| FACIAL VOLUMISATION | PEER-REVIEW The dermal filler material
should be extremely viscous and elastic, such as in the case of the calcium hydroxylapatite-based dermal filler.
the mid-face area, and in most cases will normally start
to noticeably age during the mid-40s. A reduction in the volume of the facial fat compartments plays a vital role here1, 2, 3
. This leads to 3-dimensional sagging as a result of a
lack of supporting structures in the medial cheek area (in contrast, for example, to the central parts of the face or the lateral area, which do not sag in the same manner and intensity). Tear grooves form, the previously firm cheeks lose volume, and ® in an indirect manner ® the nasolabial folds become more pronounced in most cases, while the jaw line loses its shape and definition. These processes continue to develop during the early 50s, until the whole of the mid-face is sagging downwards and in a medial direction2
.
3D vectoring The negative gravitational effect of the ageing face can be understood as the action of negative vectors. As this is a 3-dimensional process, they are referred to as negative 3-dimensional vectors. A lifting effect is achieved by using a corrective
procedure with positive vectors that act in the opposite direction (i.e. laterally and cranially). This reduces the effect of the processes occurring as part of the ageing process and restores the patientÕs youthful facial proportions as much as possible4
Figure 1 Dividing the mid-face
The treatment is largely pain-free as CaHA is usually mixed with 2% lidocaine in a 20% ratio. The 3D vectoring technique with this volume filler is discussed below.
Pre-treatment preparation In general, it is helpful to define some guidelines for this specific injection technique. First of all, the distinct
known as the 3D vector technique. The fat pads are restored to their original position by treating the area with dermal fillers, and particularly those with a high volumising capacity. The aim is to return the youthful anterior cheek projection to the patientÕs face ® depending on his/her genetics and individual ageing process ® to the upper medial and lateral cheek area. By achieving this 3-dimensional lifting and re-contouring effect, the most natural results can be achieved. Particular demands must be made of the materials
. This procedure is 102
used for this volume augmentation and lifting procedure. The dermal filler material should be extremely viscous and elastic, such as in the case of the calcium hydroxylapatite-based dermal filler (CaHA; Radiesse , Merz Aesthetics). This volumising dermal filler has both marketing authorisation from the US Food and Drug Administration (FDA) and European CE certification. Compared with volumising products based on hyaluronic acid formulations, Radiesse stands out because of its high level of viscosity and elasticity compared with most of the usual hyaluronic acid dermal fillers5
. The absence of a hygroscopic effect is also a
particular advantage. Hyaluronic acid typically has a hygroscopic effect, meaning that it attracts water, which can alter its volume as a result. Therefore, a very precise lifting effect is achieved through the injection of CaHA.
Mimetic muscles of facial expression BOTULINUM TOXINS IN CLINICAL AESTHETIC PRACTICE
Frontalis Procerus
Depressor supercilii Orbicularis oculi
Levator labii superioris alaeque nasi
Compressor naris Dilator naris
Zygomaticus minor
Zygomaticus major
Depressor septi nasi
Risorius
Orbicularis oris Modiolus Platysma
Depressor anguli oris
Figure 4.1 Mimetic muscles of facial expression. Right side depicts the superficial and the left side depicts the deeper muscles.
prime-journal.com | January/February 2013 ❚ 43 Corrugator supercilii
Levator labii superioris alaeque nasi
Levator labii superioris
Levator anguli oris
Buccinator Masseter
Depressor labii inferioris
Mentalis
Upper mid-face Lower mid-face
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