ARTICLE | FACIAL AESTHETICS | supraperiostally, using sharp needles of different


lengths (depending on the anatomical parameters). The indirect approach aims to augment the area indirectly, approaching laterally, using blunt-tipped, long cannulae of different lengths, and placing the material in a fanning pattern using the linear threading technique. The overall outcome of using both techniques results in a 3D volumisation/lifting and reshaping of the facial structures.


Case report Past medical mistory The 45-year-old female patient presented in 2009 with a profound volume loss in her mid-face, but also in the perioral region, as well as early hyperkinetic wrinkles and mimetic folds. Until she presented at the clinic, she had never received any aesthetic procedure, apart from regular medical facials as a result of acne vulgaris, and consistently used sun protection. The patient was healthy, with no allergies, no history of operations, no infections, and was not taking any medication.


Figure 3 Treatment to the crow’s feet with botulinum toxin A, (A) before treatment and (B, C, D) 3 weeks after treatment. Twelve injection points to the orbicularis oculi. Each side received three injections of 2 U intramuscularly (green) and nine injections of 0.5 U intradermally (purple). (Total dose 11 U per side)


Evaluation and diagnosis The area of concern was the patientÕs face, focusing on expression lines and a loss of volume in her mid-face. At rest, the glabellar and forehead lines marked 2 on the Merz Scale (MS)10


(moderate lines), and with a mark of


4 at maximum contraction (very severe lines). The crowÕs feet were MS 3 at rest (severe wrinkles) and MS 4 (very


Ò The most precise and easiest to handle  cannula IÕ ve ever used.Ó


DR. SABINE ZENKER Dermatology Surgery Clinic Munich, Germany


GLOBAL Launch TSK STERiGLIDE Cannula


Join our EMAA workshop on October 13th


Paris, October 12-14  at 8:30 in room 242 AB or visit our booth F13.


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