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Global, 3-dimensional approach to natural rejuvenation: part 1 – recommendations for volume restoration and the periocular area


Correspondence: H Raspaldo, MD, Facial Plastic Surgery Centre, Palais Armenonville, Rond Point Duboys d'Angers, 9, 06400 Cannes, France. E-mail:



New techniques and products have lead to a global approach for the treatment of signs of aging. However, there is little published literature on the procedures involved in this approach and currently no validated recommendations exist.


To provide a detailed, practical guide to midfacial volume restoration and rejuvenation of the periocular area based on expert consensus recommendations.


The expert committee took into account both volumetric and dynamic aspects of treatment, as well as benefits of treatment combinations, for example, combining OnabotulinumtoxinA with hyaluronic acid (HA) fillers and volumizers. An aging severity scale was established for each area, together with recommendations of appropriate products, doses, site, depth, and injection techniques, as well as rules to be respected.


The expert group concluded that volume restoration of the midface is the first essential step in the global approach because treatment for this area has the most significant positive impact. Firstly, it is important to restore the malar contour, as malar volume anchors the structure of the midface. Secondly, an assessment of the effects of malar enhancement on the appearance of the nasolabial folds and the nasojugal fold (tear trough) should be conducted because these aging signs may be decreased by malar enhancement. Finally, treatment for the nasolabial folds and periorbital area with HA should be performed when needed.


Practical guidance is provided for midfacial volume restoration and rejuvenation of the periocular area based on validated expert consensus recommendations. This will help esthetic facial physicians to achieve optimum outcomes.