Area four technique: An effective injection approach to the posterior facial frame aesthetic treatment with injectable hyaluronic acid fillers.

Abstract

Defined as a contour line from the hairline, the zygomatic arch, to the ramus and gonial angle area of the mandible, posterior facial frame (PFF) is an important aesthetic units of the face. With the development of hyaluronic acid fillers and the improvement of injection techniques, minimally invasive injection has become one of the first options to improve PFF. However, effective and systematic injection methods to improve PFF are rarely reported in the literature. We retrospectively analyzed 200 patients treated with area four technique for PFF. According to the clinical manifestations, PFF was divided into four types, and the injection strategies of the different types were described. GAIS (Global Aesthetic Improvement Scale) at 1month and 3months by patients after treatment was evaluated as primary end point. Nine-item aesthetic assessment scores reviewed by two independent observers with experience were performed. GAIS showed that patients' profile was remarkably improved for 90% of total number of subjects. Before and 3months after treatment, the assessed scores of the lateral cheek lifting (3.17 ± 0.21 vs. 2.56 ± 0.31) and PFF (3.78 ± 0.56 vs. 2.19 ± 0.48) were statistically significant reduced (p < 0.01). The jawline contouring scale (2.32 ± 0.45 vs. 1.23 ± 0.31) and the lateral cheek fullness scale (3.01 ± 0.23 vs. 2.09 ± 0.17) showed a statistically moderate decrease (p < 0.05). Area four technique provides a safe and convenient method for classifying and treating patients with insufficent PFF, which makes up for the multisite systematic injection of the face.