ArtiCle | fACiAlAeSTHeTiCS |
deposits are blended smoothly with surrounding tissue. excessive or aggressive massage is not necessary and increases the risk of swelling and bruising. At this point, stand back and examine the symmetry of
the augmentation. There may be a little swelling evident and it is important not to over-correct. However, a few minor adjustments can be made to try to achieve the best outcome from a first treatment. if still required, single depots of CaHA may be inserted with a needle supraperiosteally at the apex of the zygoma to restore more youthful facial ratios. Revolumising temporal hollows either with a fan technique using cannulae or an overlapping depot technique with a needle, is often effective. A small amount of product can be added in the pre-jowl sulcus at the deep dermis, though care is necessary, as excess will weigh the tissues down. finally, a small layer of CaHA in the deep or
cost involved when buying a cannula instead of a needle. However, the remarkable increase in patient comfort and decreased bruising make their use compelling. 3D vectoring adds another dimension to medical
Cannulae are very popular with patients as they are far more
comfortable than needles and post- procedural bruising is considerably less likely.
cosmetics practice. There are two distinct advantages of using CaHA with 3D vectoring. firstly, Radiesse has recently been shown to have a higher viscosity and elasticity than commonly used hyaluronic acid fillers9
. This results in
excellent immediate volume replacement that also lifts and holds the tissues of the mid and lower face. Secondly, in the longer term, stimulation of
collagen neogenesis maintains the correction and enhances skin quality. This is particularly noticeable at 6 months post-treatment (Figures 5–7). Care must be taken not to overvolumise the face in a
sub-dermis in the nasolabial lines, marionette lines and mentolabial folds will complete the softening of the contours and encourage collagen formation over a number of months. These final touches result in firmer, healthier looking skin, which blends well with the vectored augmentation, and completes the treatment. Minor swelling may occur. Any additional treatment is best carried out after a 2–4-week period. At this time, recontouring and micro-resurfacing with fine hyaluronic acid fillers that blend easily with surrounding tissues may perfect the treatment. for this purpose, fillers such as Belotero Basic are effective.
Discussion and conclusions The use of cannulae in medical aesthetics is still in its infancy, with many innovative developments yet to come. Cannulae provide a safer way to penetrate tissue — especially in more problematic injection sites. Cannulae are very popular with patients as they are far more comfortable than needles and post-procedural bruising is considerably less likely. Replacing needles with cannulae results in the actual procedure taking a little more time, although this is offset by the fact that no topical anaesthetics are required. There is also a slightly higher
References
1. Besins T. The “R.A.R.E.” technique (reverse and repositioning effect): the renaissance of the aging face and neck. Aesthic Plast Surg 2004; 28(3): 127–42
2. Shaw RB Jr, Katzel EB, Koltz PF
et al. Aging of the facial skeleton: aesthetic implications and rejuvenation strategies. Plast Reconstr. Surg 2011; 127(1): 374–83
3. Busso M. Vectoring approach to midfacial recontouring using calcium hydroxylapatite and hyaluronic acid. Cosmet Dermatol 2009; 22: 522–8
4. Marmur ES, Phelps R, Goldberg 34 ❚
DJ. Clinical, histologic and electron microscope findings after injection of calcium hydroyxlapatite filler. J Cosmet Laser Ther 2004; 6(4): 223–6
5. Berlin AL, Hussain M, Goldberg
DJ. Calcium hydroxylapatite filler for facial rejuvenation: a histologic and immunohistochemical analysis. Dermatol Surg 2008; 34(Suppl 1): S64–7
6 Silvers SL, Eviatar JA, Echavez .
MI, Pappas AL. Prospective, open-label, 18-month trial of calcium hydroxylapatite (Radiesse) for facial soft-tissue augmentation in patients with human
immunodeficiency virus-associated lipoatrophy: one-year durability. Plast Reconstr Surg 2006; 118(3 Suppl): 34S–45S
7. Uitto J. The role of elastin and
collagen in cutaneous aging: intrinsic aging versus photoexposure. J Drugs Dermatol 2008; 7(2 Suppl): s12–6
8. Terino EO. Alloplastic midface augmentation. Aesthet Surg J 2005; 25(5): 512–20
9. Rohrich RJ, Pessa JE. The fat
compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Recontr Surg. 2007; 119(7): 2219–27
10. Busso M, Voigts R. An
investigation of changes in physical properties of injectable calcium hydroxylapatite in a carrier gel when mixed with lidocaine and with lidocaine/epinephrine. Dermatol Surg 2008; 34(Suppl 1): S16–23
11. Sundaram H, Voigts B, Beer K, Meland M. Comparison of the rheological properties of viscosity and elasticity in two categories of soft tissue fillers: calcium hydroxylapatite and hyaluronic acid. Dermatol Surg 2010; 36(Suppl 3): 1859–65
mistaken attempt to lift tissues where skin laxity and surplus is excessive. in this case, complementary treatment modalities should also be considered, such as chemical peels, Rf technologies, and dermaroller. for excessive skin laxity and surplus, face lift surgery remains the preferred option. Using 3D vectoring, not only can facial tissues be lifted,
but traditionally tricky areas such as the lateral midface can be evenly and naturally volumised, while at the same time creating a positive vector which helps to redefine the jaw line, nasolabial and marionette lines. 3D vectoring with CaHA using atraumatic micro-cannulae speeds recovery and reduces bruising, while providing patients with a safer, more effective facial augmentation.
Declaration of interestKateGoldie is aConsultant forMerz Aesthetics, andHolyrood Biosciences. The authorwould like to thank JosineBolenius,Merz Aesthetics,Netherlands.
Medics Direct offers a range of international training courses, including cannula andvectoring courses, and online
courses.Visit
www.medicsdirect.comformore information
September 2011 |
prime-journal.com
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