Expert Consensus on Hyaluronic Acid Filler Facial Injection for Chinese Patients

Pilot Study: Hyaluronic Acid Filler Injection Techniques to Achieve Facial Balance in Asian Patients

Background

Current standard beauty practices in East Asia focus on enhancing and refining Asian features within cultural normalities.

Methods

This pilot study presents injection techniques using hyaluronic acid filler (YVOIRE), focusing on East Asian facial balance factors (line, angle, and proportion of the face). The Balance-L injection technique is suggested to achieve single convexity of the outer contour. The Balance-A technique is suggested to modify the profile angles, and the Balance-P technique is suggested to modify facial proportions. Five East Asian female patients gave written informed consent for the procedures and use of their photographs. Physicians used the Balance injection technique as per the patients' concerns and desired outcomes.

Results

Adapting the Balance-L technique, nasolabial fold and marionette lines were treated to achieve a natural look in patient 1. A harmonious profile was achieved in patient 2 by treating forehead, nose, and chin guided by the Balance-A technique. Patients 3-5 were treated using the Balance-P technique. Overall sagging was corrected by treating the anteromedial malar in patient 3. In patient 4, a dimensionally balanced face was achieved by treating the nose, chin, frontotemporal junction, anteromedian malar, and deep pyriform space. A younger and tighter appearing face was achieved in patient 5 by treating the nose, nasolabial folds, deep pyriform space, nasal dorsum and radix, and cheek.

Conclusions

The Balance injection technique for hyaluronic acid filler administration may help the achievement of East Asian-specific beauty standards of contour, angle, and proportion. Further study is required to confirm the findings of this pilot study.

Considerations for Proper Use of Hyaluronidase in the Management of Hyaluronic Acid Fillers

Effective management of complications from hyaluronic acid (HA) fillers is crucial in aesthetic medicine. This article examined the role of hyaluronidase in addressing adverse effects associated with HA fillers, such as nodules, vascular occlusions, and excessive volume. It highlights the enzyme's ability to degrade HA, thereby resolving issues that may arise from filler treatments. The discussion includes practical aspects of using hyaluronidase, such as recommended dosing, injection techniques, and potential risks. The benefits of hyaluronidase, including its rapid action in dissolving problematic fillers and its role in improving patient outcomes, are explored. The article also addresses limitations and safety considerations to provide a comprehensive understanding of hyaluronidase in the context of filler complications. By offering insights into the application and effectiveness of hyaluronidase, this article aimed to enhance practitioners' ability to manage HA filler-related issues effectively and ensure optimal results in aesthetic procedures.

Facial Skin Quality Improvement After Treatment With CPM-HA20G: Clinical Experience in Korea

BACKGROUND

Intradermal injection of CPM-HA20G, a low-viscoelasticity hyaluronic acid (HA) dermal filler with glycerol, has been shown to be effective for facial rejuvenation in Caucasians, but research in Asians is limited.

AIMS

This study aimed to evaluate the effectiveness and safety of CPM-HA20G in enhancing facial skin quality in Korean women using a protocol developed by local aesthetic experts.

PATIENTS/METHODS

In this 24-week prospective, single-arm, open-label study, 20 women received CPM-HA20G injections in the immediate subdermal layer on the anterior cheek (1 mL per side; total 2 mL) in three sessions every 4 weeks. Evaluations included biophysical assessments covering the four emergent perceptual categories (EPCs) for skin quality and subjective assessment using the Global Aesthetic Improvement Scale.

RESULTS

Significant improvements in skin glow (skin gloss, epidermal hydration), skin firmness (dermal elasticity, dermal hydration), skin surface evenness (average pore volume, pore area, pore density, pore count, maximum pore depth, total pore volume, skin roughness, sebum secretion, and skin depression volume), skin tone evenness (skin color brightness, skin redness), and transepidermal water loss were observed at Week 12 and Week 24 following the first injection with CPM-HA20G. Most subjects and investigators reported improvements in overall aesthetic appearance with the treatment, with a 100% improvement rating from both groups at Week 12. No serious adverse reactions were observed.

CONCLUSIONS

Our study provides real-world insights into the effectiveness and safety of CPM-HA20G in improving facial skin quality in an Asian population, evaluated through both objective and subjective assessments.

[Forehead injections: Anatomy, techniques, products]

Knowledge of anatomy not only allows optimal treatment and therefore full satisfaction of our patients, but is also fundamental in the prevention of complications. A thorough understanding of aging allows for effective treatments, as most patients demand a natural result, removing the inevitable signs of aging, which can only be understood by considering their aging. Facial aging is a natural but complex multifactorial process, particularly for the forehead. In this article, we will focus on botulinum toxin as well as fillers in aging.

ViSCNOVAS: A Novel Classification System for Hyaluronic Acid-Based Gels in Orthobiologic Products and Regenerative Medicine

Hyaluronic acid (HA), a naturally occurring polysaccharide, holds immense potential in regenerative medicine due to its diverse biological functions and clinical applications, particularly in gel formulations. This paper presents a comprehensive exploration of HA, encompassing its origins, molecular characteristics, and therapeutic roles in gel-based interventions. Initially identified in bovine vitreous humor, HA has since been found in various tissues and fluids across vertebrate organisms and bacterial sources, exhibiting consistent physicochemical properties. The synthesis of HA by diverse cell types underscores its integral role in the extracellular matrix and its relevance to tissue homeostasis and repair. Clinical applications of HA, particularly in addressing musculoskeletal ailments such as osteoarthritis, are examined, highlighting its efficacy and safety in promoting tissue regeneration and pain relief. Building upon this foundation, a novel classification system for HA-based interventions is proposed, aiming to standardize treatment protocols and optimize patient outcomes. The ViSCNOVAS classification system refers to viscosity, storage, chain, number, origin, volume, amount, and size. This classification is specifically designed for HA-based orthobiologic products used in regenerative medicine, including orthopedics, sports medicine, aesthetics, cosmetic dermatology, and wound healing. It aims to provide clinicians with a structured framework for personalized treatment strategies. Future directions in HA research are also discussed, emphasizing the need for further validation and refinement of the proposed classification system to advance the field of regenerative medicine. Overall, this manuscript elucidates the biological functions of hyaluronic acid and its potential in clinical practice while advocating for standardization to enhance patient care in various regenerative applications.

Chin Augmentation and Treatment of Chin Retrusion with a Flexible Hyaluronic Acid Filler in Asian Subjects: A Randomized, Controlled, Evaluator-Blinded Study

BACKGROUND

Aesthetic improvement of the chin is increasingly requested by patients, including those of Chinese origin.

METHODS

A randomized, evaluator-blinded, no-treatment controlled study evaluated the effectiveness and safety of a flexible hyaluronic acid (HA) filler, Restylane® DefyneTM (HADEF), in the correction of chin retrusion in a Chinese adult population over 12 months after treatment. On Day 1, subjects were randomized 3:1 into two groups, HADEF or delayed-treatment controls, and those in the HADEF group were administered treatment. An optional touch-up treatment was administered 1 month after treatment to obtain optimal chin augmentation. The initially untreated control group was offered delayed-treatment after 6 months (including 1-month touch-up).

RESULTS

HADEF was superior to no-treatment in improving chin retrusion according to the blinded evaluator at 6 months [Galderma Chin Retrusion Scale (GCRS) responder rate (≥ 1-point improvement from baseline) of 81% vs. 5% for untreated controls; p < 0.001, meeting the primary effectiveness objective. A majority of subjects maintained improvement at 12 months (61% in the HADEF group). All subjects reported satisfaction with results at 6 months after treatment with HADEF and aesthetic improvement rates per the global aesthetic improvement scale (GAIS) were high for 12 months following treatment, with an acceptable safety profile.

CONCLUSIONS

These results demonstrated HADEF to be effective and safe for the correction of mild-to-moderate chin retrusion in Chinese subjects, confirming findings previously observed in a western population.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of facial artery course variations, diameters, and depth by Doppler ultrasonography

BACKGROUND

The facial artery (FA) is the main blood vessel supplying blood to the face. It is essential to understand the anatomy of FA around the nasolabial fold (NLF). This study aimed to provide the detailed anatomy and relative positioning of FA to help avoid unexpected complications in plastic surgery.

METHODS

FA was observed from the inferior border of the mandible to the end of its terminal branch in 66 hemifaces of 33 patients with Doppler ultrasonography. The evaluation parameters were: (1) location, (2) diameter, (3) FA-skin depth, (4) relationship between the NLF and FA, (5) distance between the FA and significant surgical landmarks, and (6) the running layer. The FA course is classified based on the terminal branch.

RESULTS

The most common FA course was Type 1, which had an angular branch as the final branch (59.1%). The most common FA-NLF relationship was that the FA was situated inferior to the NLF (50.0%). The mean FA diameter was 1.56 ± 0.36 mm at the mandibular origin, 1.40 ± 0.37 mm at the cheilion, and 1.32 ± 0.34 mm at the nasal ala. The FA diameter on the right hemiface was thicker than that on the left hemiface (p < 0.05).

CONCLUSION

The FA mainly terminates in the angular branch, running in the medial NLF and in dermis and subcutaneous tissue, with a blood supply advantage in the right hemisphere. We suppose that a deep injection into periosteum around the NLF may be safer than an injection into the superficial musculoaponeurotic system (SMAS) layer.

The Rheology and Physicochemical Characteristics of Hyaluronic Acid Fillers: Their Clinical Implications

Hyaluronic acid (HA) fillers have become the most popular material for facial volume augmentation and wrinkle correction. Several filler brands are currently on the market all around the world and their features are extremely variable; for this reason, most users are unaware of their differences. The study of filler rheology has become a wellspring of knowledge, differentiating HA fillers, although these properties are not described thoroughly by the manufacturers. The authors of this review describe the more useful rheological properties that can help clinicians understand filler characteristics and the likely correlation of these features with clinical outcomes.

Chin Augmentation With Hyaluronic Acid: An Injection Technique Based on Anatomical Morphology

BACKGROUND

Chin augmentation with hyaluronic acid (HA) injections can effectively improve mental appearance.

OBJECTIVE

To introduce a HA injection technique for chin augmentation and evaluate its clinical effects.

METHODS

A total of 326 patients who received HA injection for chin augmentation from January 2018 to May 2021 were retrospectively reviewed. All patients were injected with the technique according to the anatomical morphology of the chin using a needle and cannula. Patient data were collected, the effects were analyzed, and adverse reactions were observed and recorded.

RESULTS

There were 326 patients involved in this study with a mean age of 26.4 years. The median volume of HA injected was 1.85 mL. The shape and contour of the chin was significantly improved in all patients immediately after injection. Most improvements were retained up to 6 months and partial improvements remained visible for 12 months. Swelling and pain occurred in 284 patients (87.1%), local ecchymosis occurred in 31 patients (9.5%), and asymmetry was found in 8 patients (2.5%). There were no other complications such as infection, embolism, necrosis, nodule, or witch's chin. All patients reported satisfaction with results of the HA injections.

CONCLUSION

Injection of HA according to the anatomical morphology of the chin is a safe and effective technique for chin augmentation and results in high patient satisfaction.

Expert recommendations on the assessment and management of complications due to hyaluronic acid soft tissue filler injections in Asians

BACKGROUND

The use of hyaluronic acid (HA) fillers for medical aesthetic purposes is increasing worldwide. Nonetheless, adverse events do occur because of patient-specific issues, injection technique, or product factors. It would be mandatory to consider cultural and anatomical features of Asians in preventing and managing the complications of HA injections.

METHODS

Literature search of studies looking at current evidence and guidelines on the management of complications following HA filler injections in Asian patients was conducted. This was followed by an expert group discussion that was convened to reach consensus recommendations on the best clinical practices.

RESULTS

The expert panel provided specific recommendations focusing on the safe use of soft tissue fillers in Asian patients, including early identification of adverse events and how to prevent and comprehensively manage these outcomes.

CONCLUSIONS

Here, we provide consensus statements of Asian experts in dermatology, plastic surgery, ophthalmology, and aesthetic medicine mainly focusing on AEs with higher risk for Asians and can be used to guide physicians in treating Asian population.