ABSTRACT Background Hyaluronic acid (HA) dermal fillers are widely used to correct age‐related midface volume deficits and improve self‐perceived attractiveness. TEOSYAL RHA 4 (also FDA‐approved as RHA Dynamic Volume) (RHA4) is a high‐strength, moderate‐stretch HA volumizing injectable designed to maintain facial dynamics. Objectives To evaluate the effectiveness and safety of RHA4 versus an active comparator (Juvéderm Voluma XC) for correction of midface volume deficits (MVD). Methods In this controlled, randomized (3:1), blinded live‐evaluator, multicenter prospective clinical study, the primary outcome was the change from baseline in Teoxane Midface Volume Deficit Scale (TMVDS) score, while the co‐primary endpoint was the proportion of responders with ≥ 1‐grade improvement on the TMVDS at 8 weeks post‐treatment. Results Overall, 201 subjects were enrolled (152 RHA4; 49 comparator); 74.6% received multilayer injections in deep and superficial midface fat pads. Mean TMVDS change at 8 weeks was −1.3 ± 0.8 with RHA4 and −1.3 ± 0.6 with comparator ( p = 0.377; upper 95% CI bound < 0.5, non‐inferiority demonstrated). The proportion of subjects achieving ≥ 1‐grade improvement (responder rate) was 87.0% (RHA4) and 90.5% (comparator) ( p = 0.786); the co‐primary endpoint was met (comparator responder rate > 70%). TMVDS responder rate following RHA4 treatment remained above 65.6% for 52 weeks, while subject‐assessed aesthetic improvement and satisfaction remained above 81.3% and 82.8%, respectively. RHA4 exhibited a good safety profile similar to the comparator. Conclusions RHA4 was shown to be as effective as the active comparator for correction of MVD, providing sustained aesthetic outcomes, high satisfaction, and good tolerability.
Background Facial aesthetic medicine has traditionally emphasized proportion, symmetry, and structural harmony based on anatomic and cultural ideals. However, rigid adherence to these principles may contribute to overcorrected, unnatural outcomes, challenging perceptions of authenticity. Although patients frequently request to "look natural," this concept remains poorly defined and is not systematically addressed in training.Objective To distinguish beauty, attractiveness, and naturalness and to propose neuroaesthetics as a framework for improving patient-centered outcomes in aesthetic medicine.Methods Narrative synthesis of interdisciplinary literature integrating neuroscience, evolutionary psychology, and aesthetic medicine, with a focus on neural mechanisms underlying attractiveness, reward processing, and social perception.Results Perceptions of attractiveness and naturalness are mediated by neural systems involved in reward valuation, rapid first-impression formation, and embodied simulation. Overreliance on static structural ideals may overlook dynamic cues critical to social and emotional evaluation. Neuroaesthetic principles provide a biologically informed framework for aligning aesthetic interventions with perceptual and psychosocial responses.Conclusions Incorporating neuroaesthetics represents a shift from structural optimization toward outcomes that prioritize authenticity, emotional resonance, and social perception. As patient expectations evolve, aesthetic providers should integrate these principles to achieve more natural and meaningful results.
Background:Minimally invasive, pan-facial aesthetic treatments rejuvenate and improve facial appearance and may impact social interactions and perceptions. Objectives:This observational pilot study used video recordings and in-person evaluations to assess social perceptions of participants before and after pan-facial treatment. Methods:Adults receiving pan-facial injectable treatments (ie, onabotulinumtoxinA [Botox Cosmetic, Allergan Aesthetics, Westport, Ireland], hyaluronic acid fillers [Juvéderm; Allergan Aesthetics, Irvine, California], or both) were invited to participate. Three measures were developed to assess perceptions of attractiveness, approachability, naturalness, trustworthiness, healthiness, and age from nonclinical observer, patient participant, and clinician perspectives: the Pan-Facial Treatment Outcome Survey, the Participant Perception of Appearance, and the Clinician Perception of Appearance. Results:Twenty-seven participants received treatment and provided video recordings, with 16 videos (n = 8 participants) selected for the study; 298 individuals enrolled as nonclinical observers. Compared with baseline assessments, nonclinical observer-reported posttreatment scores were significantly higher for perceptions of attractiveness, approachability, naturalness, healthiness, and perceived age (all P values < .05). Posttreatment participant- and clinician-reported scores were significantly higher for the same domains as well as trustworthiness (all P values < .05). Compared with baseline, participants and the clinician perceived participants as younger compared to their actual age (3.6 years younger and 2.5 years younger, respectively), and nonclinical observers perceived participants as within 6 months of their actual age after pan-facial treatment. Conclusions:Pan-facial treatments may positively impact social perceptions and self-assessments of facial appearance. These benefits extend beyond physical appearance, including improving overall social interactions and personal well-being. Level of Evidence 5 Therapeutic:For image description, please refer to the figure legend and surrounding text.
Regenerative medicine aims to restore the structure and function for improved tissue health; reduced tissue health can arise from causes such as aging, which results in the ongoing degradation of the extracellular matrix (ECM) of the skin. Replacement of a single biological component is not sufficient for an esthetic treatment to be described as regenerative; it is the relative amounts, ratios, types and organization of stimulated components that are important in a treatment’s regenerative potential. Regenerative aesthetics aims to recapture the youthful structure and function of tissue by exploiting the body’s own systems. Poly-L-lactic acid (PLLA-SCA; Sculptra®), an injectable, biodegradable, non-permanent biostimulator, induces a combination of mechanotransductional/mechanical stimulation and foreign body reaction response and promotes ECM remodeling via the production of collagen through the upregulation of cytokines interleukin-1b and CXCL6, elastin, proteoglycans and multiadhesive glycoproteins. In addition, PLLA-SCA stimulates adipocyte rejuvenation/adipogenesis and increases the thickness of the dermis and adipose layers. Hence, PLLA-SCA stimulates endogenous pathways, and the array of biostimulatory effects should not be considered individually but as interlinked with the overall goal of improvement in skin health. These effects manifest clinically as long-term improvements in the mechanical properties of the skin, the restoration of volume and elasticity, improvements in skin quality and thickness, and dermal remodeling.
