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Aesthetic Plastic Surgery

, Volume 37, Issue 2, pp 266–276 | Cite as

A Novel Approach to Structural Facial Volume Replacement

  • Neil S. SadickEmail author
  • Suveena Manhas-Bhutani
  • Nils Krueger
Review Aesthetic

Abstract

Improved understanding of the anatomy and physiology of the aging face has laid the foundation for adopting an earlier and more comprehensive approach to facial rejuvenation, shifting the focus from individual wrinkle treatment and lift procedures to a holistic paradigm that considers the entire face and its structural framework. This article presents an overview of a comprehensive method to address facial aging. The key components to the reported strategy for improving facial cosmesis include, in addition to augmentation of volume loss, protection with sunscreens and antioxidants; promotion of epidermal cell turnover with techniques such as superficial chemical peels; microlaser peels and microdermabrasion; collagen stimulation and remodeling via light, ultrasound, or radiofrequency (RF)-based methods; and muscle control with botulinum toxin. For the treatment of wrinkles and for the augmentation of pan-facial dermal lipoatrophy, several types of fillers and volumizers including hyaluronic acid (HA), autologous fat, and calcium hydroxylapatite (CaHA) or injectable poly-l-lactic acid (PLLA) are available. A novel bimodal, trivector technique to restore structural facial volume loss that combines supraperiosteal depot injections of volume-depleted fat pads and dermal/subcutaneous injections for panfacial lipoatrophy with PLLA is presented. The combination of treatments with fillers; toxins; light-, sound-, and RF-based technologies; and surgical procedures may help to forestall the facial aging process and provide more natural results than are possible with any of these techniques alone.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords

Cosmetic techniques Face Poly-l-lactic acid Rejuvenation Skin aging 

Notes

Acknowledgments

Editorial support for this article was provided by Peloton Advantage, LLC, funded by Sanofi–Aventis U.S. LLC, a Sanofi company. The authors were fully responsible for the content, editorial decisions, and opinions expressed in the current article. No author received an honorarium related to the development of this manuscript.

Disclosure

Neil Sadick is involved in workshops and serves as an injector trainer for Sanofi–Aventis U.S. S. Manhas-Bhutani has no competing financial interests or pertinent disclosures or known conflicts of interest to declare. N. Krueger has no competing financial interests or pertinent disclosures or known conflicts of interest to declare.

References

  1. 1.
    Afaq F, Mukhtar H (2006) Botanical antioxidants in the prevention of photocarcinogenesis and photoaging. Exp Dermatol 15:678–684PubMedCrossRefGoogle Scholar
  2. 2.
    Alam M, Dover JS, Arndt KA (2011) To ablate or not: a proposal regarding nomenclature. J Am Acad Dermatol 64:1170–1174PubMedCrossRefGoogle Scholar
  3. 3.
    Alam M, White LE, Martin N, Witherspoon J, Yoo S, West DP (2010) Ultrasound tightening of facial and neck skin: a rater-blinded prospective cohort study. J Am Acad Dermatol 62:262–269PubMedCrossRefGoogle Scholar
  4. 4.
    Alexiades-Armenakas MR, Dover JS, Arndt KA (2008) The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing. J Am Acad Dermatol 58:719–737PubMedCrossRefGoogle Scholar
  5. 5.
    Atiyeh BS, Dibo SA (2009) Nonsurgical nonablative treatment of aging skin: radiofrequency technologies between aggressive marketing and evidence-based efficacy. Aesthetic Plast Surg 33:283–294PubMedCrossRefGoogle Scholar
  6. 6.
    Baumann L, Woolery-Lloyd H, Friedman A (2009) “Natural” ingredients in cosmetic dermatology. J Drugs Dermatol 8(6 Suppl):s5–s9PubMedGoogle Scholar
  7. 7.
    Binder WJ (2006) Long-term effects of botulinum toxin type A (Botox) on facial lines: a comparison in identical twins. Arch Facial Plast Surg 8:426–431PubMedCrossRefGoogle Scholar
  8. 8.
    Binder WJ (2011) Facial rejuvenation and volumization using implants. Facial Plast Surg 27:86–97PubMedCrossRefGoogle Scholar
  9. 9.
    Bodendorf MO, Grunewald S, Wetzig T, Simon JC, Paasch U (2009) Fractional laser skin therapy. J Dtsch Dermatol Ges 7:301–308PubMedGoogle Scholar
  10. 10.
    Bogdan Allemann I, Kaufman J (2010) Fractional photothermolysis: an update. Lasers Med Sci 25:137–144PubMedCrossRefGoogle Scholar
  11. 11.
    Bogle MA, Ubelhoer N, Weiss RA, Mayoral F, Kaminer MS (2007) Evaluation of the multiple pass, low fluence algorithm for radiofrequency tightening of the lower face. Lasers Surg Med 39:210–217PubMedCrossRefGoogle Scholar
  12. 12.
    Burke KE (2007) Interaction of vitamins C and E as better cosmeceuticals. Dermatol Ther 20:314–321PubMedCrossRefGoogle Scholar
  13. 13.
    Carruthers A, Carruthers JD (2005) Polymethylmethacrylate microspheres/collagen as a tissue augmenting agent: personal experience over 5 years. Dermatol Surg 31:1561–1564PubMedCrossRefGoogle Scholar
  14. 14.
    Carruthers JD, Glogau RG, Blitzer A (2008) Advances in facial rejuvenation: botulinum toxin type a, hyaluronic acid dermal fillers, and combination therapies—consensus recommendations. Plast Reconstr Surg 121(5 Suppl):5S–30SPubMedGoogle Scholar
  15. 15.
    Christian MM (2003) Microresurfacing using the variable-pulse erbium: YAG laser: a comparison of the 0.5- and 4-ms pulse durations. Dermatol Surg 29:605–611PubMedCrossRefGoogle Scholar
  16. 16.
    Coleman SR, Grover R (2006) The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J 26(1 Suppl):S4–S9PubMedCrossRefGoogle Scholar
  17. 17.
    Donofrio LM (2000) Fat distribution: a morphologic study of the aging face. Dermatol Surg 26:1107–1112PubMedCrossRefGoogle Scholar
  18. 18.
    Edsman K, Nord LI, Ohrlund A, Larkner H, Kenne AH (2012) Gel properties of hyaluronic acid dermal fillers. Dermatol Surg 38:1170–1179PubMedCrossRefGoogle Scholar
  19. 19.
    Fagien S (2003) Botulinum toxin type A for facial aesthetic enhancement: role in facial shaping. Plast Reconstr Surg 112:6S–18SPubMedCrossRefGoogle Scholar
  20. 20.
    Fisher GJ, Datta SC, Talwar HS, Wang ZQ, Varani J, Kang S, Voorhees JJ (1996) Molecular basis of sun-induced premature skin ageing and retinoid antagonism. Nature 379:335–339PubMedCrossRefGoogle Scholar
  21. 21.
    Fisher GJ, Varani J, Voorhees JJ (2008) Looking older: fibroblast collapse and therapeutic implications. Arch Dermatol 144:666–672PubMedCrossRefGoogle Scholar
  22. 22.
    Fisher GJ, Wang ZQ, Datta SC, Varani J, Kang S, Voorhees JJ (1997) Pathophysiology of premature skin aging induced by ultraviolet light. N Engl J Med 337:1419–1428PubMedCrossRefGoogle Scholar
  23. 23.
    Fitzgerald R, Graivier MH, Kane M, Lorenc ZP, Vleggaar D, Werschler WP, Kenkel JM (2010) Appropriate selection and application of nonsurgical facial rejuvenation agents and procedures: panel consensus recommendations. Aesthet Surg J 30(Suppl):36S–45SPubMedCrossRefGoogle Scholar
  24. 24.
    Fitzgerald R, Graivier MH, Kane M, Lorenc ZP, Vleggaar D, Werschler WP, Kenkel JM (2010) Nonsurgical modalities to treat the aging face. Aesthet Surg J 30(Suppl):31S–35SPubMedCrossRefGoogle Scholar
  25. 25.
    Fitzgerald R, Graivier MH, Kane M, Lorenc ZP, Vleggaar D, Werschler WP, Kenkel JM (2010) Update on facial aging. Aesthet Surg J 30(Suppl):11S–24SPubMedCrossRefGoogle Scholar
  26. 26.
    Fitzgerald R, Vleggaar D (2009) Using poly-l-lactic acid (PLLA) to mimic volume in multiple tissue layers. J Drugs Dermatol 8(10 Suppl):s5–s14PubMedGoogle Scholar
  27. 27.
    Fitzgerald R, Vleggaar D (2011) Facial volume restoration of the aging face with poly-l-lactic acid. Dermatol Ther 24:2–27PubMedCrossRefGoogle Scholar
  28. 28.
    Friedman O (2005) Changes associated with the aging face. Facial Plast Surg Clin North Am 13:371–380PubMedCrossRefGoogle Scholar
  29. 29.
    Gadhia K, Walmsley AD (2009) Facial aesthetics: Is botulinum toxin treatment effective and safe? A systematic review of randomised controlled trials. Br Dent J 207:E7–E9CrossRefGoogle Scholar
  30. 30.
    Gargasz SS, Carbone MC (2010) Hand rejuvenation using Radiesse. Plast Reconstr Surg 125:259e–260ePubMedCrossRefGoogle Scholar
  31. 31.
    Gliklich RE, White WM, Slayton MH, Barthe PG, Makin IR (2007) Clinical pilot study of intense ultrasound therapy to deep dermal facial skin and subcutaneous tissues. Arch Facial Plast Surg 9:88–95PubMedCrossRefGoogle Scholar
  32. 32.
    Gogolewski S, Jovanovic M, Perren SM, Dillon JG, Hughes MK (1993) Tissue response and in vivo degradation of selected polyhydroxyacids: Polylactides (PLA), poly(3-hydroxybutyrate) (PHB), and poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHB/VA). J Biomed Mater Res 27:1135–1148PubMedCrossRefGoogle Scholar
  33. 33.
    Goldberg DJ (2009) Breakthroughs in US dermal fillers for facial soft tissue augmentation. J Cosmet Laser Ther 11:240–247PubMedCrossRefGoogle Scholar
  34. 34.
    Gosain AK, Klein MH, Sudhakar PV, Prost RW (2005) A volumetric analysis of soft tissue changes in the aging midface using high-resolution MRI: implications for facial rejuvenation. Plast Reconstr Surg 115:1143–1152PubMedCrossRefGoogle Scholar
  35. 35.
    Haneke E (2004) Polymethyl methacrylate microspheres in collagen. Semin Cutan Med Surg 23:227–232PubMedCrossRefGoogle Scholar
  36. 36.
    Herbig K, Trussler AP, Khosla RK, Rohrich RJ (2009) Combination Jessner’s solution and trichloroacetic acid chemical peel: technique and outcomes. Plast Reconstr Surg 124:955–964PubMedCrossRefGoogle Scholar
  37. 37.
    Hernandez-Perez E, Ibiett EV (2001) Gross and microscopic findings in patients undergoing microdermabrasion for facial rejuvenation. Dermatol Surg 27:637–640PubMedCrossRefGoogle Scholar
  38. 38.
    Kaczvinsky JR, Griffiths CE, Schnicker MS, Li J (2009) Efficacy of anti-aging products for periorbital wrinkles as measured by 3-D imaging. J Cosmet Dermatol 8:228–233PubMedCrossRefGoogle Scholar
  39. 39.
    Lagarde JM, Rouvrais C, Black D (2005) Topography and anisotropy of the skin surface with ageing. Skin Res Technol 11:110–119PubMedCrossRefGoogle Scholar
  40. 40.
    Laubach HJ, Tannous Z, Anderson RR, Manstein D (2006) Skin responses to fractional photothermolysis. Lasers Surg Med 38:142–149PubMedCrossRefGoogle Scholar
  41. 41.
    Lewis CD, Perry JD (2009) A paradigm shift: volume augmentation or “inflation” to obtain optimal cosmetic results. Curr Opin Ophthalmol 20:389–394PubMedCrossRefGoogle Scholar
  42. 42.
    Lods LM, Dres C, Johnson C, Scholz DB, Brooks GJ (2000) The future of enzymes in cosmetics. Int J Cosmet Sci 22:85–94PubMedCrossRefGoogle Scholar
  43. 43.
    Marmur ES, Phelps R, Goldberg DJ (2004) Clinical, histologic, and electron microscopic findings after injection of a calcium hydroxylapatite filler. J Cosmet Laser Ther 6:223–226PubMedCrossRefGoogle Scholar
  44. 44.
    Mazzuco R, Hexsel D (2009) Poly-l-lactic acid for neck and chest rejuvenation. Dermatol Surg 35:1228–1237PubMedCrossRefGoogle Scholar
  45. 45.
    McDaniel DH, Neudecker BA, DiNardo JC, Lewis JA, Maibach HI (2005) Clinical efficacy assessment in photodamaged skin of 0.5 % and 1.0 % idebenone. J Cosmet Dermatol 4:167–173PubMedCrossRefGoogle Scholar
  46. 46.
    Ogura Y, Kuwahara T, Akiyama M, Tajima S, Hattori K, Okamoto K, Okawa S, Yamada Y, Tagami H, Takahashi M, Hirao T (2011) Dermal carbonyl modification is related to the yellowish color change of photo-aged Japanese facial skin. J Dermatol Sci 64:45–52PubMedCrossRefGoogle Scholar
  47. 47.
    Onesti MG, Troccola A, Scuderi N (2009) Volumetric correction using poly-l-lactic acid in facial asymmetry: Parry Romberg syndrome and scleroderma. Dermatol Surg 35:1368–1375PubMedCrossRefGoogle Scholar
  48. 48.
    Paasch U, Haedersdal M (2011) Laser systems for ablative fractional resurfacing. Expert Rev Med Devices 8:67–83PubMedCrossRefGoogle Scholar
  49. 49.
    Pageon H (2010) Reaction of glycation and human skin: the effects on the skin and its components, reconstructed skin as a model. Pathol Biol Paris 58:226–231PubMedCrossRefGoogle Scholar
  50. 50.
    Pageon H, Techer MP, Asselineau D (2008) Reconstructed skin modified by glycation of the dermal equivalent as a model for skin aging and its potential use to evaluate anti-glycation molecules. Exp Gerontol 43:584–588PubMedCrossRefGoogle Scholar
  51. 51.
    Palm MD, Woodhall KE, Butterwick KJ, Goldman MP (2010) Cosmetic use of poly-l-lactic acid: a retrospective study of 130 patients. Dermatol Surg 36:161–170PubMedCrossRefGoogle Scholar
  52. 52.
    Pecora NG, Baccetti T, McNamara JA Jr (2008) The aging craniofacial complex: a longitudinal cephalometric study from late adolescence to late adulthood. Am J Orthod Dentofacial Orthop 134:496–505PubMedCrossRefGoogle Scholar
  53. 53.
    Peterson JD, Goldman MP (2011) Rejuvenation of the aging chest: a review and our experience. Dermatol Surg 37:555–571PubMedCrossRefGoogle Scholar
  54. 54.
    Reece EM, Pessa JE, Rohrich RJ (2008) The mandibular septum: anatomical observations of the jowls in aging: Implications for facial rejuvenation. Plast Reconstr Surg 121:1414–1420PubMedCrossRefGoogle Scholar
  55. 55.
    Robinson LR, Fitzgerald NC, Doughty DG, Dawes NC, Berge CA, Bissett DL (2005) Topical palmitoyl pentapeptide provides improvement in photoaged human facial skin. Int J Cosmet Sci 27:155–160PubMedCrossRefGoogle Scholar
  56. 56.
    Rohrich RJ, Pessa JE (2007) The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 119:2219–2227PubMedCrossRefGoogle Scholar
  57. 57.
    Rohrich RJ, Pessa JE, Ristow B (2008) The youthful cheek and the deep medial fat compartment. Plast Reconstr Surg 121:2107–2112PubMedCrossRefGoogle Scholar
  58. 58.
    Rubin JP, Yaremchuk MJ (1997) Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg 100:1336–1353PubMedCrossRefGoogle Scholar
  59. 59.
    Sadick N (2008) Tissue tightening technologies: fact or fiction. Aesthet Surg J 28:180–188PubMedCrossRefGoogle Scholar
  60. 60.
    Sadick NS, Smoller B (2009) A study examining the safety and efficacy of a fractional laser in the treatment of photodamage on the hands. J Cosmet Laser Ther 11:29–33PubMedCrossRefGoogle Scholar
  61. 61.
    Salles AG, Lotierzo PH, Gimenez R, Camargo CP, Ferreira MC (2008) Evaluation of the poly-l-lactic acid implant for treatment of the nasolabial fold: 3-Year follow-up evaluation. Aesthetic Plast Surg 32:753–756PubMedCrossRefGoogle Scholar
  62. 62.
    Sharabi SE, Hatef DA, Koshy JC, Hollier LH Jr, Yaremchuk MJ (2010) Mechanotransduction: the missing link in the facial aging puzzle? Aesthetic Plast Surg 34:603–611PubMedCrossRefGoogle Scholar
  63. 63.
    Shaw RB Jr, Kahn DM (2007) Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg 119:675–681PubMedCrossRefGoogle Scholar
  64. 64.
    Shaw RB Jr, Katzel EB, Koltz PF, Kahn DM, Girotto JA, Langstein HN (2010) Aging of the mandible and its aesthetic implications. Plast Reconstr Surg 125:332–342PubMedCrossRefGoogle Scholar
  65. 65.
    Soda A, Ikehara T, Kinouchi Y, Yoshizaki K (2008) Effect of exposure to an extremely low-frequency electromagnetic field on the cellular collagen with respect to signaling pathways in osteoblast-like cells. J Med Invest 55:267–278PubMedCrossRefGoogle Scholar
  66. 66.
    Somoano B, Hantash BM, Fincher EF, Wu P, Gladstone HB (2011) The erbium micropeel: a prospective, randomized trial of the effects of two fluence settings on facial photoaging. J Drugs Dermatol 10:179–185PubMedGoogle Scholar
  67. 67.
    Trelles MA, Allones I, Luna R (2001) Facial rejuvenation with a nonablative 1,320-nm Nd:YAG laser: a preliminary clinical and histologic evaluation. Dermatol Surg 27:111–116PubMedCrossRefGoogle Scholar
  68. 68.
    Trelles MA, Alvarez X, Martin-Vazquez MJ, Trelles O, Velez M, Levy JL, Allones I (2005) Assessment of the efficacy of nonablative long-pulsed 1,064-nm Nd:YAG laser treatment of wrinkles compared at 2, 4, and 6 months. Facial Plast Surg 21:145–153PubMedCrossRefGoogle Scholar
  69. 69.
    Tzikas TL (2004) Evaluation of the radiance FN soft tissue filler for facial soft tissue augmentation. Arch Facial Plast Surg 6:234–239PubMedCrossRefGoogle Scholar
  70. 70.
    Vleggaar D (2006) Soft tissue augmentation and the role of poly-l-lactic acid. Plast Reconstr Surg 118(3 Suppl):46S–54SPubMedGoogle Scholar
  71. 71.
    Vleggaar D, Bauer U (2004) Facial enhancement and the European experience with Sculptra (poly-l-lactic acid). J Drugs Dermatol 3:542–547PubMedGoogle Scholar
  72. 72.
    Vleggaar D, Fitzgerald R (2008) Dermatological implications of skeletal aging: a focus on supraperiosteal volumization for perioral rejuvenation. J Drugs Dermatol 7:209–220PubMedGoogle Scholar
  73. 73.
    Yaar M, Eller MS, Gilchrest BA (2002) Fifty years of skin aging. J Investig Dermatol Symp Proc 7:51–58PubMedCrossRefGoogle Scholar
  74. 74.
    Zelickson BD, Kist D, Bernstein E, Brown DB, Ksenzenko S, Burns J, Kilmer S, Mehregan D, Pope K (2004) Histological and ultrastructural evaluation of the effects of a radiofrequency-based nonablative dermal remodeling device: a pilot study. Arch Dermatol 140:204–209PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013

Authors and Affiliations

  • Neil S. Sadick
    • 1
    Email author
  • Suveena Manhas-Bhutani
    • 2
  • Nils Krueger
    • 3
  1. 1.Department of DermatologyWeill Cornell Medical College, Cornell UniversityNew YorkUSA
  2. 2.Sadick Research GroupNew YorkUSA
  3. 3.Division of Cosmetic ScienceUniversity of HamburgHamburgGermany

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