The success of hyaluronic acid filler correction depends on a number of factors, among which an important role is played by the choice of a drug that will provide an instant, but long-term result.
In an interview for estet-portal.com Anastasia Saibel – dermatovenereologist, cosmetologist, candidate of medical sciences, international expert Merz Aesthetics – spoke about the criteria for choosing fillers based on stabilized and native hyaluronic acid, the main cosmetology trends and the peculiarities of working with aged patients.
Which zones are the most relevant for today
First of all, we pay attention to the areas that affect the perception of facial harmony. In principle, it is necessary to restore those zones that contribute to the formation of the correct proportions and visual symmetry of the face.
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For some patients it is the cheekbones, for others – chin and so on. Therefore, the first thing a doctor should do is – evaluate the correct proportion and symmetry of the face, because the beauty – it is harmony. And the choice of the target correction zone – this is an individual approach, which is also extremely relevant now. In working with our patients, the main thing – individuality and harmony.
If the patient immediately wants to get a visible effect, which area do you correct first
In my opinion, in this case it is important to hear the patient, to find out which zone is significant for him. And then, of course, we start the correction from this zone. For most girls, this will be the lips. For men, probably today it is between the eyebrows. And that is why botulinum toxin therapy will still retain its leading position among all aesthetic procedures precisely due to the gradually forming, but at the same time pronounced result, which does not require rehabilitation and effort from the patient.
In working with our patients, the main – individuality and harmony.
How do you solve the problem of static wrinkles
It all depends on the area in which static wrinkles are localized. The appearance of static wrinkles is associated with a change in both the quality and quantity of the intercellular substance of the dermis (respectively, it is hyaluronic acid), and the frame functions of the skin – and these are the structures of collagen and elastin.
So, for example, if a patient has static wrinkles in the periorbital, perioral, forehead or head area, I use only stabilized hyaluronic acid, which will instantly fill these superficial wrinkles and stimulate the dermis, thereby providing a prolonged result.
But if static wrinkles are localized on the lateral surface of the face, in the neck, décolleté or on the skin of the anterior abdominal wall, which indicates changes in the structure of the skin, the collagen-stimulating filler will be the drug of choice. In my practice, this is Radiesse.
When do you prefer to use stabilized hyaluronic acid
Native non-stabilized hyaluronic acid is a physiological stimulant that regulates the activity of both fibroblasts and vascular endotheliocytes by acting on external cell receptors. But these receptors are only active during the reproductive period. With the onset of perimenopause (this applies to both women and men), we will not get a pronounced stimulating effect from native HA.
Such preparations will provide hydration and faster recovery of the skin after damage due to the accelerated re-epithelialization processes in humid conditions. But if our goal is – to obtain a pronounced stimulating effect and a long-term restoration of the dermis volume in aged patients, it is necessary to use stabilized HA. Despite the absence of stimulation of external receptors, such HA will stimulate collagen synthesis by changing the tension of the outer wall of the fibroblast cell. Yes, such stimulation will be short-term, but it will be.
Working with aged patients: effective procedures for rejuvenation
Today, studies are available that confirm that with the intradermal injection of stabilized hyaluronic acid, we get, firstly, an instant increase in the volume of the dermis. This can be tracked by ultrasound scan data. In addition, we see the preservation of this volume for a long time and an increase in the number of collagen fibers after such injections.
Thus, stabilized hyaluronic acid provides both instant and sufficiently long-lasting results, which cannot be obtained with native hyaluronic acid in an aged patient.
Stabilized HA provides both immediate and sufficiently long-term results, which in an aged patient cannot be obtained using native HA.
History taking before correction in patients 40+: what points do you pay attention to
Classical education, when we were taught to think clinically, and not just prescribe tests and therapy, allows us to work more efficiently now. According to the classification of aging morphotypes according to Kolgunenko, five aging morphotypes are distinguished up to a certain age – Each of them has certain characteristics. In some cases, they are quite pronounced, but there are also combined types. And when I am faced with a combination of different types of aging, I have questions about the health of patients.
For example, if a patient comes to me with an initially muscular type of aging – with a good volume of muscles, with their pronounced activity, but there is an edematous syndrome, most likely, there is some kind of somatic cause. In fact, this is the most unfavorable combination when edematous syndrome joins the primary morphotype. Or, for example, when I see early age-related skin atrophy in a patient that does not correspond to his passport age, I also find out why the skin ages prematurely.
Secrets of face correction with different morphotypes from Anastasia Saibel
In addition, today we must clearly define the so-called isolated morphotype – exhausted old face. Now patients not only 40+, but also 70+ come to us. In my practice, these are the parents of my patients. In patients with such severe aging, stimulation techniques will not work at all. In such cases, the somatic history is significantly burdened, and our task – choose the right drug to compensate for these signs of aging.
In such cases, it is only stabilized HA and botulinum toxin, if there is still an amplitude of muscle work, and not just hypertonicity. Therefore, when there is a dissonance between passport age and appearance, or a combination of aging morphotypes, I find out the anamnesis.
We all have our own specialization, and it is better if a professional provides assistance – so we always work as a team.
Which related specialists do you constantly cooperate with
I always work together with an endocrinologist-gynecologist or with an urologist-andrologist (depending on the gender of the patient). If I have doubts about any, for example, autoimmune processes, or in the presence of chronic hypoxia against the background of chronic anemia, of course, I turn to a therapist.
If a patient comes to me with micrognathia, impaired occlusion, bruxism, respectively, I refer him to the dentist. We all have our own specialization, and it is better if a professional – so we always work as a team.
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