Noninvasive Facial Rejuvenation. Part 2: Physician-Directed—Neuromodulators and Fillers

Abstract

A proper knowledge of noninvasive facial rejuvenation is integral to the practice of a cosmetic surgeon. Noninvasive facial rejuvenation can be divided into patient- versus physician-directed modalities. Patient-directed facial rejuvenation combines the use of facial products such as sunscreen, moisturizers, retinoids, α-hydroxy acids, and various antioxidants to both maintain youthful skin as well as rejuvenate damaged skin. Physicians may recommend and often prescribe certain products, but patients are in control with this type of facial rejuvenation. On the other hand, physician-directed facial rejuvenation entails modalities that require direct physician involvement, such as neuromodulators, filler injections, laser resurfacing, microdermabrasion, and chemical peels. With the successful integration of each of these modalities, a complete facial regimen can be established and patient satisfaction can be maximized. This article is the second in a three-part series describing noninvasive facial rejuvenation. Here the authors discuss neuromodulators and fillers in detail, focusing on indications for use, techniques, and common side effects.

Keywords

neuromodulators - fillers - noninvasive facial rejuvenation

• References

• 1 American Society of Plastic Surgeons. Plastic Surgery Statistics Report. 2015 Cosmetic Plastic Surgery Statistics. 2015. Available at: http://www.plasticsurgery.org/Documents/news-resources/statistics/2015-statistics/cosmetic-procedure-trends-2015.pdf . Accessed February 15, 2016
• 2 Carruthers A, Sadick N, Brandt F , et al. Evolution of facial aesthetic treatment over five or more years: a retrospective cross-sectional analysis of continuous onabotulinumtoxinA treatment. Dermatol Surg 2015; 41 (6) 693-701
• 3 Matarasso SL. Comparison of botulinum toxin types A and B: a bilateral and double-blind randomized evaluation in the treatment of canthal rhytides. Dermatol Surg 2003; 29 (1) 7-13 , discussion 13
• 4 Carruthers J, Carruthers A. Botulinum toxin A in the mid and lower face and neck. Dermatol Clin 2004; 22 (2) 151-158
• 5 Allen SB, Goldenberg NA. Pain difference associated with injection of abobotulinumtoxinA reconstituted with preserved saline and preservative-free saline: a prospective, randomized, side-by-side, double-blind study. Dermatol Surg 2012; 38 (6) 867-870
• 6 Sarifakioglu N, Sarifakioglu E. Evaluating effects of preservative-containing saline solution on pain perception during botulinum toxin type-a injections at different locations: a prospective, single-blinded, randomized controlled trial. Aesthetic Plast Surg 2005; 29 (2) 113-115
• 7 Kwiat DM, Bersani TA, Bersani A. Increased patient comfort utilizing botulinum toxin type a reconstituted with preserved versus nonpreserved saline. Ophthal Plast Reconstr Surg 2004; 20 (3) 186-189
• 8 van Laborde S, Dover JS, Moore M, Stewart B, Arndt KA, Alam M. Reduction in injection pain with botulinum toxin type B further diluted using saline with preservative: a double-blind, randomized controlled trial. J Am Acad Dermatol 2003; 48 (6) 875-877
• 9 Alam M, Dover JS, Arndt KA. Pain associated with injection of botulinum A exotoxin reconstituted using isotonic sodium chloride with and without preservative: a double-blind, randomized controlled trial. Arch Dermatol 2002; 138 (4) 510-514
• 10 Klein AW. Dilution and storage of botulinum toxin. Dermatol Surg 1998; 24 (11) 1179-1180
• 11 Hexsel DM, De Almeida AT, Rutowitsch M , et al. Multicenter, double-blind study of the efficacy of injections with botulinum toxin type A reconstituted up to six consecutive weeks before application. Dermatol Surg 2003; 29 (5) 523-529 , discussion 529
• 12 Alam M, Bolotin D, Carruthers J , et al. Consensus statement regarding storage and reuse of previously reconstituted neuromodulators. Dermatol Surg 2015; 41 (3) 321-326
• 13 Sundaram H, Signorini M, Liew S , et al; Global Aesthetics Consensus Group. Global aesthetics consensus: botulinum toxin type A-evidence-based review, emerging concepts, and consensus recommendations for aesthetic use, including updates on complications. Plast Reconstr Surg 2016; 137 (3) 518e-529e
• 14 Kane MAC. The long-term effects of Botox injections. The Aesthetic Meeting. Dallas, TX; 1998
• 15 Pickett A. Dysport: pharmacological properties and factors that influence toxin action. Toxicon 2009; 54 (5) 683-689
• 16 Kane M. Botulinum toxin. In: Thorne CHM, Gurtney GC, Chung K, et al, eds. Grabb and Smith's Plastic Surgery. 7th ed. Philadelphia, PA: Lippincott Williams & Williams; 2013
• 17 Broder KW, Cohen SR. An overview of permanent and semipermanent fillers. Plast Reconstr Surg 2006; 118 (3, Suppl): 7S-14S
• 18 Eppley BL, Dadvand B. Injectable soft-tissue fillers: clinical overview. Plast Reconstr Surg 2006; 118 (4) 98e-106e
• 19 Carruthers JDA, Glogau RG, Blitzer A ; Facial Aesthetics Consensus Group Faculty. Advances in facial rejuvenation: botulinum toxin type a, hyaluronic acid dermal fillers, and combination therapies—consensus recommendations. Plast Reconstr Surg 2008; 121 (5, Suppl): 5S-30S , quiz 31S–36S
• 20 Neuber GA. Fettransplantation. Chir Kongr Verhandl Deutsche Gesellschaft für Chirurgie 1893; 22: 66
• 21 Levy RM, Redbord KP, Hanke CW. Treatment of HIV lipoatrophy and lipoatrophy of aging with poly-L-lactic acid: a prospective 3-year follow-up study. J Am Acad Dermatol 2008; 59 (6) 923-933
• 22 Duracinsky M, Leclercq P, Armstrong AR, Dolivo M, Mouly F, Chassany O. A longitudinal evaluation of the impact of a polylactic acid injection therapy on health related quality of life amongst HIV patients treated with anti-retroviral agents under real conditions of use. BMC Infect Dis 2013; 13: 92
• 23 Lemperle G, Knapp TR, Sadick NS, Lemperle SM. ArteFill permanent injectable for soft tissue augmentation: I. Mechanism of action and injection techniques. Aesthetic Plast Surg 2010; 34 (3) 264-272
• 24 Nguyen AT, Ahmad J, Fagien S, Rohrich RJ. Cosmetic medicine: facial resurfacing and injectables. Plast Reconstr Surg 2012; 129 (1) 142e-153e
• 25 Woodward J, Khan T, Martin J. Facial filler complications. Facial Plast Surg Clin North Am 2015; 23 (4) 447-458
• 26 Rzany B, DeLorenzi C. Understanding, avoiding, and managing severe filler complications. Plast Reconstr Surg 2015; 136 (5, Suppl): 196S-203S