An Innovative Treatment Using Calcium Hydroxyapatite for Non-Surgical Facial Rejuvenation: The Vectorial-Lift Technique.

BACKGROUND: The facial aging process entails alterations in the volume, shape, and texture of all skin layers over time. Calcium hydroxyapatite (CaHA) is a well-established safe skin filler with unique properties to resolve some skin alterations by stimulating neocollagenesis. The vectoral-lift (V-lift) technique targets the global repositioning of facial structures by addressing distinct anatomical injection planes. It includes deep facial augmentation with Radiesse PlusTM to retain ligament restructuring and superficial subcutaneous enhancement with diluted Radiesse DuoTM. Herein, we present cases that illustrate the use of this approach. METHODS: This pilot study enrolled 36 participants (33 women and three men; ages 37-68 years) in a Brazilian clinical setting, and all patients underwent a single treatment. Photographs were taken at rest, in frontal and oblique views, before injection, and 90 days after treatment. RESULTS: Treatment resulted in elevation of the upper and middle face, notable improvements in the infraorbital hollow, and adjustment of the mean facial volume. CONCLUSIONS: The V-lift technique is a three-dimensional pan-facial treatment that relies on ligament support and face vectoring to obtain a lifting effect and facial contour restoration. It encompasses deep facial augmentation involving the use of Radiesse PlusTM for restructuring and retaining ligaments and Radiesse DuoTM for superficial subcutaneous enhancement. This approach targets a global repositioning of the facial structures by addressing distinct anatomical injection planes. It achieves a repositioning of the overall facial anatomy without requiring a substantial volumetric expansion. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Decades of beauty: Achieving aesthetic goals throughout the lifespan.

BACKGROUND: Several elements, including age, influence judgments of beauty and attractiveness. Aging is affected by intrinsic factors (e.g., genetics, race/ethnicity, anatomical variations) and extrinsic factors (e.g., lifestyle, environment). AIMS: To provide a general overview of minimally invasive injectable procedures for facial beautification and rejuvenation to meet the aesthetic goals of patients across their lifespan, organized by decade. METHODS: This case study review describes aesthetic considerations of females in their third to sixth decade of life (i.e., 20-60 years of age or beyond). Each case study reports the treatments, specifically botulinum toxin type A and soft tissue fillers, used to address aesthetic concerns. RESULTS: Signs of aging, as well as aesthetic goals and motivations, vary by age groups, cultures, and races/ethnicities. However, there are overarching themes that are associated with each decade of life, such as changes in overall facial shape and specific facial regions, which can be used as a starting point for aesthetic treatment planning. Appropriate patient selection, thorough aesthetic evaluation, product knowledge, and injection technique, as well as good physician-patient communication, are essential for optimal treatment outcomes. CONCLUSIONS: Nonsurgical facial injectable treatments can successfully enhance and rejuvenate facial features across different age ranges. A comprehensive understanding of facial aging and the aesthetic considerations of patients by the decade contributes to optimal treatment planning and maintenance.

Enhanced patient retention after combination vs single modality treatment using hyaluronic acid filler and neuromodulator: A multicenter, retrospective review by The Flame Group.

BACKGROUND: It is believed that combination treatment with both neuromodulators (NM) and hyaluronic acid soft-tissue fillers (HA) results in superior aesthetic results and increased patient satisfaction compared to either treatment alone. AIMS: To determine whether combined treatment with NM and HA leads to greater patient retention than treatment with NM or HA alone. PATIENTS/METHODS: This is a large, multi-center, retrospective review of patient retention rates from 7 aesthetic practices across 5 continents, incorporating over 2600 patients. Patient retention is interpreted as a surrogate marker for overall patient satisfaction. Retention rates were compared at 1, 3, and 5 years for patients who received NM only, HA only, or combination treatment with both NM and HA. RESULTS: Combination therapy significantly increased the probability of retention for each time point (1, 3, and 5 years) compared with NM alone (P < .0001) and HA alone (P < .0001). CONCLUSION: This large multicenter, global retrospective review demonstrates that patients who received combined HA and NM were more likely to be retained in the same practice over many years than those who received either treatment alone.

Botulinum toxin complications in registered and off-label aesthetic indications.

Botulinum toxin A (BTXA) is one of the most popular nonsurgical cosmetic procedures worldwide. Overall, this procedure is associated with favorable complications profile. Nevertheless, any medical intervention carries inherent risks. This synopsis systematically reviews adverse effects of aesthetic BTXA for both approved and off-label indications. Based on published data, the approach for prevention and management is discussed.

Clinical validation of the temporal lifting technique using soft tissue fillers.

BACKGROUND: While the temporal lifting technique has gained increasing attention, there is a dearth of objective and reliable evidence of its effects. AIM: The objective of the present study is to analyze the ability of the temporal lifting technique to reduce the midfacial volume by soft tissue repositioning and to achieve an improved pan-facial appearance by targeting exclusively the subdermal plane of the posterior and superior temple with soft tissue fillers. METHODS: A total of 12 patients (1 male and 11 females) with a mean age of 36.75 ± 6.6 years and a mean body mass index of 23.04 ± 1.3 kg/m2 were included in this prospective clinical single-center interventional study. Injection-related outcome was evaluated utilizing 3D skin vector displacement and surface volume analyses and scoring based on five different evaluators. RESULTS: Three months after the treatment, the global esthetic improvement scale rating showed an improved outcome (3.08) when evaluated by the independent observers, very improved outcome when evaluated by the treating physician (4.33), and exceptional improvement when rated by the patient (4.83). Temporal volume improved by 0.36 (P < .001), lower cheek fullness by 0.47 (P < .001), and jawline contouring by 0.51 (P < .001). No major adverse events were reported during the 3-month observational period. CONCLUSION: Objective outcome measures have provided evidence that by augmenting the posterior superior temple the volume of the middle face can be reduced and the contour of the jawline can be accentuated; this is due to the underlying fascial anatomy and the resulting soft tissue re-position.

Consensus Recommendations for the Use of Hyperdiluted Calcium Hydroxyapatite (Radiesse) as a Face and Body Biostimulatory Agent.

BACKGROUND: Calcium hydroxyapatite (CaHA) is a well-established collagen stimulator. In recent years, it has been increasingly used in hyperdiluted form as a biostimulatory agent rather than a volumizing filler to improve skin quality and firmness in both facial and corporal areas. However, guidelines on the techniques required to achieve optimal results are still lacking. The objective of this study was to develop a consensus recommendation for the safe and effective use of hyperdiluted CaHA for face and body biostimulation. METHODS: A team of 10 experts with extensive experience in dermal fillers and biostimulatory treatments for facial and body rejuvenation convened for a live meeting. Consensus was defined as approval by 70%-89% of all participants, whereas agreement of ≥90% denoted strong consensus. RESULTS: For most items, the group achieved a majority consensus. Recommendations have been provided for the face, neck, décolletage, buttocks, thighs, arms, abdomen, knees, and elbows with detailed injection techniques, providing information on insertion points, dosages, and volumes for both needle and cannula injections as well as the number of treatment sessions and intervals. CONCLUSIONS: The expert consensus supports and provides guidance for the use of CaHA as a biostimulatory agent for face and body rejuvenation. However, further clinical studies are necessary to provide physicians with the best evidence for the best treatment practices.

Facial aesthetics: achieving the natural, relaxed look.

When patients undergoing nonsurgical facial rejuvenation procedures are asked to state their expectations in terms of outcomes, the achievement of a "natural, relaxed look" usually emerges as the paramount goal. The importance to clinicians of delivering on this patient desire is becoming increasingly clear. After all, patient satisfaction is the ultimate treatment goal. This article explores aspects of what defines the natural, relaxed look and what patients are seeking when they undergo nonsurgical facial rejuvenation procedures and is based on the clinical experience of the authors. The article also offers suggestions intended to help clinicians provide each patient with appropriate outcomes and satisfaction.

Diffusion characteristics of botulinum neurotoxin products and their clinical significance in cosmetic applications.

Over the past decade, growth in the number and types of aesthetic procedures performed using botulinum neurotoxin has increased, along with the number of these products. As more options, along with emerging counterfeit agents, become available to clinicians, differences among preparations need to be considered in order to ensure optimal outcomes for patients. Once injected into the muscle, botulinum neurotoxin distributes within that tissue to produce the desired local effects. Diffusion, or the distribution of product beyond the target muscle, can be of concern because of the potential for local and systemic effects that result in muscle weakening away from the desired site. Several factors influence diffusion, including preparation characteristics (e.g. molecular size and structure), dosing and injection technique, and muscles injected. In this article, we discuss the accumulating preclinical and clinical data that differentiate botulinum neurotoxin agents with respect to their diffusion characteristics.

Multicenter, double-blind study of the efficacy of injections with botulinum toxin type A reconstituted up to six consecutive weeks before application.

BACKGROUND: It is recommended that botulinum toxin be used immediately or within 2 weeks after its reconstitution because its efficacy might be compromised by prolonged storage. OBJECTIVES: To evaluate the efficacy of botulinum toxin type A (BTX-A) reconstituted over 6 consecutive weeks for the treatment of glabellar frown lines. METHODS: Four vials of BTX-A were reconstituted each of 7 days over a period of 6 weeks, totaling 28 vials, corresponding to seven reconstitution dates. During this period, the BTX-A was stored according to the manufacturer's instructions. On the day after the last reconstitution, all of the reconstituted vials were injected in patients from four dermatologic centers taking part in this study. A total of 88 patients were treated on the same day and were followed every 2 weeks for 4 months. All patients were photographed at all stages. A number of professionals assessed the efficacy of reconstituted BTX-A based on the reduction of the maximum frowning capacity of the treated muscles. RESULTS: Of the 88 patients who were selected, 3 were excluded. Three forms of evaluation were applied, and no statistically significant differences were found in the results presented. CONCLUSION: BTX-A may be applied up to 6 weeks after reconstitution without losing its effectiveness. Other factors, which are probably individual, may influence the response to BTX-A injections.