| FACIAL AESTHETICS | PEER-REVIEW


downside of these is difficulty in removing them in cases of an adverse reaction. The practice of using a cannula is one of the basic


tendencies in contour correction, owing to its atraumatic nature and the opportunity to work with tissues at varying depths. Depending on the depth required for insertion and the characteristics of the tissues, cannulae of varying diameters and lengths can be used. It is obvious, that, when considering a deep insertion of thick and viscous hyaluronic acid, it is expedient to use a rigid cannula with a diameter of between 22 and 25 G. The length should be no less than 5 cm, such that, in accordance with the concept of levers, there is no possibility of deforming the cannula under the impact of the mass of the tissue. Furthermore, the likelihood of loss of a thick gel when forcing it through a thin cannula or needle increases significantly. Despite the lack of a stinging effect when using cannulae, there remains the possibility of rupturing brittle vessels in ageing patients when passing cannulae through tissue. This can also occur when using a needle, but bruising is less widespread. Despite the advantages of working with cannulae,


chin correction, and in some circumstances the mid- face area, require the more obvious use of a needle using the bolus and dot 8


technique, which are more


accurate. It follows from the above principle of classic volume


correction in men that the volume of product inserted into facial tissue in the course of one procedure can amount to 6–7 ml, and in some circumstances may even exceed that level. The volume of product is determined on an individual basis for each patient according to the evidence of age-related changes within the tissues, the condition of the lymphatic system, and the microcirculation in the area of correction. To prevent complications in the case of a classic


volume correction, the best solution is to perform the correction in stages.


Minimum programme for female patients The treatment programme is usually very individual by nature, but the priority area for correction is the cheekbone, especially the apex point. However, it is sometimes possible to obtain highly effective results by correcting the apex point alone, allowing the interplay of light and shade to create the effect of volume. The product is inserted supraperiosteally via a combination of cannula techniques in order to recreate the volume of the lateral cheekbone area as opposed to that of a needle vertical dot 8 the apex point.


and bolus technique to highlight


Optimal programme for female patients This programme includes volume restoration of all areas. Cheekbones and cheeks can be volumised for the beautification of the face and for the recreation of the ideal mid-face area. Markers of ageing, such as grooves and folds, can also undergo volume restoration


Key points


■ There are an increasing number of male patients seeking aesthetic procedures, owing to the social importance of having a youthful and healthy appearance


■ Aesthetic differences are based on the anatomical, physiological and psychological peculiarities between genders


■ Volume restoration of the face is a procedure that is beneficial for both genders


■ Volume reshaping of the male face does not lead to a feminisation of appearance


Figure 5 Minimum programme for the male patient (A) before and (B) after 1 ml per side of monophasic highly cohesive hyaluronic acid filler, combination of dot 8


and bolus technique


Figure 6 Optimal programme for the male patient (A) before and (B) after volumetric correction with 4 ml of monophasic highly cohesive hyaluronic acid filler


for the reshaping of the ideal mid-face, which is the key point of a youthful face. The main strategy of treatment is to start from the


lateral parts of the face towards the mid-face, from the upper face down to the lower face. This strategy aids in the optimisation of the quantity of product and the possibility of combining hyaluronic acid with high cohesivity with products of less cohesivity. Of course, for different levels of tissue it is better to


use a suitable product; for example, deep supraperiosteal injections with hyaluronic acid of high cohesivity and viscosity for the cheekbone area, while for the sub-dermal tissues it is possible to use a hyaluronic acid of medium viscosity.


Minimum programme for male patients This programme aims to make the face look healthy, sometimes younger, with the priority area being the cheek, especially the transition from the lower eyelid to the mid-cheek. Taking into account all specialities of treatment for the male patient, such as not painful, completed in one treatment, and with visible results, the best solution is a monophasic highly cohesive filler consisting of low molecular weight (short chain) hyaluronic acid. This solution of product, which optimally combines both viscosity and cohesivity, helps to achieve a lifting and volumising effect at the correct points. It is possible in this situation to use the dot technique with a cannula in accordance with the principles of the LIFT©


Concept8,9 . It is safe, without prime-journal.com | May/June 2013 ❚ 41


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