Pinch Anatomy of Forehead: An Injection Guide for Forehead Filler Treatment

With the popularity of filler injections globally, more and more injectors are using them for facial shaping and reversing the aging changes of the face. Detailed knowledge of facial anatomy, especially of important vessels and tissue planes is essential for injectors. While performing filler injections, injectors tend to pinch the tissue layers with their non-dominant hand for ease of doing the procedure. Such deformational forces cause some changes in the anatomy of tissue layers held in a pinch. During a deep pinch, the important arteries in that area can get pulled up in the pinch's tissue layers, or they can stay in their position being unaffected by pinching. The ‘pinch and pull’ can also improve the tissue space for injections, by pulling away the mobile tissue layers from the fixed ones. Knowledge of the ‘pinch anatomy’ in the forehead can be used to the injector's advantage to avoid important arteries and place filler in the correct plane. By knowing the anatomical changes during the pinched state of tissue layers, filler injections in the forehead can be performed with relative safety in the correct tissue plane.

Lower face and lifting treatments

Lower face age changes are hugely impactful on the overall ageing concerns presented by patients, and lower face-lifting treatments form an integral part of the rejuvenation and beautification of the face, as part of a comprehensive treatment plan. It is essential that the clinician possesses a deeper understanding of facial anatomy in this region, to allow a more holistic, rather than isolated, approach to rejuvenation and reduce complication risks and downtime. A combination of dermal filler and neuromodulators can be used in the lower face to produce effective, long-lasting and natural facial rejuvenation results.

Local Flaps and Grafts

Reconstruction of facial defects is a complex process that when done well can have a significant positive impact on patients’ quality of life. While the variety of specific facial defects and their causes seems endless, it is important to understand that several core tenets in local reconstruction such as facial anatomy and aesthetics, appropriate patient selection, as well as surgical technique can aid in successful repair in most cases. This review contains 17 figures, 1 table and 28 references Key words: Local flap; skin grafts; facial reconstruction; skin cancer

FORENSIC ART AND ANTHROPOLOGY

Forensic artists must overcome ingrained ideas of what the human face “should” look like in order to learn how to draw it realistically. Ironically, those ingrained images and perceptions tucked away in our minds present the biggest obstacles to realism. As a teacher of a forensic art class in anthropology at Northern Arizona University, I encounter students of varying degrees of artistic ability and background. I do not require that students have pre-requisite courses in art before taking my course because I believe that any student can learn to draw faces more realistically if they apply some basic forensic art techniques used in composite sketching combined with an understanding of facial anatomy. This article is about teaching Northern Arizona University students forensic art drawing methods, but it is also about the lesser-known aspect of doing composite sketches, such as applying cultural understanding and sensitivity when interviewing traumatized witnesses and survivors of crime. The result is a very holistic approach to composite sketching rather than a purely technical one.

The authentication and repatriation of a ceremonial tsantsa to its country of origin (Ecuador)

Tsantsas, commonly referred to as “shrunken heads”, are unique and valuable antiquities that were produced by the Shuar, Achuar, Awajún/Aguaruna, Wampís/Huambisa, and Candoshi-Shampra (SAAWC) peoples until the mid twentieth century. Originally used with ceremonial purpose during important social group functions, tsantsas became monetarily valuable as keepsakes and curios during the nineteenth century as a result of Western/European cultural encroachment. Unmet demand resulted in the production of convincing forgeries that created confusion about the authenticity of existing collections. Ceremonial tsantsas are both human remains and valuable cultural items. Their production and purpose were negatively influenced by colonialism and the outside curio market; as such many institutions may choose to repatriate them to their places of origin. Herein, we report on the authentication and repatriation of a ceremonial tsantsa recently rediscovered in a university’s natural history collection. The personal memoirs of the original collector describe that it originated in the Ecuadorean Amazon. In consultation with the government of Ecuador, it was determined that authentication was required prior to repatriation. The tsantsa was compared to a list of thirty-three distinct characteristics shared by ceremonial tsantsas. These criteria were taken from those provided by Ecuador’s National Cultural Heritage Institute and those found in prior studies from the academic literature; they include notable skin and hair features, structure and facial anatomy, and evidence of traditional fabrication and modification. We were able to affirm 30 of the 33 authenticating indicators. As part of our protocol the tsantsa was scanned with a CT-imaging system. The resulting 3D images were invaluable in discerning subtle and difficult-to-visualize characteristics regarding the skin and patterns of modification, although there are limitations related to the small size of filamentous structures. The results of the authentication were accepted by the Ecuadorean government, and the tsantsa was repatriated in June 2019. An additional benefit of CT-imaging is that data files can be generated in order to create rapid prototypes via 3D printing. In fact, as our work demonstrates, artifacts of value can be repatriated while simultaneously preserved as a volumetric replica for the purposes of a collection.

The Usefulness of Magnetic Resonance Angiography to Analyse the Variable Arterial Facial Anatomy in an Effort to Reduce Filler-Associated Blindness: Anatomical Study and Visualisation Through an Augmented Reality Application

Background The use of soft tissue fillers for facial rejuvenation is increasing rapidly and the complications, unfortunately, follow the same path. Blindness caused by intravascular filler injections is a rare but devastating complication. Knowledge of the individual arterial anatomy may aid the injector in avoiding injecting into an artery. Increasing the awareness about and illustration of the extreme variations in the individual vascular anatomy and subsequently procuring information for the accurate planning of those, so called, minimally invasive procedures may help to prevent blindness. Objectives To evaluate if the use of Magnetic Resonance Angiography (MRA) may visualise the arterial facial anatomy in a contrast- and radiation-free way and study the individual arterial variations using an augmented reality (AR) image. Methods The individual arterial anatomy of the three terminal branches of the Ophthalmic Artery (Supraorbital (SO); Supratrochlear (STr); and Dorsal Nasal (DN) arteries) of 20 volunteers was studied by a 3 Tesla MRI, adapting a recently published imaging technique, combining infrared (IR) facial warming and 3D-TOF MOTSA MRA. The resulting visualisation of the facial arteries was shown on the patient’s face through AR technology. Results The MRA was able to visualise the SO in 90.0%, STr in 92.5%, and DN arteries in 75% of the examined patients, as well as numerous variations in both vessel localization and path. Furthermore, a proof-of-concept of the AR-visualisation of the individual arterial anatomy was successfully implemented. Conclusions Dermal filler injectors should be aware of the risk of filler-induced blindness and familiarise themselves with the visualisation of the variable facial vascular anatomy around the eye. The implementation of a one-time MRA and subsequent AR-visualisation may be useful in the accurate planning of minimally invasive facial rejuvenation procedures.

Is the penile golden ratio an indicator of normal sperm count and normal hormonal status? A prospective-observational study

Background and Objective: The constant phi number (1.618…) is accepted as the indicator of esthetic beauty and harmony in numerous fields of natural sciences and is also known to be effective in various biological systems in the human body such as skeletal system and facial anatomy, respiratory system, and cardiovascular system. In this study, we aimed to compare the anthropometric proportions obtained from penile measurements and the phi-value and to investigate whether this number could be an indicator of fertility. Material and Methods: This study included 200 infertile male patients. Penile ratio (PR) was calculated by dividing the corpus penis length by the glans penis length. Patients were divided into two equal groups: Group-I included patients with a PR that was closest to the constant phi-value (n = 100) and Group-II included patients with a PR that was the most distant to the phi-value (n = 100). Spermiogram findings, and serum hormone levels were compared between the two groups. Results: Mean age was 27.37 ± 3.45 years, median penile length was 9.1 (7.1-10.2) cm, and median PR was 2.06 (1.65-2.64). In group I and II, an abnormal spermiogram was detected in 41% and 48% (P = 0.319) and hormonal dysfunction was present in 28% and 26% of the patients (P = 0.750), respectively. Overall sperm counts and sperm concentrations were significantly higher in group I compared to group II. Conclusion: Although PR may not be an indicator of normal spermiogram or hormone status, patients with a closer PR to the phi value are likely to have more favorable spermiogram values.