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. 2025 Jun 16;13(6):e6873. doi: 10.1097/GOX.0000000000006873

Multimodal Treatment Combinations and Layering to Restructure the Aging Face: Recommendations From an Expert Panel

Carla de Sanctis Pecora *,✉, Niamh Corduff †, Julia Carroll ‡, Mariana Muniz §, Sonja Sattler
PMCID: PMC12169967  PMID: 40524883

Abstract

Background:

Facial aging is a complex process that varies by facial layer and patient characteristics. Correction of the signs of facial aging can be achieved with various aesthetic treatments, including Cohesive Polydensified Matrix hyaluronic acid (CPM-HA), calcium hydroxylapatite in carboxymethylcellulose (CaHA-CMC), microfocused ultrasound with visualization (MFU-V), and incobotulinumtoxinA (incoBoNT-A). This article describes how these treatments can be used in an individualized, layered approach for whole-face rejuvenation that optimizes outcomes and patient satisfaction.

Methods:

An international panel of 5 expert aesthetic physicians convened to align on best practices for a layered approach to whole-face rejuvenation using CPM-HA, CaHA-CMC, MFU-V, and incoBoNT-A. Panelists reviewed statements about facial aging and key features of the select products supporting their use in a layered treatment plan.

Results:

The proposed layered treatment plan expands on previous work by de Sanctis Pecora and consists of targeting (1) bone and retaining ligaments; (2) muscles, ligaments, and the superficial muscular aponeurotic system; (3) fat pads; (4) the dermis; and (5) skin quality. Panelists agreed that key features of the select products inform their positioning in the layered treatment plan. Step-by-step procedures for targeting each layer—including product, injection or application technique, and/or rationale—are provided.

Conclusions:

CPM-HA, CaHA-CMC, MFU-V, and incoBoNT-A are considered by the expert panel of aesthetic physicians to be ideal treatment options to obtain a synergistic effect in layered whole-face rejuvenation.

Takeaways

Question: How can Cohesive Polydensified Matrix hyaluronic acid (CPM-HA), calcium hydroxylapatite in carboxymethylcellulose (CaHA-CMC), microfocused ultrasound with visualization (MFU-V), and incobotulinumtoxinA (incoBoNT-A) be used in a layered approach for whole-face rejuvenation?

Findings: The proposed treatment plan targets (1) bone and retaining ligaments; (2) muscles, ligaments, and the superficial muscular aponeurotic system; (3) fat pads; (4) the dermis; and (5) skin quality. Step-by-step procedures for targeting each layer—including product, injection or application technique, and/or rationale—are provided.

Meaning: CPM-HA, CaHA-CMC, MFU-V, and incoBoNT-A are considered by an expert panel of aesthetic physicians to be synergistic treatments in a layered approach to whole-face rejuvenation.

INTRODUCTION

Facial aging is complex and involves distinct but interdependent changes to all anatomic layers, including bones, ligaments, muscles, the superficial musculoaponeurotic system (SMAS), fat, and skin.1–3 Bone resorption and remodeling during aging, hypertrophy or atrophy of fat pads, lead to repositioning of ligaments, which can manifest as loss of smooth transition zones between facial areas, hollowing (eg, in the cheeks and temples), and sagging (eg, in the jowl).1,3 Dynamic and static wrinkles emerge because of repeated contractions of the underlying muscles combined with dermal atrophy, resultant from age-related degradation of collagen, elastin, and proteoglycans in the skin extracellular matrix (ECM).4–9 Changes in facial muscle strength and skin tissue can create dynamic discordance such that weakened skin tissue is more susceptible to pulling underlying muscles, resulting in hyperdynamic facial expressions.3,10 Skin quality, which comprises skin firmness, skin surface and tone evenness, and skin glow, also diminishes with facial aging due to reduced collagen and elastin content of the skin.11

Improvement of facial aging can be achieved with various aesthetic treatments, including Cohesive Polydensified Matrix hyaluronic acid (CPM-HA) fillers, calcium hydroxylapatite in carboxymethylcellulose (CaHA-CMC), microfocused ultrasound with visualization (MFU-V), and incobotulinumtoxinA (incoBoNT-A).2 CPM-HA revive (CPM-HA R), soft (CPM-HA S), balance (CPM-HA B), intense (CPM-HA I), and volume (CPM-HA V) are injectable HA products with distinct rheologic properties enabling the use for a range of effects, including structuring and treatment of perioral wrinkles, nasolabial folds, marionette lines, oral commissures, cheeks, temples, and chin.2,12,13 CaHA-CMC and CaHA-CMC with 0.3% lidocaine (CaHA (+)–CMC) are biostimulators that regenerate structural components of the skin ECM.14–19 Regeneration occurs at undiluted, diluted (1:1 CaHA-CMC:diluent), and hyperdiluted (≥1:2) concentrations; undiluted concentrations are ideal for direct filling and immediate volumization for correction of facial wrinkles, folds, laxity, stretching, and jawline contour, whereas diluted and hyperdiluted concentrations are ideal for biostimulation.17–23 MFU-V combines ultrasound visualization with microfocused ultrasound therapy to deliver focused energy to collagen-rich tissue layers, initiating collagen and elastin synthesis that promote sustained facial tissue lifting.24–29 Finally, incoBoNT-A is a highly purified botulinum neurotoxin type A that contains the active 150-kDa core neurotoxin without complexing proteins, bacterial remnants, inactive neurotoxin, or virally derived peptides, used for the treatment of dynamic wrinkles and muscle rebalancing.2,30–35

Considering the interplay between age-related changes throughout all facial layers, de Sanctis Pecora2 proposed a layered approach to facial restructuring using CPM-HA, CaHA-CMC, MFU-V, and incoBoNT-A, leading to aesthetic improvements in all 5 treated patients after 3 months.2 Here, an international panel of aesthetic physicians expanded on this work to develop expert recommendations for a systematized layered treatment plan using these aesthetic treatments.

METHODS

An international panel of 5 expert aesthetic physicians convened in São Paulo, Brazil, to discuss best practices for using CPM-HA, CaHA-CMC, MFU-V, and incoBoNT-A in a layered approach to whole-face treatment. The panel had more than 85 years of combined clinical experience in dermatology, plastic surgery, and cosmetic/aesthetic medicine. Discussion involved expert agreement on key statements regarding the facial aging process; relationships between cosmetic treatment and architecture; and synergies between aesthetic treatments for facial rejuvenation. Experts shared opinions on key features of each product supporting their use in the layered approach to whole-face treatment and reviewed specific products and techniques used in the treatment plan.

RESULTS

The Aging Process

Panelists agreed that facial aging does not occur homogenously but differs based on individual characteristics and anatomic layers. Facial age-related changes result from a multifactorial process that involves each anatomic layer (Fig. 1), including reduction of structural support from bones, displacement of ligament positioning, alteration of muscle tone and dynamic discordance, volume loss, soft-tissue descent, and skin quality reduction. Panelists also agreed that anatomic layers of the face are interconnected and interdependent, such that age-related changes in deep layers affect all other, more superficial layers.

Fig. 1.

Fig. 1.

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Cross-sectional anatomy demonstrating facial layers.

Beauty Is Architecture

Restructuring an aging face from deep to superficial layers is like building a house, which relies on a strong foundation to support subsequent construction of framing, walls, and exterior.2 All panelists agreed that when treatment starts from the foundation to the surface, restructuring “respects the original anatomy of the face,” providing “more rational use of the injectable treatments.”2 Injectable treatments targeting deep layers are warranted because correction that does not address the root cause may not achieve sustained satisfactory results.2 Moreover, it was agreed that a layered approach to treatment with CPM-HA, CaHA-CMC, MFU-V, and incoBoNT-A promotes a synergistic effect.

Key Features of Aesthetic Treatments

Panelists agreed that these aesthetic treatments, while effective individually, can be used in combination to exponentially improve treatment outcomes and patient satisfaction.

Cohesive Polydensified Matrix Hyaluronic Acid

Clinical performance of injectable products for soft-tissue augmentation is influenced by the product’s rheologic properties, which describe deformation of the product material by force application.36,37 Panelists discussed the complexity of translating laboratory rheologic measures to clinical performance of injectable HA products and the importance of demystifying this relationship to empower patients and providers to make informed treatment decisions. Panelists, therefore, agreed on the keywords to describe the clinical rheologic characteristics, specifying the clinical performance of products related to their rheologic properties in the CPM-HA collection and the consequent rationale for their use in the layered approach

Calcium Hydroxylapatite in Carboxymethylcellulose

Panelists agreed that key features supporting the use of CaHA-CMC in the layered treatment plan are (1) rheologic properties (ie, high complex viscosity and elastic modulus at undiluted concentrations, which may be reduced with dilution to increase tissue spread and stimulate collagen regeneration without added volume); (2) regenerative effects and mechanism of action (ie, fibroblast cell migration and proliferation, collagen and elastin synthesis, and angiogenesis resulting from direct fibroblast activation); and (3) favorable inflammatory profile compared with those of other biostimulators (Table 1).14,16,17,20,38–40

Table 1.

Clinical Rheologic Characteristics for Select CPM-HA Products

Product HA Concentration, mg/mL 12,13 Clinical Rheology Descriptors
CPM-HA R 20.0 with glycerol* Internal hydration and glow, injectable humectant
CPM-HA S 20.0 Refinement and airbrushing
CPM-HA B 22.5 Delicate volumization
CPM-HA I 25.5 Support, structure, dynamic, definition, precision
CPM-HA V 26.0 Shaping, contouring, and blending or transitioning between zones
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*

17.5 mg/mL glycerol.

Microfocused Ultrasound With Visualization

Visualization is a unique feature of MFU-V that enhances efficacy and safety by enabling precise and accurate energy delivery.41 The See, Plan, Treat (SPT) protocol takes advantage of this feature and allows providers to customize MFU-V application based on patient characteristics (eg, body mass index, skin thickness), facial anatomy (eg, depth of the dermis, SMAS), and the aging process (eg, degree of volume loss). The SPT protocol guides physicians on choosing the ideal transducer depth to precisely target the desired facial layer, which may vary in position among patients.42 Panelists agreed that SPT is critical for using MFU-V in the layered treatment plan, although guidelines recommend using MFU-V before injectable therapies.43 It was further agreed that application of SPT can be shaped by the goal of MFU-V application (prevention, treatment, or maintenance), facial thickness (thick, regular, or thin), and target layer, to determine the best approach using the visualization (dermis, retinacula cutis, or SMAS/platysma), customizing according to individual anatomy.

IncobotulinumtoxinA

Panelists agreed that the key features supporting use of incoBoNT-A in the layered treatment plan are its purity (designed to contain only the active core neurotoxin, reducing immunogenicity), efficacy, precision (targeted injection because of its action halo), and eco-friendliness (room-temperature storage, no cold-chain shipping, and low carbon footprint of packaging materials).33–35,44–48 Panelists agreed on the utility of incoBoNT-A for treatment of dynamic wrinkles, rebalancing mimetic facial muscles, treatment of dynamic discordance, skin quality improvement, and SMAS modulation49; 4 of 5 panelists agreed on the utility of incoBoNT-A for static wrinkle prevention.

The Layering Approach

De Sanctis Pecora2 previously showed that layered treatment with CPM-HA, CaHA-CMC, MFU-V, and incoBoNT-A led to aesthetic improvements in all treated patients (N = 5; median age, 43 y). All patients received ratings of improved or much improved on the Global Aesthetic Improvement Scale as assessed by the main investigator and an independent evaluator 3 months after treatment.2 Additionally, all patients showed improvement of 1 point or more on validated 5-point scales (0 = none, 4 = very severe) assessing skin laxity, wrinkles, and erythema (Scientific Assessment Scale of Skin Quality; day 90); dynamic forehead, glabellar, and lateral periorbital lines (Merz aesthetics scale [MAS] for forehead lines, MAS for glabellar lines, and MAS for lateral periorbital lines; day 30); upper and lower cheek fullness (MAS for upper cheek fullness and MAS for lower cheek fullness; day 90); and jawline (Merz jawline assessment scale; day 90).2,50–56 Panelists expanded on this work to establish expert recommendations for a systematized layered approach to whole-face treatment (Table 1).

Bone and Retaining Ligaments (Foundation and Support)

Panelists agreed that facial skeleton resorption generates periosteum retrusion and displaces facial ligaments and muscles, leading to loss of the mechanical advantage of these structures. Thus, panelists agreed that the layered treatment plan should begin with injection (supraperiosteal unless otherwise noted) of (1) CPM-HA I, CPM-HA V, or CPM-HA B as retrograde threads with a cannula into the forehead; (2) CPM-HA I or CPM-HA V with a needle onto the temple; (3) CPM-HA I or CPM-HA B as retrograde microboli or threads with a cannula onto the supraorbital rim; (4) CPM-HA I or CPM-HA B as microboli with a cannula onto the infraorbital rim; (5) CPM-HA I or undiluted CaHA (+)–CMC as microboli with a needle or cannula to the zygomatic arch; (6) CPM-HA I, CPM-HA V, or undiluted CaHA (+)–CMC with a needle or cannula onto the piriform fossa area; (7) undiluted CaHA (+)–CMC or CPM-HA I as microboli or boli with a needle onto the mandibular angle; and (8) CPM-HA I, CPM-HA V, or undiluted CaHA (+)–CMC as microboli or boli with a needle to the chin in 2 steps to allow time for initial results (Fig. 2). CPM-HA I, CPM-HA V, or CPM-HA B was recommended based on the clinical rheologic characteristics of each product. Panelists preferred CPM-HA I for “support and structure” and identified it as having the most prominent “clinical lift or projection” of the CPM-HA collection. In addition, panelists described CPM-HA V as the ideal product for moderate lifting and highlighted its ability to be manually shaped by the injector once administered. Finally, panelists identified CPM-HA B as the ideal choice for “delicate volumization” because of its mild lifting and volumizing effects. Furthermore, product choice depends on collagen production capacity—for example, older patients who may not demonstrate optimal collagen regeneration after CaHA (+)–CMC may benefit more from CPM-HA I. Experts agreed that failure to address changes in the skeletal foundation may limit the benefit of any facial rejuvenation procedure.

Fig. 2.

Fig. 2.

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Approach for targeting bones and retaining ligaments. aThe choice of product depends on patient need.

Muscles, Ligaments, and SMAS (Structure and Framing)

Panelists agreed that MFU-V, followed by incoBoNT-A, should be used next for tissue repositioning, lifting, and contouring (Fig. 3).57 The muscles targeted with incoBoNT-A in this step include the platysma, frontalis, and orbicularis oculi.49,58,59 BoNT-As can provide targeted relaxation of these and small mimetic depressor muscles (depressor anguli oris, corrugator supercilii, depressor supercilii, and procerus) to correct the downward muscle pull associated with aging, thereby rebalancing the muscles underlying facial expressions and enhancing facial appearance.49,59–62 If MFU-V and incoBoNT-A are administered in the same session, MFU-V should be performed first.63 Panelists noted that patients with substantial sagging due to bone loss and/or skin laxity may be treated with multiple sessions of MFU-V before receiving incoBoNT-A.64 Panelists recommended using the SPT protocol for MFU-V based on individual patient characteristics and needs, always treating at 2 or more distinct depths.63,65 Panelists also agreed that incoBoNT-A can be injected into the masseter and temporalis for contouring.66–71 One panelist noted that they do not inject into the temporalis for aesthetic applications.

Fig. 3.

Fig. 3.

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Approach for targeting muscles, ligaments, and SMAS with (A) MFU-V and (B) incoBoNT-A.

Fat Pads (Walls)

Facial fat compartments are characterized as superficial or deep relative to the SMAS.3 In general, deep fat atrophies and superficial fat tends to hypertrophy or reposition; however, superficial fat atrophy has been observed in the forehead, periorbital region, and perioral region.3 During aging, fat pad repositioning occurs due to changes in bone structure and displacement of ligaments.1,3 To restore fat compartment volume as part of the layered treatment plan, panelists agreed that deep fat pads should be targeted first, followed by superficial ones. Providers should assess results from the first step (bones and retaining ligaments) before determining whether to volumize deep fat pads. For example, support of zygomatic retaining ligaments and zygomaticus major can give a secondary improvement to the deep medial fat pad.3 To avoid an overfilled appearance, it is important to assess the patient dynamically in full animation and take a conservative approach.72 Similarly, volumization of the deep fat pads can reposition the retaining ligaments, thus interfering positively in superficial layers.2

If volumization of deep fat pads is needed, panelists recommended deep subcutaneous injection of (1) CPM-HA V from a lateral approach and fanning or microboli retrograde injection techniques with a cannula into the deep medial fat pad and (2) CPM-HA I or CPM-HA V as microboli with a needle or cannula for the chin (Fig. 4A). The panelists’ agreement on the clinical rheologic characteristics of CPM-HA V (shaping, contouring, volumizing, and blending or transitioning between zones) and of CPM-HA I (support, structure, dynamic, definition, precision; Table 1) informed their recommendation in this step. For volumization of superficial fat pads, the panelists recommended subdermal injection of (1) CPM-HA V (for patients with moderate need) or CPM-HA B (for patients with thin skin) using fanning or microboli retrograde injection techniques with a cannula into the temple; (2) CPM-HA I or CPM-HA V as retrograde vertical threads with a cannula into the preauricular area; (3) CPM-HA I, CPM-HA V, or undiluted CaHA (+)–CMC as retrograde threads with a cannula into the jawline; and (4) CPM-HA B, CPM-HA V, or CPM-HA I as retrograde threads with a cannula or blanching for CPM-HA B or CPM-HA S into nasolabial folds (Fig. 4B).

Fig. 4.

Fig. 4.

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Approach for targeting (A) deep and (B) superficial fat pads. aPanelists recommended CPM-HA V for patients with moderate need and CPM-HA B for patients with thin skin.

Dermis and Scaffold (Exterior)

Regeneration of the ECM can be achieved with injection of undiluted, diluted, or hyperdiluted CaHA-CMC. Undiluted concentrations provide correction of facial wrinkles, folds, laxity, stretching, and loss of jawline contour, whereas a 1:1 dilution is optimal for collagen regeneration.17–23,73 Panelists recommended the following approach to address superficial wrinkling, folds, and laxity (Fig. 5A): (1) subdermal cannula injection of undiluted CaHA (+)–CMC using 2–3 parallel, vertical retrograde threads fanning across the cheek into the preauricular area behind the line of ligaments if skin thickness allows; (2) subdermal cannula injection of undiluted CaHA (+)–CMC for laxity using 2 horizontal retrograde threads into the jawline following the mandibular contour; and (3) blanching with CPM-HA B or CPM-HA S for upper facial, lateral periorbital, marionette, and upper lip lines.

Fig. 5.

Fig. 5.

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Approach for targeting the dermis. aIf skin thickness allows; bThe One21 technique enables individualized treatment based on patient anatomy.60,61

Repeated contractions of the underlying muscles, combined with epidermal and dermal atrophy due to age-related ECM degradation, also contribute to development of wrinkles.4–9 Thus, panelists next recommended intramuscular injection of incoBoNT-A for whole-face treatment of dynamic wrinkles on the basis of individual assessment and patient needs (Fig. 5B). Treatment should target the underlying mimetic muscles producing the wrinkles.9,60,61 For example, the One21 technique for individualized treatment based on patient anatomy should be used for the forehead and glabellar lines.60,61 For forehead lines, an assessment grid with 21 potential injection sites is determined by (1) anatomically defined components: 2 lines across the mid-pupillary line, 5 lines based on inner and outer canthus, and the medial facial line and (2) functionally defined components: inferior limit line (lowest frown line), upper line (upmost frown line), and intermediate line.60 For glabellar wrinkles, the individualized assessment and resulting treatment scheme are based on anatomical references of contraction: because wrinkles are formed perpendicular to the underlying muscle fibers, each wrinkle demonstrates which muscle is contracting and should be treated.61 Dosage and injection points must be determined by visual assessment of the number and pattern of wrinkles as well as muscle strength.60,61 The current and previously described steps of the layered approach to whole-face treatment were hypothesized to restore balance among facial structures and improve the dynamic discordance of aging, which all panelists agreed is essential to achieve more natural-looking results.2

Skin Quality (Décor)

The final step aims to improve skin quality; panelists recommended (1) MFU-V with the 10-MHz frequency, 1.5-mm-depth transducer for increased collagen content in the dermis24,27,41; (2) diluted or hyperdiluted (1:1, 1:2, 1:3, or 1:4) CaHA-CMC injected in multiple fine subdermal retrograde threads or fanning with a cannula for regenerative biostimulation of the dermis8,19,20,74,75 and immediate subdermal injection (multipuncture with a needle or retrograde fanning with a cannula) of CPM-HA R for hydration and glow11,76; and (3) intradermal injection of diluted incoBoNT-A (eg, 5 mL of saline per 100 U of incoBoNT-A77) for improvement of skin tone (eg, erythema reduction) and skin surface evenness (eg, pore size reduction11,77; Fig. 6). Because greater immune responses have been observed after intradermal versus intramuscular delivery of biologics, owing to the prominence of dendritic cells in the dermis, a highly purified BoNT-A containing only the active neurotoxin, such as incoBoNT-A, is well suited for this purpose.77–79

Fig. 6.

Fig. 6.

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Approach for targeting skin quality with (A) MFU-V and (B) diluted or hyperdiluted CaHA-CMC or CPM-HA R and/or incoBoNT-A.

By planning a treatment starting from the foundation to the surface, based on the etiology and progression of facial aging, the layered restructuring presented herein respects the original anatomy of the face, with restoration of the balance among the structures and its functionality, providing not only more rational use of the injectable treatments, but also a more natural outcome. (See table, Supplemental Digital Content 1, which displays recommended treatment combinations per facial layer, https://links.lww.com/PRSGO/E102.) (See table, Supplemental Digital Content 2, which displays 39-year-old patient before treatment, with an accentuation of the nasojugal, mid cheek and palpebromalar groove, and the visualization of the attachment of the zygomaticus cutaneous and retaining ligaments, https://links.lww.com/PRSGO/E103.) (See table, Supplemental Digital Content 3, which displays [A, D, G, and J] before-treatment pictures; [B, E, H, and K] 1 month after incoBoNT-A injection; and [C, F, I, and L] 3 months after treatment. All pictures are in maximum contraction, https://links.lww.com/PRSGO/E104.) (See table, Supplemental Digital Content 4, which displays [A, D, G, and J] before-treatment pictures; [B, E, H, and K] 1 month after—all treatments were performed on the same day; and [C, F, I, and L] 3 months after treatment, https://links.lww.com/PRSGO/E105.) (See table, Supplemental Digital Content 5, which displays Vectra system documentation showing the displacement of the arrows, directed lateral and upwards, demonstrating a lifting effect 1 month after treatment, https://links.lww.com/PRSGO/E106.) (See table, Supplemental Digital Content 6, which displays the patient’s full treatment scheme, which includes MFU-V, fillers, biostimulation, and incobotulinumtoxin injection, addressing all changes in different layers, https://links.lww.com/PRSGO/E107.) All treatments were performed in the same session, starting with MFU-V, and following the sequence proposed herein from deep layers to the most superficial ones.

Final Considerations

Panelists agreed that a careful manual and visual assessment of all layers, in both static and dynamic states, is key to achieving a harmonious rejuvenating outcome. Additionally, panelists universally agreed that CPM-HA, CaHA-CMC, MFU-V, and incoBoNT-A present a complete range of products with unique characteristics necessary to meet the needs of a layered therapeutic approach.

CONCLUSIONS

Supported by a large body of clinical literature, CPM-HA, CaHA-CMC, MFU-V, and incoBoNT-A are considered by the expert panel of aesthetic physicians to be ideal for individualized combination treatment to obtain a synergistic effect. Panelists agreed that when used in combination, these products can exponentially improve patient outcomes and satisfaction. Facial layers are interconnected and interdependent; changes in 1 layer can affect all others. A systematized, layered, whole-face combination treatment plan allows for highly individualized rejuvenation from foundation to surface, accounting for interpatient and interlayer variation in facial aging.

DISCLOSURES

Dr. de Sanctis Pecora has received compensation for speaking engagements, travel, and advisory boards from Merz Aesthetics. Dr. Corduff has received compensation for speaking engagements, travel, and advisory boards from Merz Aesthetics. Dr. Carroll has received compensation for consulting, speaking engagements, educational presentations, and/or travel from AbbVie, Avari Medical, Galderma, Merz Aesthetics, Prollenium Medical Technologies, and Sciton. Dr. Muniz has received compensation for consulting and participation in data safety monitoring or advisory boards from Merz Aesthetics. Dr. Sattler has received compensation for speaking engagements, educational presentations, consulting, advisory boards, travel, and conducting scientific studies from AbbVie/Allergan Aesthetics, Crown Aesthetics, Evolus, Galderma, Hallura, ICA Navigation Systems, and Merz Aesthetics. Dr. Sattler has shares in ICA Navigation Systems. Funding for this work was provided by Merz Aesthetics.

ACKNOWLEDGMENTS

Writing and editorial assistance was provided under the direction of the authors by Rachel Haake, PhD, of MedThink SciCom and funded by Merz Aesthetics.

Supplementary Material

gox-13-e6873-s001.pdf (89.2KB, pdf)
gox-13-e6873-s002.pdf (1.9MB, pdf)
gox-13-e6873-s003.pdf (2.7MB, pdf)
gox-13-e6873-s004.pdf (1.3MB, pdf)
gox-13-e6873-s005.pdf (3.2MB, pdf)

Footnotes

Published online 16 June 2025.

Disclosure statements are at the end of this article, following the correspondence information.

Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com.

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gox-13-e6873-s002.pdf (1.9MB, pdf)
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