Abstract: Subjective and Objective Facial Dynamics Using Dermal Fillers Formulated for Facial Movement Adaptation

Abstract

INTRODUCTION: The fear of looking unnatural is a well-known concern for patients contemplating dermal aesthetic procedures. Facial dynamics is an increasing area of clinical focus extending beyond 3-D volume restoration, as naturalness of clinical outcomes at rest and with animation may vary. We evaluated the dynamic face using subjective and objective methods following treatment with dermal fillers formulated with physicochemical properties for facial movement adaptation. METHODS: Thirty Caucasian females (40–65 years) with moderate to severe, bilateral wrinkles in the lower face were treated with HA fillers (20mg/mL with XpresHAn TechnologyTM) and followed 4 weeks post-optimal correction. Subjective, dynamic assessments evaluated pre- versus post- expressions in motion (2D videos), using a series of standardized expressions. Facial dynamics were objectively evaluated and quantified using 3-D stereophotogrammetry (Canfield Scientific, Inc), including a younger, untreated Caucasian female cohort (N=20; 25–35 years). Satisfaction of treated subjects was assessed using a 5-point Likert scale. RESULTS: Subjective facial dynamics revealed naturalness of the lower face in motion to be at least maintained in 100% of subjects (naturalness maintained or enhanced). Collectively, 83.3% of subjects were rated with enhanced attractiveness and looked younger, without compromise in naturalness. Rater agreement was high for individual assessments of attractiveness, youthfulness, and naturalness (70.0% – 83.3%). Subject satisfaction ratings were consistent with treating investigator assessment, with post-treatment improvement across all items assessed based on proportions of subject agreement (strongly agree or agree). Highest levels of subject satisfaction (>80%) observed post-treatment pertained to overall facial appearance is pleasing (90.0%); overall facial appearance looking natural (100%); face looking natural when relaxed (96.7%) and when smiling (93.3%), and looking younger than actual age (83.3%). For specific anatomic areas (marionette lines), global dynamic assessment using 3-D stereophotogrammetry showed significantly higher levels of stretch in older (20.1%, pre-treatment) versus younger subjects (17.7%; p<=.05), with stretch levels significantly reduced post-treatment (17.9%; p<=.05) such that older subjects post-treatment resembled younger subjects. CONCLUSION: Dermal fillers formulated with XpresHAn TechnologyTM resulted in subjective dynamic assessments characterized by improvements in attractiveness and youthfulness, without compromising naturalness. Objective facial dynamics provided quantitative evidence of stretch levels resembling a younger phenotype, in areas specifically prone to dynamic volumetric effects of facial aging. This work underscores the importance of objective dynamic assessment as the fourth dimension of facial aesthetics.