| COMBINATIONAL AESTHETIC APPROACHES | PEER-REVIEW fat at 3000 rpm for 3 minutes, and placement of the fat2 .
Longevity of injected autologous fat may range from 8 months up to several years25
. Importantly, fat grafting
does not seem to work equally for all techniques, body areas nor for all patients. The main advantage of this technique resides in the autologous nature of the transplant and the presence of adipose-derived stem cells in fatty tissue. In addition to volume correction, lipostructure is associated with a trophic effect24
. Over the past few years, advances in development and
optimisation of filling materials have been accompanied by progresses in injection techniques. To date, supraperiosteal injections in order to restore lost volume in deep structural layers of the upper, middle, and lower face to provide a structural platform are frequently being used3
. Three injection access points have been proposed
including the temporal fossa to address forehead atrophy and brow ptosis; the midface to treat the tear-trough, infranasal, and malar fat pad areas, and third, the jaw line to address the mandibular angle, maxilla, and marionette lines26
. Amounts of product may vary significantly
depending on the size of the face, natural bony support, and intended results. Supraperiosteal injections may be combined with classical linear of fanning techniques to customise volumetric filling and improvement of rather superficial wrinkles with appropriate materials. Based on the recently published recommendations on BoNTA, HA dermal fillers, and combination therapies4
, committee
members agreed that the malar contour should be restored first, followed by the orbital-malar groove and the nasojugal fold, since the lifting effect usually leads to a diminution of the nasolabial folds itself. Use of thin needles or blunt cannulas, together with slow, low- pressure injections of only a little material, as well as the lowest possible number of punctures lowers the risk of adverse events. To prevent complications in the sense of nodules and granulomas, appropriate materials in the right localisation and layer together with avoidance of an intramuscular injection is warranted.
Improvement of skin surface, collagen stimulation, and skin tightening To date, improvement of skin surface, collagen loss, and skin tightening can be addressed to a certain extent by the number of different devices using a range of physical methods such as light, radiofrequency, ultrasound or the combined use of these technologies3
, as well as
microneedling, chemical peels, and thread lifting. Devices for skin tightening stimulate heat-induced structural changes in the deep dermis and subcutis leading to contraction of fibres while retaining tensile strength3,27
Both, ablative
and non-ablative fractional lasers have been well studied for indications such as improvement of photoageing, periorbital wrinkles, and atrophic acne scars.
Lasers Non-ablative wavelengths currently employed for collagen stimulation and improvement of fine rhytides include 1,064 nm29
, 1,320 nm30 , and 1,440 nm neodymium
(Nd):YAG lasers or the 1,410 nm and 1,550 nm Er:glass fibre lasers3
. For the treatment of deeper wrinkles and skin
laxity, ablative lasers with wavelengths that are strongly absorbed by water, such as the 10,600-nm carbon dioxide (CO2
) or the 2,940-nm Er:YAG laser are being used. Since . The heat-modified tissues undergo
remodelling via fibroplasia, extracellular matrix production, and new collagen deposition, leading to skin tightening and gradual dermal thickening27
. Collagen-
stimulating devices mainly include laser-based platforms and may be divided into ablative and non-ablative wavelengths as well as fractional and non-fractional technologies28
.
conventional ablative laser resurfacing may frequently result in postoperative hyper- or hypopigmentation and scars, fractional ablative devices have become increasingly popular. Fractional photothermolysis (FP)31 enables the delivery of dermal coagulative injury without confluent epidermal damage, thus decreasing the risks of scarring as well as decreasing the downtime associated with traditional ablative resurfacing. FP is based upon
prime-journal.com | March 2015 ❚ 47
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