Cotofana, Sebastian

AbstractBackgroundWhile the temporal lifting technique has gained increasing attention, there is a dearth of objective and reliable evidence of its effects.AimThe objective of the present study is to analyze the ability of the temporal lifting technique to reduce the midfacial volume by soft tissue repositioning and to achieve an improved pan‐facial appearance by targeting exclusively the subdermal plane of the posterior and superior temple with soft tissue fillers.MethodsA total of 12 patients (1 male and 11 females) with a mean age of 36.75 ± 6.6 years and a mean body mass index of 23.04 ± 1.3 kg/m2 were included in this prospective clinical single‐center interventional study. Injection‐related outcome was evaluated utilizing 3D skin vector displacement and surface volume analyses and scoring based on five different evaluators.ResultsThree months after the treatment, the global esthetic improvement scale rating showed an improved outcome (3.08) when evaluated by the independent observers, very improved outcome when evaluated by the treating physician (4.33), and exceptional improvement when rated by the patient (4.83). Temporal volume improved by 0.36 (P < .001), lower cheek fullness by 0.47 (P < .001), and jawline contouring by 0.51 (P < .001). No major adverse events were reported during the 3‐month observational period.ConclusionObjective outcome measures have provided evidence that by augmenting the posterior superior temple the volume of the middle face can be reduced and the contour of the jawline can be accentuated; this is due to the underlying fascial anatomy and the resulting soft tissue re‐position.

AbstractObjectiveThe most promising facial region for inducing pan‐facial effects is the temporal region. The temple displays signs of facial aging itself which include temporal volume loss and increased visibility of the temporal crest, the temporal vasculature, the lateral orbital rim, and the upper zygomatic arch. The objective of this article is to provide a detailed review of temple anatomy pertaining to routinely performed temporal injection techniques, their expected esthetic outcomes as well as the intendant advantages, disadvantages, and procedure pearls.Materials and MethodsThis narrative review is based on the clinical experience of the authors treating the temporal region for esthetic purposes. The postulated outcome of each technique was observed during the routine clinical practice of the authors.ResultsThe temporal region is based on a bony platform consisting of the parietal, frontal, sphenoid, and temporal bones. The overlying soft tissues are arranged in layers which contain the temporal neurovascular structures. The temporal soft tissues consist of 10 parallel layers which vary in their thickness depending on age‐related influences. Six different techniques will be addressed, which include subdermal and interfascial techniques for volumizing, low and high supraperiosteal techniques for volumizing, and supraauricular and temporal lifting techniques.ConclusionThis narrative provides a detailed anatomic overview of the temporal region and describes each commonly performed injection technique with respect to anatomy, esthetic outcome, as well as potential pearls and pitfalls. It is hoped that the description contained herein may guide esthetic practitioners toward safer and more natural outcomes when treating the face.

AbstractBackgroundTreating the lower face with neuromodulators and targeting the masseter muscle can reduce masseteric hypertrophy but can also change the facial shape. A novel observation after the treatment of the masseter muscle with incobotulinumtoxin Type A was the increase in temporal volume.AimObjectively assess temporal volume increase following treatment of masseteric hypertrophy using incobotulinumtoxin Type A.MethodsNine female patients with a mean age of 35.11 years ± 9.1 [Asian (11.1%) and Caucasian (88.9%)] were treated with incobotulinumtoxin Type A for masseteric hypertrophy. Masseteric prominence and temporal volume were assessed by two independent raters, and temporal fossa volume was measured via 3‐dimensional volumetric imaging.ResultsIndependent of the neuromodulator injection technique (ie, single‐injection versus multi‐injection), a reduction in masseteric hypertrophy occurred represented by a decrease in the masseter prominence scale. In addition, the treatment resulted in a significant improvement of the temporal volume scale and an increase in the measured volume of the temporal fossa. None of the presented measurements were statistically significantly different between the two utilized injection techniques.ConclusionsThis study supports using a full‐face approach when performing aesthetic treatments. Anatomical concepts can help to guide treatments: the compensatory increase in temporalis function after masseter muscle treatment resulted in an increased in temporal fossa volume. The findings presented herein should not be considered as a new concept for treating the temporal fossa but rather as an additional possibility for increasing the temporal volume.

Hands‐on dissection‐based learning of anatomy offers an unique and valued experience for medical students. Too often however, the inexperienced student's focus is to avoid damage to unfamiliar structures instead of understanding spatial relationships between structures. This results in unfortunate surrender of a critical learning experience. Additionally, approaches to dissection and anatomic exposure share little alignment to clinical approaches, making it less powerful in clinical applicability. The goal of this viewpoint commentary is based on the experience of the two authors and aims to demonstrate opportunity to introduce clinical approaches for dissection while incorporating relevant anatomical concepts in medical school curriculum that aligns with authentic healthcare practice. Using the dissections of the superficial face as a relevant and current topic of clinical interest, we point out that applying the currently performed dissection approach (medial‐to‐lateral) falls short of providing sufficient knowledge and understanding of the layered arrangement of facial structures. The lateral‐to‐medial approach, as performed in surgical face lifting procedures would offer a better understanding of the layers of the face and especially the superficial musculoaponeurotic system (SMAS) accounting for the difficulties of facial dissections on embalmed cadavers. This commentary could offer a potential change in paradigm for students and course facilitators for how to maximize the knowledge transfer during facial dissections. It potentially opens a door to rethink dissection‐based learning of anatomy toward techniques and approaches that are aligned to surgical access pathways and thus considered more clinically relevant.