Midface Volume Deficit Correction with Fillers in an Indian Male.

The acceptability for aesthetic treatments like botulinum toxin and dermal fillers is increasing among Indian males and male aesthetic practice is growing at a rapid pace. Men tend to have less prominent cheeks than women. Another distinction between the male and female cheek is the shape of the ogee curve which should be created flatter in its lower S curve (concave portion) in case of males.[1] Voluma XC (VYC-20) and Volift XC (VYC-17.5) use Vycross (Allergan, Irvine, CA) technology which combines low- and high-molecular-weight hyaluronic acid with a novel cross-linking process.[23] We report the first Indian case of Vycross filler range for correction of male midface volume deficit. A 38-year-old Indian male marathon runner visited the clinic with midface volume loss. On examination, he had excessive mid-cheek ptosis, infraorbital fat protuberance with mild edema and prominent nasolabial folds [Figures 1-3]. On the day of treatment, the patient duly signed written informed consent form. The patient's pre-treatment photographs were taken using Canon SLR camera with standardized settings. A topical anesthetic containing a mix of lidocaine and prilocaine was applied before the procedure to alleviate any discomfort before procedure.

Figure 1

(Front View) – Day 0 Baseline clinical picture taken before treatment

Figure 3

(Left View) – Day 0 Baseline clinical picture taken before treatment. The arrow highlights loss of S shape curve

(Right View) – Day 0 Baseline clinical picture taken before treatment. The arrow highlights loss of S shape curve

The clinical outcome was measured utilizing Allergan Mid Face Volume Deficit Scale[4] (MFVDS), clinical photography and Global Aesthetic Improvement score (GAIS). Standardized pictures were taken immediately post treatment, after 1 and 9 months with Canon SLR. Baseline pre-treatment MFVD score of 4 was recorded by the physician.

The patient was treated with VYC-20 for the midface volume deficit and VYC-17.5 for the pre-auricular area, sub-malar area and nasolabial folds using 27- and 30-gauge needle and 2 mL of product, respectively. VYC-20 was injected in the supra periosteal plane as bolus doses on the zygomatic eminence and arch. In the medial cheek, VYC-20 was injected in the subcutaneous plane as small bolus doses. Infraorbital foramen and angular artery were marked and injections were placed away from these vascular areas. Pre-auricular and sub-malar were injected using a fanning technique in the subcutaneous plane with VYC-17.5. Care was taken of parotid gland and transverse facial artery while injecting the pre-auricular area. VYC-17.5 was injected in the nasolabial folds using the linear retrograde technique in the deep dermis plane. A subtle correction was done taking care not over volumize the midface and nasolabial folds. The patient showed immediate significant improvement in MFVD which was appreciable on follow-up at 1 and 9 months. We observed improvement in the MFVD scale from a score of 4 (significant deficit) to a score of 1 (minimal deficit). We found the ease of injection was high with both the products as the extrusion force required was very low. The patient was extremely satisfied with the natural results and absence of downtime. The GAIS was reported by the patient as a score of 2 (much improved) at the end of first month [Figures 4-6] and the score was maintained at 9 months. The clinical photographs showed noticeable results even at 9 months [Figures 7-9].

Figure 4

(Front View) – Male patient after a month treated for midface deficit with Vycross range of fillers (Voluma and Volift)

Figure 6

(Left View) – Male patient after a month treated for midface deficit with Vycross range of fillers (Voluma and Volift). The arrow shows the restoration of flatter S shape curve in males

Figure 7

(Front View) – Male patient after 9 months treated for midface deficit with Vycross range of fillers (Voluma and Volift). Improvement in MFVD is seen along with sustained results up to 9 months

Figure 9

(Left View) – Male patient after 9 months treated for mid face deficit with Vycross range of fillers (Voluma and Volift). Improvement in MFVD is seen along with sustained results up to 9 months. The concave S shape curve is preserved as shown by the arrow

(Right View) – Male patient after a month treated for midface deficit with Vycross range of fillers (Voluma and Volift). The arrow shows the restoration of flatter S shape curve in males

(Right View) – Male patient after 9 months treated for midface deficit with Vycross range of fillers (Voluma and Volift). Improvement in MFVD is seen along with sustained results up to 9 months. The concave S shape curve is preserved as shown by the arrow

Jones and Murphy's multi- center, single-blind controlled study showed an improvement of one point or more on the MFVDS achieved at 6 months.[5] Our case report is also in concordance with the results demonstrated in this study. Mild erythema and edema were reported immediately after the treatment which recovered in 12 hours. No long-term adverse effects were noted. In conclusion, this case report shows the safety, efficacy and high-patient satisfaction for midface volume lift with new proprietary mix of low- and high-molecular-weight filler. However, controlled, double-blind larger studies are required to further substantiate the effectiveness of the procedure.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.