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Clinical implications of the facial anatomy for facial rejuvenation procedures
Thailand (IFMSA-Thailand) - Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok
Basic Medical Sciences
Asst. Prof. Sumet Wajanarogana Ph.D.
Thirawass Phumyoo, MSc & Prof.Tanvaa Tansatit, MD, MSc
Type of Research Project
- Basic science
What is the background of the project?
Dermal filler and botulinum toxin injections have been increased and accepted worldwide as a minimal invasive procedure to regain a younger appearance and to improve facial feature. The variety of injection techniques are employed depending on the experience of clinician with different facial planes and sites. Even though the preperiosteal plane is also recommended to perform the injection, severe complications following this plane injection have been reported such as localized necrosis, visual impairment, and cerebral infarction. The conventional filler injection has been considered as the blinded procedure. To eliminate the limitation of procedure, ultrasonography is the efficient medical imaging tool for clarifying the important internal structures even the placement of filler correlated with the soft tissue morphology, translating the sightless procedure into ultrasound-guided injection. Moreover, color Doppler ultrasonography system have indicated the explicit vascular localization and relationship with adjacent soft tissue. For this reason, executing ultrasonographic guidance prior to the injection might possibly be the alternative procedure to restrict the severe complication incidences ensuing filler injection. A thorough knowledge of arterial distribution of the face is necessary for the injectors due to the sophistication of blood supply source. The arteries bifurcate into several branches such as superficial, deep, and periosteal branches traveling in different facial soft tissue layer which located nearly the injection sites. They are supposed to be inadvertently cannulated during the filler injection. Nonetheless, few studies have determined the obvious arterial localization and topography related to the facial soft tissue that could grant proper guidance for minimizing the feasibility of vascular compromise during injection procedure.
What is the aim of the project?
This study aimed to investigate an arterial distribution and topography on the upper/middle/lower face areas correlated with facial landmarks to provide a proper guideline for enhancing the safety injection.
What techniques and methods are used?
- Conventional dissection Prior to investigation, the reference line system and facial lanmark determination was conducted to assign the Y-axis and X-axis for investigating the parameters. Then, meticulous dissection in embalmed cadavers was performed to discover the arterial distribution related to the reference lines. - Ultrasonographic assessment Ultrasound examination was operated in healthy volunteers to observe the depth and diameter of the arteries correlated to the facial soft tissue layers at each facial landmarks in accordance with reference line system. - Histology staining technique The facial soft tissue flap was harvested from the face of soft cadaver to underwent the hislogy staining process for investigating the relationship of the arteries to the facial soft tissue layers at each facial landmark in accordance with reference line system. - Sihler’s staining technique The facial soft tissue flap was harvested from the face of soft cadaver to underwent Sihler’s staining process for discovering the arterial distribution and anastomotic patterns with adjacent arteries.
What is the role of the student?
- The student will mainly observe
- The tasks of the student will be performed on his/her own
- The tasks will be done under supervision
What are the tasks expected to be accomplished by the student?
The student will be a research assistant to conducting the lab work, which will be assigned differently by tutors each day. For instance; 1. Dissecting the cadavers to collect the parameters such as measuring the distances of the arteries related to the reference line system and observing the distribution patterns of the arteries. 2. Conducting histology staining technique and Sihler’s staining technique in the facial soft tissue flap specimens which are harvested from soft cadavers to investigating the relationship of the arteries to the facial soft tissue layers at each facial landmark in accordance with reference line system and discovering the arterial distribution and anastomotic patterns with adjacent arteries. 3. Performing ultrasonographic assessment Analyzing the offline data from ultrasonographic image to collect the depth and diameter of the arteries correlated to the facial soft tissue layers at each facial landmarks in accordance with reference line system. 4. Writing summary of the result.
Will there be any theoretical teaching provided (preliminary readings, lectures, courses, seminars etc)
What is expected from the student at the end of the research exchange? What will be the general outcome of the student?
- No specific outcome is expected
What skills are required of the student? Is there any special knowledge or a certain level of studies needed?
Student shoud pass the the gross anatomy and histology subjects to obtain the basic skill of cadaveric dissection and histology staining technique prior to be the internship student.
Are there any legal limitations in the student’s involvement
Type of students accepted
This project accepts: - Medical students
- Tansatit T; Phumyoo T; Jitaree B; Sahraoui YME; Lee JH. Anatomical and ultrasound-based injections for sunken upper eyelid correction. J Cosmet Dermatol. 2019 Jun 21.
- Tansatit T; Phumyoo T; Jitaree B; Sawatwong W; Sahraoui YME. Investigation of the presence and variation of the ascending mental artery: Conventional dissections and ultrasonographic study. J Cosmet Dermatol. 2019 Mar 28.
- Tansatit T; Phumyoo T; Jitaree B; Sawatwong W; Rungsawang C; Jiirasutat N; Sahraoui YME; Lee JH. Ultrasound evaluation of arterial anastomosis of the forehead. J Cosmet Dermatol. 2018 Dec;17(6):1031-1036.
- Jitaree B; Phumyoo T; Uruwan S; Sawatwong W; McCormick L; Tansatit T. The Feasibility Determination of Risky Severe Complications of Arterial Vasculature Regarding the Filler Injection Sites at the Tear Trough. Plast Reconstr Surg. 2018 Nov;142(5):1153-1163.
- Phumyoo T; Tansatit T; Rachkeaw N. The soft tissue landmarks to avoid injury to the facial artery during filler and neurotoxin injection at the nasolabial region. J Craniofac Surg. 2014 Sep;25(5):1885-9.
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