Quantitative evaluation of volume augmentation in the tear trough with a hyaluronic Acid-based filler: a three-dimensional analysis.

BACKGROUND: Despite the prevalent use of hyaluronic acid-based filling materials for facial soft-tissue augmentation and favorable reports of durability in the infraorbital region, no quantitative data exist on the long-term durability of these products following injection. This study represents the first attempt to use three-dimensional imaging to quantify augmentation achieved and duration of effect with one hyaluronic acid product in the tear trough. METHODS: The authors conducted a prospective, blinded case series in a clinical setting. One non-animal stabilized hyaluronic acid material was used to augment 20 tear troughs to address cosmetic deficiency in this region. Patients were followed long term with three-dimensional imaging. Posttreatment and pretreatment images were compared, volume change was calculated at each time point, and percentage change between immediate and long-term posttreatment was evaluated. All measurements and calculations were performed independent of the injector. RESULTS: Residual effect from the hyaluronic acid product was demonstrable on three-dimensional imaging in 100 percent of tear troughs augmented in this study at the final follow-up visit. Average follow-up was 14.4 months (range, 8.5 to 22.75 months). Average initial augmentation measured by three-dimensional imaging was 0.21 cc per site. Average maintenance of effect for patients at the final follow-up visit was 85 percent. CONCLUSIONS: The long-term durability of a small gel particle-based hyaluronic acid in the tear trough is substantiated for the first time in an objective, quantitative fashion using three-dimensional imaging for evaluation of volumetric facial rejuvenation. Three-dimensional photographic imaging offers clinicians a precise and expeditious method for quantitatively evaluating volumetric changes in the face, and represents a significant advance in technology for studying the effects of facial aging.

Volume loss versus gravity: new concepts in facial aging.

PURPOSE OF REVIEW: The earliest techniques of facial rejuvenation have been continuously adapted to reflect changes in the understanding of the aging face. Significant, paradigm-shifting advances in this understanding have been made in recent years which have allowed application of specific therapeutic modalities, resulting in dramatically improved results over those achieved with traditional facial rejuvenation. RECENT FINDINGS: Pioneering work by several authors has shown that gravity is not the sole determinant of the aging face. These authors have demonstrated that volume loss, including that of soft tissue and bone, is at least equally important in the pathogenesis of the stigmata of aging. Rejuvenative techniques developed to reverse these atrophic changes have exhibited outstanding results. The consequence is an increasing emphasis on the use of volume restoration procedures to address the aging face. SUMMARY: Recent improvements in the understanding of the facial aging process have brought about newly refined techniques for facial rejuvenation, ushering in a new era of plastic surgery for the aging face which is being manifested by increasingly natural results.