Perioral Rejuvenation: A Prospective, Quantitative Dynamic 3-D Analysis of a Dual Modality Treatment
Brian L. Chang, BS1, Cat Chang, MD2, Michael Lanni, MD2, Anthony Wilson, MD2, Ivona Percec, MD PhD2.
1University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA, 2University of Pennsylvania Department of Plastic Surgery, Philadelphia, PA, USA.
BACKGROUND: The perioral region is the most dynamic anatomic area of the face and consequently subject to complex and dramatic changes during aging. Successful treatment for perioral rejuvenation has yet to be identified and quantified. Prior studies have all employed single modality rejuvenation with subjective measurements. The purpose of this work is to utilize our validated dynamic 3-D imaging technology to objectively and precisely quantify strain of the perioral region and further, to determine whether conservative neuromodulation combined with hyaluronic acid filler volumization can effectively decrease perioral strain with significant patient satisfaction.
METHODS: An IRB approved prospective study of a dual modality treatment for perioral rhytids was performed. Female patients with clinically significant perioral rhytids were included. Those with prior facial treatment within 1-year of treatment were excluded. Prior to injection, each patient underwent imaging with 3-D dynamic digital image correlation (DIC) and completed the validated FACE-Q survey. Baseline strain was measured for three facial expressions: lip pursing, smiling, and frowning. 18 units of Dysport were injected into the upper and lower orbicularis oris and 1cc of Restylane Silk was injected in volume-depleted perioral regions in each patient. Repeat DIC and FACE-Q evaluations were performed at 14 days and 90 days.
RESULTS: 32 female patients were recruited. A significant reduction in perioral strain was observed at day 14 that persisted at day 90: 22.9% (P < 0.01) in cheeks, 12.9% in chin (P<0.01), 17.2% (P<0.01) in marionette lines, 8.3% (P=0.04) in nasolabial folds, 12.4% (P<0.01) in upper lip, and 15.0% (P<0.01) in overall perioral region. This was concomitant with a significant increase in perioral volume at day 14: +151.45 mm3 (P<0.01) in nasolabial folds, +138.29 mm3 (P<0.01) in marionette lines, +98.10 mm3 (P<0.01) in upper lip, and +362.26 mm3 (P < 0.01) in oral commissure. Volume enhancement was only retained in the marionette lines at day 90. Further, there was a significant improvement in patient satisfaction with overall facial appearance at day 14 (+22.2%, P=0.01) that was maintained at 90 days (+21.2%, P=0.01).
CONCLUSIONS: Conservative neuromodulation and hyaluronic acid filler volumization of the perioral region without complete correction produces a quantifiable and significant reduction in strain correlating with high patient satisfaction, even at 90 days. This dual modality treatment is effective in rejuvenating the perioral region and its future optimization will provide greater therapeutic options for this anatomically complex area.
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