> ## Content Index
> Fetch the complete content index at: https://www.theplasticsfella.com/llms.txt
> Use this file to discover other available public pages before exploring further.

# Designer Nipple Filler, 3 Facial Nerve Landmarks, & Tips for Clinical Examination.
- URL: https://www.theplasticsfella.com/february-23rd/
- Published: 2025-02-21T18:48:22.000Z
- Updated: 2025-02-22T18:53:10.000Z
- Description: Also: The Sunday quiz, nerve recon tip, & 3 recommended reads.
- Author: PlasticsFella
- Tags: thePlasticsPaper

#### In this week's edition

1. ****✍️** [****Letter from P'Fella**](https://www.theplasticsfella.com/february-23rd/#a-letter-from-pfella)  
Designer Nipples...
2. ****🤓** [****The Sunday Quiz**](https://www.theplasticsfella.com/february-23rd/#the-sunday-quiz)  
How well do you know **the facial nerve*?
3. [🖼️](https://emojipedia.org/framed-picture?ref=theplasticsfella.com) [****Image of the Week**](https://www.theplasticsfella.com/february-23rd/#image-of-the-week)  
Signs of facial nerve palsy.
4. ****🚑** [****Technique Tip**](https://www.theplasticsfella.com/february-23rd/#technique-tip)  
Sural nerve graft location for nerve recon.
5. 📖 [****What Does the Evidence Say**](https://www.theplasticsfella.com/february-23rd/#what-does-the-evidence-say)  
Facial nerve branch localization.
6. ****🔥** [****Articles of the Week**](https://www.theplasticsfella.com/february-23rd/#articles-of-the-week)  
Facial nerve danger zones, parotidectomy, & assessing the facial nerve: with 1 sentence summaries.
7. 💕 [****Feedback**](https://www.theplasticsfella.com/february-23rd/#feedback)  
Suggest ideas & give feedback!

## A Letter from P'Fella

**Designer Nipples....*

👋

****Hey Team!**  
  
Nothing is currently off limits—even our most unexpected features. We have evolved from cheek and lip fillers to a trend that now offers a quick shot of hyaluronic acid to enhance nipple appearance. Priced \~$5K and promising results from six months to two years, this development is a perky twist...

Before you raise an eyebrow, consider this: a 2017 Independent article already spotlighted “designer nipples” as a controversial trend, highlighting how the quest for perfection isn’t just about major features. Scientific [literature](https://pubmed.ncbi.nlm.nih.gov/32158901/?ref=theplasticsfella.com) has documented the evolution of nipple reconstruction and augmentation techniques. So, are we truly witnessing innovation, or is this just an old idea repackaged for today’s market?

**The Big Question**  
Here’s where it gets controversial: Is this a genuine step toward personal empowerment, or are we just enabling an industry that thrives on our insecurities? This isn’t about passing judgment on anyone’s body— the literature shows all genders have reported outcomes - it’s about the fine line between self-expression and a market-driven obsession with perfection.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/02/Screenshot-2025-02-22-at-18.51.15.png)

[Source](https://link.springer.com/article/10.1007/s00266-004-0145-y?ref=theplasticsfella.com)

  
**Downstream Effects**

I'm particularly interested in the second-order effects. Redesigning every detail creates ripple effects throughout our practice. For example, altering nipple anatomy may complicate breast screening and imaging, while changes in tissue contours and projections can obscure subtle signs on [mammograms or ultrasounds](https://academic.oup.com/jbi/article-abstract/6/2/223/7638511?redirectedFrom=fulltext&ref=theplasticsfella.com), potentially leading to diagnostic challenges later. Even minor cosmetic procedures can have significant consequences for patient care.

With love,  
P'Fella ❤️  

## The Sunday Quiz

**How Well Do You Know the* ***Facial Nerve?**

****Are you ready to make it to the leaderboard?**  
  
Welcome to the next round of The Weekly Quiz.  
  
Each edition of thePlasticsPaper includes a quiz question designed to challenge and engage our readers. Keep your wits about you and join in every week — the winner at the end of six rounds will earn you a one-year subscription to thePlasticsPro.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/02/image-9.png)

## Image of the Week

**Signs of Facial Nerve Palsy*

🖼️

****Image of the Week**   
  
In this section, we feature an anatomical illustration. This week’s image highlights left-sided lower motor neuron facial nerve palsy.  
  
****(A)** Generalized muscle weakness affecting the forehead, cheek, and mouth.  
****(B)** ****Positive Bell’s phenomenon** — upward eye movement when attempting to close the left eye.

![Left-sided lower motor neurone facial nerve palsy](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/02/image-7.png)

Left-sided lower motor neurone facial nerve palsy - [Source](https://entokey.com/facial-palsy/?ref=theplasticsfella.com)

## Technique Tip

**Sural Nerve Graft Location*

🚑

****Technique Tip of the Week**   
  
This week, we’re focusing on optimal sural nerve graft location for nerve reconstruction.  
  
****Landmarks:** Found beneath superficial fascia, adjacent to the saphenous vein.  
****Technique:** Incise over the posterolateral ankle, dissect carefully to expose the nerve.  
****Tip:** Preserve the saphenous vein to minimize trauma.  
  
Efficient dissection ensures a viable graft for reconstruction.

![Sural nerve graft location for nerve reconstruction](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/02/image-8.png)

Sural nerve graft location for nerve reconstruction - [Source](https://www.cns.org/nexus/spine/case/sural-nerve-harvesting?ref=theplasticsfella.com)

## What Does the Evidence Say?

**Facial Nerve Branch Localization*

In this section, we dive deep into the latest research and evidence on medical practices and surgical techniques. 

The **temporal branch** of the facial nerve (CN VII) is a critical structure in the frontotemporal region. It typically pierces the ****parotidomasseteric fascia** below the ****zygomatic arch**, travels in the ****subcutaneous tissue**, and then enters the ****subgaleal space** above the arch (Ammirati et al., 1993). The nerve's course is variable, with ****twigs** sometimes extending ****posterior** to the ****anterior quarter** of the ****temporalis muscle** (Ammirati et al., 1993).   
  
Several landmarks have been proposed to locate the nerve, including the ****frontal branch** of the ****superficial temporal artery** (Lei et al., 2005) and a point ****3.21 cm from the tragus** along the ****zygomatic arch** (Sanderson et al., 2020). The nerve is generally found within ****2.5-3 cm** of the ****lateral orbital rim** and ****2.85 cm superior** and ****2.54 cm lateral** to the ****lateral canthus** (Hashmi et al., 2021). Various surgical techniques have been developed to protect the nerve during procedures, including ****interfascial dissection** and combined ****frontotemporal scalp**/****superficial temporal fascia dissection** (Pekár et al., 2004).

## Articles of the Week

**3 Interesting Articles with 1 Sentence Summaries*

✅

****Facial Nerve Danger Zones: Anatomical Insights for Facelift Surgery** ([Stuzin](https://journals.lww.com/plasreconsurg/abstract/2020/01000/facial%5Fnerve%5Fdanger%5Fzones.21.aspx?ref=theplasticsfella.com), 2020)  
  
Understanding the three-dimensional anatomy and danger zones of the facial nerve is crucial for preventing iatrogenic injury during facial rejuvenation surgery.

✅

****How to Optimize Facial Nerve Outcomes in Parotidectomy** ([Brenner](https://www.jprasurg.com/article/S1748-6815%2824%2900622-3/abstract?ref=theplasticsfella.com), 2025)  
  
Malignant parotid tumors often necessitate facial nerve sacrifice due to locoregional invasion, increasing the need for microsurgical reconstruction, nerve grafting, or reinnervation to optimize outcomes.

✅

****Facial Nerve Trauma: Assessing, Predicting, & Restoring Function After Injury** ([Brown](https://journals.lww.com/plasreconsurg/abstract/2019/05000/facial%5Fnerve%5Ftrauma%5F%5Fclinical%5Fevaluation%5Fand.41.aspx?ref=theplasticsfella.com), 2019)  
  
Facial nerve palsy management depends on duration, location, and mechanism of injury. Early cases may allow direct repair, grafting, or nerve transfer, while prolonged palsy requires free functional muscle transfer for reanimation.

## Feedback

### I hope you enjoyed it 😄

---