title: Global 3-dimensional approach to natural rejuvenation: recommendations for perioral, nose, and ear rejuvenation.
abstract: BACKGROUND
  There is a move toward a global, 3-dimensional approach to facial rejuvenation that has been prompted by advances in techniques and available products. However, little published literature exists on the procedures involved in this global approach, and currently, no validated recommendations exist.
  
  
  OBJECTIVE
  To provide a detailed, practical guide to rejuvenation of the perioral area, nose, and ears based on expert consensus recommendations.
  
  
  METHODS
  The aim of this approach was to take into account both volumetric and dynamic aspects of treatment, as well as the benefits of treatment combinations, for example, combining botulinum toxins with hyaluronic acid (HA) fillers and volumizers. Each set of recommendations was documented, comprising a clinical definition of the aging severity scale, together with recommendations of appropriate products, doses, site, depth, and injection techniques, as well as indication-specific rules to be respected.
  
  
  RESULTS
  HA fillers are ideal for replenishing volume loss in the lips, while rhytides around the lips can be treated with small doses of botulinum toxin. Botulinum toxin can also be used to raise the tip of the nose, to reshape nostrils, and to narrow nasal flare, with HA fillers also be used to correct small defects. HA fillers can also be used to rejuvenate sagging, atrophic or irregular ear lobes, repair torn earlobes, or erase vertical rhytides.
  
  
  CONCLUSIONS
  By providing practical guidance on rejuvenation of the perioral area, nose, and ears, esthetic facial physicians can achieve optimum patient outcomes.
authors.affiliation: v.gassia@club-internet.fr
authors.forename: Véronique
authors.initials: V
authors.lastname: Gassia
authors.forename: Hervé
authors.initials: H
authors.lastname: Raspaldo
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*; D004423:Ear; D004954:Esthetics; D005145:Face; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D008297:Male; D009055:Mouth; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D009666:Nose; D012060:Rejuvenation; D015595:Skin Aging; D055675:Viscosupplements / Q000627:therapeutic use*
chemical_list: D009465:Neuromuscular Agents; D055675:Viscosupplements; D006820:Hyaluronic Acid; D019274:Botulinum Toxins, Type A