Global Volumetric Assessment and Three-Dimensional Enhancement of the Face With Injectable Poly-L-lactic Acid

Nonsurgical methods represent the majority of cosmetic procedures performed in the United States and include the use of toxins and injectable medical devices for soft-tissue augmentation. In some cases, both nonsurgical and surgical modalities can be used synergistically for optimal facial rejuvenation. Aesthetic surgical procedures remove and reposition lax or sagging skin and tighten and/or resuspend facial musculature. Injectable medical devices can enhance the aesthetic effect of cosmetic surgery by replacing lost volume and restoring the three-dimensional appearance of the face while maintaining natural facial contours. Soft-tissue augmentation can also provide additional support for the skin, correcting natural variations in facial symmetry. This article provides a descriptive review of the age-related facial changes and suggests a method for the use of three-dimensional volumetric augmentation for soft-tissue facial rejuvenation. Age-related changes in skin elasticity, fat distribution, and facial contours require a three-dimensional treatment approach that addresses the pathophysiology of chronological aging. Volume replacement restores the youthful appearance of the face in patients opting for nonsurgical rejuvenation and complements surgical approaches as well. Optimal three-dimensional soft-tissue augmentation can be achieved using a combination of aesthetic surgery and injectable medical devices, such as collagen, hyaluronic acid, calcium hydroxylapatite, and injectable poly-L-lactic acid to improve facial volume changes and contour irregularities. Injectable medical devices replace lost volume and restore facial convexity, reestablishing the bloom of youth.