RESUMEN
Myomodulation (MyoMo) using hyaluronic acid (HA) fillers can be considered as a novel aesthetic treatment for gummy smile (GS). However, literature is still lacking information about this procedure. For this reason, the aim of the present case report was to describe a technique for MyoMo with HA as an efficient alternative for the management of GS. A 36-year-old male patient attended to our clinic complaining about excessive gingival exposure when smiling. After a clinical and digital assessment, poor bone support was observed in the premaxilla area, resulting in an increasing contraction of the levator labii superioris alaeque nasi and levator anguli oris. A multilayer approach with HA filling was performed in order to impair muscle movement and limit excessive lip elevation. As a result, a reduction on the elevation of the upper lip while smiling was achieved, and an improvement on GS was achieved. Thus, it can be proposed that Myomo with HA acid may be an effective treatment for GS, with lasting and satisfactory results. However, high-quality studies are required in order to compare patient's satisfaction with this treatment and any other possible alternative.
RESUMEN
Nonsurgical cosmetic treatments have significantly increased over the last decade. Therefore, this study aims to review the features that should be considered in orofacial esthetic procedures, thorough of a proposal of a new concept called the tissue mimicry concept (MIMT concept) and filling techniques. The MIMT concept described in this article comprises knowledge about anatomy of the face and associated structures, understanding of aging and how this process affects the facial tissues interactions (skin, subcutaneous tissues, muscles, and bones), interpretation of facial analysis, comprehension of dermal fillers characteristics and discernment of the correct filling technique for each region. Based on these variables the MIMT concept proposes the implantation of the minimum-effective quantity of acid hyaluronic fillers (HA) with different physical, chemical and rheological properties (complex viscosity and elastic modulus) in the correct layers; in order to optimize their performance resulting in a natural appearance with fewer risks of adverse events. the versatility, acceptable safety profile, biocompatibility and greater patient compliance presented in the Restylane® line (by Galderma) should be taken in consideration, since the use of a proper HA is noteworthiness. The Non-Animal Stabilized Hyaluronic Acid Tecnology (NASHA®) and the Optimal Balance Technology (OBT®), which make up this line of fillers, allow us to have very firm to very flexible gels, with different particle sizes, with an optimal concentration of HA and with viscoelastic and biocompatible characteristics according to the region of the treated face.
