| FACIAL AESTHETICS | ARTICLE References
1. Wulc AE, Sharma P, Czyz CN. The Anatomic Basis of Midfacial Aging. In: Hartstein ME, Wulc AE, Holck EE. eds, Midfacial Rejuvenation. New York: Springer Science+Business Media, LLC, 2012
2. Busso M. Vectoring Approach to Midfacial Recontouring Using Calcium Hydroxylapatite and Hyaluronic Acid. Cosmet Dermatol 2009: 22(10): 522–8
3. Benecke R. Clinical relevance of botulinum toxin immunogenicity. BioDrugs. 2012; 26(2): e1–9
4. Kukreja R, Chang TW, Cai S et al. Immunological characterization of the subunits of type A botulinum neurotoxin and different components of its associated proteins. Toxicon 2009; 53(6): 616–24
5. Frevert J. Content of botulinum neurotoxin in Botox®/Vistabel®, Dysport®/Azzalure®, and Xeomin®/Bocouture®. Drugs R D 2010; 10(2): 67–73
6. Taufig AZ, Szöke A, Kühnel W. A new strategy to detect intradermal reactions after injection of resorbable dermal fillers. J Ästhetische Chirurgie 2009; 2: 29–36
7. Hallén L, Dahlqvist A, Laurent C. Dextranomeres in hyaluronan (DiHA): a promising substance in treating vocal cord insufficiency. Laryngoscope 108(3): 393–7
8. Sundaram H, Voigts B, Beer K, Meland M. Comparison of the rheological properties of viscosity and elasticity in two categories of soft tissue fillers: calcium hydroxylapatite and hyaluronic acid. Dermatol Surg 2010; 36(Suppl 3): 1859–65
9. Zenker S. 3D Vectoring. Presented at IMCAS Paris and Shanghai, 2012
10. Rzany B, Carruthers A, Carruthers J et al. Validated composite assessment scales for the global face. Dermatol Surg 2012; 38(2 Spec No.): 294–308
Discussion TodayÕs non-invasive treatments for facial rejuvenation by dermal filler and BoNT A injections are a lot more than just filling and relaxing wrinkles. Customised relaxation of hyperactive mimic muscles and a three-dimensional multiplane volumetry strategy enable the physician to lift and smooth facial structures individually and in an aesthetically appealing way. The doctorÕs armamentarium for non-invasive
Key points
■ Non-invasive therapies such as dermal filler and BoNT A injections are moving away from single-fold- fixing, to a global restoration and three-dimensional reshaping of the facial structures
■ It is important to remember that it is about the injection techniques themselves: they are the key to a successful treatment with an appealing aesthetic outcome
■ In the field of relaxation with BoNT A, the individualised, customised approach marks the more common requests of patients
aesthetic enhancement by injections should include a profound knowledge of anatomy and the product features of the injected dermal fillers and BoNT A. One should acknowledge study results on BoNT A and dermal fillers, and be able to break this knowledge down for the individual needs and aesthetic demands of their patients. Only advancements to our injection techniques and skills will lead to a refined aesthetic results in our patients.
Conclusions The customised, individually adapted, conservative and intentionally low-dose treatment with BoNT A, as well as advanced dermal filler injection techniques with biodegradable dermal filler materials such as monophasic hyaluronic acid and calcium hydroxylapatite, enables us to globally reshape 3D facial structures in a safe, aesthetically appealing and natural way.
Declaration of interest None Figure images 1–8 ç Dr Sabine Zenker
Figure 8 Before (2005) (A) and after (2012) (B) total treatment
The doctorÕs armamentarium for non-invasive aesthetic
enhancement by injections should include a profound knowledge of anatomy and the product features of the injected dermal fillers and BoNT A.
prime-journal.com | September 2012 ❚
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