[Lecture of the Month] How to Make an Attractive Face for Koreans through Harmony Programme III

Harmony Programme; Total Approach and Management

Balance is very important not only in terms of facial features but a treatment approach as well. I would like to talk about the Harmony Programme, a new total approach and management program developed by Galderma to be launched in Korea soon.

The first phase of Harmony Programme consists of personal assessment of the patient through a questionnaire and personalized patient management through consultation with the medical staff. The treatment plan is established based on the initial evaluation and communicated to the patient. When the treatment is chosen by the patient in consulation with the medical staff, injection strategies are determined. The treatment is carried out and follow-up visits and post-treatment care are planned.

At a closer look, a standardized survey (Fig 6, 7) and pre-treatment consultation are carried out in <Step 1> to collect data on the patient including medical history, motivation and expectations for the treatment, face self-evaluation, demands, personality and financial status, etc. In <Step 2>, an objective assessment of the face (Fig 8) is carried out to identify facial symmetry, degree of volume, wrinkles, and skin conditions, etc. Based on the findings of the objective assessment, a customized treatment plan is established including the treatment area, dose and type of product, and need for combination with botulinum toxin, laser, or thread, etc. (Fig 9). The final treatment is determined by the patient in consultation with the manager of the aesthetic clinic.

The following factors should be considered in the personalized treatment plan;

Does the patient desire subtle or drastic changes?

- What are the patient’s fears regarding the treatment? (pain, bleeding, swelling, and ecchymosis, etc.)

- What are the dermal filler and botulinum toxin choices that the patient can afford according to his or her financial status?

- What is the appropriate degree of correction considering the patient’s expectations and the ideal proportions of the facial features?

- Which products are needed and in what amounts?

- Should other modalities be combined with dermal filler?

Familiarity with various treatment techniques and correct choice of the needle or cannula are required for safe and effective treatment.

Recently, the so-called “egg shape injection” (Fig 10) that is combined with dermal filler is gaining in popularity. The egg shape injection is known to create a narrow, oval shape of the face resembling that of an inverted egg.

A special concoction of botulinum toxin is used on the muscle, skin and soft tissues to reduce overly developed masseter muscles. This injection tightens the cheek skin giving a rejuvenated and narrower jawline. It also shrinks the subcutaneous soft tissues. The visible effect varies across individuals but generally, the desired narrower outline of the face is achieved with a low risk of side effects (Fig 11).

<Step 3> is the actual treatment. The goal is to create an overall harmony of facial features based on the proportions universally thought to be attractive. If the treatment goal falls short of the patient’s high expectations, the patient can be persuaded of the risks and benefits of the treatment through sufficient consultation.

<Step 4> consists of follow-up and post-treatment plan. Generally, a follow-up visit is recommended 2 weeks after treatment for assessing the outcome and the need for additional correction or combination with other treatments. This step is also used to establish a long-term treatment plan based on the patient’s expectations. During this stage, the patient is encouraged to recommend the treatment or service to those around her and continue long-term treatment. Post-treatment corrections are particularly important in treatments of the eye area. The primary treatment should be conservative so that final corrections can be made in secondary treatment. When a large amount of a hard filler is used in deeper layers in the overall facial contouring, it is important to pay close attention to hygiene and even use anaphylactic antibiotics if necessary.

Applying the Harmony Programme

Let’s take a look at how the Harmony Programme is actually used in the pre-treatment preparation, evaluation, treatment and post-treatment follow-up <Fig >. The patient may already have an ideal shape of the face, however, the face has lost volume, vitality, overall symmetry and skin elasticity with age. A detailed survey collects patient background data as well as where the patient wants change and expectations from the procedure. Then, the degree of volume, facial shape, skin conditions, degree of wrinkles, etc. are objectively evaluated to propose standards and goals for treatment. The optimal treatment choice and plan are also proposed. Lastly, the treatment choice is made through patient consultation and the selected treatment is carried out. This is followed by establishing a post-treatment plan.

The above process was followed to select the total facial contouring with dermal fillers combined with skin booster and botulinum toxin. The amounts of each product used are presented in Fig 12. The images of before and after treatment (Fig 13, 14) show that the face has recovered youthful and healthy glow with enhanced volume after treatment. The nose and other features appear more symmetrical.

Thanks to the advent of dermal fillers with various particle sizes and hardness, they can now be used in various depths of the facial skin in an overall total facial rejuvenation based on facial anatomy. Volumizing dermal fillers are slowly replacing fat graft and are increasingly combined with botulinum toxin, thread lift and laser, etc.

In Harmony Programme, HA dermal fillers with various particle sizes are used to improve the skin tone, correct fine lines around the eyes, mouth and glabella, etc. as well as indented areas around the eye. The treatment goal has switched from local correction to overall facial contouring including symmetry correction. These minimally invasive treatments can also help patients with history of previous unsuccessful surgical procedures.

The next article will feature Part 2: How to improve perioral wrinkles including nasolabial folds and marionette lines based on filler and toxin treatment.