Correction of the deformed and finely wrinkled morphotype: preparations and techniques

When choosing an approach to facial rejuvenation, in order to achieve the most natural and lasting result, it is necessary to take into account the peculiarities of aging morphotypes. Vladlena Averina – dermatovenereologist, scientific coordinator of ANK company, international speaker Teoxane – in an exclusive interview for estet-portal.com, she spoke about the features of the choice of drugs and techniques for the correction of deformative and finely wrinkled morphotypes of aging.

ED. Please tell us about the features of the correction of the deformity morphotype (heavy face).

V.A. Today, about a third of the lecture was devoted to the correction of the deformation morphotype of aging, because all women who were presented as models have either a completely deformation type of aging, or certain elements of it, i.e. combined morphotype. Accordingly, for the correction of a heavy face, considering the proportions (upper, middle and lower parts) of the face, it is important to understand what specific changes are characteristic of it.

With a deformation morphotype, such signs as sagging of the cheeks, uneven (wavy) line of the oval of the face, overhanging and drooping of the fold of the upper eyelid, double chin, fatty hernia in the lower eyelid, pronounced nasolabial folds come to the fore. At the same time, the skin retains its hydration.

Drier skin is seen on the forehead and in the perioral region. The least elastic is the skin of the neck, which means that it is in this zone that the greatest deformations should be expected (the formation of pronounced nasolabial folds, nasolabial grooves and marionette wrinkles). Also of note here is mild to moderate photoaging, slight skin hyperpigmentation, slight keratomas and lentiginous patches on the face.

Skin aging may be exacerbated by the presence of an edematous or vascular component. With an edematous component, puffiness of the face is observed, the skin has the greatest luster among other morphotypes. The vascular component is expressed by rosacea of ​​the facial skin.

The upper third of the face is not entirely suitable for botulinum toxin correction, especially the frontalis muscle, which acts as a lymphatic drainage pump. Accordingly, if you disable this function, it can lead to lymphostasis. And, even if the eyebrow does not fall as a result of the correction with botulinum toxin, swelling of the upper eyelid may develop. Therefore, a deep correction of the temporal region or a correction between two sheets of the temporal fascia is necessary not so much to add volume, but to lift the upper eyelid and the lateral part of the eyebrow.

For the middle and lower part of the face I prefer to use thicker fillers – Teosyal RHA 4 from the new line or Teosyal PureSense Ultra Deep from the classic line. For work it is better to use a 22G cannula (6 or 7 cm). From one point of insertion (in massateric) we move to the corner of the mandible. For correction in the projection of the angle of the lower jaw, we leave a bolus at this point or conduct it, directly imitating the bone of the lower jaw. And then from one point, again, turning around, we go into the deep buccal fat pack and restore the structure, since the nasolabial fat pack with a deformation morphotype will hypertrophy and slightly ptose – due to this, an overhanging nasolabial fold is formed.

ED.

What are the main features of the correction for fine wrinkled aging morphotype?

V.A.

Finely wrinkled morphotype is typical for women with a more asthenic physique, when the volumes of almost all fat packages are proportionally lost, and we observe a large number of both small and medium wrinkles. In addition, these patients may experience problems with hyperpigmentation.

As we know, with

wrinkled morphotype, age-related dystrophic changes in the dermis, epidermis and subcutaneous fat, which manifest themselves in the form of numerous wrinkles, predominate. Despite the increased sensitivity of the skin, women with this morphotype do not notice increased sensitivity to various external stimuli (cold, dry air, excessive insolation).

The skin of the neck is the most deformable. Due to the uniform distribution of subcutaneous tissue, there are no differences in the deformation of the skin of the forehead, buccal and perioral areas. This type is characterized by deep wrinkles of the upper and lower lips. Photoaging of moderate or severe degree is manifested by significant skin dyschromia and the presence of hyperkeratosis due to photodamage. 

Of course, fine-wrinkled morphotype correction should be approached more comprehensively – and with peels, and with hardware techniques (IPL, etc.), and with skin boosters.

I would like to tell you about a specially developed technique for using Teosyal RHA 1 and Teosyal Redensity I in one procedure.

This approach makes it possible both to fill small wrinkles (with Teosyal RHA 1) and to administer Teosyal Redensity I intradermally as a

skinbooster. The use of only 2 ml of these preparations gives a very beautiful result, this procedure is repeated once a month (3 procedures can be performed in total).

There is also a

technique called the star technique: from the central point of the cannulas we work with superficial fat pads (creating a push-up effect, so to speak) along several vectors that go to the infraorbital zone, to the nasolacrimal furrow, then to the cheekbone, to the nasolabial fold, to the corner of the mouth and then – to the angle of the lower jaw. Thus, we form the apple of the cheek, which looks very beautiful and natural for a finely wrinkled morphotype – after such a correction, a woman always looks younger.