Download PDF
Facial Plast Surg 2023; 39(03): 230-236
DOI: 10.1055/a-2005-0701
Original Article

Evidence-Based Medicine for Nonsurgical Facial Rejuvenation

Amrita Hari-Raj 
1   Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
,
Emily A. Spataro 
2   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Options for nonsurgical facial rejuvenation treatment have increased significantly in both availability and popularity over the past two decades. However, there remains a paucity of clinical practice guidelines and evidence-based recommendations for these procedures. The purpose of this article is to assess the presence of current high-level research for various methods of nonsurgical facial rejuvenation using the Oxford Centre for Evidence-Based Medicine. Botulinum toxin injections remain the best-studied method, with several randomized controlled trials guiding recommendations for safety and efficacy. Several studies on injectable fillers document complications and recommendations to avoid these, but sample sizes are small and many are noncomparative. Deoxycholic acid has been well examined and Food and Drug Administration approved to address submental fat but has not been studied in other areas of the face. Although chemical peels, laser skin resurfacing, energy-based facial rejuvenation, microneedling, and platelet-rich plasma have a variety of facial rejuvenation applications with minimal side effect profiles, there is significant variability with treatment protocols, outcomes measures, and randomized controlled trials with extended follow-up to develop clinical practice guidelines.

Keywords

Botox - fillers - skin resurfacing - evidence-based medicine


Publication History

Accepted Manuscript online:
30 December 2022

Article published online:
20 March 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 American Society of Plastic Surgeons. (2020) ASPS Statistics. Accessed November 28, 2022 at: https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf
    PubMedGoogle Scholar
  • 2 OCEBM Levels of Evidence Working Group*. “The Oxford Levels of Evidence 2”. Oxford Centre for Evidence-Based Medicine. Accessed January 03, 2023 at: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence
    PubMed
  • 3 Walker TJ, Dayan SH. Comparison and overview of currently available neurotoxins. J Clin Aesthet Dermatol 2014; 7 (02) 31-39
    PubMedGoogle Scholar
  • 4 Carruthers A, Carruthers J, Cohen J. A prospective, double-blind, randomized, parallel-group, dose-ranging study of botulinum toxin type a in female subjects with horizontal forehead rhytides. Dermatol Surg 2003; 29 (05) 461-467
    PubMedGoogle Scholar
  • 5 Carruthers A, Carruthers J. Prospective, double-blind, randomized, parallel-group, dose-ranging study of botulinum toxin type A in men with glabellar rhytids. Dermatol Surg 2005; 31 (10) 1297-1303
    CrossrefPubMedGoogle Scholar
  • 6 Carruthers A, Carruthers J, Said S. Dose-ranging study of botulinum toxin type A in the treatment of glabellar rhytids in females. Dermatol Surg 2005; 31 (04) 414-422 , discussion 422
    CrossrefPubMedGoogle Scholar
  • 7 Flynn TC. Advances in the use of botulinum neurotoxins in facial esthetics. J Cosmet Dermatol 2012; 11 (01) 42-50
    CrossrefPubMedGoogle Scholar
  • 8 Sundaram H, Signorini M, Liew S. et al; Global Aesthetics Consensus Group. Global aesthetics consensus: botulinum toxin type A—evidence-based review, emerging concepts, and consensus recommendations for aesthetic use, including updates on complications. Plast Reconstr Surg 2016; 137 (03) 518e-529e
    CrossrefPubMedGoogle Scholar
  • 9 Carruthers J, Fagien S, Matarasso SL. Botox Consensus Group. Consensus recommendations on the use of botulinum toxin type a in facial aesthetics. Plast Reconstr Surg 2004; 114 (6, Suppl): 1S-22S
    CrossrefPubMedGoogle Scholar
  • 10 Vachiramon V, Subpayasarn U, Triyangkulsri K, Jurairattanaporn N, Rattananukrom T. Different injection patterns of incobotulinumtoxinA for crow's feet: a split-face comparative study. J Eur Acad Dermatol Venereol 2021; 35 (01) 256-262
    CrossrefPubMedGoogle Scholar
  • 11 Alam M, Geisler A, Sadhwani D. et al. Effect of needle size on pain perception in patients treated with botulinum toxin type a injections: a randomized clinical trial. JAMA Dermatol 2015; 151 (11) 1194-1199
    CrossrefPubMedGoogle Scholar
  • 12 Alam M, Bolotin D, Carruthers J. et al. Consensus statement regarding storage and reuse of previously reconstituted neuromodulators. Dermatol Surg 2015; 41 (03) 321-326
    CrossrefPubMedGoogle Scholar
  • 13 Yang GC, Chiu RJ, Gillman GS. Questioning the need to use Botox within 4 hours of reconstitution: a study of fresh vs 2-week-old Botox. Arch Facial Plast Surg 2008; 10 (04) 273-279
    CrossrefPubMedGoogle Scholar
  • 14 Beer KR, Shamban AT, Avelar RL, Gross JE, Jonker A. Efficacy and safety of prabotulinumtoxinA for the treatment of glabellar lines in adult subjects: results from 2 identical phase III studies. Dermatol Surg 2019; 45 (11) 1381-1393
    CrossrefPubMedGoogle Scholar
  • 15 Baumann L, Dayan S, Connolly S. et al. Duration of clinical efficacy of onabotulinumtoxinA in crow's feet lines: results from two multicenter, randomized, controlled trials. Dermatol Surg 2016; 42 (05) 598-607
    CrossrefPubMedGoogle Scholar
  • 16 Qiu H, Zhao R, Cao L, Liu S, Yu D, Wang H. The aesthetic concerns of botulinum toxin type A in the treatment of neck wrinkles: a systematic review. Aesthet Surg J 2021; 41 (06) NP592-NP601
    CrossrefPubMedGoogle Scholar
  • 17 Nayfeh T, Shah S, Malandris K. et al. A systematic review supporting the American Society For Dermatologic Surgery Guidelines on the prevention and treatment of adverse events of injectable fillers. Dermatol Surg 2021; 47 (02) 227-234
    CrossrefPubMedGoogle Scholar
  • 18 Jones DH, Fitzgerald R, Cox SE. et al. Preventing and treating adverse events of injectable fillers: evidence-based recommendations from the American Society for Dermatologic Surgery Multidisciplinary Task Force. Dermatol Surg 2021; 47 (02) 214-226
    CrossrefPubMedGoogle Scholar
  • 19 Molina B, David M, Jain R. et al. Patient satisfaction and efficacy of full-facial rejuvenation using a combination of botulinum toxin type a and hyaluronic acid filler. Dermatol Surg 2015; 41 (Suppl. 01) S325-S332
    CrossrefPubMedGoogle Scholar
  • 20 Chung C, Lee JHA. A single-center, randomized, double-blind clinical trial to compare the efficacy and safety of a new monophasic hyaluronic acid filler and biphasic filler in correcting nasolabial fold. Aesthetic Plast Surg 2021; 45 (06) 2902-2908
    CrossrefPubMedGoogle Scholar
  • 21 Weinkle SH, Werschler WP, Teller CF. et al. Impact of comprehensive, minimally invasive, multimodal aesthetic treatment on satisfaction with facial appearance: the HARMONY study. Aesthet Surg J 2018; 38 (05) 540-556
    CrossrefPubMedGoogle Scholar
  • 22 Glogau RG, Glaser DA, Callender VD. et al. A double-blind, placebo-controlled, phase 3b study of ATX-101 for reduction of mild or extreme submental fat. Dermatol Surg 2019; 45 (12) 1531-1541
    CrossrefPubMedGoogle Scholar
  • 23 Humphrey S, Sykes J, Kantor J. et al. ATX-101 for reduction of submental fat: a phase III randomized controlled trial. J Am Acad Dermatol 2016; 75 (04) 788-797.e7
    CrossrefPubMedGoogle Scholar
  • 24 Humphrey S, Cohen JL, Bhatia AC, Green LJ, Green JB, Bowen B. Improvements in submental contour up to 3 years after ATX-101: efficacy and safety follow-up of the phase 3 REFINE Trials. Aesthet Surg J 2021; 41 (11) NP1532-NP1539
    CrossrefPubMedGoogle Scholar
  • 25 Goodman GJ, Spelman LJ, Lowe N, Bowen B. Randomized, placebo-controlled phase 1/2 study to determine the appropriate ATX-101 concentration for reduction of submental fat. Dermatol Surg 2021; 47 (08) 1065-1070
    CrossrefPubMedGoogle Scholar
  • 26 Pham CT, Lee A, Sung CT, Choi F, Juhasz M, Mesinkovska NA. Adverse events of injectable deoxycholic acid. Dermatol Surg 2020; 46 (07) 942-949
    CrossrefPubMedGoogle Scholar
  • 27 Samargandy S, Raggio BS. Skin Resurfacing Chemical Peels. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed February 16, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK547752/
    PubMedGoogle Scholar
  • 28 Sitohang IBS, Legiawati L, Suseno LS, Safira FD. Trichloroacetic acid peeling for treating photoaging: a systematic review. Dermatol Res Pract 2021; 2021: 3085670
    PubMedGoogle Scholar
  • 29 Kubiak M, Mucha P, Dębowska R, Rotsztejn H. Evaluation of 70% glycolic peels versus 15% trichloroacetic peels for the treatment of photodamaged facial skin in aging women. Dermatol Surg 2014; 40 (08) 883-891
    CrossrefPubMedGoogle Scholar
  • 30 Yildirim S, Gurel MS, Gungor S, Tekeli O, Canat D. Comparison of efficacy of chemical peeling with 25% trichloroacetic acid and 0.1% retinoic acid for facial rejuvenation. Postepy Dermatol Alergol 2016; 33 (03) 199-205
    CrossrefPubMedGoogle Scholar
  • 31 Xu Y, Deng Y. Ablative fractional CO2 laser for facial atrophic acne scars. Facial Plast Surg 2018; 34 (02) 205-219
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Hedelund L, Haak CS, Togsverd-Bo K, Bogh MK, Bjerring P, Haedersdal M. Fractional CO2 laser resurfacing for atrophic acne scars: a randomized controlled trial with blinded response evaluation. Lasers Surg Med 2012; 44 (06) 447-452
    CrossrefPubMedGoogle Scholar
  • 33 Ross EV, Chodkiewicz H, Javvaji S, Zumwalt J, Kutscher TD, Tran C. Enhanced pulsed dye laser for facial rejuvenation. Lasers Surg Med 2021; 53 (01) 109-114
    CrossrefPubMedGoogle Scholar
  • 34 Nistico SP, Silvestri M, Zingoni T, Tamburi F, Bennardo L, Cannarozzo G. Combination of fractional CO2 laser and rhodamine-intense pulsed light in facial rejuvenation: a randomized controlled trial. Photobiomodul Photomed Laser Surg 2021; 39 (02) 113-117
    CrossrefPubMedGoogle Scholar
  • 35 Daoud AA, Gianatasio C, Rudnick A, Michael M, Waibel J. Efficacy of combined intense pulsed light (IPL) with fractional CO2-laser ablation in the treatment of large hypertrophic scars: a prospective, randomized control trial. Lasers Surg Med 2019; 51 (08) 678-685
    CrossrefPubMedGoogle Scholar
  • 36 Austin GK, Struble SL, Quatela VC. Evaluating the effectiveness and safety of radiofrequency for face and neck rejuvenation: a systematic review. Lasers Surg Med 2022; 54 (01) 27-45
    CrossrefPubMedGoogle Scholar
  • 37 Park JH, Kim JI, Park HJ, Kim WS. Evaluation of safety and efficacy of noninvasive radiofrequency technology for submental rejuvenation. Lasers Med Sci 2016; 31 (08) 1599-1605
    CrossrefPubMedGoogle Scholar
  • 38 Shin JW, Park JT, Chae JB. et al. The efficacy of micro-insulated needle radiofrequency system for the treatment of lower eyelid fat bulging. J Dtsch Dermatol Ges 2019; 17 (02) 149-156
    CrossrefPubMedGoogle Scholar
  • 39 Sugawara J, Kou S, Kokubo K. et al. Application for lower facial fat reduction and tightening by static type monopolar 1-MHz radio frequency for body contouring. Lasers Surg Med 2017; 49 (08) 750-755
    CrossrefPubMedGoogle Scholar
  • 40 Verner I. Clinical evaluation of the efficacy and safety of fractional bipolar radiofrequency for the treatment of moderate to severe acne scars. Dermatol Ther 2016; 29 (01) 24-27
    CrossrefPubMedGoogle Scholar
  • 41 Battle F, Battle S. Clinical evaluation of safety and efficacy of fractional radiofrequency facial treatment of skin type VI patients. J Drugs Dermatol 2018; 17 (11) 1169-1172
    PubMedGoogle Scholar
  • 42 Khan U, Khalid N. A systematic review of the clinical efficacy of micro-focused ultrasound treatment for skin rejuvenation and tightening. Cureus 2021; 13 (12) e20163
    PubMedGoogle Scholar
  • 43 Lu PH, Yang CH, Chang YC. Quantitative analysis of face and neck skin tightening by microfocused ultrasound with visualization in Asians. Dermatol Surg 2017; 43 (11) 1332-1338
    CrossrefPubMedGoogle Scholar
  • 44 Alexiades M, Berube D. Randomized, blinded, 3-arm clinical trial assessing optimal temperature and duration for treatment with minimally invasive fractional radiofrequency. Dermatol Surg 2015; 41 (05) 623-632
    CrossrefPubMedGoogle Scholar
  • 45 Maisel-Campbell AL, Ismail A, Reynolds KA. et al. A systematic review of the safety and effectiveness of platelet-rich plasma (PRP) for skin aging. Arch Dermatol Res 2020; 312 (05) 301-315
    CrossrefPubMedGoogle Scholar
  • 46 Hausauer AK, Humphrey S. The physician's guide to platelet-rich plasma in dermatologic surgery part II: clinical evidence. Dermatol Surg 2020; 46 (04) 447-456
    CrossrefPubMedGoogle Scholar
  • 47 Kang BK, Shin MK, Lee JH, Kim NI. Effects of platelet-rich plasma on wrinkles and skin tone in Asian lower eyelid skin: preliminary results from a prospective, randomised, split-face trial. Eur J Dermatol 2014; 24 (01) 100-101
    CrossrefPubMedGoogle Scholar
  • 48 Cameli N, Mariano M, Cordone I, Abril E, Masi S, Foddai ML. Autologous pure platelet-rich plasma dermal injections for facial skin rejuvenation: clinical, instrumental, and flow cytometry assessment. Dermatol Surg 2017; 43 (06) 826-835
    CrossrefPubMedGoogle Scholar
  • 49 Mehryan P, Zartab H, Rajabi A, Pazhoohi N, Firooz A. Assessment of efficacy of platelet-rich plasma (PRP) on infraorbital dark circles and crow's feet wrinkles. J Cosmet Dermatol 2014; 13 (01) 72-78
    CrossrefPubMedGoogle Scholar