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Background: This study evaluates the efficacy of reverse and antegrade thread lifting vectors in conjunction with thread selection for correcting nasolabial folds and marionette lines, aiming to enhance treatment precision and effectiveness. Methods: Three female patients aged 43, 48, and 53, presenting with primary concerns regarding nasolabial folds, underwent distinct treatment regimens utilizing various types of threads and vectors. Additionally, video demonstrations were recorded to showcase the procedural techniques employed in each case. Results: The outcomes of the thread lifting procedures demonstrated significant improvements in the correction of the nasolabial fold and marionette line. Conclusion: Innovative thread insertion techniques involve entry points above the zygomatic arch and threading toward the temple hairline for lateral face lifting. These utilize barbs to pull skin and underlying tissues. The reversal technique involves inserting threads in a criss‐cross pattern, forming a fibrous structure that may prolong the duration of results. Various thread combinations, considering factors such as composition, thickness, and barb size, provide customized procedures. This research introduces clinical applications, including temple area hairline lifting for nasolabial fold and marionette line correction, reverse vectors targeting nasolabial folds and marionette lines, and antegrade approaches from the lateral side. [ABSTRACT FROM AUTHOR]

The midface is a key area in facial aesthetics, highly susceptible to age-related changes such as fat pad absorption, bone resorption, and loss of skin elasticity. These changes lead to the formation of prominent folds, such as the nasolabial fold. In addition, critical vascular structures and non-vascular components, such as the facial artery, angular artery, and parotid gland, make this region prone to complications during filler injections. High-frequency ultrasound (HFUS) offers real-time, radiation-free visualization of facial anatomy, enabling injectors to accurately target the desired treatment planes and avoid critical structures. This article is the second in a series of articles on ultrasound-guided facial injections and focuses on the midface. It provides a detailed overview of the sonographic anatomy of key areas, including the nose, tear trough, nasolabial fold, zygomatic, and preauricular regions. Step-by-step techniques for ultrasound-guided filler injections are described, emphasizing the importance of scanning both before and during injections to ensure safe filler placement. By using ultrasound in this area, injectors can possibly minimize risks such as vascular occlusion and other complications, such as the Tyndall effect and intra-parotid injection. With ongoing advancements, ultrasound-guided injections are expected to become more refined, enhancing both aesthetic outcomes and patient safety. [ABSTRACT FROM AUTHOR]

Background: Injection cosmetics have become popular in recent years. The nasolabial fold is one of the most important and dangerous regions in the midface, and its three-dimensional relationship with the facial artery remains unclear. Methods: Fifty-two cadavers infused with lead oxide contrast medium via the external carotid arteries were scanned by computed tomography (CT). The three-dimensional model was reconstructed using Mimics and Origin software, and the relevant data were calculated using validated algorithms. Results: There were three facial artery types according to its course in relation to the nasolabial fold. In the most common type, accounting for 83.7% of specimens, the facial artery evolves into an angular artery, with a horizontal distance between facial artery and nasolabial fold of − 1.90 ± 2.40, − 3.90 ± 2.95, − 5.18 ± 3.42, − 5.59 ± 3.53, − 5.59 ± 3.83, − 6.07 ± 4.10, − 6.92 ± 3.70, − 6.79 ± 3.37, − 4.52 ± 3.20, and − 2.76 ± 3.60 (mm) from the nasal ala to the oral commissure and a vertical distance of − 4.03 ± 2.56, − 3.27 ± 2.27, − 2.81 ± 2.57, − 2.1 ± 2.64, − 1.5 ± 3.32, − 0.71 ± 3.99, 0.92 ± 4.43, 0.4 ± 5.31, − 4.14 ± 5.14, − 7.05 ± 4.74 (mm). Conclusions: The facial artery is vulnerable to damage when injecting filler in the nasolabial fold. For the upper 1/3 of the nasolabial fold, the supraperiosteal layer is recommended for injection, while for the lower 2/3 of the nasolabial fold, the dermal layer along the nasolabial fold is recommended. 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 http://www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Hypersensitivity to the new dermal injectable porcine-based collagen with lidocaine featuring a novel cross-linking technology (test filler) for nasolabial fold correction was compared to the commercially available traditional cross-linked dermal injectable porcine-based collagen with lidocaine (control filler). Methods: Recruited participants (n = 279) received a single 0.1 mL intradermal injection of either test filler or control filler in the left forearm as a screening skin allergy test. Injection sites were assessed clinically at 24 h post-implant. Treatment was given to 252 successfully screened participants, and injection sites were monitored for 21 days. Immunological examinations were performed at screening and then at 4 and 24 weeks post-treatment. Observations for adverse events continued until the 52nd week. Results: Intradermal allergy testing results were negative for all the test recipients (0/124) and positive for two control recipients (2/132, 1.5%). Most of the participants exhibited no changes in serum immunoglobulin (IgG, IgM) and complement (C3, C4) levels. No serious adverse events related to the device were recorded. Most adverse events were common complications of dermal filler treatment and were related to the injection site. Most adverse effects were resolved or under control by 52 weeks. Conclusions: Hypersensitivity reactions with the test filler were lower than those with the control filler, validating the safe use of test filler for nasolabial fold correction without the need for pretreatment skin testing. [ABSTRACT FROM AUTHOR]

Background: Hyaluronic acids (HAs) can have very different actions not only depending on injector and host factors but also depending on their molecular weight. Whereas short chain HA has immunological activity long chain HA influences fibroblasts and may stimulate them to produce collagen. Although this is generally thought to be a positive feature it may be disadvantageous in certain localizations. Patients and Methods: We have encountered 23 patients who developed fibrous tissue next to the nasolabial folds accentuating them and becoming very obvious while smiling. Hyaluronidase injection did not reduce this mass. Results: Intralesional triamcinolone acetonide injection led to rapid improvement. Discussion: Fibrotic tissue reaction not responding to hyaluronidase may be the result of HA injection and can effectively be treated with intralesional steroid injection [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to establish the relationship of facial artery with nasolabial fold by color Doppler sonography and to determine facial artery variations and their relationship with age, gender, or hemifaces. Methods: The study included 188 patients (94 women, 94 men) aged 18–60 years. Overall, 376 facial arteries in both hemifaces were evaluated for the course within nasolabial fold, symmetry, and relationship with gender. Results: The mean age of the patients was 39.29 ± 12.81 years. Type A (55.7%) was the most common type in both hemifaces. There was no significant relationship between the course of facial artery and age (P >.05). Asymmetrical course of facial artery was more common in females (54.3%). In both genders, type A was the type with highest symmetry detected. Conclusions: Nasolabial fold is one of the important facial regions for filler injection. To prevent vascular injection, course of facial artery should be identified within the nasolabial fold. Type A was the most common type in both hemifaces and genders. Although the rates were close to each other, asymmetry in the course of the facial artery was observed in most of the patients. Ultrasonographic examination which is non‐invasive and non‐ionizing imaging method can be performed carefully before filler injection to determine vascular tissues. [ABSTRACT FROM AUTHOR]

The classification of nasolabial folds into three types, each with distinct causative factors and mechanisms, is explored. Age-related changes in facial skin and connective tissues are examined in detail, revealing variations across different facial regions due to variances in tissue firmness and thickness. The innovative 'Reverse Technique,' involving cog threads to enhance tissue traction and effectiveness in thread-lifting procedures, is introduced. Detailed technical guidelines, anatomical considerations, and safety measures are provided, emphasizing the importance of identifying optimal vectors and fixing points to achieve maximum lifting effects while minimizing potential risks, particularly those associated with vascular structures. Additionally, the 'Cross Technique using volumizing thread' is discussed, designed to smooth tissue boundaries and rejuvenate sagging areas. Facial anatomy, including the positioning of arteries and ligaments, is underscored as essential for ensuring the safety and efficacy of procedures. In conclusion, this review stands as a comprehensive guide for practitioners, offering insights into innovative thread-lifting methods and their applications in addressing nasolabial folds. The primary focus is on achieving optimal aesthetic results while prioritizing patient safety. [ABSTRACT FROM AUTHOR]

The midface is a key area in facial aesthetics, highly susceptible to age-related changes such as fat pad absorption, bone resorption, and loss of skin elasticity. These changes lead to the formation of prominent folds, such as the nasolabial fold. In addition, critical vascular structures and non-vascular components, such as the facial artery, angular artery, and parotid gland, make this region prone to complications during filler injections. High-frequency ultrasound (HFUS) offers real-time, radiation-free visualization of facial anatomy, enabling injectors to accurately target the desired treatment planes and avoid critical structures. This article is the second in a series of articles on ultrasound-guided facial injections and focuses on the midface. It provides a detailed overview of the sonographic anatomy of key areas, including the nose, tear trough, nasolabial fold, zygomatic, and preauricular regions. Step-by-step techniques for ultrasound-guided filler injections are described, emphasizing the importance of scanning both before and during injections to ensure safe filler placement. By using ultrasound in this area, injectors can possibly minimize risks such as vascular occlusion and other complications, such as the Tyndall effect and intra-parotid injection. With ongoing advancements, ultrasound-guided injections are expected to become more refined, enhancing both aesthetic outcomes and patient safety.

Background and Objective: The deepening of the nasolabial fold (NLF) is a common occurrence during the aging process, necessitating the development of an objective method to evaluate changes in NLFs. The objective of our study was to introduce a method of depth deviation based on three‐dimensional (3D) image for evaluating the efficacy of hyaluronic acid (HA) injection in correcting NLFs. Methods: Between May 2019 and November 2019, we recruited 56 Chinese volunteers with moderate to severe NLFs for this study. The participants received HA injections and were followed up for a period of 12 months. Pre and posttreatment, we collected the Wrinkle Severity Rating Scale (WSRS) scores and 3D images. To assess the efficacy of NLF correction, we used the maximum value of depth deviation (MVD) based on 3D images and the Global Aesthetic Improvement Scale (GAIS) score. Additionally, we compared the relationship between MVD and other clinical parameters. Results: Fifty‐four female participants completed the study and were included in the analysis. The HA injection resulted in a significant decrease in NLF severity (p < 0.05). One month after the injection, the average GAIS score was 4.72 ± 0.45, and the average MVD was 2.10 ± 0.56 mm. Both the GAIS score and the average MVD exhibited a decline over time during the follow‐up period, with the average MVD showing a significant correlation with the GAIS score at all time points (p < 0.05). Conclusions: Using 3D technology, we demonstrated that the quantitative data provided by MVD can serve as an objective method for evaluating the correction of NLFs. [ABSTRACT FROM AUTHOR]

The article titled "A Two-Center, Prospective, Randomized Controlled Trial to Evaluate the Efficacy and Safety of and Satisfaction with Different Methods of ART FILLER® UNIVERSAL Injection for Correcting Moderate to Severe Nasolabial Folds in Chinese Individuals," authored by Feng et al. in Aesthetic Plastic Surgery, aims to compare two hyaluronic acid (HA) injection techniques for enhancing nasolabial folds: the conventional injection method and the ligament injection method. However, concerns have arisen regarding the methodology employed in this study. Having a precise understanding of the properties of the active substance is crucial for treatment standardization. It is imperative to comprehensively grasp the key characteristics of the employed HAs to determine any potential correlation between these properties, outcomes, and the likelihood of complications. Understanding HA's rheological properties, including viscosity, elasticity, and cohesiveness, is essential for selecting the most appropriate facial filler. While recognizing the authors' contributions, we firmly believe that further analysis should encompass these factors. Level of Evidence V 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. [ABSTRACT FROM AUTHOR]

Kenneth Beer,1 Brian Biesman,2 Sue Ellen Cox,3 Stacy Smith,4 Laura Picault,5 Patrick Trevidic6 1Beer Dermatology, West Palm Beach, FL, USA; 2Private Practice, Nashville, TN, USA; 3Aesthetic Solutions, Chapel Hill, NC, USA; 4California Dermatology & Clinical Research Institute, Encinitas, CA, USA; 5Teoxane Clinical Development Department, Genève, Switzerland; 6Expert 2 Expert, Paris, FranceCorrespondence: Patrick Trevidic, Expert 2 Expert, 7 Rue de Sontay, Paris, 75116, France, Tel +33 145 016 415, Fax +33 145 008 981, Email patrick.trevidic@orange.frPurpose: Cannulas are increasingly used for injecting hyaluronic acid fillers, as they are thought to improve patient comfort safety and treatment tolerability. This study aimed to demonstrate the non-inferiority of a Resilient Hyaluronic Acid 4 (RHA 4) filler injected with a cannula versus a needle for the treatment of moderate to severe nasolabial folds (NLF).Patients and Methods: A total of 50 subjects were included in a randomized, evaluator-blinded, split-face trial. The NLF were injected with RHA 4 using a cannula on one side of the face and using a needle on the other side on Day 0. A touch-up could be performed 4 weeks later. The subjects were followed up for 12 weeks after the last injection, ie, injection on Day 0 or touch-up. Efficacy was evaluated using a Wrinkle Severity Rating Scale (WSRS), the Global Aesthetic Improvement Scale (GAIS), and patient-reported outcomes. Safety assessments included the injection-site pain, common treatment reactions (CTRs), and adverse events (AEs).Results: Twelve weeks after the last injection, the efficacy of the cannula treatment was found to be non-inferior to that of the needle treatment, based on the WSRS score improvements. The other study endpoints showed the equivalent efficacy and safety of the two methods. No serious or unexpected AEs were reported.Conclusion: RHA 4 may be effectively and safely injected into the NLF using a cannula or a needle, provided it is administrated by a trained practitioner.Keywords: cosmetic techniques, hyaluronic acid, injections, nasolabial fold, treatment outcome

The facial artery (FA) is the main blood vessel supplying blood to the face. It is essential to understand the anatomy of FA around the nasolabial fold (NLF). This study aimed to provide the detailed anatomy and relative positioning of FA to help avoid unexpected complications in plastic surgery. FA was observed from the inferior border of the mandible to the end of its terminal branch in 66 hemifaces of 33 patients with Doppler ultrasonography. The evaluation parameters were: (1) location, (2) diameter, (3) FA-skin depth, (4) relationship between the NLF and FA, (5) distance between the FA and significant surgical landmarks, and (6) the running layer. The FA course is classified based on the terminal branch. The most common FA course was Type 1, which had an angular branch as the final branch (59.1%). The most common FA-NLF relationship was that the FA was situated inferior to the NLF (50.0%). The mean FA diameter was 1.56 ± 0.36 mm at the mandibular origin, 1.40 ± 0.37 mm at the cheilion, and 1.32 ± 0.34 mm at the nasal ala. The FA diameter on the right hemiface was thicker than that on the left hemiface (p < 0.05). The FA mainly terminates in the angular branch, running in the medial NLF and in dermis and subcutaneous tissue, with a blood supply advantage in the right hemisphere. We suppose that a deep injection into periosteum around the NLF may be safer than an injection into the superficial musculoaponeurotic system (SMAS) layer. [ABSTRACT FROM AUTHOR]

Background: Hyaluronic acid is the most popular dermal filler in the treatment of nasolabial folds. Injection methods vary among physicians. Methods: A randomized, two-center, double-blind, intraindividual trial was designed to compare a new method of injecting ART FILLER® UNIVERSAL using the retaining ligament with the traditional method (linear threading and bolus injection) in moderate to severe nasolabial folds. Forty patients with moderate to severe nasolabial folds were randomized into groups A and B. Group A received injections via the traditional method on the left side and the ligament method on the right side, while group B received the reverse. Clinical efficacy and patient safety were independently assessed by a blinded evaluator, the injector, using the Wrinkle Severity Rating Scale (WSRS), the Global Aesthetic Improvement Scale (GAIS), and the Medicis Midface Volume Scale (MMVS) at 4 weeks (before and after the touch-up injection), 8 weeks, 12 weeks, and 24 weeks after the baseline injection. Results: From the perspective of the blinded evaluator, the improvements in WSRS scores from baseline did not differ significantly between the ligament method (0.73 ± 0.61) and the traditional method (0.89 ± 0.61) at week 24 (p > 0.05). The mean GAIS score at week 24 was 1.41 ± 0.49 for the traditional method and 1.32 ± 0.47 for the ligament method (p > 0.05). Conclusions: The efficacy and safety of the ligament method for the management of nasolabial folds are comparable to those of the traditional method in terms of WSRS and GAIS score improvement in the long run. The ligament method is superior to the traditional method in that it improves midface deficits with fewer adverse events. Level of Evidence II: 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. Clinical Trial Registration: This study was registered with the Chinese Clinical Trial Registry under the registration number ChiCTR2100041702. [ABSTRACT FROM AUTHOR]

Introduction: The propeller flap taken from the nasolabial flap is well suited for the medial canthal reconstruction. The propeller flap used in one-stage reconstruction is suitable for maintaining the normal concavity of the medial canthus; however, sometimes, the use of the propeller flap can lead to various complications. Aim: In this research article, we aimed to investigate the results of repairing the medial canthus defect using a propeller flap from the nasolabial fold. Materials and Methods: This study was a descriptive and cross-sectional research. We performed this retrospective study with the participation of 37 patients with medial canthal defects who underwent surgical treatment at a research and training hospital in the past 3 years. Data were obtained from the electronic medical records. In patients with medial canthal defects, the results of patients reconstructed with a propeller flap taken from the nasolabial fold were observed. Results: Of the patients, 37.8% were between 65 and 74 years old, and 59.5% were male. 83.8% of the medial defects resulted from the excision of basal cell carcinoma. After repair of the medial canthal defect, venous stasis developed in 8.1% of patients and trapdoor deformity in 13.5% of patients. Patients who developed venous stasis recovered without intervention, and those with trapdoor deformity underwent surgical intervention again. Smokers had a higher risk of venous stasis, and women had a higher risk of developing trapdoor. Conclusion: Successful patient outcomes after surgery are very important in the repair of medial canthal defects. The use of the propeller flap has produced excellent results. However, it is very important to stop smoking during the perioperative process. We recommend more detailed studies in larger sample groups on the development of the trapdoor in women. We conclude that the propeller flap taken from the nasolabial fold is effective and safe in the medial canthal reconstruction. [ABSTRACT FROM AUTHOR]

Nasolabial folds (NLFs) are the most pronounced sign of facial aging. This study explored the efficacy and safety of polycaprolactone gel in treating Chinese patients with moderate-to-severe NLFs. Patients with moderate-to-severe NLF who wished to be treated by dermal fillers were recruited from three centers between July 2017 and September 2019. The randomizing ratio was 1:1 in the polycaprolactone group (polycaprolactone injection) or control group (sodium hyaluronate gel injection). The primary endpoint was the effectiveness rate of Wrinkle Severity Rating Score (WSRS) scores at 12 months after injection. The full-analysis set (FAS) and safety sets had 80 patients in the polycaprolactone group and control group, respectively. In the FAS, the effectiveness rate at 12 months in the polycaprolactone group was 88.8% compared with 23.8% in controls (P < 0.001). The improvement in WSRS sustained during 12 months in the polycaprolactone group, while gradually vanished in the control group since 3 months after surgery. The global aesthetic improvement scale (GAIS) by investigator assessments was improved, much improved, or very much improved in all patients during follow-up, while the proportion of patients with a "no change" assessment gradually increased during follow-up after 6 months in the control group. The rates of injection-related adverse event (AE) and serve injection-related AE were 8.8 versus 11.3% and 0 versus 1.3% in the polycaprolactone group and control groups, respectively. Polycaprolactone gel injection is effective and safe to treat moderate-to-severe NLFs in Chinese patients. [ABSTRACT FROM AUTHOR]

The classification of nasolabial folds into three types, each with distinct causative factors and mechanisms, is explored. Age-related changes in facial skin and connective tissues are examined in detail, revealing variations across different facial regions due to variances in tissue firmness and thickness. The innovative ‘Reverse Technique,’ involving cog threads to enhance tissue traction and effectiveness in thread-lifting procedures, is introduced. Detailed technical guidelines, anatomical considerations, and safety measures are provided, emphasizing the importance of identifying optimal vectors and fixing points to achieve maximum lifting effects while minimizing potential risks, particularly those associated with vascular structures. Additionally, the ‘Cross Technique using volumizing thread’ is discussed, designed to smooth tissue boundaries and rejuvenate sagging areas. Facial anatomy, including the positioning of arteries and ligaments, is underscored as essential for ensuring the safety and efficacy of procedures. In conclusion, this review stands as a comprehensive guide for practitioners, offering insights into innovative thread-lifting methods and their applications in addressing nasolabial folds. The primary focus is on achieving optimal aesthetic results while prioritizing patient safety.

(1) Background: Asians tend to have a regressive midface. Midface augmentation is an effective treatment, and various materials have been used as fillers for this purpose. Bio-Oss bone powder has a strong positive effect on promoting new bone regeneration, and has been used in the dental field for over 30 years. However, it has not been used and reported as a filler in midface augmentation. (2) Objective: To evaluate the safety and efficacy of midface augmentation using Bio-Oss bone powder in treating midface retrusion and resulting nasolabial folds, and to develop a predictive model for patient satisfaction. (3) Methods: 85 patients underwent midface augmentation through an intraoral approach with Bio-Oss. Treatment efficacy was assessed by blinded investigators. The data on safety were collected from patient interviews at each follow-up visit. A questionnaire was used for investigating patient satisfaction. The influencing factors of satisfaction were analyzed by univariate and multivariate analysis. A nomogram to predict the risk of dissatisfaction was built based on significant factors with R software. Results: Compared to baseline, there was a significant improvement (p < 0.001) in Wrinkle Severity (4) Rating Scale scores at week 24, with a mean decrease of 0.52 ± 0.57. The aesthetic improvement rate evaluated by the Global Aesthetic Improvement Scale was 92.9%. Four mild treatment-related adverse events were noted. The majority of patients were satisfied overall. A nomogram with good prediction performance was plotted. (5) Conclusions: This new procedure yielded safe and satisfactory aesthetic results. A nomogram with good test performance and discriminative ability was established for predicting patient satisfaction. [ABSTRACT FROM AUTHOR]

A 51-year-old man was referred for a skin defect with paresthesia and decreased pain in his right ala. He had a history of herpes zoster infection 3 weeks previously. Excisional biopsy and culture showed no evidence of skin malignancy or infection. He was diagnosed with trigeminal trophic syndrome (TTS) after herpes zoster infection. A two-stage folded nasolabial flap was used to reconstruct the defect. The patient was satisfied with the cosmetic outcomes of surgery, and there was no evidence of recurrence during the follow-up. TTS, a rare skin condition that presents with paresthesia, anesthesia, and facial ulceration, occurs after trigeminal nerve injury, which can be caused by herpes zoster infection in rare cases. TTS is an often-persistent condition with a high recurrence rate, causing cosmetic problems. Some surgical methods have been attempted, but our case presents the first use of a folded nasolabial flap to treat TTS. The flap was symmetric, without any nostril collapse. It is also noteworthy that the outcome was excellent with only a skin flap that did not use a bony framework. Herein, we report a rare case of TTS that occurred after herpes zoster infection and was successfully treated with a folded nasolabial flap.

Carlo Di Gregorio,1 Gerd Gauglitz,2 Jackie Partridge3 1Plastic Surgery Unit Clinica Candela, Palermo, Italy; 2Haut- und Laserzentrum im Glockenbachviertel, Munich, Germany; 3The Aesthetic Consultancy, Edinburgh, ScotlandCorrespondence: Carlo Di Gregorio, Plastic Surgery Unit Clinica Candela, via Villareale 54, Palermo, 90141, Italy, Tel +39 91 586592, Email cdigregorio@hotmail.comPurpose: Patients seeking treatment for the midface are individuals with different objectives and characteristics of skin and soft tissue. In this study, patients were treated in the midface with one of three products with different properties; HARV, HARD, or HARL, using a treatment algorithm based on primary need for treatment (volumizing, lifting or contouring) and tissue coverage (thin or thick tissue). The aim was to optimize the treatment outcome and to provide an individualized treatment approach that distinguishes different types of patients seeking midfacial treatment.Materials and Methods: Subjects were treated in the midface at baseline to achieve optimal aesthetic results (≤ 2 mL per side of the face), and touch-up was allowed after 4 weeks (≤ 1 mL per side of the face). Study visits were scheduled at Weeks 8, 16 and 24. Assessments included aesthetic improvement of the midface, evaluation of midface fullness, and subject satisfaction. Safety evaluations included local tolerability symptoms collected at 4 weeks after treatment and adverse events.Results: A total of 90 subjects were included in the study, mean age was 45 years (range 29– 55) and 82% of subjects were female. Mean total injected volume for the products was 4.4 mL (HARV and HARL) and 4.2 mL (HARD). At least 92% of subjects were assessed as aesthetically improved throughout the study. Assessment of midface fullness showed ≥ 90% of subjects being responders until Week 24. In addition, subject satisfaction was high throughout the study. Tenderness, bruising and swelling were the most reported local tolerability symptom for all study products, and no adverse events related to study product/treatment were reported.Conclusion: Midface treatment with either HARV, HARD, or HARL using a treatment algorithm to guide the choice of product to individual subject needs was effective and safe for up to 24 weeks after treatment.Keywords: aesthetic improvement, MMVS, subject satisfaction, natural-looking, nasolabial fold, safety

Background: Facial morphology changes with aging, producing an aged appearance, but the mechanisms involved are not fully established. We recently showed that subcutaneous fat infiltrates into the dermal layer with aging, but it is not yet clear whether and how this drastic change of the dermal layer influences facial appearance. Purpose: We aimed to establish the role of fat infiltration in producing an aged facial appearance and to clarify the mechanism involved. Methods: We analyzed the severity of fat infiltration in cheek skin of 30 middle‐aged female volunteers by means of ultrasonography. Severity of the nasolabial fold, an established age‐related morphology, was evaluated based on our photographic grading criteria as a measure of aged appearance. Skin elasticity was measured with a Cutometer. Results: Fat infiltration to the dermal layer was detected at the cheek skin noninvasively by means of ultrasonography. Fat infiltration severity, measured as the minimum depth of the fat inside the dermal layer from the skin surface, was positively correlated with the magnitude of the nasolabial fold. Further, fat infiltration severity was significantly negatively correlated with dermal elasticity. Conclusions: Our results suggest that fat infiltration into the dermal layer is a critical factor inducing aged appearance of the face. The infiltrated fat decreases the dermal elasticity, which exacerbates nasolabial folds, namely producing an aged facial appearance. [ABSTRACT FROM AUTHOR]

Background: Restylane Defyne (HARD, with lidocaine) has been shown to be effective and safe for facial augmentation including nasolabial folds (NLFs) in Caucasians. Incorporating lidocaine in injectable fillers has become a common practice that improves the patient's experience. Objectives: To evaluate efficacy and safety of HARD compared to Restylane (HAR, the gold standard HA filler) for correction of NLFs in a Chinese population. Methods: In this 12‐month, randomized, split‐face, evaluator‐blinded study of the efficacy and safety of treatment of NLFs with HARD or HAR, Chinese adults (n = 173) with moderate or severe wrinkle severity of both NLFs received treatment with HARD on one NLF, and HAR on the opposite NLF. Results: The primary objective was met: WSRS response rates at Month 6 (i.e., ≥1‐grade improvement according to the blinded evaluator) were similar (72.9% and 72.8% for HARD and HAR, respectively). HARD was non‐inferior to HAR; the 95% CI for the difference in response rates was −5.7% to 5.5%. Likewise, products were effective and comparable in terms of reduced wrinkle severity of NLFs and improved Global Aesthetic Improvement Scale (GAIS) score (according to the blinded evaluator and subject) throughout the study. Both products were well‐tolerated, and injection of the lidocaine‐containing product (HARD) was less painful. Conclusions: HARD was non‐inferior to HAR for treatment of moderate‐to‐severe NLFs at 6 months post‐treatment. Overall, the results from this study indicate that HARD is safe and effective up to 12 months in a Chinese population. [ABSTRACT FROM AUTHOR]

Background: Nasolabial fold (NLF) reveals the aging of the face, and various treatments for NLF have been developed currently. However, most methods introduced to evaluate NLF are subjective and qualitative. Objectives: This study was aimed to establish and validate a quantitative evaluation method by three-dimensional imaging, and thus accordingly to determine the relationship between quantitative measurements and wrinkle severity rating scale (WSRS) score. Methods: Seventy-five Asian female volunteers were enrolled for evaluating the severity of NLF based on both WSRS score and three-dimensional imaging. Three-dimensional imaging was used to collect the quantitative measurements of NLF, including length, width, and depth. The relationship between multiple WSRS scores and quantitative measurements was compared statistically. Besides, thirty patients with moderate or severe NLF were admitted to receive hyaluronic acid injection for NLF correction. All NLFs were evaluated quantitatively pre-injection and 3 months post-injection. Results: The results revealed a statistically significant positive relationship between the WSRS score and the length, width, and depth of NLF, respectively. After 3 months of hyaluronic acid injection, the mean WSRS score, the length, width, and depth of NLF were significantly reduced. Conclusions: Three-dimensional imaging can be used to quantitatively assess the severity of the nasolabial folds, compensating for the deficiencies of traditional scales. This technique may help improve rejuvenation procedures for the aging nasolabial fold. 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. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the efficacy and safety of Cutegel ® MAX (Cutegel) in the correction of moderate-to-severe nasolabial folds (NLFS) compared to Restylane ® (Restylane, control)., Methods: This study was a 52-week, multicenter, randomized, double-blinded, active-controlled clinical trial. Qualified participants with moderate-to-severe NLFs were randomly assigned in a 1:1 ratio to receive Cutegel or Restylane. For the primary efficacy endpoint, the response rate was defined as the percentage of subjects exhibiting an improvement of at least one-point based on blinded evaluation of Wrinkle Severity Rating Scale (WSRS) at 24 weeks after injection. Other secondary efficacy endpoints and treatment-emergent adverse events (TEAEs) were assessed., Results: Of 340 subjects randomized, 317 completed the week 52 visit. In the per protocol set (PPS), the blinded evaluator-assessed response rates at week 24 were 81.17% for Cutegel versus 77.56% for Restylane ( p  =  0.327). The between-group treatment differences in response rates were 3.60% [95% confidence interval (CI) = (-5.39%, 12.60%)], which demonstrated the noninferiority of Cutegel. Other secondary efficacy endpoints supported this. No significant differences were observed in the occurrence of adverse events between the two groups., Conclusion: Similar to Restylane, Cutegel was effective and well tolerated in correcting moderate-to-severe NLFs among the Chinese population.

Background: Injectable poly-D,L-lactic acid (PDLLA), under the brand name of AestheFill (REGEN Biotech, Inc., Seoul, South Korea), is a biocompatible, biodegradable, and biostimulatory product utilized to correct soft tissue volume loss. Its efficacy and safety have not been fully studied in a large cohort., Objectives: The aim of the study was to evaluate the efficacy and safety of a novel dermal filler injectable, poly-D,L-lactic acid., Methods: This was an evaluator-blinded, multicenter, randomized controlled trial to compare the efficacy and safety of PDLLA vs hyaluronic acid in the correction of the nasolabial fold. Two hundred and sixty patients with moderate to severe nasolabial folds were enrolled and randomized to the treatment group (PDLLA) or control group (hyaluronic acid). Each patient received a PDLLA or hyaluronic acid injection for nasolabial fold augmentation and was followed for 52 weeks. The Wrinkle Severity Rating Scale (WSRS) and Global Aesthetic Improvement Scale (GAIS) were applied to evaluate topical nasolabial fold augmentation and overall improvement, respectively., Results: At 24 weeks, 67.6% of patients in the PDLLA group had an at least 1-grade improvement on the WSRS, compared to 60.9% of patients in the control group with an at least 1-grade improvement on the WSRS (P < .05). At each visit, the PDLLA group showed more improvement on the baseline WSRS than the control group. PDLLA was safe and well tolerated, with no severe adverse events., Conclusions: PDLLA shows noninferior efficacy in correcting nasolabial folds compared to hyaluronic acid., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Injectable biostimulators are widely used to improve facial aging signs. This study was performed to compare the genetic pathways affected by 2 different injectable biostimulators., Methods: Randomized 13-week study (n = 21) comparing gene expression after poly l-lactic acid (PLLA-SCA) and calcium hydroxylapatite (CaHA-R) injections (baseline [BL] and Day 28) as treatment of nasolabial fold wrinkles. Punch biopsy was performed at BL and day 90; RNA was isolated, gene expression was analyzed, and bulk RNA sequencing performed. Data from both pathways were studied using the Search Tool for Retrieval of Interacting Genes/Proteins and Reactome databases., Results: Analysis at Day 0 and Day 90 showed differing gene regulation for PLLA-SCA and CaHA-R (after accounting for minor differences at BL, p < .05 at Day 90 for 9-12 genes). PLLA-SCA uniquely correlates with genes involved in adipocyte regeneration, while CaHA-R did not affect these genes. Clinically, this could translate to healthy fat replacement with an enhanced effect beyond the improvement of the collagen structure and a longer-lasting effect with PLLA-SCA. Furthermore, the adipokines that appear to be upregulated are regenerative with a positive impact on skin health., Conclusion: PLLA-SCA has a novel and unique signature, which supports a potential regenerative mechanism of action through its role in the modulation of adipocyte function., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To update the evidence on the effectiveness and safety of hyaluronic acid gel combined with lidocaine for treating nasolabial folds., Methods: We searched electronic databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science using subject headings and keywords associated with hyaluronic acid and lidocaine in the context of nasolabial folds. Inclusion criteria were met by randomized controlled trials (RCTs) comparing the efficacy and safety of hyaluronic acid gel with or without lidocaine. Outcomes measured included visual pain analog scale (VAS) scores, wrinkle severity scale scores, and adverse events. The quality of RCTs was evaluated using the Cochrane Randomized Controlled Trials Scale, which encompasses criteria such as randomization, allocation concealment, blinding, dropout, and withdrawal rates, and was assessed by two independent reviewers., Results: No significant difference in overall wrinkle severity rating scale scores was observed between HA with lidocaine and HA without lidocaine [MD = 0.08, 95% CI (- 0.09, 0.24), P = 0.36]. However, there was a significant reduction in pain scale scores (VAS) [SMD = -2.47, 95% CI (- 4.15, - 0.79), P = 0.004]; no significant differences were noted in the ncidence of at least one adverse event [RR = 0.97, 95% CI (0.90, 1.05), P = 0.51]; and there were no significant differences in swelling [RR =  0.99, 95% CI (0.92, 1.06), P = 0.80], erythema [RR = 1.01, 95% CI (0.91, 1.11), P = 0.91], bruising [RR = 0.99, 95% CI (0.89, 1.13), P = 0.86], itching [RR = 1.03, the 95% CI (0.88, 1.21), P = 0.74], induration [RR = 1.04, 95% CI (0.92, 1.17), P = 0.55], and papules [RR = 0.77, 95% CI (0.58, 1.02), P = 0.07]. There was a significantly lower incidence of tenderness [RR = 0.91, 95% CI (0.86, 0.97), P = 0.002] only in the control group. Sensitivity analysis confirmed the stability of results across all outcome indicators with low sensitivity and high confidence. Subgroup analysis indicated higher wrinkle severity scores among East Asians compared to Europeans and Americans., Conclusions: HA containing lidocaine significantly reduces pain and is comparable in effectiveness and safety of HA without lidocaine. The clinical effects appear more pronounced in East Asians. Due to the limited number of related studies, further research is necessary., Level of Evidence I: 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 ., Competing Interests: Declarations. Conflict of interest: The authors declare no conflicts of interest. Human or Animal Rights: This article does not involve any studies with human participants or animals performed by any of the authors. Informed Consent: Informed consent is not required for this type of study., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Hyaluronic acid dermal fillers are used for multiple indications, including wrinkle correction and restoration of volume/fullness., Objectives: The aim of this study was to compare the efficacy and safety of 2 hyaluronic acid products for correcting moderate to severe nasolabial folds (NLFs)., Methods: A prospective, randomized, double-blind, split-face study was undertaken. The subjects' left and right NLFs were randomly allocated for treatment with DKL23 or Juvéderm Volift. Follow-up was conducted at 1, 3, 6, and 9 months. The changes from baseline on the Wrinkle Severity Rating Scale and the Global Aesthetics Improvement Scale were evaluated. Posttreatment adverse events (AEs) were recorded., Results: Forty-eight women (median age, 57.0 years) with Type I to VI skin were enrolled. Both treatments showed statistically significant improvement (P < .0001) in NLFs according to the Wrinkle Severity Rating Scale score from baseline to each of the time points assessed. The improvement in NLFs was maintained until the end of the study (9 months). Furthermore, the change from baseline to each of the time points assessed was similar between DKL23 and Juvéderm Volift. Investigator- and subject-rated Global Aesthetics Improvement Scale scores showed similar rates of improvement (indicated by the sum of responses of improved, much improved, or very much improved) between the 2 products. The AEs reported in the study were in line with previous and expected experience after injection of hyaluronic acid dermal fillers. The types of AEs, their rates, intensity, and duration were comparable between the 2 products., Conclusions: DKL23 improved NLF severity from baseline and for up to 9 months, and the results were comparable to the improvement shown by Juvéderm Volift. Treatment was safe and well tolerated., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society.)

Objective: This study aims to fill the knowledge gap regarding the effects of high frequency facial neuromuscular electrical stimulation (fNMES) on facial aging, using a device equipped with CERTEC (Cell Energy Regeneration Technology) operating between 40 and 190 kHz., Methods: This prospective split-face study was conducted at Tokyo University Hospital between March and May 2023 with 24 healthy adult women aged 30-59. The intervention group used the fNMES device along with basic skin care on one side of the face, and basic skin care alone on the other side for 8 weeks. Evaluations included changes in skin wrinkles, sagging, and blood flow., Results: This study found significant improvements in skin elasticity and degree of wrinkles in the areas intervened with fNMES (p < 0.05, respectively). In addition, the intervention resulted in significant improvements in jawline angle (p < 0.01), submental volume (p < 0.05), cheek volume (p < 0.05), maximum nasolabial fold depth (p = 0.03), and total volume of the nasolabial folds (p = 0.03). The fNMES intervention also showed improvement in blood flow (p < 0.05). These improvements were also subjectively assessed by the participants in subject questionnaires at 8 weeks after the intervention (p < 0.05)., Conclusion: This study suggests that high frequency fNMES effectively improves facial skin elasticity, reduces wrinkles and sagging, promotes blood flow, and contributes to overall facial appearance rejuvenation. Although further studies are needed, high frequency fNMES appeared promising as a noninvasive anti-aging therapy., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Polycaprolactone (PCL)‐based fillers are widely used for skin rejuvenation and wrinkle reduction. The objective of this study is to compare the efficacy and safety of newly developed PCL‐based fillers (SYB filler®; SF‐01) and widely used existing PCL‐based fillers (Ellansé‐M®) for correction of moderate‐to‐severe nasolabial folds. In a randomized, participant‐and evaluator‐blinded, matched‐pair, prospective study, participants were randomized for injections of SF‐01 or Ellansé‐M® in both nasolabial folds. Efficacy was evaluated using the Wrinkle Severity Rating Scale (WSRS), Global Esthetic Improvement Scale (GAIS), and a three‐dimensional (3D) scanner. All adverse events (AEs) were examined and reported. At month 12, both SF‐01‐and Ellansé‐M®‐treated groups showed statistically significant improvements in the WSRS, GAIS, and 3D scanner scores compared to baseline. The difference in changes in WSRS scores at month 12 between the two groups was 0.08 ± 0.34 compared to baseline. The upper limit of the 95.0% confidence interval was 0.0031, which was lower than the predefined margin for non‐inferiority (0.35). All AEs were injection site‐related (swelling, pain, and erythema) and disappeared within 30 min after the procedure. SF‐01 was non‐inferior to Ellansé‐M® and demonstrated favorable efficacy and safety at 12 months after correcting moderate‐to‐severe nasolabial folds. [ABSTRACT FROM AUTHOR]

Botulinum toxin type A (BTA) injections into the subjacent orbicularis oris muscle have been shown to improve appearance and produce narrower cheiloplasty scars. This study was performed to determine the effect of BTA injected at different sites on the unilateral cleft lip scar and cleft side nostril width. A double-blind, randomized prospective trial was conducted involving 64 consecutive patients with unilateral cleft lip undergoing primary cheiloplasty between September 2016 and January 2019. The patients were randomized to receive BTA injections either into the subjacent orbicularis oris muscle (4 points group) or into the bilateral nasolabial fold region (6 points group) during cheiloplasty. The scars were assessed by photographic scar width measurements and Vancouver scar scale assessment tool. The cleft side nostril width was compared to the non-cleft side width. Fifty-six patients completed the trial, 24 in the 4 points group and 31 in the 6 points group. There was no significant difference in scar width or nostril width measurements between the groups at the end of follow-up. The Vancouver scar scale assessment was also similar between the groups. There was no significant difference in scar width or nostril width measurements after cleft lip repair between patients treated with botulinum toxin injections to the subjacent orbicularis oris muscle and patients treated with injections in the nasolabial region. [ABSTRACT FROM AUTHOR]

Esthetic upper lateral cutaneous lip reconstruction preserves the apical triangle, nasolabial fold symmetry, and free margin position. The tunneled island pedicle flap (IPF) is a novel single-stage reconstruction to achieve these goals. Describe the technique and patient and surgeon-reported outcomes for the tunneled IPF reconstruction of upper lateral cutaneous lip defects. Retrospective chart review of consecutive tunneled IPF reconstruction following Mohs micrographic surgery (MMS) at a tertiary care center between 2014 and 2020. Patients rated their scars using the validated Patient Scar Assessment Scale (PSAS), and independent surgeons rated scars using the validated Observer Scar Assessment Scale (OSAS). Descriptive statistics were generated for patient demographics and tumor defect characteristics. Twenty upper lateral cutaneous lip defects were repaired with the tunneled IPF. Surgeons rated scars with a composite OSAS score of 11.83 ± 4.29 (mean, SD) [scale of 5 (normal skin) to 50 (worst scar imaginable)] and an overall scar score of 2.81 ± 1.11 [scale of 1 (normal skin) to 10 (worst scar imaginable)]. Patients rated their scars with a composite PSAS score of 10 ± 5.39 [scale of 6 (best possible score) to 60 (worst)] and with an overall score of 2.2 ± 1.78 [scale of 1 (normal skin) and 10 (very different from normal skin)]. One flap was surgically revised for pincushioning, but none experienced necrosis, hematoma, or infection. The tunneled IPF is a single-stage reconstruction for upper lateral cutaneous lip defects with favorable scar ratings by patients and observers. [ABSTRACT FROM AUTHOR]

Purpose: Patients seeking treatment for the midface are individuals with different objectives and characteristics of skin and soft tissue. In this study, patients were treated in the midface with one of three products with different properties; HARV, HARD, or HARL, using a treatment algorithm based on primary need for treatment (volumizing, lifting or contouring) and tissue coverage (thin or thick tissue). The aim was to optimize the treatment outcome and to provide an individualized treatment approach that distinguishes different types of patients seeking midfacial treatment. Materials and Methods: Subjects were treated in the midface at baseline to achieve optimal aesthetic results (≤ 2 mL per side of the face), and touch-up was allowed after 4 weeks (≤ 1 mL per side of the face). Study visits were scheduled at Weeks 8, 16 and 24. Assessments included aesthetic improvement of the midface, evaluation of midface fullness, and subject satisfaction. Safety evaluations included local tolerability symptoms collected at 4 weeks after treatment and adverse events. Results: A total of 90 subjects were included in the study, mean age was 45 years (range 29– 55) and 82% of subjects were female. Mean total injected volume for the products was 4.4 mL (HARV and HARL) and 4.2 mL (HARD). At least 92% of subjects were assessed as aesthetically improved throughout the study. Assessment of midface fullness showed ≥ 90% of subjects being responders until Week 24. In addition, subject satisfaction was high throughout the study. Tenderness, bruising and swelling were the most reported local tolerability symptom for all study products, and no adverse events related to study product/treatment were reported. Conclusion: Midface treatment with either HARV, HARD, or HARL using a treatment algorithm to guide the choice of product to individual subject needs was effective and safe for up to 24 weeks after treatment. [ABSTRACT FROM AUTHOR]

Background: Mannitol may be a good excipient for hyaluronic acid (HA) filler., Objective: This study aimed to assess the tolerability and effectiveness of a mannitol-containing HA filler for the improvement of nasolabial folds (NLFs)., Patients and Methods: Thirty Middle Eastern participants aged 18 to 65 years with moderate-to-severe NLFs on the Wrinkle Severity Rating Scale (WSRS) received 1 to 2 mL of a HA filler containing mannitol in both NLFs. Wrinkle Severity Rating Scale; volume, depth, and area of NLFs; and ultrasound parameters were measured at baseline, Weeks 2, 12, and 24 after the injection. Adverse events and participants' satisfaction were recorded in all follow-up visits., Results: Eighty-nine percent, 86%, and 61% of participants showed at least one grade improvement in WSRS, at Weeks 2, 12, and 24, respectively. The area and volume of NLFs significantly decreased compared with baseline ( p -value < .01). In severe NLFs, echo density of the dermis significantly increased at Week 2. Participants reported great satisfaction with the treatment, and adverse events were mainly mild and transient. One patient had significant pain during injection, but this resolved without sequelae., Conclusion: The tested mannitol-containing HA filler showed to be effective in Middle Eastern participants. The safety will require a follow-up larger study., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Hyaluronic acid (HA) gel is a widely used dermal filler for the correction of facial volume loss. The relationship between the characteristics of HA and clinical efficacy remains unclear. The aim of this systematic review and meta‐analysis was to compare the efficacy and safety of monophasic and biphasic HA in the treatment of nasolabial folds (NLFs). Methods: Studies were identified by searching the electronic databases PubMed, Embase, and Web of Science from inception to May 2021. Randomized controlled trials (RCTs) were selected according to the inclusion criteria. Outcomes included the Wrinkle Severity Rating Scale (WSRS) score, Global Aesthetic Improvement Scale score, and incidence of adverse events. Results: A total of 1190 patients from 14 RCTs were included in the meta‐analysis. The mean WSRS score improvement in the biphasic HA group was much lower than that in the monophasic HA group (MD = 0.18, 95% CI: 0.16–0.20, p < 0.00001). The subject satisfaction percentage was significantly higher for monophasic than biphasic HA (RR = 1.95, 95% CI: 1.09–3.48, p = 0.02). There was no significant difference in the adverse event rate between the monophasic and biphasic HA groups (RR = 0.96, 95% CI: 0.75–1.24, p = 0.77). Conclusions: Regardless of whether improvement in NLFs or patient satisfaction is considered, monophasic HA is better than biphasic HA. Regarding the adverse event rate, there is no difference between monophasic and biphasic HA. [ABSTRACT FROM AUTHOR]

Introduction: Biomechanical qualities of the skin tissue change following numerous pathological and natural (ageing) conditions. The best skin treatments are those resulting in a positive outcome with the fewest adverse effects. In this study, high-frequency ultrasonography (US), which provides a quantifiable scale, was utilized to evaluate the impact of a 2-W laser on characteristics of nasolabial fold (NLF) including depth and area, epidermis and dermis thicknesses, and Young's modulus (YM). Methods: Nine female subjects (54.09 ± 0.09 years old) with Fitzpatrick skin types III-IV and five young control participants (26 ± 1.28 years old) for providing the control data were included in this study. Laser therapy was applied twice weekly for seven consecutive sessions. A class IV laser with 810-nm and 980-nm wavelengths, 2-W power, and 25-Hz frequency was applied twice a week for seven consecutive sessions. The energy administered had a density of 8 J/cm2. An evaluation using high-frequency ultrasound (40 MHz) was accomplished before and 48 hours after the final treatment session. The Face-Q questionnaire was used to assess the patient's perspective on this procedure. Results: For each US parameter, the intraclass correlation coefficient was high (ICC > 0.9). After the laser treatment, NLF depth, area, epidermis, dermis, YM, and Face-Q significantly improved compared to baseline (P < 0.05). Conclusion: For the assessment of skin tissue, high-frequency US is a reliable technique. The 2-W laser is a safe, effective, and non-invasive procedure for enhancing skin features. [ABSTRACT FROM AUTHOR]

Abstract Background Injectable fillers are currently widely used in the clinical practice; there are many indications for injectable fillers including facial and gluteal rejuvenation, management of post-traumatic facial disfiguring, and pathological volumetric loss secondary to certain disease medications like human immune deficiency virus (HIV) medications. Radiologists should be familiar with the specific imaging features of the injectable fillers, characteristic anatomical locations, and possible complications to avoid diagnostic pitfalls especially when incidentally discovered while imaging of other pathological process like neoplastic work up or granulomatous lesions follow-up. Results The study included 48 patients (45 females and 3 males): 44 patients with facial injectable fillers and four patients with pelvic injectable fillers. Of the 48 patients, 37 patients showed unremarkable fillers features with normal morphological features and anatomical distribution, and eleven patients showed complications: six patients showed one complication, and five patients showed more than one complications. Dedicated fillers imaging study was done in 22 patients, while in the other 26 patients, imaging was done for other reasons, and fillers were notified and documented. Magnetic resonance imaging (MRI) was done for 46 patients; two patients were subjected to combine ultra-sonographic and CT examinations with no clinical indication for MRI study assessment. Conclusion Magnetic resonance imaging (MRI) is an effective tool for evaluation of facial and gluteal region fillers with delineation of their imaging features and related potential complications. Differentiation between fillers and neoplastic or granulomatous lesions could be accurately done with MRI.

Background: Nasolabial fold formation is increasingly becoming a cause of concern for many people. However, no network meta-analysis has compared the efficacy of different fillers in treating nasolabial folds. This network meta-analysis simultaneously compared the efficacy and safety of various fillers., Methods: We included randomized controlled trials (RCTs) that used fillers to treat nasolabial folds. We extracted data of Wrinkle Severity Rating Scale (WSRS), Global Esthetic Improvement Scale (GAIS, investigator) scores, GAIS scores (self-reported) and adverse events., Results: We included 13 RCTs. WSRS scores at 6 months were higher in patients receiving HA than those receiving poly (L-lactic acid) (mean difference [MD] 0.630, 95% confidence interval [CI] 0.275, 0.985) but significantly lower in patients receiving HA than in those receiving bovine collagen (MD - 0.580, 95% CI - 0.777, - 0.383) and porcine collagen (MD - 0.525, 95% CI - 0.790, - 0.260). Regarding adverse events, HA was significantly less likely to cause nodule formation compared with bovine collagen (RR 0.593, 95% CI 0.438, 0.803)., Conclusion: HA is a safe filler for correcting nasolabial folds, and poly (L-lactic acid) showed potential in treating nasolabial folds., Level of Evidence I: 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Hyaluronic acid-based dermal fillers are the cornerstones of wrinkle correction and facial contour redefinition., Objective: To assess the efficacy and safety of EST LF compared with RES L for the treatment of nasolabial folds (NLFs)., Materials and Methods: In this prospective, split-face, randomized, investigator and subject-blinded trial, 45 subjects with moderate-to-severe symmetrical NLFs were randomized to EST LF on one side of the face and RES L on the other side and were followed up for 9 months. The primary end point was change in WSRS score from the baseline to Month 1 (M1). Secondary end points included changes in WSRS score at other time points, aesthetic improvement, wrinkle volume quantification, adverse events, and local tolerance., Results: The efficacy difference between EST LF and RES L at M1 was in favor of EST LF (-0.16, CI, -0.28 to -0.03]), demonstrating its noninferiority. Considering other time points, significant differences were observed at 3 and 6 months for EST LF , assessed with WSRS, GAIS, or NLF volume quantification. Both treatments were well tolerated., Conclusion: EST LF is effective and well tolerated for the treatment of NLFs., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society for Dermatologic Surgery, Inc.)

Background: Hyaluronic acid (HA) fillers have been widely used in humans since 1958 because of their biomedical safety. Restylane® was introduced in the1990s as a favorable temporary filler option for facial augmentation. Subsequently, many new HA filler products, including the Sardenyashape®, have been introduced, but comparative studies of these products are limited. Here, we compared tolerability (wrinkle severity rating scale, WSRS), pain (visual analog scale, VAS score), satisfaction (global esthetic improvement scale, GAIS), and safety of a new monophasic HA (MHA) filler (Sardenyashape®) containing lidocaine, used to correct nasolabial folds (NLFs), with those of biphasic HA (BHA) filler (Restylane LYFT®) containing lidocaine. Methods: We enrolled 96 participants with visible NLFs in this randomized, double-blind, single-center clinical study. Participants were injected with a new MHA filler in one NLF and a BHA filler and were reassessed for cosmetic changes at 8 and 24 weeks. Wrinkle severity was assessed using the 5-point WSRS. Results: At week 24, the mean improvement in WSRS compared to baseline was 1.92 ± 0.75 and 2.24 ± 0.66 for MHA and BHA fillers, respectively, and corresponding average pain values using the VAS score 30 min after the procedure were 0.04 ± 0.25 and 0.02 ± 0.15, respectively, showing no significant difference. Average GAIS values 8 weeks after the procedure with MHA and BHA fillers were 1.89 ± 0.77 and 1.40 ± 0.82, respectively (p < 0.001). Both fillers were well tolerated, with mild adverse reactions. Conclusion: The evaluation of the effect of Sardenyashape® with lidocaine on NLF in this study proved its effectiveness and safety for use in correcting NLF. Level of Evidence II: 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. [ABSTRACT FROM AUTHOR]

Tissue fillers injections remain to be one of the most commonly performed cosmetic procedures. The aim of this meta-analysis was to systematize and present available data on the aesthetic outcomes and safety of treating the nasolabial fold area with tissue fillers. We conducted a systematic review of randomized clinical trials that report outcomes concerning treatment of nasolabial fold area with tissue fillers. We searched the MEDLINE/PubMed, ScienceDirect, EMBASE, BIOSIS, SciELO, Scopus, Cochrane Controlled Register of Trials, CNKI and Web of Science databases. Primary outcomes included aesthetic improvement measured using the Wrinkle Severity Rating Scale score and Global Aesthetic Improvement Scale. Secondary outcomes were incidence rates of complications occurring after the procedure. At baseline, the pooled mean WSRS score was 3.23 (95% CI: 3.20–3.26). One month after the procedure, the pooled WSRS score had reached 1.79 (95% CI: 1.74–1.83). After six months it was 2.02 (95% CI: 1.99–2.05) and after 12 months it was 2.46 (95% CI: 2.4–2.52). One month after the procedure, the pooled GAIS score had reached 2.21 (95% CI: 2.14–2.28). After six months, it was 2.32 (95% CI: 2.26–2.37), and after 12 months, it was 1.27 (95% CI: 1.12–1.42). Overall, the pooled incidence of all complications was 0.58 (95% CI: 0.46–0.7). Most common included lumpiness (43%), tenderness (41%), swelling (34%) and bruising (29%). Tissue fillers used for nasolabial fold area treatment allow achieving a satisfying and sustainable improvement. Most common complications include tenderness, lumpiness, swelling, and bruising. Level of Evidence II: "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." [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To describe our clinical experience with, and functional outcomes of the nasolabial flap for reconstruction of orofacial defects. Methods: Design: Retrospective Case Series Setting: Tertiary National University Hospital Participants: Records of 11 patients on whom a nasolabial flap was performed for reconstruction of head and neck defects between January 2013 and December 2018 were analyzed. Results: All patients underwent wide excision with or without frozen section, with or without neck dissection, and nasolabial flap closure was performed by a single surgeon. There were no major complications. In two cases, the nasolabial flap was used as an adjunct for Abbé and deltopectoral flap reconstruction. One had poor oral competence due to the bulk of the deltopectoral flap. Acceptable aesthetics and functional outcomes were achieved. Conclusion: The nasolabial flap is a viable alternative for reconstruction of orofacial defects following head and neck surgeries. Additional cases can help validate our initial experience

To investigate the efficacy and safety of Dermalax in the correction of moderate to severe nasolabial folds (NLFs) compared to Restylane. A total of 324 subjects with moderate to severe NLFs were enrolled in this multicenter, randomized, double-blind, active-controlled clinical study. Eligible subjects were randomly assigned to the test group received Dermalax injection (n = 162) or control group received Restylane injection (n = 162). Clinical efficacy and safety were assessed based on the Wrinkle Severity Rating Scale (WSRS) and the Global Esthetic Improvement Scale(GAIS) at weeks 2, 8, 16, 24, 36 and 48 weeks after injection. At week 24, similar improvements of effective rate were obtained on the Dermalax group (93.75%) and Restylane group (89.44%). Significances were found at 36 weeks and 48 weeks after injection, Dermalax seemed be better than Restylane in maintaining the effect in the later period. The improvement of mean WSRS score for test group was superior to that of control group with significance. GAIS scores rated at week 24 were 1.65 VS 1.94 (p <.001) and 2.10 VS 2.27 (p =.060), seperately. Dermalax was no inferior to or better than that of the control filler Restylane in correcting of moderate to severe NLFs in Chinese subjects. [ABSTRACT FROM AUTHOR]

Background: As deep nasolabial folds (NLF) are associated with facial aging, there is an increasing demand for esthetic correction with filler injections. Understanding the anatomy of the angular artery (AA) and facial artery (FA) around the NLF region is essential for ensuring the safety of dermal filler injections into the NLF. The purpose of this study was to provide detailed vascular anatomical information on the course and depth of AA and FA around NLF using Doppler ultrasound on live cases. Methods: FA was observed from the origin level adjacent to the mandible corpus to the end of its terminal branch AA in 168 hemifaces of 84 cases with Doppler ultrasonography. Results: We made a classification of the FA course based on the NLF. The minimum and maximum depths of the FA along its course were measured in 84 cases. The results showed that its course may be highly superficial (2.5 mm at the mandibular origin, 3.7 mm at the cheilion, 3.7 mm at the nasal ala) or it may follow a very deep course near the periosteum (15.0 mm at the mandibular origin, 18.7 mm at the cheilion, 23.5 mm at the nasal ala). FA depth was varied between 5.98 mm and 6.62 mm at the mandibular origin, between 8.36 mm and 9.20 mm at the cheilion, between 9.52 mm and 10.51 mm at the nasal ala at a 95% confidence interval. Conclusions: This study suggests that there is no absolutely safe depth or region for nasolabial fold filler injections. [ABSTRACT FROM AUTHOR]

Background: MRI analyzed quantitatively the HA injected into the NLF subcutaneous fat to correlate the gel diffusion and degradation with the morphological changes of the NLF appearance for twelve months. Measurements of the gel diffusion and degradation were taken by MRI as parameters to assess the clinical efficacy and long-acting of the HA in NLF rejuvenation. Method: HA was applied into the superficial compartment of the subcutaneous fat of twenty NLFs. Each NLF received three injection points, from the nasal ala toward the oral commissure, 1.0–1.5 cm distant from each other, according to the NLF length. A bolus injection technique without retrograde backflow applied per injection point 0.15–0.20 ml of HA for moderate. NLF and 0.20–0.25 ml for severe NLF. Patients were evaluated through MRI and clinically twenty-four hours, one month and twelve months after the HA application. Results: MRI, in T2-weighted, displayed the gel as a dense, spindle-shaped nodule as pattern of the gel diffusion, measuring its largest longitudinal and transverse axes. Twenty-four hours after HA application the longitudinal axis measured 1.79 cm, after one month 2.33 cm and at month twelve 0.91 cm. The transverse axis measured 0.92 cm at 24 hours, 1.13 cm after one month and 0.47 cm at month twelve. Conclusion: Despite reduction in size and denseness of the spindle-shaped nodule, the small amount of gel presenting into the subcutaneous fat after twelve months of the application evidenced the HA efficacy and long-acting in NLF rejuvenation. 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. [ABSTRACT FROM AUTHOR]

Background: Facial aging is a multifactorial process characterized by structural changes to the dermis and ligaments, lipoatrophy in the fat pads and hypodermis, remodeling of the bony skeleton, change in muscle tonicity and tissue descent. Aims: The purpose of this study is to evaluate the efficacy of a hyaluronic acid‐based treatment for the aging face that addresses all its causes in a caudal to cranial and medial to lateral direction: the centrifugal technique. Methods: Between March 2015 and January 2018, 187 patients were treated with a high G' hyaluronic acid in two sessions, one/two weeks apart, to improve signs of facial aging, starting from the lower centrofacial area and progressing laterally and cranially. Results were assessed using a Global Aesthetic Improvement Scale (GAIS) judging pre‐ and post‐treatment (32 weeks) pictures. Results: The technique effectively treated the aging face. The investigator and all patients evaluated the results improved or very much improved and agreed that the results were very natural looking. Conclusion: Use of a systematic centrifugal technique to address the signs of facial aging resulted in significant and long‐lasting improvement, as judged by the investigator and high patient acceptance and satisfaction. [ABSTRACT FROM AUTHOR]

Background: Multiple types of fillers have been developed for soft tissue augmentation. Objective: We investigated the efficacy and safety of the novel filler BM-PHA. Methods: In this multicenter, randomized, split-face study, 91 participants received injections of BM-PHA and Restylane Perlane (PER) into the nasolabial folds. Efficacy was determined by the improvements in the Wrinkle Severity Rating Score (WSRS) and Global Esthetic Improvement Scale (GAIS), and safety by adverse events, laboratory tests, and a check of vital signs. Results: WSRS scores assessed by independent evaluators at Week 24, the primary efficacy measure, showed no significant difference between the two treatments. The treatments also showed no significant differences in WSRS scores assessed by the evaluators at Week 8 and WSRS and GAIS scores assessed by the treating investigators and participants at Weeks 8 and 24. The proportion of nasolabial folds whose WSRS scores improved by at least one grade at Week 24 was similar between the treatments. Only minor local side effects were reported without sequelae. Conclusion: BM-PHA was not inferior to PER in the treatment of moderate to severe nasolabial folds and may be an appropriate alternative product for their improvement. Further studies are needed to confirm the long-term safety of BM-PHA. [ABSTRACT FROM AUTHOR]

Objectives: In patients with facial paralysis, facial reanimation surgery may be needed to normalize facial soft tissue function/movements. Critical for this normalization is the dynamics of the nasolabial folds (NLFs). The objective of this prospective, observational study was to determine the 3D morphologic dynamics of the NLFs in patients with unilateral facial palsy and normal subjects. Settings and Sample Population: 3D facial soft tissue movement data collected from adults with unilateral, facial paralysis (Bell's Palsy, n = 36); and (2) an age‐ and sex‐frequency matched control group (n = 68). Materials and methods: Movement data were collected during repeated animations from participants using a video‐based motion capture system. Movement in terms of displacement and asymmetry of the NLFs, nasal and circumoral regions were analyzed in the lateral, vertical and depth planes; as well as movement of the commissure and NLFs relative to the lower lip midline. Two‐sample t tests were used to test for significant group differences. Results: Patients NLFs had less mean displacement, greater mean asymmetry and uncoordinated movements compared with the controls. For both groups during smiling, the NLF and commissure landmarks had approximately similar magnitudes of displacement (control range = 11‐14mm; patient range = 7‐10mm). Conclusion: NLF dynamics during smiling were as significant as oral commissure excursion. Thus, an immobile NLF is an unnatural feature of facial animations. Surgical treatments that address impaired NFL movements must be considered to create a more natural surgical outcome especially during smiling. [ABSTRACT FROM AUTHOR]