๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Introduction
CHAPTER 75 Approaches to Facial
Wrinkles and Contouring
Vince Bertucci Mohammad Almohideb Kucy Pon
SUMMARY
The past several years have seen a paradigm shift to viewing facial aging and
the development of rhytides as a three- dimensional process.
Rather than simply filling in facial creases, injectors now focus on volumizing
and contouring the face to indirectly address the root cause of wrinkle formation.
Judicious combinations of neuromodulators and fillers provide patients with a
minimally invasiveโthough not risk freeโapproach to wrinkle reduction and contouring that may ultimately lead to an aesthetically pleasing outcome.
Beginner Tips
Combined use of sharp needle injections and blunt microcannulas, depending on the
site and treatment goals, may be used to achieve a balance of safety and efficacy.
Beware overtreatment of lateral canthal rhytides with botulinum toxin in order to
avoid creating an unusual smile with a shelf-like appearance and overprojection of the cheeks anteriorly.
Prior to injecting, palpate and avoid the temporal artery and slowly aspirate on the
needle plunger to minimize the risk of intravascular placement; keep in mind that a negative aspiration test does not guarantee nonintravascular placement.
Expert Tips
Deeper filler placement is less effective in the submalar area due to the lack of bony
support.
BTX-A may be suitable for treating hyperdynamic โaccordionโ cheek lines with one to
six units of intracutaneous BTX-A to each side. This can be achieved by one to two injection points over the mid-to-lateral malar eminence.
When injecting fillers in the tear trough, undercorrection is advocated, as the
hygroscopic nature of HA fillers makes this area prone to edema, bulging, and the Tyndall effect.
Donโt Forget!
The global aesthetics consensus recommends the following toolkit for managing HA
filler complications: hyaluronidase, oral and intralesional steroids, empiric antibiotics (minocycline, ciprofloxacin, or clarithromycin), antiviral agents, topical nitroglycerin (1%), antihistamines, aspirin 325 mg orally, warm compresses, bacterial culture kit, and phone numbers of prearranged referrals (e.g., ophthalmologists, hyperbaric oxygen).
Err on the side of underdosing perioral BTX.
Pitfalls and Cautions
With filler injections, the highest risk of blindness and changes is in the glabella
(38.8%) followed by the nasal region (25.5%), nasolabial area (13.3%), and forehead (12.2%).
Avoid overcorrection of the jawline so as to prevent masculinization of the female
face.
Avoid completely effacing the nasolabial folds, and preferentially augment the cheek
prior to considering direct fold injection.
Extra care should be taken for nasal dorsum fillers.
BTX-A injections should be placed higher on the forehead to minimize the risk of
eyebrow and eyelid ptosis.
CHAPTER 75 Approaches to Facial