Technical Considerations for Filler and Neuromodulator Refinements

Neuromodulator Injection for Gummy Smile

SUMMARY

Neuromodulators have become a treatment of choice for the management of excess gingival show, or "gummy smile." There have been many proposed algorithms for the optimal placement and dosage of neuromodulator to inject in these locations. The authors aim to clarify these points and provide surgeons with a reliable way to manage the gummy smile that results from hyperactive muscles of the midface.

Pan-Asian Consensus on Calcium Hydroxyapatite for Skin Biostimulation, Contouring, and Combination Treatments

BACKGROUND

Several usage guidelines for calcium hydroxylapatite (CaHA), a dermal filler material, exist for non-Asian patients, making it necessary to determine whether their findings and consensuses are applicable to Asian patients who have distinct anatomies, cultural preferences, and aesthetic requests.

OBJECTIVE

We sought to develop a Pan-Asian consensus on CaHA use in skin biostimulation, contouring, and combination treatments for face and body indications.

METHODS

A survey on CaHA usage for contouring and biostimulation indications in Asian patients was conducted, followed by discussions to establish consensus statements and topics for examination.

RESULTS

Several aspects of facial shaping and contouring or skin biostimulation with CaHA were agreed on, including that dilution is not a key consideration, that microfocused ultrasound with visualisation precedes CaHA in same day or session treatments, and that cannulas should be used. Among the many agreements on interventions in specific facial and body areas, there were also disagreements due to the diverse Asian patient presentations, requests, and access to tools or products; for example, CaHA should be placed in the interfascial layer for temple contouring, CaHA should not be injected directly into the infraorbital area for safety, and diluted CaHA should be injected subdermally for nonfacial or whole-face biostimulation and contouring.

CONCLUSION

Our disagreements highlight the diversity of Asian facial morphotypes and desired aesthetic outcomes and underscore the need for customized aesthetic strategies to accommodate the heterogeneity of Asian anatomies, cultural preferences, and aesthetic ideals. Establishing consensus statements on critical aspects of Asian patient considerations, efficacy and safety, is crucial. This document provides strategic guidance on the use of classic, diluted CaHA for biostimulation or undiluted Radiesse^®(+) (Merz Pharma GmbH & Co. KGaA, Frankfurt, Germany) for lifting and contouring to ensure consistent CaHA delivery for successful patient outcomes.

Advanced Techniques for the Use of Neurotoxins in Non-Surgical Facial Rejuvenation

BACKGROUND

Neurotoxins initially were used to treat hyperfunctional rhytids of the face, but now have been expanded to improve facial shaping, correct facial asymmetry and even improve skin texture and tone.

METHODS

The clinical approach to non-surgical facial rejuvenation is approached into four anatomical regions: the upper face, midface, lower face and neck.

RESULTS

The key muscles of the upper face include frontalis, orbicularis oculi, corrugator supercilii, procerus, depressor supercilii and temporalis. The muscles in the midface to be discussed include the levator labii superioris, levator labii superioris alaeque nasi, depressor anguli oris, depressor septi nasi and nasalis. Treatment of the lower face focuses on the orbicularis oris, mentalis, depressor anguli oris and masseter muscles. Finally, treatment of the neck region will be reviewed with emphasis on platysmal bands and necklace lines as well as the Nefertiti lift.

CONCLUSIONS

Non-surgical facial rejuvenation using neurotoxins should be performed safely and effectively in order to avoid and treat complications.

LEVEL OF EVIDENCE V

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