title: Midface and perioral volume restoration: a conversation between the US and Italy.
abstract: BACKGROUND
  There are numerous dermal fillers available to injectors in the US and Europe for the correction of age-related volume loss in the midface and perioral regions. Product availability differs between these two aesthetic markets due to US Food and Drug Administration (FDA) regulatory requirements. The purpose of this study is to discuss differences in filler selection by two practitioners in the US and Europe based upon both stylistic approach and filler availability in each market.
  
  
  OBJECTIVE
  To analyse and discuss the approach to midface as well as lip and perioral volume restoration by two independent dermatologists working in the US and Italy.
  
  
  METHODS
  Seven patients were selected for discussion and divided into two groups: 1) those requiring midface volumization and 2) those undergoing perioral or lip volume replacement. Patients in the midface group were injected with Juvéderm Voluma® XC, Juvéderm® Volift® with lidocaine, Restylane- L®, Perlane-L® or Radiesse®. Patients in the perioral and/or lip group were injected with Juvéderm® Volbella™, with lidocaine, or Belotero Balance™. Patients were photographed before and immediately after injection to evaluate aesthetic outcomes. In each case, filler selection was based upon patient characteristics, anatomical considerations and inherent filler properties.
  
  
  RESULTS
  All patients were extremely satisfied with their treatments. There were no significant immediate or delayed complications following treatment with any of the dermal fillers used.
  
  
  CONCLUSIONS
  Volume restoration in the midface and perioral or lip region can be effectively achieved using a variety of dermal fillers. The dermal filler portfolio available in Europe is exponentially larger than that in the US. Product selection in either market is ultimately the result of the physician's experience injecting each dermal filler, as well as his or her personal preferences.
authors.forename: Erin
authors.initials: E
authors.lastname: Gilbert
authors.forename: Lucia
authors.initials: L
authors.lastname: Calvisi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003357:Cosmetic Techniques; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005145:Face; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D007558:Italy; D008012:Lidocaine / Q000627:therapeutic use; D008046:Lip; D008875:Middle Aged; D009055:Mouth; D009339:Needles; D017060:Patient Satisfaction; D012060:Rejuvenation; D015595:Skin Aging; D014481:United States
chemical_list: D003879:Dermatologic Agents; C526061:Juvederm Ultra; C502935:Perlane; D006820:Hyaluronic Acid; D008012:Lidocaine; C445361:Restylane