| FACIAL REJUVENATION | PEER-REVIEW short period of time, dozens of procedures have been
introduced, with only small differences between each. Just as ‘many roads lead to Rome’, a favourable result can be achieved in different ways with variable results. This article will discuss the most important options, suggest correct indications for each technique, and list their advantages and disadvantages4
.
Dermal fillers Dermal fillers work by providing support for facial structures, while botulinum toxin reduces the mimetic effects. In combination, these products can be used effectively to reshape and rejuvenate the face and neck. Dermal fillers can be used throughout the face to: ■ Raise the eyebrows ■ Fill the tear trough ■ Reshape the nose ■ Lift the nose tip ■ Fill nasolabial folds and oral comissures ■ Fill the cheeks ■ Raise the cheekbones ■ Reshape the jaw line. This ‘minimal approach’ offers a faster, less painful, and
less costly alternative or complement to surgical facelifts. The dermal filler material should be extremely viscous and elastic, such as in the case of the calcium hydroxylapatite-based dermal filler Radiesse (Merz Aesthetics, San Mateo, CA.). Radiesse stands out because of its high-level of viscosity and the absence of any hygroscopic effect 5
. Hyaluronic acid (HA) is, at present, the gold standard
of dermal fillers. The range of HAs launched on the market may present some differences in terms of viscosity and duration; however, the safety standards are very high, as stated in Raspaldo’s article6
. For over 10
years, HA has been used in aesthetic dermatology throughout Europe. This agent is safe, and physicians can choose from a wide range of HAs to enhance the face. They also have the option of a new series of low molecular HAs with Juvéderm® VYCROSS™ technology from Allergan, which allows us to better manage the entire face with different concentrations of HAs and a variety of viscosities. The author first began to fill wrinkles, but new
procedures progressively allowed the option to restore facial volumes. However, it is important to bear in mind that successful aesthetic treatments also require some level of artistic talent in order to achieve a natural overall look. Better knowledge of physiologic HA functions
will offer physicians the possibility to discover and propose refinements in anti-ageing techniques7
. HA is a polysaccharide that occurs
Figure 1 (A) Patient with multiple signs of skin ageing and sagging of malar and jowl area, as well as severe resorption of fat compartment, and (B) patient after treatment with the Juvéderm® family of dermal fillers. A nice aesthetic result is achieved and can be improved further with three Fraxel® treatments (Solta Medical, Inc., Hayward, CA.)
treatment can optimise results and lengthen the duration of the effects of these products, which can range from approximately 3 to 12 months (Juvéderm® ULTRA VOLUMA®, VOLIFT®, and VOLBELLA™; Allergan, Irvine, CA.). HA is a suitable ‘lunchtime’ procedure because it
allows the patient to go back to work and has no down time. It is typically associated with less pain and mistakes can be better corrected, which makes it a good choice for fearful patients. Combining a number of dermal fillers can require less quantity of product and provide a longer-lasting result. As the skin is an anisotropic and viscoelastic material, using these products in combination takes advantage of their hydrophobic and hydrophilic properties. This association mimics the natural composition and biomechanics of the skin, and can provide better and longer-lasting results. It must be underlined that there are long-lasting HAs such as Juvéderm® VOLUMA, and reabsorbable materials that last longer and can be used in the mid-face and chin, or in the mandibular line.
Fillers can temporarily
naturally in the dermis. As a dermal filler, it produces a natural look and structural mobility. Furthermore, its high water-binding capacity works to restore the hydrated, elastic volume of the dermis. HA requires no skin testing and is available around the world in a variety of shapes and types. Follow-up procedures a few weeks after the initial
achieve many of the same
results as plastic surgery and may in some cases prepare a patient for surgery.
Why choose a liquid facelift? Dermal fillers are both alternatives and complements to plastic surgery. Some patients are reluctant to undergo surgery, have contraindications for surgery, or wish to avoid the postoperative recovery period. Fillers can temporarily achieve many of the same results as plastic surgery and may, in some cases, prepare a patient for surgery. Dermal fillers can also be important allies after surgery. For example, in the treatment of nose sequelae after aesthetic rhinoplasty, they can help to relieve patient anxiety without the need for repeat surgery. It is important that all patients have realistic expectations for these procedures and
understand that fillers can restore balance, enhance appearance, and minimise the signs of ageing. Facial
prime-journal.com | June 2013 ❚ 45
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84