| VOLUMISING TECHNIQUES | ARTICLE
options with hyaluronic acid should be considered: Where to inject? What to inject? How to inject?
What to inject? Even if an ‘ideal filler’ does not exist, it is clear that hyaluronic acid is the gold standard product for the rejuvenation of the mid-face, especially with the recent advances in the quality of volumising products2
. The
authors also have experience with fat injections, with remarkable results. However, it is easier and more flexible to use hyaluronic acid (greater technical, surgical and anaesthetic requirements are necessary for fat injections). There are a number of criteria that should guide
Figure 6 Levels of injection. Green represents highly cross-linked hyaluronic acid, while blue represents less cross-linked hyaluronic acid
giving an empty zone above the mid-cheek groove (remember the thin zone of the pear). Filling this empty zone will provide two benefits. The first is the pure effect of beautification; the second is somewhat of a moderate lifting effect. Adequate volumisation is very effective at giving the impression of a mini-facelift. The pear retransforms into an apple. It is important to be aware of moderation in the filling volume — less is more. This non-surgical lifting effect can delay an eventual surgical facelift. Scales 1 and 2 are excellent indications for volumisation.
Scale 5 does not require any volumisation, as the volume is already excessive. Scale 6 is rare. A face with excessive volume has no tendency to sag; therefore, this is a poor indication for volumisation.
Beautification and rejuvenation of the mid-face with hyaluronic acid To fully understand the benefits of the treatment options available, it is important that patients understand how their skin and facial structure have aged, and how these techniques can naturally enhance or refresh their facial appearance. Three questions for injectable treatment
To fully
understand the benefits of the treatment options available, it is important that patients understand how their skin and facial structure have aged, and how these techniques can naturally enhance or refresh their facial appearance.
product choice: ■ Safety is paramount ■ Medical criteria: minimise the risk of secondary and adverse reactions (e.g. immunogenic response, granuloma), good incorporation into human tissue, and compatibility with other techniques (past or future)
■ Technical criteria: quality and predictability of the result, ease of injection, duration of the result, stability in the injected area without secondary migration of the product
■ Cohesivity, gel hardness and softness, consistency, mono or biphasic: they are specific to each brand of hyaluronic acid
■ The cost is certainly a factor, but is in no way comparable to the safety and quality criteria.
For these reasons, the authors’ philosophy is to
eliminate permanent or semi-permanent products, using only resorbable products so as not to risk complications such as foreign body reactions, granulomas, scar tissue, and functional and aesthetic side-effects. It is important to bear in mind that patients and physicians aspire for both safety and quality. This gives confidence to patients and provides credibility to the physicians. For the authors, hyaluronic acid responds best to these criteria (as does autologous fat). Today, more than 70 brands of hyaluronic acid
exist on the medical market in Europe alone. The quality is improving and it is clear that the future of the injection will be optimised by research to develop the ideal product.
Figure 7 Vectors for superficial injection. Lifting vectors (A) and ‘hammock’ vectors (B)
prime-journal.com | January/February 2012
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