New Aesthetic Unit (NAU) Method: A Comprehensive Method Based on Accurate Anatomical Assessment and Precise Multilayering Panfacial Treatment for Hyaluronic Acid Fillers

Abstract

Background: Recent progress in anatomy enables a more sophisticated approach to treat patients with facial aesthetic concerns (PFAC) with HA fillers. Furthermore, advances in rheology have offered a range of HA fillers with different biomechanical properties adapted to different indications.

Methods: Based on recent anatomical and rheological progresses, the author has developed a new methodology that couples an accurate patient assessment tool and a panfacial precise treatment instrument. In the presented method, the face is divided into 6 units called New Aesthetic Units (NAU). NAUs are classified on the extent of volume deficiency and asymmetry, ranging from none to moderate to severe deficiencies. After discussion with the patient regarding the assessment findings, a customized treatment plan, including timelines and number of sessions, is recommended. The modalities of the treatment are exhaustively described for each NAU based on multilayering, best practice medicine, and expert consensus available in the literature.

Results: Before-and after-case studies are presented to illustrate how the NAU method is used in routine practice for the treatment of two patients with HA fillers.

Conclusion: The NAU method is not only a practical and accurate roadmap for the assessment and treatment of PFAC with HA fillers, but also facilitates communication between injectors and patients and data analysis.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Aesthetics; Dermal fillers; Facial aging; Hyaluronic acid; Rejuvenation.

Fig. 1

a Frontal view of the NAUs. b Profile view of the NAUs

Fig. 2

a Frontal view of the anatomical components of the NAUs. b Profile view of the anatomical components of the NAUs .c Frontal view of the NAUs and their associated deep fat compartments. d Profile view of the NAUs and their associated superficial fat compartments

Fig. 2

a Frontal view of the anatomical components of the NAUs. b Profile view of the anatomical components of the NAUs .c Frontal view of the NAUs and their associated deep fat compartments. d Profile view of the NAUs and their associated superficial fat compartments

Fig. 3

Frontal view of NAU 1 and NAU 3, and respective subunits. Entry points a1, a2, b, c are represented in green

Fig. 4

a Frontal view of the superficial fat compartments associated with NAU 2 Entry points b and c are represented in green. b Frontal view of the interfascial compartments associated with NAU 2. Entry points b and c are represented in green.

Fig. 5

a Frontal view of subunits NAU 4a, 4b, 4c and 4d. Entry points c and d are represented in green. b Profile view of subunits NAU 4e, 6c, 6d, 6e, 6f and associated superficial fat pad compartments. Entry point e is represented in green

Fig. 6

a Frontal view of NAU 5, NAU 6a and 6b and associated superficial fat pad compartments. Entry points c, f and g are represented in green. b Frontal view of subunits NAU 6a and 6b and associated deep fat pad compartments. Entry point e is represented in green

Fig. 7

Before-and-after pictures of Patient 1 following full-face treatment: RHA3 (2 mL), RHA2 (1 mL), RHA4 (3 mL), and Ultra Deep (1.5 mL)

Fig. 8

Before-and-after pictures of Patient 2 after NAU 6 treatment: NAU 6a (0.6 mL Ultra Deep subperiosteal), Ultra Deep (2 mL), and RHA4 (2.5 mL)