| COMBINATION THERAPIES | PEER-REVIEW Tear trough procedures usually require the addition of
volume to the underlying depression, for which dermal fillers will often be recommended. The reason for undertaking this investigation was that this treatment methodology works well for smaller wrinkles, but the influence on the skin does not always sufficiently increase lost volume and has no impact on the bony contour. However, complaints such as dryness, flaking and
even skin fissures increase, and the patient will begin to consider the fallacy of high expectations. This is because no treatment to the mucous membrane is carried out when it becomes sensitive to hormonal imbalance and change. The authors understand that complex treatments must be carried out in this patients cohort, as not only visible changes to volume occurred, but also invisible changes to hormonal levels caused by prolonged changes to the bone, and soft tissue quantity (fat) and quality (mucosa and skin). This is well known to endocrinologists, but is often not taken into account by the majority of cosmetic dermatologists and surgeons. It is for these reasons that the authors have developed
the IMPACTç Concept algorithm for diagnoses and treatment, to ensure that hormonal changes are taken into account when treating age-related changes to facial appearance (Table 1; Figure 1). Once this algorithm is complete, then the decision with regard to treatment of the tear trough in the menopausal patient can be made. The authors believe that the degree of ptosis intensity determines the choice of either an invasive or non-invasive approach for correction. As a result, an optimum treatment outcome is achieved, which does not compromise the method with incorrect and short- term results.
Treatment To investigate the IMPACT Concept treatment algorithm, the authors treated two patient groups. Group 1 comprised 30 female patients aged 50–60 years, who were treated following the IMPACTç Concept, where hormonal changes were taken into account and special treatment prescribed. Group 2 comprised 10 female patients aged 50–60 years, without any influence on hormonal status. The aim was to compare the differences ® if any ® between the results. All patients were at either menopausal or post-menopausal stages, which was the main criterion for inclusion in this study. Other criteria for inclusion were that patients had not received any medical aesthetic procedures at least 18 months prior to the study, as well as no surgical aesthetic procedures at all. All patients were randomly divided into the groups. In line with the IMPACTç Concept, the authors
recommended the following algorithm of treatment for the menopausal female patient: ■ 1. Consultation with an endocrinologist, with hormone replacement therapy (HRT) considered as the estriol group of drugs can influence the quality of all mucous layers, and anti-osteoporosis drugs can prevent changes to the bony structure
■ 2. Application of phytoestrogens to the skin Figure 2 Non-surgical tear trough correction, (A) before and (B) after treatment
prime-journal.com | March 2013 ❚ 55 Table 2 GAIS scoring DEGREE DESCRIPTION
1 Exceptional improvement Excellent corrective result after a session 2 Very improved patient
3 Improved patient 4 Unaltered patient 5 Worsened patient
Marked improvement of the appearance, but not completely optimal
Improvement of the appearance, better compared with the initial condition, but a touch-up is advised
The appearance substantially remains the same compared with the original condition
The appearance has worsened compared with the original condition
WRINKLE SEVERITY
WITHOUT SMILING 0 Absent 1 Minimal
2 Mild 3 Moderate 4 Severe
Table 3 Proposal of Investigators: Global Assessment of PeriOral Lines Severity Scale DESCRIPTION
No visible wrinkles
Minimal wrinkles, within 0.5 cm length and minimal depth
Moderately deep wrinkles, between 0.5 and 1 cm in length, without attaching vermilion
Moderately deep wrinkles, between 0.5 and 1 cm in length with attaching vermilion, or deep wrinkles, between 0.5 and 1 cm in length without attaching vermilion
Deep wrinkles, with a length of more than 1 cm, with or without attaching vermilion
Every woman will experience three stages of hormonal
reorganisation known as pre-menopause, menopause, and post-menopause.
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