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PEER-REVIEW | COMBINATIONAL AESTHETIC APPROACHES | in facial skin, fatty tissues, musculature, and bone


has initiated a trend towards a global, 3-dimensional, multi-faceted approach involving muscle control, volume restoration, and recontouring for optimal facial rejuvenation. With the many options available, a detailed facial analysis


and


documentation, in depth discussions of the potential alternatives, their chronical order and indications, safety aspects, costs, and lasting of results prior to any therapy is warranted


to


maximise patient satisfaction. An increasing body


of literature provides assistance for specific techniques


and


anticipated outcomes. Recommendations in various areas by well-known experts advocate certain procedures for specific indications and discuss potential orders of treatments. For example, 60% of the faculty joining a recently published consensus paper on BoNTA, HA dermal fillers, and combination therapies4


by BoNTA treatment when a combination approach is indicated. The committee also agreed that the malar contour should be restored first, followed by the orbital-malar groove and the nasojugal fold, since the


References


1. Lewis CD, Perry JD. A paradigm shift: volume augmentation or ‘inflation’ to obtain optimal cosmetic results. Current opinion in ophthalmology. 2009;20:389- 394.


2. Dulguerov N, D’Souza A. Update on treatment rationale and options for the ageing face. Current opinion in otolaryngology & head and neck surgery. 2011;19:269-275.


3. Sadick NS, Manhas-Bhutani S, Krueger N. A novel approach to structural facial volume replacement. Aesthetic plastic surgery. 2013;37:266-276.


4. Carruthers JD, Glogau RG, Blitzer A. Advances in facial rejuvenation: botulinum toxin type a, hyaluronic acid dermal fillers, and combination therapies--consensus recommendations. Plastic and reconstructive surgery 2008; 121:5S-30S; quiz 31S-36S


5. Carruthers J, Carruthers A. Botulinum toxin type A treatment of multiple upper facial sites: patient-reported outcomes. Dermatologic surgery: official publication for American Society for Dermatologic Surgery 2007; 33: S10-17


6. Binder WJ. Long-term effects of botulinum toxin type A (Botox) on facial lines: a comparison in identical twins. Archives of facial plastic surgery 2006; 8(6):426-431


52 ❚


7. Vartanian AJ, Dayan SH. Complications of botulinum toxin A use in facial rejuvenation. Facial plastic surgery clinics of North America 2005; 13(1):1-10


8. Carruthers JA, Lowe NJ, Menter MA, et al. A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines. Journal of the American Academy of Dermatology 2002; 46(6): 840-849


9. Funt D, Pavicic T. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Clinical, cosmetic and investigational dermatology 2013; 6: 295-316


10. Pickett A. Serious issues relating to counterfeit dermal fillers available from Internet sources. Journal of the American Academy of Dermatology 2011; 65(3): 642-643


11. Olenius M. The first clinical study using a new biodegradable implant for the treatment of lips, wrinkles, and folds. Aesthetic plastic surgery 1998; 22(2): 97-101


12. Kulichova D, Borovaya A, Ruzicka T, Thomas P, Gauglitz GG. Understanding the safety and tolerability of facial filling therapeutics. Expert opinion on drug safety 2014; 13: 1215-1226


13. Tezel A, Fredrickson GH. The science of hyaluronic acid dermal fillers. Journal of


cosmetic and laser therapy : official publication of the European Society for Laser Dermatology 2008; 10: 35-42


14. Yutskovskaya Y, Kogan E, Leshunov E. A randomized, split-face, histomorphologic study comparing a volumetric calcium hydroxylapatite and a hyaluronic acid-based dermal filler. Journal of drugs in dermatology: JDD 2014; 13: 1047-1052


15. Greco TM, Antunes MB, Yellin SA. Injectable fillers for volume replacement in the aging face. Facial plastic surgery: FPS 2012; 28: 8-20


16. De Boulle K, Glogau R, Kono T, et al. A review of the metabolism of 1,4-butanediol diglycidyl ether-crosslinked hyaluronic acid dermal fillers. Dermatologic surgery : official publication for American Society for Dermatologic Surgery 2013; 39: 1758-1766


17. Bass LS, Smith S, Busso M, McClaren M. Calcium hydroxylapatite (Radiesse) for treatment of nasolabial folds: long-term safety and efficacy results. Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 2010; 30: 235-238


18. Berlin A, Cohen JL, Goldberg DJ. Calcium hydroxylapatite for facial rejuvenation. Seminars in cutaneous medicine and surgery 2006; 25: 132-137


19. Mest DR, Humble GM. Duration of correction for human immunodeficiency virus-associated lipoatrophy after


retreatment with injectable poly-L-lactic acid. Aesthetic plastic surgery 2009; 33: 654-656


20. Mazzuco R, Hexsel D. Poly-L-lactic acid for neck and chest rejuvenation. Dermatologic surgery : official publication for American Society for Dermatologic Surgery 2009; 35: 1228-1237


21. Haneke E. Polymethyl methacrylate microspheres in collagen. Seminars in cutaneous medicine and surgery 2004; 23: 227-232


22. Goldberg DJ. Breakthroughs in US dermal fillers for facial soft-tissue augmentation. Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology 2009; 11: 240-247


23. Carruthers A, Carruthers JD. Polymethylmethacrylate microspheres/ collagen as a tissue augmenting agent: personal experience over 5 years. Dermatologic surgery : official publication for American Society for Dermatologic Surgery 2005; 31: 1561-1564; discussion 1565


24. Coleman SR. Structural fat grafting: more than a permanent filler. Plastic and reconstructive surgery 2006; 118: 108S-120S


25. Glasgold M, Lam SM, Glasgold R. Autologous fat grafting for cosmetic


enhancement of the perioral region. Facial plastic surgery clinics of North America 2007; 15: 461-470, vi


26. Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plastic and reconstructive surgery 2007; 119: 2219-2227; discussion 2228-2231


27. Sadick N. Tissue tightening technologies: fact or fiction. Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 2008; 28: 180-188


28. Alam M, Dover JS, Arndt KA. To ablate or not: a proposal regarding nomenclature. Journal of the American Academy of Dermatology 2011; 64: 1170-1174


29. Trelles MA, Alvarez X, Martin-Vazquez MJ, et al. Assessment of the efficacy of nonablative long-pulsed 1064-nm Nd:YAG laser treatment of wrinkles compared at 2, 4, and 6 months. Facial plastic surgery: FPS 2005; 21: 145-153


30. Trelles MA, Allones I, Luna R. Facial rejuvenation with a nonablative 1320 nm Nd:YAG laser: a preliminary clinical and histologic evaluation. Dermatologic surgery: official publication for American Society for Dermatologic Surgery 2001; 27:1 11-116


31. Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for


lifting effect usually leads to a diminution of the nasolabial folds itself. Others suggest specific injection access points for optimal volume augmentation26


. Indeed, the scientific


and clinical evidence on BoNTA and fillers has very much improved over recent years while the wide field of technologies assuring improvement of skin surface, collagen loss, and skin tightening


remains


relatively unclear. Non-ablative


skin


tightening technologies offer the prospect of reduction of wrinkles and skin sagging with minimal downtime, discomfort, and risk of adverse events. The excellent safety profile is


frequently mitigated by the limited efficacy of such procedures.


Ablative CO2


modalities (chemical peels, and Er:YAG laser therapy)


have demonstrated superior efficacy in treating rhytides in the ageing face. However, due to the removal of the epidermis, prolonged erythema, infections, scarring, and permanent pigmentary changes may be faced. Here, fractional


use fillers first followed


Thread lifting and injection lipolysis represent promising minimally invasive procedures.


photothermolysis enables the delivery of dermal coagulative injury without confluent epidermal damage, thus decreasing the risks of scarring as well as decreasing the downtime associated with traditional ablative resurfacing while providing


March 2015 | prime-journal.com


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