(By Dr. Raspaldo, this article was published in the ”Anti-Age” Magazine n°2)

Mini-lift, micro-lipostructure, botulinum toxin and hyaluronic acid injectionsto improve volumes and the facial structure

From the simplest procedure to the most complex one, there are 4 major steps involved when you want to have a thinner face and neck, and the 4 of them can be combined:

– the botulinum toxin

– the volumizing hyaluronic acid injections

– the micro-liposuction

– the mini-facelift

These non-invasivemedical methods were made possible bythe evolving knowledge,the high-valueand safe injectables but also by several practitioners’ innovative skills. There are two main categories:

– techniques with direct action on the thicknessof the face (non invasivesurgical methods),

– techniques with indirect action on the facialvolumes and the muscles’ dynamic (medical injections).

(We will not discuss the traditional thinning methods here).

The botulinum toxin

For 40 years, the botulinum toxin has been used successfully and safely all over the world to treat muscle spasms. Since 1991, the botulinum toxin has also been used in facial rejuvenation aesthetics. The product was granted theMarketing Authorization (MA) in France in 2003; it is therefore approved by the Ministry of Health for the treatment of wrinkles.

In the past 7 years,many other indications have been discovered, especially forthe lower face. We have published two major scientific studies leading to the French consensus on the use of botulinum toxin for the upper and lower face (Journal of Cosmetic Dermatology 2011, Raspaldo and coll.).

The botulinum toxin has a place of choice, before surgery, when it comes to treating the lower face and the neck. When injected carefully and in low dose into the cutaneous muscle of the neck (also called Platysma), it relaxes the depressor muscles (which“pull” the face and the neck downwards). As a result, it supportsthe so-called ”levator” muscles (that “lift” the mandibular line) and thus improves the shape of the face.

A similar treatment is used to correct the “square” appearance of the jaws: botulinum toxininjectionsin the Masseter muscle, which develops considerably when a person chews constantly. Thisis what happens in Asia or the USA where peopleoften chew all day. The botulinum toxin decreases the permanent contraction of this powerful muscle.The muscle volume goes down and the shape of the face changes.

Finally, the botulinum toxin is used in addition to a facelift, in order to maintain the relaxation of the platysma muscle, which is the depressor muscle of the mandibular line.

The volumizing hyaluronic acid

For a long time, aesthetic procedures consisted in filling wrinkles, which sometimes resulted in an increased volume in the lower face. But today’s innovative volumizing products make it possible to reshape the volumes and create a new, upward-oriented facial shape (a heart-shaped face). We work on the shadows and the lights, the full and the thin areas, the convexities and the concavities, the domes and the valleys, we increase the cheekbones projection to give the illusion that the lower face is thinner.

The method: cross-linked hyaluronic acid (Voluma type) is injected at a deep level, in order to recreate the lost volume in the midface (cheekbones and hollow under the eyes), reshape facial volumes (heart-shaped) and restore the harmony of the facial features. This concept, called”heart of face”(HeART of Face®) is based on a natural approach to facial rejuvenation. It is designed to act on three dimensions, the volumes (heart-shaped), the skin texture (by hydrating it) and when used with botulinum toxin, the face dynamic (expression lines, mimicry).

We can use the same method and products for injections in the chin, in order to improve its contour  and increase its projection, which from a profile view, will make the neck angle (or neck-chin angle) look deeper.

This is the best way to complete the facial slimming medical treatment with injectable products.

Micro-lipostructure

When the cheeks look“heavy”, partially thickened by excessive fattissue, butthe skin still has good elasticity, and no drooping skin, liposuction under local anesthesia is the perfect indication.

The method: A micro-cannula is inserted inthree entry points (under the chin and under each earlobe) after local anesthesia. The excess fat is extracted,then the skin goes back to its natural shape (as a result of subcutaneous scarring).

No bandages are needed. You will have towear an elastic dressingat night for 21 days. The three microstitches are removed on the 6th day. Bruising can occur for 7 to 15 days. It’s a painless procedure. In case excess loosening skin needs to be removed, this procedure provides optimal results when associated to a mini-lift.

Mini-lift

This is a soft reshaping of the different structures of the face and the neck (skin, muscles and fat). The use ofa video camera (or Endoscopy) has allowed great progressesin reducing scars, and increasing the precision of the procedure, because we can perfectly visualize the fine anatomy of the face and neck. Endoscopy can reduce scars and make recovery easier.

Another interesting consequence is that the procedure can be easily performed under neurolept analgesia (or local anesthetic reinforcedby sedative perfusion) and generally requires only 12 to 24 hours of hospitalization. It goes without saying that this procedure requires the same precautions as all the other surgical procedures, meaning: two prior consultations, a clearconsent, mandatory quote, pre-anesthesia consultation, a biologicalfull analysis, a fully equipped clinic and a surgery blockcomplying with all safety standards.

During recovery, edemamay occur for 7 to 15 days, possible bruising for 7 to 21 days, but little or no pain.Using these techniques can definitely provide natural and lasting results.