Botox injection and fillers

Abstract

 

BACKGROUND: Full-face rejuvenation with dermal fillers in patients with multiple aesthetic indications is rarely studied.

OBJECTIVE: To assess whether a new range of hyaluronic acid filler is suitable for full-face rejuvenation and to evaluate efficacy, safety, and patient satisfaction.

MATERIALS AND METHODS: In this 6-month study, participants could receive five different fillers from the same range Juvederm fillers for up to eight indications (periorbital lines, tear troughs, cheeks, cheek folds, nasolabial folds, upper lip lines, lips, and marionette lines). Outcomes included global aesthetic improvement, improvement in each indication, adverse events, local tolerability, and satisfaction.

RESULTS: Seventy-seven participants with a mean age of 54.5 were enrolled; 48.1% had five or more indications treated. Mean total injection volume (baseline and touch-up) per participant was 6.7 mL. At month 6, 92.1% of participants remained at least improved over baseline, 79.7% of participants were satisfied or very satisfied with the durability of the results, and 63.0% of participants felt a lot or much better than before injection. No specific safety concerns were reported except expected injection site reactions.

CONCLUSION: In participants with multiple indications, full-face rejuvenation using JUVEDERM FILLERS INJECTION provided effective, safe, satisfactory results.

 

Although traditional aesthetic treatments with dermal fillers focus on eliminating individual wrinkles such as nasolabial folds and marionette lines, the importance of additional volume restoration on tear troughs, cheeks, lips, and chin is now increasingly appreciated.1-8 This full-face approach aims to achieve optimal volume correction and represents a new trend in the armamentarium of anti-aging techniques. It offers a new option to patients who seek to improve their appearance but are not ready for surgical procedures.9
Full-face rejuvenation with dermal fillers is a novel and complete approach that has rarely been studied in clinical trials. In a study by Carruthers and colleagues, participants were randomized to receive treatments of Botox injection alone, HA filler alone, or combination therapy of Botox injection and HA filler in the lower face, including the lips, oral commissures, marionette lines, and chin.5 In another study, Taub and colleagues showed that 10 participants receiving 6 to 9 mL of HA filler perceived an average decrease in apparent age of 7.8 to 9 years after 2 to 4 weeks.15 Although those results demonstrated the effectiveness of the full-face approach, a longer study with a larger sample size would be more informative about the fillers and the approach. In addition, only two HA fillers were used in each of those two studies. The present study assessed the effect of full-face rejuvenation using five HA fillers from the same range. The outcome measurements include investigator assessments and patient-reported outcomes, which are crucial for evaluating aesthetic treatments.

 

Results of this study support the effective and safe usage of the JUVEDERM FILLERS INJECTION filler range in full-face treatment. Although it is difficult to draw specific conclusions because of the number of variations in the study design (filler formulation, indication, wrinkle severity at baseline, injection volume, and technique), similar results on efficacy, safety, and patient satisfaction were observed for each filler for all indications treated in the study and for each indication with all commonly used fillers. Good aesthetic improvements were observed early after injection and were sustained for 6 months. Based on wrinkle severity scores for each indication, there was on average one grade of improvement at 6 months from baseline, regardless of choice of filler. These efficacy results for various indications were consistent with the results of previous randomized controlled trials on the treatment of nasolabial folds.16,17 In those two studies, moderate and severe nasolabial folds were treated with JUVEDERM FILLERS INJECTION Classic and JUVEDERM FILLERS INJECTION Deep, respectively, and approximately one grade of improvement on the 5-point Wrinkle Severity Rating Score was observed in both studies at 6 months. There was also one grade of improvement at 18 months after the treatment of moderate nasolabial folds with JUVEDERM FILLERS INJECTION Classic, with retreatment at 9 months (data on file). The effect of a single treatment with JUVEDERM FILLERS INJECTION Deep lasted for 1 year, with improvement of more than one grade reported at 12 months (data on file). Together, those efficacy results suggest that the full-face approach is economically viable because of the good durability of JUVEDERM FILLERS INJECTION. The high level of patient satisfaction reported in this study, with majority of participants willing to recommend the treatment to others and to receive the same treatment again, further confirmed the investigator’s assessments of efficacy and durability.

 

One important difference between the full-face approach and the traditional treatment focusing on one or two individual wrinkles is the quantity of filler injected at each treatment session. In this study, participants received on average 6.7 mL of JUVEDERM FILLERS INJECTION fillers (5.4 mL at baseline and 2.5 mL at touch-up), similar to the volume of HA fillers that participants in the Taub and colleagues study received (6–9 mL) and approximtely twice as much as the volume that participants in the Carruthers and colleagues study, in which only lower face was treated, received. Although the quantity of injected filler appears to be large, it was consistent with the severity of wrinkles (on average moderately deep) and volume loss (thin lips) at baseline. The participants in this study were selected because they had multiple volume and wrinkle indications. They were also on average older than the participants in the Taub and colleagues and Carruthers and colleagues studies (mean age 54.5 vs 49 and 48.1, respectively).5,15 Younger patients with fewer indications may require less filler to achieve satisfactory results. The total volume of fillers injected did not seem to affect the level of patient satisfaction, suggesting that the full-face approach with the complete range allows treatments adapted to individual needs, which is important for patient satisfaction. Despite the large quantity of HA fillers injected per participant, good safety was demonstrated in the study, with only one related AE reported and no particular safety concerns other than the expected and temporary injection site reactions.10 In addition, 95.8% of participants found that the treatment results looked natural.

 

This study has the weakness of being an open trial. Nevertheless, the patient-reported outcomes confirmed the investigator-assessed results, which were consistent with the results of previous randomized controlled studies.16,17 Furthermore, the open-label design was considered necessary for the investigators to become familiar with the new filler range and to gain experience and information regarding the suitable indications for each JUVEDERM FILLERS INJECTION filler.

 

This study not only demonstrated efficacy and safety of the JUVEDERM FILLERS INJECTION range in the full-face approach, but also provided information regarding the indications that may be suitable for each JUVEDERM FILLERS INJECTION filler. There is no ideal filler for all different treatments involved in full-face rejuvenation. Fillers of different physical properties should be carefully selected to adapt to the specific indication, the severity of the defect, and the expected outcomes of each patient.1,18 HA fillers are different in terms of degree of cross-linking, gel calibration (sizing), and concentration of HA. Together, those factors determine the viscous (G’) and elastic (G”) modulus of the filler, the target tissue layer in the skin, the suitable size of needle, and thus the appropriate indication.19 Fillers with higher G’ can better resist deformation and in theory have longer durations of effect, whereas fillers with lower G’ are smoother and better for the correction of superficial lines.20 Although the five fillers in the JUVEDERM FILLERS INJECTION range have the same HA concentration (20 mg/mL), they are produced with different degrees of cross-linking and gel calibration, which result in distinctive physical properties designed to match to their specific indications.12

 

Hyaluronic acid (HA) fillers are appropriate for use in full-face rejuvenation because of their excellent safety profile.10,11 The JUVEDERM FILLERS INJECTION filler range (Emervel, Galderma SA, Lausanne, Switzerland) includes five fillers (JUVEDERM FILLERS INJECTION Touch, JUVEDERM FILLERS INJECTION Classic, JUVEDERM FILLERS INJECTION Lips, JUVEDERM FILLERS INJECTION Deep, and JUVEDERM FILLERS INJECTION Volume), each of which was designed to have physical properties specifically adapted to its defined indication (Table 1). Although the concentration of HA is constant (20 mg/mL) in the various fillers from the same range, the degree of cross-linking and gel calibration varies, resulting in fillers with different gel firmness and lifting capacities.12 In this study, we examined efficacy, safety, and patient satisfaction during 6 months of full-face rejuvenation with this new HA filler range.

 

 

 

 

Keywords

 

Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face, Fillers, Botox, lip fillers, nasolabial folds, wrinkles, plasma injection, vampire facelift, vampire facial, prp injection, platelet-rich plasma, wrinkles, filler injection, Botox injection, juvederm, restylane, micro cannula, dermal fillers, skin tightening, skin rejuvenation, skin tightening, Botox cosmetic, smile lines, frown lines, sad face, tired face, aged face

 

 

 

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