| COMBINATIONAL AESTHETIC APPROACHES | PEER-REVIEW
convincing results. Thread lifting and injection lipolysis also represent promising minimally invasive procedures, although additional study data and optimisation of protocols and material/agents may be needed before giving final recommendations. Particularly with the latter procedures, recommendations on potential useful combinations and chronical orders are mostly based on individual indications, personal experience, patient desires, and costs. The author tends to begin with BoNTA procedures relatively early and — after a certain age — combines these with non- or ablative fractional procedures (depending on quality of the skin surface) for skin tightening and further improvement of fine wrinkles. After improvements of skin texture, the author administers filling materials (depending on skin quality, preference of patients; however, HA is most frequently used) and usually starts restoring the malar contour first, followed by the orbital-malar groove and — if needed — nasolabial and marionette folds. In cases of excess fatty tissue or significant skin laxity in the lower face, injection lipolysis or thread lifting may be employed if patients do not want surgical procedures.
Conclusion Improved understanding of the complex anatomic alterations of the ageing face has shifted the focus from treating individual wrinkles to a rather holistic paradigm. A combination of the here described options tailored to the individual needs of patients will help create natural- appearing results and, therefore, a high level of patient satisfaction. With all the options available to date, a detailed facial
analysis and documentation is necessary. In depth discussion of available alternatives, their indications, safety aspects, costs, and duration of results prior to any therapy are warranted to maximize patient satisfaction and minimize side-effect profile. In depth understanding of the complex anatomy of the human face is mandatory
Key points Anti-ageing treatment
to date frequently asks for a multidimensional approach in order to target the complex age-related alterations in facial skin, musculature, fatty tissues, and bone
A combination of
different approaches may optimize and maximize aesthetic outcomes and patient satisfaction
With all the options
available to date, a detailed facial analysis and in depth discussion of available alternatives, their indications, as well as safety aspects is necessary
Solid knowledge of
anatomy, techniques, materials, and associated indications are crucial
A ‘less is more’
approach and scheduled touch-up sessions may prevent most adverse events and will help maximize patient satisfaction
not only for treatment with fillers and BoNTA but also for other approaches such as thread lifting and injection lipolysis. Only careful patient selection and counselling will lead to expected outcomes and will prevent side-effects such as skin dimpling, temporary numbness, and extruded or visible cones such as those observed after thread lifting. These complications depend more on technique and less on products. While combination of the herein described options tailored to the individual needs of the patient will often lead to more natural- appearing results it should not be underestimated that some combinations may increase the risk of additional unpredictable side-effects. Potential interaction between certain filling materials
or lasers, which have not yet been studied in detail, should lead to careful handling. Even though signed informed consent of the patient may protect the responsible clinician legally, side–effects, even transient and mild ones, represent time lost from work and will decrease patient trust if not clearly communicated beforehand. From the author’s experience, solid knowledge of
anatomy, techniques, materials, and associated indications are crucial. Furthermore, careful explanation of side effects and expected outcomes prior to the procedure, as well as a ‘less is more’ approach and scheduled touch-up sessions will prevent most adverse events and will help maximize patient satisfaction.
Declaration of interest None Figures 1–5 © Gerd G. Gauglitz
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