Multimodal Treatment Combinations and Layering to Restructure the Aging Face: Recommendations From an Expert Panel

Facial aging is a complex process that varies by facial layer and patient characteristics. Correction of the signs of facial aging can be achieved with various aesthetic treatments, including Cohesive Polydensified Matrix hyaluronic acid (CPM-HA), calcium hydroxylapatite in carboxymethylcellulose (CaHA-CMC), microfocused ultrasound with visualization (MFU-V), and incobotulinumtoxinA (incoBoNT-A). This article describes how these treatments can be used in an individualized, layered approach for whole-face rejuvenation that optimizes outcomes and patient satisfaction.

An international panel of 5 expert aesthetic physicians convened to align on best practices for a layered approach to whole-face rejuvenation using CPM-HA, CaHA-CMC, MFU-V, and incoBoNT-A. Panelists reviewed statements about facial aging and key features of the select products supporting their use in a layered treatment plan.

The proposed layered treatment plan expands on previous work by de Sanctis Pecora and consists of targeting (1) bone and retaining ligaments; (2) muscles, ligaments, and the superficial muscular aponeurotic system; (3) fat pads; (4) the dermis; and (5) skin quality. Panelists agreed that key features of the select products inform their positioning in the layered treatment plan. Step-by-step procedures for targeting each layer-including product, injection or application technique, and/or rationale-are provided.

CPM-HA, CaHA-CMC, MFU-V, and incoBoNT-A are considered by the expert panel of aesthetic physicians to be ideal treatment options to obtain a synergistic effect in layered whole-face rejuvenation.