A guide to treating your wrinkles with HA dermal filler

By Dr. TRACY MOUNTFORD, MBBS MBCAM

How long do the results last?

Hyaluronic acid treatments are not permanent and usually last between 3-24 months.

Nevertheless, the average duration of treatment depends on several factors: our skin type, the severity of the wrinkle/fold to be corrected, the type of injection and the volume of product injected.

Cosmetic products may also be used to maintain and enhance the effects of the HA dermal filler injections.

What are the benefits of volumisers?

The use of HA volumisers for the restoration or creation of facial volume can significantly help to rebalance facial disproportion and, by reducing wrinkles and volume loss, can produce a younger and healthier appearance.66,97

Volumisers can be used to create volume in targeted areas such as cheekbones and the chin.

They can also be used to recover volume in wide areas such as the cheeks, temples and the jawline.

66. Michaud T, Gassia V, Belhaouari L. Facial dynamics and emotional expressions in facial aging treatments. J Cosmet Dermatol. 2015;14(1):9-21. 97. Figus A, Wormald JC, Wade RG, Bistoni G. Hyaluronic acid for facial rejuvenation. In: Curinga G, Rusciani A, eds. Minimally Invasive Procedures for Facial Rejuvenation. Foster City, USA: OMICS Group eBooks; 2014

Dermal Filler in the Upper Face

Forehead “Frown Lines” & Glabella

Although these lines that are etched across our foreheads can be the result of natural ageing, they are more commonly caused by years of brow-raising, frowning, and daily sunscreen neglect.

Because HA attracts and holds water when injected, it plumps our skin so that these unwanted lines and wrinkles in this dynamic zone become less visible.5

Glabella lines (frown lines), also result from frequent frowning and can be treated with HA fillers.42

Although botulinum toxin injections are usually used to treat the upper face, very good results are observed with newer generation HA dermal fillers.

42. Lemperle G, Holmes RE, Cohen SR, Lemperle SM. A classification of facial wrinkles. Plast Reconstr Surg. 2001;108(6):1735-50; discussion 51-2.

Tear Trough

Even after a good night’s sleep, do you find that you look tired all the time? The truth of the matter is that circles under the eyes occur not only in people who do not sleep enough or lead an unhealthy lifestyle.

Even in healthy people who get adequate rest, dark circles or bags under the eyes can emerge.

Dark circles and “bags” under the eyes can make us look tired or older than our years.58,66

58. Coleman SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J. 2006;26(1s):S4-9. 66. Michaud T, Gassia V, Belhaouari L. Facial dynamics and emotional expressions in facial aging treatments. J Cosmet Dermatol. 2015;14(1):9-21.

To refresh and rejuvenate tired looking eyes, injection of fillers into the tear trough is a quick and effective procedure. At The Cosmetic Skin Clinic, we choose gels have been specifically designed (lightweight with minimal gel swelling to reduce the risk of adverse effects) for natural looking result and long-term correction of this difficult to treat area.90 90. Data on File. 13.

Products containing HA that is particularly adapted to this challenging and fragile area can help fight dark spots and circles under our eyes.66,76,89,90,91 66. Michaud T, Gassia V, Belhaouari L. Facial dynamics and emotional expressions in facial aging treatments. J Cosmet Dermatol. 2015;14(1):9-21.

Treating the area under our eyes with HA may also stimulates the production of collagen leading to a higher quality of the skin in terms of hydration, elasticity and radiance 77,89

77. Wollina U, Goldman A. Hyaluronic acid dermal fillers: safety and efficacy for the treatment of wrinkles, aging skin, body sculpturing and medical conditions. Clin Med Rev Ther. 2011;3(107-121). 89. Berguiga M, Galatoire O. Tear trough rejuvenation: A safety evaluation of the treatment by a semi-cross-linked hyaluronic acid filler. Orbit. 2017 Feb;36(1):22-26.

Crow’s Feet

There are essentially two main types of crow’s feet lines:58,66

58. Coleman SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J. 2006;26(1s):S4-9. 66. Michaud T, Gassia V, Belhaouari L. Facial dynamics and emotional expressions in facial aging treatments. J Cosmet Dermatol. 2015;14(1):9-21.

Those that appear due to the actions of our underlying muscles. This can easily be illustrated if we smile or squint: this activates the muscles around the outside of our eyes to form crow’s feet.

Those that are present all the time, even when we are at complete rest or asleep. They result from a long history of, for example, squinting, frowning and sun damage.

Hyaluronic acid dermal fillers are an excellent option to correct fine lines and superficial wrinkles in sensitive areas such as the crow’s feet and eyebrows.

Hyaluronic acid dermal fillers are a minimally invasive treatment option..29 We can temporarily improve our skin’s appearance by getting injections (using a very small needle) of an HA dermal filler directly into our crow’s feet.66,71

66. Michaud T, Gassia V, Belhaouari L. Facial dynamics and emotional expressions in facial aging treatments. J Cosmet Dermatol. 2015;14(1):9-21. 71. Muhn C, Rosen N, Solish N, Bertucci V, Lupin M, Dansereau A, et al. The evolving role of hyaluronic acid fillers for facial volume restoration and contouring: a Canadian overview. Clin Cosmet Investig Dermatol. 2012;5:147-58. 29. Data on File. 3.

Dermal Filler in the Mid Face

Cheeks

Our cheeks have a huge impact on how we look. Round, plump cheeks (does the phrase “baby face” ring a bell?) create a youthful appearance and high cheekbones are generally considered attractive.

Volumising the cheeks has an extraordinary rejuvenation looking effect.

The quality of our skin decreases with the loss of collagen, elasticity and hyaluronic acid. Bone is reabsorbed around our eyes, cheeks and jawline. As a consequence, our face may appear deflated and sunken in the cheek area, leaving us with a bitter, sad and tired appearance.50,58,66,79

50. Emre IE, Cakmak O. Ageing face, an overview – Aetiology, assessment and management. Otorhinolaryngol. 2013;6(3):160-6. 58. Coleman SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J. 2006;26(1s):S4-9. 66. Michaud T, Gassia V, Belhaouari L. Facial dynamics and emotional expressions in facial aging treatments. J Cosmet Dermatol. 2015;14(1):9-21. 79. Dayan SH, Bassichis BA. Facial dermal fillers: selection of appropriate products and techniques. Aesthet Surg J. 2008;28(3):335-47 79. Dayan SH, Bassichis BA. Facial dermal fillers: selection of appropriate products and techniques. Aesthet Surg J. 2008;28(3):33

The simplest and quickest way to restore the lost volume in your cheeks is with HA dermal fillers that are specially formulated to replenish volume such as Teosyal RHA4. 27,29.

27. Brandt FS, Cazzaniga A. Hyaluronic acid gel fillers in the management of facial aging. Clin Interv Aging. 2008;3(1):153-9. 29. Data on File. 3

Besides restoring volume in the midface, superficial lines and wrinkles, such as accordion lines, can also be treated with dynamic HA filler to improve skin surface texture, radiance and hydration.29,66

29. Data on File. 32. Tosti A, De Padova MP. Atlas of Mesotherapy in Skin Rejuvenation. London, UK: Informa Healthcare; 2007.

66. Michaud T, Gassia V, Belhaouari L. Facial dynamics and emotional expressions in facial aging treatments. J Cosmet Dermatol. 2015;14(1):9-21.

The results of HA dermal filler treatments can last up to 24 months.31

31. Topical report. Injectible products to fill wrinkles. France: ANSM: Agence nationale de sécurité du médicament et des produits de santé; 2012.

Dermal Fillers in the Lower Face

Lips

Full lips have always symbolised glamour and sensuality, especially in women. It is no wonder that lip augmentation remains one of the most requested aesthetic treatments, in young and old patients alike.

Although most lips will lose volume and definition with age, pursing or puckering our lips frequently, when sipping or smoking, along with increased sun exposure, are major causes of wrinkles and lines around the lips (also known as bar code and smoker lines).42,66 42. Lemperle G, Holmes RE, Cohen SR, Lemperle SM. A classification of facial wrinkles. Plast Reconstr Surg. 2001;108(6):1735-50; discussion 51-2. 66. Michaud T, Gassia V, Belhaouari L. Facial dynamics and emotional expressions in facial aging treatments. J Cosmet Dermatol. 2015;14(1):9-21.

Hyaluronic acid dermal fillers are well adapted to replenish the volume lost and re-establish the pleasing aesthetic look of well-proportioned and voluminous lips.

At The Cosmetic Skin Clinic, we choose a filler that respects the movements/dynamics of the lips.

The amount of treatments needed to see satisfactory results vary from individual to individual & depends on several factors, including, age, lifestyle, skin type & expected outcomes. 77

77. Wollina U, Goldman A. Hyaluronic acid dermal fillers: safety and efficacy for the treatment of wrinkles, aging skin, body sculpturing and medical conditions. Clin Med Rev Ther. 2011;3(107-121).

Chin

Our chin plays an important role in the overall silhouette and symmetry of our face. Balanced and harmonious facial features are key to a beautiful appearance and self-confidence. If we have a short or stubby chin, the entire facial structure is affected.85 85. Sykes JM, Fitzgerald R. Choosing the Best Procedure to Augment the Chin: Is Anything Better than an Implant? Facial Plast Surg. 2016 Oct;32(5):507-12.

As we grow older, our chin tends to lose volume and projection.50,58 To combat this, HA can be used to gently reshape the fullness and soft contours of our chin for a completely natural looking result.66 50. Emre IE, Cakmak O. Ageing face, an overview – Aetiology, assessment and management. Otorhinolaryngol. 2013;6(3):160-6. 58. Coleman SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J. 2006;26(1s):S4-9. 66. Michaud T, Gassia V, Belhaouari L. Facial dynamics and emotional expressions in facial aging treatments. J Cosmet Dermatol. 2015;14(1):9-21.

If you feel that your chin is not adequately prominent or is not balancing your other facial features, a chin augmentation with HA may be the solution

Chin augmentation with HA dermal fillers is a good way to improve beauty with minimal risk, no down time and results.27,66,85,86 27. Brandt FS, Cazzaniga A. Hyaluronic acid gel fillers in the management of facial aging. Clin Interv Aging. 2008;3(1):153-9. 66. Michaud T, Gassia V, Belhaouari L. Facial dynamics and emotional expressions in facial aging treatments. J Cosmet Dermatol. 2015;14(1):9-21.

Even with a modest amount of filler, the chin can have a noticeable improvement. This can also help to define the jawline. 85,86 85. Sykes JM, Fitzgerald R. Choosing the Best Procedure to Augment the Chin: Is Anything Better than an Implant? Facial Plast Surg. 2016 Oct;32(5):507-12. 86. Data on File. 11.

Dermal Filler in the Lower Face, Chin & Neck

Jaw

A well contoured jawline is an important aspect of the overall aesthetic correction of the lower face.

In fact, the main typical youthful features are:66

Hyaluronic acid fillers can be used to safely and effectively reshape and contour the jawline, as well as restore volume loss to create a youngerlooking appearance

66. Michaud T, Gassia V, Belhaouari L. Facial dynamics and emotional expressions in facial aging treatments. J Cosmet Dermatol. 2015;14(1):9-21.

Neck and Decolletage

With age, the skin on your neck loses collagen, elastin and fat. Necklines appear initially fine but with time, they get deeper. The skin on your décolletage starts looking crepey.

Sagging skin and folds as well as, wrinkles, on the neck and décolletage are often the first noticeable signs of skin ageing.42,50,58,87 Along with the normal ageing process, increased sun exposure of this area can also take a toll on the skin of our neck and décolleté, which may become droopy and “turkeylike.”42,50,58

42. Lemperle G, Holmes RE, Cohen SR, Lemperle SM. A classification of facial wrinkles. Plast Reconstr Surg. 2001;108(6):1735-50; discussion 51-2. 87. Redka-Swoboda W. Treatment of neck lines and décolleté with HA fillers: specific protocols associating TEOSYAL® Redensity [I] to the new resilient semicrosslinked TEOSYAL® RHA1 depending on patient morphotypes. 2016. Anti-age magazine #24.

These changes are caused by the loss of elasticity and accumulation of fat in the neck area.50,58

50. Emre IE, Cakmak O. Ageing face, an overview – Aetiology, assessment and management. Otorhinolaryngol. 2013;6(3):160-6. 58. Coleman SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J. 2006;26(1s):S4-9.

By nourishing the skin from within and restoring its density, HA is a highly desirable candidate to tighten and redefine our neck and jawline to regain a youthful looking neck.

*DISCLAIMER Patient experience and results may vary. These are dependent on a number of factors such as lifestyle, age and medical history.

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