Maximizing Panfacial Aesthetic Outcomes: Findings and

Recommendations From the HARMONY Study

Michael S. Kaminer, MD,* Joel L. Cohen, MD,† Ava Shamban, MD,‡
William Philip Werschler, MD,x Garrett T. Shumate, BS,║ Adrienne Drinkwater, PhD,¶ and
Conor J. Gallagher, PhD║

BACKGROUND Aesthetic medicine has evolved from targeting individual treatment areas to a global
approach of panfacial rejuvenation. HARMONY was the first clinical study to systematically demonstrate
positive physical and psychosocial impacts of panfacial treatment.

OBJECTIVE Provide evidence-based guidance on treatment strategies to help maximize outcomes in patients
seeking panfacial rejuvenation.

MATERIALS AND METHODS Study sites with the lowest (n = 2) and highest (n = 2) improvements based on
FACE-Q Satisfaction with Face Overall scores were analyzed to understand differences in treatment strategy
that may contribute to incrementally greater patient satisfaction.

RESULTS The highest scoring sites exhibited greater improvement in all patient-reported outcomes and
investigator-assessed measures related to dermal filler treatment compared with the lowest scoring sites. The
highest sites favored lateral malar augmentation and used less volume medially versus the lowest sites. In the lower
face, the highest sites used greater volumes and more HYC-24L than HYC-24L+. Initial treatment volumes were more
conservative at highest than lowest sites; greater volumes were used by highest sites in touch-up treatments.

CONCLUSION Product usage trends common to the highest scoring sites (including injection volume,
injection sites, and product selection) may provide guidance on best practices for a panfacial approach to
aesthetic treatment to maximize patient satisfaction.

Supported by Allergan plc. Editorial support for this article was provided by Peloton Advantage, Parsippany,
New Jersey, and was funded by Allergan plc. M.S. Kaminer has received research grants from Allergan plc. J.L.
Cohen serves as a consultant and clinical trial investigator for Allergan plc. A. Shamban serves as an inves-
tigator for Allergan plc, Medicis, and Galderma, and as a consultant for Allergan plc and Merz Aesthetics. W.P.
Werschler has served on an advisory board, as a speaker, and as a consultant and/or received research funding
from Allergan plc, DermAvance, Galderma, Healion, Merz Aesthetics, Polyremedy, Revance, Suneva, and
Thermi. G.T. Shumate is an employee of Allergan plc and owns stock/options in the company. C.J. Gallagher
was an employee of Allergan plc at the time of this analysis. A. Drinkwater is an employee of Peloton
Advantage, which received funding for medical writing and editorial services related to this manuscript from
Allergan plc. The opinions expressed in this article are those of the authors. The authors received no
honorarium/fee or other form of financial support related to the development of this article.

A esthetic medicine has evolved from targeting

individual treatment areas to a more global
approach to facial rejuvenation (i.e., panfacial
treatment).1–3 Different treatment modalities are often
required based on whether the areas of concern display
volume loss, lines, wrinkles, or folds. However, there
is a paucity of data-driven best practices for panfacial
aesthetic treatment in the literature, and evolution in

*SkinCare Physicians, Inc., Chestnut Hill, Massachusetts; †AboutSkin Dermatology and DermSurgery, Englewood,
Colorado; ‡AVA MD, Santa Monica, California; xMedicine/Dermatology, University of Washington, School of Medicine,
Seattle, Washington; ║Medical Affairs, Allergan plc, Irvine, California; ¶Peloton Advantage, Parsippany, New Jersey

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided
in the HTML and PDF versions of this article on the journal’s Web site (www.dermatologicsurgery.org).

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
· ·
ISSN: 1076-0512 Dermatol Surg 2019;00:1–9 DOI: 10.1097/DSS.0000000000002271

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
 HARMONY: PANFACIAL BEST PRACTICES
product usage trends often relies on anecdotal
evidence being shared among injectors. The
HARMONY study examined the impact of a
combination of multiple minimally invasive facial
aesthetic treatments consisting of injectable
neuromodulator, injectable hyaluronic acid dermal
fillers, and a topical eyelash enhancement product.4,5
Although the HARMONY study specified the dosing
and location of neuromodulator and subject-applied
eyelash enhancer, the injector had discretion regarding
filler product selection, injection technique, and
volume. At the primary end point (Month 4), all sites
reported significant improvement across a range of
validated patient-reported outcome measures and
investigator-assessed effectiveness measures.
However, some clinical sites reported greater overall
improvement than other sites.
This post hoc analysis of the HARMONY study aimed
to gain a better understanding of whether differences
in treatment approach (e.g., filler product selected,
filler volume, and injection location) may have
allowed certain clinical sites to achieve incrementally
greater improvements than others.
Methods
Study Design
The HARMONY study, a single-blind, 4-month study
(clinicaltrials.gov identifier, NCT02176356), was
conducted at 10 sites in the United States.4,5 Study sites
were located in California, Colorado, Florida, Illinois,
Massachusetts, Texas, and Washington. The protocol
was approved by a central Institutional Review Board
(Schulman Associates IRB; Cincinnati, OH). All sub-
jects provided written informed consent before study
participation. The study enrolled women and men
aged 35 to 65 years for aesthetic correction of mod-
erate to severe facial wrinkles and folds and eyelash
hypotrichosis. Detailed study methods and eligibility
criteria were previously reported.4
Treatments
Study treatments have been previously reported.4
Briefly, subjects applied 0.03% ophthalmic solution
2 DERMATOLOGIC SURGERY
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
(Latisse; Allergan plc, Dublin, Ireland) once daily.
Facial lines and folds were treated with HYC-24L
(Juvéderm Ultra XC) and/or HYC-24L+ (Juvéderm
Ultra Plus XC), and VYC-20L (Juvéderm Voluma
XC) was used for volume restoration (all products,
Allergan plc). Investigators were to use only one
product per treatment area. On Days 1 (initial
treatment) and 14 (touch-up treatment), HYC-24L
and/or HYC-24L+ were injected as needed for
nasolabial folds (NLF), oral commissures (OC),
perioral lines (POL), marionette lines (ML), and/or
radial cheek lines (RCL), with a maximum total
volume (initial and touch-up) of 6.0 mL. On Days 1
and 14, VYC-20L could be injected into the zygo-
maticomalar, anteromedial cheek, and/or submalar
regions of the midface, as needed, for midface vol-
ume deficit (MFVD), with a maximum total volume
of 4.0 mL. At Month 3, onabotulinumtoxinA
(Botox Cosmetic; Allergan plc) was injected for
glabellar lines (GLs) and/or crow’s feet lines (CFLs).
All treatments were administered according to label
instructions.
Assessments
All effectiveness assessments were completed at
Month 4. The primary effectiveness measure was the
mean change from baseline on the validated 10-item
FACE-Q Satisfaction with Facial Appearance Overall
Scale.5,6 Subject-assessed secondary effectiveness
measures included mean change from baseline on the
FACE-Q Aging Appearance Appraisal Scale, the
FACE-Q Social Confidence Scale, the FACE-Q Psy-
chological Well-Being Scale,7,8 and the FACE-Q Age
Appraisal Visual Analog Scale (VAS)7; assessment of
perceived age on the Self-Perception of Age question-
naire9; and improvement on the Global Aesthetic
Improvement Scale (GAIS). An evaluating investigator
blinded to treatment assessed secondary effectiveness
measures, which included mean change from baseline
on scales evaluating physical outcomes (overall
MFVD on the Midface Volume Deficit Scale
[MFVDS],10 severity of NLF, OC, and POL on the
NLF Severity Scale, OC Severity Scale, and POL
Severity Scale, respectively11,12; severity of GL and/or
CFL using the corresponding Facial Wrinkle Scale
[FWS]13; and eyelash prominence on the Global
 KAMINER ET AL

Eyelash Assessment [GEA] scale),14 as well as
improvement on the GAIS.
Effectiveness analyses were conducted on all subjects
who received treatment with all products and com-
pleted the Month 4 post-treatment effectiveness
assessments. The current post hoc analysis evaluated
results from the 2 study sites (19 total subjects) with
the highest improvements and the 2 study sites (20
total subjects) with the lowest improvements on the
primary end point.
Results
Demographics and Baseline Characteristics
All subjects in the highest and lowest groups were
female, although male subjects were enrolled in the full
HARMONY study population. No meaningful dif-
ferences were noted in baseline characteristics across
most objective measures as well as in satisfaction and
psychosocial scales when comparing the highest and
lowest study sites (Table 1). The median ages of sub-
jects in the highest and lowest groups were 55 and 49
years, respectively.
highest sites achieved a 52% greater improvement in
satisfaction with their facial appearance compared
with the lowest sites. For the investigator-assessed
measures, the highest sites exhibited greater magni-
tude of improvement in all filler-treated areas at
4 months after treatment (Table 3).
Dermal Filler Characteristics
Midface
The highest sites used 2.7-mL total mean volume of
VYC-20L, while the lowest sites used a total mean vol-
ume of 2.9 mL (Figure 1). Submalar region (V4) treat-
ment was performed in only 53% of subjects in the
highest sites versus 75% of subjects in the lowest sites.
When those subjects in the highest and lowest sites who
received submalar treatment were removed from the
analysis, the difference in the use of VYC-20L between
the highest and lowest sites was even more pronounced:
the highest sites placed a mean of 1.9 mL of filler in the
zygomaticomalar region compared with 1.2 mL in the
lowest sites. The lowest sites in this subanalysis appeared
to favor product placement in the anteromedial cheek
region (V3), with a mean of 1.8 mL in those sites com-
pared with 1.3 mL in the highest sites.

Outcomes in Highest and Lowest Sites

The highest sites consistently exhibited greater Lower Face

improvement in all patient-reported outcomes at the In the lower face, the combined product volume
final study time point (Table 2). Subjects treated at the (HYC-24L and HYC-24L+) was greater in the highest

TABLE 1. Subject Demographics and Baseline Characteristics

Parameter, Mean Highest Sites Lowest Sites

Age, yr 54.1 49.8
Fitzpatrick skin phototype 3.1 3.1
FACE-Q Satisfaction with Facial Appearance Overall 22.4 22.7
FACE-Q Aging Appearance Appraisal 18.5 19.2
FACE-Q Social Confidence Scale 22.1 22.6
FACE-Q Psychological Well-Being Scale 27.8 28.4
Self-perception of age, yr 0.5 0.3
Overall midface volume deficit 3.1 3.0
Nasolabial folds 2.4 2.5
Oral commissures 2.1 2.1
Perioral lines 1.9 1.8
Glabellar line severity at maximum frown 2.2 2.6
Crow’s feet line severity 2.3 2.4
Eyelash prominence 1.6 1.9

00:00:MONTH 2019 3

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 HARMONY: PANFACIAL BEST PRACTICES

TABLE 2. Mean Change From Baseline in Patient-Reported Outcomes in Highest and Lowest Study Sites
at 4 Months, Based on Raw, Non–Rasch-Transformed Values

Highest vs Lowest
Highest Sites Lowest Sites Sites

Mean Change From Mean Change From

Parameter Baseline Baseline Percent Difference
FACE-Q Satisfaction with Facial 13.8 9.1 52
Appearance Overall
FACE-Q Aging Appearance Appraisal 28.7 24.3 103
FACE-Q Aging Appearance Appraisal 26.1 23.6 70
(VAS)
FACE-Q Social Confidence Scale 7.3 4.2 75
FACE-Q Psychological Well-Being Scale 8.2 5.1 60
Self-perception of age, yr 26.3 23.4 89
Appearance of periorbital lines 214.2 210.4 37
Global aesthetic improvement scale 1.7 1.5 16

VAS, visual analog scale.

versus the lowest sites, with a higher ratio of HYC-24L
to HYC-24L+ (Figure 2). In the highest sites, 84% of
subjects received HYC-24L and 68% received HYC-
24L+. Volumes of HYC-24L and HYC-24L+ by
injection site and highest and lowest sites are shown in
Table 4.
(Figure 3). Although investigators were instructed to
use a single product in a specific treatment area, this
did not always occur. The lowest sites more often used
2 products in a given location versus the highest sites,
either across visits or at the same visit (See Supple-
mental Digital Content 1, Table S1, http://links.lww.
com/DSS/A197).

Touch-up Treatments and Product Layering Treatment strategies from the highest and lowest sites
The highest sites used a greater volume of fillers for based on volume of filler in the midface and lower face
touch-up treatments compared with the lowest sites per treatment area are shown in Figure 4, while

TABLE 3. Mean Change From Baseline in Investigator-Assessed Effectiveness Measures in the Highest
and Lowest Study Sites at 4 Months

Highest vs Lowest
Highest Sites Lowest Sites Sites

Mean Change From Mean Change From

Parameter Baseline Baseline Percent Difference
Glabellar lines (FWS) 21.21 21.70 229
Eyelash prominence (GEA) 1.47 1.90 222
Crow’s feet lines (FWS) 21.37 20.88 63
Midface volume deficit (MFVDS) 21.95 21.20 62
Nasolabial folds (NLFSS) 21.32 20.90 46
Perioral lines (POLSS) 21.26 20.72 75
Oral commissures (OCSS) 21.32 20.68 92
Global aesthetic improvement 1.6 1.1 55
scale

FWS, facial wrinkle scale; GEA, global eyelash assessment; MFVDS, midface volume deficit scale; NLFSS, nasolabial fold severity scale;
OCSS, oral commissure severity scale; POLSS, perioral line severity scale.

4 DERMATOLOGIC SURGERY

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

Figure 1. Mean volume of VYC-20L placed in the midface (V1–V4), zygomaticomalar region (V1, V2), anteromedial cheek
region (V3), and submalar region (V4) in the highest and lowest study sites.
Supplemental Digital Content 2, Figure S1, http://
links.lww.com/DSS/A198, shows differences between
highest and lowest sites in product preference and
usage for each facial region.
Discussion
This analysis of data from the HARMONY study
showed that the treatment approach of the highest
sites resulted in incrementally greater physical out-
comes compared with the lowest sites. These
enhanced physical outcomes were associated with
greater subject satisfaction across a range of vali-
dated measures. The findings may provide an
objective basis to guide treatment strategies and
product selection to maximize the outcomes of
panfacial treatment.
Differences between highest and lowest sites were
particularly notable in filler treatment of the mid and
lower face, where investigators had flexibility to indi-
vidualize their treatment approach. In general, inves-
tigators began filler treatments with the midface.
Despite using less overall volume of VYC-20L in the
midface, the highest performing sites were still able to
achieve greater improvement in MFVDS scores and a
corresponding increase in subject satisfaction com-
pared with the lowest performing sites. The volumes of
VYC-20L used in this study were substantially lower
than the volumes used in the pivotal trial to support
FDA approval of VYC-20L for MFVD, suggesting a
© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
KAMINER ET AL
trend toward volumes in daily practice associated with
more efficient product placement.4
Based on the authors’ clinical experience in restoring
midface volume, placement of greater volumes of fill-
ers in the anteromedial cheek region (V3) may inhibit
expression and movement and may cause a motion-
related unnatural fullness at the cheek:tear trough
junction, which may result in lower subject satisfac-
tion with the outcome. This observation correlates
with the findings of the present analysis, in that a
“lateral and less” strategy to midface volume resto-
ration was used by the highest sites (i.e., the highest
sites used greater volume in the zygomaticomalar
region [V1 and V2] and less volume in the ante-
romedial cheek region [V3] than the lowest sites).
Inversely, the lowest sites used more volume medially
and had comparatively lower improvement on the
GAIS than the highest sites. When subjects who did not
receive submalar (V4) treatment were analyzed sepa-
rately, the “lateral and less” trend was further
amplified.
Greater combined volume was used in the lower face in
the highest sites, with subsequently greater subject
satisfaction and higher investigator-assessed effec-
tiveness compared with the lowest sites. Greater vol-
umes do not always indicate a greater risk for
unnatural outcomes, as subject satisfaction and
investigator-assessed global aesthetic improvement
data suggest otherwise. Technique, product placement
00:00:MONTH 2019 5
 HARMONY: PANFACIAL BEST PRACTICES
Figure 2. Overall volume of HYC-24L and HYC-24L+ used in the lower face to correct nasolabial folds, oral commissures,
marionette lines, radial cheek lines, and perioral lines. All subjects were treated with HYC-24L, HYC-24L+, or both.
(both not formally assessed in this study), and product
selection may potentially play a greater role than vol-
ume in terms of patient satisfaction and other out-
comes. Specifically, the HARMONY investigators
recommended treating the midface first, then sub-
sequently moving to lower-face filler injections as a
general rule for improving facial appearance.4 This
approach may reduce the requirement for filler in
other facial areas or lead to selection of alternative
products for more subtle correction.
This analysis showed clear preferences in product
selection for given locations. The preferences demon-
strated by the highest sites in this study are in line with
the concept that a product with more robust structural
properties (e.g., HYC-24L+) may be preferred to
address deeper wrinkles and folds, and a product with
softer mechanical properties (e.g., HYC-24L) may be
preferred to achieve a more subtle correction.1,15
Although the highest sites used a greater total volume
in the NLF, they reported more frequent use of HYC-
24L than HYC-24L+. This NLF correction was pre-
ceded by midface volume treatment with VYC-20L.
Taken together, these findings may suggest that VYC-
20L had the indirect effect of softening NLF, resulting
in a subsequent need for softer correction with a
product such as HYC-24L.
Both the highest and lowest sites demonstrated a
preference for HYC-24L for treatment of POL. By
6 DERMATOLOGIC SURGERY
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contrast, HYC-24L+ was preferred for treatment of
both ML and OC. HYC-24L+ may have been pre-
ferred for these locations to provide greater support
and structure due to its more robust properties. The
highest sites generally did not treat RCL, which may
indicate that the investigators did not consider the
RCL to be a priority treatment area. Alternatively,
this may have been secondary to prohibition of the
use of HYC-24L or HYC-24L+ in the radial cheeks if
VYC-20L was used in the underlying submalar
area.4 The study protocol specifically prohibited the
use of multiple products in any given location.
Nonetheless, layering of different products in a
given facial area was recorded during the touch-up
treatment. However, this finding was less common
in the highest sites, suggesting that greater
improvements were achieved when using only one
product per location.
Based on the FACE-Q Age Appraisal VAS, subjects in
the primary HARMONY study reported looking a
mean of 4.6 (SD, 4.19) years younger than their actual
age at Month 4.5 In this analysis, subjects in the highest
sites reported looking a mean of 6.1 years younger
than their actual age after treatment, compared with
3.6 years younger for the lowest sites. With respect to
improving appearance versus reversing signs of aging,
these data suggest that panfacial treatment achieved
both: as the subjects expressed greater satisfaction
with their faces, the investigators observed
 KAMINER ET AL

TABLE 4. Volume of HYC-24L and HYC-24L1 Used in the Lower Face, by Injection Site

Highest Sites Lowest Sites

Mean mL Per Subject Mean mL Per Subject

Injection Site/Product (% of Subjects Treated) (% of Subjects Treated)
All injection sites
HYC-24L and HYC-24L+ 4.0 (100) 3.4 (100)
Nasolabial folds
HYC-24L and HYC-24L+ 2.0 (89) 1.2 (95)
HYC-24L 2.0 (79) 0.6 (20)
HYC-24L+ 0.7 (32) 1.1 (90)
Oral commissures
HYC-24L and HYC-24L+ 0.9 (100) 1.0 (90)
HYC-24L 1.0 (40) 0.5 (65)
HYC-24L+ 0.7 (68) 0.7 (75)
Marionette lines
HYC-24L and HYC-24L+ 1.2 (50) 1.1 (75)
HYC-24L 0.3 (10) 0.5 (40)
HYC-24L+ 1.1 (53) 0.8 (75)
Radial cheek lines
HYC-24L and HYC-24L+ 0.0 (0) 0.8 (30)
HYC-24L 0.0 (0) 0.5 (30)
HYC-24L+ 0.0 (0) 0.7 (15)
Perioral region
HYC-24L and HYC-24L+ 0.8 (79) 0.6 (55)
HYC-24L 0.7 (68) 0.6 (55)
HYC-24L+ 1.0 (16) 0.3 (15)

improvements in severity scales, and the patients
reported looking younger.
The highest sites used greater touch-up volumes across
all filler products, suggesting a more conservative
approach to initial treatment. Use of lower injection
volumes at the initial visit may lower the risk of side
effects such as swelling and bruising, allows time for
hydration of the hyaluronic acid–based products
in situ, and gives the product time to integrate with the
tissue16: ultimately, this may lead to more efficient filler
use and may minimize the potential for over-
correction. Redraping of the tissue over the restored
volume may also influence the placement and quantity
of touch-up filler.
Although greater improvement from baseline in GL
was reported in the lowest sites, the mean severity of
GL based on the FWS score at the Month 4 time point
was similar between the highest and lowest sites. For
unknown reasons, improvement in eyelash promi-
nence with bimatoprost was greater in the lowest
versus highest sites.
The differences seen in treatment strategy may not
apply to all patients encountered in clinical practice
because of variables such as age, sex, race, and life-
style. Nevertheless, the HARMONY study is unique in
the prospective collection of data sufficient to support
an analysis of treatment strategies used by individual
injectors, provided that the same products are used for
injection. Differences in the mean and median ages of
subjects in the highest and lowest groups were poten-
tially reflected in patient-reported outcomes in that
improvements after treatment may have been inter-
preted dissimilarly based on age. The open-label
design of this study precluded the blinded assessment
of outcomes by subjects. However, the objective end
points were evaluated by a blinded rater. The 4-month
duration of the study allowed for the assessment of

00:00:MONTH 2019 7

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 HARMONY: PANFACIAL BEST PRACTICES

Figure 3. Use of VYC-20L, HYC-24L, and HYC-24L+ for touch-up treatments on Day 14 in the highest and lowest study sites.

outcomes after full implementation of a panfacial
treatment strategy. Evaluation after a longer time
interval may help to identify if long-term implications
exist regarding differences between treatment strate-
gies used by the highest and lowest sites.
Conclusions
In this analysis of results from the HARMONY study,
panfacial aesthetic treatment extended beyond physi-
cal improvements in multiple facial areas to increased
subject satisfaction with facial appearance overall,
social confidence, psychological well-being, and the
perception of younger age. Using the same palette of
products, the greater improvements achieved by the
highest sites suggest that treatment strategy and tech-
nique have a positive and synergistic effect on patient
outcomes. Characteristics of product usage trends
common to the highest sites, including injection vol-
ume, injection sites, and products selected, provide the

Figure 4. Side-by-side comparison of filler volume used per treatment area by the highest sites and by the lowest sites.
Adapted with permission from Allergan plc.

8 DERMATOLOGIC SURGERY

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 KAMINER ET AL

first evidence-based guidance on best practices for a 7. Panchapakesan V, Klassen AF, Cano SJ, Scott AM, et al. Development
and psychometric evaluation of the FACE-Q aging appraisal scale and
panfacial approach to aesthetic treatment to continu- patient-perceived age visual analog scale. Aesthet Surg J 2013;33:
ously improve aesthetic outcomes and maximize 1099–109.

patient satisfaction. 8. Klassen AF, Cano SJ, Schwitzer JA, Scott AM, et al. FACE-Q scales for
health-related quality of life, early life impact, satisfaction with
outcomes, and decision to have treatment: development and validation.
Acknowledgments Vic A. Narurkar, MD, who Plast Reconstr Surg 2015;135:375–86.

served as an author on this manuscript, has since 9. Carruthers A, Carruthers J. Patient-reported outcomes with botulinum
neurotoxin type A. J Cosmet Laser Ther 2007;9(Suppl 1):32–7.
passed away. The authors are grateful for his
10. Jones D, Murphy DK. Volumizing hyaluronic acid filler for midface
contribution. volume deficit: 2-year results from a pivotal single-blind randomized
controlled study. Dermatol Surg 2013;39:1602–11.

References 11. Buchner L, Vamvakias G, Rom D. Validation of a photonumeric

wrinkle assessment scale for assessing nasolabial fold wrinkles. Plast
1. Carruthers JD, Glogau RG, Blitzer A. Advances in facial rejuvenation: Reconstr Surg 2010;126:596–601.
botulinum toxin type A, hyaluronic acid dermal fillers, and
12. Cohen JL, Thomas J, Paradkar D, Rotunda A, et al. An interrater and
combination therapies—consensus recommendations. Plast Reconstr
intrarater reliability study of 3 photographic scales for the classification
Surg 2008;121(Suppl 5):5S–30S.
of perioral aesthetic features. Dermatol Surg 2014;40:663–70.
2. Sundaram H, Liew S, Signorini M, Vieira Braz A, et al. Global
13. Moers-Carpi M, Carruthers J, Fagien S, Lupo M, et al. Efficacy and
Aesthetics Consensus: hyaluronic acid fillers and botulinum toxin type
safety of onabotulinumtoxinA for treating crow’s feet lines alone or in
A—recommendations for combined treatment and optimizing
combination with glabellar lines: a multicenter, randomized, controlled
outcomes in diverse patient populations. Plast Reconstr Surg 2016;137:
trial. Dermatol Surg 2015;41:102–12.
1410–23.
14. Smith S, Fagien S, Whitcup SM, Ledon F, et al. Eyelash growth in
3. Swift A, Remington K. BeautiPHIcation: a global approach to facial
subjects treated with bimatoprost: a multicenter, randomized, double-
beauty. Clin Plast Surg 2011;38:347–77.
masked, vehicle-controlled, parallel-group study. J Am Acad Dermatol
4. Narurkar VA, Cohen JL, Dayan S, Kaminer MS, et al. A comprehensive 2012;66:801–6.
approach to multimodal facial aesthetic treatment: injection techniques 15. Pierre S, Liew S, Bernardin A. Basics of dermal filler rheology. Dermatol
and treatment characteristics from the HARMONY study. Dermatol Surg 2015;41(Suppl 1):S120–S6.
Surg 2016;42(Suppl 2):S177–S91.
16. Hee CK, Shumate GT, Narurkar V, Bernardin A, et al. Rheological
5. Weinkle SH, Werschler WP, Teller CF, Sykes JM, et al. Impact of properties and in vivo performance characteristics of soft tissue fillers.
comprehensive, minimally invasive, multimodal aesthetic treatment on Dermatol Surg 2015;41(Suppl 1):S373–81.
satisfaction with facial appearance: the HARMONY study. Aesthet
Surg J 2018;38:540–56.

6. Klassen AF, Cano SJ, Scott A, Snell L, et al. Measuring patient-reported Address correspondence and reprint requests to: Michael S.
outcomes in facial aesthetic patients: development of the FACE-Q. Kaminer, MD, 1244 Boylston Street, Chestnut Hill, MA
Facial Plast Surg 2010;26:303–9. 02467, or e-mail: mkaminer@skincarephysicians.net

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