A Novel Idea in the Use of Ultrasound to Guide Nasolabial Hyaluronic Acid (HA) Dermal Filler Injections to Prevent Alar Nasal Necrosis
Bibliographic record
Abstract
Background Nasolabial dermal filler (DF) injections are one of the most popular cosmetic procedures performed worldwide. DF injections at the nasolabial fold have been associated with nasal necrosis due to inadvertent intravascular injection of the adjacent facial artery (FA). Current DF injection protocols are devoid of imaging the anatomical site, and the use of ultrasound (US) for imaging the FA is very limited in literature. The purpose of this study is to determine the feasibility of utilizing US to identify and measure the FA at different bony landmarks near and within the nasolabial region. Methods Part I Cadaveric dissections (n=18; 10 female, 8 male) will be completed to explore the course of the FA from the external carotid artery to the terminal branches supplying facial structures. Part II A bilateral US of the FA using 13–6 MHz, 38 mm linear array US transducer was performed on consenting adults (n=16; 9 female, 7 male) from the Department of Anatomy and Cell Biology at Western University. The following bony landmarks were identified and used for US measurements, taken in real time: anterior‐inferior angle of the mandible, mandibular teeth, maxillary teeth, maxillary ridge. Measurements of FA diameter, artery distance to skin, and artery distance to bone were obtained at each landmark using digital image distance measurements on the Sonosite M‐Turbo P08189‐88R US machine. Results Part I Preliminary results (n=8; 4 female, 4 male) show FA variability between cadaveric specimens, as well as left/right FA variability within cadaveric specimens themselves. Part II Preliminary results of the average FA distance to the skin measured at 0.438 cm ± 0.126 for the left FA and 0.459 cm ± 0.205 for the right FA. A significant difference (P< 0.05) was noted for FA distance to the skin between the left mandibular teeth (0.481 cm ± 0.107) and left maxillary ridge (0.343 cm ± 0.097). Conclusions These findings highlight the importance of understanding the anatomy of the FA within the nasolabial fold, and the need to carefully personalize the placement of DF injections, due to the anatomical variability identified in both the cadaveric and ultrasound portions of the study. Furthermore, since it is feasible to identify and measure the FA using the selected US transducer, the future direction of this study will be to examine the application of US to guide DF injections. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".