Expert Consensus on Hyaluronic Acid Filler Facial Injection for Chinese Patients.

BACKGROUND: Beauty standards vary by race and region, which must be accounted for in creating beauty. Chinese have unique features, including a depressed nose, flat midface, and small chin, and have different cosmetic concerns. We performed a consensus study on filler injections based on the Chinese standard of beauty due to a lack of such study. METHODS: We organized the YVOIRE Consensus Group, including 5 plastic surgeons. We discussed common problematic areas seen in Chinese and described techniques based on our experience with hyaluronic acid fillers, while considering peer-reviewed articles, followed by multiple consensus-developing sessions. RESULTS: Chinese faces are characterized by retruded forehead, chin, and low nasal bridge, with certain features believed to bring good fortune. Therefore, profiles of the forehead, nose, lip, and chin have substantial effects on attractiveness. The demand for cosmetic procedures is high among the young generation who particularly desire nose and chin augmentation. Attractive Chinese facial shapes are characterized by a long, slender facial shape and pointed chin. Lips are narrow and thick. When injecting fillers for Chinese, it is necessary to apply special methods that produce results consistent with these characteristics. CONCLUSIONS: Understanding the concept and demand of beauty depending on race and region is important. Patients should be evaluated before aesthetic procedures. Maintaining hygiene during the procedure is crucial. Moreover, methods for preventing pain are essential. Fillers should be injected into the correct anatomical site and layer to minimize side effects and maximize effectiveness.

A modified reduction malarplasty utilizing 2 oblique osteotomies for prominent zygomatic body and arch.

The shape of the zygomatic body and arch have great influences to the facial contour of Orientals. The prominent zygoma makes the appearance look more fierce. Nowadays in China, the number of patients who underwent reduction malarplasty is increasing rapidly. Therefore, it is important to develop a reliable surgical procedure with small wound and good effects. Included in this report were 46 patients with prominent zygomatic body and arch treated between October 2007 and November 2010. Combined intraoral and extraoral approaches were used, and 2 oblique osteotomies were performed to anterior and posterior part of malar complex, respectively. The isolated zygoma segment was then internalized utilizing z-plasty for the posterior end and inward sliding and internal fixation for the anterior end. The extraoral approach was made through a small temple incision. All patients were subjectively satisfied with the postoperative appearance. Their face contours were effectively improved by the modified procedure. One patient had short-term numbness of the medial zygomatic region skin; no other complications were observed during the follow-up period. This surgical procedure was carried out using combined intraoral and extraoral approaches. No visible scars left on the face. After 2 oblique osteotomies were made, the anterior inward sliding and posterior z-plasty could be easily performed to the isolated zygomatic bone. No segmental bone removal was required. The natural curve of the face contour was maintained while the malar complex was reshaped. We concluded that it is an effective and safe reduction malarplasty technique for Orientals.

[Expression of inducible nitric oxide synthase in cartilage in progression of temporomandibular joint osteoarthritis].

OBJECTIVE: To study the expression of inducible nitric oxide synthase (iNOS) in cartilage of temporomandibular joint osteoarthriti (TMJOA), and to evaluate the role of iNOS in the progression of TMJOA. METHODS: The goats were used and TMJOA was induced by injection of collagenase in upper joint space. The joints were obtained and were investigated by using immunohistochemistry at 2, 4, 12, 24 weeks after injection. RESULTS: Almost no expression of iNOS in normal cartilage of TMJ. In the diseased joints, strong or definite iNOS reactivity was expressed. CONCLUSION: iNOS plays an important role in the progression of TMJOA.

[Recombinant human BMP-2 accelerates bone formation of mandibular distraction osteogenesis in rabbits].

OBJECTIVE: To study the effects of rhBMP-2 on bone formation of mandibular distraction osteogenesis in rabbits. METHODS: Bilateral mandibular osteotomies were performed in 12 mature rabbits. 5 mg rhBMP-2 with the collagen carrier was implanted in the osteotomy site of one side of the mandibles. Only the collagen sponge was placed in the contra-lateral side as control. The mandibles of 8 rabbits were lengthened by 6mm using a custom-made distractor. At 4 weeks after the end of distraction, all animals were killed and the distracted calluses were harvested and processed for histological, scanning electron microscopic, as well as Ca/P ratio analysis. RESULTS: The regenerated bone was found in the distraction gap after mandibular lengthening. The mandibular side treated with rhBMP-2 had greater amounts of new bone formation and earlier mineralization than contra-lateral side (non-rhBMP-2 treated). CONCLUSION: Recombinant human BMP-2 appears to be able to accelerate bone formation of mandibular distraction osteogenesis in rabbits.

[Expression of vascular endothelial growth factor during mandibular distraction osteogenesis in rabbits].

OBJECTIVE: To investigate the expression pattern of vascular endothelial growth factor (VEGF) in the distracted callus during mandibular osteodistraction. METHODS: Bilateral mandibular osteotomies were performed in 12 rabbits. 3 rabbits were sacrificed respectively at 0, 7, 14 and 28 days after completion of distraction. The newly formed calluses were harvested and processed for histology and immunohistochemistry of VEGF. RESULTS: Intense angiogenesis was observed in the regenerated callus after mandibular lengthening, and positive staining for VEGF was mainly noted in vascular endothelial cells and the active osteoblasts. CONCLUSIONS: Mechanical strain created by distraction led to angiogenesis in distraction gap. VEGF may play a critical role in angiogenesis and subsequent osteogenesis during mandibular lengthening.

[The effects of L-NMMA on experimental temporomandibular joint osteoarthrosis in goats].

OBJECTIVE: To investigate the effects of repeated injections of L-NMMA on a goat model with osteoarthrotic temporomandibular joint (TMJ) disease. METHODS: Eight goats were selected in this study. Bilateral TMJ osteoarthrosis (OA) was induced by injecting 0.5% collagenase. L-NMMA was injected into one side of TMJs at 4 weeks after collagenase injection (one time every three days). Another joint as control was simultaneously injected using 0.9% saline solution. All goats were killed at 12 weeks after collagenase injection. The TMJ specimens were harvested and processed for histological examination. Modified Mankin's grading score system was used for evaluating changes in the TMJ. RESULTS: The control side of TMJs showed severe osteoarhrotic changes in the condyle whereas the L-NMMA-treated TMJs showed less degenerative alterations. The histologic score was 3.83 in the L-NMMA treated side, and 6.33 in the control. There was a significant difference in osteoarthrotic changes between the L-NMMA-treated and control TMJs (P < 0.01). CONCLUSIONS: Repeated intra-articular injection of L-NMMA into TMJ may play a role in inhibiting TMJOA progression.