PEER-REVIEW | FACIAL REJUVENATION |
features may be refined, but they will not be changed
completely or permanently (Figure 1). Facial reshaping with dermal fillers requires regular
maintenance. Results will usually last for 3–12 months once the desired result has been achieved. However, patients may return two to three times per year for regular maintenance to prevent defects from getting as bad as they were originally. Maintenance of these results would require two or three treatments during the first year, followed by treatment twice per year, and possibly once per year thereafter. The restoration of volume using dermal fillers
The composite facelift is a
can rebalance facial proportions, increase symmetry, and by reducing wrinkles, produce a younger appearance. Plastic surgery can also achieve these effects, but with considerably greater financial and patient costs, including lost work time and the painful recovery process. Many patients who do not have weeks for recovery are seeking faster alternatives for aesthetic improvement that do not involve significant surgical procedures. Dermal fillers also provide a non-aggressive treatment that can be used preventively in younger patients, or as a means to ‘test drive’ some of the changes that can be made more permanent with surgery8
. There are four commonly reported techniques for
filler injection—serial puncture, threading, fanning, and cross-hatching—but there is currently no algorithm for choosing an injection technique. While certain situations may lend themselves to a particular technique, this decision is typically surgeon-dependent and related to experience, defect size and location, as well as the particular filler being used. In the serial puncture
46 ❚ June 2013 |
prime-journal.com
well-described technique for comprehensive facial
rejuvenation that includes tissue repositioning of every part of the ageing face.
technique, the skin is held taut and the needle inserted up to the appropriate depth. The product is then delivered in a small bolus to fill the defect, following which the needle is removed. The needle can then be reinserted along a particular defect and a new bolus injected. This technique is often used for lip augmentation or superficial placement of fillers along a particular wrinkle. In the threading technique, the needle is inserted into the defect and tunnelled through at the appropriate depth. As the needle is being withdrawn, the product is delivered in a slow, continuous stream. This technique is commonly used for lip augmentation and nasolabial fold injection. The fanning technique is similar to the threading technique, but the direction of the needle is continually changed in a radial fashion, and new lines are injected without withdrawing the needle tip.
Cross-hatching involves a series of threads injected in a perpendicular fashion to each other. The fanning and cross-hatching techniques are generally used to fill larger defect areas6
.
Surgical facelift The composite facelift is a well-described technique for comprehensive facial rejuvenation that includes tissue repositioning of every part of the ageing face. The most distinct characteristic separating this from all other facelifts is the movement of the cheek and malar tissues in a superior–medial vector instead of a superior–lateral vector and arcus marginalis release and septal reset, in which the orbital septum is sutured over the orbital rim.
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