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Carlo Di Gregorio,1 Gerd Gauglitz,2 Jackie Partridge3 1Plastic Surgery Unit Clinica Candela, Palermo, Italy; 2Haut- und Laserzentrum im Glockenbachviertel, Munich, Germany; 3The Aesthetic Consultancy, Edinburgh, ScotlandCorrespondence: Carlo Di Gregorio, Plastic Surgery Unit Clinica Candela, via Villareale 54, Palermo, 90141, Italy, Tel +39 91 586592, Email cdigregorio@hotmail.comPurpose: Patients seeking treatment for the midface are individuals with different objectives and characteristics of skin and soft tissue. In this study, patients were treated in the midface with one of three products with different properties; HARV, HARD, or HARL, using a treatment algorithm based on primary need for treatment (volumizing, lifting or contouring) and tissue coverage (thin or thick tissue). The aim was to optimize the treatment outcome and to provide an individualized treatment approach that distinguishes different types of patients seeking midfacial treatment.Materials and Methods: Subjects were treated in the midface at baseline to achieve optimal aesthetic results (≤ 2 mL per side of the face), and touch-up was allowed after 4 weeks (≤ 1 mL per side of the face). Study visits were scheduled at Weeks 8, 16 and 24. Assessments included aesthetic improvement of the midface, evaluation of midface fullness, and subject satisfaction. Safety evaluations included local tolerability symptoms collected at 4 weeks after treatment and adverse events.Results: A total of 90 subjects were included in the study, mean age was 45 years (range 29– 55) and 82% of subjects were female. Mean total injected volume for the products was 4.4 mL (HARV and HARL) and 4.2 mL (HARD). At least 92% of subjects were assessed as aesthetically improved throughout the study. Assessment of midface fullness showed ≥ 90% of subjects being responders until Week 24. In addition, subject satisfaction was high throughout the study. Tenderness, bruising and swelling were the most reported local tolerability symptom for all study products, and no adverse events related to study product/treatment were reported.Conclusion: Midface treatment with either HARV, HARD, or HARL using a treatment algorithm to guide the choice of product to individual subject needs was effective and safe for up to 24 weeks after treatment.Keywords: aesthetic improvement, MMVS, subject satisfaction, natural-looking, nasolabial fold, safety

Gerd Gauglitz,1 Stephanie Steckmeier,1 Julian Pötschke,2 Hannah Schwaiger,1 1Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany; 2Department of Plastic and Hand Surgery, Klinikum St Georg gGmbH, Leipzig, Germany Purpose: Cohesive Polydensified Matrix® hyaluronic acid (CPM-HA) volumizer has been used successfully for several years to reverse biometric volume loss during facial aging. This observational study explored the additive effect on nasolabial folds when CPM-HA volumizer is injected into the neighboring cheek area.Patients and methods: In this open-label, prospective, postmarketing noninterventional study, 18 adult patients seeking esthetic enhancement of the lateral cheek hollows and cheekbone area were injected with CPM-HA volumizer integrated with lidocaine (CPM-HA-VL) in the upper or lower cheek area. Safety and performance of CPM-HA-VL up to 12 months after injection with follow-up visits at week 4 and month 3, 6, and 12 were assessed. The primary endpoint was improvement of cheek fullness on the validated Merz Aesthetics Scales. Additionally, changes in nasolabial folds were quantified using a phaseshift rapid in vivo measurement of skin optical three-dimensional (3D) in vivo measurement device. Results: Patients (94.4% female, median age 52 years, age range 39–69 years) were injected with a mean volume of 2.5±1.1 mL CPM-HA-VL per side. Immediately after injection, mean severity for upper and lower cheek fullness assessed on the validated MAS improved from 2.5±0.6 and 2.8±0.5, respectively, to 1.0±0.0, and remained unchanged through month 12. Improvement in relation to baseline was attested on the Global Aesthetics Improvement Scale for all assessments. Compared with baseline, the following assessments offered a statistical significance in the reduction of wrinkle depth of nasolabial folds (maximum depth reduction by 30.4% at 3 months) according to optical 3D in vivo measurements. Pain during injection was minimal and abated within 30 minutes. Treatment was well tolerated and led to great patient satisfaction.Conclusion: CPM-HA-VL injected into the upper and lower cheeks led to long-lasting satisfactory cosmetic results in cheek augmentation as well as in reducing depth of nasolabial folds adjacent to the injection site. Keywords: CPM-HA-VL volumizing filler, facial rejuvenation, esthetic procedure, dermal filler, PRIMOS 3D