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Advances in Facial Rejuvenation: Botulinum Toxin Type A, Hyaluronic Acid Dermal Fillers, and Combination Therapies–-Consensus Recommendations

Carruthers, Jean D. A. M.D.; Glogau, Richard G. M.D.; Blitzer, Andrew M.D., D.D.S.; the Facial Aesthetics Consensus Group Faculty

Plastic & Reconstructive Surgery: May 2008 - Volume 121 - Issue 5 - pp 5S-30S
doi: 10.1097/PRS.0b013e31816de8d0
Cosmetic: Original Articles

Background: Facial aesthetics and rejuvenation are evolving rapidly due to changes in products, procedures, and patient demographics. Clinicians can benefit from ongoing guidance on products, tailoring treatments to individual patients, treating multiple facial areas, and using combinations of products and ways to optimize outcomes.

Methods: A multidisciplinary group of aesthetic treatment experts convened to review the properties and uses of botulinum toxin type A (BoNTA) and hyaluronic acid fillers and to update consensus recommendations for facial rejuvenation using these two types of products. The group considered paradigm shifts in facial aesthetics; optimal techniques for using BoNTA and hyaluronic acid fillers alone and in combination; the influence of patient sex, ethnicity, cultural ideals, and skin color on treatment; general techniques; patient education and counseling; and emerging trends and needs in facial rejuvenation.

Results: The group provided specific recommendations by facial area, focusing on relaxing musculature, restoring volume, and recontouring using BoNTA and hyaluronic acid fillers alone and in combination. For the upper face, BoNTA remains the cornerstone of treatment, with hyaluronic acid fillers used to augment results. These fillers are central to the midface because of the need to restore volume. BoNTA and hyaluronic acid in combination can improve outcomes in the lower face.

Conclusions: Optimal outcomes in facial aesthetics require in-depth knowledge of facial aging and anatomy, an appreciation that rejuvenation is a three-dimensional process involving muscle control, volume restoration, and recontouring, and thorough knowledge of properties and techniques specific to each product in the armamentarium.

Vancouver, Canada; San Francisco, Calif.; and New York, N.Y.

From the Department of Ophthalmology, University of British Columbia; Department of Dermatology, University of California, San Francisco; and Department of Otolaryngology–Head and Neck Surgery, Columbia University.

Received for publication November 5, 2007; accepted February 4, 2008.

The faculty of the Facial Aesthetics Consensus Group is listed in an Appendix at the end of this article.

Disclosures: The faculty’s financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this continuing medical education activity are listed in an Appendix at the end of this article.

Jean D. A. Carruthers, M.D., University of British Columbia, Suite 740-943 West Broadway, Vancouver, V5Z 4E1 British Columbia, Canada, drjean@carruthers.net

©2008American Society of Plastic Surgeons