Objective Dynamic Assessment of the Lower Face involving Dermal Fillers Designed for Facial Movement Adaptation
Ivona Percec, MD, PhD;Vince Bertucci, MD, FRCPC;Nowell Solish, MD, FRCPC;Ted Wagner, BA;Alessandra Nogueira, MD;Jay Mashburn, PhD
Background: ‘Facial dynamics’ is a complex interplay of skin physicomechanical properties in concert with underlying soft tissue volume and muscle activity, requiring clinical consideration in optimizing natural facial rejuvenation. Advances in 3D stereophotogrammetry and analytical algorithms permit interpolation of the complexities of the dynamic face into simple, color-coded strain images conveying the degree of skin surface stretch and compression. We present what is believed to be the first clinical results involving 3D stereophotogrammetry to objectively detect and quantify strains associated with the dynamic face following dermal fillers specifically designed to accommodate facial animation.
Methods: Dynamic strain evaluation was performed on 30 Caucasian females 40-65 years of age using a novel, markerless 3D dynamic imaging capture system (Canfield Scientific, Inc.). 3D video image capture was performed using standardized expressions prior to, and 6 weeks post-dermal filler treatment (hyaluronic acid 20mg/mL with XpresHAn TechnologyTM) in subjects with moderate to severe, bilateral wrinkles in the lower face. 3D video image evaluation included a younger, untreated cohort of 20 Caucasian female subjects (25-35 years of age). Degree of stretch and compression were quantified for discrete anatomic areas of interest (AOIs) including the full-face, lower face, nasolabial folds, upper lip, marionette lines, and chin. Strain analyses evaluated dynamic differences by age and by pre- versus post-treatment comparisons.
Results: The dynamic face was quantified as a state of simultaneous stretch and compression regardless of expression, anatomic area or age. Using a global dynamic assessment (GDA), significant differences in stretch were observed by age for the full face AOI, with higher degrees of stretch favoring the younger cohort (9.3%) compared to older subjects (8.4%; P<.05). In isolated anatomic areas such as the marionette AOI, GDA showed a significant difference in degree of stretch between older (20.1%) and younger (17.7%; P≤.05) subjects, with higher stretch observed in older subjects, and dermal filler treatment reduced degree of stretch to levels resembling a younger phenotype. Similar results were observed when examining anatomic areas, by individual expressions.
Conclusions: Dynamic strain analysis is an innovative method for evaluating the dynamic face following dermal filler use, and provides objective evidence of stretch levels resembling a younger phenotype, in areas prone to effects of facial aging. Additionally, post-treatment reduction in both stretch and compression objectively conveyed a dermal tightening effect.