Cosmetic Medicine

Aesthetic Surgery Journal

2021, Vol 41(9) 1068–1076
Nonsurgical Redefinition of the Chin and © The Author(s) 2020. Published
by Oxford University Press on behalf
Jawline of Younger Adults With a Hyaluronic of The Aesthetic Society. All rights re-
served. For permissions, please e-mail:
Acid Filler: Results Evaluated With a Grid journals.permissions@oup.com
DOI: 10.1093/asj/sjaa179
www.aestheticsurgeryjournal.com
System Approach

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Dario Bertossi, MD; Massimo Robiony, MD; Andrea Lazzarotto, MD;
Giorgio Giampaoli, MD; Riccardo Nocini, MD ; and
Pier Francesco Nocini, MD

Abstract
Background: Aesthetic treatment of the lower face is increasingly in demand, particularly owing to age-related changes
in appearance. VYC-25L is a novel hyaluronic acid filler with high G′ and high cohesivity, specifically designed for sculpting
and contouring of the chin and jaw.
Objectives: The aim of this study was to assess the use of a grid traced onto the chin and jaw for guiding treatment with
VYC-25L.
Methods: This was a retrospective, single-center analysis of data from adult patients undergoing treatment of the lower
third of the face with VYC-25L. A grid system of horizontal and vertical lines was used to systematize the process of treat-
ment planning and performance.
Results: Thirty subjects were enrolled (53.3% female; mean [standard deviation] age, 34.4 [2.8] years). The mean quantity
of VYC-25L used was 4.0 [0.8] mL. Based on the 5-point Global Aesthetic Improvement Scale, 29 patients (96.7%) rated
their appearance at 20 days posttreatment as “much improved” or “very much improved.” The only complications re-
corded were early transient soft-tissue edema (n = 14; 46.7%) and bruising (n = 6; 20.0%). There were no cases of infection,
paresthesia, asymmetry, hematoma, necrosis, or skin discoloration.
Conclusions: Treatment of the chin and jawline with VYC-25L, with injection locations determined by a standardized
grid-based approach, appears to be effective and safe with high rates of patient satisfaction. Injection of this filler offers a
potentially high-impact approach for patients across a variety of biological and economic circumstances.

Level of Evidence: 4

Editorial Decision date: June 16, 2020; online publish-ahead-of-print June 27, 2020.

clinic and maxillofacial surgery department, Department of Oral

Dr Bertossi is an associate professor and head of the maxillofacial and Maxillofacial Surgery, University of Verona, Policlinico G.B.
plastic surgery unit, Dr Giampaoli is a resident in maxillofacial Rossi, Verona, Italy.
surgery, and Dr R. Nocini is a resident in otolaryngology, Department
of Oral and Maxillofacial Surgery, University of Verona, Policlinico Corresponding Author:
G.B. Rossi, Verona, Italy. Dr Robiony is head of the maxillofacial Dr Dario Bertossi, Department of Oral and Maxillofacial Surgery,
department and Dr Lazzarotto is a resident in maxillofacial surgery, University of Verona, Policlinico G.B. Rossi, Piazzale L. Scuro 10,
Department of Maxillofacial Surgery, University of Udine, Academic 37134, Verona, Italy.
Hospital of Udine, Udine, Italy. Dr P.F. Nocini is head of the dental E-mail: pierfrancesco.nocini@univr.it; Instagram: @prof.dariobertossi
Bertossi et al 1069

The jawline is defined by a curvilinear shadow from the trial in patients with chin retrusion, VYC-25L improved
mandibular angle to the anterior chin. In oblique view, the glabella-subnasale-pogonion facial angle and overall pa-
shadow framing the jawline has a “hockey stick” shape tient well-being, with no serious treatment-related adverse
that is typically straight in young adults—a uniform shape events (AEs).22 The aim of the present study was to assess
that runs from the mentum to the angle of the mandible. the use of a chin and jawline grid traced onto patients’ skin
This is usually considered to be an aesthetically pleasing to guide nonsurgical treatment with VYC-25L.
feature in both men and women.1
Assessment of the jawline is complex because there
are many variables to consider, including anatomic fea- METHODS
tures relating to facial type, sex, race, and age-associated
changes. In particular, facial aging leads to lost skin elas-
Study Design
ticity; relaxation of ligaments and displacement from their

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This was a retrospective analysis of data from patients with
original site, causing a prominent labiomandibular sulcus; varying degrees of mandibular hypoplasia undergoing
and jowl deformity and submental laxity, leading to the for- treatment of the lower third of the face with VYC-25L at
mation of a double chin (sagging jawline).2 Simultaneously, a single center between February and April 2019. The
irregularities in jawline definition arise from volume de- study was conducted in accordance with the Declaration
scent of midface fat compartments and mandibular bone of Helsinki. All enrolled patients provided written informed
loss, with soft-tissue ptosis at the jowl resulting in fullness consent.
inferior to the mandibular border.3 Loss of bone and soft- Eligible subjects were adult females or males wishing
tissue volume accentuates the pre-jowl sulcus. to undergo nonsurgical correction of the lower third of
These alterations convert the youthful “hockey the face. Exclusion criteria included chronic corticosteroid
stick” shape of the jawline to an irregular “W” shape.3 therapy, local infection, diabetes, bleeding disorders, his-
Furthermore, a genetically underdeveloped or recessed tory of systemic autoimmune or oncologic conditions, or
chin is also associated with a less aesthetically pleasing psychiatric conditions that could affect treatment. Smokers
facial profile and can contribute to early loss of definition and pregnant women were also ineligible.
of the jawline.
There are several surgical and nonsurgical options
Patient Evaluation and Treatment System
for correcting the jawline, which can address underlying
bone loss and soft-tissue displacement and rejuvenate the The key aspect of diagnosis was clinical examination of
skin.3-5 In patients who do not wish to undergo surgery, the the lower face from the anterior, lateral, and three-quarter
use of hyaluronic acid (HA) fillers is becoming increasingly views, to allow assessment of the facial soft-tissue rela-
popular. Techniques and physiologic concepts have been tions between jawline, chin, and midface. Pretreatment
developed with these products that facilitate the achieve- photographs were taken from frontal, lateral, three-quarter,
ment of outcomes comparable to those achieved with sur- and basal angles.
gery.5,6 For example, the MD Codes recently developed by With regard to the jawline, diagnostic assessments in-
Dr Mauricio de Maio provide a standardized framework of cluded: cervicomental angle (which should be between
treatment subunits and techniques within individual facial 105° and 120°); chin height, width, and projection; man-
areas. In a similar vein, we have used facial grids traced dibular body height and length; gonial angle prominence
onto patients’ faces to demarcate discrete treatment units and measure (which should be around 120° in males and
and standardize our approach.7-9 120°-130° in females); and soft-tissue thickness. Additional
The Vycross portfolio of HA fillers provides a versatile features considered included scarring, previous surgeries,
range of products that can be used across all areas of the parotid gland pathologies and dimensions, submandibular
face. These fillers contain varying concentrations of HA gland protrusion and dimensions, and muscle asymmetries.
to achieve different levels of firmness.10 The safety and Volume loss was assessed anterior and posterior to
efficacy of these treatments have been demonstrated in the jowl. Treatment decisions were made based on in-
a number of studies, with key outcomes including resto- dividual patient anatomy and desired results. Generally,
ration of volume, filling of lines and wrinkles, and hydra- in patients with minimal jowl ptosis (typically younger
tion of the skin.11-21 Results typically last for 9 to 24 months individuals), the addition of pre-jowl volume was used
depending on the product used. for jawline restoration; a more ptotic jowl usually re-
The latest addition to the Vycross portfolio is VYC-25L, quired a greater degree of volumizing to camouflage its
which has the highest G′ (stiffness) and highest cohesivity presence.
in the range, and was designed to allow sculpting and con- Differences in normal anatomy between men and
touring of the chin and jaw area. In a recent randomized women are also a key factor in assessing and treating
1070 Aesthetic Surgery Journal 41(9)

the lower face, and particularly the jawline.23-25 In males, Special attention was always paid to danger areas. In
the mandible is often relatively large with broader particular, the facial nerve and parotid gland are at risk
bigonial width, the gonial region is more squared, and during shaping of the posterior mandibular ramus/angle;
the ramus drops down relatively vertically from the ear they are both deep structures and hence can be avoided
region and turns anteriorly with a mildly pronounced by injecting into the subdermal plane. When injecting in
gonial angle; in females, the jawline typically shows a the peri-jowl region, mandibular ligament area, or mandib-
more gentle curve running from the ear region to the ular body, care was taken to avoid the facial artery. This
chin. Thus, male faces generally exhibit greater angu- should always be identified and protected prior to injec-
larity, whereas female faces show less angularity and tion. After crossing the inferior mandibular border, the fa-
increased “softness” of the jawline. Angularity of the fa- cial artery curves around it, passes in front of the anterior
cial contour lines in women can sometimes diminish per- edge of the masseter muscle, pierces the deep fascia, and
ceived attractiveness. enters the face. At this point, the facial artery (with its ac-

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A grid system of horizontal and vertical lines was used companying vein) lies immediately under the platysma and
to systematize the process of treatment planning and per- crosses the mandibular branch of the facial nerve lying un-
formance. The exact positions of these lines are described derneath. It was avoided by injecting in the subdermal or
in Table 1 and are summarized graphically in Figure 1. Lines subperiosteal plane.
were traced onto individual patients’ faces with skin pen-
cils to allow precise recording of defects and to generate
reproducible injection points that could be precisely quanti-
Assessments
fied. Details of these injection points are provided in Table 2. Assessments of treatment outcome and complications
Points B, M, C, RLM, and LLM were for female patients; points were included in clinical examinations at 3 days, 1 week,
B, M, C, RMLM, and LMLM were for male patients. Other 1 month, and 6 months postinjection. Clinical photographs
points (jowl 1-4 and 5-7) were used to further redefine the were taken prior to treatment and at designated times
jawline. Equivalent MD Codes, as defined in de Maio’s stand- after the procedure.
ardized approach to treatment, are also shown in Table 2. Twenty days posttreatment, patients were asked to
Before finalizing the treatment plan, a full patient his- evaluate their satisfaction with results compared with
tory was taken, with particular focus on previous filler treat- pretreatment according to the 5-point Global Aesthetic
ments. As far as possible, patients were advised to avoid Improvement Scale (GAIS) as very much improved, much
blood-thinning agents for 1 week prior to treatment to re- improved, improved, no change, or worsened.
duce bruising.

Statistical Analyses
Injection Procedures
Descriptive statistics are provided throughout. This in-
Patients were treated in the lower third of the face with the
cludes mean, standard deviation, and range for continuous
high-G′ and high-cohesivity dermal filler VYC-25L (25 mg/
variables, and frequency and percentage for categoric
mL HA; Volux) from the Vycross range (Allergan, Dublin,
variables.
Ireland). Key treatment areas were the chin, labiomental
sulcus, jawline, and marionette lines. Filler quantities
per injection point are provided in Table 2. Broadly, the
chin apex and vertex were injected with 0.5 to 1.5 mL of RESULTS
VYC-25L through a 27G 13-mm cannula (TSK Laboratory,
Tochigi, Japan) deep to the bone, and the labiomental A total of 30 patients were enrolled: 16 females (53.3%) and
sulcus was treated with 0.3 to 0.7 mL of VYC-25L injected 14 males (46.7%). The mean [standard deviation] age was
into the superficial fat compartment with a 25G 5-cm can- 34.4 [2.8] years (range, 20-45 years). Nineteen patients
nula (TSK). The jawline was injected with 0.5 to 1.5 mL of (13 female; 6 male) were aged 20-35 years, and 11 were
VYC-25L, and marionette lines with 0.5 to 1.0 mL of VYC- aged >35 years (3 female; 8 male). None had received pre-
25L, each with a 25G 5-cm cannula into the superficial fat vious aesthetic treatment in the chin or jawline, and none
compartment. A detailed description of the approach to received concurrent treatment in this area of the face with
these areas is provided in Appendix. other therapies apart from fillers.
The lower face was not injected in isolation, and defi- Subjects were injected with a mean volume of VYC-25L
ciencies in the upper and midface were also treated, as of 4.0 [0.8] mL. Example before-and-after images are pro-
required. vided in Figures 2 and 3.
Bertossi et al 1071

Table 1. Chin and Jawline Grid

Frontal view

Vertical lines

1 Vertical line M (midline), through point M (midline interpupillary) to point Sp (subnasal point)

2 Vertical line MC (medial canthal), at the medial palpebral commissure on point Mc

3 Vertical line P (pupillar), running through the pupil midline

4 Vertical line LC (lateral canthal), at the lateral palpebral commissure on point Lc

5 Vertical line T (tragus), at a distance of 1 cm from the lateral palpebral commissure

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6 Vertical line Ocr (right oral commissure)

Horizontal lines (perpendicular to line M)

1 Horizontal line Sn (subnasal point), on the columellar insertion

2 Horizontal line Il (interlabial), on the labial rim

3 Horizontal line b, on the b point (labiomental point)

4 Horizontal line m, on the most protruding point of the chin soft tissue

5 Horizontal line c, on the lowest chin soft tissue point

Side view

Vertical lines

1 Vertical line TVL (true vertical line), passing the subnasale perpendicular to the ground with
patient looking into mirror

2 Vertical line Loc (lateral oral commissure), at the lateral oral commissure

3 Vertical line LC (lateral canthal), at the lateral palpebral commissure on point Lc

4 Vertical line AM (anterior masseter border), on the anterior border of the masseter muscle

5 Vertical line T (tragus), at a distance of 1 cm from the lateral palpebral commissure

Horizontal lines (perpendicular to line M)

1 Horizontal line hSn, on the columellar insertion (subnasal point)

2 Horizontal line hIl (interlabial), on the labial rim

3 Horizontal line hb, on the b point (labiomental point)

4 Horizontal line hm, on the most protruding point of the chin soft tissue

5 Horizontal line hc, on the lowest chin soft tissue point

Patient satisfaction with treatment was high. Based on DISCUSSION

the 5-point GAIS, 29 out of 30 patients (96.7%) rated their
appearance after treatment as “much improved” or “very This analysis demonstrated the safety and patient satis-
much improved” (Table 3). faction resulting from chin and jawline treatment with the
Patients were followed up for a mean of 8 months HA filler VYC-25L administered according to a grid-based
(range, 6-10 months). Complications are listed in Table 4. methodology, in a relatively young cohort of patients with
The only AEs reported were early transient soft-tissue varying degrees of mandibular hypoplasia.
edema (n = 14; 46.7%) and bruising (n = 6; 20.0%). There Jawline sculpting is a particularly demanding form of
were no cases of infection, paresthesia (transient or treatment because it plays such an important role in facial
permanent), asymmetry, hematoma, necrosis, or skin aesthetics.2,3,5,6 The jawline should be well defined, pro-
discoloration. viding distinct separation of the lower face from the neck.
1072 Aesthetic Surgery Journal 41(9)

A B

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C

Figure 1. Illustration of the chin and jawline grid. (A) A frontal view of a 33-year-old female, and side views of (B) a 36-year-old
male and (C) a 33-year-old female.

Table 2. Injection Points

Point MD codea Filler quantity, mL per side Notes

B C1 0.7 Labiomental area, injection in superficial fat compartment, not a danger

area

M C2 0.3 Most protruding chin soft tissue, deep on bone, not a danger area

C C4 0.2 Lowest chin soft tissue, deep on bone, not a danger area

RLM / LLM C3 0.2 Most protruding chin soft tissue, at the intersection of MC line with hm
line, deep on bone, danger area, for female patients

RMLM / LMLM C3 0.2 Most protruding chin soft tissue, at the intersection of Loc line with hm
line, deep on bone, danger area, for male patients

Jowl 1-2 M1-2-3 0.5 1 lateral, and 2 medial to Loc line between Il line and hm line

Jowl 3-4 Jw4-5 0.5 3 below hm line lateral to Loc line, and 4 the most anterior point of the
jawline, 1 cm in front of the oral commissure

5 Jw3 0.3 Mandibular line in front of LC line, superficial fat compartment, cannula,
danger area (facial artery)

6 Jw1 0.5 Mandibular angle, below Il line behind LC line, superficial fat compartment
(over SMAS), cannula, not a danger area

7 Jw2 0.5 Pretragal and upper gonial angle area, superficial fat compartment (over
the SMAS), cannula, danger area

aMD codes: C, chin; Jw, jawline; M, marionette lines. Il, interlabial; Loc, lateral oral commissure; LC, lateral canthal; MC, medial canthal; SMAS, superficial muscular
aponeurotic system. See Table 1 for definition of hm line.
Bertossi et al 1073

A B A B

C D C D

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E F E F

Figure 2. Nonsurgical redefinition of the chin and jawline Figure 3. Nonsurgical redefinition of the chin and jawline
with VYC-25L based on a grid system approach. (A, C, E) with VYC-25L based on a grid system approach. (A, C, E)
A 33-year-old female before and (B, D, F) 38 weeks after A 41-year-old female before and (B, D, F) and 24 weeks after
treatment with 8 mL of VYC-25L in the lower face. treatment with 6 mL of VYC-25L in the lower face.

This region may be relatively unattractive in the absence sulcus may be accentuated by increased fullness and de-
of clear demarcation—whether due to skeletal factors (eg, scent of the jowl.
increased gonial angle, reduced mandibular body length, Fillers provide a valuable nonsurgical option for correc-
atrophy, or under- or overdevelopment of the mandible) or tion of the jawline. However, compared with other areas of
soft-tissue factors (eg, increased cervical facial adiposity, the face, there have been relatively few published studies
or redundant lower facial soft tissue). focusing on treatment of the jaw and chin with fillers.
Treatment of the jawline is increasingly in demand, The semipermanent filler calcium hydroxylapatite has
owing to changes that occur with advancing age.3,5 For ex- been studied in jawline treatment and results have been
ample, volume loss in the labiomandibular fold can mani- positive.26,27 In a recent study, use of this treatment in the
fest as a shadow anterior to the jowl from oral commissure jaw was associated with significant restoration of volume;
to jawline. Furthermore, the pre-jowl sulcus may become however, patients reported only “moderate” aesthetic im-
increasingly visible as volume loss progresses at the infe- provements.27 Furthermore, these treatments cannot be
rior portion of the mandible anterior to the jowl. Cephalic removed if positioned in the wrong area.
retraction in the pre-jowl sulcus is due to fixation of the skin In our experience, HA fillers are a better option, not
to the underlying resorbing bone via the mandibular liga- least because they can be removed with hyaluronidase
ment. Shadowing in the labiomandibular fold and pre-jowl if the patient is dissatisfied with the result or if there are
1074 Aesthetic Surgery Journal 41(9)

Table 3. Patient Satisfaction at Day 20 Posttreatment Table 4. Complications

Patient GAIS rating Patients, n (%) Complication Patients, n (%)

Very much improved 26 (86.7) Transient (24-hour) soft-tissue edema 14 (46.7)

Much improved 3 (10.0) Bruising 6 (20.0)

Improved 1 (3.3) Infection 0 (0.0)

No change 0 (0) Paresthesia 0 (0.0)

Worsened 0 (0) Asymmetry 0 (0.0)

N = 30. GAIS, Global Aesthetic Improvement Scale. Hematoma 0 (0.0)

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Necrosis 0 (0.0)

Skin discoloration 0 (0.0)

N = 30.

complications.28 Furthermore, HA acts like a rejuvenating minor bruising (20.0%). Nonetheless, even with a standard-
agent because it integrates itself into the extracellular ma- ized approach, good injection technique remains essential
trix; biopsies taken at 6 months post-HA injection have to prevent complications. In particular, the risk of intravas-
confirmed that HA can reorganize and integrate into the cular injection can be minimized by remaining in the super-
extracellular matrix, giving greater compactness and firm- ficial (subdermal) or deep (periosteal) planes. Alternatively,
ness to the tissue.29 the use of blunt-tipped cannulas of various sizes and
HA products with high G′ and high cohesivity may be small boluses per injection can be applied to reduce AEs.
particularly well suited to use in the jawline. VYC-25L Furthermore, aspiration prior to injection may help to mini-
contains an HA concentration 25 mg/mL and was specif- mize the risk of intravascular injection31 and should be con-
ically designed for sculpting and contouring of the chin sidered, particularly in high-risk injection areas.28
and jaw. In a randomized trial of 119 patients with chin We should acknowledge the limitations of the present
retrusion, injection of VYC-25L in the chin and pre-jowl work, in particular its retrospective, single-center design.
area improved the glabella-subnasale-pogonion facial Further prospective, multicenter, randomized trials of
angle and was associated with high rates of investigator- VYC-25L treatment in the lower face, in addition to that
and patient-assessed aesthetic improvement and overall of Ogilvie et al,22 would of course be valuable—particu-
patient satisfaction.22 Treatment benefits remained ap- larly if they incorporate longer follow-up than the present
parent at study completion at 18 months.30 Given the analysis (6-10 months). Nonetheless, our study is the first
long-lasting effects of VYC-20,13,14 which has similar phys- demonstration of the efficacy and safety of VYC-25L in a
ical properties to VYC-25L, it is reasonable to expect that “real-world” clinical setting, with the added innovation of
the effects of VYC-25L should last for at least 24 months. the novel grid system used. In addition, the Ogilvie et al
The present analysis lends support to the data from the study only injected the chin and pre-jowl area, and hence
randomized trial, and adds to it by extending the treat- the present study is the first to assess treatment of the full
ment to the full length of the jaw. Outcomes were favor- length of the jaw with VYC-25L. An additional limitation of
able and rates of patient satisfaction were particularly our study is that the cohort was relatively small and young
high. This makes redefinition of the jawline a potentially (mean age, 34.4 years); nonetheless, it is representative of
high-impact aesthetic procedure that can be offered to our practice in this indication.
patients with a wide variety of biologic and economic
circumstances.
A grid system was used to standardize our approach CONCLUSIONS
to treatment. We have previously shown that similar grid
systems in other areas of the face are simple to use and The sculpting of a straight, youthful jawline is com-
lead to positive treatment outcomes with low complication monly requested by patients. However, it is also a de-
rates.7-9 manding treatment that should be approached only by
Indeed, the potential for improved patient safety experienced injectors with suitable training. We have de-
through greater systematization of approach may be a key scribed a chin and jawline sculpting technique based on
advantage of grid systems. In the present analysis, AEs progression from chin contouring to the peri-jowl region
were confined to transient soft-tissue edema (46.7%) and to the angle of the mandible. With a focus on anatomic
Bertossi et al 1075

danger zones, the use of a grid system can provide a safe 9. Bertossi D, Lanaro L, Dorelan S, Johanssen K,
treatment guide for achieving good aesthetic outcomes. Nocini P. Nonsurgical rhinoplasty: nasal grid ana-
Overall, treatment of the jawline and chin with the novel lysis and nasal injecting protocol. Plast Reconstr Surg.
filler VYC-25L appears to be effective and safe for the cor- 2019;143(2):428-439.
rection of genetic and aging-related volume loss, with high 10. Goodman GJ, Swift A, Remington BK. Current concepts
in the use of Voluma, Volift, and Volbella. Plast Reconstr
rates of patient satisfaction.
Surg. 2015;136(5 Suppl):139S-148S.
11. Philipp-Dormston WG, Eccleston D, De Boulle K, Hilton S,
Supplemental Material
van den Elzen H, Nathan M. A prospective, observational
This article contains supplemental material located online at study of the volumizing effect of open-label aesthetic use
www.aestheticsurgeryjournal.com. of Juvéderm® Voluma® with lidocaine in mid-face area. J
Cosmet Laser Ther. 2014;16(4):171-179.
Acknowledgments 12. Philipp-Dormston WG, Hilton S, Nathan M. A prospective,

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The authors thank Dr Timothy Ryder from Biological open-label, multicenter, observational, postmarket study
Communications Limited (London, UK) for assistance in ed- of the use of a 15 mg/mL hyaluronic acid dermal filler in
iting and submitting the final draft, funded by Allergan (Dublin, the lips. J Cosmet Dermatol. 2014;13(2):125-134.
Ireland) at the request of the investigator. 13. Few J, Cox SE, Paradkar-Mitragotri D, Murphy DK. A
multicenter, single-blind randomized, controlled study of
Disclosures a volumizing hyaluronic acid filler for midface volume def-
Dr Bertossi is a consultant and speaker for Allergan (Dublin, icit: patient-reported outcomes at 2 years. Aesthet Surg J.
Ireland). The other authors declared no potential conflicts of 2015;35(5):589-599.
interest with respect to the research, authorship, and publica- 14. Humphrey S, Carruthers J, Carruthers A. Clinical experi-
tion of this article. ence with 11,460 mL of a 20-mg/mL, smooth, highly co-
hesive, viscous hyaluronic acid filler. Dermatol Surg.
Funding 2015;41(9):1060-1067.
15. Raspaldo H, Chantrey J, Belhaouari L, et al. Lip and perioral
Writing and editorial assistance was provided to the authors by enhancement: a 12-month prospective, randomized, con-
Dr Timothy Ryder (Biological Communications Limited, London, trolled study. J Drugs Dermatol. 2015;14(12):1444-1452.
UK) and funded by Allergan (Dublin, Ireland) at the request of 16. Calvisi L, Gilbert E, Tonini D. Rejuvenation of the perioral
the investigator. All authors met the ICMJE authorship criteria. and lip regions with two new dermal fillers: the Italian ex-
Neither honoraria nor payments were made for authorship. perience with Vycross™ technology. J Cosmet Laser Ther.
2017;19(1):54-58.
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