| FACIAL REJUVENATION | PEER-REVIEW Botulinum toxin and dermal fillers can also be
combined with particular types of lasers or light sources in order to produce non-ablative or fractional skin rejuvenation, vascular alterations, and adequate skin tightening, as well as improve pigmented lesions, wrinkles, and acne scars. The concept is to treat the wrinkles and folds, and also improve the photodamage related to the ageing process and skin laxity. Facial plastic surgery procedures, such as
cervicofacial rhytidectomy or blepharoplasty, are the most common procedures used in combination with fillers and botulinum toxin. Whether the optimal moment for injecting botulinum toxin is before or after the surgery remains a subject of debate. A potential advantage of its use prior to surgical intervention is the stabilisation of cutaneous or even myocutaneous tissues. This, in turn, would facilitate their adequate accommodation, decreasing tension in the incision, suture, flaps and traction areas, thus improving the quality of the scarring process 8
. The literature indicates that rejuvenation of the
mid-face is a rapidly evolving field attracting broad interdisciplinary interest. Success in mid-facial rejuvenation depends on eliciting patient concerns, arriving at an accurate diagnosis, and executing a treatment plan accordingly. Emphasis should be placed on long-lasting results. As with rejuvenation elsewhere in the face, a combination of tissue suspension and
Injectable
facial fillers offer an excellent option in the treatment of facial ageing, wrinkling, and contour defects.
References
1. Fedok FG. Advances in minimally invasive facial rejuvenation. Curr Opin Otolaryngol Head Neck Surg 2008, 16(4): 359–68
2. Carruthers A, Carruthers J, Monheit GD, Davis PG, Tardie G. Multicenter, randomized, parallel-group study of the safety and effectiveness of onabotulinum toxin A and hyaluronic acid dermal fillers (24-mg/ml Smooth, Cohesive Gel) alone and in combination for lower facial rejuvenation. Dermatol Surg 2010; 36: 2121–34
3. Nocini PF, Luigi Chiarini L, Bertossi D. Cosmetic procedures in orthognathic surgery. J Oral Maxillofac Surg 2011; 69: 716–23
4. Botti G, Pelle Ceravolo M. Midface and neck aesthetic plastic
surgery. Parma: Acta Medica, 2012
5. Zenker S. Midfacial augmentation with a volume filler. PRIME 2012; 2 (7): 40–8
6. Raspaldo H. Volumizing effect of a new hyaluronic acid sub-dermal facial filler: a retrospective analysis based on 102 cases. J Cosmet Laser Ther 2008; 10(3): 134–42
7. Andre P. New trends in face rejuvenation by hyaluronic acid injections. J Cosmet Dermatol 2008; 7: 251–8
8. de Maio M. The minimal approach: an innovation in facial cosmetic procedures. Aesth Plast Surg 2004; 28: 295–300
9. Choucair RJ, Hamra ST. Nuances of the Composite Face-lift
Technique. Semin Plast Surg 2009; 23: 247–56
10. Wollina AGU. Facial rejuvenation for middle-aged women: a combined approach with minimally invasive procedures. Clin Interv Aging 2010; 23(5): 293–9
11. Downs BW, Wang TD. Current concepts in midfacial rejuvenation. Curr Opin Otolaryngol Head Neck Surg 2008; 16: 335–38
12. Bertossi D, Sbarbati A, Cerini R et al. Hyaluronic acid: in vitro and in vivo analysis, biochemical properties and histological and morphological evaluation of injected filler. Accepted for publication Eur J Dermatol 2013.
volume augmentation is often necessary in order to produce the most satisfied patients10–12
.
Declaration of interest None Figures 1, 2 © Dario Bertossi
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