INTRODUCTION
Facial appearance is a defining hallmark of identity and self-confidence.1, 2 Changes in skin quality, such as the loss of elasticity and decreased dermal thickness, in addition to alterations in fat pads, muscle, and bone, contribute to structural remodeling in the aging face.3,4 These changes influence self-perception and are often the primary motivation for patients seeking out facial rejuvenation.
In most cases, intrinsic facial aging occurs in a predictable chronological pattern. Loss of volume in the malar, perioral and pre-mental regions is an early and common phenomenon of aging. Volume loss in the periocular area and temples is also commonly observed, especially in cases of weight loss or more advanced facial aging. In this study we present seven case vignettes highlighting volume restoration in the malar and perioral region to illustrate how product selection, in addition to individual techniques, guide our injection practices in two different aesthetic markets.
CASE VIGNETTES
Midface Volume Replacment
Patient 1 (Juvéderm Voluma® XC)
A 42 year-old woman presented complaining of volume loss in the cheek area due to a rapid reduction in weight after a recent pregnancy. She was not breastfeeding at the time of injection. She had never been treated with any dermal fillers in the deep malar region but had been injected in the nasolabial folds 1 month previously with 1 mL of Volift® 0.5 mL for each nasolabial fold with a threading technique. The patient was injected with Juvéderm Voluma XC, 1 mL per zygomatico-malar zone in microboluses using a serial puncture technique with the supplied 27G x 1†needle in both the deep supra periosteal and deep dermal planes. No topical anaesthesia was needed. The treatment was well tolerated with minimal trauma and no significant post-procedure swelling (Figure 1).
Patient 2 (Juvéderm® Volift® with lidocaine)
A 43 year-old woman presented for correction of the deepening of her nasolabial folds. She had been treated 6 months previously for the same complaint by another physician with hyaluronic acid (1 mL of Restlylane®) without satisfaction. At the time of her visit, she requested a longer-lasting and more natural appearing treatment than the previous one. She was injected with Juvéderm Volift with lidocaine 1 mL (0.5 mL per side using a 30G x ½†needle in the deep dermis with a linear threading technique). Minimal post-injection bleeding was easily controlled (Figure 2).
Patient 3 (Restylane- L®)
A 40 year-old woman presented 5 months after her first dermal
