Hyaluronic acid (HA) fillers have become the most popular material for facial volume augmentation and wrinkle correction. Several filler brands are currently on the market all around the world and their features are extremely variable; for this reason, most users are unaware of their differences. The study of filler rheology has become a wellspring of knowledge, differentiating HA fillers, although these properties are not described thoroughly by the manufacturers. The authors of this review describe the more useful rheological properties that can help clinicians understand filler characteristics and the likely correlation of these features with clinical outcomes.

Soft-tissue fillers made of hyaluronic acid and combined with lidocaine have recently become a popular tool in aesthetic medicine. Several manufacturers have developed their own proprietary formulae with varying manufacturing tools, concentrations, crosslinked three-dimensional network structures, pore size distributions of the fibrous networks, as well as cohesivity levels and rheological properties, lending fillers and filler ranges their unique properties and degradability profiles. One such range of hyaluronic acid fillers manufactured using the novel eXcellent three-dimensional reticulation (XTR™) technology was evaluated in comparison with other HA fillers and filler ranges by an independent research laboratory. Fillers manufactured with the XTR™ technology were shown to have characteristic rheological, crosslinking and biophysical factors that support the suitability of this filler range for certain patient profiles.

Bioabsorbable barbed suspension double-needle threads have recently been thrust into the limelight as a minimally invasive alternative for skin repositioning. When compared to surgical face lifting, use of these threads requires reduced procedural and recovery time, no general anesthesia, confers immediate patient satisfaction, with no cutaneous incisions and no apparent scars, and is more tolerable. There is currently limited literature providing clinical guidance on the use of these suspension threads; hence, this consensus document was developed as the first publication to discuss the technical aspects of facial rejuvenation using the double-needle barbed bioabsorbable and hydrolyzable thread composed of copolymer poly (ε-caprolactone-co-L-lactic acid) or PC_xL_yA, that is, Definisse threads. The Board of Aesthetic Leaders and Investigators (BALI) is a panel of dermatologic surgery and plastic surgery experts who convened last July 2018 in Indonesia to discuss the aforementioned challenges. A thorough literature search was done where a review of specific technical recommendations based on prevailing practice and available guidelines pertaining to suspension threads were described and are summarized in this paper. A detailed list of pretreatment recommendations in the assessment of both Asian and Caucasian facial types, aging facial types, guidance on insertion techniques, and aftercare instructions for clinicians to review has been included here.

Background: Patient care following botulinum toxin injections has long been guided by anecdotal instructions, often based on theoretical considerations. This study evaluates the necessity of extended post-treatment instructions by analyzing outcomes and satisfaction in patients who followed only a 10 min precaution protocol. Materials and Methods: A retrospective, multicentric study was conducted across six Italian centers, analyzing 5014 patients treated with botulinum toxin for upper facial wrinkles between 2015 and 2020. Outcomes included adverse effects—particularly upper eyelid ptosis—and patient satisfaction. Follow-up was performed at two weeks. Results: No cases of upper eyelid ptosis were observed. Among 4000 patients who attended follow-up, adverse effects occurred in only 5.99%, notably lower than rates reported in the literature. Of the 2010 patients who completed the satisfaction questionnaire, 90% reported being very satisfied. These findings support the safety of limiting post-treatment instructions to 10 min. Conclusions: Our findings indicate that omitting extended post-injection instructions does not negatively impact patient satisfaction or complication rates. Given the toxin’s rapid internalization and localized effect, extended behavioral restrictions may be redundant. However, the absence of a control group and lack of statistical analyses limit the strength of these conclusions. In addition, this is a short-term study. Future prospective, randomized trials are needed to develop evidence-based post-care protocols to optimize esthetic outcomes, patient safety, and long-term efficacy.

Incobotulinum toxin A (Bocouture^®) is a highly purified formulation of botulinum toxin A, devoid of complexing proteins. This characteristic minimises immunogenicity and promotes targeted action. Its high efficacy and safety make it particularly suitable for aesthetic applications, such as full-face and neck rejuvenation. Nonetheless, there exists a lack of standardised dosing protocols for applications in a comprehensive full-face treatment. The present study aims to establish an expert consensus regarding the appropriate dosing and specific injection techniques for incobotulinum toxin A in holistic full-face and neck aesthetic treatments. A multidisciplinary panel comprising six Italian experts in dermatology, plastic surgery, and neurology comprehensively reviewed existing literature (PubMed) on the aesthetic applications of incobotulinum toxin A, supplemented by their clinical experiences. Incobotulinum toxin A was administered to patients with the assistance of a portable electromyography (EMG) device to ensure precise targeting of the muscles. The primary focus was to define optimal injection sites and dosages for various facial and neck muscles, aiming to maximise aesthetic outcomes while minimising toxin diffusion. The unique characteristics of incobotulinum toxin A, including its high purity and low immunogenicity, facilitate its safe utilisation in a full-face approach with a decreased risk of adverse events. The implementation of EMG-guided injections significantly enhanced accuracy, thereby improving treatment outcomes by mitigating unwanted toxin dispersal and achieving muscle-specific effects. The consensus reached underscored the validity of a full-face approach, highlighting the necessity of a thorough understanding of muscle anatomy and the application of precise injection techniques. An overwhelming consensus (83.3-100.0%) was attained for most of the proposed strategies, indicating that the full-face treatment regimen employing incobotulinum toxin A yields effective and enduring results.