title: Advances in facial rejuvenation: botulinum toxin type a, hyaluronic acid dermal fillers, and combination therapies--consensus recommendations.
abstract: 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
  A multidisciplinary group of aesthetic treatment experts convened to review the properties and uses of botulinum toxin type A (BoNTA) and hyaluronic acid fillers and to update consensus recommendations for facial rejuvenation 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 education and counseling; and emerging trends and needs in facial rejuvenation.
  
  
  RESULTS
  The group provided specific recommendations by facial area, focusing on relaxing musculature, 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 outcomes 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 recontouring, and thorough knowledge of properties and techniques specific to each product in the armamentarium.
authors.affiliation: Vancouver, Canada; San Francisco, Calif.; and New York, N.Y. From the Department of Ophthalmology, University of British Columbia; Department of Dermatology, University of California, San Francisco; and Department of Otolaryngology-Head and Neck Surgery, Columbia University.
authors.forename: Jean D A
authors.initials: JDA
authors.lastname: Carruthers
authors.forename: Richard G
authors.initials: RG
authors.lastname: Glogau
authors.forename: Andrew
authors.initials: A
authors.lastname: Blitzer
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003357:Cosmetic Techniques / Q000592:standards*; D004359:Drug Therapy, Combination; D004502:Education, Medical, Continuing; D005145:Face; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D009498:Neurotoxins / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012060:Rejuvenation
chemical_list: D000276:Adjuvants, Immunologic; D009498:Neurotoxins; D006820:Hyaluronic Acid; D019274:Botulinum Toxins, Type A