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| FACIAL VOLUMISATION | PEER-REVIEW References


1. Rhorich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 2007; 119(7): 2219–27


2. Wulc AE, Sharma P, Czyz CN. The anatomic basis of midfacial aging. Hartstein ME, Wulc AE, Holck DEE. eds, Midfacial Rejuvenation. New York: Springer Science+Business Media, 2012


3. Besins T. The ‘R.A.R.E.’ technique (reverse and repositioning effect): the renaissance of the aging face and neck. Aesthetic Plast Surg 2004; 28(3): 127–42


4. Busso M. Vectoring approach to midfacial recontouring using calcium hydroxylapatite and hyaluronic acid. Cosmet Dermatol 2009; 22: 522–528


5. 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


An even and sustained injection pressure is desirable.


Correction should be completed to the clinical endpoint; overcorrection must be avoided. A typical fan is successfully carried out by using approximately 0.1 ml of material, but, of course, the amount will vary depending on the individual. Using this injection technique, the treatment is


continued in the same way from the second entry point (Figure 3). If an additional augmentation is required medially, another entry point is set; this usually runs perpendicular to the pupil. The third injection point can be seen in Figure 4. From this point a number of vectors can be placed in this direction towards the chin, thus reshaping the whole jaw line (CaHA to be placed supraperiosteally) and subdermally to treat the lateral cheek wrinkles in a crosshatch way (Figure 5 ® showing the whole procedure). All treated areas are subsequently checked manually after implantation (moulding).


Results The immediately visible treatment results normally last 12 months or longer. Typical effects caused by the injections, such as reddening, low grade haematoma or swelling are in most cases unobtrusive and temporary. Touch-up treatments are seldom necessary. This treatment methodology is the authorÕs personal approach, which has been developed over a number of years and from the authorÕs own experience. It is adaptable to many different facial


The 3D vectoring


technique represents a modern injection method for mid-face augmentation and lifting.


Key points


n Today’s aesthetic enhancement techniques are more than just filling wrinkles. Facial shaping and re-shaping beyond lines and folds requires a comprehensive armamentarium to achieve optimal results. Minimally-invasive and advanced injection techniques


using dermal fillers enable us to globally shape, volumise and lift the facial structures in a 3D way


n Positioning positive vectors to counteract the signs of ageing with biodegradable dermal filler material can create a lateral and vertical lifting effect, while


volumising the facial structures


n The most appropriate dermal fillers to use for this technique are biodegradable, highly viscous and elastic materials, with a strong collagen-stimulating potential, such as calcium hydroxylapatite or highly cohesive hyaluronic acids


n Performing advanced and innovative injection techniques to lift and reshape the facial structures with 3D vectoring represents a promising new approach to the signs of facial ageing effectively, safely, and in an appealing aesthetic way


prime-journal.com | January/February 2013 ❚ 47


Figure 5 Mid-face 3D vectoring


features, and while there is more than one Ô recipeÕ for treatment, it is necessary to provide some guidelines for treatment, as well as to define facial landmarks and entry points in order to successfully carry out this 3D vectoring treatment.


Conclusions The 3D vectoring technique represents a modern injection method for mid-face augmentation and lifting. The Radiesse volume filler with its high level of viscosity and elasticity, and consequently precise lifting capacity, is particularly suitable for this therapy. As a result of a technically perfect mid-face augmentation treatment, results can be achieved that show a particularly beautiful 3-dimensional reshaping and re-contouring.


 Declaration of interest None  Figure images 1–5 ç Dr Sabine Zenker


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