Perioral Rejuvenation: A Prospective, Quantitative Dynamic Three-Dimensional Analysis of a Dual Modality Treatment

Abstract

Background The perioral region is the most dynamic anatomic area of the face and subject to complex and dramatic changes during aging. Successful treatment for perioral rejuvenation has yet to be identified, and prior studies have reported only subjective outcomes. Objectives The purpose of this study was to utilize our validated dynamic 3-dimensional imaging technology to determine whether conservative neuromodulation combined with hyaluronic acid filler volumization can decrease perioral strain and increase volume with significant patient satisfaction. Methods An IRB-approved prospective study of a dual modality treatment for perioral rhytids was performed on females with perioral aging who had not had prior facial treatment within the past year. Eighteen (18) units of Dysport were injected into the upper and lower orbicularis oris and 1 cc of Restylane Silk was injected in volume-depleted perioral regions in each patient. Each patient underwent imaging with digital image correlation (DIC) and completed the FACE-Q survey prior to injection and at 14 days and 90 days postinjection. Results Thirty-two female patients were recruited. A significant reduction in perioral strain was observed at both day 14 and day 90. This was concomitant with a significant increase in perioral volume at day 14 that at 90 days was significantly retained in the marionette lines. Further, there was a significant improvement in patient satisfaction with overall facial appearance at day 14 that was maintained at 90 days. Conclusions Conservative neuromodulation and hyaluronic acid filler volumization of the perioral region produces a significant reduction in strain correlating with high patient satisfaction, even at 90 days. This dual modality treatment is effective in rejuvenating the perioral region, and its future optimization will provide greater therapeutic options for this anatomically complex area. Level of Evidence: 4

Use of AbobotulinumtoxinA for Cosmetic Treatments in the Neck, and Middle and Lower Areas of the Face: A Systematic Review

“…A total of 625 papers were identified in the electronic database searches; 65 duplicate papers were excluded before citation screening and 510 papers were excluded during citation screening ( Figure 1 ). There were no relevant studies identified in the supplementary searches, and 40 of the remaining 50 papers were excluded during full-text review, leaving 10 studies (three observational studies [OSs] [ 21 , 22 , 23 ], five non-randomized controlled trials [ 24 , 25 , 26 , 27 , 28 ] and two studies reporting data from one randomized controlled trial [RCT] [ 29 , 30 ]) included in the SLR. In the included studies, sample size ranged from 10 to 383 patients, mean age was 32.8 to 55.9 years and percentage of female participants was 92.7% to 100% across six studies that reported gender.…”

“…In the included studies, sample size ranged from 10 to 383 patients, mean age was 32.8 to 55.9 years and percentage of female participants was 92.7% to 100% across six studies that reported gender. Three studies were conducted in Brazil [ 22 , 29 , 30 ], two in Lebanon [ 24 , 26 ], two in the USA [ 21 , 27 ] and one each in South Korea [ 25 ], Taiwan [ 28 ] and Thailand [ 23 ]. Six of the studies looked at aboBoNT-A injections in various parts of the middle and lower regions of the face for the treatment of various conditions, including lower eyelid wrinkles, nasal wrinkles, platysmal bands at rest and at maximal contraction and marionette lines [ 23 , 24 , 26 , 27 , 29 , 30 ].…”

“…Three studies were conducted in Brazil [ 22 , 29 , 30 ], two in Lebanon [ 24 , 26 ], two in the USA [ 21 , 27 ] and one each in South Korea [ 25 ], Taiwan [ 28 ] and Thailand [ 23 ]. Six of the studies looked at aboBoNT-A injections in various parts of the middle and lower regions of the face for the treatment of various conditions, including lower eyelid wrinkles, nasal wrinkles, platysmal bands at rest and at maximal contraction and marionette lines [ 23 , 24 , 26 , 27 , 29 , 30 ]. Of the remaining four studies, two looked at patients that received injections in the masseter muscles [ 25 , 28 ], one looked only at treatments for excessive gingival display (gummy smile) [ 22 ] and one looked at injections in the platysma muscle only [ 21 ].…”

“…Treatment approaches are summarized, by study, in Table 1 , and by indication, in Table 2 and Figure 2 . All except one study [ 27 ] included approaches to toxin dilution. In eight studies, aboBoNT-A was diluted in saline to produce concentrations ranging from 70 to 250 U/mL (most often 2 or 2.5 mL normal saline to dilute 500 U of aboBoNT-A) for different indications ( Figure 2 ) [ 21 , 22 , 23 , 24 , 25 , 26 , 29 , 30 ].…”

A modified method for corner mouth lift in scar-prone patients

“…We introduced a new CML technique to reduce postoperative scarring and reported our results. A considerable amount of research has been performed on aging lips, and lip surgery has mainly been conducted as an ancillary procedure in facial rejuvenation [5]. A traditional facelift may improve jowl and marionette lines to a certain extent.…”