Abstract

Introduction: Midface rejuvenation is the cornerstone of a beautiful face. It is integral in the aesthetic appeal of an Asian face.
Aim: To critically appraise 3 popular non-invasive procedures regarding midface rejuvenation for Asian beautification from an evidence based approach.
Objective: To evaluate the evidence for 3 increasingly popular aesthetic procedures in Asia for non-surgical midface rejuvenation, using best evidence topics methodology. • Thread lifts • Hyaluronic acid fillers • High intensity focused ultrasound (HIFU) Hence the research question is: What is the safety and efficacy of Thread lifts vs. Hyaluronic acid fillers vs. HIFU in midface rejuvenation in Asian adults?
Method: A comprehensive search of the current literature was used using PubMed, Cochrane and Google Scholar. Non-English, animal studies and in-vitro studies were excluded. 45 relevant studies of variable quality were included. Data from these 41 studies were abstracted into table for the purpose of answering the focused three-part question according to Best BETs methodology.
Results: There are numerous high level evidence papers supporting the safety, efficacy and cost effectiveness of the use of hyaluronic acid fillers in midface rejuvenation. There is good evidence for the role of HIFU while Thread lifts lacks high powered data regarding their efficacy and safety.
Conclusion: Hyaluronic acid fillers are the treatment of choice for safe, efficient and cost-effective midface rejuvenation. When non-invasive treatments are preferred, HIFU is a relatively good alternative.

Keywords: Hyaluronic acid; Rejuvenation; Dermal fillers; Canfield imaging systems; Aesthetic improvement