Introduction: Bellafill (Suneva Medical Inc) is a semipermanent injectable soft tissue filler composed of smooth and uniform polymethylmetacrylate (PMMA) microspheres suspended in a bovine collagen gel. It is a third generation PMMA filler, with more uniform shapes and sizes of the PMMA microspheres, which has been purported to decrease the incidence of granuloma formation. Methods: We performed a retrospective review of our clinical experience from 2014 to 2017 with Bellafill as a soft tissue injectable filler in the following clinical scenarios: deep nasolabial folds, depressed facial acne scars, malar volume loss, temporal wasting, tear trough deformity, chin augmentation, angle of jaw augmentation, and lip augmentation. The primary outcome is the rate of adverse events, and the secondary outcome is subjective patient satisfaction. Results: From 2014 to 2017, 842 syringes of Bellafill were administered to 212 patients, for a total of 417 procedures. Of the 417 procedures, 96 (23.0%) were for acne scars, 82 (19.7%) malar volume restorations, 65 (15.6%) nasolabial fold augmentations, 45 (10.8%) chin augmentations, 42 (10.1%) tear trough volume restorations, 28 (6.7%) temple volume restorations, 25 (6.0%) rhinoplasty touch-ups for small areas of nasal depression, 22 (5.3%) lip augmentations, and 12 (2.9%) jaw angle augmentations were performed. A range of 1 to 12 syringes were injected into each patient, over 1 to 3 sessions; 6 cases of adverse events occurred (1.4%). There were 4 cases of solitary nodules in the injection site, 1 case of lower eyelid oedema which persisted for 3 months and 1 case of lower lip oedema which resolved within hours. Patient satisfaction rates ranged from 83.3% for angle of jaw augmentation to 99.0% for improvement of acne scars. Conclusion: Bellafill is a safe and effective option for a semipermanent soft tissue filler, with high patient satisfaction and a good safety profile.

Purpose of Review: To provide the reader with a clear overview of facial anatomy as it relates to injection of botulinum toxin. Recent Findings: The review suggests the presentation of multiple combinations of facial musculature, with the forehead, glabellar, and nasal base areas as particular areas of variation. Differences in musculature result in different wrinkling patterns; with age, these changes first become apparent in the upper face, particularly in the forehead and glabellar area. Summary: Botulinum toxin is well suited to achieve the optimal outcome: it is popular, safe, and non-invasive and presents with few adverse effects. Though limited, when adverse effects do arise these are primarily related to poor injection technique, often fuelled by poor anatomical knowledge. For clinicians to achieve the best outcomes with botulinum toxin use, an understanding of the facial muscles’ anatomy, actions, and interactions is key. This paper discusses the broad and intricate detail regarding the key target muscles of botulinum toxin, based on both literature review and cadaveric dissection carried out by the authors.

Dorsal preservation techniques in rhinoplasty are experiencing a renaissance in recent years. New techniques and modifications to existing techniques are being described at an intensifying pace. Dorsal preservation, however, is not a new concept and was first described over 120 years ago. It is timely that we conduct a review of the key techniques and concepts of dorsal preservation in rhinoplasty that had been published over the past 120 years, at a moment in which we consider as a revival of this school of thought.

The Asian nose has its unique morphology and forms a significant proportion of noses treated by the rhinoplasty surgeon not only in Asia but also in other countries where the Asian diaspora resides. The anatomical features and dimensions of the Asian nose differ from noses of persons of African, Caucasian, Indian, and Middle Eastern origins, poses its own challenges, and warrants a unique set of techniques for its aesthetic improvement. In this article, we present an overview of the approach to the lengthening of the Asian nose, drawing from our own experience with managing the Asian nose and referencing the published literature on the subject.

Buccal fat removal is a cosmetic procedure performed to reduce cheek “chubbiness” and create a more sculpted appearance of the face ( Figure 1). It is commonly performed transorally via an incision in the buccal mucosa, followed by dissection into the buccal cheek fat and excising an appropriate amount of fat ( Figure 2),^1,2 or transposing the fat to volumize other craniofacial regions.³ One ultrasonographic study estimated the volume of buccal fat per cheek to be 11.67 mL and reported that the average amount of fat removed was 2.74 mL.⁴ Although the procedure is relatively simple, a challenge surgeons face is estimating the amount of fat removed and ensuring that equal amounts of fat are removed from both cheeks. Failure to do so may lead to facial asymmetry. To solve this issue, we describe a simple technique utilizing a syringe and needle to estimate the volume of fat removed intraoperatively. This method also allows for documentation of the volume of fat excised in the operative notes, which is necessary from a medicolegal point of view particularly in cosmetic surgery, and can help with pre- and postoperative counselling of patients.