A guide to treating your wrinkles with HA dermal filler

By Dr. TRACY MOUNTFORD, MBBS MBCAM

What are anti-wrinkle treatments (hyaluronic acid-based fillers)?

Hyaluronic acid (HA)-based dermal filler anti-wrinkle treatments are:27

  • Mini-invasive
  • Non-surgical
  • Non-permanent

When HA is injected, it acts like an inflated cushion to support your facial structures and tissues that may have lost volume or elasticity due to normal ageing. 27 Hyaluronic acid dermal fillers are applied to reduce the appearance of wrinkles, restore volumes and contours and create a balanced, natural look. 5,59,102

What are the benefits of hyaluronic acid dermal fillers?

In addition to their effectiveness in smoothing out wrinkles and rejuvenating facial features, HA fillers also have the following benefits: 5,27,36,59

  • Biocompatible and safe
  • Allergic reactions are unlikely
  • Can be easily removed if necessary
  • Minimal patient discomfort and downtime
  • Adverse reactions are uncommon
  • Results are long-lasting, but not permanent

5. Olejnik, A., Goscianska, J. and Nowak, I. Significance of hyaluronic acid in cosmetic industry and aesthetic medicine. Chemik 66, 129–135 (2012). 27. Brandt FS, Cazzaniga A. Hyaluronic acid gel fillers in the management of facial aging. Clin Interv Aging. 2008;3(1):153-9. 36. Gold MH. Use of hyaluronic acid fillers for the treatment of the aging face. Clin Interv Aging. 2007;2(3):369-76. 59. Fida M, Dervishi O, Pupo L, et al Aesthetic Dermatology Today. IJSR. 2015;4(10):1799 – 1803 102. Andre P. New trends in face rejuvenation by hyaluronic acid injections. J Cosmet Dermatol. 2008 Dec;7(4):251-8.

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 uses of HA injections?

Hyaluronic acid injection treatments can be used to:27,62,66,75

  • Correct wrinkles, whether they be fine lines, deep set folds or creases
  • Create volume in targeted areas or recover volume in wide areas
  • Deeply hydrate and improve the tone and firmness of your skin

27. Brandt FS, Cazzaniga A. Hyaluronic acid gel fillers in the management of facial aging. Clin Interv Aging. 2008;3(1):153-9. 62. 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):921. 75. Data on File. 7.

Areas of the face you can treat with HA fillers…

Hyaluronic acid fillers are used to treat all areas of the face, which can be divided into upper, middle, and lower face.27,66

Upper Face

Midface

Lower Face

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):921.

Hyaluronic acid fillers can also be used to treat the neck and décolleté.

What are volumisers?

Hyaluronic acid dermal fillers can be used for volume restoration and contouring facial features. 66,71,103 Hyaluronic acid volumisers can be injected into different layers of your skin to correct both volume loss and structural defects. 71

It is not simply the addition of volume, but correct placement of the volumiser will create excellent results in restoring a natural youthful appearance. 71

What’s more, new Hyaluronic Acid gels with optimised properties are now available that respect our facial movements such as RHA4 Teosyal.

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, 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. 103. Data on file. 15

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.

Nasolabial Folds

Nasolabial folds are sometimes referred to as smile or laugh lines.65 These lines typically, curve down from the side of our nose to the corners of our mouth.42 65.Burgess, edited by Cheryl M. (2005). Cosmetic Dermatology. Berlin, Heidelberg: Springer-Verlag Berlin Heidelberg. p. 106. 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.

As we age, and our facial structures begin to sag, these dynamic lines become more prominent looking on our face: they become more noticeable as the skin hangs down, giving us a “defeated” look.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.

Hyaluronic acid dermal fillers are the best treatment option to plump up the skin under nasolabial folds. They restore the lost volume and soften the appearance of creases, providing noticeable and natural looking results.27,66 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.

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).

Marionette Lines

Marionette lines are the lines that run from the corners of the mouth to the chin. The problem with marionette lines is that they tend to show emotion, even if we’re not trying to express anything, leading others to believe that we’re sad, angry or disappointed.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.

There are a few options for softening the appearance of marionette lines. Filling these lines with HA dermal fillers is easy, highly accessible and actually the most popular. 27 By using dermal fillers to replace the lost volume in our skin, it is possible to dramatically reduce and smooth the appearance of marionette lines.29,66 Our face will quickly look happier and younger. 27,66

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. 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 work immediately by adding volume to smooth away marionette lines.

The results usually last more than 12 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.75

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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