and malar fat pad, as well as other structural changes. Fine lines and wrinkles begin to appear: ■Glabellar folds ■Periorbital lines ■Nasolabilal folds ■Perioral wrinkles ■Cheek lines ■Marionette lines. Dehydration and loss of vitality in the skin, as well as
loss of density and glow, are also apparent. All symptoms should be treated simultaneously, in order to offer the patient a homogeneous and harmonious result.
The technique To avoid excesses and an artificial look, I always ask the patient to bring a picture of his/her youth to get an idea where and how much volume I have to inject, according to the original shape of the patient’s face and expression. Before the injection, it is advisable to apply a topical
anaesthetic cream. For global facial rejuvenation, nerve blocks may enhance the patient’s (and doctor’s) comfort. When considering a treatment of global facial rejuvenation that requires adding volume to the deficient areas, filling in the deep wrinkles and boosting the superficial layers of the skin, it is important to start at the top and work down. I always recommend volumising the zygomatic area first, with Pluryal® Volume using a flexible cannula (27 gauge). Owing to the enhanced projection of the cheeks followed by a light ‘lifting’ effect, some changes will occur to the lower parts of the face, and therefore less volume could be needed in the nasolabial folds, for example. The advantage of this first zygomatic injection point is that the whole cheek and temporal areas can be treated from one single injection point. One must take into account that using flexible cannulae means that the substance will be injected into the deep dermis and/or in a subdermal plane, using a retrograde or a cross-hatching technique. The best way to treat the upper face is by recreating the ‘Ogee curve’. As soon as the recontouring is done, it is time to
address the deep wrinkles by using either Pluryal® or Pluryal® Volume with the cannula or sharp needle, which allows infiltrating the substance in different layers of the skin. In my experience, treatment of tear trough deformity gets the best results by using the sharp needle, touching the bone and placing the substance exactly under the orbicularis muscle. This deformity doesn’t normally need much substance (0.2–0.4 cc) to get a good result.
Treating the nasolabial folds can be done using both
techniques by filling the folds with a proper volume. The next step is to treat the mentolabial folds, by lifting the corner of the mouth and injecting Pluryal® Volume or Pluryal® into the marionette lines. Finally, the contour of the mental angle and the impression over the mandibular retaining ligament can be corrected using the cannula or sharp needle with Pluryal® or Pluryal® Volume. As soon as the result of the ‘basis’ is satisfying, it is time
the t“Treatment of ear trough
deformity gets the best results by using the sharp needle, touching the bone and placing the substance
exactly under the orbicularis muscle.
”
to use Pluryal® Booster to work on the surface by attenuating the fine lines and restoring the skin’s elasticity and hydrobalance. The best results are achieved by injecting Pluryal® Booster under the superficial lines in the superficial dermis in a retrograde or antegrade fashion (30 G needle). I also inject this product using a multi-bolus technique in those areas of the face that need to be revitalised and redensified. This may cause some papules, bruising and swelling, which could last for 6–24 hours, but a harmonious, natural result is ultimately achieved. Following injection, I massage the treated areas firmly and advise patients not to massage themselves for at least 24 hours. Combining hyaluronic acid with botulinum toxin injections can provide an even longer lasting effect.
The results Taking into account the correct multi-layer technique, and thanks to the high elasticity of the products, the results are always natural and long-lasting. Building up the face with Pluryal® Volume, working on the folds and wrinkles with Pluryal®, and treating fine lines and loss of density with Pluryal® Booster provides complete rejuvenation.
Further information
www.mdskin-solutions.com AMWC Booth number E20, Level -1, Hall Diaghilev
prime-journal.com | March 2013 ❚
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