Resumo

Objectives: Bone and Fat Pad Restoration Using CMC Combined with HA Innovative Approaches in Facial Rejuvenation Introduction: The aging process affects facial structure at multiple levels including skin, fat, and bone, necessitating effective restoration techniques. Current strategies predominantly focus on skin and fat replacement using CMC and HA fillers. However, this publication introduces a novel concept of "bone projection," addressing the structural impact of bone loss on facial aging. By respecting natural anatomical fat pads and supporting collapsed anatomical structures, our approach evaluates MRI data on facial skeletal aging to target key areas such as the chin, zygomatic arch, jawline, temples. Materials / method: From May 2022 to February 2024, a study involving 21 cases employed a new modeling technique using deep CMC injections aimed at restoring age-related bone atrophy. Material placement at the periosteum's edge marked the bone restoration boundary. Following this, HA fillers of high viscosity were strategically injected using specialized cannulas or needles to replace volume loss. Each case received a maximum volume of 6-8 ml per session, with HA containing Lidocaine to minimize discomfort. Results: The advantage of using cross-linked CMC, unlike HA, is its reduced propensity for edema, facilitating precise evaluation of bone restoration. Sequential injections addressed fat pad losses, utilizing high-viscosity HA for deep compartments and lower density formulations for subdermal layers. Minimal pain was reported during injections, with no adverse reactions noted post-procedure. Follow-up evaluations at 2, 7, and 10 days revealed stable outcomes without the need for painkillers, antibiotics, or topical treatments. Conclusion: CMC cross-linked filler demonstrates efficacy in bone restoration alongside HA for addressing higher-level fat pad losses, with no observed interactions or complications. Safe practices, including meticulous anatomical considerations during injections, contribute to enhanced outcomes in bone volume restoration from skin to underlying structures. Plans for managing potential vascular embolism risks involving immediate dissolution strategies for both CMC and HA further ensure procedural safety.