial masculinization procedures in cisgender patients may be considered in the transgender patient population with favorable outcomes. However, further research is needed on techniques and objective outcome measures of facial masculinization procedures in the transgender population.

Nonsurgical Management of Facial Masculinization and Feminization.

BACKGROUND: Transgender patients may seek nonsurgical methods for facial masculinization and feminization as an adjunct or alternative to undergoing surgical procedures. OBJECTIVES: The authors reviewed the existing literature regarding this topic and provided an overview of nonsurgical techniques for facial masculinization and feminization. METHODS: A comprehensive literature search of the PubMed and MedLine databases was conducted for studies published through December 2017 for techniques and outcomes of nonsurgical facial masculinization and feminization. Keywords were used in performing the search. Data on techniques, outcomes, complications, and patient satisfaction were collected. RESULTS: Four articles fit our inclusion criteria. Given the lack of published literature describing facial injectables in transgender patients, data from the literature describing techniques in cisgender patients were utilized to supplement our review. CONCLUSIONS: Facial feminization can be achieved through injectables such as neurotoxin and fillers for lateral brow elevation, lip augmentation, malar augmentation, and improvement of rhytids. Facial masculinization can be achieved with injectables used for genioplasty, jawline augmentation, and supraorbital ridge augmentation. One must develop best practices for these techniques in the transgender patient population and increase awareness regarding nonsurgical options.

Single-stage versus two-stage arteriovenous loop microsurgical reconstruction: A meta-analysis of the literature.

BACKGROUND: Arteriovenous (AV) loops can be utilized in a single- or two-stage approach in free flap reconstruction when proper vessels are not available. However, there exists no consensus on which method leads to superior microsurgical and patient outcomes. The purpose of this article was to review single- versus two-stage AV loops utilized in free flap reconstruction with a focus on complications and overall outcomes. METHODS: A systematic review of AV loops for autologous free tissue transfer was conducted. Endpoints investigated included flap characteristics, timing to second stage, complications, and outcomes. A Student's t-test and forest plots were used for statistical analysis. RESULTS: Thirty-five unique papers discussed utilizing AV loops in a single- or two-stage approach, yielding 260 and 98 single- and two-stage AV loops, respectively. There was a statistically significant higher rate of major complications in two-stage as compared to single-stage AV loops. There was a non-statistically significant difference in rate of minor complications in the single-stage as compared to two-stage AV loops. Overall, there was a statistically significant higher success rate in the single-stage as compared to two-stage AV loops CONCLUSION: There was a statistically significant higher rate of major complications and failures in two-stage AV loops. As well-conducted randomized controlled studies are nearly impossible to perform in this population, the decision to pursue a single- versus two-stage reconstruction should ultimately be determined based on individual patient co-morbidities, the size and etiology of defect, and the type of free tissue transfer planned.

Vascularization Potential of Electrospun Poly(L-Lactide-co-Caprolactone) Scaffold: The Impact for Tissue Engineering.

BACKGROUND Electrospun nanofibers have widespread putative applications in the field of regenerative medicine and tissue engineering. When compared to naturally occurring collagen matrices, electrospun nanofiber scaffolds have two distinct advantages: they do not induce a foreign body reaction and they are not at risk for biological contamination. However, the exact substrate, structure, and production methods have yet to be defined. MATERIAL AND METHODS In the current study, tubular-shaped poly(L-lactide-co-caprolactone) (PLCL) constructs produced using electrospinning technology were evaluated for their potential application in the field of tissue regeneration in two separate anatomic locations: the skin and the abdomen. The constructs were designed to have an internal diameter of 3 mm and thickness of 200 µm. Using a rodent model, 20 PLCL tubular constructs were surgically implanted in the abdominal cavity and subcutaneously. The constructs were then evaluated histologically using electron microscopy at 6 weeks post-implantation. RESULTS Histological evaluation and analysis using scanning electron microscopy showed that pure scaffolds by themselves were able to induce angiogenesis after implantation in the rat model. Vascularization was observed in both tested groups; however, better results were obtained after intraperitoneal implantation. Formation of more and larger vessels that migrated inside the scaffold was observed after implantation into the peritoneum. In this group no evidence of inflammation and better integration of scaffold with host tissue were noticed. Subcutaneous implantation resulted in more fibrotic reaction, and differences in cell morphology were also observed between the two tested groups. CONCLUSIONS This study provides a standardized evaluation of a PLCL conduit structure in two different anatomic locations, demonstrating the excellent ability of the structure to achieve vascularization. Functional, histological, and mechanical data clearly indicate prospective clinical utilization of PLCL in critical size defect regeneration.

Postnatal Pancraniosynostosis in a Patient With Infantile Hypophosphatasia.

Hypophosphatasia is a rare metabolic bone disorder that predisposes patients to craniosynostosis. Typically, patients born with hypophosphatasia will exhibit fused cranial sutures at birth. This is the first reported case of delayed onset of pancraniosynostosis in a patient with infantile hypophosphatasia. The severity of onset and delayed presentation in this patient are of interest and should give pause to those care providers who treat and evaluate patients with hypophosphatasia.

Three-Dimensional Changes in the Midface Following Malar Calcium Hydroxyapatite Injection in a Cadaver Model.

BACKGROUND: Three-dimensional (3D) changes in the midface following malar calcium hydroxyapatite (CaHa) injection have not been systematically analyzed. OBJECTIVES: The authors analyzed 3D volume changes in midface and naso-labial fold (NLF) volume, as well as lateral movement in the NLF/naso-labial crease (NLC) junction following malar injection of CaHa in a cadaver model. METHODS: A single surgeon injected CaHa in the supraperiosteal plane. Sequential images were obtained with the VECTRA 3D system pre- and post-1.5- and 3-cc CaHa injections. All measurements were performed by a single examiner. Injection location was verified anatomically. RESULTS: Injections were performed in 16 fresh cadaver hemi-faces. Maximal increases in projection were centered on the malar injection site, with associated decreases in projection and volume in the infero-medial locations. Relative mean increases in volume of 3.16 cc and 4.94 cc were observed following the 1.5-cc and 3-cc injections, respectively. There was a relative decrease in the volume of the NLF of -0.3 cc and -0.4 cc following the 1.5- and 3-cc injections, respectively. Injection of CaHa was associated with lateral movements of the NLF-NLC junction at the level of the nasal sill, philtral columns, and oral commissure, measuring 2.7, 2.5, and 1.9 mm and 2.8, 2.9, and 2.4 mm following the 1.5- and 3-cc injections, respectively. Anatomical dissection verified the location in the supraperiosteal space and within the middle malar fat pad. CONCLUSIONS: Following malar CaHa injection, 3D photographic analysis showed a measureable lifting effect with recruitment of ptotic tissue and lateral movement of the NLF-NLC junction in a cadaver model.