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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significant changes. this consensus focused on the treatments and treatment sequences, as these may be influenced by patient factors, such as cultural preferences and personal finances. Treatment suggestions for patients with the ideal oval/heart face shape. for beautification or enhancement of facial features that are less prominent in asians, only specific concerns should be addressed. for example, filler can be injected into the medial cheek or pyriform aperture for anterior projection of the nose or concavities. for more heart-shaped faces, augmentation of the medial malar area may be necessary for oval shaping and to increase anterior projection (figure 2). Treatment suggestions for patients with oblong/rectangular face shape. oblong/rectangular faces contain a longer mandibular bone that pulls fat downward and flattens the central area. this requires lower face narrowing and smoothing, midface/anterior area projection, temple and forehead smoothing, and nose and lip augmentation (figure 3). Treatment suggestions for patients with round face shape. to bring the round face closer to the oval shape, the masseter should be reshaped and contoured via Bont-a injection to slim or narrow the lower face, and midface anterior projection should be improved through chin elongation (figure 4). 22 JCAD journAl oF clinicAl And Aesthetic derMAtologY august 2017 • Volume 10 • number 8 c o n s e n s U s tAble 5. consensus on combination treatment strategies for the lower face in asian patients a esthetIc defIcIency and IndIcatIon recoMMendatIons addItIonal coMMents early InterVentIon/ enhanceMent restoratIon BeaUtIfIcatIon a . perioral rhytides 1. BoNT-A 2. HA fillers 1. BoNT-A and HA fillers 2. M-FUV (Ultherapy) not applicable – no voting none B. lip enhancement 1. HA fillers 2. Additional effects with BoNT-A and/or M-FUV (Ultherapy) (for lip eversion) Bruising may be a consideration c. Marionette lines 1 . BoNT-A and/or HA and/or CaHA fillers 2. M-FUV (Ultherapy) (if indicated) 1 . HA and/or CaHA fillers in the midface and jawline AND BoNT-A 2. M-FUV (Ultherapy) not applicable – no voting experts advise against injecting too deeply or into submucosa as this may cause nodules, especially if multiple injections with large volumes are performed d. chin volume loss 1. HA and/or CaHA fillers 2. BoNT-A (if indicated) BoNT-A and HA and/or CaHA fillers 1. ha and/or caha fillers* 2. Bont-a (if indicated)* none e. Mental crease BoNT-A only below the mentalis BoNT-A and HA and/or CaHA fillers (combination) not applicable – no voting Mental crease is rarely treated in asian patients. Bont-a should be injected below the mental crease as early intervention to weaken the contraction of the mentalis f. Jawline (lateral line of jaw) no consensus overall: Moderate (63.6%): M- fUV (Ultherapy) then Bont-a (only if indi- cated) low (45.45%): Bont-a (only if indicated) then M-fUV (Ultherapy) Radiesse and/or HA fillers, followed by BoNT-A (if indicated) and M-FUV (Ultherapy) Moderate consensus (63.6%): fillers first followed by Ultherapy and Bont-a Moderate consensus (77.78%): radiesse and/or ha fillers, followed by Bont-a (if indicated) and M-fUV (Ultherapy) consensus was not reached for early intervention of the jawline because Bont-a may be placed intradermally, may be used for platysma band treatment, or for the masseter. therefore, this lack of clarity led to the inability to reach an agreement. G. Masseter hypertrophy BoNT-A doses are crucial to prevent concurrent sagging 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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