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| THE MALE FACE | ARTICLE


Figure 3 38-year-old showing an improvement in skin quality and smoothing of the nasolabial fold with a liquid lift (Belotero Basic 1 ml, Merz Aesthetics, Germany). (A) before and (B) after two procedures 1-year apart


The nasolabial folds are the most popular indication for dermal filler


injections. The folds should be considered together with the cheek bone area for the best results.


that should never be crossed. For calcium


hydroxylapatatite, serial puncture technique with deep seated microdroplets of ≤ 0.1 mL aliquot are administered24


. .


To avoid persistent malar oedema, small volume injections should be placed supraperiosteally, otherwise they could impede the lymphatic flow above the malar septum25 Persistence of hyaluronic acid fillers is a function of the


concentration, cross-linking and percentage elasticity (i.e. the proportion of elasticity in a cross-linked hyaluronic acid formulation). Persistence is related to a reduction in wrinkle severity and an increase in volume26


. The nasolabial folds are the most popular indication


for dermal filler injections (Figures 2 and 3). The folds should be considered together with the cheek bone area for the best results27


. Volume loss in the malar fat pad


will aggravate the nasolabial folds. The authors therefore recommend starting any mid-face sculpting on the cheek bones with a liquid lift. When using a hyaluronic


acid filler, monophasic and highly cross-linked products are preferred. Shear forces can decrease viscosity in dermal fillers. Higher shear forces are expected in areas with significant muscle movement. As a liquid lift to the cheek bones reduces the appearance of nasolabial folds indirectly, persistence of augmentation will last longer compared with injections along the nasolabial folds alone28, 29


.


Hollowing of the cheeks is a consequence of loss of malar fat pad, as well as laxity of associated fibrous septae and the superficial musculoaponeurotic system (SMAS). The therapeutic targets are therefore volume and laxity. To improve volume loss, hyaluronic acid fillers are administered using a fanning technique, beginning with the deep subcutaneous layers. Other options are cross-hatching or serial puncture injections. The latter is preferred for calcium hydroxylapatatite. The tower technique with a combination of perpendicular


Figure 4 48-year-old neck lipodystrophy and flaccidity in the lower third of the face and cervical region (A). Six months after subdermal laserlipolysis (B) (Smartlipo, Deka, Italy)


prime-journal.com | June 2012





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