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The article titled "Myomodulation with Facial Fillers: A Comprehensive Technical Guide and Retrospective Case Series" by Coimbra et al. in Aesthetic Plastic Surgery presents a technical guide for holistic facial treatment using hyaluronic acid (HA) fillers and a map for addressing individual facial units through myomodulation. The authors' approach is appreciated for its value. However, concerns arise about the employed methodologies. Understanding HA's properties is vital for treatment standardization. The significance of HA's rheological properties, encompassing viscosity, elasticity, and cohesiveness, is critical for optimal dermal filler selection. The authors' insights are acknowledged, yet further analysis considering these factors is recommended. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Placement of fillers in close proximity to the mimetic or sphincter muscles of the face appears to enhance or suppress muscle action in a relatively predictable way. Methods: From June 2016 to June 2021, patients who underwent the first author's technique of myomodulation with dermal fillers to address aesthetic concerns or to manage facial spasms or synkinesis were evaluated in a retrospective case series. Additionally, the authors provide a technical guide for a whole-face approach to treatment with fillers and a conceptual map for treatment of each facial subunit with a focus on myomodulation. Results: A total of 1352 patients (1108 women, 244 men; mean age, 51 years) underwent at least 1 treatment session during the 5-year study period. The treatment patterns of the study population and details of 2 representative cases are presented. Conclusions: Although not well understood mechanistically, myomodulation with injectable fillers shows promise for significant and reliable results of facial rejuvenation. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: A surgical technique was developed to soften the nasolabial folds by liposuction and severing of the cutaneous insertions of the mimetic muscles. This procedure was used for 11 patients from September 2006 to June 2009. Methods: With the patients under local tumescent anesthesia, extraoral incisions were made in nine cases and intraoral incisions in two cases. Liposuction was performed superior and lateral to the nasolabial fold using an order-made one-hole 2.5-mm cannula. After liposuction, the fibrae septa and the cutaneous insertions of the mimetic muscles in the nasolabial region were severed by a sharp-edge eye scissors. Compressive dressings were maintained for 3 days. Results: All the patients, followed up from 3 months to 3 years, were satisfied with the aesthetic results. Both the depth and the length of the nasolabial folds were decreased conspicuously. The most obvious change was improvement in the lateral part of the nasolabial folds. The extraoral scars were almost imperceptible. Severe complications were not observed in this series. Conclusion: Surgical softening of the nasolabial folds by liposuction and severing of the cutaneous insertions of the mimetic muscles is especially suitable for 40- to 60-year-old women with aging faces who are unwilling to undergo a face-lift. The procedure is simple, and the anatomic causes for deepening of the nasolabial folds can be corrected. Patients usually are satisfied with the final postoperative results. [ABSTRACT FROM AUTHOR]

The application of the Face Recurve theory gives rise to new technical opportunities in the fields of both aesthetic medicine and aesthetic surgery to block the action of the age marker fascicules largely responsible for aging of the paramedian folds. With respect to aesthetic medicine, the combination of botulinum toxin and soft tissue fillers has proven effective. On the basis of the authors’ theory, however, two new technical refinements become pertinent. First, the filler must be injected predominantly deep to the muscle to treat the skin depressions in a more natural manner, bringing restoration to the curve of the overlying muscle. Second, a very low number of botulinum toxin units (one-fourth to one unit) should be injected into specific muscles to diminish their resting tone without diminishing their maximal contraction strength. With respect to aesthetic surgery, the authors present new techniques for the treatment of early aging, specifically a combination of segmental muscular section, microliposuction, and retromuscular fat grafting, all of which can be performed readily with the patient under local anesthesia. For more advanced aging, surgery offers new treatment opportunities that include the concentric malar lift for correction of the midface region, with repositioning of suborbicularis oculi fat back onto the orbital rim from its descended eccentric displacement at the hands of repeated orbicularis oculi contractions. At the same time, specific muscles can be weakened and fat volume restored. Each area can be studied in a specific way and treated definitively. Currently, the skin does not need to be tensioned to a maximum during a face-lift for treatment of the irregular jaw line, the palpebromalar groove, and so forth. Skin tension can be moderated to remove only the true excess of skin. Facial contour is improved, whereas the specific glide is restored between muscles and their underlying fat. [ABSTRACT FROM AUTHOR]