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Díaz-Aguayo I, Urdiales-Gálvez F, Benítez PA, Carvajal-Larrate A, Farollch-Prats L, Hospido A, Mira M, Uva L, Zuluaga L. Aesthetic management of lips and perioral region with Hylacross® and Vycross® hyaluronic-acid based fillers: A document of recommendations. J Cosmet Dermatol 2024; 23:2843-2856. [PMID: 38751134 DOI: 10.1111/jocd.16358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/20/2024] [Accepted: 04/22/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Lip volumization and perioral rejuvenation with hyaluronic-acid (HA) based dermal fillers are generating increasing interest and demand. However, this topic is still having many unmet needs nowadays. This document aimed to provide tips and recommendations that may help clinicians to achieve optimal and more predictable aesthetic outcomes. METHODS A multidisciplinary group of aesthetic medicine doctors from Spain and Portugal reviewed the tools used for assessing the patient and aesthetic outcomes, as well as the different techniques and products used in lips/perioral rejuvenation. RESULTS The consensus panel provided specific recommendations focusing on the basic information to collect before performing the aesthetic procedure; comprehensive approach to lips/perioral region rejuvenation; clinical and aesthetic assessment tools; product and technique selection; patient profile and needs; and safety issues (complications/adverse-events). CONCLUSIONS The rapid evolution of techniques and tools for assessing the patient and aesthetic outcomes, as well as the development of new HA-based fillers makes it necessary to update the clinical recommendations that guide the daily practice of clinicians, particularly those who have less experience with these procedures. This document addressed relevant subjects related to lip/perioral-region rejuvenation to perform the correct procedure, with the appropriate HA-based, on the right patient; to help specialists to obtain optimal and predictable aesthetic outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Mar Mira
- Clínica Mira + Cueto, Madrid, Spain
| | - Luís Uva
- Clinica Personal Derma, Lisbon, Portugal
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Massidda E, Ciampa S, Iozzo I, Emanuele E, Minoretti P. Real-World Outcomes of Lip Augmentation Using a Hyaluronic Acid-Based Filler With Low 1,4-Butanediol Diglycidyl Ether Content: A Prospective, Open-Label, Multicenter, Post-marketing Study. Cureus 2024; 16:e53513. [PMID: 38439998 PMCID: PMC10911686 DOI: 10.7759/cureus.53513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Background 1,4-butanediol diglycidyl ether (BDDE) is the most common cross-linker used to produce hyaluronic acid (HA)-based dermal fillers. However, BDDE may have cytotoxic and potentially mutagenic effects, raising safety concerns. Consequently, manufacturers are developing new HA filler formulations with reduced BDDE levels to mitigate potential biological risks. Here, we sought to evaluate the clinical outcomes of lip augmentation performed using an HA-based filler with a reduced BDDE content (Agex Fill Volume®; Biodue SpA, Barberino Tavarnelle, Italy) in a real-world clinical setting. Methods This was a prospective, open-label, multicenter, post-marketing study conducted over six months. Thirty adult subjects (29 women and one man) who desired a ≥1-point improvement on the validated Lip Fullness Scale 2 (LFS2) were enrolled. The primary efficacy endpoint was the post-procedural increase in the investigator-reported LFS2 compared to baseline. Other endpoints included self-perceived happiness assessed using the Happiness Measure Scale (HMS) and safety. Results Of the study participants, 73% (22/30) demonstrated an improvement of at least one point in their LFS2 scores immediately after treatment compared to baseline, thus qualifying as responders. Six months later, the responder rate, based on LFS2 scores, remained steady at 66.7% (20/30). Importantly, these aesthetic improvements were consistently associated with a positive impact on subject-reported HMS, with a significant difference (p < 0.001) between post-treatment and baseline scores. All adverse events (AEs) reported after treatment were mild. Conclusions Agex Fill Volume®, a HA filler with low BDDE content, provides a safe and effective option for enhancing lip volume in real-world aesthetic settings.
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Affiliation(s)
- Enrico Massidda
- Dermatology, Italian Society of Aesthetic Medicine, Cagliari, ITA
| | - Sonia Ciampa
- Dermatology, Poliambulatorio Rimedical, Santarcangelo di Romagna, ITA
| | - Ivano Iozzo
- Dermatology, Iozzo Antonucci Medical Center, Bologna, ITA
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Michon A, Hassan H. Is More Better? Benefits of Hyaluronic Acid Soft Tissue Filler on the Psychological- and Social-Related Quality of Life Dimensions. Aesthet Surg J Open Forum 2022; 4:ojac086. [PMID: 36540630 PMCID: PMC9757680 DOI: 10.1093/asjof/ojac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Hyaluronic acid (HA) soft tissue fillers are popular for volumizing, sculpting, or rejuvenating the face. Their effect beyond these cosmetic benefits remains poorly defined, especially the changes in the psychological and social dimensions of health following cosmetic HA filler injections. Objectives To determine whether injecting more facial aesthetic units with HA soft tissue filler will improve the health-related quality of life dimension of patients. Methods A prospective study was conducted to assess the psychological and social benefits of treating multiple facial aesthetic units with HA soft tissue filler using 3 validated FACE-Q scales at baseline and 4 weeks posttreatment between January and August 2022. Results Data for 28 participants (n = 26 females [93%]; mean age: 49.7 ± 10.1 years) are available and reveal significant improvements on the psychological (+24.5; P < .001) and social functioning (+18.5; P < .001) FACE-Q scales and a reduction in the appearance-related distress score (-17.8; P < .001) posttreatment compared to baseline. A mean volume of 4.7 mL (range 1.0-15.2 mL) was injected. However, patients who had >2 facial aesthetic units injected did not statistically score better on the FACE-Q scales. Conclusions Facial treatment with HA fillers was associated with a marked improvement in the health-related quality of life dimension. While understanding patients' aims and motivation, an individualized treatment approach is strongly encouraged instead of a "whole-face" approach. Level of Evidence 3
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Affiliation(s)
- Alain Michon
- Corresponding Author: Dr Alain Michon, 349 St. Laurent Blvd, Ottawa, Canada K1K 2Z7. E-mail:
| | - Haidar Hassan
- Clinical senior lecturer, Blizard Institute, Queen Mary University of London, London, UK
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Commentary on An Objective, Quantitative Assessment of Flexible Hyaluronic Acid Fillers in Lip and Perioral Enhancement. Dermatol Surg 2021; 47:643-644. [PMID: 33899791 DOI: 10.1097/dss.0000000000002966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dayan S, Fabi S, Nogueira A. Lay rater evaluation of naturalness and first impression following treatment of lower face wrinkles with hyaluronic acid fillers. J Cosmet Dermatol 2021; 20:1091-1097. [PMID: 33426781 DOI: 10.1111/jocd.13927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hyaluronic acid (HA) dermal fillers formulated with XpresHAn TechnologyTM were subjectively assessed by investigators and subjects. AIMS To test whether treatment with HA dermal fillers (HARR and HARD ) deemed natural by injectors and subjects are considered natural by the public and receive positive first impressions. METHODS Videos of open-smile expressions of subjects at baseline to Day 42 were assessed by "lay raters" (n = 3004) who indicated agreement with "Face looks natural" and first impressions using Likert-type scales. RESULTS Naturalness of facial appearance was noninferior at Day 42 compared with baseline. Assessments of first impression demonstrated statistically significant changes from baseline in overall first impression, social skills, dating success, attractiveness, and athletic success. Rater gender and age did not affect scores. Subgroup analysis found three groups had significant positive changes: those aged ≤ 55 years, subjects with natural outcome, and those that received more than 4 mL of filler. Subjects without a natural outcome had a significant negative change. CONCLUSIONS Treatment with HA facial fillers, HARR and HARD , produces outcomes deemed natural by injectors, subjects, and the public. While subjective, this study demonstrates that clinicians should aim for a "natural outcome" that receives optimal first impressions from the public.
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Affiliation(s)
- Steven Dayan
- University of Illinois, Chicago, IL, USA.,Denova Research, Chicago, IL, USA
| | - Sabrina Fabi
- Goldman, Butterwick, Groff, Fabi & Wu Cosmetic Laser Dermatology, San Diego, CA, USA.,University of California, San Diego, CA, USA
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Cristel RT, Dayan SH, Akinosun M, Russell PT. Evaluation of Selfies and Filtered Selfies and Effects on First Impressions. Aesthet Surg J 2021; 41:122-130. [PMID: 32003427 DOI: 10.1093/asj/sjz362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Selfies and filtered selfies are becoming more prevalent throughout society and in the facial plastic surgery clinic. The term "Snapchat dysmorphia" has been used to describe patients seeking procedures to look like their selfie or filtered selfie. This is particularly frequent in the Millennial population, aged 22 to 37 years. OBJECTIVES The authors sought to determine the effects on first impression from different photograph types: selfies, filtered selfies, a rear-facing smartphone camera, and a digital camera (DC). We hypothesize that the DC photographs will have the highest rated first impressions among evaluators despite the popularity of selfies and filtered selfies. METHODS This study included 240 evaluators and 4 patients each completing the 4 different photograph types. The evaluators completed a survey rating first impression on various measures of success for each photograph type. RESULTS A total of 960 first impressions were recorded for each of the 8 subscales, yielding 7680 individual assessments of first impression. The DC photograph was found to have the highest first impression scores among the 4 photograph types. There was no statistical difference between selfies and filtered selfies. The rear-facing smartphone camera received the lowest first impression scores. CONCLUSIONS Our findings indicate that the standard DC photograph taken during a preoperative consultation has higher first impressions than selfies or filtered selfies. Although "Snapchat dysmorphia" may continue to be a growing trend in the near future, our findings provide important information to discuss with patients in the preoperative visit to set realistic expectations.
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Affiliation(s)
- Robert T Cristel
- Department of Otolaryngology, Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Illinois at Chicago, Chicago, IL
| | - Steven H Dayan
- Department of Otolaryngology, Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Illinois at Chicago, Chicago, IL
| | - Moriyike Akinosun
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Parker T Russell
- School of Medicine, University of Missouri-Columbia, Columbia, MO
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Abstract
BACKGROUND Cosmetic procedures have demonstrated beneficial effects on physical appearance based on anatomic markers as well as patient-perceived self-image and quality of life. Recent studies of observer-reported outcomes (OROs) suggest an additional benefit from aesthetic interventions. OBJECTIVE The authors aimed to review the evidence of OROs from cosmetic procedures performed on the head and neck. PATIENTS, METHODS AND MATERIALS PubMed, Embase, and Cochrane Library databases were searched for relevant studies, yielding 24 included original investigations. RESULTS These studies captured 686 total patients, 8,257 observer evaluations, and a variety of interventions including face-lifts, blepharoplasty, rhinoplasty, and minimally invasive treatments including botulinum toxins and hyaluronic acid fillers. Forty-one distinct reported OROs were grouped into 12 descriptive domains. Domains were further grouped into 3 higher-order categories: aesthetics and wellness, social capacities, and skills and competencies. Improved perception after cosmetic intervention is most reproducibly demonstrated for the following ORO domains: age, attractiveness, sociability, relationship success, and occupational and financial competency. CONCLUSION The synthesized findings imply a tertiary layer of benefit for cosmetic intervention beyond anatomical and patient-centered outcomes through enhanced perceptions of others. These findings may inform the pre-procedure risk-benefit discussion with patients of cosmetic medicine and drive future research into longitudinal outcomes.
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Affiliation(s)
- Payal Shah
- Both authors are affiliated with The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
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Wollina U, Goldman A. Lip enhancement and mouth corner lift with fillers and botulinum toxin A. Dermatol Ther 2020; 33:e14231. [PMID: 32852076 DOI: 10.1111/dth.14231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
Beautiful lips are responsible for facial attractiveness and a youthful appearance. During aging process, lips become thinner and the red lips borders get poor defined. Downturn of the corners of the mouth suggests negative emotions. Lip surgery and underlying pathology may result in asymmetries and lip incontinence. Minor invasive procedures with hyaluronic acid fillers and botulinum toxin A are versatile tools to improve appearance of the lips, restore function and improve psycho-social well-being. In this review, we discuss anatomy, safety concerns, injections techniques as well as esthetic and medical indications.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | - Alberto Goldman
- Department of Plastic Surgery at Hospital São Lucas da PUCS, Porto Alegre, Brazil
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A New and Different Lip Augmentation Material Containing Cartilagenous Tissues Harvested From Rhinoplasty. J Craniofac Surg 2020; 32:e27-e28. [PMID: 32833835 DOI: 10.1097/scs.0000000000006841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Lips are an important unit of the lower face. In the literatures, not so many augmentation methods are seen except the fat graft, filler material, alloplastic prosthesis, fascia grafts. Each one has both advantages and disadvantages. The most valuable method for lip augmentation should be minimally invasive, low cost, and resistant to resorption. The authors are presenting different and novel graft material for lip augmentation. The method has some important advantages such as both long lasting result and no cost, and not any donor area morbidity.
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Pan B, Zhao R, Wu S, Lin H, Long Y, Hao G, Chen J, Nian F. A combined method of oral commissure lifting for perioral rejuvenation in Asians. J Plast Reconstr Aesthet Surg 2020; 73:2217-2224. [PMID: 32595087 DOI: 10.1016/j.bjps.2020.05.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/31/2020] [Accepted: 05/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND A drooping oral commissure shows an appearance of ageing and sadness. To improve it with less complications has become a rising aesthetic concern for Asians. OBJECTIVES To share our method for oral commissure lifting by a combined technique including skin resection, oral commissure suspension, and dissection of the depressor anguli oris muscle (DAO), and to present the follow-up outcomes. METHODS This was a retrospective study of patients who underwent oral commissure lifting between 10/2012 and 03/2019 at the Department of Plastic Surgery, Peking University Third Hospital. The patients were routinely followed at 1 week, 1 month, and over 6 months. After operation, cases with the cheilions (oral commissure points) located above the ipsilateral lateral thickening points were considered to be effective, with the points at the same level were considered to be mildly effective, and with the cheilions below the ipsilateral lateral thickening points were considered to be ineffective treatment. RESULTS Surgery took around an hour. Swelling subsided within 9.2±3.4 days. The red color of the scar disappeared within 3.7±1.5 months and the natural facial expression was restored within 7.9±2.6 weeks. Among the 159 cases, 125 (78.6%) were obviously effective, 21 (13.2%) were mildly effective, and 13 (8.2%) were ineffective. After the first operation, 112 patients (70.4%) were satisfied, 39 patients (24.5%) were basically satisfied, and eight patients (5.0%) were unsatisfied. CONCLUSIONS The combined technique for the oral commissure lifting displayed a significant effect with little complication in Asian patients.
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Affiliation(s)
- Bailin Pan
- Department of Plastic Surgery, Peking University Third Hospital.
| | - Runlei Zhao
- Department of Plastic Surgery, Peking University Third Hospital
| | - Siqiao Wu
- Department of Plastic Surgery, Peking University Third Hospital
| | - Hengju Lin
- Department of Plastic Surgery, Peking University Third Hospital
| | - Yan Long
- Department of Plastic Surgery, Guizhou Provincial People Hospital
| | - Guang Hao
- Department of Plastic Surgery, Peking University Third Hospital
| | - Jing Chen
- Department of Plastic Surgery, Peking University Third Hospital
| | - Fuhong Nian
- Department of Plastic Surgery, Peking University Third Hospital
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In Response to Dayan SH et al, “Assessment of the Impact of Perioral Rejuvenation With Hyaluronic Acid Filler on Projected First Impressions and Mood Perceptions”. Dermatol Surg 2020; 46:856. [DOI: 10.1097/dss.0000000000001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
An upturned mouth corner is associated with brightness, optimism, and friendliness, whereas a downturned mouth corner not only conveys negative feelings such as sadness, depression, and tiredness, but also makes a person appear years older than they are. Surgical approaches to the correction of a downturned mouth corner can result in predictable and long-lasting results. However, because of their fear of postsurgical scars and long downtimes, many patients are reluctant to undergo surgery involving the mouth corner. As a consequence, minimally invasive procedures have become increasingly popular in recent years. Among these, botulinum toxin type A and injectable fillers play a significant role. The author uses botulinum toxin type A and hyaluronic acid filler injections as complementary procedures for lifting flat or downturned mouth corners in young patients. This method has produced reliable and consistent outcomes without severe complications such as necrosis or infection in over 100 patients, as reflected in high patient satisfaction. The combination of botulinum toxin type A and hyaluronic acid filler provides excellent results in young patients who desire an uplifted mouth corner and are reluctant to undergo surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.
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Fusade T. Quoi de neuf en dermatologie interventionnelle ? Ann Dermatol Venereol 2019; 146:12S11-12S18. [DOI: 10.1016/s0151-9638(20)30101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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