When a patient comes to us and starts complaining that he has nasolabial folds, I always start working with such a patient according to the following protocol. First, I make a correction of the volume of the zygomatic region. This is very important for lifting the nasolabial fold. After filling in the zygomatic area, I proceed to the correction of puppet wrinkles and only then I look at how the nasolabial folds look. In no case should you start your work with nasolabial folds! Before starting the correction, it is necessary to take into account not only the condition of the skin and muscles, but also correctly assess changes in the bones of the skull with age.
Due to changes in the hormonal background, not only the condition of the skin changes. The main changes in the architecture of the face will occur due to the aging of the bones of the skull. How does the skull age? With aging, we observe the resorption and thinning of some bones and, consequently, there is a displacement of the muscles that are attached to the bones of the skull on one side and woven into the skin on the other. Muscles change their location and move down and inward. Visually, this will look like an overhang of soft tissue. This causes dynamic facial aging.
This condition will be emphasized by areas of the face in which there is a lack of volume. It is this area that is the temporal region. Changing the volume of this area will improve both the perception of dynamic changes in the orbit and reduce the overhang of tissues in the nasolabial region. That is why it makes sense to start working from the temporal region.
Temporal region correction can be done using the "Russian Roulette" technique. You can only work with this technique if you are absolutely confident in your knowledge of anatomy, because. in this area there are many vessels and nerves. The introduction of the drug is carried out using a needle that enters the skin perpendicularly. Entry is made to the full depth of the needle.
An aspiration test must be brought before starting the administration of the drug. It is always important to be sure that you do not hit the vessel! It is necessary to make a correction bolus and in layers. To reduce soreness, the administration of the drug should be slow.
After the correction has been made, it is necessary to distribute the preparation with soft massage movements.
An important feature of the "Russian Roulette" insertion technique is a powerful rejuvenating effect with an inconspicuous place of correction. This gives beauty and naturalness to the face of the patient.
The full version of the material is available at this link Secrets of working with patients over 40 from Professor Giammatteo Cecchini.
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