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A Comprehensive Approach to Multimodal Facial Aesthetic Treatment: Injection Techniques and Treatment Characteristics From the HARMONY Study

Narurkar, Vic A. MD; Cohen, Joel L. MD; Dayan, Steven MD; Kaminer, Michael S. MD; Rivkin, Alexander MD; Shamban, Ava MD; Sykes, Jonathan M. MD; Teller, Craig F. MD, FAAD; Weinkle, Susan H. MD; Werschler, W. Philip MD; Drinkwater, Adrienne PhD; Pucci, Michael L. PhD; Gallagher, Conor J. PhD

Erratum

In the article that appeared on page S188 in the May 2016 Special Issue of Dermatologic Surgery , each instance of HYC-20L and HYC-20L+ should have read HYC-24L and HYC-24L+, respectively.

Dermatologic Surgery. 42(11):1311, November 2016.

doi: 10.1097/DSS.0000000000000743
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BACKGROUND The HARMONY study is the first clinical trial to assess the impact of a global approach to facial rejuvenation with several minimally invasive modalities, using patient-reported outcome measures.

OBJECTIVE Provide details of this treatment approach and describe investigators' experiences and recommendations based on this study.

METHODS This multicenter, 4-month study evaluated subject satisfaction with and psychological impact of combined treatment with VYC-20L (Juvéderm Voluma XC), HYC-24L (Juvéderm Ultra XC), HYC-24L+ (Juvéderm Ultra Plus XC), onabotulinumtoxinA (Botox), and bimatoprost 0.3% ophthalmic solution (Latisse). Treatment-naive adults with moderate-to-severe facial lines and folds and eyelash hypotrichosis received on-label, staged treatment with fillers. Bimatoprost was self-administered once daily for 17 weeks from day 1. OnabotulinumtoxinA was administered for glabellar lines, crow's feet lines, or both at month 3.

RESULTS Overall, 100 subjects received bimatoprost for eyelash hypotrichosis, 96 received onabotulinumtoxinA for glabellar lines and/or crow's feet lines, and 96 received VYC-20L for midface volume deficit. From 17 to 96 subjects received HYC-24L and/or HYC-24L+ for nasolabial folds, oral commissures, marionette lines, perioral lines, or radial cheek lines. Injections of filler generally progressed from cranial to caudal, with midface injected first. Investigator-reported factors that may have contributed to the potential benefits of this approach include the critical role of the midface in facial aesthetics, use of lower volumes of filler in individual facial areas, and anesthetic effects.

CONCLUSION The investigators' perspectives and experience with the injection pattern, sequencing, volumes, and techniques may provide valuable guidance for a multimodal approach to facial aesthetic treatment.

*Bay Area Laser Institute, San Francisco, California;

AboutSkin Dermatology and DermSurgery, Englewood, Colorado;

DeNova Research, Chicago, Illinois;

§SkinCare Physicians, Chestnut Hill, Massachusetts;

Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California;

AVA MD, Santa Monica, California;

#UC Davis Medical Group, Sacramento, California;

**Bellaire Dermatology Associates, Bellaire, Texas;

††Private Practice, Bradenton, Florida;

‡‡University of Washington, School of Medicine, Seattle, Washington;

§§Peloton Advantage, Parsippany, New Jersey;

‖‖Allergan plc, Irvine, California

Address correspondence and reprint requests to: Vic A. Narurkar, MD, Bay Area Laser Institute, 2100 Webster Street, #505, San Francisco, CA 94115, or e-mail: vicnarurkar@yahoo.com

This study was funded by Allergan plc, Dublin, Ireland. Medical writing and editorial support were provided by M. L. Pucci, PhD, of Peloton Advantage, Parsippany, NJ, and was funded by Allergan plc, Dublin, Ireland. J. L. Cohen, A. Rivkin, and A. Shamban have served as a consultant and investigator for Allergan plc. S. Dayan has received research support, speaking fees, or consulting fees from Allergan plc. V. A. Narurkar serves as an investigator and consultant for Allergan plc. W. P. Werschler has served as a clinical investigator, consultant, and advisory board member for, and/or has received research support from, Allergan plc. M. S. Kaminer, J. M. Sykes, C. F. Teller, and S. H. Weinkle have no conflict of interests to disclose. C. J. Gallagher is an employee of Allergan plc, Irvine, CA. The opinions expressed in this article are those of the authors. The authors received no honorarium or other form of financial support related to the development of this article.

© 2016 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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