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

## TL;DR

This study explores combining collagen stimulators and hyaluronic acid to address midface aging, showing improved results compared to single-material treatments.

## Contribution

The paper introduces a layered treatment strategy for midface rejuvenation using both collagen stimulators and hyaluronic acid.

## Key findings

- All six cases showed improvement in target aging signs with the layered treatment strategy.
- Quantitative improvements were observed in infraorbital hollowing and tear trough cases at follow-ups.
- Treatments were well-tolerated with only transient, expected reactions.

## Abstract

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.

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.

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).

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 at 6 months; and Case 6 (compound aging) showed progressive improvement, with Hirmand, MVDSS, and WSRS scores all improving by at least two grades at the 10‐month follow‐up. Treatments were well‐tolerated, with only transient, expected reactions observed.

This case series suggests that a combined/layered treatment strategy based on anatomical presentation may offer a safe and effective option for personalized midface rejuvenation. These preliminary observations provide a basis for future research and should be interpreted within the limitations of a small, non‐comparative study design.