Vectorial Facial Sculpting: A Novel Sub-SMAS Filler Injection Technique to Reverse the Impact of the Attenuated Retaining Ligaments.

Background Age-related attenuation of the orbital, zygomatic, and masseteric ligaments contribute to temporal brow ptosis, deepening nasolabial fold, and jowl, respectively. Aims To present and assess the vectorial facial sculpting (VFS) technique, a novel nonsurgical panfacial rejuvenation method which focuses on reversal of the impact of attenuated ligaments on the aging face. Methods This case series included women who underwent vectorial facial sculpting at a private clinic from June 2018 to January 2019. Sagging tissues in the lateral brow, nasolabial fold, and jowl were repositioned in a directed manner with vectors whose cross-product counteracted the vector of the respective causative attenuated ligament. Filler material was deposited into the supraperiosteal/sub-SMAS plane in right angle vectors at the lateral supra-orbital rim for brow ptosis, pre-auricular and malar region for nasolabial fold and across the jawline region for jowl. Standardized photographs were taken before and at 3 months following treatment. Outcome was assessed by both the patients and an independent investigator using a validated Global Aesthetic Improvement Scale. Adverse outcomes were documented. Results Forty-five patients of mean age 59.8 +/- 3.9 years were included. Mean Global Aesthetic Improvement Scale scores for patients and an independent investigator alike at 3 months following treatment indicated "very much improved" (1.44 +/- 0.66 and 1.56 +/- 0.78, respectively). The procedure was well tolerated with no adverse events. Conclusion Vectorial facial sculpting is a comprehensive anatomical approach for nonsurgical directional tissue mobilization. Based on physical and mathematical rules to reverse the respective causative attenuated ligament, the technique effectively and safely restores youthful facial contours.