Male Rejuvenation: Injectables.

The use of injectables can effectively treat the areas of greatest facial esthetic concern in males. Due to significant differences in the facial anatomy of men compared to women, treatment strategy, dosage, and technique differs. This article will review the pharmacology, preparation, pertinent anatomy, technique, risks, and adverse events associated with injectable agents emphasizing unique differences in male anatomy and esthetics.

Personalized Research on the Aging Face-A Narrative History.

Throughout history, people have struggled to find out the secret of youth. The aim of the manuscript is to review the main achievements regarding the exploration of the aging face phenomenon. It should be very important to know the evolution in this field due to the increase in life expectancy among the population. Our purpose is for the current study to serve as a starting point towards exploring novel research avenues in molecular biology and the confocal immunofluorescence of cervicofacial soft tissues, employing cutting-edge techniques. All changes in the shape of the facial skeleton, soft tissue, retaining ligaments, fat compartments, and the skin envelope contribute to facial aging to varying degrees.

A proof of concept: Clinical anti-aging efficacy and safety of Lactiplantibacillus plantarum LB244R® applied topically in a double-blinded placebo-controlled study.

BACKGROUND: With the increasing age of the westernized population, there is also increasing economic and aesthetic interest in reducing the signs of skin aging. Additionally, the physical aspect of aging can be displeasing and have detrimental effects psychologically in individuals. Probiotics have shown potential as anti-aging agents, albeit proper studies are needed to confirm their potential. AIMS: Proving that Lactiplantibacillus plantarum LB244R® could alleviate aging signs relative to its placebo vehicle. PATIENTS/METHODS: In total, 46 subjects were randomly assigned either the ointment with live bacteria, L. plantarum LB244R® or its vehicle ointment, and had to use the assigned ointment twice daily for 56 days. On Day 0, Day 28, and Day 56 subepidermal low echogenic band (SLEB) thickness, dermal density, skin firmness and elasticity, skin hydration, transepidermal water loss (TEWL), skin pH, collagen fiber visualization using confocal microscopy, Crow's feet, spot score, skin smoothness, and complexion radiance were assessed by dermatologists. RESULTS: All parameters except TEWL improved relative to their baseline (D0) for the active group. L. plantarum LB244R® improved SLEB thickness, dermal density, skin elasticity, skin hydration, and Crow's feet wrinkle score relative to the placebo vehicle ointment. CONCLUSION: The study demonstrates an anti-aging effect of L. plantarum LB244R® for topical skin use in the first double-blinded, vehicle-ointment placebo-controlled clinical study.

Rejuvenation in Men Facial Aging: A Combined Approach.

Facelift surgery, also known as rhytidectomy, is a popular cosmetic procedure aimed at reversing the signs of facial aging. While facelift surgery is more commonly performed in women, an increasing number of men are seeking this procedure to maintain a youthful appearance. The long recovery period conflicts the overall primary outcome anticipated by men undergoing rhytidectomy, i.e., appear younger, youthful, and ready to reaffirm their value in the working environment. Anterior direct neck lift, blepharoplasty (upper and lower eyelid blepharoplasty), and lipofilling are three techniques that have been shown to be effective in improving facial rejuvenation outcomes in elderly male patients. However, there is little to no evidence of the safety and efficacy of these techniques when used in combination. By combining these techniques, we hypothesized that we could achieve outcomes comparable to traditional facelift surgery, but with a lower risk of complications and a shorter recovery time. We conducted a retrospective case series study of 18 male patients who underwent facial rejuvenation surgery using the combination of anterior direct neck lift, blepharoplasty (upper and lower eyelid blepharoplasty), and lipofilling at our institution between 2018 and 2021. All 18 patients completed the study, with an average follow-up of 12 months. No major complications were observed, and all patients reported a high level of satisfaction with their outcomes.Level of Evidence IV 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 .

A new easy technique to identify the correct artificial hair implantation site: A case series and preliminary results.

BACKGROUND: The implantation of artificial hair is a successful standardized procedure to restore bald areas or scarred alopecic surfaces of the scalp in both sexes. MATERIALS AND METHODS: Sebometric measurements were taken, pre, 1, 3, and 6 months postimplant in two symmetric frontotemporal areas of the scalp of seven volunteers to be implanted with 50 units of artificial hair. The artificial hair used in this study are Biofibre 4.0 produced by Medicap srl, Italy. RESULTS: The dermaroller assisted procedure was performed only on one side, and the plain random implant contralaterally for comparison. A marked downregulation of the sebum concentration was observed in the dermaroller treated area 1, 3, and 6 months later in respect to the control side. CONCLUSION: The dermaroller assisted procedure is safe and effective in reducing the foreign body reaction by the sebaceous glands and the vascular axis injured by the implanting needle; a longer standing success of the implanted hair can thus be achieved reducing the burden of inflammatory reaction.

Evaluation and Treatment Planning for the Aging Face Patient.

Facial aging is a multifactorial process that occurs due to alterations in the skin, soft tissue, and bony skeleton. When considering treatments for the aging face and neck, a multifaceted approach targeting each of these areas should be considered. Although surgical intervention remains a key component to the holistic care of the aging face patient, a multitude of minimally invasive techniques is now available to optimize the care of the patient seeking rejuvenation. Proper patient evaluation and counseling on realistic expectations are critical and will be discussed here. A brief overview of common minimally invasive treatments will be presented.

Mastering Midface Injections.

Injectable filler is one of the most common cosmetic procedures performed annually. An aging face shows a characteristic loss of volume in the deep fat pads of the midface. The goal of midfacial rejuvenation with injectable filler is to restore lost volume, with the suborbicularis fat pad and deep medial cheek fat being the most critical areas. Filler can be instilled here with a cannula or needle with successful outcomes. However, this procedure is not without complications if proper technique and underlying anatomy are not respected.

Retrospective real-world study of Definisse threads for jaw line reshaping in Indian patients (REDEFINE JAW study).

BACKGROUND: Thread lifting is a minimally invasive aesthetic procedure that lifts and realigns sagging tissue. Definisse double-needle threads are the latest fourth generation absorbable, monofilament, suspension barbed threads of synthetic origin with convergent bidirectional barbs. Definisse thread produces dual action; mechanical action gives a lifting effect and over a period, it promotes histological revitalizing action. OBJECTIVES: To evaluate the real-world efficacy and safety of Definisse double-needle threads for lower facial lifting for jaw line reshaping in Indian patients. METHODS: This is an observational, retrospective study involving patients who underwent treatment for lower-face reshaping using Definisse double-needle 12 cm threads. RESULTS: Fifty patients with a mean age of 47.44 years were included in the study with an average follow-up of 5.14 months. All the patients have undergone Jawline Reshaping (JR) procedure, while 70% of patients also underwent Malar Reshaping (MR) technique simultaneously. Mean of Physician and Subject Global Aesthetic Improvement Scale (PGAIS and SGAIS) showed improvement immediately after the procedure (mean scores 2.82 and 2.7, respectively) and showed further improvement at the follow-up (3.72 and 3.58, respectively). Moreover, most of the patients immediately after the procedure rated the improvement in PGAIS and SGAIS as "much improved" compared to pre-procedure appearance (78% and 66%, respectively), while, at follow-up, 76% and 66% of the patients, respectively, rated "improved very much" compared to pre-procedure appearance. CONCLUSION: Current study has demonstrated the effectiveness of the latest Definisse threads in Indian patients in performing tissue repositioning to provide a noticeable lifting effect. Procedure was also well tolerated and none of the patients developed serious complications.

Cheek wrinkles revisited: Etiological classifications and nonsurgical treatment options.

BACKGROUND: Wrinkles are one of the key signs of an aging face. Cheek wrinkles have a prominent negative impact on facial aesthetic. Recognizing the pathology and types of different cheek wrinkles, and the possible minimal invasive interventions to treat them, are crucial for optimal aesthetic outcome. OBJECTIVE: The classification of cheek wrinkles based on etiology, past literature, and wrinkle pattern, and the outlining of possible treatment options. RESULT: Five different types of cheek wrinkles are described: Type 1-Atrophic cheek wrinkles, Type 2-dynamic expressional cheek wrinkles, Type 3-static expressional cheek wrinkles, Type 4-laxity cheek wrinkles, and Type 5-sleep cheek wrinkles. Treatment options and techniques for different types of cheek wrinkles are recommended accordingly.

The Study of a Validated Assessment Scale for a Localized Submental Fat Volume.

BACKGROUND: This aim of this study was to develop an objective tool for rating submental fat applied to Koreans. METHODS: The study was conducted between April 2019 and October 2019. A total of 92 subjects were enrolled in the study. Clinical photos of the subjects were categorized using validated CR-SMFRS by three plastic surgeons and one dermatologist. The categorized photos were then shown to six different plastic surgeons for evaluation. RESULTS: The Cohen's kappa value for the six raters were 0.830, 0.742, 0.703, 0.907, 0.862, and 0.793 with statistical significance (p < 0.001). ICC value was between 0.860 and 0.966 (p < 0.001). Since the Cohen's value and ICC were above 0.6 for all raters, the ratings performed by all six raters were used in the analysis. The ICC values between raters were between 0.899 and 0.902. CONCLUSIONS: We came up with a set of reference photos that can be used for submental fat rating scale applicable to Korean subjects. LEVEL OF EVIDENCE: II.

Facial Soft Tissue Ptosis: A Quantitative Analysis using 3d Facial Scan App For iPhone.

Although the modifications of the aging face have been widely described, to our knowledge, there are no studies that quantitatively analyze the degree of soft tissues facial ptosis. Using a specific iPhone application, the faces of a heterogeneous group of volunteers were scanned and studied with the aim to virtually measure the entity of facial ptosis.Two facial scans, upright and supine, were performed by using the Bellus3D Face app for iPhone in a sample of 60 volunteers. We virtually superimposed the two scans, and then, we calculated the discrepancy between them through the Geomagic Design X 3D software. A multivariate regression statistical model was used to analyze the correlation between the mean discrepancy values compared to three main variables: age, BMI and gender. Mean ptosis increases with age (coeff. = 0.02; 95% CI = 0.01-0.02, p < 0.001), BMI (coeff. = 0.03; 95% CI = 0.01-0.05; p < 0.001) and has been found higher in females (female versus male: coeff. = 0.22; 95% CI = 0.13-0.31; p < 0.001). The method we used allowed us to measure the degree of ptosis, and to make a complete morphological study of the effect of gravity on the facial surface in a very accurate, low cost and easily reproducible way.

Evaluation and Treatment Planning for the Aging Face Patient.

Facial aging is a multifactorial process that occurs due to alterations in the skin, soft tissue, and bony skeleton. When considering treatments for the aging face and neck, a multifaceted approach targeting each of these areas should be considered. Although surgical intervention remains a key component to the holistic care of the aging face patient, a multitude of minimally invasive techniques is now available to optimize the care of the patient seeking rejuvenation. Proper patient evaluation and counseling on realistic expectations are critical and will be discussed here. A brief overview of common minimally invasive treatments will be presented.

Mastering Midface Injections.

Injectable filler is one of the most common cosmetic procedures performed annually. An aging face shows a characteristic loss of volume in the deep fat pads of the midface. The goal of midfacial rejuvenation with injectable filler is to restore lost volume, with the suborbicularis fat pad and deep medial cheek fat being the most critical areas. Filler can be instilled here with a cannula or needle with successful outcomes. However, this procedure is not without complications if proper technique and underlying anatomy are not respected.

Effectiveness of jawline, jaw angle, and marionette lines correction in combination with double needles threads (APTOS) and a collagen-stimulating dermal filler (ELLANSE): An innovative technique.

INTRODUCTION: Facial aging is a multifactorial process in which considerable changes occur in different face structures. Thread lifting is one of the most common minimally invasive treatments related to facial rejuvenation. This study aimed to evaluate the efficacy and safety of jawline, jaw angle, and marionette lines correction in combination with APTOS threads and ELLANSE M types through an innovative technique. MATERIALS AND METHODS: In this prospective chart review study, 50 patients with ptosis candidates for lower face correction were included between October 2019 and February 2020. To perform correction of the jawline, jaw angle, and marionette lines, APTOS thread (LLN2GS) and ELLANSE M type were used through an innovative technique. The efficacy (6 and 12 months after the surgery) and safety (1, 6, and 8 weeks after the surgery) were assessed by two surgeons independently. Data were analyzed by SPSS ver. 22 for windows (IBM Inc.). RESULTS: In this study, 50 patients (4 male and 46 female) with Mean ± SD age of 53.84 ± 10.79 years old (Range: 42 years) were included. Regarding the results, patients' level of satisfaction (improved to excellent levels) increased from 74% at 6 months after the surgery to 86% at 12 months after the surgery. Moreover, the level of satisfaction obtained from surgeons (improved to excellent levels) decreased from 96% to 86% at 6 and 12 months after the surgery, respectively. Based on the results, there were substantial and perfect agreements between the surgeon and the independent surgeon to evaluate the surgery efficacy of facial rejuvenation 6 and 12 months after the surgery. No side effects were reported 6 and 8 weeks after surgery. CONCLUSION: Regarding the results, due to rare complications, deep satisfaction, and short downtime, the correction of the lower face in combination with APTOS thread (LLN2G) and ELLANSE M type through our innovative technique be considered an efficient and safe treatment.

Three-Dimensional Photogrammetric Study on Age-Related Facial Characteristics in Korean Females.

BACKGROUND: Understanding the age-related morphological changes of facial soft tissue is fundamental in achieving improved outcomes of rejuvenating procedures. Three-dimensional (3D) photogrammetry is a reliable and convenient anthropometric tool to assess facial soft tissue. OBJECTIVE: The aim of this study was to establish age-related facial soft tissue morphology in Korean adult females using non-invasive 3D photogrammetry. METHODS: One hundred and ninety-two female participants were divided into three groups based on age: the younger group (aged 20~39 years), middle group (40~59 years), and older group (60~79 years). Thirty-six landmarks were identified via 3D photogrammetric scanning (Morpheus 3D, Morpheus Co., Ltd., Seongnam, Korea). Forty-one facial dimensions were analyzed using the imaging software to find significance between the age groups. RESULTS: Smaller upper-facial volume (p=0.019) and shorter upper-facial height (p=0.034) were observed in the older group than in the younger group. In the mid-face, narrowed palpebral fissure (p<0.001) with elongated upper eyelid height (p<0.001) and widened nose (p<0.001) were observed in the older group compared with the younger group. Longer lower-facial height (p<0.001) with longer and wider philtrum (p<0.001, p=0.004, respectively), shorter lower vermilion height (p<0.001), wider mouth width (p<0.001), and smaller lower vermilion angle (p<0.001) were seen in the older group when compared with the younger group. Moreover, greater angles of nasofrontal, nasomental, and labiomental angle (p=0.015, p=0.015, p=0.080, respectively), and smaller nasofacial angle (p=0.034) were observed in the older group than in the younger group. CONCLUSION: Our results provide clues of aging-related facial morphological characteristics in Korean female population.

Superficial and Deep Facial Anatomy and Its Implications for Rhytidectomy.

The relationship of the skin, the superficial and deep fat compartments, and the ligaments that connect these structures is key to performing any rhytidectomy. In order to successfully mobilize, elevate, and reposition the facial soft tissues, a detailed understanding of facial anatomy is required. This article details the anatomy of the midface and neck that is essential to understanding and performing the face-lift operation.

From the Deep-Plane Rhytidectomy to the Vertical Platysma Advancement.

This article provides the facial plastic surgeon with anatomic and embryologic evidence supporting use of the deep-plane technique and understanding the evolution of the technique over decades to the vertical platysma advancement for optimal treatment of facial aging. The original description of the deep-plane rhytidectomy described a basic subsuperficial musculoaponeurotic system dissection in the midface. This plane of dissection provides access to deeper anatomic structures. A detailed description of the procedure is provided to allow safe and consistent performance. Insights into anatomic landmarks, technical nuances, and alternative approaches for facial variations are presented.

Thermistor-controlled subdermal skin tightening for the aging face: Clinical outcomes and efficacy.

OBJECTIVE: Patients are increasingly seeking nonsurgical treatment for the aging face. The purpose of this study was to evaluate the clinical efficacy and outcomes of a thermistor-controlled subdermal skin tightening device (ThermiTight) as a treatment modality for the aging face. METHODS: A retrospective analysis of 12 patients was completed on patients having undergone ThermiTight for midface and neck skin tightening. Only five patients had a greater than 1 year follow-up and were included in the study. Two blinded reviewers assessed photographs taken pre-procedure and 1 year post-procedure using a standardized skin laxity scale. Patient charts were reviewed to assess for complications up to 12 months post-treatment. RESULTS: The mean age of included patients was 57 years, and all five patients were female. One (20%) patient treated with ThermiTight was also treated with injectables (Botox, Juvéderm) simultaneously. One (20%) patient developed a wound complication. One (20%) patient complained of incisional site pain at her first postoperative visit that subsequently self-resolved. On a five-point scale to assess facial skin laxity, there was an average improved score of 0.85 per patient (P < .001) at one year post-procedure. Two blinded reviewers correctly categorized photographs as either being "baseline" or "post-procedure" 100% of the time. There was no significant difference between the skin laxity scores by the blinded reviewers (P = .05). CONCLUSION: ThermiTight is a new technology used for nonsurgical treatment of the aging face. Long-term outcomes demonstrate the safety and efficacy of the procedure. Complications are rare, but possible, in the use of ThermiTight. Level of Evidence: 3.

Evaluating the Safety and Efficacy of a Highly Viscous 33-mg/mL Hyaluronic Acid Volumizing Filler in the Treatment of Facial Wrinkles: An Open-Labeled, Clinical Trials.

BACKGROUND: The 33-mg/mL hyaluronic acid (HA) formulation is a highly concentrated, cross-linked, cohesive, smooth, and completely reversible volumizing filler approved by Conformité Européene. For the first time, we aimed to evaluate the long-term efficacy and safety of the 33- mg/mL HA filler for soft tissue augmentation in the treatment of facial wrinkles. MATERIALS AND METHODS: After optimal wrinkle correction was achieved in the patients undergoing treatment by injecting the 33-mg/mL HA filler at the injection site plus one touch-up at a 2-week interval, the safety and efficacy of the filler were assessed on the 5-point Facial Volume Loss Scale through the 1-year study period. Patients were evaluated daily for 14 days and after 6 and 12 months post-treatment. RESULTS: A total of 86 subjects were treated. The mean wrinkle scores of the patients were 3.95+0.79 (range of 3-5) before treatment, 2.3+0.94 (range 1-5) six months after treatment, and 2.93+1.29 (range of 1-5) one year after treatment. Clinically significant mean wrinkle correction (P=0.001) was still evident at>12 months of treatment through 33-mg/ mL HA formulation. A clinically significant correction at>12 months after treatment was maintained by 79% of patients. Nodule formation and swelling were more frequent when the 33- mg/mL HA filler was used compared with the use of less concentrated HA fillers. One patient developed angioedema-like swelling and induration last few months. CONCLUSION: The 33-mg/ mL HA filler can provide long-term correction lasting for one year or more. Adverse effects, especially swelling and nodule formation were more common in this filler compared with less concentrated HA fillers. The side effects were correlated with the volume of the injected filler. We recommend using this concentration with low volume or combining high volume with lower concentration.

Difficult Necks and Unresolved Problems in Neck Rejuvenation.

Neck rejuvenation attempts to correct the unattractive features that result from the process of facial aging. The aesthetic goals of surgery include creating a well-defined jaw contour, optimal cervicomental angle, smooth-appearing skin, and a healthy redistribution of soft tissue volume. Unique patient characteristics create inherent challenges that may limit the degree to which improvement can be made. Psychological expectations and motivations influence patient satisfaction and must be understood through careful evaluation and counseling. This article describes common difficult situations encountered during neck rejuvenation and discusses unresolved problems. Several clinical examples along with specific surgical solutions are included.