title: A Comprehensive Approach to Multimodal Facial Aesthetic Treatment: Injection Techniques and Treatment Characteristics From the HARMONY Study.
abstract: BACKGROUND
  The HARMONY study is the first clinical trial to assess the impact of a global approach to facial rejuvenation with several minimally invasive modalities, using patient-reported outcome measures.
  
  
  OBJECTIVE
  Provide details of this treatment approach and describe investigators' experiences and recommendations based on this study.
  
  
  METHODS
  This multicenter, 4-month study evaluated subject satisfaction with and psychological impact of combined treatment with VYC-20L (Juvéderm Voluma XC), HYC-24L (Juvéderm Ultra XC), HYC-24L+ (Juvéderm Ultra Plus XC), onabotulinumtoxinA (Botox), and bimatoprost 0.3% ophthalmic solution (Latisse). Treatment-naive adults with moderate-to-severe facial lines and folds and eyelash hypotrichosis received on-label, staged treatment with fillers. Bimatoprost was self-administered once daily for 17 weeks from day 1. OnabotulinumtoxinA was administered for glabellar lines, crow's feet lines, or both at month 3.
  
  
  RESULTS
  Overall, 100 subjects received bimatoprost for eyelash hypotrichosis, 96 received onabotulinumtoxinA for glabellar lines and/or crow's feet lines, and 96 received VYC-20L for midface volume deficit. From 17 to 96 subjects received HYC-24L and/or HYC-24L+ for nasolabial folds, oral commissures, marionette lines, perioral lines, or radial cheek lines. Injections of filler generally progressed from cranial to caudal, with midface injected first. Investigator-reported factors that may have contributed to the potential benefits of this approach include the critical role of the midface in facial aesthetics, use of lower volumes of filler in individual facial areas, and anesthetic effects.
  
  
  CONCLUSIONS
  The investigators' perspectives and experience with the injection pattern, sequencing, volumes, and techniques may provide valuable guidance for a multimodal approach to facial aesthetic treatment.
authors.affiliation: *Bay Area Laser Institute, San Francisco, California; †AboutSkin Dermatology and DermSurgery, Englewood, Colorado; ‡DeNova Research, Chicago, Illinois; §SkinCare Physicians, Chestnut Hill, Massachusetts; ‖Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; ¶AVA MD, Santa Monica, California; #UC Davis Medical Group, Sacramento, California; **Bellaire Dermatology Associates, Bellaire, Texas; ††Private Practice, Bradenton, Florida; ‡‡University of Washington, School of Medicine, Seattle, Washington; §§Peloton Advantage, Parsippany, New Jersey; ‖‖Allergan plc, Irvine, California.
authors.forename: Vic A
authors.initials: VA
authors.lastname: Narurkar
authors.forename: Joel L
authors.initials: JL
authors.lastname: Cohen
authors.forename: Steven
authors.initials: S
authors.lastname: Dayan
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kaminer
authors.forename: Alexander
authors.initials: A
authors.lastname: Rivkin
authors.forename: Ava
authors.initials: A
authors.lastname: Shamban
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Sykes
authors.forename: Craig F
authors.initials: CF
authors.lastname: Teller
authors.forename: Susan H
authors.initials: SH
authors.lastname: Weinkle
authors.forename: W Philip
authors.initials: WP
authors.lastname: Werschler
authors.forename: Adrienne
authors.initials: A
authors.lastname: Drinkwater
authors.forename: Michael L
authors.initials: ML
authors.lastname: Pucci
authors.forename: Conor J
authors.initials: CJ
authors.lastname: Gallagher
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000069580:Bimatoprost / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003357:Cosmetic Techniques / Q000523:psychology; D000067548:Dermal Fillers / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005140:Eyelashes; D005145:Face; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007039:Hypotrichosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D016037:Single-Blind Method; D015595:Skin Aging
chemical_list: D000959:Antihypertensive Agents; D000067548:Dermal Fillers; C526061:Juvederm Ultra; C526062:Juvederm Ultra Plus; C000596435:Juvederm VOLUMA; D009465:Neuromuscular Agents; D006820:Hyaluronic Acid; D019274:Botulinum Toxins, Type A; D000069580:Bimatoprost