Background: The aging process of the face comprises all layers: skin, subcutaneous fat, muscles, and skeleton, and the signs of aging depend mainly on which layer is mostly affected. Objective: To evaluate the aging facial skeleton, as well as establish the sexual differences, areas with a strong predisposition to resorption, and aesthetic repercussion for better treatment approach. Methods: Skulls from the Forensic Anthropology Department of the Institute of Forensic Medicine of Belo Horizonte, Brazil, were classified according to gender and age group (i.e., 50 years). Structural changes were classified according to gender and age group. Results: Of the 241 skulls included, 192 were male skulls and 49 female. Sexual dimorphism and age-related peculiarities are described herein. Conclusions: The knowledge of the anatomy of the aging face, taking into consideration all the layers (skin, fat pads, muscles, and bones), as a whole, for the treatment of folds and shadows is vital for a better and more natural final aesthetic outcome.

Background: Injectable poly‐L‐lactic acid (PLLA) has been proven safe and effective with numerous medical applications for more than 25 years. The product has been approved in over 40 countries and is being used for soft tissue augmentation in the face and certain body parts. With the increased demand for subtle and natural‐looking aesthetic treatments in the Asia‐Pacific region, there is also a heightened need for consistent preparation and effective treatment methodologies to optimize outcomes for Asian patients.Methods: The body of evidence in medical literature, clinical data of presented case reports, and the collective experience of the authors are reflected in these consensus recommendations, which also take under consideration the availability of biostimulators in the Asia‐Pacific region.Results: The resulting consensus recommendations include patient selection and assessment, management of treatment expectations, appropriate preparation and storage, proper injection techniques and treatment plans, management of adverse effects, PLLA combination with other facial rejuvenation procedures, and other constructive considerations.Conclusions: In the above consensus recommendations, the authors shared their best practices in accordance with the updated preparation and treatment protocols of PLLA. These recommendations represent the clinical and real‐world techniques utilized by authors in providing PLLA treatments for Asian patients.

Background: To handle the increasing influx of prescription medication‐driven weight loss (mdWL) patients in aesthetic practices, clinicians must be aligned on identifying discerning factors and strategies for managing this unique patient population.Objectives: (1) Define the mdWL patient; (2) describe the mdWL patient's aesthetic expectations; (3) determine the most relevant methods of assessing mdWL patients in clinical practice; (4) determine the effects of mdWL on specific facial tissue layers; (5) identify important treatment considerations for the mdWL patient; and (6) identify the temporal sequencing of non‐surgical options in the mdWL patient.Methods: Preparatory research included patient interviews, market research, and a systematic literature review. Following this, an international, multidisciplinary three‐round Delphi study was conducted to collect information on practice setting, physician and patient demographics, and previous experience, and for panelists to vote on consensus statements regarding managing mdWL patients in aesthetics.Results: mdWL is best defined by the percent of BMI lost within ≤ 6 months. Three‐dimensional volumetric analysis is an effective quantitative assessment, while photo‐numeric scales and patient‐reported outcome measures are relevant qualitative measures. Tissue layers most affected by mdWL include the skin and superficial and deep fat pads. A major concern for aesthetic mdWL patients seeking aesthetic treatments is the fear of appearing to have gained weight following treatments, while for physicians it is ensuring their mdWL patients look healthy and natural. The key selection and critical timing of aesthetic treatments throughout the mdWL journey are described.Conclusions: The first global consensus‐based guidelines for understanding and managing the aesthetic needs of mdWL patients are presented.

Background: Poly‐l‐lactic acid (PLLA‐SCA; Sculptra) was approved in 1999 in Europe and 2004 in United States as a collagen biostimulator. It is a freeze‐dried preparation containing 150 mg PLLA‐SCA per vial and, since approval, has been recommended to be reconstituted 72 h before treatment, which can hinder its use in clinical practice. In 2021, the manufacturer authorized the reconstitution of PLLA‐SCA immediately before use.Objective: To evaluate adverse events in patients treated with immediately reconstituted PLLA‐SCA on the face, body, and scars.Method: This was a retrospective analysis of medical records of patients treated with immediately reconstituted PLLA‐SCA for aesthetic purposes from January 1, 2021, to December 31, 2021, at two medical centers.Results: A total of 274 treatment sessions were conducted on 167 patients (ranging from 1 to 5 sessions per patient). Of these, 228 sessions (151 patients) targeted the face, 39 sessions (22 patients) addressed the body, and 7 sessions (5 patients) focused on scars. The mean final concentration of PLLA‐SCA was 15.30 mg/mL for the face, 8.35 mg/mL for the body, and 10.53 mg/mL for scars. The majority of injections were administered with a blunt cannula (face: 87.3%, body: 100%, scars: 57%), and in 6 out of 7 scar treatments, PLLA‐SCA was additionally applied topically after fractional treatment. One patient developed a PLLA‐SCA nodule 30 days after facial treatment, which resolved after two saline injections. The most common adverse events were bruising (face: 6.57%, body: 7.69%) and mild pain (face: 3.07%). No events required further intervention.Conclusion: This study reports an adverse event profile with immediately reconstituted PLLA‐SCA, used on the face, body, and scars, similar to that reported with PLLA‐SCA reconstituted 72 h prior to use.Trial Registration: This was a retrospective study of medical records at two medical centers, and trial registration was not required.

Background: The growing popularity of aesthetic procedures involving fillers, biostimulators, and neurotoxins has prompted concerns about patient safety. To address these concerns, a global Safety Task Force (STF) was formed.Aims: The inaugural STF meeting prioritized vascular compromise prevention and management, guiding clinical trial design and materials for future meetings, and collecting data from experts on current safety methods.Methods: The STF was formed and consisted of 16 experts from nine different countries, with each possessing distinct expertise in various fields related to aesthetic injectables. Current safety data, protocols, knowledge gaps and future research priorities were discussed and voted upon.Results: The establishment of a global database for tracking filler‐related AEs was favored by 93% of participants. Discussions revolved around the database's scope, data standardization, and whether non‐medical contributors should be included. Aspiration as a safety technique garnered support from 73% of participants. Approximately 43% of participants incorporate ultrasound in their injections, with divergent opinions on its impact and potential when used as a standard of practice versus in AE management. Most physicians on the task force incorporated cannula use for some of their injections (93%). There were varying perspectives on treatments for vascular adverse events (VAE), the primary causes, and the adoption of new protocols in the field.Conclusions: The STF meeting underscored the need for a coordinated effort to address complications related to HA fillers, including VAE management and hyaluronidase protocols. Reliable treatment endpoints were evaluated, but improved measurement methods are needed. Future meetings will focus on addressing delayed complications, furthering safety in this field.