I. Imaging Findings

In the frontal and lateral facial X-ray views, multiple slender, high-density needle-like shadows are observed, primarily located in the subcutaneous or muscular layers near both cheeks and the temporomandibular joint areas. There is no apparent sign of bone destruction or fracture, and no obvious soft tissue swelling or abnormal mass is detected. These slender metallic shadows vary in orientation, some showing slight curvature, characterized by their thin and regular shapes.

II. Potential Diagnoses

1. Subcutaneous or muscular foreign bodies (implanted foreign materials in the face): Given the high density and needle- or filament-like appearance, it is necessary to consider whether there are iatrogenic or external metallic implants, such as cosmetic or therapeutic wires, or other plastic surgical materials.
2. Residual permanent metallic needles from acupuncture or embedded needle therapy: Based on the patient's treatment history, especially a background of acupuncture or embedded needles, and the imaging findings of slender metal wires distributed in the subcutaneous tissue, this possibility is high.
3. Other causes of facial metallic foreign bodies: Such as metal fragments retained after trauma or jewelry embedding. However, traumatic fragments often display irregular shapes and distribution, and patients generally have a history of trauma, making this possibility relatively lower.

III. Final Diagnosis

Considering the patient’s history of permanent subcutaneous gold needle implantation treatment for depression, and based on the imaging findings of multiple distributed and relatively regular wire-like metallic shadows, the most likely diagnosis is:

Slender metallic acupuncture needles remaining in the facial soft tissues following permanent acupuncture (embedded needle) therapy.

IV. Treatment Plan and Rehabilitation

Currently, the imaging does not show any evidence of localized infection, tissue damage, or complications caused by the needles. If the patient experiences no local discomfort, infection, or allergic reactions, no specific intervention is necessarily required. However, if any of the following situations occur, prompt medical consultation or further management may be needed:

• Local pain, swelling, subcutaneous induration, skin discoloration, or ulceration.
• Suspected metal allergy reactions in the patient.
• Needle displacement causing compression of tissues or nerves.

For depression treatment, continue collaborating with psychiatrists or psychotherapists to adopt a comprehensive therapy approach (medication, counseling, physical therapy, etc.).

Rehabilitation/Exercise Prescription Recommendations

• General Principle: Moderate exercise is beneficial for both mental and physical health, with a gradual and individualized approach.
• Types of Exercise: Options may include walking, light jogging, swimming, yoga, or tai chi, which feature gentle, low-impact movements.
• FITT-VP Principle:
  • Frequency (F): 3-5 times per week, according to personal schedule.
  • Intensity (I): Moderate intensity (slight sweating, mildly increased heart rate but not severe shortness of breath).
  • Time (T): 20-45 minutes each time, gradually extended depending on tolerance.
  • Type (T): Alternate aerobic exercises with relaxation-focused training, avoiding a single type of exercise.
  • Volume (V) & Progression (P): Gradually increase exercise duration or frequency based on physical adaptation, avoiding sudden excessive increases.
• Notes: If the patient has other physical conditions such as osteoporosis or poor cardiopulmonary function, basic examinations should be completed first, or exercise should be performed under professional medical guidance to ensure safety.

V. Disclaimer

This report is based on the available imaging data and the patient's provided medical history. It serves as a reference opinion and cannot replace an in-person consultation or the guidance of a professional physician. If any questions arise or symptoms worsen, please seek medical attention and follow the advice of a specialist promptly.