全球美学共识：透明质酸填充剂与A型肉毒毒素——不同患者群体联合治疗及优化效果的建议
Global Aesthetics Consensus: Hyaluronic Acid Fillers and Botulinum Toxin Type A-Recommendations for Combined Treatment and Optimizing Outcomes in Diverse Patient Populations.
作者信息
Sundaram Hema, Liew Steven, Signorini Massimo, Vieira Braz André, Fagien Steven, Swift Arthur, De Boulle Koenraad L, Raspaldo Hervé, Trindade de Almeida Ada R, Monheit Gary
机构信息
Rockville, Md.; Sydney, New South Wales, Australia; Milan, Italy; Rio de Janeiro and Sao Paulo, Brazil; Boca Raton, Fla.; Montreal, Quebec, Canada; Aalst, Belgium; Cannes, France; and Birmingham, Ala.
出版信息
Plast Reconstr Surg. 2016 May;137(5):1410-1423. doi: 10.1097/PRS.0000000000002119.
BACKGROUND
Combination of fillers and botulinum toxin for aesthetic applications is increasingly popular. Patient demographics continue to diversify, and include an expanding population receiving maintenance treatments over decades.
METHODS
A multinational panel of plastic surgeons and dermatologists convened the Global Aesthetics Consensus Group to develop updated guidelines with a worldwide perspective for hyaluronic acid fillers and botulinum toxin. This publication considers strategies for combined treatments, and how patient diversity influences treatment planning and outcomes.
RESULTS
Global Aesthetics Consensus Group recommendations reflect increased use of combined treatments in the lower and upper face, and some midface regions. A fully patient-tailored approach considers physiologic and chronologic age, ethnically associated facial morphotypes, and aesthetic ideals based on sex and culture. Lower toxin dosing, to modulate rather than paralyze muscles, is indicated where volume deficits influence muscular activity. Combination of toxin with fillers is appropriate for several indications addressed previously with toxin alone. New scientific data regarding hyaluronic acid fillers foster an evidence-based approach to selection of products and injection techniques. Focus on aesthetic units, rather than isolated rhytides, optimizes results from toxin and fillers. It also informs longitudinal treatment planning, and analysis of toxin nonresponders.
CONCLUSIONS
The emerging objective of injectable treatment is facial harmonization rather than rejuvenation. Combined treatment is now a standard of care. Its use will increase further as we refine the concept that aspects of aging are intimately related, and that successful treatment entails identifying and addressing the primary causes of each.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
背景
填充剂与肉毒毒素联合用于美容日益普遍。患者人口统计学特征持续多样化，包括数十年来接受维持治疗的人群不断扩大。
方法
一个由整形外科医生和皮肤科医生组成的跨国小组召集了全球美容共识小组，以全球视角制定关于透明质酸填充剂和肉毒毒素的最新指南。本出版物探讨了联合治疗策略，以及患者多样性如何影响治疗计划和结果。
结果
全球美容共识小组的建议反映出联合治疗在面部下、上半部分以及一些中面部区域的使用增加。一种完全根据患者量身定制的方法会考虑生理年龄和实际年龄、与种族相关的面部形态类型以及基于性别和文化的审美理想。在容量不足影响肌肉活动的部位，建议降低毒素剂量以调节而非麻痹肌肉。毒素与填充剂联合适用于先前单独使用毒素治疗的多种适应症。关于透明质酸填充剂的新科学数据促进了基于证据的产品选择和注射技术方法。关注美学单元而非孤立的皱纹，可优化毒素和填充剂的治疗效果。这也为长期治疗计划以及对毒素无反应者的分析提供了依据。
结论
可注射治疗的新目标是面部协调而非年轻化。联合治疗现已成为一种标准治疗方法。随着我们完善衰老各方面密切相关且成功治疗需要识别并解决每个主要原因的概念，联合治疗的使用将进一步增加。
临床问题/证据水平：治疗性，V级
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