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Rejuvenation of the Upper Face and Periocular Region: Combining Neuromodulator, Facial Filler, Laser, Light, and Energy-Based Therapies for Optimal Results

Langelier, Nicole MD; Beleznay, Katie MD; Woodward, Julie MD

doi: 10.1097/DSS.0000000000000740
Original Article

BACKGROUND The upper face and periocular region is a complex and dynamic part of the face. Successful rejuvenation requires a combination of minimally invasive modalities to fill dents and hollows, resurface rhytides, improve pigmentation, and smooth the mimetic muscles of the face without masking facial expression.

METHODS Using review of the literature and clinical experience, the authors discuss our strategy for combining botulinum toxin, facial filler, ablative laser, intense pulsed light, microfocused ultrasound, and microneedle fractional radiofrequency to treat aesthetic problems of the upper face including brow ptosis, temple volume loss, A-frame deformity of the superior sulcus, and superficial and deep rhytides.

RESULTS With attention to safety recommendations, injectable, light, laser, and energy-based treatments can be safely combined in experienced hands to provide enhanced outcomes in the rejuvenation of the upper face.

CONCLUSION Providing multiple treatments in 1 session improves patient satisfaction by producing greater improvements in a shorter amount of time and with less overall downtime than would be necessary with multiple office visits.

*Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina;

Department of Dermatology & Skin Science, University of British Columbia, Vancouver, British Columbia, Canada;

Departments of Ophthalmology, and

§Dermatology, Duke University Medical Center, Durham, North Carolina

Address correspondence and reprint requests to: Nicole Langelier, MD, Department of Ophthalmology, Duke University Medical Center, 3475 Erwin Road, Durham, NC 27710, or e-mail:

J. Woodward is a consultant for all companies mentioned within this article, but did not receive any funding from any company related to this work. The remaining authors have indicated no significant interest with commercial supporters.

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