Six out of ten cosmetic medicine procedures in France are injections of Botulinum toxin. With a steady growth of 10% per year, thistechnique attracts more and more women, at a younger age.

Women under35 are twice as many receiving Botulinum toxin injections than womenover 55. For women who are determined to delay signs of aging, as for all those who are definitely fans, Botox remains a magical and safe product for smoothing wrinkles.

The technique is safe,since it has been used from 1977 for medical purposes, to correct the strabismus of the newborn. The danger lies not in the product, but in the hand of the practitioner. The right doseof Botulinum toxin is effective for diminishing muscle contractions. But poorly dosed or injected in the wrong place, it canbe responsible for a closed eye, an asymmetrical smile or a frozen-lookingforehead.

The effects of Botulinum toxin settle in slowly, they become visible afterthree to fifteen days, and last three to six months, according to the quantity injected.

But the crucial questionis: what is the best age to start?

The answer is basically when you feel the need to. But in order to prevent wrinkles, some patients prefer to start veryearly. The goal is not to correct wrinkles, but to prevent them from showing up.

How many times in a lifetime do you need Botulinum toxin? If you startearly enough and you care for your skin, there is no actual limit. You can get Botulinum toxin injections all life long, witha minimum of three months timebetween two sessions, otherwise you could develop a resistance to the toxin, which would then become ineffective.

For those who don’t necessarily want to chase downwrinkles but simply seek for a freshlookingface, Botox is a standard,self-sufficienttreatment.

Regenerate the skin during sleep and wake up to a fresh complexion.

This is the number one concern of 60% of women, even before wrinkles; it almost turns to obsession and makes the number of aesthetic procedures go up.

This is to say how fatigue ruins the lives of many people. Twenty years ago, women searched the advice of a practitionerhoping for arejuvenating action. Today, they ask us to make them look more radiant and well-rested. By the age of 30, almost a third of our patients complain about their sad and tired-lookingfaces. Surprisingly, their complexion looks dull even after a good night’s sleep.

The problem is that they often live a hectic life, and when the body has drawn too much energy, it causes several visible symptoms: dull complexion, deep dark circles, sagging skin around theeyes, sagging tissues, contracted muscles – like the lion’wrinkles onthe forehead, the mouth folds– and all this makes a person look ten years older.

There’s a real change in the metabolism hiding behind these external signs of skin fatigue.

An exhausted body generates a large amount of ”waste”that prevents the skin from recovering. When the body is overworked or stressed, not only does the melatoninlevel (powerful antioxidant and universal cell repairer) drop, but thecortisol level (which is a collagendestroyer) goes up. And that’s not all. Glycation, which is responsible for the stiffening of the skinfibers, causing wrinkles,  accelerates. At the same time, the proteasome, the cell scavenger responsible for cleaning the damaged proteins, is overwhelmed.

It’s a very complex process. This is why acting on the skin brightness is not enough, we have to act on all the signs of fatigue and strengthen the cellular regeneration mechanisms that are at work at night.

This is the aim that we will be discussing asa “regeneration” protocol when you come visit us in our clinic.

The cosmetic surgery has made tremendous progresses. I am delighted to see what we can achieve today thanks to the enthusiasm and the energy in the world of surgery.

The technologies are improvingand we have many resources available while we try to offer personalized solutions to our patients, going from medical procedure tocosmetic surgery procedures.

Our standards are more preciseand reliable. We have also been able to reduce the procedures time,  making them safer for patients.

The improvement of medical devicesis another important evolution, and they are used in both medicine and cosmetic surgery. These are engineering products backed up by many years of researchand development.

Let’s not forget that the products continue to improve, reducing the painand the recovery time while improving the immediate results and making them last longer. For example the quality of injectables gotbetter: they last longer, their “feel” or texture are more natural and the side effects very much reduced. We contributed to this evolution with countless trainings that we provided for the last 25 years all overthe world.

The two major evolution incosmetic surgery are: the improvement of non-invasive procedures and the natural-looking results.

I would like to thank the scientists who help us improve our procedures, as well as my colleagues, many of whom work relentlessly to achieve progresses for our patients’benefit.

We should also mention the introduction of the recent ISO “IMAL” certification, which makes it easier for patients to have quality procedures using adapted and sophisticated tools.

What product combination should be considered if we wanted to make the effects of fillers such as hyaluronic acidlast longer?

The combination of botulinum toxin and hyaluronic acid appears to be very promising for extending the fillers life time while reducing the muscle activity in the treated area. This observation follows many scientific studies.

For patients who receivedhyaluronic acid injections, the early degradation of hyaluronic acid-based fillers limits theimprovement. The improvement levelis not only affected by the fillers properties, but also by other factors, likethe force of the surrounding muscles.

Relaxing the skin muscles allows us to protectthe hyaluronic acid implants from the forces generated by mimicry.

According to the latest scientific studies measuring results 3 months after the procedures, botulinum toxin seems tolower the hyaluronic acid gel degradation by 42%. In addition, the product still in place after 3 months was 50% higher in areaswhere botulinum toxin was used.

The difference is not only measurable but also visible. This is backed up by clinical experience showing that botulinum toxin injectionscombined with hyaluronic acid injections provide longer lasting results.

The neckcarries our head on our shoulders, so there’s no way it should be neglected.

From the first signs of weakness, many of you have tried cosmetic care without much success, but have you tried the latest, safe aesthetic medicine techniques?

The skin on your neck is twice as thin as onthe cheeks (2 mm for the one and 4 mmfor the other), so it degradesmuch faster. In reality, its texture is very close to that of the crow’s feet. Besides, the neck isconstantly solicited by the head’smovements.

The downside of this mobility are the skin lines,three times deeper than those of the face and an accelerated slackening tendency. The cleavageis not better off: its skin may be thicker – up to 7 mm – butit has no fat, which causes vertical wrinkles. Besides, this area is often exposed to UV.

The fine lines on the neck can be treated with hyaluronic acid.

The repeated injections with skin boosters, containing fluid hyaluronic acid, are the ideal indication for smoothing the epidermis. But we can also usethicker hyaluronic acid. Starting with thesecond session, the epidermis is deeply hydrated, plumped and densified. One session per month for three monthsis the ideal treatment,repeated every year.

As for the “turkey neck”, responsible for the platysmal bands startingunder the chin, a botulinum toxin injection into the platysmuscle is enough to erase them. But given the size of this muscle, the effects are inevitably short lasting: three months instead of six.

I am pleased to welcome you in our IMAL–certified clinic : the IMAL is a result of the ISO certification, which is the highest quality and control guarantee.

COULD THERE BE A CONNECTIONBETWEEN THE CITY OF GRASSE AND PROFILOPLASTY?

They say that ”There is no hasard”. It was indeed a blessing for me that our “profiloplasty” workshop was hosted in Grasse, the city of scents.

This testimony I received by mail says it all: ”Thank you so much for this magical evening of a high level of expertise, it was a real challenge to treat difficult patients,but your clinical fine analysis, your scientificmethod andyour injecting techniqueswere key factors tosuccess. All this encourages me to continue using profiloplasty in the global approach of the face.”

The nose is king, in this kingdom of scents.

Yes, we breathe through ournose, but reducing this organ to its simple biological function would be like saying that our eyes are only there to help us see.

The profiloplasty is the analysis of the face as a whole: the aim is to evaluate the balance of the different structures and the facial harmony, and when necessary, to subtly modify theprofile in order to restore the face’s harmony. The forehead (upper third), the nose (middle third) which can be too long, too crooked. The lips thatmay be too thin, the chin that counter-balancesthe whole (lower third), all these elements respond to precise proportion ratios.

It’s all about taking the proportions into consideration. Considering only an isolated face element  does not always provide a satisfying result.

For medical rhinoplasty for instance, we can always try to treat a nasal hump, but this will not be enough if the chin is visibly receding… So we will increase its volume using injections.

In other cases, a nose may seem a little toosmall, but it’s actually the chin that is too prominent. The cheekbones volume and shape are also questioned a lot, because they participate in this global face architecture.

Yesterday we made injections in Masterclass sessions in Grasse, on a patient for a medical rhinoplasty (Effeil Tower Nose Lift®), a profiloplasty and a Chic Lift®.

This patient wished to testify of her experience:

“Hello Hervé,
Congratulations and thank you for this remarkable demonstration last night.
What a brio, what an admirable talent and how easy it is.
Many thanks !
To beauty, to talent, to opera our passion.
A thousand beautiful things and successes.
Have a good day
Florence”

What is the Eiffel Tower Nose Lift®?
It is a concept of medical rhinoplasty by injection of hyaluronic acid by recreating in successive stages the various stages of the Eiffel Tower: its solid base, its majestic body and the graceful tip.

What is Chic Lift®?
Excerpt from our article on Facesculpture, global rejuvenation of the face:

“The eye, the jewel of the eye, is magnified by its box made, above, concentrically, the crown of the forehead, a slight temporal convexity, a convex eyebrow reflecting the light, a well drawn eyelid without notch or ptosis, a smooth transition between the eyebrow and the upper eyelid, and below, a convexity of the malar apex and a short lower eyelid, in gentle transition with the cheek. No unsightly shadow between forehead and cheekbones forms an elegant “C” (Chic-Lift®) found in all young and attractive faces, and recreating this smooth transition with injectables is our goal. ”

As for the profiloplasty, this is an intervention to correct the profile of the patient:
– whether surgical with rhinoplasty and implant – chin prosthesis in the same session, outpatient
– or medical: injection of the chin with hyaluronic acid and botulinum toxin

Watch this video on Injections in the chin

The cosmetic surgery techniques have considerably improved over time. Practitioners don’t only tend the skin, they also tighten the muscles, for a longerlasting result, 10 to 15 years if the patient has a healthy lifestyle and stays away from sun and tobacco.

The facelift is not dead, on the contrary, it is still a frequent procedure. It has even become a more personalized procedure, thoroughly discussed with the patient, according to her or his needs andexpectations.

When there is not too much excess skin, I often discuss the possibility of anendoscopic facelift. It minimizes the post-operative effects and reduces scarring.

This type of facelift is appropriate for thetreatment of the upper face areas(from the forehead and the temples to the cheekbones and cheeks). The procedure is performed withsmall incisions (1 to 2 cm) perfectly hiddenin the scalp. It is ideally adapted to the sagging face treatment (eyebrow, forehead, look, cheekbone) if there is not too muchexcess skin.

This results in a better eyebrowpositioning, the cheekbones repositioning, amore widelook, an almond-shapedeye, or even the reduction of the naso-genial fold.

Thisis an important procedure to me, because in 1998, I created a new range of surgical instruments specifically designed for video-endoscopy LIFTING. In 2003, at the first Aesthetica Congress in Biarritz, I won the best video trophy for this ENDOSCOPIC LIFT.

The Botulinum toxin is still intriguing,as much as it is acclaimed.

Botulinum toxin is the most importanttreatment in our clinic, and I witnessed its evolution, starting with the first introduction in France: I was one of the first practitioners researching its effects and contributing to the medical official launch in February 2003, a memorable date.

Did you know that Botulinum toxin is a natural injectable medicine used since 1974?

It was approvedfor the first time in the USA as an anti-aging facial treatment in 2002. Botulinum toxin is indeed a muscle relaxant and thanks to Botulinum toxin injections, we can correct wrinkles occurringbecause of muscle contractions.

Among with other research colleagues, we conducteda survey in order to identify the current practices in France, with the aim of providing recommendations on the different Botulinum toxin treatments for the aging upper-and midface.

The general considerations, the main treatment rules, the injection specifications (dose, areasand techniques), the associated procedures / treatments and the post-operative care were defined for each areaof the face.

According to the participants tothis consensus, the use of Botulinum toxin is a globaltreatment, both preventive and corrective.

In our time when, thanks to the rise of aesthetic medicine, the stigmata of age are no longer inevitable, by far the most requested intervention is that of the rejuvenation of the gaze. Why this frequency?

Because the gaze is a reflection of the inner life and, very often, the alterations due to the time that give it a weary look no longer correspond to an inner youth, an appetite to live remained intact

New techniques and injectables have led to a holistic approach to the treatment of signs of aging. However, there is little published documentation of the procedures involved in this approach and currently no validated recommendations exist.

So I wanted to provide a detailed and practical guide to restoring the volume of the middle part of the face and rejuvenating the area of ​​the gaze on the basis of expert consensus recommendations.

The conclusion?

The combination of treatment, combining for example injections of botulinum toxin, Hyaluronic Acid and volumizing products undeniably provide an optimal embellishment and rejuvenation of this area.
Remember that each look has its own morphology and characteristics that give it its personality and charm.

Video about my approach to Chic-LiftChic-Lift

What do Prague and Paris have in commun ? What if it was the Eiffel Tower? Or the ”Eiffel Tower nose lift”, to be more exact. Medical rhinoplasty is a key technique today. However, we needed to rely on a ”standard”, a solid “modus operandi” that could help us offer our patients effective results and maximum safety.

That’s why I launched the first official nose treatment course in Prague. This training was based on my global medical rhinoplasty concept called: the EIFFEL TOWER NOSE-LIFT®. This was held as part of a global Allergan laboratory symposium, one of the leaders in aesthetic medicine.

The concept consists in 5 sequences, each of them representing one of the Eiffel Tower’s stages: its solid base, its majestic body, its various stages, and its graceful tip ….

Non-surgical rhinoplasty can be extremely effective and easy, provided that the practitioner is experienced, has expert anatomy knowledge and considers several artistic principles.

The demonstration was made with the participation of patients of different nationalities (Asian, African, European) and / or following a secondary rhinoplasty, ranging from an “easy nose” case to a “difficult nose” case.

The idea was to enable all practitioners to offer their patients the best possible care, maximum security and results that live up to their reputation. The priority is always to offer our patients the highest satisfaction.

See PRS GLOBAL OPEN article on natural rhinoplasty by Dr. Raspaldo

Here are some testimonials after the first official rhinoplasty presentation at Allergan Medical International Institute:

– “Hi Hervé, have the team mentioned, excellent teaching material! It will be incredibly exciting to see you live in Prague at our big AMI annual event! Thank you for producing these and sharing them with us. ”
Caroline Van Hove
Senior Vice President, Allergan Medical Aesthetics
International Strategic Marketing & amp; Head of Commercial Excellence ”

– “Herve, what fantastic videos! Thank you for sharing. I look forward to see it live in action, in Prague “.
Courtney Kennedy
Associate Director, International Medical Education ”

– “Watched all the video’s, they are fabulous. 🙂 Congratulations Herve, a real triumph. ”
Mark Chaplin Ph.D
Director International Medical Education

Article written by Mr. Thomas Josse

En février dernier j’ai eu l’occasion de me rendre en Azerbaïdjan pour participer au lancement de la toxine botulique.

Nous remercions chaleureusement toutes les personnes rencontrées à Bakou lors de mon séjour à + de 4000 kilomètres de là…

Voici les témoignages qui me m’apportent l’audace et la motivation de bien faire mon métier.

“Dear Herve,
Thanks for the visit to Baku! We fascinate with your professionalism and fascination.
Many famous speakers came here, but your visit is special.
Thanks for the marketing!
I hope that you will see Baku more than once and we will find joint interests.

Yours sincerely,
Elshan Mammadov
PhD, Director of Azeri Med Branch Companies
Baku, Azerbaijan

“ Dear Hervé,

Just a quick note coming from my side – it was a pleasure and honour to have you as our key Faculty during the botulinum toxin Launch last week in Baku,
Azerbaijan!
The mere fact that 300 injectors were invited, and close to 500 of them attended the botulinum toxin launch on 2nd February (every second aesthetic doctor from Azerbaijan!) – shows how immense the interest is – for Allergan products, and for Your views, thoughts, insights and magic – on stage, and during the live injections!
Not only that you did a superb job with introducing botulinum toxin to the audience, but you also re-established the Juvederm Vycross collection as their products of choice for getting the best of results in treating the periorbital region!
All backed-up by practical tips and tricks during the 20:1 Masterclass for their top injectors, taking place on 3rd February in Kepro Clinic.
Thank you for attending all of the TV shows, interviews and filming sequences, and thank you for drinking coffee and chatting with Azerbaijani celebrities!
Most of all, thank you for accepting the colourful Azerbaijani culture so openly!”

Tea Andabaka PhD

Rédaction  : Thomas Josse