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Hyaluronic Acid Microdroplet Injection for Skin Quality Enhancement

Summary and Key Features Skin quality encompasses visual, tactile, and mechanical attributes including hydration, smoothness, elasticity, and radiance of the skin. Healthy skin is an essential component of perceived beauty. Treatment of skin quality is an important yet often-overlooked aesthetic treatment. Hyaluronic acid microdroplet injection for skin quality is an effective, well-tolerated procedure with high patient satisfaction. Proper technique allows for predictable results without socially relevant…

Earlobe Rejuvenation

Summary and Key Features The earlobe is a site of adornment and a reflection of beauty across world cultures. With increasing interest in facial and neck rejuvenation, the earlobes have emerged as a site of cosmetic concern. Like other sun-exposed areas of skin, the earlobes may exhibit signs of age, including pigmentary and vascular changes, increased laxity, loss of volume, and elongation (ptosis). Volume loss of…

Soft Tissue Augmentation and Buttocks Contouring

Summary and Key Features A female body shape with a small waist and round buttocks is considered as the most attractive. Autologous fat grafting is the gold standard for volumizing the gluteal area. Collagen biostimulator injection into the gluteal area is indicated to correct postoperative irregularities, contour, cellulite, stretch marks, and sagging skin. Gluteal Aesthetics The buttocks are important in sexual attraction and in the concept…

Soft Tissue Augmentation of the Neck and Chest

Summary and Key Features Soft tissue fillers are increasingly being utilized for rejuvenation of the neck and décolletage to create a seamless transition from the rejuvenated face. Hyaluronic acid fillers are best used for improving the appearance of necklace lines on the neck. Biostimulatory fillers, such as hyperdilute CaHA and PLLA, improve fine lines and skin laxity of the neck and chest with minimal to no…

Soft Tissue Augmentation of the Hands

Summary and Key Features Aging of the hands is characterized by superficial changes as well as volume loss and prominence of underlying structures. Restoration of volume by means of autologous fat transfer or filler material has proven to be a safe and effective rejuvenation strategy. The most common fillers for the hands are calcium hydroxyapatite, hyaluronic acid, and autologous fat. Poly-L-lactic acid has fallen out of…

Soft Tissue Augmentation of Lip Lines

Summary and Key Features Intrinsic and extrinsic factors contribute to the appearance of aging skin. Vertical lip lines or perioral rhytides contribute to the aged appearance of the perioral area and are a significant cosmetic concern for patients. Women exhibit perioral lines much more frequently and more severely than men. Lines are caused by repeated contraction of the orbicularis oris muscle, along with loss of collagen…

Lip Augmentation

Summary and Key Features The lips are a defining feature of the face; enhancement of lip volume and structure through the use of fillers is a commonly requested cosmetic procedure. Ethnic variations and aesthetic preferences should be considered in the evaluation and treatment planning for lip augmentation. Hyaluronic acids are commonly used filler products for lip rejuvenation; their safety profile, coupled with their potential reversibility using…

Soft Tissue Augmentation of the Chin and Jawline

Summary and Key Features The use of injectable soft tissue fillers in the chin and jawline is becoming increasingly popular. A deep knowledge of the underlying anatomy and anatomic changes that occur with age is essential to improve outcomes and minimize risk when treating the lower face. Hyaluronic acid-, calcium hydroxyapatite-, and poly- l -lactic acid-based injectables can all be considered for chin and jawline augmentation.…

Filler Injection of the Melolabial Folds and Marionette Lines

Summary and Key Features Addressing the melolabial folds and marionette lines is a key issue in facial rejuvenation. Understanding the underlying anatomy of the perioral region, careful consideration of filler properties, and tailoring treatment to the patient's individual goals are key to achieving optimal outcomes. Discussion of the underlying factors that contribute to the development of melolabial folds and marionette lines. Expert recommendations for filler selection…

The Anatomical Basis for Safe Injection Rhinoplasty

Introduction Injection rhinoplasty is not a new concept. Beauticians and unlicensed practitioners have been injecting paraffin, silicone oil, cooking oil, and other permanent “filler” materials into the nose for decades, especially in Asia, where the desire to augment the nose is high. 1 This has led to a slew of foreign body complications that included abnormal swelling, migration, granulomas, infection, and even cavernous sinus thrombosis. In…

Midface

Summary and Key Features The midface is considered the region between the lower eyelid and the oral commissure. A full, wide, and naturally projected midface is related to youth and beauty. Similar to other facial areas, local aging encompasses bone, muscles, retaining ligaments, fat, and skin changes in a multifactorial process. Structure and contour evaluation of the different facial shapes can be an important tool used…

Infraorbital Hollow and Nasojugal Fold

Summary and Key Features The infraorbital hollow (IOH) refers clinically to the curvilinear depression below the eyes and comprises the tear trough, nasojugal fold, and palpebromalar groove. With thin skin overlying bone and little to no subcutaneous fat in this region, the IOH can be an unforgiving region and challenging to treat with injectable agents. Periocular filler injections yield better outcomes in patients with thicker, smoother…

Volumetric Treatment of the Brows

Summary and Key Features Orbits that are large, round, and hollow are associated with age, not youth. Young orbits are almond shaped, the bone is not visible, and there may be considerable fullness of the upper lid. The same configurations that are seen in younger patients may be perceived as looking old in older ones. Communication is difficult in the periorbital area. Many patients want the…

Three-Dimensional Reflation of the Glabella and Adjacent Forehead

Summary and Key Features Soft tissue fillers are employed to restore lost frontal volume and lift the brow. The forehead is a high-risk location for complications from soft tissue filler injection. A detailed knowledge of the underlying neurovascular anatomy is essential to effective and safe treatment. Informed consent must include discussion of the potential for both superficial and deep vascular occlusion and its management. Introduction The…

Soft Tissue Augmentation of the Temple

Summary and Key Features Lipoatrophy of the temporal region can result from the aging process, low body fat, certain genetic disorders, treatment with antiretroviral therapy, or physical trauma. Effective augmentation of the temporal region with soft tissue fillers can produce gratifying results for both the patient and the physician. Administration of hyaluronic acid fillers to augment the temple has gained significant popularity because of their ease…

Forehead Reflation

Summary and Key Features Rejuvenation of the upper face relies on toxins, but for some patients with etched-in lines, true correction requires replacement of volume in the forehead concavity and filling of lines at the superficial dermal level. Although multiple fillers are available to correct the upper third of the face, we recommend calcium hydroxylapatite for deep volumization and hyaluronic acid fillers for fine lines specifically.…

Bellafill

Summary and Key Features Bellafill is currently the only US Food and Drug Administration (FDA)-approved long-term filler indicated for the correction of the nasolabial folds and atrophic acne scars. Bellafill is composed of smooth, round, and uniform microspheres (30–50 μm in diameter) of nonresorbable polymethylmethacrylate (PMMA). The PMMA microspheres of Bellafill are suspended in a water-based bovine collagen gel with lidocaine Bovine collagen is enzymatically cleaved…

Liquid Injectable Silicone

Summary and Key Features Two forms of highly purified injectable liquid silicone (Silikon-1000 and Adatosil-5000) are US Food and Drug Administration (FDA) approved for intraocular tamponade of retinal detachment. Both products may be legally injected off-label for skin augmentation, according to the 1997 FDA Modernization Act. Industrial liquid silicone, including “medical-grade” industrial liquid silicone, may contain contaminants that cause granulomatous reactions. Industrial-grade liquid silicone should never…

Introduction to Permanent Fillers: Pros and Cons

Summary and Key Features Permanent fillers are materials composed of nonabsorbable or permanent materials. These agents can provide long-lasting results but carry more potential risk. Polymethylmethacrylate and liquid injectable silicone are the only currently available permanent fillers available in the United States. Nonbiodegradable fillers can achieve full and long-lasting correction but carry the risk of permanent adverse effects. Introduction In the past 15 years, there has…

Autologous Fat

Summary and Key Features Autologous fat is an ideal filler that provides patients with long-lasting revolumization. With proper patient assessment, planning, and treatment, facial augmentation provides a safe means to restore the youthful contours of the face. The use of autologous nanofat, microfat, and stromal vascular fraction in small grafts placed strategically throughout the soft tissue planes of the face stimulates ongoing regeneration of facial texture,…