Facial Contouring With Fillers, Neuromodulators, and Lipolysis to Achieve a Natural Look in Patients With Facial Fullness

December 2016 | Volume 15 | Issue 12 | Original Article | 1536 | Copyright © December 2016

Chytra Anand MD

Kosmoderma Clinics, Bangalore, India

BACKGROUND: The desire for and use of nonsurgical injectable esthetic facial treatments is on a rise in Asia. Recent advances, including more versatile facial fillers, refined injection techniques, and adoption of a global facial approach, have in turn contributed to improved patient outcomes and increased patient satisfaction. The sought after nonsurgical treatments include the use of botulinum toxin, con- touring of the face with soft tissue fillers, and thinning of the face with injection lipolysis. AIM:To achieve a leaner, oval face shape with smooth contours. METHODS: A combination technique was applied, whereby narrowing of face was achieved with use of botulinum toxin, contouring with soft tissue llers, and thinning the face with injection lipolysis. Treatments were applied on 15 women aged between 25 and 40 years and observed with follow up for 12 weeks. Hyaluronic acid (HA)-based dermal fillers (Perlane, Voluma, and Juvederm), botulinum toxin type A (Botox), and a lipolytic solution of phosphatidylcholine with deoxycholate (Dermastabilion, Aesthetic Dermal, Spain) were used to achieve a natural look in these patients with a fuller appearance of the face. The procedure was performed to reduce the facial width using botulinum toxin type A and the reduction of submental and cheek fat by injecting lipolysis injection. RESULTS: All the women (n = 15) had edema for up to 2 weeks after undergoing lipolysis; however, two patients had edema for 3 weeks. After injecting the patient with botulinum toxin type A, no adverse event was observed; however, after using HA-based filler, one patient was observed to have bruising on the chin. CONCLUSION: Use of HA-based fillers, neuromodulators (botulinum toxin), and injectable lipolytics are well-tolerated and are effective nonsurgical modalities to achieve facial recontouring for slimming of the face. J Drugs Dermatol. 2016;15(12):1536-1542.


Fullness of the facial tissue and submental fat is a major concern of individuals, especially in the Indian population.1 It has been widely observed that some Indian women have a higher amount of soft tissue in the face, especially in the mid face area.2 It has also been stated that people with a round face have relatively shorter chin than others.3 Thus, the facial structure varies among different populations, races, and places of habitat due to various environmental factors govern- ing the individuals along with their food habits.4,5 Food habits, mainly the consumption of fat, lead to an increase in the full- ness of the face and as a result of this fat deposition, especially in the submental region, the face appears broader or round.6 Moreover, due to different aesthetic preferences among ethnic groups and cultures,7 varying facial anatomy, morphology, and skin tones, it has been observed that an oval face with rounded contours is more preferred by Indians than broad or round contours.2,7,8 The structural and morphological features specific to the In- dian face lead to a need for unique Indian esthetic treatment strategies.7 Despite the increasing popularity of injectable treat- ments such as procedures with a mixture of botulinum toxin and hyaluronic acid (HA)-based llers worldwide,7,9 only a few articles have described their combined use in Indian popula- tions in detail.10–12 However, discovery of these predictable and safe injectable agents has increased their use, and understand- ing of their role in the facial contouring eld.13 This has helped practitioners to upgrade their skills from previously used ‘two-dimensional’ treatment strategies for reduction of facial lines in aging to the use of injectable treatments for creating three-dimensionality to achieve facial esthetic restructuring and rejuvenation in patients of all ages.14 Studies conducted in the past have widely reported the domi- nance of surgical techniques in the eld of facial rejuvenation, as they were the only way to attain three-dimensional changes.15 The significance of volume restoration was recently recognized and, in many cases, it has taken priority over two-dimensional lifting using the scalpel. Moreover, surgical procedures have also been reported to result in apparent loss of volume.16 Re- cent studies have shown the preferred use of botulinum toxin and HA-based llers over surgical techniques in the facial rejuvenation field.14 According to the 2006 report of American Society of Aes- thetic Plastic Surgeons, HA-based dermal llers are the most