Trends for Facial Injectable Therapies in Medical Aesthetics

Aesthetic dermatology has evolved and progressed during the last two decades. The term “Medical Aesthetics” is now coined here as the horizons for corrections and restoration by scientific rational are expanding and are beyond cosmetics only. The injectable used before the phase involved only intralesional steroids used for cystic acne. With the advent of minimally invasive procedures, the injectable techniques and options have reached a long way, empowering the dermatologist with the ability to correct facial texture; volumize, contour, lift, and alter muscle tone; and achieve focal fat reduction by simply using injectable therapy.

The agents used for injection into the skin include fillers, toxins, platelet-rich plasma, stem cells, lipolytic agents, and tranexamic acid. A new paradigm is, thus, in the stage of evolution where injection protocols for aesthetics are being redefined.

With more number of injecting agents available and more patients seeking less invasive procedures, a physician must be well versed with the molecular details of these agents, safe treatment techniques, risks, and safety profiles associated with these therapies in addition to achieving optimal outcomes.

The symposium on injectables in dermatology reviews the trends and techniques of current injectables in aesthetic dermatology. The dynamic relaxation of the face has evolved further to now impart changes/enhancements in skin texture and luminosity, enhancement in facial shape, and reduction in glandular activity of sebaceous, sweat, and salivary glands, therefore leading to a lot more aesthetic application as authored by Shetty[1] in the article “Dynamic relaxers of face.” The toxins can achieve more than just dynamic relaxation of the face if depth of injection is altered and dilution is modified as emphasized.

The article on simplifying injectable for volumetric rejuvenation elaborates techniques depending on fat pad depletion and structured approach to liquid lifting with regard to depths for filler injection on various facial compartments with emphasis on safety aspects during the treatments.[2] A graded approach to deep restoration followed by superficial one in subsequent session is bought forth with diagram representations.

Injectable treatments with fillers do carry risks and have potential for complications; an article by Vedamurthy[3]“Beware what you inject: complications of injectables—dermal fillers” discusses the 16% rise in filler therapies in 2016, challenges of complications associated with filler treatments from bruising to vascular complications, and infections. The measures one can resort to in order to prevent them as well as the solutions to approach the complications and manage them are highlighted in tabular form.

Recently, certain lipolytic agents such as deoxycholate have achieved the approval of the Food and Drug Administration, and submental and preplatysmal fat lipolysis is now enabled with injectable. This has opened new therapeutic dimensions as very few minimally invasive procedures can achieve this. Talathi[4] elaborates the lipolysis action of various injectable agents, their concentration, and mechanism of action in detail in article “Fat busters: lipolysis for face and neck.” The use of lignocaine with lipolytic agents and their safety and efficacy have been described in the study. The article “Deoxycholate (ATX-101) mixed with lidocaine to minimize pain/discomfort in nonsurgical treatment of submental fullness appearance” by Rauso[5] highlights the protocol and dosage used by the author to ease the discomfort associated with injecting lipolytic agents.

Injectable therapies for medical aesthetics that are minimally invasive and seek to correct volume, texture, relaxation, and lipolysis are here to stay. The injectable treatments scientifically target most aspects of rejuvenation and antiaging therapies in all zones: upper, middle, and lower face and the neck region, which the patients desire with gratifying results. Understanding the molecules and their diverse uses as well as formulating safe and synergistic treatment protocols for combining the therapy constitute the future of injectable treatments globally.