๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Fillers
Fillers
Direct correction of the melomental crease can be achieved using a few approaches. By starting just medial to the lower part of the melomental crease, one can shorten the length of the crease, reduce the appearance of volume loss in this region, and improve the mandibular contour. Moving more superiorly helps to create a smooth transition as one moves from the lower medial cheek to the melomental region. In addition, downturned mouth angles can benefit from filler injections inferomedial to the oral commissures as well as BTX-A injections to the DAO.128 It is helpful to consider the length of the mental crease when treating this area. Aim to ensure that the length of the mental crease is no more than half the length of the lips. By treating concavity in the melomental region, one can achieve this goal. As in the case of the nasolabial fold, three injection planes may be utilized for the melomental region. Supraperiosteal towering placement along the mandible can efface deep melomental folds. Subcutaneous injections are used for volume loss along the melomental fold and adjacent prejowl through fanning, threading, or microaliquot techniques. Subdermal microaliquots,
fanning, threading, or cross-hatching techniques can be used for more superficial rhytides. Filler selection is similar to the nasolabial fold. Blunt cannulas (1ยฝ or 2 in, 27 or 25 gauge) may be utilized with an entry point along the mandible, in the prejowl region. This access point permits treatment of the entire melomental region while also permitting access to the area lateral to the melomental fold if necessary. Blunt cannulas are best suited for subcutaneous and subdermal plane placements with fanning and threading techniques to correct volume loss and superficial rhytides, respectively. Rhytid correction of nasolabial, marionette, oral commissures, and upper and lower perioral rhytides was assessed in an open label study of 20 patients. The study evaluated small-gel-particle HA (Restylane) and large-gel-particle HA (Restylane Lyft). Both were found to be safe and effective for perioral wrinkles and correction of folds. Adverse events in decreasing order of occurrence were bruising, tenderness, swelling, redness, headache, and discomfort. Bruising was more common in the nasolabial crease and marionette fold areas. Adverse events resolved within an average of 4 days.129
Botulinum toxin A global consensus paper for BTX-A treatment recommended an equivalent total of 2 to 4 units of intramuscular onabotulinumtoxin A to one or two injection points per side to the DAO muscle to attenuate the downward pull of the DAO muscle on the oral commissures. Of this group, 68% favored same-session treatments with BTX-A and fillers.27 A split-face clinical trial of 20 patients revealed no difference between 10 units abobotulinumtoxin A versus 4 units onabotulinumtoxin A in treating the DAO muscle.130