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A Case Series on a Layered Biomaterial Strategy for Midface Rejuvenation: Combining Collagen Stimulators and
1Plastic Surgery and Medical Cosmetic Center, The Affiliated Eye Hospital of Jiangxi Medical College, Nanchang University, Nanchang, China.
Background:
The midface is a key area where aging signs first appear, involving multi-layered changes such as epidermal fine lines, volume loss leading to hollowing and sagging, and deep structural support weakening resulting in nasolabial fold deepening. Single-material treatments often fail to address this complexity comprehensively. While hyaluronic acid (HA) effectively restores volume, its impact on skin texture is limited; collagen stimulators promote long-term collagen regeneration but lack immediate shaping capability.
Objective:
Through the presentation of six typical cases, this study aims to illustrate the clinical application of a layered treatment strategy using HA and collagen stimulators, either alone or in combination. It seeks to describe how this anatomy-based approach can address single or compound midface aging signs and provide a preliminary clinical reference for comprehensive rejuvenation.
Methods:
This descriptive case series included six female patients with distinct midface aging phenotypes. Efficacy was assessed blindly by independent physicians using standardized scales (GAIS, Merz, Hirmand, MVDSS, WSRS).
Results:
All cases showed improvement in target aging signs. Quantitative improvements were observed: Case 3 (infraorbital hollowing) improved from Merz Grade 2 to 1; Case 4 from Merz Grade 4 to 1; Case 5 (tear trough) improved from Hirmand Grade 2 to 0 at 6 months; and Case 6 (compound aging) showed progressive improvement, with Hirmand, MVDSS, and WSRS scores all improving by at least two grades at the 10-month follow-up. Treatments were well-tolerated, with only transient, expected reactions observed.
Conclusion:
This case series suggests that a combined/layered treatment strategy based on anatomical presentation may offer a safe and effective option for personalized midface rejuvenation. These preliminary observations provide a basis for future research and should be interpreted within the limitations of a small, non-comparative study design.
