A Case Series on a Layered Biomaterial Strategy for Midface Rejuvenation: Combining Collagen Stimulators and Hyaluronic Acid

Early human evidence such as case series or small samples is exploring possible benefits.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Background The midface is a key area where aging signs first appear, involving multi-layered changes such as epidermal fine lines, volume loss leading to hollowing and sagging, and deep structural support weakening resulting in nasolabial fold deepening. Single-material treatments often fail to address this complexity comprehensively. While hyaluronic acid (HA) effectively restores volume, its impact on skin texture is limited; collagen stimulators promote long-term collagen regeneration but lack immediate shaping capability. Objective Through the presentation of six typical cases, this study aims to illustrate the clinical application of a layered treatment strategy using HA and collagen stimulators, either alone or in combination. It seeks to describe how this anatomy-based approach can address single or compound midface aging signs and provide a preliminary clinical reference for comprehensive rejuvenation. Methods This descriptive case series included six female patients with distinct midface aging phenotypes. Efficacy was assessed blindly by independent physicians using standardized scales (GAIS, Merz, Hirmand, MVDSS, WSRS). Results All cases showed improvement in target aging signs. Quantitative improvements were observed: Case 3 (infraorbital hollowing) improved from Merz Grade 2 to 1; Case 4 from Merz Grade 4 to 1; Case 5 (tear trough) improved from Hirmand Grade 2 to 0

Evidence level

Early human evidence such as case series or small samples is exploring possible benefits.

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