title: Global, 3-dimensional approach to natural rejuvenation: part 1 - recommendations for volume restoration and the periocular area.
abstract: BACKGROUND
  New techniques and products have lead to a global approach for the treatment of signs of aging. However, there is little published literature on the procedures involved in this approach and currently no validated recommendations exist.
  
  
  OBJECTIVE
  To provide a detailed, practical guide to midfacial volume restoration and rejuvenation of the periocular area based on expert consensus recommendations.
  
  
  METHODS
  The expert committee took into account both volumetric and dynamic aspects of treatment, as well as benefits of treatment combinations, for example, combining OnabotulinumtoxinA with hyaluronic acid (HA) fillers and volumizers. An aging severity scale was established for each area, together with recommendations of appropriate products, doses, site, depth, and injection techniques, as well as rules to be respected.
  
  
  RESULTS
  The expert group concluded that volume restoration of the midface is the first essential step in the global approach because treatment for this area has the most significant positive impact. Firstly, it is important to restore the malar contour, as malar volume anchors the structure of the midface. Secondly, an assessment of the effects of malar enhancement on the appearance of the nasolabial folds and the nasojugal fold (tear trough) should be conducted because these aging signs may be decreased by malar enhancement. Finally, treatment for the nasolabial folds and periorbital area with HA should be performed when needed.
  
  
  CONCLUSIONS
  Practical guidance is provided for midfacial volume restoration and rejuvenation of the periocular area based on validated expert consensus recommendations. This will help esthetic facial physicians to achieve optimum outcomes.
authors.affiliation: Private Practice, Facial Plastic Surgery Centre, Cannes, France. doctor@raspaldo.fr
authors.forename: Hervé
authors.initials: H
authors.lastname: Raspaldo
authors.forename: Véronique
authors.initials: V
authors.lastname: Gassia
authors.forename: François-Rene
authors.initials: FR
authors.lastname: Niforos
authors.forename: Thierry
authors.initials: T
authors.lastname: Michaud
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003357:Cosmetic Techniques; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005138:Eyebrows; D005143:Eyelids; D005546:Forehead; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012060:Rejuvenation; D015595:Skin Aging
chemical_list: D003879:Dermatologic Agents; D009465:Neuromuscular Agents; D006820:Hyaluronic Acid; D019274:Botulinum Toxins, Type A