| beST prAcTIce | ArTIcLe regardless of cultural ideals and ethnic differences,
the ideal in facial aesthetics tends to be characterised by symmetry, smooth convexities (e.g. an ogee curve to the cheek), and a larger facial dimension in the upper face relative to the lower face, providing aesthetically appealing angularity7 shape8
. The inverted triangle, or heart , typifies the younger face and is, in general,
considered more aesthetically pleasing than the reverse3,4
(Figure 2). Inherent in this view is the concept of
evaluating the entire face to maintain overall harmony and balance. Fundamental to successful facial rejuvenation and
volume restoration is an in-depth knowledge and understanding of facial musculature and its innervation, soft tissue anatomy (e.g. fat distribution), associated vasculature, and physiology of these structures and systems, as well as knowledge of the dynamic and volumetric changes that occur in ageing. Such knowledge is an absolute prerequisite to the use of products such as Juvéderm VOLUMA and other volumising and dermal filler agents. A comprehensive aesthetic evaluation of the entire face, grounded in anatomy and physiology, allows the development of a facial rejuvenation plan that can help patients obtain a natural, balanced, harmonious, and, therefore, satisfactory outcome9
.
The Juvéderm family of hyaluronic acids Hyaluronic acid is an attractive, highly suitable option for soft tissue augmentation because it occurs naturally in all species, can bind large volumes of water, and is viscoelastic10
. The main limitation of native hyaluronic
acid — its short half-life in tissue resulting from enzymatic degradation — can be overcome by crosslinking to create a product of longer duration10, 11
. As a result of
manufacturing differences, existing hyaluronic acids vary in the amount and type of crosslinking, amount of free or soluble hyaluronic acid, total concentration, and formulation consistency and hardness that they exhibit11
.
consequently, commercially available hyaluronic acids also differ in their clinical performance properties. The Juvéderm family of hyaluronic acid is
distinguished from other products in a number of ways. Importantly, the Juvéderm products are homogenised during the manufacturing process using Hylacross technology, which results in smooth, cohesive gels. In comparison, others such as the restylane® (Q-Med, Uppsala, Sweden) family of products, are sized into average particle sizes by a sieving process that results in a more granular formulation with a tendency to be slurry-like in consistency11, 12
. The differences in
cohesiveness were apparent in an in vitro comparison between Juvéderm VOLUMA and restylane SubQ, a 1000 gel particle/mL formulation. The flow of liquid from the more slurry-like product is evident and is in contrast to the cohesive nature of Juvéderm VOLUMA. This difference may underlie clinical consequences such as the migration and mobility of implanted material observed with restylane SubQ, but not with Juvéderm VOLUMA.
properties13
Formulations also vary considerably in their rheologic . The Juvéderm products extrude evenly and
permit clinicians to inject gradually and gently with a steady flow12
. This is in contrast with restylane products,
which may require a higher injection pressure to initiate the flow followed by modulation of the pressure12
.
consequently, an irregular flow may create subdermal irregularities when restylane products are injected. All of the products in the Juvéderm family provide
predictable, highly satisfactory aesthetic outcomes. Within the Juvéderm family, products differ in a number of their properties (Table 1), providing clinicians with an array of options for meeting the diverse needs and goals of patients. For example, Juvéderm ULTrA 2 (Juvéderm ULTrA in the US) is often the best choice for lip
The use of
botulinum toxin type A in aesthetic medicine has helped spur the growth of minimally- invasive procedures in facial aesthetics.
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