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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an early intervention/ enhancement or restoration intervention. the high risk of vascular compromise in this area requires that interventions involving caha be performed only by skilled injectors. Nasolabial fold (NLF). the nlf was differentiated into upper and lower folds due to the potential for vascular compromise. 12 correction through lateral facial revolumization should always be attempted first. for the upper fold, only ha fillers for early intervention/enhancement and ha fillers and/or caha fillers for restoration (table 4e) were recommended. Lower-face indications. lower-face indications discussed included perioral rhytides, lip fullness, marionette lines, chin, mental crease, and jawline (table 5). Perioral rhytides. the use of Bont-a before ha fillers for early intervention/enhancement and Bont-a with ha fillers before MfU-V for the restoration of perioral rhytides (table 5a) were recommended. readers are urged to refer to the previous consensus publication for recommended treatment timeline. 1 several experts suggested using Bont-a only for early intervention/ enhancement or if "mimetic activity" was pronounced. Lip fullness/enhancement. lip enhancement or shape change would be considered a beautification procedure in patients with sufficient lip volume (table 5B). While caha is contraindicated for this indication, ha is recommended. Marionette lines. While some experts agreed that early intervention/enhancement required Bont-a, others suggested using MfU-V to minimize jowl fat pad protrusion or combining 20 JCAD journAl oF clinicAl And Aesthetic derMAtologY august 2017 • Volume 10 • number 8 c o n s e n s U s tAble 3. consensus on combination treatment strategies for the upper face in Asian patients Aesthetic d eFicienc Y And indicAtion recoMMendAtions A dditionAl coMMents eArlY intervention/ enhAnceMent restorAtion beAutiFicAtion a. Volume deficiency in forehead without brow ptosis ha fillers only* ha + Bont-a if applica- ble ha + Bont-a (if applicable)* asian foreheads rarely show sagging, but patients with brow ptosis might have naturally low brows. as more volume is lost, the brow becomes more ptotic but without sagging. B. Volume deficiency in forehead w ith brow ptosis Bont-a to lift the brow* 1. Bont-a to lift the brow 2 . MfU-V (Ultherapy) and/or ha and/or caha fillers not applicable – no voting this is not typically requested in Korean and taiwanese patients. In thailand, early intervention only requires toxin while restoration requires all treatments. c. forehead rhytides 1. Bont-a* 2. ha fillers* 1. Bont-a (unless contraindicated) 2. ha fillers not applicable – no voting none d. lateral canthal lines only Bont-a M-fUV (Ultherapy) and/or ha fillers not applicable – no voting none e. Glabellar frown lines only Bont-a* 1. Bont-a 2. ha fillers not applicable – no voting to perform both procedures on the same day for restoration, dr. seo would ideally start with Bont-a but both Bont-a and ha fillers are required for restoration; ideally, doctors would wait 1–2 weeks before performing filler injections. f. temporal hollows ha fillers ha and/or caha (radiesse)*† ha and/or caha (radiesse) none G. temporalis hypertrophy Bont-a* 30–50U/side of Xeomin can be used for early intervention recommendations with an asterisk (*) received strong consensus (at least 90% agreement). numbered treatments indicate the order in which the procedures should be performed. †procedure or technique is only recommended for experienced users. ha= hyaluronic acid. Bont-a= Bontulinum toxin type a. caha=calcium hydroxylapatite. MfU-V= Microfocused ultrasound with visualization

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