How to recreate the volume of the face with a filler: professional advice

Today we will talk about deep supraperiosteal preparations – which of them are in the cosmetologist's arsenal, and what can he achieve with them, which of the drugs and at what age of the patient is most preferable.

Will help readers of estet-portal.com deal with these issues Andrey Viktorovich Danilyuk, aesthetic surgeon, specialist in in regenerative medicine, certified trainer of PMG in invasive techniques in aesthetic medicine.

Why is it important to recreate the volume of the face for a rejuvenating effect

I would like to start a conversation about fillers with the phrase of the great sculptor "The power of great masters lies in the knowledge of volumes." The work of a sculptor is directly related to appearance, but he embodies it in stone, while we work with a living person, but we are dealing with the same volumes and forms as the sculptor. Therefore, we need to know the final image – what we want to achieve, how the drug introduced into this or that zone will change the appearance, how, what and where to inject in order to get what we want. The beautician is also partly a sculptor, but a sculptor of the human body.

There are two categories of patients who may need to adjust the volume of the face – they are young and old. Young – have some kind of congenital, genetically determined & nbsp; lack of volumes, age – already complain that the volumes of the face are disappearing, its oval, the shape is changing.  Lack of volume in young people can be both insignificant and significant. This is such a relative border when we need to understand – we can manage with our injectables, and when we can't, the patient has a direct path to plastic surgeons.

About age-related changes – the question is also somewhat relative, since it is not always possible to clearly define the boundary between youth and old age. Each person perceives himself in his own way - either young or old. What is old age in the aesthetic aspect? When – Clearly, it's a question of attitude. What changes are taking place, and, most importantly – what can we do about it? It is very important how patients see themselves in the mirror, and with what request they come to us. Let's say the patient wants to fill in the nasolabial fold. But she sees herself in the mirror directly, and not from the side, and therefore does not understand the reason for the formation of this fold. She believes that she has lost volume in the area of ​​the nasolabial fold, but all the problems in the lower third of the face appear because the volume in the middle third is leaving. The patient can understand this if he is photographed from the side or given the opportunity to evaluate the face with two mirrors. If we correct the nasolabial fold, then there is a risk of making the lower third of the face heavier.

Why can facial volume decrease with age?

There is one of the theories of aging – This is the damage accumulation theory. What does it include? Let us return to the question of at what age human cells begin to age. The cell has its own life cycle, for example, a skin cell lives for 21-24 days. Why does the body grow? Because the processes of cell growth and division prevail over the processes of their death. But by about the age of 25 in humans, these processes are equalized. At this age, he still looks young, because, as a rule, there is no accumulated damage yet. Then the processes of destruction begin to prevail. They don't happen faster, they happen at the same speed, but the recovery processes become slower and the damage starts to accumulate. Dilapidated cells begin to accumulate and these under-restored tissues give us manifestations of age-related changes. This is important for understanding what and why we restore during the procedure. As destruction accumulates, there is & nbsp; a decrease in the volume of the dermis, subcutaneous adipose tissue, all other soft tissues up to the bone tissue. Studies show that the volume of tissue in a person after 25 years of age decreases by about 1% per year.

Why are our actions as cosmetologists aimed at restoring facial volumes?  

Bone – it is the foundation of the face on which all the soft tissues lie and rely on it. If this base is deformed with age, then the tissues also sink, as if falling inward.  Studies have shown that not only the density of bone tissue, its mass, but also its shape decreases. And if in other parts of the skull this is not so obvious, then in the region of the middle third of the face – upper jaw and zygomatic area – the process is very clear. Fat packs lie here – deep and superficial, the dermis becomes thinner, the bone goes deeper and, naturally, enhances age-related manifestations. Thus, the restoration of bone volume is always in the first place. And often even this procedure alone is enough to completely correct all the changes which appeared in the lower third of the face – flies, marionette lines, nasolabial folds.

What happens with age in our tissues? In the periorbital region, the bone is resorbed in the upper inner and lower outer corners. The lower outer angle along the bony edge of the orbit is connected to the infraorbital ligament, which connects the bone to the skin. The ligament keeps the skin from ptosis. With age, this corner of the bone descends, along with the bone, the ligament descends, and the manifestations of the paint bag worsen.  The upper inner corner also decreases in volume and rises, while the tail of the eyebrow falls and its inner edge rises.

The angle of the lower jaw is sharper at a young age, but with age it resolves and becomes more blunt. The branch of the lower jaw is shortened, the excess skin on it is collected in jowls.

What does the middle third of the face consist of and how should this be taken into account when correcting?

The middle part of the face includes the  infraorbital ligament, which joins the bony edge of the orbit, the zygomatic ligament, superficial and deep fat packages. The boundary between superficial and deep fat pads is SMAS – muscular-aponeurotic layer (there are mimic muscles, ligaments, and all this is covered with fascia). Superficial fat plays the role of an energy storage system, while deep fat performs nutritional functions.

Thus, age-related changes in the middle third of the face are manifested by a decrease in volume and stretching of the skin. At the same time, the skin becomes thinner and, under the influence of gravity, falls down, its area increases, forming overhangs that look like folds of the lower third on the face. Each fold is held by its own ligament. No matter how much drug we inject, the ligament will still hold the skin, and we will not be able to smooth out the folds until complete alignment.

What can a beautician do to restore facial volume

We can restore the missing volume, and at all levels. Volume restoration preparations are divided by density into three types: high, medium and low density. Each of them has its own level of introduction. Correction with dense preparations always comes first, since you need to start from the base. Before them, there can only be botulinum toxin or threads that stimulate collagen preparations. If we introduce a dense preparation, and then carry out collagen stimulation, the skin will stretch on the added volume of tissues, and then it may sag. Therefore, first you need to slightly reduce the skin, increase its elasticity (by peeling, laser resurfacing, and other methods), and when the contraction has already begun, we prick a dense preparation in order to raise the reduced skin to the surface. In this case, even when the volume of the drug is gone,

In our arsenal we have 2 groups of supraperiosteal preparations. The so-called high-density shaping preparations based on hyaluronic acid withstand the pressure of tissues that lie on top, correct the shape of deep-seated bone, and last a long time. The second group of drugs – based on calcium hydroxyapatite. This substance cannot be approached as a classic filler. It has a slightly different principle. This drug is diluted with anesthetic. When we inject the drug, we create volume due to the liquid, which will go away within a month, but the internal volume of normotrophic collagen will begin to grow due to the irritating and stimulating effect of calcium hydroxyapatite. This collagen gives the effect of lifting, not just filling. The drug stimulates the production of collagen

Which drug and in which case do we choose for facial volume?

Young people mostly lack congenital volumes, which means they do not have the void that is typical for age-related patients with a decrease in bone and adipose tissue.  Therefore, in this category of patients, preference is given to preparations based on hyaluronic acid.  The tissues of young patients quickly regenerate, and therefore, after further withdrawal of the drug, they will easily recover. In aged women, regeneration is weak, and therefore, after the removal of a dense preparation that squeezes the surrounding tissues, they age much faster. Therefore, preference is given to more fluid preparations – with calcium hydroxyapatite, which impregnates tissues, filling the voids that have appeared there with age.

Thus, when we evaluate our ability to correct any changes, we must consider all the reasons why these changes occurred. And only by restoring deep tissues in the middle zone, bone volumes, we can achieve an acceptable result.