Nonsurgical Periorbital and Facial Rejuvenation: A Paradigm Shift for Patients and Surgeons

  • Christopher C. Lo
  • Ashley Campbell
  • Joseph A. EviatarEmail author


There is an expanding role for nonsurgical techniques in periorbital and facial rejuvenation. While these treatments can sometimes replace surgery, they more often play an adjunctive role. First, this chapter presents an approach to evaluating patients and reviews the current understanding of the aging face. While new products are entering the market at lightning speed, we present an overview of the current classes of products and techniques available. Furthermore, the underlying philosophy behind successful aesthetic rejuvenation is introduced. There is a synergy to these techniques, which should be capitalized upon for the benefit of the patient.


Botulinum toxin Botox Neurotoxin Fillers Soft tissue augmentation Lasers Peels Devices Radiofrequency Skin care 


  1. 1.
    Friedman O. Changes associated with the aging face. Facial Plast Surg Clin North Am. 2005;13(3):371–80.PubMedCrossRefGoogle Scholar
  2. 2.
    Kahn DM, Shaw RB. Overview of current thoughts on facial volume and aging. Facial Plast Surg. 2010;26(5):350–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Zoumalan RA, Larrabee WF Jr. Anatomic considerations in the aging face. Facial Plast Surg. 2011;27(1):16–22.PubMedCrossRefGoogle Scholar
  4. 4.
    Mancini R, Khadavi NM, Goldberg RA. Nonsurgical management of upper eyelid margin asymmetry using hyaluronic acid gel filler. Ophthal Plast Reconstr Surg. 2011;27(1):1–3.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Keaney TC, Anolik R, Braz A, et al. The male aesthetic patient: facial anatomy, concepts of attractiveness, and treatment patterns. J Drugs Dermatol. 2018;17(1):19–28.PubMedGoogle Scholar
  6. 6.
    Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin Cutan Med Surg. 2009;28(2):115–29.PubMedCrossRefGoogle Scholar
  7. 7.
    Wong C-H, Mendelson B. Facial soft-tissue spaces and retaining ligaments of the midcheek: defining the premaxillary space. Plast Reconstr Surg. 2013;132(1):49–56.PubMedCrossRefGoogle Scholar
  8. 8.
    Pessa JE, Zadoo VP, Yuan C, et al. Concertina effect and facial aging: nonlinear aspects of youthfulness and skeletal remodeling, and why, perhaps, infants have jowls. Plast Reconstr Surg. 1999;103(2):635–44.PubMedCrossRefGoogle Scholar
  9. 9.
    Gosain AK, Klein MH, Sudhakar PV, Prost RW. A volumetric analysis of soft-tissue changes in the aging midface using high-resolution MRI: implications for facial rejuvenation. Plast Reconstr Surg. 2005;115(4):1143–52; discussion 1153–55.CrossRefGoogle Scholar
  10. 10.
    Wysong A, Kim D, Joseph T, MacFarlane DF, Tang JY, Gladstone HB. Quantifying soft tissue loss in the aging male face using magnetic resonance imaging. Dermatol Surg. 2014;40(7):786–93.PubMedGoogle Scholar
  11. 11.
    Wysong A, Joseph T, Kim D, Tang JY, Gladstone HB. Quantifying soft tissue loss in facial aging: a study in women using magnetic resonance imaging. Dermatol Surg. 2013;39(12):1895–902.PubMedCrossRefGoogle Scholar
  12. 12.
    Goldberg RA. The three periorbital hollows: a paradigm for periorbital rejuvenation. Plast Reconstr Surg. 2005;116(6):1796–804.PubMedCrossRefGoogle Scholar
  13. 13.
    Rohrich RJ, Pessa JE. The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments. Plast Reconstr Surg. 2008;121(5):1804–9.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Gierloff M, Stöhring C, Buder T, Gassling V, Açil Y, Wiltfang J. Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg. 2012;129(1):263–73.CrossRefGoogle Scholar
  15. 15.
    Ramanadham SR, Rohrich RJ. Newer understanding of specific anatomic targets in the aging face as applied to injectables: superficial and deep facial fat compartments – an evolving target for site-specific facial augmentation. Plast Reconstr Surg. 2015;136(5 Suppl):49S–55S.PubMedCrossRefGoogle Scholar
  16. 16.
    Lee S, Yen MT. Nonsurgical rejuvenation of the eyelids with hyaluronic acid gel injections. Semin Plast Surg. 2017;31(1):17–21.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Mustak H, Fiaschetti D, Goldberg RA. Filling the periorbital hollows with hyaluronic acid gel: long-term review of outcomes and complications. J Cosmet Dermatol. 2017; Scholar
  18. 18.
    Morley AMS, Taban M, Malhotra R, Goldberg RA. Use of hyaluronic acid gel for upper eyelid filling and contouring. Ophthal Plast Reconstr Surg. 2009;25(6):440–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Mustak H, Fiaschetti D, Gupta A, Goldberg R. Eyebrow contouring with hyaluronic acid gel filler injections. J Clin Aesthet Derm. 2018;11(2):38–40.Google Scholar
  20. 20.
    Goldberg RA, Fiaschetti D. Filling the periorbital hollows with hyaluronic acid gel: initial experience with 244 injections. Ophthal Plast Reconstr Surg. 2006;22(5):335–41; discussion 341–43.PubMedCrossRefGoogle Scholar
  21. 21.
    Pessa JE. An algorithm of facial aging: verification of Lambros’s theory by three-dimensional stereolithography, with reference to the pathogenesis of midfacial aging, scleral show, and the lateral suborbital trough deformity. Plast Reconstr Surg. 2000;106(2):479–88; discussion 489–90.PubMedCrossRefGoogle Scholar
  22. 22.
    Mendelson BC, Hartley W, Scott M, McNab A, Granzow JW. Age-related changes of the orbit and midcheek and the implications for facial rejuvenation. Aesthet Plast Surg. 2007;31(5):419–23.CrossRefGoogle Scholar
  23. 23.
    Shaw RB Jr, Kahn DM. Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg. 2007;119(2):675–81; discussion 682–83.PubMedCrossRefGoogle Scholar
  24. 24.
    Scott AB. Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. Ophthalmology. 1980;87(10):1044–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Jankovic J, Brin MF. Therapeutic uses of botulinum toxin. N Engl J Med. 1991;324(17):1186–94.CrossRefGoogle Scholar
  26. 26.
    Felber ES. Botulinum toxin in primary care medicine. J Am Osteopath Assoc. 2006;106(10):609–14.PubMedGoogle Scholar
  27. 27.
    Binder WJ, Brin MF, Blitzer A, Schoenrock LD, Pogoda JM. Botulinum toxin type A (BOTOX) for treatment of migraine headaches: an open-label study. Otolaryngol Head Neck Surg. 2000;123(6):669–76.PubMedCrossRefGoogle Scholar
  28. 28.
    Wu DC, Fabi SG, Goldman MP. Neurotoxins: current concepts in cosmetic use on the face and neck – lower face. Plast Reconstr Surg. 2015;136(5 Suppl):76S–9S.PubMedCrossRefGoogle Scholar
  29. 29.
    Zanchi M, Favot F, Bizzarini M, Piai M, Donini M, Sedona P. Botulinum toxin type-A for the treatment of inverse psoriasis. J Eur Acad Dermatol Venereol. 2008;22(4):431–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Glaser DA, Pariser DM, Hebert AA, et al. A prospective, nonrandomized, open-label study of the efficacy and safety of onabotulinumtoxinA in adolescents with primary axillary hyperhidrosis. Pediatr Dermatol. 2015;32(5):609–17.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Min P, Xi W, Grassetti L, et al. Sebum production alteration after botulinum toxin type a injections for the treatment of forehead rhytides: a prospective randomized double-blind dose-comparative clinical investigation. Aesthet Surg J. 2015;35(5):600–10.PubMedCrossRefGoogle Scholar
  32. 32.
    Shah AR. Use of intradermal botulinum toxin to reduce sebum production and facial pore size. J Drugs Dermatol. 2008;7(9):847–50.PubMedGoogle Scholar
  33. 33.
    Alam M, Barrett KC, Hodapp RM, Arndt KA. Botulinum toxin and the facial feedback hypothesis: can looking better make you feel happier? J Am Acad Dermatol. 2008;58(6):1061–72.PubMedCrossRefGoogle Scholar
  34. 34.
    Rappl T, Parvizi D, Friedl H, et al. Onset and duration of effect of incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA in the treatment of glabellar frown lines: a randomized, double-blind study. Clin Cosmet Investig Dermatol. 2013;6:211–9.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Jandhyala R. Relative potency of incobotulinumtoxinA vs onabotulinumtoxinA a meta-analysis of key evidence. J Drugs Dermatol. 2012;11(6):731–6.PubMedGoogle Scholar
  36. 36.
    Carruthers A, Sadick N, Brandt F, et al. Evolution of facial aesthetic treatment over five or more years: a retrospective cross-sectional analysis of continuous onabotulinumtoxinA treatment. Dermatol Surg. 2015;41(6):693–701.PubMedCrossRefGoogle Scholar
  37. 37.
    Carruthers JD, Carruthers JA. Treatment of glabellar frown lines with C. botulinum-A exotoxin. J Dermatol Surg Oncol. 1992;18(1):17–21.PubMedCrossRefGoogle Scholar
  38. 38.
    Molina B, Grangier Y, Mole B, et al. Patient satisfaction after the treatment of glabellar lines with Botulinum toxin type A (Speywood Unit): a multi-centre European observational study. J Eur Acad Dermatol Venereol. 2015;29(7):1382–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Carruthers JD, Lowe NJ, Menter MA, Gibson J, Eadie N, Botox Glabellar Lines II Study Group. Double-blind, placebo-controlled study of the safety and efficacy of botulinum toxin type A for patients with glabellar lines. Plast Reconstr Surg. 2003;112(4):1089–98.PubMedGoogle Scholar
  40. 40.
    Lizzul PF, Narurkar VA. The role of calcium hydroxylapatite (Radiesse) in nonsurgical aesthetic rejuvenation. J Drugs Dermatol. 2010;9(5):446–50.PubMedGoogle Scholar
  41. 41.
    Carruthers A, Carruthers J. A single-center, dose-comparison, pilot study of botulinum neurotoxin type A in female patients with upper facial rhytids: safety and efficacy. J Am Acad Dermatol. 2009;60(6):972–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Wieder JM, Moy RL. Understanding botulinum toxin. Surgical anatomy of the frown, forehead, and periocular region. Dermatol Surg. 1998;24(11):1172–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Steinsapir KD, Groth MJ, Boxrud CA. Persistence of upper blepharoptosis after cosmetic botulinum toxin type A. Dermatol Surg. 2015;41(7):833–40.PubMedCrossRefGoogle Scholar
  44. 44.
    Scheinfeld N. The use of apraclonidine eyedrops to treat ptosis after the administration of botulinum toxin to the upper face. Dermatol Online J. 2005;11(1):9.PubMedGoogle Scholar
  45. 45.
    Ghalamkarpour F, Robati RM, Aryanejad F, Toossi P. Supraciliary wrinkles and botulinum toxin A. Clin Exp Dermatol. 2010;35(4):388–91.PubMedCrossRefGoogle Scholar
  46. 46.
    Mazzuco R, Hexsel D. Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. J Am Acad Dermatol. 2010;63(6):1042–51.PubMedCrossRefGoogle Scholar
  47. 47.
    Polo M. Botulinum toxin type A in the treatment of excessive gingival display. Am J Orthod Dentofac Orthop. 2005;127(2):214–8; quiz 261.CrossRefGoogle Scholar
  48. 48.
    Gart MS, Gutowski KA. Aesthetic uses of neuromodulators: current uses and future directions. Plast Reconstr Surg. 2015;136(5 Suppl):62S–71S.PubMedCrossRefGoogle Scholar
  49. 49.
    Choe SW, Cho WI, Lee CK, Seo SJ. Effects of botulinum toxin type A on contouring of the lower face. Dermatol Surg. 2005;31(5):502–7; discussion 507–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Wu WTL. Botox facial slimming/facial sculpting: the role of botulinum toxin-A in the treatment of hypertrophic masseteric muscle and parotid enlargement to narrow the lower facial width. Facial Plast Surg Clin North Am. 2010;18(1):133–40.PubMedCrossRefGoogle Scholar
  51. 51.
    Kim N-H, Chung J-H, Park R-H, Park J-B. The use of botulinum toxin type A in aesthetic mandibular contouring. Plast Reconstr Surg. 2005;115(3):919–30.PubMedCrossRefGoogle Scholar
  52. 52.
    Peng H-LP, Peng J-H. Complications of botulinum toxin injection for masseter hypertrophy: incidence rate from 2036 treatments and summary of causes and preventions. J Cosmet Dermatol. 2018;17(1):33–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Matarasso A, Matarasso SL. Botulinum A exotoxin for the management of platysma bands. Plast Reconstr Surg. 2003;112(5 Suppl):138S–40S.PubMedCrossRefGoogle Scholar
  54. 54.
    Rohrich RJ, Rios JL, Smith PD, Gutowski KA. Neck rejuvenation revisited. Plast Reconstr Surg. 2006;118(5):1251–63.PubMedCrossRefGoogle Scholar
  55. 55.
    Kane MAC. Nonsurgical treatment of platysma bands with injection of botulinum toxin a revisited. Plast Reconstr Surg. 2003;112(5 Suppl):125S–6S.PubMedCrossRefGoogle Scholar
  56. 56.
    Wu WTL. Microbotox of the lower face and neck: evolution of a personal technique and its clinical effects. Plast Reconstr Surg. 2015;136(5 Suppl):92S–100S.CrossRefGoogle Scholar
  57. 57.
    Kaufman MR, Miller TA, Huang C, et al. Autologous fat transfer for facial recontouring: is there science behind the art? Plast Reconstr Surg. 2007;119(7):2287–96.PubMedCrossRefGoogle Scholar
  58. 58.
    Buck DW 2nd, Alam M, Kim JYS. Injectable fillers for facial rejuvenation: a review. J Plast Reconstr Aesthet Surg. 2009;62(1):11–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Lambros V. Fat grafting: a growing problem? Plast Reconstr Surg. 2018;141(2):527–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Murray CA, Zloty D, Warshawski L. The evolution of soft tissue fillers in clinical practice. Dermatol Clin. 2005;23(2):343–63.PubMedCrossRefGoogle Scholar
  61. 61.
    Center for Devices, Radiological Health. Dermal fillers (soft tissue fillers) – dermal dillers approved by the Center for Devices and Radiological Health. Accessed 10 Aug 2018.
  62. 62.
    Narins RS, Beer K. Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg. 2006;118(3 Suppl):77S–84S.PubMedCrossRefGoogle Scholar
  63. 63.
    Glicenstein J. The first “fillers”, vaseline and paraffin. From miracle to disaster. Ann Chir Plast Esthet. 2007;52(2):157–61.PubMedCrossRefGoogle Scholar
  64. 64.
    Eviatar J, Lo C, Kirszrot J. Radiesse: advanced techniques and applications for a unique and versatile implant. Plast Reconstr Surg. 2015;136(5 Suppl):164S–70S.PubMedCrossRefGoogle Scholar
  65. 65.
    Andre P, Lowe NJ, Parc A, Clerici TH, Zimmermann U. Adverse reactions to dermal fillers: a review of European experiences. J Cosmet Laser Ther. 2005;7(3–4):171–6.PubMedCrossRefGoogle Scholar
  66. 66.
    Lowe NJ, Maxwell CA, Patnaik R. Adverse reactions to dermal fillers: review. Dermatol Surg. 2005;31(11 Pt 2):1616–25.PubMedGoogle Scholar
  67. 67.
    Ramesh S, Fiaschetti D, Goldberg RA. Orbital and ocular ischemic syndrome with blindness after facial filler injection. Ophthal Plast Reconstr Surg. 2018;34(4):e108–10.PubMedGoogle Scholar
  68. 68.
    DeLorenzi C. Complications of injectable fillers, part 2: vascular complications. Aesthet Surg J. 2014;34(4):584–600.PubMedCrossRefGoogle Scholar
  69. 69.
    DeLorenzi C. Complications of injectable fillers, part I. Aesthet Surg J. 2013;33(4):561–75.PubMedCrossRefGoogle Scholar
  70. 70.
    Kim YJ, Kim SS, Song WK, Lee SY, Yoon JS. Ocular ischemia with hypotony after injection of hyaluronic acid gel. Ophthal Plast Reconstr Surg. 2011;27(6):e152–5.PubMedCrossRefGoogle Scholar
  71. 71.
    Sung MS, Kim HG, Woo KI, Kim Y-D. Ocular ischemia and ischemic oculomotor nerve palsy after vascular embolization of injectable calcium hydroxylapatite filler. Ophthal Plast Reconstr Surg. 2010;26(4):289–91.PubMedCrossRefGoogle Scholar
  72. 72.
    Sung W-I, Tsai S, Chen L-J. Ocular complications following cosmetic filler injection. JAMA Ophthalmol. 2018;136(5):e180716.PubMedCrossRefGoogle Scholar
  73. 73.
    Myung Y, Yim S, Jeong JH, et al. The classification and prognosis of periocular complications related to blindness following cosmetic filler injection. Plast Reconstr Surg. 2017;140(1):61–4.PubMedCrossRefGoogle Scholar
  74. 74.
    Chang S-H, Yousefi S, Qin J, et al. External compression versus intravascular injection: a mechanistic animal model of filler-induced tissue ischemia. Ophthal Plast Reconstr Surg. 2016;32(4):261–6.PubMedCrossRefGoogle Scholar
  75. 75.
    Scheuer JF 3rd, Sieber DA, Pezeshk RA, Gassman AA, Campbell CF, Rohrich RJ. Facial danger zones: techniques to maximize safety during soft-tissue filler injections. Plast Reconstr Surg. 2017;139(5):1103–8.PubMedCrossRefGoogle Scholar
  76. 76.
    Fang M, Rahman E, Kapoor KM. Managing complications of submental artery involvement after hyaluronic acid filler injection in Chin region. Plast Reconstr Surg Glob Open. 2018;6(5):e1789.PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    DeLorenzi C. New high dose pulsed hyaluronidase protocol for hyaluronic acid filler vascular adverse events. Aesthet Surg J. 2017;37(7):814–25.PubMedCrossRefGoogle Scholar
  78. 78.
    Sun Z-S, Zhu G-Z, Wang H-B, et al. Clinical outcomes of impending nasal skin necrosis related to nose and nasolabial fold augmentation with hyaluronic acid fillers. Plast Reconstr Surg. 2015;136(4):434e–41e.PubMedCrossRefGoogle Scholar
  79. 79.
    Zhu G-Z, Sun Z-S, Liao W-X, et al. Efficacy of retrobulbar hyaluronidase injection for vision loss resulting from hyaluronic acid filler embolization. Aesthet Surg J. 2017;38(1):12–22.PubMedCrossRefGoogle Scholar
  80. 80.
    Hwang CJ, Mustak H, Gupta AA, Ramos RM, Goldberg RA, Duckwiler GR. Role of retrobulbar hyaluronidase in filler-associated blindness: evaluation of fundus perfusion and electroretinogram readings in an animal model. Ophthal Plast Reconstr Surg. 2018;
  81. 81.
    Carruthers JDA, Fagien S, Rohrich RJ, Weinkle S, Carruthers A. Blindness caused by cosmetic filler injection: a review of cause and therapy. Plast Reconstr Surg. 2014;134(6):1197–201.PubMedCrossRefGoogle Scholar
  82. 82.
    Carruthers J, Fagien S, Dolman P. Retro or peribulbar injection techniques to reverse visual loss after filler injections. Dermatol Surg. 2015;41(Suppl 1):S354–7.PubMedCrossRefGoogle Scholar
  83. 83.
    Hwang K. Hyperbaric oxygen therapy to avoid blindness from filler injection. J Craniofac Surg. 2016;27(8):2154–5.PubMedCrossRefGoogle Scholar
  84. 84.
    Henderson R, Reilly DA, Cooper JS. Hyperbaric oxygen for ischemia due to injection of cosmetic fillers: case report and issues. Plast Reconstr Surg Glob Open. 2018;6(1):e1618.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Hwang CJ, Morgan PV, Pimentel A, Sayre JW, Goldberg RA, Duckwiler G. Rethinking the role of nitroglycerin ointment in ischemic vascular filler complications: an animal model with ICG imaging. Ophthal Plast Reconstr Surg. 2016;32(2):118–22.PubMedCrossRefGoogle Scholar
  86. 86.
    Takai Y, Tanito M, Matsuoka Y, Hara K, Ohira A. Systemic prostaglandin E1 to treat acute central retinal artery occlusion. Invest Ophthalmol Vis Sci. 2013;54(4):3065–71.PubMedCrossRefGoogle Scholar
  87. 87.
    Lowe NJ, Lask G, Griffin ME, Maxwell A, Lowe P, Quilada F. Skin resurfacing with the ultrapulse carbon dioxide laser. Observations on 100 patients. Dermatol Surg. 1995;21(12):1025–9.PubMedCrossRefGoogle Scholar
  88. 88.
    Goldman MP. Observations on the use of fractionated CO2 laser resurfacing. J Drugs Dermatol. 2009;8(1):82–6.PubMedGoogle Scholar
  89. 89.
    Ortiz AE, Goldman MP, Fitzpatrick RE. Ablative CO2 lasers for skin tightening: traditional versus fractional. Dermatol Surg. 2014;40(Suppl 12):S147–51.PubMedCrossRefGoogle Scholar
  90. 90.
    Chiu RJ, Kridel RWH. Fractionated photothermolysis: the Fraxel 1550-nm glass fiber laser treatment. Facial Plast Surg Clin North Am. 2007;15(2):229–37, vii.PubMedCrossRefGoogle Scholar
  91. 91.
    Doshi SN, Alster TS. 1,450 nm long-pulsed diode laser for nonablative skin rejuvenation. Dermatol Surg. 2005;31(9 Pt 2):1223–6; discussion 1226.PubMedGoogle Scholar
  92. 92.
    Ang P, Barlow RJ. Nonablative laser resurfacing: a systematic review of the literature. Clin Exp Dermatol. 2002;27(8):630–5.PubMedCrossRefGoogle Scholar
  93. 93.
    Babilas P, Schreml S, Szeimies R-M, Landthaler M. Intense pulsed light (IPL): a review. Lasers Surg Med. 2010;42(2):93–104.CrossRefGoogle Scholar
  94. 94.
    Feng Y, Zhao J, Gold MH. Skin rejuvenation in Asian skin: the analysis of clinical effects and basic mechanisms of intense pulsed light. J Drugs Dermatol. 2008;7(3):273–9.PubMedGoogle Scholar
  95. 95.
    Hedelund L, Due E, Bjerring P, Wulf HC, Haedersdal M. Skin rejuvenation using intense pulsed light: a randomized controlled split-face trial with blinded response evaluation. Arch Dermatol. 2006;142(8):985–90.PubMedCrossRefGoogle Scholar
  96. 96.
    Tsukahara K, Tamatsu Y, Sugawara Y, Shimada K. Relationship between the depth of facial wrinkles and the density of the retinacula cutis. Arch Dermatol. 2012;148(1):39–46.PubMedCrossRefGoogle Scholar
  97. 97.
    Pritzker RN, Robinson DM. Updates in noninvasive and minimally invasive skin tightening. Semin Cutan Med Surg. 2014;33(4):182–7.PubMedCrossRefGoogle Scholar
  98. 98.
    Fabi SG. Noninvasive skin tightening: focus on new ultrasound techniques. Clin Cosmet Investig Dermatol. 2015;8:47–52.PubMedPubMedCentralCrossRefGoogle Scholar
  99. 99.
    Lee HS, Jang WS, Cha Y-J, et al. Multiple pass ultrasound tightening of skin laxity of the lower face and neck. Dermatol Surg. 2012;38(1):20–7.PubMedCrossRefGoogle Scholar
  100. 100.
    Derrick CD, Shridharani SM, Broyles JM. The safety and efficacy of cryolipolysis: a systematic review of available literature. Aesthet Surg J. 2015;35(7):830–6.PubMedCrossRefGoogle Scholar
  101. 101.
    Singh SM, Geddes ERC, Boutrous SG, Galiano RD, Friedman PM. Paradoxical adipose hyperplasia secondary to cryolipolysis: an underreported entity? Lasers Surg Med. 2015;47(6):476–8.PubMedCrossRefGoogle Scholar
  102. 102.
    Gülbitti HA, Colebunders B, Pirayesh A, Bertossi D, van der Lei B. Thread-lift sutures: still in the lift? A systematic review of the literature. Plast Reconstr Surg. 2018;141(3):341e–7e.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Christopher C. Lo
    • 1
  • Ashley Campbell
    • 2
  • Joseph A. Eviatar
    • 3
    Email author
  1. 1.Oculoplastic and Orbital SurgeryUCLA Doheny and Stein Eye InstitutesLos AngelesUSA
  2. 2.Division of OculoplasticsJohn Hopkins Wilmer Eye InstituteBaltimoreUSA
  3. 3.Facial AestheticsOmni Aesthetic MDNew YorkUSA

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