On July 20, an author's seminar was held in Kyiv by the trainer of the company "OnCosmetics", aesthetic surgeon and dermatocosmetologist Danilyuk Andrey Viktorovich. The doctor of the first category with fifteen years of experience shared his experience in contouring the nasolacrimal sulcus with colleagues. Working with injection techniques in this area requires high qualifications, sufficient experience and great knowledge of a specialist.
The seminar consisted of two parts: theoretical and practical, so the doctors were able not only to master the theory, but also to evaluate Andrey Viktorovich's practical approach. On estet-portal.com read the most important information about the features of the correction of the nasolacrimal sulcus.
Dense preparations for lacrimal trough contouring
Working with the periorbital zone is mainly periosteal, because the superficial tissues are very thin and we are limited in our ability to work superficially.
It is necessary to choose drugs that can work both deeply and superficially without getting complications.
With age, not only the volume of adipose tissue, but also bone tissue decreases, therefore, first of all, it is necessary to recreate the lack of bone tissue. It has been proven that the bones of the skeleton are resorbed unevenly. The orbit begins to intensively resolve in the lower-outer and upper-inner angle, which leads to the descent of the infraorbital ligament and the upper part of the molar sac. With age, the skin over the paint bag folds, the outer edge of the eyebrow drops, and the inner – rises, and the eyebrow from the female oblique position passes into a horizontal one. With the help of dense preparations, we restore the shape of the bone tissue, returning the rest of the tissue to its place.
Peculiarities of working with muscles in the periorbital zone
The main muscle of the periorbital region – circular muscle of the eye. The main problem associated with it – This is the formation of mimic wrinkles. In this zone, it is necessary to work not with large doses of botulinum toxin, but by intradermally injecting the drug in meso dilution, because there are zygomatic muscles, muscles that raise the corners of the lips, and a concentrated drug can diffuse and cause complications. Therefore, to obtain a good result, it is necessary to work with microdoses of the drug. This technique of mimic wrinkles correction is called "mesobotox".
Cannula – the only acceptable option for plasty of the nasolacrimal sulcus
Why is it better to work with a cannula in the periorbital area? There have been many cases when, after correcting this area with a needle, it was necessary to dissolve the drug, not because it is bad, but because the needle injects it between the fibers of the ligament. As a result of this, the ligament is defibrillated, inflamed, and it is not the preparation that contours, but the inflamed ligament itself. Until the drug is removed from the bundle – this roller will be palpable. The cannula is safe for plasty of the nasolacrimal sulcus, it cannot inject the drug into the ligament and into the vessel, it spreads it over the surface of the bone and therefore there are no complications.
How to work on the periosteum so as not to get ischemic complications
The injection needle for contouring has a cut of about 2 mm in length. If you pierce the skin perpendicularly in the injection area, and there comes across a vessel – all tissues are pierced, the front wall of the vessel is pierced, and the back – pressed against the bone. The entire section of the needle is in the vessel, and the drug is injected directly into it.
In order not to get into the vessel, the cut should not be in the vessel, and therefore the puncture must be done not where the drug should be, but retreating from it by about 1.5 centimeters. The skin is pierced with the cut down, and then with a diving movement the cut is placed on the periosteum – an angle of about 30 degrees with respect to the bone is obtained. Even if a vessel came across in this place – it is stitched through, the cut lies on the periosteum and the dense drug moves the vessel along the needle, so the drug does not penetrate into the vessel. In addition, with this insertion, the tip of the needle does not bend against the bone and the needle remains sharp all the time.
Working with fat packs during nasolacrimal trough plastic surgery
There are orbital, zygomatic, medial, central and lateral fat packs of the face. In addition to the lateral, all packages are adjacent to the periorbital zone. Each pack has septa that hold the fat. Gravity pulls the fat down, so there is a void at the top of the bag, and at the bottom – floating fat, and overhanging folds are formed. If the fold was formed due to tissue ptosis – lifting techniques are needed, and if the fold is true – the drug can be injected directly into it. It is easy to distinguish a true crease from a false one: you need to put the patient down, and if the crease is smoothed out – it is false if there is no – true. When performing plastic surgery of the nasolacrimal sulcus, we work between two folds: infraorbital and zygomatic. These ligaments secrete two fat packs: deep infraorbital fat and Bish's medial fat pack. How close are the ligaments to each other – we don't know, but with the help of a cannula, you can go from below, fill the fat pack and leave the drug on the periosteum under the ligament, creating a support for both the ligament and the skin in the area of it.
Technique of contour plastics of the nasolacrimal trough
The markup is done by bottom access. First of all, we mark the infraorbital ligament along the bony edge of the orbit, then we separate the molar sac along the submolar groove.
Puncture point – this is the intersection of a vertical down from the outer canthus and a horizontal drawn from the nose.
Through this point, you can enter both the nasolacrimal sulcus and the cheekbone area. Through the puncture point we reach the vertical, lowered through the corner of the eye. At first, the work is done superficially and in microdoses, the drug is laid out linearly retrograde with thin threads and never gets into the same channel, so that the drug fills the area, soaks the surrounding tissues and does not migrate. The less drug per pass, the better. Further, through the SMAS we pass deep to the periosteum and in the same way lay out a dense preparation there. This is how we perform superficial-deep contouring of the nasolacrimal trough.
Thank you for staying with estet-portal.com. Read more articles about contouring in the section "Cosmetology".
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