arTicLE | The sOfT lifT |
subcutaneous or supraperiostal injection to replace volume loss in facial adipose tissues and create more defined facial contours1
. This study shows that the effect of a Restylane/
Restylane subQ treatment, together with an additional follow-up treatment, can last for as long as 18 months.
and negative effects and risks. Patients were
photographed before the treatment, after 2–3 weeks, and for those who needed it, after an eventual touch-up during the first control. By using the soft lift concept, the authors attempted to lift the corner of the mouth, the mid-face, the jaw line, and shape and lift the eyebrows. for harmonisation of the face, the authors wanted to correct the dorsum of the nose (Figure 1), shape the cheeks, bringing back volume, shape the contour of the chin and the wrinkled and saggy earlobes, and reduce the depth of the nasolabial fold and fine lines around the eyes. in addition to the use of neurotoxins, the authors wanted to reduce the depth of the corrugator fold, and to increase the effect, supplemental hyaluronic acid was used in the very deep folds. To achieve good and safe results, neurotoxins in particular were used for the upper third of the face3
. in exceptional cases, the middle and
lower third of the face can be defined by relaxing the depressor anguli muscle, making the masseter muscle weak, and relaxing the mentalis muscle. in the middle third of the face, it is often necessary to restore volume and lift the ageing face with NAshA gels (Figures 2–4).
Hyaluronic acid NAshA gel is a biocompatible, biodegradable, injectable and non-toxic gel. The Restylane family of products are well-known as aesthetic beauty treatments. The different products are used for soft tissue augmentation, such as filling wrinkles and lines, correcting facial contours, and reshaping the face by constant shape in the subcutaneous layers. The gel improves skin quality by increasing skin elasticity, which induces collagen production in the dermis. in 2007, a study found that the Restylane filler, by stretching the fibroblasts, creates new collagen in the skin8
. At the same time, it inhibits the break down of
existing collagen. Restylane is a well-documented and researched
cross-linked hyaluronic acid. it is a crystal-clear gel that is injected using different techniques in small or large quantities in the dermis, subcutis/hypodermis or epifascial/epiperiostal on the bone. Restylane consists of a minimally-modified hyaluronic acid that is similar to that which is naturally found in the body. The contents can be described as a natural sugar-like polymer, and Restylane is slowly broken down in a natural way in the body. Restylane subQ is a NAshA product indicated for deep
16 ❚ October 2011 |
prime-journal.com
Figure 1 This 40-year-old woman asked for more harmony in the oculofacial area and the dorsum of her nose. Treatment with 0.2 ml Restylane Lidocaine, with a sharp needle, (A) before and (B) immediately after
Neurotoxins The use of neurotoxins such as BOTOX/Vitstabel and Azzalure (all of which are botulinum toxin type A), should be regularly combined to achieve an excellent result. They support a relaxed appearance and effectively reduce lines and folds (Figure 5) — frown lines, crow’s feet, forehead creases, neck bands, gummy smile, and masseter muscle hypertrophy can be safely and successfully treated. Patients who require minimally-invasive procedures are fond of this effective and high rate of improvement, with rapid onset and a long duration of action (longer than 4 months for some patients). Knowledge about the mechanisms of action and the ability to use neurotoxins as an adjunctive treatment are mandatory for those working in the field of facial cosmetic surgery9
. The therapeutic effects of botulinum toxin are
principally, if not exclusively, derived from an alteration in the release of ACh at pre-synaptic neurons. Botulinum toxin A causes paralysis by inhibiting ACh release at the neuromuscular junction. This is accomplished in three steps: ■ The toxin binds the nerve ■ The toxin is internalised into the nerve ■ The toxin is cleaved by internal proteolytic enzymes, and the degradation by-products interfere with the normal process of vesicle fusion to the plasma membrane. This results in the inhibition of the exocytosis of ACh10
.
Injection techniques The importance of choosing the right product and right consistency of product for the specific part of the face, as well as for different patients with different skin quality
Figure 2 Oculofacial area of a 44-year-old woman treated with the reinforced Pix’L+ microcannulae 28. (A) before treatment and (B) 4 weeks later
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