When evaluating the signs of aging in each patient, the doctor must keep in mind the multifactorial nature of this process and take into account the peculiarities of age-related changes that affect all layers of the face. Analyzing aging at every anatomical level gives the physician the ability to make a correct diagnosis and create an accurate and effective plan for invasive and non-invasive facial rejuvenation treatments. According to plastic surgeon Fernando Felice (Fernando Felice), this approach allows you to achieve maximum results that will last for a long time.
Fernando Felice (Fernando Felice) – plastic surgeon, Buenos Aires (Argentina)
Surgical and non-surgical procedures for facial rejuvenation
Every esthetician is well aware of how the skin ages and what the consequences of this process for the patient's appearance. At the same time, the specialist must be able to determine when the patient needs surgical procedures for facial rejuvenation, and in which cases it is possible to obtain good results using minimally invasive methods.
Thus, surgical intervention allows repositioning tissues, removing excess skin and fat formed as a result of aging (flies, fat in the submandibular region).
However, after surgical procedures, it is important to seek the help of cosmetic procedures again in order to improve the condition of the skin, smooth out dynamic and fine wrinkles, and restore lost facial volume.
The specialist should be able to determine when a patient needs surgical procedures for facial rejuvenation, and in which cases good results can be obtained using minimally invasive methods.
That is why, in addition to surgical methods, Dr. Felice uses a range of procedures to rejuvenate the face at various layers, including CO2 lasers, IPL, PRP, hyaluronic acid and botulinum toxin.
Case Study: Combination of Surgical and Cosmetic Procedures for Facial Rejuvenation
A 64-year-old female patient came to Dr. Felice complaining of pronounced signs of aging in her face and neck (Fig. 1). In order to select an individual program of treatments for facial rejuvenation, Dr. Felice analyzed the changes in the following layers of the face:
- skin: laxity, fine lines, pronounced folds and furrows;
- subcutaneous adipose tissue: bags under the eyes, pronounced nasolacrimal grooves, loss of volume in the cheeks, blurred lip contour, lowered corners of the mouth, fat deposits in the submandibular region, loss of clarity of facial contour;
- muscles: forehead wrinkles, crow's feet, brow lines and rabbit wrinkles;
- bone tissue: bone resorption in the periorbital region.
Fig. 1 (A) before and (B) after completion of the 30-day anti-age plan
Facial rejuvenation treatments on different layers
In order to choose the right facial rejuvenation procedures, it is necessary to discuss with the patient his needs, expectations, desired and final result. The task of the doctor – guide the patient, help him formulate aesthetic tasks correctly, the solution of which will allow him to create a natural and harmonious image.
In this case, Dr. Felice first referred the patient for surgical procedures – cervicofacial lifting, upper and lower blepharoplasty. A cervicofacial lift was performed to reposition the SMAS, remove the bands of platysma and jellies. After that, lipoaspiration of the submandibular fat was performed. This procedure allows you to "put in place" tissue, and without this, according to the author, in this case it would not be possible to achieve good results with the help of additional procedures for facial rejuvenation at the level of:
- skin;
- subcutaneous adipose tissue;
- muscle.
Facial rejuvenation treatments at skin level
Fractional CO2-laser
Facial rejuvenation with fractional CO2-laser should be carried out after assessing the patient's skin condition and eliminating possible contraindications in order to avoid dyschromia and other undesirable phenomena. It is recommended to provide both superficial and deep laser exposure to the skin. This allows you to smooth out fine wrinkles, as well as even out the texture and tone of the skin within a month after the procedure, and also after 4-6 months, the elasticity of the skin will increase.
Platelet-Rich Plasma
This facial rejuvenation procedure is suitable for almost any patient, regardless of age. PRP therapy does not cause allergic reactions, since platelet-rich plasma is obtained directly from the patient's blood. As a result of intradermal administration of PRP, the production and regeneration of collagen, elastin and other components of the extracellular matrix are naturally stimulated, which trigger a cascade of chemical and structural changes in the dermis necessary for skin rejuvenation and smoothness.
Mesotherapy and hyaluronic acid
This procedure improves outcomes after PRP therapy. Our goal – inject hyaluronic acid intradermally to provide deep and long-lasting hydration of the skin. Mesotherapy and hyaluronic acid can be used to work on the face, décolleté and hands. Result – soft, smooth, radiant and firm skin.
Facial rejuvenation procedures at the level of subcutaneous fat
Hyaluronic acid fillers are used to replenish volumes lost due to aging in certain areas of the face. Each time before working with a particular area of the face, we must establish the appropriateness of the specified procedure.
It goes without saying that it is always necessary to use only quality products that provide a good and long lasting result. When choosing a filler, it is necessary to take into account the characteristics of a particular zone and the desired effect.
When choosing a filler, it is necessary to take into account the characteristics of a particular zone and the desired effect.
Facial rejuvenation treatments at the muscle level
The purpose of botulinum toxin injections for facial rejuvenation – provide muscle relaxation in the injection area. Botulinum toxin is often used to eliminate wrinkles in the upper third of the face, where the most important muscle is the frontal – the only elevator in the area. The injection of botulinum toxin into the orbicular muscle of the eye allows not only to smooth out crow's feet, but also to raise the outer edge of the eyebrow.
Botulinum toxin in this area is also injected into the following muscles:
- muscle wrinkling the eyebrow;
- muscle of the proud;
- muscle that lifts the upper lip and wing of the nose.
Dr. Felice believes that the best result of facial rejuvenation treatments – natural. And to achieve it, the specialist must be able to determine the target muscle for the injection of botulinum toxin in each individual patient. Moreover, it is important not only to know where to inject the drug, but also its exact dosage.
Taking into account the above, we can conclude that it is necessary to select procedures for facial and neck rejuvenation based on the individual needs of the patient.
Of course, patients do not always unconditionally agree to all procedures for facial rejuvenation: lack of funds, worries about side effects – possible reasons for not taking certain anti-age therapies. The task of the doctor in this case – correctly explain to the patient the priority of the selected procedures and help to choose the most effective of them. It is equally important to always work with high quality products and technologies that will ensure patient safety and long lasting results.
It is necessary to select procedures for facial and neck rejuvenation based on the individual needs of the patient.
Facial rejuvenation treatment plan selected in this case study
In this case, a 64-year-old patient underwent the following procedures:
Day 0: cervicofacial lift, upper and lower blepharoplasty.
Day 7: Fractional CO2 laser treatment (CO2RE, Syneron Candela, Irvine, CA) including mid-to-deep dermis.
Day 7: Injection of platelet-rich plasma into the neck, décolleté and face (immediately after laser rejuvenation).
Day 14: Skinbooster (1 ml Juvéderm® Hydrate® (Allergan plc, Dublin, Ireland) instillation into the face, neck and décolleté.
Day 21: Botulinum toxin injections in the frontalis muscle (5 IU each side), brow pucker (7 IU each side), prostrate muscle (4 IU), orbicularis eye muscle (14 IU per side), and levator levator muscle. lip and wings of the nose (2.5 IU per side).
Day 30: HA filler (Juvéderm® Voluma® (1 ml)) in each cheek (Ck1, Ck2, Ck3 points according to Mauricio De Maio MD CODES®) and Juvéderm® Volbella® 1 ml to lips (MD CODES® points: Lp1, Lp3, Lp5, Lp6).
Day 30: PRP administration (second procedure).
Read also: Algorithm for the joint work of a surgeon and a cosmetologist
This case study is an excellent example of a combination of surgical and minimally invasive procedures for facial and neck rejuvenation. However, it is important to understand that in each individual case, the appropriateness of applying one or another anti-age approach is determined individually. The doctor must be aware that it is he who guides the patient in choosing procedures that will achieve the most natural and long-term results.
According to Prime magazine.
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