| FACIAL AESTHETICS | PEER-REVIEW
asymmetry. The stages of the procedure are: ■ Correct facial analysis ■ Determine priority areas for correction ■ Choose the product for volume restoration in accordance with rheological characteristics of the product and the anatomical peculiarity of the area for correction
■ Perform volumisation in a staged process, during which it is not necessary to strive to achieve the effect of a complete correction for the male patient (a levelling of the contours, the smoothing of folds and wrinkles), thus avoiding a feminisation of the face.
the Golden Decagon Matrix, which was described by Stephen Marquardt4
. The beautiful face for a woman is youthful with a
heart-shaped form, the ‘triangle of youth’, and ideal mid-face. The ideal female face is characterised by the ovoid form of the mid-cheek area with an eccentric apex located high on the mid-face, below and lateral to the lateral canthus.
Volume restoration for the male face There are also two main goals for male treatment; the first is to refresh the face, the second being not to recreate the ideal face of a man, but to make the face appear healthy and more muscular. The ideal male face has a mid-cheek with an
anteromedial fullness, wider based malar prominence, and with the apex being more medial and flatter. Projected cheekbones are considered a feminine trait. The male face is square and the jaw is strong. A mandibular projection is considered more acceptable 7
.
Lifting or volume restoration of the cheek area, volumisation of the chin, and the recreation of the mandibular line help to achieve a fresh and muscular outcome for men. It is very important to explain all the nuances of a procedure to the male patient. Volume restoration of the male face does not feminise the face in any way. There are two strategies of treatment for both genders,
these are the minimum and optimal programmes. The indications for a minimum programme include a patient’s first treatment or a worried patient who does not want to change much. For any patient like this, it is possible to offer treatment in accordance with the LIFT© Concept (Less Invasive Facial Treatment), which is designed to be performed using fewer injections, less product, but with the same result of regaining a youthful look, which is in many cases more natural 8,9
.
The optimal programme includes the volume restoration of all areas, taking into account facial
Figure 2 Minimum programme for the female patient (A) before and (B) after 2 ml monophasic high cohesivity and viscosity hyaluronic acid filler in mid-face, 0.8 ml of hyaluronic acid of medium viscosity in nasolabial foldes, marionettes, and lips
Areas of correction Mid-facial volumisation Volume loss in this area is caused by a diminishing of volume in the bone structure of the malar process of the zygoma, atrophy of the superficial fat compartment, and weakening of the system of ligaments in the mid-facial area 10,11
. Volume restoration in this area is conducted at the
periosteal level in the malar region and at the deep fat pad level in the case of the mid-face.
Contour restoration of the lower jaw This implies the insertion of product supraperiosteally with the goal of repairing the involution of the bone structure of the lower jaw. To restore this zone in men it is preferable to use a cannula and a monophasic highly cohesive dermal filler that consists of cross-linked hyaluronic acid with low molecular weight.
The ideal female face is
characterised by the ovoid form of the mid-cheek area
with an eccentric apex located high on the mid-face, below and lateral to the lateral canthus.
Chin volumisation This age-related deformation is linked to the resorption processes of the bone tissues, muscle hyperactivity (m. mentalis, m. depressor anguli oris, m. depressor labii inferioris), and atrophy of the superficial fat pad. Correction includes a restoration of the chin protuberance combined with the alignment of a more expressive (forceful) shape in this area in men. The product
of choice for this is hyaluronic acid inserted supraperiosteally by needle for a crisper formation of the chin protuberance.
Nasolabial folds These are formed as a result of muscle hyperactivity, excess skin under the nasolabial folds, and bone atrophy in this area. Inject the product at the level of the deep layers of the subcutaneous fat pad to create a base for the upper subcutaneous fat pad and skin of this area. One of the dangers in working with the nasolabial fold in men is the possibility of creating an unnatural look, caused by using too much product. This can lead to the compression, by a large volume of viscous and thick product, of the angular artery with the subsequent development of ischaemia in the mid-facial tissues. As a preventive measure against such a development, it is vital to combine the treatment of the nasolabial folds
prime-journal.com | May/June 2013 ❚ 39
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