PAN-ASIAN CONSENSUS-Key Recommendations for Adapting the World Congress of Dermatology Consensus on Combination Treatment with Injectable Fillers, Toxins, and Ultrasound Devices in Asian Patients

Abstract

BACKGROUND. The demand for minimally invasive aesthetic procedures has driven requests by physicians for guidance on their use in Asian patients, who have unique cultural preferences, social trends, and anatomy. However, few guidelines exist, particularly on combination treatment strategies for different facial shapes or indications such as the modification of face shapes to the "oval ideal."Physicians must, therefore, apply Caucasian patient-optimized guidelines to their Asian patients. METHODS. Eleven specialists developed a consensus on the use of botulinum toxin A (BoNT-A), calcium hydroxylapatite (CaHA) and hyaluronic acid (HA) fillers, and microfocused ultrasound with visualization (MFU-V) devices in Asian patients on upper-, middle-, and lower-face indications, including strategies to modify different facial shapes to the oval shape. Approval from 70 to 90 percent of all participants led to moderate consensus, while 90 percent agreement denoted a strong consensus. RESULTS. For early intervention/enhancement and restoration, most combination strategies are similar between Asian and Caucasian patients. Compared to Caucasian patients, however, beautification is a more common focus in Asian patients. The "ideal" oval facial shape can be created using different interventions depending on the patient's baseline characteristics. CONCLUSIONS. Although treatments and treatment sequences for early intervention/enhancement and restoration for beautification in Asian patients are similar to those in Caucasian patients, different treatment strategies may be required.

Keywords: Asian; botulinum toxin; combination treatment; consensus guidelines; fillers.

FIGURE 1.

Common face shape categories The ace shape categories for women (top) and men (bottom). Five classical face shapes are widely recognized regardless of geography, age, or gender. The oval and heart are considered ideal for women. (Photos courtesy of Merz Pharmaceuticals GmbH.)

FIGURE 2.

Treatment recommendations for the already ideal oval/heart shape A) HA fillers can be applied for forehead augmentation and in the temples to increase the convexity of the curvature and create fullness and contouring here, as well as in the cheeks, to improve contours. Hairstyling can be used to narrow transverse widths over the cheekbones (photo courtesy of Dr. Yates Chao); B) Patient 1 received BoNT-A for the masseter several months prior to the photo being taken (left), which shows an exaggerated subzygomatic depression, aggravated zygomatic prominence, and a blunt chin. For oval shaping and face slimming, 1mL of filler was used per side for volumization of the subzygomatic depression and the anterior chin (right) (photos courtesy of Dr. Kyle Seo).

FIGURE 3.

Treatment recommendations to bring the oblong/rectangular face closer to the ideal oval shape A) Examples of beautification interventions on the oblong face (photo courtesy of Dr. Yates Chao); B) Patient 2 received toxin treatment for the masseter and temporalis (photo courtesy of Dr. Kyle Seo); C) Patient 3 shown at different viewing angles, before HA and CaHA filler treatment (top left and bottom left), with visible curve sculpting and contouring effects after 17 days (top right and bottom right) (photos courtesy of Dr. FW Tseng).

FIGURE 4.

Beautification of the round face to bring it closer to the oval shape A) Treatment recommendations for the round face (photo courtesy of Dr. Yates Chao); B) Patient 4 received BoNT for the masseter and filler for chin augmentation (photos courtesy of Dr. Yates Chao); C) Patient 5 also received filler for the subzygoma (posterior cheek) (photos courtesy of Dr. Kyle Seo).

FIGURE 5.

Treatment recommendations to bring the square face closer to the ideal oval shape A) To modify a square face to an oval shape, HA fillers can be used to increase facial projection, enhance contours at the forehead and temples, and increase fullness. BoNT-A can be applied for jawline slimming and to create a Nefertiti lift, while CaHA fillers can be injected into the chin for contouring and projection. M-FUV devices can then be used to tighten the lower cheeks and sharpen angles (photo courtesy of Dr. Yates Chao); B) Patient 6, example of square to oval shape modification (photo courtesy of Dr. Yates Chao); C) Patient 7 before treatment (left and day 0 photos) and 40 days after BoNT-A injection to the masseter, with obvious masseter reduction. Treatment details are listed (photo courtesy of Dr. FW Tseng).