Publications by authors named "N Iblher"

34 Publications

A morphometric study of age- and sex-dependent changes in eyebrow height and shape.

J Plast Reconstr Aesthet Surg 2019 Jun 17;72(6):1012-1019. Epub 2019 Jan 17.

Private Clinic for Plastic Surgery Freiburg, Freiburg, Germany.

Background: Rejuvenation procedures of the periorbital region and the forehead, with the eyebrow as a key structure, are often performed in plastic surgery. There is no common consent on the changes of aging in this region and the consecutive treatment options. This study was designed to support the body of literature with a broader data basis about the natural changes of eyebrow position and its shape.

Methods: The brow shape, the lid axis, and the distance between both medial canthi (DMC) were analyzed retrospectively on randomly selected standardized photographs of healthy Caucasian females and males. Six defined heights of the upper brow border, including the position and height of the highest brow point (HBP) and the angle of the upper brow line, were measured.

Results: A total of 244 Caucasian females and males in two groups (<34 years and >55 years) were analyzed. The data showed a difference between brow shapes of young females and males, especially relating to the HBP, which is located medially in young females. The brow shape of females assimilates toward a male shape with aging. The eyebrow moves upward, the DMC widens, and the lid axis drops laterally in both sexes with aging.

Conclusions: Our data suggest that rejuvenation procedures should focus on not only lifting the brow but also reshaping and stabilizing the brow, especially the HBP, which plays an important role in defining the upper brow line. Our findings can explain why lifting the brow can create not only an undesired surprise but also an older look.
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June 2019

A 3D Morphometrical Evaluation of Brow Position After Standardized Botulinum Toxin A Treatment of the Forehead and Glabella.

Aesthet Surg J 2019 04;39(5):553-564

Department of Plastic and Hand Surgery, Freiburg University Medical Center, Freiburg, Germany.

Background: Botulinum toxin treatment for forehead wrinkles has been extensively studied and found to be a safe and reproducible procedure. However, the effect on the position of the eyebrows, which relies on the dynamic positioning of the treated muscles, has received less attention and has not been studied with 3-dimensional (3D) technology.

Objectives: The authors sought to evaluate the changes of eyebrow position after standardized botulinum toxin treatment of glabella or glabella and frontalis muscles with 3D imaging.

Methods: In a prospective study, 2 groups of adult females were treated with botulinum toxin A at the glabella only (G) or at the glabella and the frontalis muscle (F/G). The brow position was measured at 5 positions with 3D photography before injection and 2 weeks, 3 months, and 6 months after injection. Results were statistically analyzed and related to patient age.

Results: In the F/G group, the brow descended significantly almost across the whole brow length after 2 weeks. The descent lessened after 3 months and moved medially. No clear trend was evident in the G group. There was no significant change attributed to patient age in both groups.

Conclusions: Botulinum toxin treatment of the glabella and frontalis muscle impacts the position and configuration of the eyebrow. The degree of change is affected by the amount of frontalis weakening rather than by treatment of the glabella. While age in general is not a reliable predictor, individual factors play the major role in how pronounced a change of the brow can be expected.

Level Of Evidence: 2:
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April 2019

Prospective 3D analysis of facial soft tissue augmentation with calcium hydroxylapatite.

J Cosmet Laser Ther 2017 Oct 22;19(5):283-289. Epub 2017 Mar 22.

d Private Practice for Plastic and Aesthetic Surgery , Freiburg , Germany.

Background: Facial rejuvenation is an expanding field with an increasing number of treatment modalities. Several non-autologous filler materials are available for soft tissue augmentation. Calcium hydroxylapatite (CaOH) is aimed at increasing collagen neosynthesis and thereby producing long-term augmentation effects. Despite a multitude of observational reports, the field is suffering from lack of quantitative morphometric evaluation methods.

Objective: The objective of this proof-of-principle study was to investigate whether the effects of facial tissue augmentation with CaOH (RADIESSE™) can be quantified and followed up using 3D surface scanning.

Methods: 3 female subjects received augmentation of the mid and lower face with CaOH. The faces were recorded prior, directly after, and two weeks and six months after the injection using standardized photos and 3D scanning. Computational analysis allowed quantifying the change in volume and displacement of the facial surface. Additionally, a patient satisfaction questionnaire was administered.

Results: In all subjects, increase in facial volume could be quantified and was present after two weeks and six months.

Conclusions: 3D surface scanning is an adequate tool for objective quantification of changes after facial augmentation with filler materials. Persistent volume augmentation after CaOH injections could be quantified after two weeks and six months. Evidence level: IV.
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October 2017

Complication assessment and prevention strategies using midfoot fusion bolt for medial column stabilization in Charcot's osteoarthropathy.

Foot (Edinb) 2016 Dec 4;29:36-41. Epub 2016 Nov 4.

Department of Orthopedic and Trauma Surgery, University Medical Center, Hugstetterstrasse 55, Germany; Department of Orthopedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 500 Odense C, Denmark.

In Charcot's osteoarthropathy stabilization of the medial column of the foot was introduced in order to establish a stable foot and reduce the risk for amputation. This study was performed to analyze postoperative complications, define risk factors for those and develop strategies for prevention. Since bolt dislocation takes place frequently, it was aimed to predict an appropriate time point for bolt removal under the condition that osseous healing has occurred. Fourteen consecutive patients with neuroosteoarthropathy of the foot and arch collapse were treated with open reduction and stabilization using midfoot fusion bolt and lateral lag screws. Age, gender, presence of preoperative osteomyelitis or ulcer, number of complications and operative revisions, Hba1c value, consolidation of arthrodesis, presence of a load-bearing foot and period to bolt dislocation was assessed. The mean follow-up was 21.4±14.6 (mean±SDM) months, 64% of patients suffered from diabetes with a preoperative Hba1c of 8.5±2.4. The mean number of revisions per foot was 3.6±4.1. Bolt dislocation was seen in 57% of the patients following 11.3±8.5 months; in 75% of these patients bony healing occurred before dislocation. There was a significant association between preoperative increased Hba1c value, presence of preoperative ulcer and wound infection. Healing of arthrodesis was demonstrated in 57% and a permanent weight-bearing foot without recurrent ulcer was achieved in 79%. The early and late postoperative complications could be controlled in general. A fully load-bearing and stable foot was obtained, despite osseous consolidation was not detected in all of these cases. Once a stable foot has established early removal of fusion bolt should be considered. To decrease the risk of infection Hba1c should be adjusted and ulcers should be treated before the operation.
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December 2016

Aging Changes of the Male Lips-A Lesser Evil Than in Females?

Ann Plast Surg 2017 Mar;78(3):334-337

From the Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany.

Background: Although aging changes of the female perioral region and aesthetic procedures for perioral rejuvenation are described in literature, specific data for the male population are lacking. This study aims to evaluate perioral aging process in the male population to compare quality and quantity of the observed changes to the female population.

Methods: Magnetic resonance imaging (MRI) scans of 22 male subjects, were recruited into 2 age groups: young (20-35 years) and old (65-80 years) and the following parameters were measured: length of visible upper lip, thickness of upper lip at the level of vermilion border, thickness of upper lip at the level of the mid lip, and cross-section area of upper lip. Cadaver transverse sections of the upper lip of 10 individuals in 2 age groups, young (<40 years, n = 5) and old (>80 years, n = 5) underwent histological analysis of the relevant anatomical structures.

Results: The MRI analyses does not show a statistically significant difference in upper lip lengths of old and young subjects (P = 0.213). Upper lip thickness decreases statistically significant (P < 0.001), the midline sagittal upper lip area does not show a significant change (P = 0.57). Histomorphometry shows a statistically significant decrease of cutis thickness, increase of subcutaneous fat, thinning of the orbicularis muscle, and a broadening of the orbicularis oris angle.

Conclusions: The aging changes of the perioral region in men and women are similar in regard to the general processes, yet the extent of the changes is less striking in the men.
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March 2017