察爾斯大夫 美麗殿堂 Dr. Charles Meridien Palace

Avoiding Malar Edema During Midface/Cheek Augmentation with Dermal Fillers（3）

The final injection (not shown) is at the medial portion of the zygomatic arch. At each site, the needle is walked along the periosteum, depositing small amounts of filler without withdrawing the needle to limit the number of puncture sites and their resultant ecchymosis and edema. HA-JU is injected with a 30-gauge, ½-inch needle. CaHA is injected with a 28-gauge, ¾-inch needle.

The material is molded to smoothness gently so as not to predispose the patient to ecchymoses. The purpose of Molding is to smooth and manipulate the filler into the area of volume deficiency. Attention is directed when molding not to overly flatten or disperse the filler, necessitating higher volume of filler as a result of loss of correction. Overzealous massage can result in filler moving more superficially through needle tracts, thus increasing the propensity for visible material and malar edema. The ultimate objective is a Smooth blending between the lower eyelid, nasolabial fold, and the cheek. All bleeding points are treated with immediate and sustained direct pressure. Postinjection ice packs and Head elevation are employed.

Midfacial volume restoration using fillers is performed Medially to Laterally, since Volumes should be most Limited Medially beneath the malar septum. Volumes need only be restricted by aesthetic goals when treating the malar eminence, lateral orbital rim, zygomatic arch, and submalar hollow. Facial volume restoration is performed correcting the Midface prior to the Lower face. Expansion of the midfacial soft tissue envelope will result in an Effacement of the nasolabial folds and a reduction of the filler volume required for their correction.

Figures 5 and ​and66 show three patients with malar edema who had been treated for volume enhancement using HA or CaHA, both injected through a transcutaneous approach using Fanning and Threading technique in the Suborbicularis plane. In Figure 5, a 39-year-old female received HA into her tear troughs and infraorbital rims. She was treated with 20 units of Vitrase (ISTA Pharmaceuticals, Inc.) to ameliorate her malar edema. In Figure 6, a 44-year-old woman received a total of 1.3mL of CaHA in her midface (0.65mL per side), with malar edema evident five weeks post-treatment (A), and a 40-year-old woman received a total of 2.6mL of CaHA (1.3mL per side), with malar edema evident at three weeks post-treatment (B).

Figure 5A and 5B

A 39-year-old woman received hydroxylapatite in her tear trough and infraorbital rim. Malar edema could be observed three weeks post injection (A). The patient was treated with 20 units of Vitrase, which led to resolution (B).

Figure 6A and 6B

A 44-year-old woman received a total of 1.3mL of calcium hydroxylapatite in her midface (0.65mL per side), with malar edema evident five weeks post-treatment (A). A 40-year-old woman received a total of 2.6 mL of calcium hydroxylapatite (1.3mL per side), ...

The author has performed more than 350 midfacial augmentations using this technique without any occurrence of malar edema or other significant adverse events, such as severe bruising, contour irregularities, visible material, or infraorbital nerve injury. The majority of patients were treated with a combination of CaHA and HA-JU. Average volume was one Half a syringe of each material Per side, i.e., 0.65mL of CaHA per side (in 1.3mL syringe) and 0.4mL of HA-JU per side. The HA-JU was injected in the area Beneath the Malar septum and the CaHA for Enhancement of the Malar eminence Lateral to the Lateral canthus. This approach was selected because of the ability to dissolve hyaluronic acid using hyaluronidase, if malar edema or other adverse event should occur. In addition, HA-JU has a significantly lower G' than CaHA, making it less likely to compress the lymphatics of the area bounded by the malar septum. The higher G', or Lifting force exerted by CaHA, the more successfully elevated the thicker cheek tissues of the Malar eminence, Lateral orbital rim, and Zygoma. Figure 7 is representative of

the results obtained in the use of HA in the treatment of tear trough and infraorbital hollow.

Figure 7

Correction of tear trough and infraorbital hollow using calcium hydroxylapatite.

Recently, the author has employed the HA Belotero Basic (Merz), approved in Europe and recently approved in the United States, placed subcutaneously, for correction of tear troughs and infraorbital hollows, without adverse events. No Tyndall effect or visible material was observed. This HA was again combined with CaHA treatment of the malar eminence and inframalar hollow as aesthetically necessary.

Conclusion

Facial volume restoration and contour enhancement using dermal fillers have become a valuable addition to the aesthetic surgeon's armamentarium. These techniques are relatively quick to perform, have little down time, and result in a high rate of patient satisfaction. Adverse events have been reported however, particularly when the area of the lower eyelid are injected. Although malar edema is a severe adverse event, its incidence can be reduced by proper patient selection, proper filler selection, limiting filler volume, and by placing filler material deep into the Malar septum at the immediate Preperiosteal level.

Acknowledgment

The author appreciates the editorial assistance of David J. Howell, PhD, RRT (San Francisco, California) in the development of this manuscript.

Footnotes

DISCLOSURE :

Dr. Funt has received consulting fees for his work with Merz Aesthetics and serves as one of the company's medical advisors. He is also part of the national speakers bureau of Allergan Corporation and receives honoraria for educational activities. Financial support for preparation of this manuscript was provided in part by Merz Aesthetics (San Mateo, California).

REFERENCES

1. Tzikas TL. A 52-month summary of results using calcium hydroxylapatite for facial soft tissue augmentation. Dermatol Surg. 2008;34:S9–315. [PubMed]

2. Graivier MH, Bass LS, Busso M, Jasin ME, Narins RS, Tzikas TL. Calcium hydroxylapatite (Radiesse) for correction of the mid- and lower face: consensus recommendations. Plast Reconstr Surg. 2007;120(Suppl):55S–66S. [PubMed]

3. Silvers SL, Eviatar JA, Echavez MI, Pappas AL. Prospective, open-label, 18-month trial of calcium hydroxylapatite (Radiesse) for facial soft-tissue augmentation in patients with human immunodeficiency virus-associated lipoatrophy: one-year durability. Plast Reconstr Surg. 2006;118(Suppl.):34s–45s. [PubMed]

4. Werschler WP. Treating the aging face: a multidisciplinary approach with calcium hydroxylapatite and other fillers, part 2. Cosmetic Dermatol. 2007;20(12):791–796.

5. Busso M, Karlsberg PL. Cheek augmentation and rejuvenation using injectable calcium hydroxylapatite (Radiesse®) Cosmetic Dermatol. 2006;19:583–588.

6. Pessa JE, Garza JR. The malar septum: the anatomic basis of malar mounds and malar edema. Aesthetic Surg J. 1997;17(1):11–17. [PubMed]

7. Pessa JE, Zadoo VP, Adrian EK, Woodwards R, Garza JR. Anatomy of “black eye”: A newly described fascial system of the lower eyelid. Clin Anat. 1998;11:157–161. [PubMed]

8. Busso M, Voigts R. An investigation of changes in physical properties of injectable calcium hydroxylapatite in a carrier gel when mixed with lidocaine and with lidocaine/ epinephrine. Dermatol Surg. 2008;34:S16–S24. [PubMed]

Avoiding Malar Edema During Midface/Cheek Augmentation with Dermal Fillers（2）

Fillers, alone or in conjunction with facial surgery, can restore facial harmony, balance, and beauty. Nevertheless, treatment of this area is not without its complications. Bruising, erythema, pain, Infection, Skin necrosis, Over- and Under- correction, and Infraorbital nerve injury resulting in numbness and dysesthesia have been reported, regardless of the filler type (hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid) used. Nodules, Lumps, visible material, and generalized and Malar edema may also occur. Malar edema is a particularly significant adverse event because it is disfiguring, poorly tolerated by patients, can persist for months, and responds minimally, if at all, to treatment.

Anatomic Basis for Malar Edema

Malar edema is an adverse event arising from filler injections of the central midface to correct the Infraorbital hollow and Tear trough. It occurred in two patients treated by the author after placing Calcium hydroxylapatite (CaHA, Radiesse®, Merz Aesthetics, San Mateo, California) in a retrograde linear threading and fanning technique from multiple access points. The edema was long lived—6 to 8 months—and only minimally responsive to massage, head elevation, taping, salt avoidance, methylprednisolone, and conservative intralesional steroid injections. Although these two cases involved CaHA, malar edema arising from injections with hyaluronic acid (HA) has also been seen in clinical practice.

The phenomenon of malar edema can be explained by an understanding of the anatomy of the lower eyelid. Pessa and Garza6,7 reported their findings after performing 18 fresh cadaver dissections. Using dye injections, histological evaluation, and gross anatomical dissection, they identified a Fascial structure of the lower eyelid and cheek that they called the Malar septum. It originates from the Orbital rim periosteum at the Arcus marginalis superiorly and inserts into the Cheek skin 2.5 to 3cm inferior to the Lateral canthus. It divides the Suborbicularis oculi fat (SOOF) into Superior and Inferior components. The Inferior component is confluent with the Cheek fat and the Superior component contributes to the Malar mounds. At the level of the inferior border of the orbicularis oculi, the malar septum fuses with the fibrous septa of the superficial cheek fat and dermis.

The authors stated that the Malar septum is a relatively impermeable barrier that allows tissue edema and hemoglobin to accumulate superior to its Cutaneous insertion, and thus defines the lower anatomical boundary of several clinical entities : Malar edema, Malar mounds, Festoons, and Periorbital ecchymosis. Its anatomy is consistent from person to person regardless of age.

Transcutaneous Preperiosteal Injection Using Limited Puncture Sites

The area bounded by the Lower eyelid margin superiorly, the Medial canthus medially, the Lateral canthus laterally, and the Submalar region inferiorly is the least forgiving and most prone to adverse events. Injected filler Superficial to the malar septum may serve to Augment the impermeable barrier of the Malar septum, further impeding lymphatic drainage resulting in fluid accumulation and prolonged edema. Fillers may also cause edema by Direct pressure on the lymphatics when Volumes are too large whether they are superficial or deep to the septum. In addition, the greater a filler's Elasticity or Elastic modulus (G')—lifting capacity—the more likely it is to compress the lymphatic flow, resulting in edema. Malar edema is likely related to the Volume of injectate, the filler's Physical characteristics, its Depth of injection, and the patient's Propensity toward the problem.

Any filler injected within the boundaries of the malar septum should be placed immediately onto Periosteum (Pre-periosteally). In addition to avoiding malar edema, placing Small boluses of filler directly on Bone has the additional advantage of avoiding lumps, nodules, and visible material. The result is more natural and aesthetically pleasing because it is an augmentation of the underlying skeletal structure, resulting in an expansion and elevation of the overlying soft tissue envelope. Since the material is placed in an Avascular space, there is less bruising and lower embolic potential. Preperiosteal small bolus technique can be accomplished using either an Intraoral or Transcutaneous approach. The author prefers a transcutaneous approach because it is less technically demanding, easier to teach, has less risk of infraorbital nerve injury and in theory has less risk of infection and biofilm creation. Another approach would be the use of a Nonparticulate, Monophasic, less refractive HA capable of being placed in the Subdermal plane without being visible or causing a Tyndall effect. This would allow correction of the tear trough and infraorbital hollow without compressing the deeper lymphatic structures.

Technique. A careful examination of the patient is made, being observant for any evidence of existing malar edema or malar bags. Inquiry about a history of cheek edema after excessive salt or alcohol intake or upon awakening is followed by a discussion to assure that the patient is in agreement with the treatment plan. In a patient who is unsure, a “Trial run”, wherein Lidocaine is injected to simulate her postinjection appearance, can be performed. Preinjection photographs are taken. Small volume, bilateral infraorbital nerve blocks are placed with 2% lidocaine no more than 0.2mL. The filler is mixed with 2% lidocaine with 1:100,000 epinephrine.8 A volume of 0.2mL of 2% Lidocaine with Epinephrine is sterilely mixed with a 1.5mL syringe of CaHA and 0.08mL of 2% Lidocaine with Epinephrine with a 0.8mL syringe of hyaluronic acid Juvederm Ultra (HA-JU, Allergan).

The first injection is placed Medial to the Infraorbital nerve, entering perpendicular to the skin approximately 1cm Beneath the Inferior orbital rim (Figure 2). The needle is then “walked” medially toward the medial canthus, depositing 0.05mL aliquots. Additional deposits are placed close to the orbital rim as well as laterally and inferiorly. The Nondominant index finger is used to establish the Inferior orbital rim location so as to prevent deposition of material into the orbital area. If the needle is in contact with the bone at the time of extrusion of filler, then the material will not be deposited into the infraorbital foramen or within the infraorbital nerve. The second injection is Lateral to the infraorbital nerve; the third is at the Malar eminence (Figures 3 and ​and44).

Figure 2

First injection is placed medial to the infraorbital nerve, entering perpendicular to the skin one cm beneath the inferior orbital rim. The needle is then “walked” medially toward the medial canthus, depositing 0.05 mL aliquots.

Figure 3

The second injection is lateral to the infraorbital nerve.

Figure 4

The third injection is at the malar eminence.

Avoiding Malar Edema During Midface/Cheek Augmentation with Dermal Fillers（1）

David K. Funt, MD

J Clin Aesthet Dermatol. 2011 December; 4(12): 32–36.

PMCID: PMC3244361

（http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3244361/）

Abstract

As dermal fillers have evolved, Volume restoration and Contour enhancement have become the objective of advanced injectors. The value of injections of dermal fillers into the midface is well documented in the literature. However, the Midface, particularly the Infraorbital hollow, is the facial area most prone to adverse events from filler treatment. Malar edema is a particularly significant and long-lasting untoward event that is frequently reported. This article reviews the anatomic basis for malar edema, relates it to filler injection technique, and presents the author's preferred method of injection to help ensure avoidance of this adverse event.

The introduction of more durable and robust dermal filler materials has expanded the indications for dermal fillers, especially for the face. There probably is no area of the face that has not been treated with injectable fillers. Clinicians are now approaching facial aesthetic improvement and rejuvenation in a more global fashion, rather than focusing exclusively on the correction of wrinkles and folds. In contrast to amelioration of isolated wrinkles and folds, volume restoration and contour enhancement have become the objectives of advanced injectors. The value of midfacial volume restoration and enhancement has been well documented in the literature.1–5 However, when treating this area, the injector can experience adverse events, including the significant and long-lasting complication of malar edema. This article presents the anatomic basis of malar edema and the author's preferred injection technique to prevent this untoward event.

Midfacial Volume Restoration

The malar fat pad is a discrete, Triangular shaped area of thickened Subcutaneous fat, Based at the Nasolabial fold with its Apex at the Malar eminence in the youthful face. It is attached to the overlying skin and is supported by Multiple fibrous septae that extend from the superficial musculoaponeurotic system (SMAS) and into the Dermis. Loss of skin elasticity and Weakening of these septae, as well as Volume loss within the Deep medial cheek fat,6 lead to a Downward and forward descent of the Skin and Malar fat pad until it bulges against the fixed nasolabial fold.

These sequelae of aging result in Deepening of the nasolabial folds, progressive Hollowing of the cheeks, and Loss of prominence of the malar eminences. The Lower eyelid lengthens, increasing visibility of the Orbicularis oculi muscle, coupled with the formation of Tear trough and a Crescent or “V”-shaped deformity along the maxilla and zygoma. There is Recession of the nasal alar cheek junction. Individual fat pockets become discernable as separate entities rather than the smooth transitions from convexities to concavities seen in youth (Figure 1). It is the author's view that no other facial injection site provides greater rejuvenation than the midface.

Figure 1

Volume loss in the aging face

達人醫美診所遭踢爆用密醫埋線、施打肉毒桿菌　羅霈穎呼：若代言會隨便放一張和別人的合照嗎？

記者黃子瑋／台北報導

▲知名達人診所涉找密醫，北檢搜索調查。（圖／東森新聞）

▲羅霈穎、吳宗憲曾為該醫美診所背書。（圖／中天、資料照）

不少名人加持的「達人連鎖醫美診所」日前遭檢舉雇用密醫，為患者埋線、施打肉毒桿菌，甚至進口未經核准的藥品器材。吳宗憲、羅霈穎等人，還幫忙拍攝影片，等於幫診所背書，羅看新聞才知自己肖像權被盜用，她表示：「當初是有一個經紀人介紹，要我去試試看。我若代言會隨便放一張和別人的合照嗎？」

檢方7日大規模搜索15家診所，傳喚負責人、假醫師。「本土天王」吳宗憲還曾幫診所拍攝影片，助理詹美慧表示「這是3、4年前的事，和這次事件應該無關。」不過，她表示吳宗憲當時的確有親身檢測，並未有任何狀況。

羅霈穎則是由某經紀人介紹，「說是朋友的公司，去試一下，對方也要求拍攝影片。」而今蠟燭兩頭燒的她，為許聖梅、James事件煩心，還突然被爆肖像遭濫用，她說：「第一，希望對方找出合約書，證明我們有簽約。第二，在我找律師前，盡快對外發表聲明，私下協調。」

名人代言達人醫美診所驚爆聘密醫進行埋穴！

2013/10/07 綜合報導　　　　　

地區：台北市報導     

　　愛漂亮要小心，台北市南京東路的達人醫美診所，擁有高知名度，還曾經找明星代言，但卻被檢舉，涉嫌聘僱密醫，來進行埋線穴道治療，連使用的醫療器材都未經核准，檢調兵分10路，大動作約談10多人。

　　標榜健康埋線瘦身，南京東路上的達人醫美診所，被檢舉涉嫌違法密醫，檢調兵分10路，搜了滿滿一箱，還有一顆顆藥物，跟不知名的產品，也疑似違法使用，全帶回進一步調查。

　　診所人員表情僵硬，顯然也嚇壞了，所有問題一概不回應。診所人員頭也不回，直接進了辦公室，仔細看，牆上雖然有合格證照，但檢舉人指證歷歷，說這間診所找密醫幫忙埋線，侵入性治療當然違法。

　　除了被搜，還有10幾個人被帶回偵訊，診所為了吸引愛漂亮的女生，還不定時找明星代言。現在爆出密醫事件，就算診所關燈，也蓋不住被檢調掀出來的真相。

知名醫美連鎖店「達人診所」涉無照看診密醫執行醫療業務被聲押　

糗！漏夜偵訊太累醫護快閃上錯車　使用來路不明的藥物

掛名創辦人林品如未到案 6人交保2聲押　

胡煥昌曾違法判緩刑密醫化名「羅文峰」重出江湖

2013/10/8 吳嘉莉報導

知名醫美連鎖店「達人診所」，涉嫌利用沒有經過衛生署核准的減重等器材替客戶診療，並雇請密醫執行醫療業務。

調查局展開搜索，並約談診所包括醫生及護士到案說明，經過漏夜偵訊後，全案依違反醫師法、及藥事法罪嫌，總共將六人交保，醫師胡煥昌及負責人孫偉中則被聲押！

凌晨一點鐘結束整晚的偵訊，診所遭到約談的醫生及護士，看到外頭守候的媒體，三步併作兩步奔跑離開地檢署，一時情急還上了媒體的車輛！

達人診所因為涉嫌雇用沒有執照的醫師看診，以及使用來路不明的藥物，從昨晚陸續傳喚相關人員到案，結束偵訊後，檢方以違反醫師及藥事法罪嫌，將六人以五到十萬元不等交保，密醫胡煥昌以及負責人孫偉中聲押，而掛名創辦人林品如人在國外，沒有到案！

根據了解，在台北分店看診的胡煥昌，之前就曾因違反「醫師法」判處緩刑，後來他化名為「羅文峰」，並向退休醫師借牌，在達人診所行醫！

除此之外，胡煥昌還私下透過管道從韓國進口藥品，再貼上自創品牌的標籤轉賣給診所，並在臉書上販賣，不法所得之多，也讓辦案員警直呼賺很大，現在不肖密醫及商人全部落網，也還給消費者一個公道。

法語：Balian d'Ibelin，義大利語：Baliano d'Ibelin，英語：Balian of Ibelin，中文：伊貝林的貝里昂

伊貝林的貝里昂（法語：Balian d'Ibelin，義大利語：Baliano d'Ibelin），為十二世紀耶路撒冷王國（拉丁語：Regnum Hierosolymitanum）十字軍（拉丁文：Cruciata）重要的貴族（an important French noble in the crusader Kingdom of Jerusalem in the 12th century）。

伊貝林的貝里昂是伊貝林的貝里昂之子（the youngest son of Barisan of Ibelin）、雨果及鮑德溫之兄弟（brother of Hugh and Baldwin）。由於父亦以貝里昂聞名，故有時亦被稱為小貝里昂（Balian the Younger〉。

別名：拉姆拉的貝里昂（Balian of Ramla）或那不勒斯的貝里昂（Balian of Nablus）。

1150年，貝里昂大哥雨果死後，伊貝林城由貝里昂的二哥鮑德溫繼承，鮑德溫欲保持原爵位拉姆拉領主，因此將伊貝林城轉讓予貝里昂。

1174年，貝里昂與鮑德溫支持的黎波里的雷蒙三世（Raymond III of Tripoli）取代普蘭西的米爾斯（Miles of Plancy）成為國王鮑德溫四世（Baldwin IV）之攝政王。

1177年，兄弟參與蒙吉薩戰役（Battle of Montgisard）。同年，貝里昂與阿馬里克一世（King Amalric I）之遺孀瑪利亞康尼娜（Maria Comnena）繼承那不勒斯之爵位。

1183年，貝里昂兄弟支持雷蒙反對當時的攝政王，西比爾（Sibylla）之夫、呂濟尼昂的呂西尼昂的蓋伊（Guy of Lusignan）。同年，貝里昂出席了鮑德溫五世（Baldwin V）的加冕典禮，當時鮑德溫四世猶在世，此一加冕是為了阻止蓋伊為王而舉行。

1185年，鮑德溫四世去世，當時年僅8歲的鮑德溫五世正式即位，卻在隔年就死亡。雷蒙欲立托倫的韓福瑞四世（Humphrey IV of Toron）為王，但拒絕支持蓋伊。貝里昂勉強宣誓效忠蓋伊，而其兄則因拒絕而被放逐至安條克（Antioch）。

貝里昂留在耶路撒冷王國，在1187年哈丁戰役（Battle of Hattin）中生還，與王后西比爾（Queen Sibylla）及牧首哈克略（Patriarch Heraclius）一同守禦耶路撒冷，並在同年10月與薩拉丁（Saladin）談判投降事宜。伊貝林、那不勒斯、拉姆拉及貝里昂的所有其它領地在哈丁戰役後，被薩拉丁佔領，貝里昂及家人逃至的黎波里。

蓋伊與蒙費拉的康拉德（Conrad de Montferrat）王權爭奪，貝里昂一開始支持蓋伊，其後與瑪利亞密謀，以康拉德與耶路撒冷的伊莎貝拉（Isabella of Jerusalem）的婚姻為條件，轉而支持康拉德。康拉德死後，伊莎貝拉嫁給香檳的亨利二世（Henry II of Champagne），貝里昂轉為亨利的顧問，並在1192年幫助英國的理查一世（Richard I of England）和薩拉丁協議停戰，終止第三次十字軍東征（Third Crusade）。伊貝林仍在薩拉丁的控制之下，理查將凱蒙特（Caymont）的統治權給予貝里昂做為補償。

1193年，貝里昂去世，其子伊貝林的約翰（John of Ibelin）成為貝魯特男爵（Lord of Beirut）及耶路撒冷的治安官。

山根整太高變怪？佩甄挨批整過頭

作者：張雅惠 | TVBS – 2013年10月9日

不少人為了愛美整形整上癮，藝人們則是為了保持光鮮亮麗的一面，也得定時進廠維修，但藝人佩甄的山根，就被網友說，實在高得很不自然，本來長得好好的，太高反而醜掉了，被批評，佩甄自己倒是把負面轉為正面能量，認為其實只要自己開心就好，網友的意見，她謝謝指教。

節目片段：「應該是滿大姐的，所以她有自己的梳化。」

聊當年當幕後工作人員的往事，佩甄提到的大牌藝人，讓人好奇，就連她的鼻子，也成為觀眾注意的焦點。節目片段：「可是她就是整個很火的，一直在瞪那個梳化，一直瞪一直瞪，然後吹完了之後，她就這樣，吹好了嗎，好了嗎，你說啊，好了嗎。」

看佩甄的山根快高到額頭，跟她9年前的臉相比，變得很不自然，甚至讓不少網友反應，本來長得好好的，太高反而醜掉了，真的好奇怪，就連佩甄自己都說。藝人佩甄：「導致於很多人發現，你好像山根變很凸，變希臘人這樣，或是看到我就說，欸，成龍喔，小S一看到我就是說，欸，那個，你動了山根喔。」

被批評整過頭，佩甄反而看很開，但就有整形醫生指出，這樣反而容易造成反效果。

整形醫師梁偉中：「有些人要求很高，那醫生就配合他們，那如果打得太高，或是打太多造成一些後遺症，其實在臨床上都是有可能會發生的。」

節目片段：「有從大三就開始，在很多不同節目當工讀生。」

就連同一集的藝人阿本，也被說，天啊，整形整得太明顯，看起來很詭異。

節目片段：「我就覺得，因為平常看電視，會覺得她好有氣質。」

有個做醫美老公的佩甄，因為太方便，一時過了頭，不過，她說。

藝人佩甄：「很多人覺得這樣太高，有些人覺得這樣比較漂亮，那你要聽誰的，所以我覺得自己心情開心最重要。」

網友的意見很重要，但自己跟枕邊人喜歡就好，也強調，整形千萬別過頭，最後弄得整張臉變形，得不償失。

Proof that Marilyn Monroe Did have a chin implant：X-rays and Medical notes that reveal late star's cosmetic surgery go up for auction

By Reuters Reporter

PUBLISHED: 18:52 GMT, 8 October 2013 | UPDATED: 15:56 GMT, 9 October 2013

Hollywood history: A physician's notes on Marilyn Monroe (left, in 1940s and right, in 1950s) and X-rays that indicate that she had cosmetic surgery will be on auction next month

Collector's item: The set of six X-rays -including this one that shows the actress's frontal facial bones - and a file of doctors' notes are expected to fetch between $15,000 and $30,000

Confirmation: A self-published memoir by Beverly Hills plastic surgeon Norman Leaf in 2010 claimed that Monroe underwent cosmetic surgery on her chin in 1950

Changing looks: 'Nobody thought [she had plastic surgery],' said Martin Nolan, executive director of Julien's Auctions, of the actress (pictured in 1949, pre-surgery). 'They thought she was such a natural beauty'

Evidence: Dr Michael Gurdin's notes were first drawn up in 1958 when the actress complained about a 'chin deformity' and the note listed her married name, Marilyn Miller (she was married to playwright Arthur Miller)

Make-over: Gurdin's notes refer to a 1950 cartilage implant in Monroe's chin, while Leaf states in his memoir that she underwent a slight rhinoplasty procedure on the tip of her nose

Nose job？A radiologist's notes included in the lot determined that there was no damage to Monroe's nose, but a recent evaluation of the X-rays found a minute fracture, the auction house said

Secret identity: Doctors used the name Joan Newman as Monroe's alias on the X-rays which list her height as five-foot-six (1.68 m) and her weight as 115lbs (52 kg)

Famous face: Monroe's (with Arthur Miller) biggest films, such as How to Marry a Millionaire and Some Like It Hot, were all shot after 1950, the year she underwent chin surgery

Movie history: The white wedding gown worn by Julie Andrews as Maria von Trapp in the Sound of Music is expected to sell at the auction for between $30,000 and $50,000

The white wedding gown worn by Julie Andrews as Maria von Trapp in the Sound of Music is expected to sell for between $30,000 and $50,000.

Very vintage: The dress has undergone some 'post-production alterations' after being used for other events by the studio but is nonetheless expected to be a hit at the auction

Iconic artifact: The Lone Ranger mask worn by Clayton Moore in the Forties and Fifties is predicted to rake in the highest bid, with an estimate of $60,000

Beam me up: Trekkies will be happy to hear that Captain Kirk's original 'avocado green' tunic and boots will also be put under the hammer, and could also rake in between $30,000 and $50,000

The set, which dates from 1950 to 1962, is expected to sell for between $15,000 and $30,000

A physician's notes on Marilyn Monroe that indicate that the Hollywood sex symbol had undergone cosmetic surgery will be up for sale next month along with a set of her X-rays, an auction house said on Tuesday.

The set of six X-rays and a file of doctors' notes that offer a partial medical history of the Gentlemen Prefer Blondes actress from 1950 to 1962, are expected to fetch between $15,000 and $30,000 at auction on November 9 and 10, said Julien's Auctions in Beverly Hills, California.

The notes written by Hollywood plastic surgeon Michael Gurdin appear to confirm speculation that Monroe, who epitomized glamour and set a standard of movie star beauty during the latter part of Hollywood's golden era, went under the knife for cosmetic reasons.

The seller, who is so far unnamed, received the items as a gift from Gurdin.

'Nobody really thought about Marilyn Monroe having plastic surgery. It was always speculation - did she or didn't she?' said Martin Nolan, executive director of Julien's Auctions.

'They thought she was such a natural beauty, they didn't want to believe.'

Gurdin's notes include references to a 1950 cartilage implant in Monroe's chin, which he observed to have slowly begun to dissolve.

Monroe's biggest films, such as 1953's How to Marry a Millionaire, 1955's The Seven Year Itch and 1959's Some Like It Hot, were all shot after 1950.

'Also at that time, going back to the 1950s, people didn't go for plastic surgery procedures,' Mr Nolan added. 'This is very, very new.'

The X-rays are dated June 7, 1962, after Monroe saw Gurdin following a late night fall and two months before the actress would die at age 36 from an overdose of barbiturates. The death was ruled a probable suicide.

Monroe would also be fired by studio 20th Century Fox from the unfinished film Something's Got to Give the following day for her constant absences.

The X-rays include Monroe's frontal facial bones, a composite right and left X-ray of the sides of her nasal bones and dental X-rays of the roof of her mouth.

Marilyn Monroe chin-implant x-ray up for auction

A set of three chest X-rays of Monroe from 1954 sold for $45,000 at a 2010 auction.

A self-published memoir by Beverly Hills plastic surgeon Norman Leaf in 2010 claimed that Monroe underwent cosmetic surgery on her chin in 1950, citing the same notes made by Gurdin, Leaf's medical partner.

Leaf also states in his memoir that Monroe underwent a slight rhinoplasty procedure on the tip of her nose.

A radiologist's notes included in the lot determined that there was no damage to Monroe's nose from the fall, but a recent evaluation of the X-rays found a minute fracture, the auction house said.

Doctors used the name Joan Newman as Monroe's alias on the X-rays which list her height as five-foot-six (1.68 m) and her weight as 115lbs (52 kg).

Gurdin's notes were first drawn up in 1958 when the actress complained about a 'chin deformity' and the note listed her married name, Marilyn Miller.

She was married to playwright Arthur Miller from 1956 to 1961.

The notes also indicate that Monroe suffered from neutropenia, a low level of a white blood cell type, in 1956 while in England and had an ectopic pregnancy in 1957.

These aren't the only pieces of Hollywood history going under the hammer at the Icons & Idols: Hollywood auction next month.

Mr Nolan notes that the dress has undergone some 'post-production alterations' after being used for other events by the studio.

But the stunning Dorothy Jacobs creation is nonetheless expected to be a hit at the auction.

Trekkies will be happy to hear that Captain Kirk's original 'avocado green' tunic and boots will also be put under the hammer.

The outfit, worn by William Shatner in his iconic role, could also rake in between $30,000 and $50,000.

Another iconic artifact from past cinema that will be put up for auction is the Lone Ranger mask, worn by Clayton Moore in the Forties and Fifties.

This is one of the items that is predicted to rake in the highest bid, with an estimate of $60,000.

Other items that will be included in the bidding are a dress worn by the Princess Diana in the Nineties, and a tracksuit worn by the late James Gandolfini in season five of the Sopranos.