Journal of Clinical and Aesthetic Dermatology

AUG 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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Page 18 of 67

superficial fat pads as an early intervention/ enhancement in the treatment of cheek volume deficiencies that were not affected by laxity (table 4B). to address volume loss, fillers (ha or caha) were suggested (table 4a–c) for early intervention/enhancement. for cheeks suffering laxity, MfU-V treatment immediately before ha and/or caha fillers was suggested for same-day restoration treatments, as published in previous consensus statements. 1 for early combination interventions, MfU-V (to tighten skin) and/or ha (to volumize) treatments were suggested. as caha filler has volumization and skin-tightening benefits, it can be used alone to treat skin laxity or in combination with MfU-V. ha and/or caha fillers were recommended for anteromedial, submalar, and subzygomatic cheek areas; however, only advanced users should attempt caha fillers in the anteromedial cheek (table 4a–c). Nose shaping. the use of ha fillers and/or caha before Bont-a (if indicated; table 4d) was recommended for nose shaping, which was considered a beautification procedure rather than 19 JCAD journAl oF clinicAl And Aesthetic derMAtologY august 2017 • Volume 10 • number 8 c o n s e n s U s tAble 2. summary of recommendations from the Vancouver consensus on combination treatment strategies for caucasian patients: combination treatment strategies for asian patients no. stateMent for consIderatIon consen- addItIonal sUGGestIons A . general recommendations 1 thoroughly assess anatomical structure and age-related changes to the bone, fat, liga- ment, muscle, and skin. 1 00% n one 2 discuss treatment goals and ensure that the patient understands the progressive nature of the aging process. 1 00% n one 3 formulate an individualized treatment plan. 100% 4 discuss cost and estimate the most effective treatment(s) and the sequence of procedures and/or treatments. 100% none 5 In patients with limited financial means, focus on treating areas that will have the great- est impact. 91% none 6 avoid over-treatment and unnatural results or, conversely, under-treatment and subopti- mal results. 100% none 7 schedule appropriate follow-up visits to assess and document results. 100% none b. topicals 1 Use broad-spectrum ultraviolet (UV) protection of at least 30 sun protection factor (spf) daily. 100% 2 add a moisturizing agent with restorative additives for improvements in hydration, fine lines, laxity, dyschromia, and to brighten the skin. 100% perform skin analysis with dermatologist and recommend other modalities, (e.g., laser). c. sequence of multiple treatments in one area 1 If possible, allow 1–2 weeks after each procedure to allow for resolution of local side ef- fects and assess the results. refinement of recommendations by experts: If possible, allow the appropriate time after each procedure to allow for resolution of local side effects and assess the results. 100% 100% first follow-up visit should not be earlier than 2 weeks after treat- ment, regardless of the emergence of unwanted effects. 2 Bont and ha and/or caha fillers may be performed on the same day in either sequence. 91% to avoid toxin spreading beyond the treatment area, Bont-a can be done as second-line treatment following filler (ha and/or caha). 3 for combination therapy with multiple agents on the same day, Ulthera is performed prior to injectable agents as long as there is no significant tissue swelling. refinement of recommendation by experts: for combination therapy with multiple agents on the same day, Ulthera is performed prior to injectable agents. 91% 82% combination therapy can be done on the same day if toxins are ap- plied to a different anatomical region (e.g., cheeks versus forehead). to do within the same region, a 1–2 week wait is recommended.

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