Carruthers Jean D A, Carruthers Alastair
Department of Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada.
Dermatol Surg. 2005 Nov;31(11 Pt 2):1604-12. doi: 10.2310/6350.2005.31248.
Until recently, deep facial sculpting was exclusively the domain of surgical interventions. Recent advances in the available array of dermal and subdermal fillers combined with an esthetic appreciation by both surgeons and nonsurgeons alike of the positive effect of filling the volume-depleted face have led to an expansion in the indications for the use of soft tissue augmenting agents.
Subdermal support of the lateral two-thirds of the brow, the nasojugal fold, the malar and buccal fat pads, the lateral lip commissures, and the perioral region, including the pre-jowl sulcus, all restore youthful facial contour and harmony. An important advance in technique is the subdermal rather than the intradermal injection plane.
"Instant" facial sculpting giving a brow-lift, cheek-lift, lip expansion, and perioral augmentation is possible using modern soft tissue augmenting agents. The softer, more relaxed appearance contrasts to the somewhat "pulled" appearance of subjects who have had surgical overcorrections. Treatments can be combined with botulinum toxin and other procedures if required.
Newer advances in the use of fillers include the use of fillers injected in the subdermal plane for "lunchtime" facial sculpting. Using the modern esthetic filler compounds, which are biodegradable but longer lasting, subjects can have a "rehearsal" treatment or make it ongoing. Some individuals, such as those with human immunodeficiency virus (HIV)-related lipoatrophy or those who desire to obtain a longer-lasting effect, may elect to use a nonbiodegradable filling agent.
直到最近，深度面部塑形还完全是外科手术的领域。现有的一系列真皮和皮下填充剂的最新进展，以及外科医生和非外科医生都认识到填充面部容量缺失所带来的积极美学效果，导致软组织填充剂的使用适应症有所扩大。
对眉外侧三分之二、鼻颧沟、颊脂垫、口角外侧以及包括颌前沟在内的口周区域进行皮下支撑，均能恢复年轻的面部轮廓与和谐感。技术上的一项重要进展是采用皮下而非皮内注射层面。
使用现代软组织填充剂能够实现“即时”面部塑形，包括提升眉部、脸颊、扩张唇部以及丰满口周。这种更柔和、更自然的外观与手术过度矫正者略显“紧绷”的外观形成对比。如有需要，治疗可与肉毒杆菌毒素及其他手术相结合。
填充剂使用方面的新进展包括在皮下层面注射填充剂以进行“午餐时间”面部塑形。使用可生物降解但持续时间更长的现代美学填充剂，受术者可以进行“预演”治疗或使其持续进行。一些人，如患有人类免疫缺陷病毒（HIV）相关脂肪萎缩的人或希望获得更持久效果的人，可能会选择使用不可生物降解的填充剂。
