Search Results (362)

This study evaluated the safety and effectiveness of HYDRAGEL A2, an injectable medical device containing hyaluronic acid (HA), polynucleotides (PN), and niacinamide, for improving facial skin quality. These ingredients are increasingly recognized for their synergistic effects in aesthetic medicine, with HA and PN providing hydration and skin support, and niacinamide offering anti-inflammatory and antioxidant properties. A prospective, open-label clinical investigation was conducted on 42 female subjects (mean age 45 ± 1 years, Fitzpatrick skin phototypes II-V) to assess skin elasticity, hydration, and mild skin depression correction following cheek area injections. Efficacy was measured using the Global Aesthetic Improvement Scale (GAIS), Antera 3D^® (texture), Cutometer^® (elasticity/firmness), Corneometer^® (hydration), and Dermascan^® (density/thickness) devices at baseline (D0), week 2 (W2/D14), and week 6 (W6/D42). GAIS values showed significant overall facial improvement (p < 0.001) by both investigators and subjects, where 100% of subjects rated their appearance as improved immediately post-injection (D0), with sustained improvements at D42. Objective measurements revealed significant improvements in skin texture (reduced roughness), elasticity, firmness, hydration (p < 0.001), density, and thickness, demonstrating the combined benefits of the HA, PN, and niacinamide blend. Injection site reactions, primarily mild and transient, were reported immediately post-injection. Investigators and subjects reported high satisfaction with the product’s ease of use and aesthetic outcomes. Globally, HYDRAGEL A2, leveraging the established benefits of HA, PN, and niacinamide, was well-tolerated and effectively enhanced facial skin quality, demonstrating significant and sustained improvements in monitored skin parameters. The study concludes that this combination of ingredients, formulated in HYDRAGEL A2, provides a well-tolerated approach associated with improvements in skin quality. Full article

Oral and Maxillofacial Surgery (OMFS) is a surgical specialty with a distinctive position at the intersection of medicine and dentistry. This unique expertise enables reliable reconstructions of complex head and neck defects, with a focus on function, esthetics, and quality of life. This review examines the historical progression, current practices, and prospective directions of head and neck reconstruction, with particular emphasis on the essential contributions of Oral and Maxillofacial Surgeons (OMSs). Beginning with early reconstructive efforts in ancient civilizations and progressing through the transformative advancements of the Renaissance, the introduction of anesthesia and antiseptics, and innovations during periods of war, the specialty has evolved in response to increasing clinical complexity. The contemporary era is characterized by the integration of microvascular reconstruction, dental rehabilitation, and advanced imaging modalities, enhancing the restoration of occlusal function, facial aesthetics, and overall quality of life. Emerging innovations such as patient-specific three-dimensional printed hardware, tissue engineering, regenerative medicine, artificial intelligence, and supermicrosurgical techniques are expected to further reshape reconstructive approaches. These technological advances aim to reduce the number of surgical steps, improve biological reconstruction, and enhance diagnostic and planning capabilities. However, they also raise ethical considerations and validation challenges that warrant careful assessment. In conclusion, Oral and Maxillofacial Surgeons continue to play a central and expanding role in head and neck reconstruction and rehabilitation. Owing to comprehensive training and technological expertise, the specialty is uniquely positioned to advance value-based, multidisciplinary care while persistently striving to improve functional, aesthetic, and quality-of-life outcomes for patients with complex craniofacial defects. Full article

Background and Objectives: Frontal bone osteomas are benign tumors characterized by the abnormal proliferation of bone. Though typically asymptomatic, these masses often produce visible forehead deformity and may cause localized discomfort. Endoscopic resection has emerged as an optimal technique for appropriately selected frontal osteomas because it enables complete excision while minimizing visible scarring and risk of neurovascular injury. This case series reviews the senior author’s patient outcomes and complications using a scalp-based, endoscopic-assisted surgical approach for frontal bone osteoma excision. Materials and Methods: A review was conducted of all patients (n = 22) who underwent endoscopic-assisted frontal bone osteoma excision performed by a single surgeon between February 2019 and December 2025. All procedures involved endoscopic visualization through remote scalp incisions, osteoma excision, and frontal bone contouring. Patient demographics, presenting symptoms, CT imaging findings, operative details, histopathology results, and postoperative outcomes were recorded. Results: Twenty-two patients underwent endoscopic-assisted excision of frontal bone osteomas performed by the senior author (NT). The primary concern prompting surgical intervention was aesthetic deformity, with localized pain reported in some cases. For all patients, CT imaging was obtained preoperatively to evaluate lesion size and anatomical relationships to nearby facial structures. Histopathology confirmed cortical bone consistent with osteoma in all cases. Postoperative swelling and ecchymosis were common in the first week but resolved spontaneously. No contour irregularities, fluid collections, residual bone, or sensory deficits were observed. Some alopecia was noted in the first three patients, prompting the senior author to modify the technique. All patients healed with small, flat, well-concealed scars adjacent to the hairline. Conclusions: This single-surgeon experience demonstrates that endoscopic-assisted excision of frontal bone osteomas is a safe and effective technique that permits complete excision with excellent aesthetic outcomes and minimal morbidity. The operative framework presented in this study, including surgical planning, technique steps, and postoperative management, supports endoscopic resection as an ideal alternative to traditional direct approaches for frontal bone osteomas. Full article

Introduction. The superficial musculoaponeurotic system (SMAS) is fundamental for facial soft tissue support and surgical rejuvenation. Although its morphology in the midface and neck is well characterized, the structure of its cranial extension to the forehead remains a subject of terminological uncertainty. The aim of this study was to conduct a detailed histological and immunohistochemical examination of the forehead supporting structures to characterize their morphology and propose an expanded, region-specific classification of the SMAS. Material and methods. Full-thickness tissue specimens (n = 30) were obtained from five standardized facial regions (parotid, buccal, temporal, frontal, and cervical) from 12 male and 18 female body donors (aged 25–70 years). Specimens were processed for histological analysis using hematoxylin and eosin, van Gieson staining, and Masson’s trichrome. Immunohistochemical staining for S100 protein was used to identify neural structures. Morphometric analysis was performed on digitized sections to quantify interseptal distances and the depth of superficial nerve trunks. Results. The analysis confirmed the established SMAS types (I–V) in the cheek, parotid gland, and neck, confirming the validity of the method. Two distinct, sequentially arranged structures were identified on the forehead, proposed as new types. Type VI (neurovascular arborization) is a discrete fan-shaped structures with a central collagen core surrounding a neurovascular bundle, showing positive S100 staining. These structures, spaced approximately 2.2 mm apart, function as true retaining ligaments. Type VII (fibroseptal) SMAS patterns is vertically oriented, purely fibrous septa (retinacula cutis) connecting the aponeurosis to the dermis, devoid of neural elements, and spaced approximately 9.2 mm apart. Importantly, the superficial nerve trunks were located at an average depth of only 1.09 mm (range: 0.57–1.97 mm) from the skin surface. Conclusion. This study identified two novel SMAS patterns in the forehead—neurovascular arborization (type VI) and fibroseptal (type VII)—supporting the expanded functional seven-type classification of the SMAS. The extremely superficial location of the forehead nerves (average 1.1 mm) defines a critical “danger zone” for aesthetic procedures. These findings provide a refined anatomical basis for improving the precision and safety of both surgical and minimally invasive facial procedures. Full article

Background/Objectives: This study aimed to evaluate whether patients’ decisions to undergo orthodontic–surgical treatment for dentofacial deformity are associated with Orthognathic Quality of Life Questionnaire (OQLQ) scores, and to identify which domains show the strongest relationship with treatment acceptance. Methods: Adult patients (≥18 years) who were offered orthognathic surgery by the same orthodontic specialist team completed the Hungarian version of the OQLQ. The primary outcome was whether the patient proceeded with surgery following consultation (yes/no). The questionnaire comprises 22 items across four domains, from which domain-specific and total scores (range: 0–88) were calculated. Given the non-normal distribution and group imbalance, comparisons between groups were performed using nonparametric tests, and associations were further evaluated using Firth penalized logistic regression adjusted for age and sex. Results: A total of 133 patients were included, of whom 107 proceeded with surgery and 26 did not proceed. Median total OQLQ scores were higher in the surgery group than in the decline group (40.0 [IQR: 27.0–52.0] vs. 31.5 [16.0–52.5]), although this difference was not statistically significant. In adjusted analyses, the total OQLQ score was not independently associated with treatment acceptance. Among the domains, only facial aesthetics showed a modest association that reached statistical significance (OR per 1-point increase: 1.10; 95% CI: 1.002–1.22). Conclusions: In this single-center cross-sectional study, OQLQ scores showed only a limited association with treatment acceptance. The observed effect was modest, and only the facial aesthetics domain demonstrated a statistically significant relationship, with a confidence interval close to unity, indicating a borderline and potentially unstable association. These findings suggest that patient-reported quality of life alone is insufficient to explain treatment decisions. The OQLQ may be useful as a supportive tool in clinical consultation, particularly for identifying concerns related to facial appearance, but should not be used as a standalone predictor of whether patients proceed with surgery. Full article

Background: Achieving facial harmony in patients with micrognathia requires precise chin augmentation. While conventional ready-made implants often fail to conform to unique mandibular surfaces, expensive patient-specific options like PEEK or Titanium lack intraoperative adjustability. We introduce an innovative, cost-effective workflow utilizing 3D-printed templates to fabricate customized Polymethyl Methacrylate (PMMA) implants, emphasizing their clinical feasibility and intraoperative versatility. Methods: We retrospectively analyzed 20 patients with mild-to-moderate micrognathia (<6 mm advancement) who underwent genioplasty between March 2021 and June 2022. Patient-specific templates were produced via Fused Deposition Modeling (FDM) using low-shrinkage Acrylonitrile Butadiene Styrene (ABS) filament. During surgery, final PMMA implants were molded using these sterilized templates. Accuracy was evaluated by comparing mental advancement across preoperative, virtual simulation, and 6-month postoperative stages using Vectra 3D scanning. Results: Quantitative analysis revealed high fidelity between virtual planning and clinical outcomes. The mean discrepancy in horizontal advancement was only 1.02 mm (Planned: 5.04 mm vs. Actual: 4.02 mm). Statistical analysis showed a strong positive correlation (r = 0.928, p = 0.001). Subjective patient satisfaction was high, with 90% reporting “exceptional” or “very improved” results on the Global Aesthetic Improvement Scale (GAIS). Two cases of transient numbness resolved spontaneously within two months. Conclusions: This workflow combines FDM-based template fabrication with intraoperative PMMA molding, enabling real-time adjustment of implant geometry. The results demonstrate a high level of agreement between virtual planning and postoperative outcomes, supporting the clinical reliability of this approach. It may serve as a practical alternative to conventional CAD/CAM methods, particularly in cases requiring both precision and intraoperative flexibility. Full article

Background: With the increasing demand for non-surgical facial rejuvenation, injectable collagen biostimulators such as poly-L-lactic acid (PLLA), calcium hydroxyapatite (CaHA), polycaprolactone (PCL), poly-D,L-lactic acid (PDLLA) and powdered polydioxanone (PPDO) have become widely used by facial aesthetic practitioners. These agents stimulate neocollagenesis, providing gradual improvement in skin firmness, elasticity and facial contour with long-lasting results. While manufacturers emphasize the efficacy and favorable safety profile of these products, adverse events such as nodules, edema, inflammatory reactions and, in rare cases, granulomas have been reported. To date, no comprehensive systematic review has evaluated the proportion and nature of adverse effects associated with all major collagen biostimulators in facial aesthetic procedures. This study aims to synthesize current evidence on the proportion of adverse events linked to injectable collagen biostimulators. Methods: The systematic review will include clinical studies involving adults undergoing facial aesthetic procedures with PLLA, PDLLA, CaHA, PCL and PPDO that report adverse events during or after treatment. The search will be conducted in six main databases: CENTRAL, EMBASE, LILACS, PubMed, SCOPUS and Web of Science. No restrictions will be applied regarding language or publication date. The screening process will occur in two phases: first, two independent reviewers will assess titles and abstracts against the eligibility criteria; second, the same reviewers will conduct full-text evaluations. Data will be synthesized narratively, with a meta-analysis of proportions performed if appropriate. Additionally, sample characteristics, treatment protocols, study design and main findings will be reported. The risk of bias will be assessed independently by two reviewers using appropriate tools, based on the study design, with the support of artificial intelligence. PROSPERO registration number: CRD420251062785. Full article

Background: The relationship between facial aesthetic procedures and changes in the stomatognathic system has attracted increasing interest, motivating investigations into their functional and structural impacts. This longitudinal observational study analyzed molar bite force and orofacial tissue pressure in adults who underwent hyaluronic acid injections in the mandibular angle. Methods: Ten adults (eight women and two men; mean age 34.3 ± 11.2 years) with normal occlusion and no temporomandibular disorders were included. The MD Codes guided injection points of 2 mL of hyaluronic acid in the mandibular angle. Maximum right and left molar bite force was measured using a digital dynamometer, and tongue, lip, and cheek pressures were measured with a Pro-Fono Biofeedback device. Assessments occurred before and at 15, 30, and 60 days. Repeated measures ANOVA with Bonferroni correction was applied (p < 0.05), and effect sizes and 95% confidence intervals were calculated. Results: No statistically significant differences were observed in maximum molar bite force throughout the follow-up period. Regarding orofacial pressures, a significant main effect of time was observed for tongue pressure (p = 0.03); however, the effect size was moderate-to-large, and values showed considerable variability across participants. Lip and cheek pressures remained stable over time. Conclusions: Hyaluronic acid injection in the mandibular angle did not show clinically detectable changes in maximum molar bite force, suggesting short-term preservation of masticatory function within the 60-day follow-up period. These findings are limited to short-term observations and specific sample characteristics. The observed variation in tongue pressure may reflect adaptive functional adjustments, although variability across participants was considerable. Full article

Background: Dermatology and aesthetic medicine make extensive use of microneedling, a minimally invasive and safe treatment. Across the research, it has been shown that microneedling combined with chemical peels is also more effective than chemical peels alone. However, data on procedures in dark-skinned individuals is rather scarce. Aim/Objective: This study aimed to determine the efficacy of using a 4% retinol solution product containing novel TGF-β activators and antioxidants combined with a microneedling technique in the treatment of hyperpigmentation, atrophic acne scars, and enlarged pores in patients with skin of color, generally corresponding to Fitzpatrick skin phototypes IV–VI. Methods: Each of the 10 patients underwent three peel treatment series, with a 30-day interval between each session. Moreover, skin hydration, elasticity, and pigmentation were examined using the Multi Skin Test MC 1000 Courage + Khazaka, and the Observ 520x device. Results: All patients reported an overall improvement and an enhancement in skin tone after the procedure. The majority of them stated subjective improvement in the reduction of facial skin issues: redness, hyperpigmentation, uneven structure, wrinkles, dehydration, dryness, and sebaceous gland activity. The least improvement was noted in scar reduction or liquidation. An objective evaluation revealed a statistically significant improvement in hyperpigmentation and elasticity in the study group. An improvement, however, not statistically significant, in hydration parameters was demonstrated during the study. Conclusions: This study suggests that a combined peel therapy of 4% retinol serum product containing novel TGF-β activators and antioxidants, together with a microneedling technique, may improve facial hyperpigmentation of the skin, as well as regulate sebaceous gland activity, their size, and reduce sebum production. The recommended method is relatively simple to use, low-cost, has minimal adverse effects, and is well tolerated by patients with skin of color. Full article

Background: The nasolabial angle is widely used in orthodontic diagnosis, but its composite geometric nature complicates interpretation. Whether it primarily reflects skeletal or soft-tissue influences remains unclear, as no previous study has quantitatively partitioned its angular components using multivariable regression in a large adult sample. Objective: The objective of this study is to quantify the relative angular contributions of skeletal classification and soft-tissue parameters to NLA morphology using a multivariate cephalometric model. Methods: A retrospective analysis of 504 adult lateral cephalograms was conducted. Subjects were categorized by sagittal (Class I, II, or III) and vertical skeletal patterns (hyperdivergent, normodivergent, and hypodivergent). Measured variables included the NLA, nasal inclination (N/FH), upper lip inclination (L/FH), upper lip thickness, and maxillary incisor inclination. Correlation and multivariable regression analyses were performed. Results: Although the NLA differed across sagittal classes (p = 0.001; η² = 0.047), upper lip inclination demonstrated the strongest association with the NLA (r = 0.766; R² = 0.588). In multivariable analysis, L/FH exhibited the largest standardized contribution (β = 0.752, p < 0.001), while vertical pattern and lip thickness were not independently associated. Class II showed a modest independent association (β = 0.083, p = 0.006). Conclusions: Nasolabial angle variation largely reflects upper lip orientation rather than skeletal classification alone. These findings support component-based interpretation, emphasizing separate evaluation of lip inclination during esthetic orthodontic assessment. Full article

Botulinum neurotoxin (BoNT) treatment outcomes are commonly assessed through visual evaluation of facial wrinkle patterns, a process that remains inherently subjective despite structured grading systems. This study evaluated whether contemporary multimodal artificial intelligence (AI) systems can identify facial changes associated with BoNT treatment, using region-specific wrinkle patterns as surrogate markers of underlying muscle activity. A dataset of 46 facial images (23 pre-treatment, 23 post-treatment) was analyzed using four multimodal models, each assessed across five independent runs. Models were tasked with classifying treatment state from single images, detecting wrinkle presence in the forehead, glabella, and periorbital regions, and generating exploratory severity scores and age estimates. Two models achieved 100% accuracy in distinguishing pre- from post-treatment images in this dataset, while region-specific wrinkle detection was variable and frequently did not exceed majority-class baselines. Inter-run reliability varied substantially across models. Exploratory wrinkle severity scores showed directional differences between treatment states, whereas apparent age estimates demonstrated minimal systematic variation. These findings suggest that global facial changes associated with BoNT treatment appear to be detectable in model outputs, but region-specific assessment remains limited, underscoring the need for cautious interpretation and further validation. Full article

Background: Generative artificial intelligence (AI) can produce realistic human faces that are shared on social media, from where younger generations often derive body image norms. Aesthetic bias in these systems may promote unrealistic standards of beauty. This study examines whether generative AI produces facial images that are perceived by humans as more attractive than real human faces. Thus, we examine AI-generated facial imagery as a contemporary site of consumer culture, where beauty may become biased, unrealistic, and commodified: generating an algorithmically optimized product circulating through social media and digital platforms without proper regulation. Methods: Fifty AI-generated female faces were prospectively compared with 50 photographs of female models from a model agency. Facial attractiveness was rated by plastic surgeons, using a Likert scale and Mann–Whitney U for analysis. Results: AI-generated images received higher mean aesthetic scores than real photographs (7.79 vs. 6.88, p < 0.05), despite prompts requesting unattractive features. Conclusions: The AI model showed a small but consistent bias toward enhanced facial attractiveness. As AI-generated imagery increasingly shapes visual culture, this bias may contribute to unrealistic beauty standards, highlighting the need for AI literacy, responsible use of AI, and ethical oversight, especially when shared on social media. Full article

Background/Objectives: This study aimed to describe and quantify facial soft tissue changes in two patients who underwent radiotherapy (RT) for head and neck cancers, using three-dimensional (3D) stereophotogrammetry and surface deviation analysis. The aims were (i) to assess the progression of morphological alterations over time (ii) and to evaluate the clinical potential of 3D surface mapping in documenting RT-related aesthetic changes. Methods: Two patients with head and neck cancer undergoing RT were analyzed using three-dimensional stereophotogrammetry (3dMD Trio-system, Atlanta, GA, USA) at three timepoints: before RT (T0), 45 days after the start of RT (T1), and 6 months after the start of RT (T2). Facial 3D scans were processed using Geomagic Control 2014 software (v.3D Systems, Morrisville, NC, USA) to perform standardized alignments and calculate volumetric deviations, create colorimetric deviation maps, and conduct Root Mean Square (RMS) analysis. Results: Between T0 and T1, both patients showed soft tissue volume reduction, primarily in the mandibular and submental regions, likely reflecting acute treatment effects and weight loss. Between T0 and T2, an increase in soft tissue volume was observed, especially in the lower face and neck, consistent with late radiation effects such as lymphedema and post-treatment weight gain. RMS values ranged from 5.53 mm to 6.87 mm across patients and time points, indicating measurable morphological changes. The upper third of the face remained stable and served as a reliable reference region for alignment. Conclusions: RT may be associated with significant, region-specific changes in facial and cervical soft tissues in HNC patients, but these preliminary observations must always be correlated with weight loss and confirmed by further studies. 3D stereophotogrammetry is a reliable, non-invasive method for detecting and quantifying these alterations over time. This technique can offer valuable insights for clinical monitoring and could promote better patient counseling and potentially mitigate the psychological burden associated with facial changes. Full article

Architectural heritage plays a central role in shaping visitors’ emotional experiences within cultural tourism contexts. However, empirical research examining how specific architectural styles evoke emotional responses remains limited, particularly when using objective measurement techniques. This study investigates emotional reactions to architectural heritage by applying the Stimulus–Organism–Response (SOR) theoretical framework. In this model, architectural styles act as environmental stimuli, emotional processing represents the organismic state, and the resulting emotional activation constitutes the response. An experimental protocol was conducted with a sample of 645 participants exposed to a series of standardized architectural heritage images representing different architectural styles and infrastructure types. Emotional reactions were captured in real time through facial emotion recognition technology, enabling the objective measurement of eight basic emotions: neutral, happiness, sadness, surprise, fear, disgust, anger, and contempt. The collected emotional data were statistically analyzed using Analysis of Variance (ANOVA) to identify significant differences in emotional responses across architectural styles, heritage typologies, and gender. When significant differences were detected, Tukey’s HSD post hoc tests were applied to determine specific group contrasts. The findings reveal that different architectural styles generate distinct emotional patterns, highlighting the role of architectural aesthetics as a powerful mediator of affective engagement with heritage environments. From a theoretical perspective, this research contributes to heritage tourism and environmental psychology by integrating the SOR framework with real-time emotion detection technologies, providing a novel methodological approach for analyzing emotional responses to architectural heritage. Full article

Background/Objectives: Unilateral condylar hyperplasia is an idiopathic condition that causes facial asymmetry and occlusal problems. Currently, traditional treatment protocol is the combination of orthognathic and extra-oral condylectomy surgery via pre-auricular incision, which can create aesthetic problems with additional risks of facial nerve damage. The purpose of this study was to report management of condylar hyperplasia patients through minimally invasive condylectomy that was planned via virtual methods. Methods: The custom-made cutting guides were produced, and unilateral condylectomy operations were performed via intra-oral approach. Orthognathic surgery with/without genioplasty operations were either done with condylectomy in one session or in an additional session. Results: Custom-made cutting guides produced by virtual methods provided easy operations without any need for additional extra-oral incisions. Planned osteotomies were transferred successfully from the virtual surgical plan and resections of the excess bone tissues were performed using novel piezo surgery devices. The bones were fixed to their pre-planned position using 3D-printed titanium plates. The patients healed without any complications. Results of this innovative virtually guided protocol tested showed functional and esthetic results without any extra-oral scars with no facial nerve damage. Conclusions: Combination of intra-oral condylectomy with orthognathic surgery using 3D-printed titanium cutting guides seems to be an advantageous approach with successful results in terms of aesthetics and function for management of mandibular condylar hyperplasia patients; however, there is an urgent need in the scientific literature for further clinical research with a larger number of subjects. Full article