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A Novel Approach to Structural Facial Volume Replacement

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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.

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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.

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Authors and Affiliations

  1. Department of Dermatology, Weill Cornell Medical College, Cornell University, 911 Park Avenue, Suite 1A, New York, NY, 10075, USA

    Neil S. Sadick

  2. Sadick Research Group, 911 Park Avenue, Suite 1A, New York, NY, 10075, USA

    Suveena Manhas-Bhutani

  3. Division of Cosmetic Science, University of Hamburg, Martin-Luther-King-Platz 6, 20146, Hamburg, Germany

    Nils Krueger

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  1. Neil S. Sadick
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  2. Suveena Manhas-Bhutani
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  3. Nils Krueger
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Correspondence to Neil S. Sadick.

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Sadick, N.S., Manhas-Bhutani, S. & Krueger, N. A Novel Approach to Structural Facial Volume Replacement. Aesth Plast Surg 37, 266–276 (2013). https://doi.org/10.1007/s00266-012-0052-6

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