Aesthetic Surgery Journal最新文献

{"title":"Orbicularis Oculi Toxin Injection for Treating Levator Palpebrae Superioris Weakness: Clinical Effect and Safety in a Cohort Study.","authors":"Shunbing Lu, Qingqian Wei, Juan Ma, Jun Zhuang, Xueshang Su, Yunshun Lu, Ziming Zhang, Yutong Liang, Jintian Hu","doi":"10.1093/asj/sjag076","DOIUrl":"https://doi.org/10.1093/asj/sjag076","url":null,"abstract":"<p><strong>Background: </strong>Ptosis, the drooping of the upper eyelid caused by levator palpebrae superioris muscle dysfunction, is a common condition that can impair vision and quality of life. It can arise independently or as a secondary condition to diseases such as myasthenia gravis. Traditional treatments for ptosis include surgical interventions, but botulinum toxin injections have gained interest due to their non-invasive nature and promising results in improving eyelid function.</p><p><strong>Objectives: </strong>To evaluate the efficacy and safety of orbicularis oculi muscle toxin injections in comparison to traditional levator palpebrae superioris muscle shortening surgery for the treatment of ptosis.</p><p><strong>Methods: </strong>A cohort study was conducted with 36 patients diagnosed with levator palpebrae superioris muscle weakness. Patients were divided into two groups: an experimental group receiving botulinum toxin injections and a control group undergoing traditional surgery. Primary outcomes included changes in palpebral fissure height, visual scores, and patient satisfaction. Secondary outcomes involved adverse reactions and recovery time.</p><p><strong>Results: </strong>The experimental group showed a significant improvement in palpebral fissure height (3.5 mm) and visual function compared to the control group (1.7 mm). Patient satisfaction was higher in the experimental group, particularly due to the non-invasive nature and shorter recovery period. The incidence of adverse reactions was lower in the experimental group, with fewer complications like scarring.</p><p><strong>Conclusions: </strong>Botulinum toxin injection may represent a minimally invasive alternative in carefully selected patients, particularly those with mild dysfunction or those wishing to avoid surgery. It provides significant improvements in palpebral fissure height and visual function, with fewer side effects and a faster recovery, making it a viable option for early-stage patients or those wishing to avoid surgery. Further studies should explore its long-term effectiveness.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Piezoelectric Versus Conventional Rhinoplasty: A GRADE-assessed Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Sajad Armanfar, Mehdi Rasti Ardakani, Mozhdeh Vahidiataabadi","doi":"10.1093/asj/sjag082","DOIUrl":"https://doi.org/10.1093/asj/sjag082","url":null,"abstract":"<p><p>Piezoelectric osteotomy may reduce postoperative morbidity after rhinoplasty, but time-based effects remain uncertain. We aimed to understand the time-based effectiveness and safety of piezoelectric osteotomy versus conventional method. We searched major databases and trial registries from inception to 1 Dec 2025 for randomized trials comparing piezoelectric versus conventional rhinoplasty. The study was conducted in accordance with PRISMA guidelines and was registered in PROSPERO (CRD420261277439). Random-effects meta-analyses pooled continuous outcomes as standardized mean differences and binary outcomes as risk ratios; ROB-2 and GRADE were applied. Nineteen studies met the inclusion criteria (905 patients; 476 piezo, 475 conventional), of which 15 were pooled. Edema generally favoured piezo across postoperative days within the first week, reaching statistical significance at postoperative day (POD) 2 (SMD -0.92, 95%CI -1.70 to -0.13) and POD7 (SMD -0.64, 95% CI -1.06 to -0.22), but not at POD1, 3, or 4. Similarly, ecchymosis was significantly reduced at POD1 (SMD -1.33, 95%CI -2.59 to -0.07), POD2 (SMD -1.13, 95%CI -1.97 to -0.30), and POD7 (SMD -0.62, 95%CI -1.16 to -0.08). Pain at POD2 was also lower with piezo (SMD -1.23, 95%CI -1.90 to -0.57). Mucosal integrity loss occurred in none of the piezo cases and was significantly less frequent than in controls (RR 0.09, 95%CI 0.02 to 0.44). Osteotomy duration did not differ significantly between groups and showed considerable heterogeneity. Publication bias and GRADE assessment results were acceptable. Piezoelectric rhinoplasty improves early swelling, bruising, pain, and mucosal safety versus conventional osteotomy, while operative time remains uncertain.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Botulinum Toxin Injection Intervals on the Irreversibility of Targeted Muscle Paralysis: An Electromyographic Study.","authors":"Mohamed Badie Ahmed, Mariam Al Aloosi, Jeffrey A Cohen, Mitchell A Stotland","doi":"10.1093/asj/sjag081","DOIUrl":"https://doi.org/10.1093/asj/sjag081","url":null,"abstract":"<p><strong>Background: </strong>Botulinum neurotoxin A (BoNT-A) is widely used clinically, yet its temporary effects require repeated injections that increase cost and inconvenience. Claims that repeated BoNT-A use alters efficacy lack rigorous evaluation. Unlike peripheral nerve transection, which causes irreversible denervation after 12-24 months, the long-term physiological effects of BoNT-A chemodenervation remain unclear.</p><p><strong>Objectives: </strong>Using electromyography (EMG), we investigated whether prolonged short-interval BoNT-A administration induces irreversible paralysis of glabellar muscles.</p><p><strong>Methods: </strong>Twenty-one Caucasian female participants aged 35-60 years with at least moderate glabellar lines were recruited and randomized to receive BoNT-A injections either every 6 weeks (Group I), every 9 weeks (Group II), or every 12 weeks (Group III). Each session consisted of five injections totaling 20 U of onabotulinum toxin A to the glabellar muscles. The 3-year study included a 108-week treatment phase and then a 48-week follow-up, with serial corrugator electromyographic recordings undertaken over the course of the 156-week period. The EMG data was analyzed using linear regression models.</p><p><strong>Results: </strong>Analysis demonstrated a consistent, statistically divergent reduction in corrugator EMG activity across all post-treatment time points, with maximal suppression at 108 weeks, indicating a durable neuromodulatory effect. Predictive-margins analysis showed sustained suppression from baseline through 156 weeks in all groups, with only a late increase remaining well below pretreatment levels. Relative to the 9-week group, the 12-week group exhibited higher EMG activity, while no meaningful difference was observed for the 6-week group.</p><p><strong>Conclusions: </strong>In this 3-year study, including 2 years of short-interval BoNT-A injections and 3 years of EMG assessment, prolonged intermittent BoNT-A administration produced a sustained chemodenervation effect that persisted beyond treatment cessation and exceeded the duration typically observed with standard clinical dosing intervals. Larger studies with longer follow-up are required to confirm these findings.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Lies Beneath: Carotid Artery Depth and the Safe Use of Hemostatic Nets in Facelift Surgery.","authors":"Sakar Gupta, Aidan W O'Shea, Armin Edalatpour, Ahmed M Afifi","doi":"10.1093/asj/sjag075","DOIUrl":"https://doi.org/10.1093/asj/sjag075","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have demonstrated the effectiveness of the hemostatic net in reducing post-rhytidectomy hematomas; however, its safety in relation to the proximity to the carotid vessels is unknown.</p><p><strong>Objectives: </strong>This study aims to provide anatomical data on the depth of the carotid artery and its branches along the neck to inform data-based guidelines for hemostatic net placement to decrease risk of inadvertent vessel injury.</p><p><strong>Methods: </strong>We retrospectively studied rhytidectomy patients at a single academic aesthetic surgery center who had subsequent neck imaging within 10 years. We studied the common, internal, and external carotid arteries bilaterally at the C2 (angle of mandible), C3 (hyoid), and C4 (thyroid cartilage). For each, distance between the corresponding left and right vessels and vessel depth from the skin were measured.</p><p><strong>Results: </strong>33 patients (81.9% female; average age at rhytidectomy=64.2 years and at imaging=69.1 years) had images of sufficient quality. At C2-C4, carotid depths ranged from 20.5-32.9 mm. The closest artery to the skin along the neck is internal carotid artery at the level of the thyroid cartilage (C4).</p><p><strong>Conclusions: </strong>A thorough understanding of the vascular structures in post-rhytidectomy neck underlies safe placement of the hemostatic net. Assuming the use of ⅜ circle suture needle, a 24mm needle (19mm chord length) offers greater inherent margin relative to the mean vessel depth at C4 (20.5mm). However, with a 32mm needle (25mm chord length), safe use depends on controlled bite depth and surgical technique (more oblique needle entry) to maintain a safe margin from carotid vessels.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Silicone Leakage In Vivo: Validation of a Reproducible Histological Method for Breast Implant Surveillance.","authors":"Erik E F Bak, Linda R Gudjonsdottir, Kattia V Nguyen, Tim K Weltz, Mathias Ørholt, Simon Sabroe, John V Q Tran, Mathilde N Hemmingsen, Caroline B G Norlin, Marie R Mortensen, Jens J Elberg, Charlotte C Uth, Louise V Mielke, Jesper Trillingsgaard, Lisbet R Hölmich, Michail Sorotos, Fabio Santanelli di Pompeo, Mark W Clemens, Andreas Larsen, Mikkel Herly","doi":"10.1093/asj/sjag073","DOIUrl":"https://doi.org/10.1093/asj/sjag073","url":null,"abstract":"<p><strong>Background: </strong>Silicone leakage from breast implants may contribute to fibrosis leading to capsular contracture, yet no standardized method exists to quantify silicone leakage reliably.</p><p><strong>Objectives: </strong>To validate a histological method for quantifying silicone in the breast implant capsule and to determine whether a single biopsy provides a reliable estimate of total capsule silicone.</p><p><strong>Methods: </strong>Capsule biopsies were obtained from patients undergoing revision surgery after primary breast augmentation. Cohort 1 (n=20) assessed inter-regional variation across four capsule regions. Cohort 2 (n=80) assessed intra-regional variation using adjacent biopsies from the inferior capsule region. Silicone was quantified on hematoxylin and eosin-stained sections using the negative imprint of silicone vacuoles and foam cells. Total capsule silicone was estimated by integrating the silicone fraction with implant surface area and capsule thickness. Reproducibility between and within regions was evaluated using intraclass correlation coefficients (ICC).</p><p><strong>Results: </strong>Median (IQR) estimated silicone volumes were 0.031 mL (0.017-1.36) in the superior region, 0.10 mL (0.018-0.31) in the inferior region, 0.041 mL (0.009-0.41) in the anterior region, and 0.063 mL (0.010-0.80) in the posterior region (p=0.40). Inter-regional reproducibility was good (ICC=0.86, 95%CI 0.75-0.94). Intra-regional reproducibility was excellent (ICC 0.94; 95%CI 0.90-0.96).</p><p><strong>Conclusions: </strong>This study establishes a simple and reproducible histological method for quantifying silicone deposition within the breast implant capsule and demonstrates that a single capsule biopsy reliably reflects total silicone burden. By enabling standardized, in vivo assessment of silicone exposure, this approach provides a practical framework for post-market surveillance, and comparative implant evaluation.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Combined Septal Extension and Derotation Grafts in Asian Rhinoplasty: A Quantitative Analysis of Tip Projection and Stability.","authors":"Chih-Jung Huang, Tzong-Yueh Tsai, Cheng-I Yen, Hung-Chang Chen, Chun-Shin Chang, Yen-Chang Hsiao","doi":"10.1093/asj/sjag079","DOIUrl":"https://doi.org/10.1093/asj/sjag079","url":null,"abstract":"<p><strong>Background: </strong>Short nose correction in Asian rhinoplasty is challenging due to weak septal cartilage, thick skin envelopes, and strong postoperative contractile forces that compromise long-term tip stability.</p><p><strong>Objectives: </strong>This study aimed to quantitatively compare the long-term outcomes of three nasal tip-plasty techniques-derotation graft with columellar strut (DG+CS), septal extension graft alone (SEG only), and combined septal extension with derotation graft (SEG+DG).</p><p><strong>Methods: </strong>A total of 324 patients who underwent cosmetic rhinoplasty by a single surgeon from 2015 to 2022 were retrospectively analyzed. Standardized lateral-view photographs were used to measure nasal length, tip projection, and nasolabial angle, normalized to facial length, and expressed as percentage change over time. Long-term outcomes (>12 months) were compared using non-parametric statistical tests.</p><p><strong>Results: </strong>The SEG+DG group demonstrated the most consistent and durable improvements in nasal length and tip projection across all postoperative intervals. Significant intergroup differences were observed in long-term nasal length and tip projection (p < 0.001), with SEG+DG and SEG only both outperforming DG+CS. SEG+DG also showed the lowest variability and most stable trend, whereas the nasolabial angle showed a significant omnibus difference (p = 0.009) that did not persist after post-hoc pairwise correction. Revision rates were lowest in the SEG+DG group (6.5%), compared to SEG only (10.6%) and DG+CS (14.3%).</p><p><strong>Conclusions: </strong>The combined use of septal extension and derotation grafts provides superior and sustained structural support, offering a more reliable approach for correcting short nose deformity in Asian rhinoplasty.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Immunological Assessment of the Capsules From Silicone Implants With 0-µm and 4-µm Surfaces.","authors":"Nathan R Chan, Taylor M Levee, Sally M Winkler, Ronika S Leang, Allen Gabriel","doi":"10.1093/asj/sjag072","DOIUrl":"https://doi.org/10.1093/asj/sjag072","url":null,"abstract":"<p><strong>Background: </strong>The immune system drives the foreign body response (FBR) to breast implants, triggering cellular and molecular events that lead to the formation of an implant capsule. Implant surface topography may influence this immunological process.</p><p><strong>Objectives: </strong>Assess the immune response to silicone implants with smooth or 4-μm surface roughness.</p><p><strong>Methods: </strong>Custom-made, miniaturized implants or coupons of commercially available breast implant shells with smooth (0-μm) or 4-μm surfaces were implanted subcutaneously in the dorsolumbar region of mice. Capsule samples were harvested after 3, 6, or 9 weeks. Immune cells were characterized via histology scoring based on the International Organization for Standardization (ISO) 10993-6:2016 guidelines (biological evaluation of medical devices), flow cytometry, immunohistochemistry, and gene expression analysis.</p><p><strong>Results: </strong>Histological total sum scores, indicating overall inflammation, were similar between smooth and 4-µm implants at 3, 6, and 9 weeks postimplantation. Macrophages, key regulators of the FBR, were comparable between smooth and 4-µm implants, as demonstrated by flow cytometry analysis and CD11b+ histology staining. Further analysis of proinflammatory and anti-inflammatory macrophages showed similar phenotypes between smooth and 4-µm implants. Regulatory T cell populations, which are responsible for suppressing excessive immune responses and maintaining immune balance, were similar in capsule tissues from smooth and 4-µm implants, as determined by flow cytometry and Foxp3 gene expression analysis. Gene expression of markers for cell populations and mechanotransduction were comparable at all timepoints.</p><p><strong>Conclusions: </strong>Host immune responses were similar for breast implants with surface roughness of 0 µm or 4 µm up to 9 weeks postimplantation in mice.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Contouring After Weight Loss: Bariatric Surgery, Glucagon-like Peptide-1 Therapy and Lifestyle Impacts on Complications.","authors":"Gemma Sharp","doi":"10.1093/asj/sjag077","DOIUrl":"https://doi.org/10.1093/asj/sjag077","url":null,"abstract":"","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-year Results of the PERLE Implant in Breast Augmentation and Augmentation-mastopexy.","authors":"James Lucocq, Taimur Shoaib","doi":"10.1093/asj/sjag074","DOIUrl":"https://doi.org/10.1093/asj/sjag074","url":null,"abstract":"<p><strong>Background: </strong>Advances in the manufacturing of breast implants through improved shell architecture, gel cohesivity, and surface topography may mitigate against post-operative complications following breast augmentation.</p><p><strong>Objectives: </strong>The present study aims to report five-year results of the PERLE implant (GC Aesthetics) which is a round breast implant with an average surface roughness of 5 μm that was launched in 2020.</p><p><strong>Methods: </strong>A retrospective cohort study was performed including consecutive patients undergoing primary or secondary bilateral breast augmentation and augmentation-mastopexy with PERLE implants between December 2020-2025. The primary outcomes were implant-related complications and re-operation over five years. Outcomes were analysed per-patient and per-implant.</p><p><strong>Results: </strong>738 patients (augmentation, n=592; augmentation-mastopexy, n=146) receiving 1,476 implants were followed up for up to five years (median follow-up, 34 months). Implant-related complications occurred in 2.8% of patients overall: 2.2% (13/592) following augmentation and 5.5% (8/146) following augmentation-mastopexy. The per-patient rate of capsular contracture was 0.5% following augmentation (n=3) and 0.7% following augmentation-mastopexy (n=1). Per-implant, the overall rate of capsular contracture was 0.3% (subglandular, 0.4% [2/476]; dual-plane, 0.3% [2/690]; subfascial, 0.0% [0/296]; and submuscular, 0.0% [0/14]). The rate of implant malposition was 0.7% and 1.4% per implant inserted, following augmentation and augmentation-mastopexy, respectively. The 1-, 3- and 5-year re-operation rate for implant-related complications was 1.2%, 2.1% and 2.5%, respectively in the augmentation group. No cases of implant rupture, rippling or BIA-ALCL were reported.</p><p><strong>Conclusions: </strong>At five years, breast augmentation and augmentation-mastopexy using the PERLE implant demonstrated low rates of capsular contracture, implant malposition, and implant-related re-operation.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Characterization of Transverse Facial Artery Perforators: A Micro-computed Tomography and Cadaveric Study.","authors":"Hyung-Jin Lee, In-Seung Yeo, Haeryun Ahn, Ji-Hyun Lee","doi":"10.1093/asj/sjag071","DOIUrl":"https://doi.org/10.1093/asj/sjag071","url":null,"abstract":"<p><strong>Background: </strong>Perforators of the transverse facial artery (TFA) contribute to the formation of the subdermal vascular plexus of the lateral face. However, detailed three-dimensional information regarding the layer-specific course, depth, and relationship with landmarks remains limited.</p><p><strong>Objectives: </strong>To elucidate the three-dimensional topography of TFA perforators and the associated subdermal vascular plexus using contrast-enhanced micro-computed tomography (micro-CT), conventional CT, and cadaveric dissection.</p><p><strong>Methods: </strong>Forty-eight hemifaces from 24 non-frozen adult cadavers were analyzed. Forty hemifaces underwent CT imaging and anatomical dissection, whereas eight hemifaces were subjected to phosphotungstic acid (PTA) staining and micro-CT imaging. The locations of the perforators were quantified using surface landmarks (the lateral canthus, ala of the nose, and otobasion inferius), and the depth of the subdermal vascular plexus were measured along predefined reference lines.</p><p><strong>Results: </strong>TFA perforators were identified in 96% of hemifaces, typically as a single dominant perforator (91.3%). The emergence point was located 31.7 ± 6.9 mm lateral and 40.3 ± 4.2 mm inferior to the lateral canthus at a depth of 11.3 ± 3.7 mm. After traversing the SMAS, the perforators branched into a subdermal vascular plexus (depth: 3-5 mm) distributed in the inferolateral orbital and malar regions.</p><p><strong>Conclusions: </strong>These three-dimensional anatomical data provide a practical reference for both surgical and minimally invasive interventions. By defining the precise location and depth of the TFA perforator system, these findings can help optimize flap design in facelifts and reconstructive surgeries, while also improving the safety of interventions such as filler injections and thread-lifting.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}