aUniversity of South Florida Department of Dermatology & Cutaneous Surgery, Tampa, FL bCosmetic Dermatologist and Mohs Surgeon, Bradenton, FL
becomes effaced and attened, and the philtral columns lose definition.10 Lip augmentation needs to be performed correctly, recreating Cupid’s bow and adding volume to the lips without giving them a sausage appearance (Figure 2). Upper cutaneous lip rejuvenation using neuromodulators and fillers can soften perioral rhytides and redefine the philtral columns. Sagging cheeks can result from fat and bone loss in the mid face. The cheek can be resculpted by either injecting filler or by using resorbable polyglycolide/L-lactide (PLGA) suspension sutures with bidirectional cones that reposition the tissue and stimulate collagen formation to add back volume. Repositioning the cheeks can also improve the appearance of the lower face, thus minimizing the interventions that will need to be performed in this area. Marionette lines and more prominent pre-jowl sulci result from volume loss in the lower third of the face and can give the appearance of a frown. Injection of fillers, such as calcium hydroxylapatite, can replace lost volume, soften these lines, and be used to turn the corners of the mouth upward, giving patients their smiles back (Figure 3). The mandibular sweep can also be recreated to hide sagging jowls by injecting filler, such as calcium hydroxylapatite, along the angle of the jaw and in front of the jowl. In contrast, platysmal bands, as well as horizontal neck lines, which have started to appear in even younger people as a result of looking down at one’s phone while texting, are best treated using neuromodulators. Even if patients have aesthetic procedures to improve their facial appearance, their hands, which can appear skeletonized due to volume loss if left untreated, can provide a clue to their true age. Injecting calcium hydroxylapatite using a blunt-tipped cannula can reshape a skeletonized hand and give the hands a more youthful appearance (Figure 4). Newer innovations, including the aforementioned PLGA sus- pension sutures, have allowed dermatologists to expand their aesthetic repertoire. Deoxycholic acid injections can be used to reduce submental fat and sharpen the cervicomental angle (Figures 5 and 6). Radiofrequency energy can be used for a variety of applications, since heat from the injectable cannula can stimulate collagen production beneath the skin, as well as shrink brous septae and melt fat at higher target temperatures.
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