ARTICLE | VOLUMISING TECHNIQUES |
Figure 5 Sagging of the skin and the superficial malar fat draws the three grooves (palpebromalar, mid-cheek and nasolabial), the apple (C) transforms into a pear (D)
and latero-oral vertical fine wrinkles are the manifestation of the risorius
■ Positional wrinkles, caused by gravity or by positioning during sleep (i.e. ‘sleep wrinkles’). In the mid-cheek these wrinkles are parallel to the nasolabial fold. These plications become permanent with the loss of skin plasticity. They stay in the position where they were plicated; these are ‘false folds’
■ Tissue accumulation wrinkles. The nasolabial fold is a typical example of this wrinkle type owing to the accumulation of superficial malar fat and skin above it. It separates two zones: the upper and external zone — the cheek area where the superficial malar fat–skin pairing has no strong attachment at a deep level and so can slide and sag; and the lower and medial zone — surrounding the upper lip, where the skin adheres to the orbicularis labii muscle and therefore cannot slide.
Male versus female ageing Men have less fatty tissue than women, the cause of which is certainly hormonal — the level of testosterone in men compared with the richness of progesterone and oestrogen in women. One only needs to observe the changes in certain female athletes or bodybuilders who take anabolic steroids. Furthermore, male skin is thicker and richer in hair and sebaceous glands. Skin is less pleated and subject to fine heliodermic wrinkles. However, it does sag with ageing.
Classification of ageing on a six-point scale Classification by means of a scale is interesting as a tool for both understanding and teaching. All classifications favour one element over another; therefore, depending on whether you consider one of these elements as more essential, the scales can be adjusted according to: ■ The volume of the pommettes: insufficient, normal, excessive
■ The sagging of the mid-face with age: whether it is weakened or not.
In the authors’ opinion, the combination of these two
■ Heliodermic wrinkles, caused by damage to the dermis by variable elastolysis, are superficial and fine wrinkles caused by epidermal and dermal atrophy with alterations to the network of elastic fibres. The upper lip barcode is a typical example, but it may also exist on the cheeks
■ Dynamic wrinkles, owing to the influence of the underlying muscles (‘muscles peauciers’ in French because they are attached to the skin, ‘peau’). The ‘peauciers’ at this level are the orbital part of orbicularis oculi muscle and further down, the risorius muscle. Crow’s feet wrinkles are the expressions of the former,
36 ❚ January/February 2012 |
prime-journal.com
factors must be taken into account. As a result, a six-point classification scale of ageing can be used: ■ Scale 1: insufficient volume without sagging ■ Scale 2: insufficient volume with sagging ■ Scale 3: normal volume without sagging ■ Scale 4: normal volume with sagging ■ Scale 5: excessive volume without sagging ■ Scale 6: excessive volume with sagging. Indications for treatment will therefore depend on this
assessment scale: beautification when only the volume is insufficient; and beautification plus rejuvenation when there is tissue relaxation and hence sagging. Scale points 3 and 4 perfectly illustrate the value of
this classification. In the case of scale 3, the volume is considered as normal. In theory, any additional volume is not necessary — it would be superfluous and hence not indicated. Scale 4 is a good indication for a moderate addition, despite the normal volume. Sagging exists,
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 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92