Transgender Aesthetic Procedures Private Clinic Nottingham Minimally Invasive Facial Treatments Research Article
Here at Medskin Clinics we have time served ex-NHS nurses who as fully qualified and experienced to offer free aesthetic advice at a local clinic close to your location. Geographically we offer facial aesthetic procedures in and around Nottingham, Newark, Chesterfield, Newark, Leicester, Derby and Lincoln with outreach nurses located in Leicester, Lincoln, and Sheffield.
All our staff are inclusive and welcome every client with the same friendly approach, we are active supporters of the LGBTQ+ community all year round, not just for Pride Month.
Lovely to see the new Treat Kitchen in @_VictoriaCentre #Nottingham supporting @outBurst youth group with the sale of some of their products. Good luck on their opening day today! pic.twitter.com/AkJLIm54RQ
— Notts LGBT+ Network (@NottsLGBT) June 17, 2021
Nottingham Local Useful LGBT Websites – For activities, groups and social venues to (socially distance) gather and meet new people.
When conducted with sensitivity and attention to individual patient goals at varying stages of transition, facial procedures can be of great benefit in enhancing patients’ self-perception and overall quality of life. Source: Considerations for the Use of Minimally Invasive Aesthetic Procedures for Facial Remodeling in Transgender Individuals (2021 publication)
Received 28 January 2021
Accepted for publication 21 April 2021
Published 13 May 2021 Volume 2021:14 Pages 513—525
Checked for plagiarism Yes
Editor who approved publication: Dr Jeffrey Weinberg
Abstract: There is increasing demand among transgender individuals for minimally invasive aesthetic procedures, such as injectable facial fillers and neurotoxins, for facial remodeling and transformation. These procedures may increase transgender individuals’ satisfaction with their appearance and allow them to more effectively harmonize their physical appearance with their perception of self. There is currently a lack of information in the medical literature regarding guidelines for the use of these products in transgender patients. In this report, the authors provide experience-based treatment considerations and recommendations for use of minimally invasive facial aesthetic procedures in transgender patients, including case studies illustrating the use of these procedures for both male-to-female and female-to-male transitioning patients.
This report highlights the success of minimally invasive methods for assisting transgender patients in achieving their facial remodeling goals. Clinicians play an integral role in the transitioning process for transgender patients, and facial transformation is a key element of this process.
When conducted with sensitivity and attention to individual patient goals at varying stages of transition, facial procedures can be of great benefit in enhancing patients’ self-perception and overall quality of life.
Keywords: transgender persons, hyaluronic acid, neurotoxins
Private Nurses and Local Clinics, Confidential, Independent Gay, Lesbian and LGBTQ+ Inclusive
The proportion of individuals who identify as transgender or gender-diverse ranges from 0.1% to 2.7% depending on the age, inclusion criteria, and geographic location.1 Among these individuals, there is increasing demand for minimally invasive aesthetic procedures, such as injectable facial fillers and neurotoxins, for facial transformation.2,3 Transgender individuals may seek facial aesthetic modifications during their transitioning process by considering ideals that relate to looking more feminine or masculine.4,5 They want their outward appearance—the face they present to the world—to reflect how they feel about themselves.4
Differences between masculine and feminine faces have a hormonal basis: high estrogen levels result in high cheekbones, a proportional nose, full lips, as well as a relatively small and narrow chin, whereas high testosterone levels result in prominent supraorbital ridges, linear eyebrows, a flat midface, a more prominent nose, thin lips, and a squared jawline with a strong chin.6 Some transitioning patients receive hormonal therapy and gender-affirmation surgery, with the most dramatic changes in facial anatomy achieved through surgery. However, the use of minimally invasive facial aesthetic procedures may increase transgender individuals’ satisfaction with their appearance and yield aesthetic enhancements that meet desired feminizing or masculinizing goals as patients start or complete their transition.5,7 A number of transgender individuals identify with the traditional binary notions of gender; however, some individuals do not identify with the classic binary gender roles and may choose to be gender-diverse or to express themselves somewhere on the spectrum between feminine and masculine;8 they do not want to look vaguely feminine or masculine, preferring instead to pass as their self-identified gender.4 Minimally invasive procedures such as botulinum toxin, injectable fillers, skin resurfacing, and topical skin care products are essential in this regard, accomplishing the fine detail work necessary not only to transition to feminine or masculine faces, but also for self-affirmation. These procedures complement the structural changes accomplished by surgery, smoothing overly sharp transitions, softening edges, and filling in details.
The medical literature on the transgender use of fillers, toxins, and other minimally invasive aesthetic procedures is currently lacking.4,9 A review of the existing literature indicated that the most-studied transgender research topic was “therapeutics and surgeries,” with the majority of the research in this area focusing on case studies investigating issues such as outcomes of surgeries, hormone treatments, and silicone injections.10 Although high interest exists for the technical aspects of surgery on the sexual organs, there is dramatically less interest among the medical community in the transition of facial characteristics.10 Thus, there is a need to develop treatment plans and recommendations for minimally invasive aesthetic procedures. These procedures help to achieve the facial transformation goals of transgender patients, including matching outward appearance with self-perception, ultimately improving their quality of life.7
It’s important to know all about anti-wrinkle botox injections, dermal and lip fillers, including how long they last. Below, we’ve listed some important facts which we think you should know. Questions? Call now on: 03301 132 2640 or send a message online with your postcode, we will be in touch shortly.
Book via text if you prefer on 07537 416 110 (SMS only).
Book lip fillers, wart removal, Botox anti wrinkle aesthetic treatments at a local licensed clinic location of Medskin Clinics. Our staff are time served, fully qualified, and experienced NHS and Private Nurses. If you feel like dermal fillers or Botox could be the best route for you, schedule a free consultation at one of our Medskin Clinics based in Chesterfield, Newark and Nottingham. Our nurses travel throughout these regions and may have an outreach clinic that’s very close to your location.
Part 1: Considerations for Facial Aesthetic Modifications in Transgender Patients
Optimal Care for the Transgender Patient
Although transgender patients may seek feminizing or masculinizing effects, the clinician must be aware that the aesthetic preferences of transgender individuals may not conform to traditional binary standards of facial beauty.7 A key element of transgender aesthetic goals may not be the achievement of femininity or masculinity itself, but rather acquiring feminine or masculine attributes that align with the patient’s self-affirmation; transgender individuals commonly seek aesthetic procedures to avoid being misgendered or identified incorrectly. The goals of transgender patients may also be associated with the desire to convey certain positive character attributes with associated social, professional, cultural, and economic advantages.6
Transgender patients seeking minimally invasive injectable procedures should receive personalized initial consultation and follow-up, with instruction that maintenance treatments will be required to retain physical changes provided by these procedures.5
Maintenance is extremely important to preserve the desired and achieved facial features, but patients must also appreciate the economic consequences of repeated facial treatments.2 Because the lack of or reduced insurance coverage for aesthetic procedures in many countries may create limitations for some patients, clinicians may need to help patients prioritize their aesthetic goals.9,11
For confidential and friendly, experienced advice don’t hesitate to call 03301 132 2640 or send a message online
Understanding the aesthetic concerns and psychological well-being unique to the transgender population is important for providing optimal patient care.12 Transgender patients may experience “gender dysphoria” or distress about their assigned sex at birth.12 Inclusive and compassionate patient communication is key when working with transgender patients and managing treatment expectations. Clinicians should also realize that communication may differ between transgender and cisgender male/female patients. Staff should be trained to address transgender patients using the patients’ preferred pronouns and identifiers, and intake forms should request information about “gender” rather than “sex,” with a write-in option for “other.”4 The authors also recommend self-reflection for clinicians to ensure their own comfort with and acceptance of transgender patients before working with them, as well as improved professional training for healthcare providers to better understand and address the healthcare needs of transgender patients.13 Otherwise, a lack of compassion or acceptance may subtly emerge during patient interactions, possibly to the detriment of patients’ psychological well-being.
Clinicians should be aware of and sensitive to the different steps of the transition process that transgender patients may undergo, understanding that the transition process is fluid and ongoing, with patients often needing to “grow into” their new looks.11,14 There are currently no formal guidelines regarding the timing of when during the transition process of facial feminization or masculinization nonsurgical procedures should occur. Many physical changes resulting from hormone therapy do not fully develop until 2 years after therapy initiation.4 Patients may therefore be seeking aesthetic facial procedures at various stages during the process, from those who have not yet started hormone therapy because they are still exploring the idea, to those who have been on hormone therapy for less than 6 months, for 6 to 18 months, or for many years. The needs and expectations of patients at each stage will be different, and treatment approaches should take into account the significant changes in facial structure, soft tissue distribution, and skin quality brought about over time by hormonal therapy.5,7
Part 2: Technical Recommendations for the Use of Minimally Invasive Injectable Procedures for Facial Remodeling in Transgender Patients
With support from existing literature, the authors offer several treatment recommendations using injectable fillers and toxins for when an assigned male or female at birth is feminizing or masculinizing, respectively (Table 2). When the individual is transitioning from male to female (ie, transwoman), larger doses of both fillers and toxins may be required because facial skin and muscle mass tend to be thicker in cisgender males than in females.33,34 Based on these inherent genetic differences, more frequent maintenance injections of toxin may also be needed for patients undergoing male-to-female transition9 to maintain an appearance that communicates youthfulness and femininity.35 In addition, the type of product and doses for medical aesthetic treatments will need adjustment depending on the patients’ stage of the transition process and the time-dependent effects of hormonal therapies, as discussed above.7
When performing injectable facial remodeling procedures in transgender patients, clinicians should consider different injection sites and properties of dermal fillers and toxins. Injection sites for fillers include the zygomaticomalar region, anteromedial cheek, nose, and submalar regions, as well as chin, jawline, temples, supra-orbital brow, forehead, tear trough, nasolabial folds, and melomental folds.5,34,41 Clinicians should consider the rheologic properties of fillers when selecting the most appropriate filler for the desired outcomes. For proper placement of toxins with a genderizing approach as the goal, it is often necessary to adjust the distribution and placement of injections outside of standard injection points. For example, being more conservative with injections in the frontalis muscle in men can prevent eyebrow ptosis.34 In addition, retaining frontalis muscle activity above the lateral one-third of the brow can lift the eyebrow, providing a feminine arched eyebrow.9 Consideration should also be given to smoothing the skin for males transitioning to females, such as decreasing pore size and fine lines, as well as improving skin tightness, using lasers, peels, and cosmeceuticals because smooth skin looks younger and thus more fertile and feminine.35,42
Case Study #1 (Facial transformation in a 40-year-old male-to-female transgender patient )
Facial transformation in a 40-year-old male-to-female transgender patient (Figure 2). The patient received 12 units of onabotulinumtoxinA at the crow’s feet lines to lift her eyebrows, 12 units in the glabella, and 8 units in the chin. She also received the HA dermal filler VYC-20L for left temple hollow filling (1.5 cm3), malar and zygomatic augmentation (2 cm3), nonsurgical rhinoplasty to straighten the nose (0.5 cm3), and chin sculpting (1.5 cm3). The patient also underwent lip augmentation with 1 cm3 of HYC-24L. The outcome for this patient was a subtle feminization of her face. Midface volumization brought the cheek apex into a more superolateral position, creating a soft and feminine ogee curve, as well as a more oval shape to the face. Brow elevation gave her a slight arch to the lateral one-third of her eyebrow. Her nose became smoother, straighter, and more delicate via tip elevation and camouflage of the dorsal hump. Lastly, the lower face was feminized by lip augmentation, as well as tapering and narrowing of the chin.
Minimally invasive injectable procedures are an important complement to hormonal therapy and gender affirmation surgery for patients undergoing gender transition. These procedures allow the fine detail work necessary on the face to assist transgender patients in matching their outward appearance to how they perceive themselves. The importance of this aspect of the transition process is highlighted in the existing medical literature, including a survey-based assessment of 327 transgender individuals, which reported that facial modification was often a greater priority than other procedures on other body locations, especially for men transitioning into women.4 Some patients, especially those who have just embarked on their gender transition journey, appreciate a temporary, reversible modality such as injectables, which gives them the possibility to try out a more subtly feminine or masculine look prior to committing to the more permanent and dramatic changes of surgery.5 Furthermore, some transgender patients may not be ideal surgical candidates, and injectables may be the only option for their facial transformation.4 Subtle and effective changes can be achieved with minimally invasive injectable procedures; these procedures can produce results with minimal risk and downtime, thus greatly aiding the transition process.4,9
This report highlights the success of minimally invasive methods for assisting transgender patients in their facial remodeling goals and in the progress of their transition journey. Clinicians play an integral role in the transitioning process for transgender patients, and facial transformation is a key element of this process.
Different facial fillers last for varying amounts of time, so a free consultation with our nurses will help you decide which is best for you in terms of longevity and the final look you want to achieve.
NEW 2021 Blog Post – What are the different types of Dermal Fillers? What aesthetic and beauty benefits does each type provide? If you want your lips to look plump for as long as possible, tell our nurses so they can accommodate your wishes (as long as your lips are suitable for that specific filler).
How Long do Lip Fillers Last? 6 months
On average, lip fillers last for 6 months. They will be bruised for a few days after the procedure, so you’ll start to notice the results after about a week. They do gradually fade over time, so you may feel like your lips are getting smaller in the month before you get them re-filled.
The length of time fillers last depends on the person
The size of lip fillers does depend on people’s individual metabolisms. This means that while your lip fillers may last 6 months, they could last for 8 months on someone else. It is an individual process, and if you get lip fillers repeatedly, you’ll gradually learn how long they work for you.
Lip Filler Injections After Care Tips
If you wish your lips were a little plumper, lip fillers could be an ideal option for you. They add volume and give you more definition while still maintaining the natural shape of your lips. However, after the procedure, it’s important you follow your doctor’s instructions to make your recovery as pleasant and stress-free as possible. Here we’ve listed some common aftercare tips to consider.
Apply ice and stay hydrated
Bruising, swelling, and redness are normal after the treatment. To help manage these side effects, apply an ice pack covered in cloth to your lips. This will also help with any pain that you may have. Staying hydrated is imperative to getting good results. Hyaluronic acid from dermal fillers draws water from your body to the treated cells for a fuller effect, so drink lots of water and eat hydrating fruits and vegetables.
Do not fly for a holiday (advice on green and amber European countries notwithstanding – June, 2021)
It is recommended that you wait a few weeks before flying. This is because flying can be very dehydrating and interferes with tissue pressure, again increasing bruising and swelling.
Avoid strenuous activities – For the first 24 to 48 hours after getting lip fillers, avoid activities that might elevate your heart rate and blood pressure to minimise swelling. To prevent sweating, stay away from saunas and steam rooms as well.
Avoid smoking and alcohol – Smoking increases the risk of infection, so do not smoke until you are completely healed. Alcohol causes inflammation, so it can increase bruising and swelling. It also acts as a blood thinner and should be avoided before and after the procedure.
Avoid makeup – To avoid infection, avoid using any lip products for at least 24 hours. Keep the area clean by using a gentle cleanser or whatever your doctor recommends.
Know the warning signs – Dermal fillers are a non-invasive treatment, but like any other medical procedure, there are risks involved. If you experience intolerable pain, intense swelling and bruising, bleeding, and excessive heat to the lip area, contact your doctor immediately.
Qualified Nurse-Led Treatments at Mesdkin Clinics
Here at MedSkin Clinic, all of our practitioners are qualified to administer the treatment and are here to support you through your recovery. Contact us today to book your free consultation.
Article Authors: De Boulle K, Furuyama N, Heydenrych I, Keaney T, Rivkin A, Wong V, Silberberg M
1. Goodman M, Adams N, Corneil T, Kreukels B, Motmans J, Coleman E. Size and distribution of transgender and gender nonconforming populations: a narrative review. Endocrinol Metab Clin North Am. 2019;48(2):303–321. doi:10.1016/j.ecl.2019.01.001
2. Lai YC, Kazlouskaya M, Kazlouskaya V. Historical and current state of dermatologic care for sexual and gender minority populations. Dermatol Clin. 2020;38(2):177–183. doi:10.1016/j.det.2019.10.001
3. Ginsberg BA. Dermatologic care of the transgender patient. Int J Womens Dermatol. 2017;3(1):65–67. doi:10.1016/j.ijwd.2016.11.007
4. Ginsberg BA, Calderon M, Seminara NM, Day D. A potential role for the dermatologist in the physical transformation of transgender people: a survey of attitudes and practices within the transgender community. J Am Acad Dermatol. 2016;74(2):303–308. doi:10.1016/j.jaad.2015.10.013
5. Dhingra N, Bonati LM, Wang EB, Chou M, Jagdeo J. Medical and aesthetic procedural dermatology recommendations for transgender patients undergoing transition. J Am Acad Dermatol. 2019;80:1712–1721. doi:10.1016/j.jaad.2018.05.1259
6. Hicks KE, Thomas JR. The changing face of beauty: a global assessment of facial beauty. Otolaryngol Clin North Am. 2020;53(2):185–194. doi:10.1016/j.otc.2019.12.005
7. MacGregor JL, Chang YC. Minimally invasive procedures for gender affirmation. Dermatol Clin. 2020;38(2):249–260. doi:10.1016/j.det.2019.10.014
8. Galupo MP, Lomash E, Mitchell RC. “All of my lovers fit into this scale”: sexual minority individuals’ responses to two novel measures of sexual orientation. J Homosex. 2017;64(2):145–165. doi:10.1080/00918369.2016.1174027
9. Ascha M, Swanson MA, Massie JP, et al. Nonsurgical management of facial masculinization and feminization. Aesthet Surg J. 2019;39(5):NP123–NP137. doi:10.1093/asj/sjy253
10. Marshall Z, Welch V, Minichiello A, Swab M, Brunger F, Kaposy C. Documenting research with transgender, nonbinary, and other gender diverse (trans) individuals and communities: introducing the global trans research evidence map. Transgend Health. 2019;4(1):68–80. doi:10.1089/trgh.2018.0020
11. Garrett MB. Working with transgender individuals in case management practice. Prof Case Manag. 2018;23(1):19–24. doi:10.1097/NCM.0000000000000251
12. Sullivan P, Trinidad J, Hamann D. Issues in transgender dermatology: a systematic review of the literature. J Am Acad Dermatol. 2019;81(2):438–447. doi:10.1016/j.jaad.2019.03.023
13. Ufomata E, Eckstrand KL, Spagnoletti C, et al. Comprehensive curriculum for internal medicine residents on primary care of patients identifying as lesbian, gay, bisexual, or transgender. MedEdPORTAL. 2020;16:10875. doi:10.15766/mep_2374-8265.10875
14. Marks DH, Awosika O, Rengifo-Pardo M, Ehrlich A. Dermatologic surgical care for transgender individuals. Dermatol Surg. 2019;45(3):446–457. doi:10.1097/DSS.0000000000001718
15. Carruthers JD, Glogau RG, Blitzer A. Advances in facial rejuvenation: botulinum toxin type A, hyaluronic acid dermal fillers, and combination therapies—consensus recommendations. Plast Reconstr Surg. 2008;121(suppl5):5S–30S. doi:10.1097/PRS.0b013e31816de8d0
16. Whitaker LA, Morales L Jr, Farkas LG. Aesthetic surgery of the supraorbital ridge and forehead structures. Plast Reconstr Surg. 1986;78(1):23–32. doi:10.1097/00006534-198607000-00003
17. Berli JU, Capitán L, Simon D, Bluebond-Langner R, Plemons E, Morrison SD. Facial gender confirmation surgery—review of the literature and recommendations for Version 8 of the WPATH Standards of Care. Int J Transgend. 2017;18(3):264–270. doi:10.1080/15532739.2017.1302862
18. Deschamps-Braly JC. Facial gender confirmation surgery: facial feminization surgery and facial masculinization surgery. Clin Plast Surg. 2018;45(3):323–331. doi:10.1016/j.cps.2018.03.005
19. Morrison SD, Vyas KS, Motakef S, et al. Facial feminization: systematic review of the literature. Plast Reconstr Surg. 2016;137(6):1759–1770. doi:10.1097/PRS.0000000000002171
20. de Maio M. Ethnic and gender considerations in the use of facial injectables: male patients. Plast Reconstr Surg. 2015;136(suppl5):40S–43S. doi:10.1097/PRS.0000000000001729
21. Fernbach M. Recommendations for age and sex diagnoses of skeletons. J Hum Evol. 1980;9(7):517–549.
22. Goldstein SM, Katowitz JA. The male eyebrow: a topographic anatomic analysis. Ophthal Plast Reconstr Surg. 2005;21(4):285–291. doi:10.1097/01.iop.0000169253.68675.18
23. Dempf R, Eckert AW. Contouring the forehead and rhinoplasty in the feminization of the face in male-to-female transsexuals. J Craniomaxillofac Surg. 2010;38(6):416–422. doi:10.1016/j.jcms.2009.11.003
24. Garvin HM, Ruff CB. Sexual dimorphism in skeletal browridge and chin morphologies determined using a new quantitative method. Am J Phys Anthropol. 2012;147(4):661–670. doi:10.1002/ajpa.22036
25. Gunter JP, Antrobus SD. Aesthetic analysis of the eyebrows. Plast Reconstr Surg. 1997;99(7):1808–1816. doi:10.1097/00006534-199706000-00002
26. Freund RM, Nolan WB 3rd. Correlation between brow lift outcomes and aesthetic ideals for eyebrow height and shape in females. Plast Reconstr Surg. 1996;97(7):1343–1348. doi:10.1097/00006534-199606000-00003
27. Rohrich RJ, Janis JE, Kenkel JM. Male rhinoplasty. Plast Reconstr Surg. 2003;112(4):1071–1085; quiz 1086. doi:10.1097/01.PRS.0000076201.75278.BB
28. Koudelova J, Bruzek J, Caganova V, Krajicek V, Veleminska J. Development of facial sexual dimorphism in children aged between 12 and 15 years: a three-dimensional longitudinal study. Orthod Craniofac Res. 2015;18(3):175–184. doi:10.1111/ocr.12096
29. Wysong A, Joseph T, Kim D, Tang JY, Gladstone HB. Quantifying soft tissue loss in facial aging: a study in women using magnetic resonance imaging. Dermatol Surg. 2013;39(12):1895–1902. doi:10.1111/dsu.12362
30. Wysong A, Kim D, Joseph T, MacFarlane DF, Tang JY, Gladstone HB. Quantifying soft tissue loss in the aging male face using magnetic resonance imaging. Dermatol Surg. 2014;40(7):786–793. doi:10.1111/dsu.0000000000000035
31. Donnelly SM, Hens SM, Rogers NL, Schneider KL. Technical note: a blind test of mandibular ramus flexure as a morphologic indicator of sexual dimorphism in the human skeleton. Am J Phys Anthropol. 1998;107(3):363–366. doi:10.1002/(SICI)1096-8644(199811)107:3<363::AID-AJPA11>3.0.CO;2-Y
32. Thayer ZM, Dobson SD. Sexual dimorphism in chin shape: implications for adaptive hypotheses. Am J Phys Anthropol. 2010;143(3):417–425. doi:10.1002/ajpa.21330
33. Cohen BE, Bashey S, Wysong A. Literature review of cosmetic procedures in men: approaches and techniques are gender specific. Am J Clin Dermatol. 2017;18(1):87–96. doi:10.1007/s40257-016-0237-x
34. Scherer MA. Specific aspects of a combined approach to male face correction: botulinum toxin A and volumetric fillers. J Cosmet Dermatol. 2016;15(4):566–574. doi:10.1111/jocd.12247
35. Spiegel JH. Facial feminization for the transgender patient. J Craniofac Surg. 2019;30(5):1399–1402. doi:10.1097/SCS.0000000000005645
36. Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin Cutan Med Surg. 2009;28(2):115–129. doi:10.1016/j.sder.2009.05.001
37. Kuroe K, Rosas A, Molleson T. Variation in the cranial base orientation and facial skeleton in dry skulls sampled from three major populations. Eur J Orthod. 2004;26(2):201–207. doi:10.1093/ejo/26.2.201
38. Blumenfeld J. Racial identification in the skull and teeth. Totem Univ West Ontario J Anthropol. 2000;8(1):4.
39. Samizadeh S, Wu W. Ideals of facial beauty amongst the Chinese population: results from a large national survey. Aesthetic Plast Surg. 2018;42(6):1540–1550. doi:10.1007/s00266-018-1188-9
40. Ruoss AV, Short WR, Kovarik CL. The patient’s perspective: reorienting dermatologic care for lesbian, gay, bisexual, transgender, and queer/questioning patients. Dermatol Clin. 2020;38(2):191–199. doi:10.1016/j.det.2019.10.003
41. Philipp-Dormston WG, Eccleston D, De Boulle K, Hilton S, van den Elzen H, Nathan M. A prospective, observational study of the volumizing effect of open-label aesthetic use of Juvéderm® VOLUMA® with lidocaine in mid-face area. J Cosmet Laser Ther. 2014;16(4):171–179. doi:10.3109/14764172.2014.910079
42. Fink B, Neave N. The biology of facial beauty. Int J Cosmet Sci. 2005;27(6):317–325. doi:10.1111/j.1467-2494.2005.00286.x
43. de Maio M, Swift A, Signorini M, Fagien S. Facial assessment and injection guide for botulinum toxin and injectable hyaluronic acid fillers: focus on the upper face. Plast Reconstr Surg. 2017;140(2):265e–276e. doi:10.1097/PRS.0000000000003544
44. Gart MS, Gutowski KA. Overview of botulinum toxins for aesthetic uses. Clin Plast Surg. 2016;43(3):459–471. doi:10.1016/j.cps.2016.03.003
45. Qaqish C. Botulinum toxin use in the upper face. Atlas Oral Maxillofac Surg Clin North Am. 2016;24(2):95–103. doi:10.1016/j.cxom.2016.05.006
46. Lee DH, Jin SP, Cho S, et al. RimabotulinumtoxinB versus onabotulinumtoxinA in the treatment of masseter hypertrophy: a 24-week double-blind randomized split-face study. Dermatology. 2013;226(3):227–232. doi:10.1159/000349984
47. Haworth RD. Customizing perioral enhancement to obtain ideal lip aesthetics: combining both lip voluming and reshaping procedures by means of an algorithmic approach. Plast Reconstr Surg. 2004;113(7):2182–2193. doi:10.1097/01.PRS.0000122546.90916.B4
48. Dallara JM, Baspeyras M, Bui P, Cartier H, Charavel MH, Dumas L. Calcium hydroxylapatite for jawline rejuvenation: consensus recommendations. J Cosmet Dermatol. 2014;13(1):3–14. doi:10.1111/jocd.12074
49. Buckingham ED, Glasgold R, Kontis T, et al. Volume rejuvenation of the lower third, perioral, and jawline. Facial Plast Surg. 2015;31(1):70–79. doi:10.1055/s-0035-1544945