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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Bont-a with fillers for restoration. ha and/or caha should be applied over the prejowl sulcus following mid-face restoration interventions (table 5c). Mentalis. Bont-a may be utilized only if mimetic activity was observed, and first line treatment with toxin was recommended for early intervention/enhancement and restoration (table 5e). Jawline. caha, high in elasticity and viscosity, is ideal for jawline creation. for beautification, the masseter or platysma, but not the jaw, should be treated with toxin, while filler should be used to sculpt different shapes and increase bone definition (table 5f). Masseter hypertrophy. the use of Bont-a for all interventions was recommended (table 5G). toxin dose is a critical consideration. 13,14 toxin denervation without concomitant prejowl/chin augmentation can result in jowl fat sagging; hence, combination treatments are recommended. for early intervention/enhancement and beautification, most patients may require only Bont-a for the masseter. however, older patients with prominent jowls and submalar and subzygoma depressions may require concurrent filler augmentation of the cheek and chin or MfU-V for lifting. part 2: combination treatment strategies for Asian patients— Modifying face shapes to achieve the "oval ideal." the experts unanimously agreed that the oval or heart facial shape was an aesthetic goal of asian patients and that combination treatments were recommended to achieve this because single interventions were unlikely to produce 21 JCAD journAl oF clinicAl And Aesthetic derMAtologY august 2017 • Volume 10 • number 8 c o n s e n s U s tAble 4. consensus on combination treatment strategies for the mid-face in Asian patients AESTHETIC DEFICIENC Y AND INDICATION R ECOMMENDATIONS ADDITIONAL COMMENTS E ARLY INTERVENTION/ ENHANCEMENT RESTORATION BEAUTIFICATION a . anteromedial cheek volume deficiency HA and/or CaHA fillers (Radiesse) caha (radiesse) should only be used by advanced operators for this indication B. submalar cheek volume deficiency HA and/or CaHA fillers (Radiesse) combination of fillers and/or M-fUV (Ultherapy)* not applicable – no voting Moderate consensus (70%) was also received for the use of ha and/or caha fillers followed by M-fUV (Ultherapy), although this order is performed only if there is skin laxity. Weak consensus (40%) was received for the use of M-fUV (Ultherapy) followed by ha and/or caha fillers. depending on the degree of submalar volume deficiency and laxity, performing M-fUV (Ultherapy) first may reposition fat in the treated area; therefore, less filler will be required subsequently. c. subzygomatic cheek volume deficiency HA and/or CaHA (Radiesse) none d. nose shaping no voting no voting 1. HA fillers and/or CaHA (Radiesse) 2. BoNT-A (if indicated) radiesse should only be used by advanced operators for this indication e. nasolabial folds (nlf) HA fillers only HA fillers and/or CaHA (Radiesse) not applicable – no voting radiesse in the upper part of the fold should be avoided Geographical differences exist for this indication (see main text) recommendations shown in italics have received total consensus of 100% agreement given by the experts, while those indicated with an asterisk (*) received strong consensus (at least 90% agreement). numbered treatments indicate the order in which the procedures should be performed. ha= hyaluronic acid. Bont-a= Bontulinum toxin type a. caha=calcium hydroxylapatite. MfU-V= Microfocused ultrasound with visualization

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