Background Microfocused ultrasound with visualization has become one of the more popular nonsurgical facial rejuvenation therapies available. Although the treatment has gained wide acceptance, providing adequate pain relief during the procedure can be challenging. Objectives The aim of this study was to test our hypothesis that nerve blocks prior to treatment would be well tolerated and significantly reduce patient discomfort. Methods Subjects undergoing microfocused ultrasound were offered the choice of participating in a split face nerve block, bilateral block, or a control group. Nerves targeted included infraorbital, supratrochlear, supraorbital, zygomaticofrontal, mental, great auricular, and cervical plexus. Pain assessment was based on a 10-point Wong-Backer FACES Pain score. Results A total of 65 patients were included in the study: 28 in the split face group, 19 in the bilateral block group, and 18 without a block. The mean [standard deviation] pain score of the bilateral block cohort was 3.9 [1.2], and that of the control group was 5.1 [1.7] (P = 0.001). Patients in the split face cohort reported a higher pain score on the unblocked side of the face (7.5 [1.3]) than on the blocked side (2.9 [1.0]) (P < 0.001). The mean pain score for local anesthetic injection was 2.7 and 1.4 for the split face and the bilateral groups, respectively. There were no adverse events. Conclusions Nerve blocks are well tolerated and significantly improve patient comfort during microfocused ultrasound treatment without compromising outcomes or increasing adverse events. Level of Evidence: 2

Background Perioral rhytids are a bothersome sign of aging for many patients. While multiple treatments exist, choosing an optimal modality may be difficult taking into consideration that rhytids in this region are fine and the anatomy dynamic. Objective To compare the efficacy and safety, and patient satisfaction of a small-particle hyaluronic acid filler with 0.3% lidocaine (SP-HAL, Restylane Silk®) and cohesive polydensified matrix hyaluronic acid filler (CPM-HA, Belotero Balance®) in reducing uperficial perioral rhytids. Methods The study was double-blinded, and 48 subjects with moderate to severe superficial perioral rhytids were enrolled. Subjects were randomized to receive either CPM-HA in the left perioral region and SPHAL in the right, or vice versa. Rhytid severity was measured by patients using a linear analog scale, and for investigators a validated 5-point scale, for 180 days following treatment. Results Both SP-HAL and CPM-HA achieved a reduction in rhytid severity, and neither treatment group returned to baseline after 180 days. Investigator-reported scores for rhytid severity were significantly better for SP-HAL compared to CPM-HA and remained so at 180 days (p < 0.05). SP-HAL also proved significantly better for reducing rhytids according to patient scores, although this difference occurred between 120 and 180 days only. Adverse events included rash and mild acne for CPM-HA, while SP-HAL was associated with one post-inflammatory nodule and two occurrences of Tyndall effect. Conclusion While both SP-HAL and CPM-HA are effective at reducing perioral rhytid severity and have similar safety profiles, SP-HAL possesses a longer duration of effect.

There are many treatments for neck laxity and fullness, both invasive and noninvasive. The purpose of this study was to evaluate the effectiveness of combined infrared, radiofrequency, mechanical massage, and suction therapy in performing contour changes in the submental and lateral neck regions. This was a single-center, prospective cohort study in which 30 patients were treated with a session of combined infrared, radiofrequency, mechanical massage, and suction therapy once a week for 4 weeks. Follow-up was performed at posttreatment months 1, 3, and 6. Both subjects and investigators completed submental fat grading scales and lateral neck and jowl linear analog scales. Exclusion criteria included history of soft tissue augmentation, cosmetic injections, ablative or nonablative skin resurfacing, or surgical procedures in the lower facial region, as well as weight gain or loss exceeding 10 pounds during the study period. There was a significant difference between mean ± SD neck and jowl investigator scores at day 0 and month 6, which were 5.6 ± 0.9 and 4.4 ± 1.0, respectively ( P < .05). Mean investigator submental fat score at day 0 was 1.9 ± 0.7 vs 1.5 ± 0.6 ( P = .04) at month 6. Differences between mean patient neck and jowl and submental fat scores were also statistically significant between day 0 and month 6. At day 0, the mean patient neck and jowl score was 4.7 ± 0.8 vs 3.2 ± 1.1 at month 6 ( P < .05), and at day 0, the mean patient submental fat score was 2.2 ± 0.5 vs 1.8 ± 0.6 at month 6 ( P < .05). Combined infrared, radiofrequency, mechanical massage, and suction therapy provides an effective, noninvasive treatment modality for improving contour of the lateral neck and submentum.