COSMETIC Advances in Facial Rejuvenation: Botulinum Toxin Type A, Hyaluronic Acid Dermal Fillers, and Combination Therapies–-Consensus Recommendations

Background: Facial aesthetics and rejuvenation are evolving rapidly due to changes in products, procedures, and patient demographics. Clinicians can benefit from ongoing guidance on products, tailoring treatments to individual patients, treating multiple facial areas, and using combinations of products and ways to optimize outcomes. Methods: Amultidisciplinary group of aesthetic treatment experts convened to review the properties and uses of botulinum toxin type A (BoNTA) and hyal-uronic acid fillers and to update consensus recommendations for facial reju-venation using these two types of products. The group considered paradigm shifts in facial aesthetics; optimal techniques for using BoNTA and hyaluronic acid fillers alone and in combination; the influence of patient sex, ethnicity, cultural ideals, and skin color on treatment; general techniques; patient edu-cation and counseling; and emerging trends and needs in facial rejuvenation. Results: The group provided specific recommendations by facial area, focusing on relaxingmusculature, restoring volume, and recontouring using BoNTA and hyaluronic acid fillers alone and in combination. For the upper face, BoNTA remains the cornerstone of treatment, with hyaluronic acid fillers used to augment results. These fillers are central to the midface because of the need to restore volume. BoNTA and hyaluronic acid in combination can improve out-comes in the lower face. Conclusions: Optimal outcomes in facial aesthetics require in-depth knowledge of facial aging and anatomy, an appreciation that rejuvenation is a three-dimensional process involving muscle control, volume restoration, and recon-touring, and thorough knowledge of properties and techniques specific to each product in the armamentarium. (Plast. Reconstr. Surg. 121 (Suppl.): 5S, 2008.) Substantial and rapid change typifies the fieldof facial aesthetics and rejuvenation as phy-sicians and patients continue their quest for minimally invasive yet highly effective and safe approaches to mitigate the signs of facial aging.1,