The author provides a comprehensive overview of a variety of considerations for clinicians to consider when assessing the upper third of the face, through discussion of anatomy, the importance of treatment planning, symptoms of complications, as well as treatment strategies. The author raises many valid points, including the altered anatomy of patients having undergone previous facial surgery, advising caution in this context, as well as caution in placing dermal filler over existing injectate. The author implies that descending and thinning skin may not always enhance visibility of facial vessels. It is important to note that this may not always be the case as the vasculature of the face anastomoses extensively. The author places emphasis on three-dimensional facial analysis as key to a successful aesthetic outcome, with recommendation placed on the importance of patients being informed of all possible treatment modalities to correct their presenting concern and the importance of referral when this falls beyond the scope of the clinician’s skillset. A sound overview is presented of upper facial treatment indications, including licensing considerations of the FDA approved toxins with practical guidance on injection technique(s). More detail could have been provided with regard to the prescribing and clinical rationale for consideration of a praclonidine hydrochloride, particularly in the context of unlicensed use in eyelid ptosis following toxin injection, in relation to side-effects. The statistics quoted are not current for the reported numbers of blindness from injection of dermal filler, although the author does provide a detailed overview of injection technique considerations to reduce the incidence of dermal filler related adverse events, underpinned by referenced anatomical descriptions.

Upper facial rejuvenation: the role of surgical and non-surgical interventions.
Brennan C.


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Anna Baker

BJN Aesthetic Nurse of the Year 2016.

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