RESUMEN
OBJECTIVE: A group of established aesthetic physicians sought to develop treatment guidelines for assessing Asian face morphologies that reflect accurate and current beauty standards across Asia. DESIGN: Physicians completed surveys, debated, and voted on their clinical strategies and developed an alternative simplified visual tool of assessment (SVAT) that discerns between country variations in genetic and ideal morphotypes. SETTING: Electronic and paper surveys were followed by consensus debates and voting. PARTICIPANTS: Established aesthetic physicians practicing regularly on Asian patients. MEAUSUREMENTS: A clinically applicable SVAT was developed, which considered facial index, mid-face projection, upper and lower face shape, submalar contour, nose length and dorsal height, eye shape and brow shape, proportion of lips-to-lower face and ratio of upper-to-lower lip, and chin shape. RESULTS: For facial shape change, physicians always assessed the horizontal thirds, facial symmetry, and lip-chin complex profile, and also analyzed overall face shapes and Ogee curves. Criteria for creating oval-shaped faces was also defined and included treating indications, such as loss of angularity and bilateral masseter muscle hypertrophy, narrow jawlines, and longer and wider foreheads. Critical differences and similarities in country-specific aesthetic preferences, treatment requests, and considerations or strategies were uncovered, including the inadequacy of assessing overall peripheral facial shapes. CONCLUSION: This consensus establishes the assessment and treatment criteria for achieving ideal shapes for Asian patients. Specific descriptors are affected by variations; therefore, we present the visual criteria for Asian facial morphotypes. We hope that physicians new to treating Asian patients can use this clinical information to improve their practice.
RESUMEN
With their high elasticity and viscosity, calcium hydroxylapatite (CaHA) fillers are now widely used to treat age-related or hereditary facial soft tissue volume deficits. CaHA filler volume augmentation is further enhanced by its ability to stimulate neocollagenesis and improve skin quality. However, its high viscosity and cohesivity may hinder its spread and distribution, while its injection by cannula or needle may require moderate extrusion force and lead to uneven distribution or focal accumulation in tissues. Thus, new or modified delivery techniques and tools have emerged, particularly from East Asian physicians. One such technique is hyperdilution with diluents such as lidocaine or normal saline. CaHA hyperdilution appears to be more frequently used by experienced injectors who have varying methodologies. Here, we demonstrate the precise delivery of diluted filler to treat indications related to hereditary volume deficits, volume loss, or aging in the periorbital, nasolabial and submalar regions, marionette lines, and hollowed mid-facial areas. Regardless of age or indication, dilution eases filler delivery for the injector, while using lidocaine as the diluent decreases patient discomfort and minimizes pain. Increasing injection diluent volumes reduces filler thickness (viscosity) and facilitates its even spread, encouraging skin stimulation through more direct contact with tissues and minimizing unevenness. Our results effectively demonstrate that hyperdilution is an innovative and positive evolution in CaHA filler delivery.
