Réunion de consensus - Dr. Raspaldo · Web viewtype of ARTICLE: INNOVATIVE TECHNIQUES. word count: …… words. FACECULPTURE®:. CURRENT TECHNIQUES FOR temporal REJUVENATION with

Temporal Rejuvenation

TARGET JOURNAL: DERMATOLOGY SURGERY

TYPE OF ARTICLE: INNOVATIVE TECHNIQUES

WORD COUNT: …… WORDS

FACECULPTURE®:

CURRENT TECHNIQUES FOR TEMPORAL REJUVENATION WITH

INJECTABLES AND FUTURE DEVELOPMENTS

Dr Hervé Raspaldo

Face and Neck Surgeon, member of the French society of plastic and reconstructive surgery

(SOFCPRE) -Facial Plastic Surgery Centre, Palais Armenonville,

Rond Point Duboys d’Angers, 06400 Cannes, France

CORRESPONDENCE AUTHOR:

Dr Hervé Raspaldo

Facial Plastic Surgery Centre

Palais Armenonville

Rond Point Duboys d’Angers, 9

06400 Cannes, France

Telephone: +33 492 986 530

[email protected]

RUNNING HEADER: ‘TEMPORAL REJUVENATION’

COMMERCIAL INTERESTS AND SOURCES OF FINANCIAL OR MATERIAL

SUPPORT: None

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ABSTRACT

The temporal area is one of the facial areas to show signs of ageing, frequently forgotten by

patients and physicians to be assessed and treated. Temporal rejuvenation is a new

cornerstone area of interest for aesthetic practitioners and there is increasing demand,

particularly since it can be performed without the need for major surgery, and is associated

with a very short recovery period. Temporal rejuvenation with injectable products can

provide dramatic results and a youthful appearance lasting between 1 to 2 years.

Temporal lifting provides greatest benefits from young to old by repositioning the eyebrows,

reducing crow’s feet lines, firming the outer area of the eye and lightening the hooding of the

outer eyelid. Temporal and midface rejuvenation techniques have evolved significantly over

the past few decades and are now performed endoscopically or via a limited number of short

incisions in the hairline above the temple. Non-surgical approaches to temporal rejuvenation

comprise hyaluronic acid fillers, poly-L-lactic acid and botulinum toxin type-A, the latter very

recently being used to treat masseter hypertrophy in place of surgery. In order to achieve

optimal outcomes, the author recommends use of a 4-point baseline temporal ageing scale

which can be used to establish the most appropriate product and volume prior to treatment.

Changing the facial muscular balance with botulinum toxin, reshaping nicely the eyebrow

arch and volumizing the temporal aree the key points for a successful upperface rejuvenation.

Its combination with mid and lowerface treatment with injectable products complete our

method of global approach named the Faceculpture®.

Maximum Word Count: ….words (Maximum: 250 words)

KEYWORDS: Temporal, Midface, Facial Rejuvenation, volume, Faceculpture, Heart of

Face, eyebrow.Global approach

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WHY PERFORM TEMPORAL REJUVENATION

The temporal area is the region situated above the zygomatic arch, limited upward by the

temporal crest (or linea temporalis, junction of the frontal, temporal and parietal bones) and

laterally by the hairline. It is one of the important facial areas to show signs of ageing. The

characteristic features associated with the ageing process occur due to a volume loss (or fat

sliding). As individuals age, the facial skeleton loses volume in all dimensions, and there is

diminished bony support and skin tone due to reduced collagen production and elastin fibre

breakdown. Also, a decline in sebaceous gland activity reduces the skin’s ability to retain

moisture and maintain suppleness. Fat and soft tissues sag downwards leading to widening of

the vertical orbital apertures, and there is less anterior projection in the cheek, temples and

brow regions (1). Descent of the Bichat fat pad over the upper mandible can increase lower

facial jowling, and there is evidence to show that the contour of the temporal fossa changes ,

as the maxilla undergoes changes over time (2). Thus, the ageing process results in temple

skeletonisation, lateral eyebrow ptosis, malar descent, drooping eyes and tear trough

deformity, a heavy jaw line and hypertonic contractions of the depressor muscles (3).

Aesthetic treatment of the ageing temporal fossa is a rather neglected element of overall facial

rejuvenation, since the complexity of the anatomy and pathophysiology remain rather

controversial, and therefore the search for the ideal long-lasting temporal rejuvenation

technique continues. Volume augmentation with autologous fat or fillers is an important

aspect of facial rejuvenation. Midface rejuvenation via open approaches using suspension

techniques traditionally has included either a temporal or a periorbital approach and these

continue to be an important option for surgeons when rejuvenating the ageing temples and

midface (4).

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Temporal rejuvenation is a new area of interest combined with midface and this is increasing

due to demand. Currently there is no universally acknowledged technique for temporal

facelift. Temporal lifting is of the greatest benefit to those in their mid-30’s or early 40’s who

are noticing the first signs of ageing around the eyes, and it helps to eliminate the ‘sad’ or

‘tired’ look without the need of undergoing major surgery. This procedure lifts the brows,

reduces crow’s feet lines, firms the outer area of the eye and lightens the hooding of the outer

eyelid. A major benefit of temporal lifting is that it is a very short procedure, with a minimal

recovery period. It can be performed as a day case procedure or under twilight anaesthesia

involving 12-24-hour hospitalisation, followed by a 7-15 day recovery period.

ANATOMY OF THE TEMPORAL AREA

Knowledge of the various layers and structures of the temporal area is essential to

understanding the ageing process in this region and its correction. Under the skin and its

strongly attached subcutaneous tissue, there are 3 fascial layers within the temporal region,

comprising the superficial temporal fascia (or temporo-parietal fascia), and the superficial and

deep layers of the deep temporal fascia, which attach the dermal roof to the bony floor. In

between those superficial and deep temporal fascia there a sliding space named the “Merkel

space”, very useful for the temporal dissection. Sensory innervation of temporal and midface

is supplied by the trigeminal nerve which penetrates the periosteum and preperiosteal fat (5).

A number of key studies have been performed which have contributed to a fuller

understanding of temporal area and midfacial anatomy and have led to safer and more

effective aesthetic treatments in this area. Stuzin et al conducted a study in facial soft tissue

anatomy to investigate the relationship of the superficial facial fascia (SMAS) to the mimetic

muscles, deep facial fascia, and underlying facial nerve branches. Results showed that the

facial soft tissue architecture is arranged in a series of concentric layers comprising skin,

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subcutaneous fat, superficial fascia, mimetic muscle, deep facial fascia (parotidomasseteric

fascia), and the plane containing the facial nerve, parotid duct, and buccal fat pad (6).

Rohrich and Pessa studied the histology of the septal boundaries between several adjacent

subcutaneous fat compartments. Their findings showed that subcutaneous fat is

compartmentalised by fibrous fascial condensations that travel from the superficial fascia to

the dermis. These septa form an interconnecting framework that limits shearing forces on the

face and provides a ‘retaining system’. This concept suggests that the face ages

3-dimensionally, with separate compartments changing relative to one another by both

position and volume (7).

Ghavami et al noted that some ambiguity existed regarding the exact anatomical limits of the

orbicularis retaining ligament, particularly its medial boundary in both the superior and

inferior orbits. A clear understanding of this anatomy is necessary during periorbital

rejuvenation. A ligamentous system was found that arises from the inferior and superior

orbital rim that is truly periorbital and may serve to act as a fixation point for the orbicularis

muscle of the upper and lower eyelids, and to protect the ocular globe. This ligament spans

the entire circumference of the orbit from the medial to the lateral canthus, with a fusion line

between the orbital septum and the orbicularis retaining ligament in the superior orbit,

indistinguishable from the arcus marginalis of the inferior orbital rim. Laterally, the

orbicularis retaining ligament contributes to the lateral canthal ligament (8).

Investigations of the courses taken by nerves supplying that region have been conducted.

Pitanguy and Ramos plotted the course of the frontotemporal nerve on the skin as a line

starting from a point 0.5cm below the tragus and passing 1.5cm above the lateral extremity of

the eyebrow. They established that, after the main division, 5 major branches of the facial

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nerve exist: temporal (frontal), zygomatic, buccal, mandibular, and cervical (9). Stuzin et al

examined the anatomy specifically of the temporal region, with particular reference to the

frontal branch of the facial nerve. Results showed that the frontal branch travelled in a

constant plane along the undersurface of the temporoparietal fascia and was quite superficial

as it crossed the zygomatic arch. The deep temporal fascia and superficial temporal fat pad are

anatomically important structures which adjoin the periosteum of the zygomatic arch and lie

deep to the frontal nerve. These findings were significant since they contributed to the

development of a safe method of dissection within the temporal region (10).

Ishikawa conducted a study in an attempt to define the distribution of the temporal branch of

the facial nerve in relation to surrounding tissues and found that the temporal branch generally

branched into 3 or 4 rami and its trajectory was either straight or curved, depending on the

relationship between the middle and the posterior ramus. The distances from the bony lateral

canthus to each point were relatively constant and there was no difference between the right

and the left side. As a consequence of these findings, it was possible to establish new

guidelines for protection of the entire temporal branch from surgical injury by dissecting and

undermining the superficial layer of the deep temporal fascia , including the deep temporal fat

pad (which is in continuity with the Bichat buccal fat pad)(11).

HISTORY OF TEMPORAL AND MIDFACE REJUVENATION

Upper and midface rejuvenation has evolved significantly over the past few decades. A

pioneer in field, Tessier, first described subperiosteal dissection of midface in the late 1970’s

(5). Tessier noted that the ‘facial mask’ comprises all of the tissues lying on top of the

skeleton: periosteum, deep adipose tissue, superficial musculo-aponeurotic tissue and skin.

The periosteum is the intermediate zone between the skeleton, responsible for the shape of the

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face, and the more superficial tissues which complete the shapes and, most importantly,

represent the mobile part of the face and the site of facial expression. An effective ‘mask-lift’

depends upon complete subperiosteal dissection of the malar bones, zygomatic arches and

orbital margins. Subperiosteal dissection via a coronal incision is useful to lift the facial mask

and to remodel the orbital margins, as well as to obtain bone grafts from the parietal area in

order to reinforce the glabella, check bones and nasogenial folds (12).

Hamra performed a composite rhytidectomy which added a midface component by elevating

the lateral part of the orbicularis oculi muscle and by fixating the temporal flap to the

temporal muscle by removing a squared part of the deep temporal fascia muscle (13). Isse was

the first to propose an endoscopic lateral myotomy of the Orbicularis Oculi to relax that

depressor muscle to help the Frontalis muscle to lift the tail of the eyebrow (333 ISSE)

(Raspaldo – in Midface enhancement). Ramirez extended the endoscopic forehead lift to the

midface, with the subperiosteal midface lift. The results obtained were excellent results and he

concluded that this type of facelift was a viable alternative to standard techniques (15).

PRINCIPLES OF TEMPORAL LIFT

The temporal facelift can be performed by a surgeon either endoscopically or via a limited

number of short incisions (up to approximately 4cm) in the hairline above the temple (hence

the term ‘temporal lift’). The incision is parallel to the hairline but behind the anterior

hairline in order to allow detachment of the anterior portion of forehead and temple skin,

eyebrow area and malar cheekbone skin areas. The area is pulled and deep stitches allow

repositioning. Since the incisions are small and scars are hidden in hair, they are not visible

and sutures are generally removed after 10 days. This procedure restores the eyebrows to their

natural position and elevates the temporal tissues by lifting up drooping cheek tissue over the

cheekbone to restore a more prominent, youthful contour. It reduces crow’s feet lines, firms

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outer eye areas and lightens hooding of the outer eyelid, and also has some effect on

nasolabial folds.

SURGICAL APPROACHES TO TEMPORAL REJUVENATION

Surgical approaches to temporal rejuvenation traverse deep into superficial temporal fascia

(superior most extension of SMAS layer) which is the most superficial of the temporal fascial

layers, and contains the frontal branch of the facial nerve, temporal artery and vein, so it is

important to ensure that care is taken to avoid injury to these structures. The subperiosteal

facelift, or ‘mask lift’ was first described by Tessier in 1979 and it provides a vertical lift to

the facial soft tissues to allow remodeling and repositioning at the level of their bony origins.

It is a deep technique which allows rejuvenation of the upper two-thirds of the face. Section

of the superficial leaflet of the temporal aponeurosis reveals the Deep Musculo Aponeurotic

System (DMAS) which can be used to raise all of the soft tissues of the face while protecting

the frontal branch of the facial nerve. Elevation of the tissues of the face is essentially vertical

and acts on the forehead, temporal region, gaze and cheekbones (19).

Psillakis and Ramirez amongst others, further extended subperiosteal dissection for treatment

of the midface, jawline and neck (20).

Krastinova-Lolov, fellow of Paul Tessier continues to develop the ‘mask lift’ with facial

aesthetic resculpturing as a facial aesthetic surgery technique based on a different approach to

the ‘ageing face’. This technique seeks to normalise, rejuvenate and embellish the face

through a sub-periosteal lift of the facial mask and transformation of the underlying structures

by facial aesthetic sculpturing of the facial skeleton (21).

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Thus it can be seen that improvements in surgical techniques have led to advances in temporal

rejuvenation. Stuzin et al noted that increased experience gained in face lifting has resulted in

refinements in the procedure that have led to increased consistency in results (22).

NON-SURGICAL APPROACHES TO TEMPORAL REJUVENATION

Facial aesthetics and rejuvenation are evolving rapidly due to changes in products, procedures

and patient demands. They ask for less aggressive treatments, no downtime but still effective

results. Clinicians can benefit from ongoing guidance on products, a new grading of facial

ageing, tailoring treatments to individual patients, treating multiple facial areas, and using

combinations of products to optimise outcomes. There are now a number of products

available for non-surgical temporal rejuvenation which are safe, effective and versatile.

Hyaluronic acid (HA):

Juvéderm Ultra® 4 is an effective hyaluronic acid (HA) dermal filler which provides

predictable and natural results that are long-lasting but temporary. It is easy to use by

practitioners and treatment is well-tolerated by patients since it contains lidocaine to reduce

the pain of injection (23) (+ Levy publications).

From a recent advisory board meeting comprising a panel of French experts from the field of

aesthetic enhancement who met to define a consensus regarding global facial rejuvenation,

Juvéderm Ultra® 4 was indicated for treatment of more superficial lines and folds. However,

its effectiveness in the temporal region was acknowledged since it was also considered

effective for the treatment of marked nasolabial folds and in the mid-facial area, such as the

cheek and eyebrows, as well as in young women requiring a small quantity of volumising

product, or as a supplement to Juvéderm VOLUMA™.

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Juvéderm VOLUMA™:

Juvéderm VOLUMA™ is the latest generation of cross-linked HA volumiser and clinical

studies have demonstrated its safety and high levels of satisfaction with the results of

treatment. It was specifically developed to restore lost facial volume (e.g. in the cheeks,

cheekbones and chin) and the product was developed to be very smooth, viscous and robust,

making it easier to inject during treatment and resulting in a fuller, smoother, natural look and

feel, with benefits lasting up to18 months post-treatment (24).

NewFill® / Sculptra®:

Sculptra® is a biocompatible, resorbable injectable filler composed of poly-L-lactic acid

(PLLA). It belongs to the class of stimulatory fillers that create their effect through

encouraging neocollagenesis when injected, and therefore differs from traditional, static fillers

such as HA and collagen. Both the natural method of volume restoration and the persistence

of results for up to 2 to 3 years make this product a worthy first-line treatment of choice for

cosmetic rejuvenation, as well as for reconstructive soft tissue deficits and lipoatrophy (26).

Sculptra® is effective and commonly used for the midface and temporal fossa, with more

limited use in the mental and prejowl areas.

Botulinum Toxin Type-A (BoNTA) to change the muscular balance:

The role of BoNTA in temporal rejuvenation was considered by Carruthers et al, and Fagien-

Raspaldo (biblio 3333) who reported on a multidisciplinary group of aesthetic treatment

experts who convened to review the properties and uses of BoNTA and HA fillers and to

update consensus recommendations for facial rejuvenation. The group provided specific

recommendations by facial area, focusing on relaxing musculature, restoring volume, and

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recontouring using BoNTA and HA fillers alone and in combination. For the upper face,

BoNTA remains the cornerstone of treatment, with HA fillers used to augment results and to

restore volume. BoNTA and HA in combination can improve outcomes (28).

BoNTA for Masseter Hypertrophy:

A recent development in the field of midface enhancement is BoNTA treatment of masseter

hypertrophy which is generally caused by bruxism (grinding teeth), temporo-mandibular joint

disorders, or misaligned jaws. The condition may cause discomfort or simply present an

asymmetrical appearance. Furthermore, Asian persons, particularly those of Korean and

Japanese descent, often seek correction of masseter hypertrophy for aesthetic reasons since

their characteristic appearance of high cheekbones and distinct mandibular contour are

features valued in the West, but because of the more delicate topography of the typical Asian

face, zygomas and mandibular angles that are overly prominent upset the balance, rendering

the face overly flat, wide and square. In addition to its undesirable aesthetic appearance, in

some East Asian cultures the prominent zygoma and mandibular angle have traditionally been

associated with negative personal characteristics. Therefore, Asian patients who might

hesitate to have other types of surgery are willing to undergo reductive correction of these

areas in order to create a more delicate jaw line and reduced mandibular angle.

Several studies of BoNTA as a treatment for masseter hypertrophy show good results, with

high satisfaction rates. This procedure is a simple alternative to surgery providing predictable

results. Kim et al investigated retrospectively the long-term treatment effects of BoNTA by

analysing the follow-up data of masseter hypertrophy patients. Results showed that BoNTA

injections had a long-term effect on masseter muscle hypertrophy and a positive correlation

11


was found between the number of injections and the decrease of muscle volume (30). With

respect to the recommended BoNTA injection technique for masseter hypertrophy, the author

advises 1 or 2 injections at sites located away from the facial nerve and deep under the

aponevrosis of the masseter muscle. We use 16 up to 20 units of Onabotulinum toxin per side,

through 1 up to 3 injection sites. The consequence is a functional reduction of the masseter

muscle mass (volume) who softens the lowerface. Consequently, when the patient masticate,

chew or bite he will use more his temporal muscle. That creates a volume augmentation of the

temporal muscle. And it helps to enhance the vertical attractive triangle of beauty (the Heart

of Face®) (biblio Raspaldo, in Monduzzi editore).

TECHNIQUE OF INJECTION IN THE TEMPORAL AREA:

The key points are to know where to inject, how to inject, how deep, which quantity and what

kind of product.

-WHERE TO INJECT: BASED ON CLINICAL CORRELATION WITH

TEMPORAL ANATOMY (FIG. X)

That creates a volume augmentation

-HOW DEEP (FIG. XX)

That creates a volume augmentation SUPERFICIAL, MERKEL,DEEP TF

-QUANTITY (TABLE #)

That creates a volume augmentation

RESULTS OF TEMPORAL REJUVENATION

Whatever technique is used, temporal rejuvenation using non-surgical techniques can produce

dramatic results. The main benefits include a youthful appearance lasting some 1 to 2 years,

with minimal or no scarring, reduced bleeding, no hair loss and shorter recovery time

compared to surgical techniques. It can provide the ‘chiselled’, ‘model look’ combining

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midface rejuvenation. This highly successful procedure can provide some tension to the

cheekbones and result in a more attractive gaze, just as when one’s hair and temple is pulled

back and up.

INDICATIONS:

In order to provide an objective pre-treatment assessment of the patient to determine

suitability for temporal rejuvenation, the author recommends the use of his 4-point temporal

ageing scale at baseline comprising:

Stage 1: Normal, convex or straight temporal fossa

Stage 2: Early signs of a slight depression (i.e. hollow)

Stage 3: Concavity of temporal fossa, with some visible temporal vessels.

Stage 4: Skeletonisation of the temporal fossa, bones are visible; severely visible veins

and artery; severe concavity of the fossa

Depending upon the stage of temporal ageing at baseline, the optimum aesthetic product and

volume required can then be roughly established in advance of treatment. The following

guideline is recommended buy the author to obtain maximum benefits:

Stage 1: No treatment

Stage 2: 0.4cc-0.8cc of Juvéderm Ultra® 4 per side +/- OnaBonTa 16U/ Masseter

Stage 3: 1-2cc of Juvéderm VOLUMA™ per side +/- OnaBonTa 16-18U/ Masseter

Stage 4: 2-4cc Juvéderm VOLUMA™ per side

Superficial lines can then be managed using superficial injections of Juvéderm Ultra® 4.

TEMPORAL CASE STUDIES

Dr Raspaldo: please provide ‘before’ and ‘after’ photographs and any information

regarding treatment technique used for patients who have undergone temporal rejuvenation

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COMPLICATIONS OF TEMPORAL INJECTIONS

The risks associated with non-surgical techniques comprises bruising and pin-prick bleeds.

CONCLUSION

Temporal, or midface, enhancement has evolved significantly over the past few decades.

Temporal rejuvenation is a new area of interest for aesthetic practitioners and its popularity is

increasing due to demand from patients, particularly since it can now be performed without

the need for major surgery, and it is associated with a very short recovery period. The

benefits of temporal facelifts are greatest for those in their mid-30’s or early 40’s, and in this

group of patients the results of this highly successful procedure can be dramatic.

It is essential to have a full knowledge of the anatomy of midface in order to understand the

ageing process and its associated correction. In this paper, different techniques for temporal

rejuvenation have been discussed, as well as consideration of a range of effective products

available, including HA fillers, poly-L-lactic acid and BoNTA. According to the stage of

temporal ageing at baseline, the optimum product and volume required can be established in

advance of treatment to achieve maximum benefits. Juvéderm VOLUMA™ is particularly

recommended for temporal rejuvenation by the author due to its high rates of safety and

efficacy, lack of downtime post-injection, and long-lasting results which can be up to 18-24

months.

ACKNOWLEDGMENTS

Medical writing support for this paper was provided by Debbie Jordan.

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REFERENCES

1. Finn JC, Cox SE, Earl ML (2003) Social implications of hyperfunctional facial lines.

Dermatol Surg 29:450-455

2. Vikram ZP, Pessa JE (2000) Biological arches and changes to the curvilinear form of

the aging maxilla. Plast and Reconstr Surg 106(2):460-466

3. Raspaldo H (2007) Facial design, architecture and volume - the new 3D sculpture

using botulinum toxin and deep injectable fillers: facial rejuvenation using Btx

expertise combined with injectable fillers in upper, mid and lower face. Allergan

Academy, Poster session, London April 13

4. LaFerriere KA, Castellano RD (2009) Surgical approaches to the midface complex.

In: Papel ID, Frodel JL, Holt GR, Larrabee WF, Nachlas NE, Park SS, Sykes JM,

Toriumi DM Facial plastic and reconstructive surgery. Third edition. Thieme

Medical Publishers Inc, New York

5. Stuzin JM, Baker TJ, Gordon HL (1992) The relationship of the superficial and deep

facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg 89(3):441-

449

6. Rohrich RJ, Pessa JE (2008) The retaining system of the face: histologic evaluation of

the septal boundaries of the subcutaneous fat compartments. Plast Reconstr Surg

121(5):1804-1809

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7. Ghavami A, Pessa JE, Janis J, Khosla R, Reece EM, Rohrich RJ (2008) The

orbicularis retaining ligament of the medial orbit: closing the circle. Plast Reconstr

Surg 121(3):994-1001

8. Pitanguy I, Ramos AS (1966) The frontal branch of the facial nerve: the importance of

its variations in face lifting. Plast Reconstr Surg 38(4):352-356

9. Stuzin JM, Wagstromn L, Kawamoto HK, Wolfe SA (1989) Anatomy of the frontal

branch of the facial nerve: the significance of the temporal fat pad. Plast Reconstr

Surg 83(2):265-271

10. Ishikawa Y (1990) An anatomical study on the distribution of the temporal branch of

the facial nerve. J Craniomaxillofac Surg 18(7):287-292

11. Tessier P (1989) Subperiosteal face-lift. Ann Chir Plast Esthet 34(3):193-197 [Article

in French]

12. Hamra ST (1990) The deep-plane rhytidectomy. Plast Reconstr Surg 86(1):53-61

13. Ramirez OM, Pozner JN (1996) Subperiosteal minimally invasive laser endoscopic

rhytidectomy: the SMILE facelift. Aesthetic Plast Surg 20:463-470

14. Cornette de Saint Cyr B (1994) Subperiosteal face lift or ‘mask lift’. Ann Chir Plast

Esthet 39(5):557-570

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15. Ramirez OM, Maillard GF, Musolas A (1991) The extended subperiosteal face lift: a

definitive soft-tissue remodeling for facial rejuvenation. Plast Reconstr Surg

88(2):227-236

16. Krastinova-Lolov D (1995) Mask lift and facial aesthetic sculpturing. Plast and

Reconstr Surg 95(1):21-36)

17. Stuzin JM, Baker TJ, Baker TM (2000) Refinements in face lifting: enhanced facial

contour using vicryl mesh incorporated into SMAS fixation. Plast Reconstr Surg

105(1):290-301

18. Raspaldo H (2008) Volumizing effect of a new hyaluronic acid sub-dermal facial

filler: a retrospective analysis based on 102 cases. J Cosmet Laser Ther 10(3):134-142

19. Lacombe V (2009) Sculptra: a stimulatory filler. Facial Plast Surg 25(2):95-99

20. Carruthers JD, Glogau RG, Blitzer A [Facial Aesthetics Consensus Group Faculty]

(2008) Advances in facial rejuvenation: botulinum toxin type a, hyaluronic acid

dermal fillers and combination therapies – consensus recommendations. Plast

Reconstr Surg 121(5 Suppl):5S-30S

21. Kim NH, Park RH, Park JB (2010) Botulinum toxin type A for the treatment of

hypertrophy of the masseter muscle. Plast Reconstr Surg 125(6):1693-1705

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22. Levy PM, De Boulle K, Raspaldo H. A split-face comparison of a new hyaluronic

acid facial filler containing pre-incorporated lidocaine versus a standard hyaluronic

acid facial filler in the treatment of naso-labial folds. J Cosmet Laser Ther

2009;11(3):169-73

23. Raspaldo H, De Boulle K, Levy PM. Longevity of effects of hyaluronic acid plus

lidocaine facial filler. J Cosmet Dermatol 2010;9(1):11-15

24. Schaverien MV, Pessa JE, Rohrich RJ. Vascularized membranes determine the

anatomical boundaries of the subcutaneous fat compartments. Plast Reconstr Surg

2009;123(2):695-700

25. Raspaldo H. New Era of Facial-3D Rejuvenation using injectable products and how

to measure the results Heart of Face®. European Annual Congress of Facial Plastic

Surgery; 24-28 September 2008, Monduzzi Editore (Italie) 2009

26. Fagien S, Raspaldo H. Facial rejuvenation with botulinum neurotoxin: an anatomical

and experiential perspective. J Cosmet Laser Ther 2007;9(suppl 1):23-31

27.

Herve – you mentioned the following papers but I can’t find them. Please can you either

provide the full reference for me or add in the text you want associated with each one in the

main manuscript? Thanks.

Raspaldo H. Lifting harmonieux: Technique - Philosophie = Harmonious

rhytidectomy. Journal français d'oto-rhino-laryngologie. ISSN 0398-9771.

Symposium de Chirurgie Plastique de la Face, Lyon , FRANCE,1996 ;45(4), (88

18

http://www.refdoc.fr/?traduire=en&FormRechercher=submit&FormRechercher_Txt_Recherche_name_attr=listeTitreSerie:%20(Journal%20fran%C3%A7ais%20d'oto-rhino-laryngologie)

http://www.refdoc.fr/?traduire=en&FormRechercher=submit&FormRechercher_Txt_Recherche_name_attr=identifiantsDoc:%20(0398-9771)


p) (28 ref):255-267 [please provide translation of paper which is in French and not

available via Internet]

Raspaldo H. Midface enhancement (in ‘Facial plastic and reconstructive surgery’ –

Book edited by Hodder Arnold, 2006 ) [cannot find this reference on Medline or via

Internet]

Mendelsohn PRS anatomy of the temporal area [cannot find this reference on Medline

or via Internet]

Santini J, Raspaldo H, Kestemont P, Magnani M. Surgical planes of dissection of the

face: anatomic basis for composite face lifts. In: FACE (Facial Aesthetic

Communication in Europe), 1994 [cannot find this reference on Medline or via

Internet]

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CONFLICT OF INTEREST DISCLOSURE

Dr Raspaldo is a consultant for Allergan Inc.

20

Documents

Réunion de consensus - Dr. Raspaldo · Web viewtype of ARTICLE: INNOVATIVE TECHNIQUES. word count: …… words. FACECULPTURE®:. CURRENT TECHNIQUES FOR temporal REJUVENATION with