Aesthetic Applications for Fillers

The Clinical Problem—The Aging Face ( Fig. 3.1 )

How Does the Face Age?

Each face ages in its own way according to genetics and external factors, such as sun, tobacco, diet, life stress, and illness.

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The main phenomena are the appearance of wrinkles, loss and shifting of facial volumes, and contraction of the muscles used in making facial expressions.
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The solution for the shifting of facial volumes will be surgical and, for muscle contractions, botulinum toxin will be used.
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Hyaluronic acid will treat wrinkles and the loss of facial volume by supplying good hydration, thus enhancing the condition of the tissue.
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Analyzing the face will detect the weak areas to be treated first. The next step is to determine the healing and preventive treatment plan by focusing on the facial areas that tend to age faster.
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A distinction among wrinkles, skin folding, and grooves should be made because their treatments are different.

Wrinkles and Skin Folding

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A wrinkle can be described as a fracture of the skin. It can range from deep to shallow and may appear as being inscribed or engraved into the skin. When superficial, it may appear as just a thin line. Most importantly, it is apparent even when the face is at rest, without expression or contraction.
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Wrinkles are due to a modification of the cellular architecture of the skin. They should be differentiated from grooves, which are permanent hollows, and from skin folding, which is visible only when the muscles used for facial expression contract and then disappear once the muscles relax. For example, the muscle contraction near the upper lip shows folds when the vowel “u” is pronounced. Later in life, a skin fracture may replace these temporary folds and, as wrinkles, will eventually cease to disappear at rest. The treatment for wrinkles and skin folding differs.

Grooves

Grooves are hollows that do not all have the same origin. The grooves of glabella are due to the corrugator contraction, the nasolabial folds are due to multiple factors, such as zygomatic contraction, fall of the nasolabial fat, and maxillary bony loss, and so-called bitterness folds, which are due to a fall of the jowl fat. The medical treatment for these grooves consists in filling them by raising tissues with a highly reticulated filler.

Clinical Examples

Treating Wrinkles ( Fig. 3.2 )

Using a very fine needle, 32 or 33 gauge, hyaluronic acid is injected to raise the wrinkle level and, in effect, make it disappear or strongly fade. The depth of the injection will depend on the wrinkle depth. All wrinkles, even the finest, can be treated. An injection that is too superficial can leave visible small beads, and too deep an injection can be ineffective. Thus, the quality of the result will rest on the appropriate depth of the injection, size of the needle used, and amount of injected hyaluronic acid.