Quantification of the Aesthetically Desirable Female Midface Position.

BACKGROUND: The purpose of this study was to attempt to determine a reliable method of evaluating midface position. We assessed a novel parameter called WIZDOM (Width of the Interzygomatic Distance of the Midface) and its relationship to other facial metrics. OBJECTIVES: The goal was to evaluate midfacial position quantitatively in women by examining 2-dimensional photographs of a subset of women with idealized facial proportions. METHODS: Three examiners analyzed stock photographs of nonsmiling female model faces. Numerous parameters were analyzed for each photograph, including: interpupillary distance, medial canthus (MC) to lip, brow length, WIZDOM, WIZDOM to MC, WIZDOM to hairline, WIZDOM to chin vertical, and lateral brow to WIZDOM. Meaningful relationships between various parameters were statistically analyzed. Examiner measurements were assessed for interobserver reliability. RESULTS: Fifty-five female model photographs were included in the analysis. The average interpupillary distance was 59.2 mm ± 3.54 (range, 50.5-67.3 mm). The WIZDOM average was 108 mm ± 5.81 (range, 93-127 mm) and brow length was 107 mm ± 5.87 (range, 96.7-124 mm). The difference between brow length and WIZDOM was not statistically different (P = 0.834). The interobserver reliability between the 3 examiners was excellent for all parameters (P < 0.01), ranging from 0.718 (WIZDOM-MC) to 0.993 (interpupillary distance). The WIZDOM measurement was reproducible with an interobserver coefficient of 0.939. CONCLUSIONS: WIZDOM can be used to quantify aesthetically desirable midfacial position in patients and can be used as a measurement to aid in assessment and as an ideal to achieve balanced aesthetic results in midface restorative procedures-lifting or volumization-in females.

The Role of Gravity in Periorbital and Midfacial Aging.

BACKGROUND: With respect to the pathogenesis of periorbital and midfacial aging, gravity may play a greater role than volume loss. OBJECTIVES: The authors determined the effect of shifting from the upright to the supine position on specific attributes of facial appearance and ascertained whether facial appearance in the supine position bore any resemblance to its appearance in youth. METHODS: Participants who showed signs of midface aging were positioned in the upright and supine positions, and photographs were obtained during smiling and repose. For each photograph, examiners graded the following anatomic parameters, using a standardized scale: brow position, tear trough length and depth, steatoblepharon, cheek volume, malar bags/festoons, and nasolabial folds. Some participants provided photographs of themselves taken 10 to 15 years earlier; these were compared with the study images. RESULTS: Interobserver correlation was strong. When participants were transferred from upright to supine, all anatomic parameters examined became more youthful in appearance; findings were statistically significant. The grading of anatomic parameters of the earlier photographs most closely matched that of current supine photographs of the subjects smiling. CONCLUSIONS: In the supine position, as opposed to the upright position, participants with signs of midface aging appear to have much more volume in the periorbita and midface. For the subset of participants who provided photographs obtained 10 to 15 years earlier, the appearance of facial volume was similar between those images and the current supine photographs. This suggests that volume displacement due to gravitational forces plays an integral role in the morphogenesis of midface aging.

Vibration anesthesia for the reduction of pain with facial dermal filler injections.

BACKGROUND: Vibration anesthesia is an effective pain-reduction technique for facial cosmetic injections. The analgesic effect of this method was tested in this study during facial dermal filler injections. The study aimed to evaluate the safety and efficacy of vibration anesthesia for these facial injections. METHODS: This prospective study analyzed 41 patients who received dermal filler injections to the nasolabial folds, tear troughs, cheeks, and other facial sites. The injections were administered in a randomly assigned split-face design. One side of the patient's face received vibration together with dermal filler injections, whereas the other side received dermal filler injections alone. The patients completed a posttreatment questionnaire pertaining to injection pain, adverse effects, and preference for vibration with future dermal filler injections. RESULTS: The patients experienced both clinically and statistically significant pain reduction when a vibration stimulus was co-administered with the dermal filler injections. No adverse events were reported. The majority of the patients (95 %) reported a preference for vibration anesthesia with subsequent dermal filler injections. CONCLUSIONS: Vibration is a safe and effective method of achieving anesthesia during facial dermal filler injections. 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 .