By Dr. Hervé Raspaldo, article published in the ”Anti-Âge magazine” #1

The signs of aging will show up as dynamic wrinkles and linesin the upper face, and as volume loss changes in the middle and lower partof the face. Fillers (such as hyaluronic acid) and botulinum toxin have led to the development of minimally invasive procedures and a three-dimensional approach to facial rejuvenation: it’s a faster, less painful and less expensive alternative to the face lift; this approach can also be a perfect complement tosurgery,if the later is needed. Today the aesthetic face care is global and no longer focuses on removing wrinkles alone. The global purposeis to reshape the volumes and recreate a well balancedface, according tothe following criteria: soft and round face contours, convex cheekbones and well-drawn mandibular contour.

Using innovative products, we cangive the face its ideal shape, a heart-shaped contour, with the heart base inthe upper face area, while the tip points downwards (this shape is usually reversed with age).

As a facial esthetics specialist, Ihave developedaprocedurecalled Faceculpture®, based on a natural approach to facial rejuvenation and acting on 3 levels,the face dynamics (expression lines, mimicry), the heart-shaped volumes (HeArt of face®), and the skin texture: the botulinum toxin injections are meantto erase hyperdynamic wrinkles, restore harmonious volumes and fill wrinkles and lines, but also to hydrate the tissues.

 There are 2 types of injectables:

The Botulinum toxin

It relaxes the muscles, restores the esthetic balance of the face and stops the progression of the expression lines. For the upper face area, it is injected into the hyperdynamic muscles (which are responsible for the horizontal wrinkles on the forehead), the glabella, the nose, the crow’s feet (at the outer corner of the eyes), and the lower eyelid. It can also help repositioning the saggingeyebrows and improve their shape. As for the lower part of the face, botulinum toxin helps repositioning the tip of the nose, or treating dilated nostrils, fine lines, mouth lines, a gummy or an asymmetric smile,other asymmetries of the face, prominent masseters, the orangepeel aspect on the chin or the dewlap.

Dermal fillers

They restore volumes. There are several types of derma fillers: some of them are temporarily effective andresorbable, like the hyaluronic acid, the collagen, the calcium hydroxyapatite and the polylactic acid. Others are non resorbable and permanent, like the polymethacrylate, and the silicone.

The hyaluronic acid(HA) is currently the most frequentlyused filler, because it has a highfilling quality,natural resorption and it’s perfectly safe. Injections compensate for the age-related volume loss. There are different ranges of hyaluronic acids with different viscosity levels, adapted to different treatment areas and they can be used simultaneously for one patient:

 – The low viscosity products are particularly adapted to the so-called ”topping” technique, usedfor the treatment of fine lines,dark circles or hollow eyes.

– The medium viscosity products can reduceface wrinkles (perioral wrinkles, lip contour, nasolabial folds, mouth lines, forehead wrinkles).

– The high-viscosity products restore volumes in the cheekbones, cheeks, temples, nose and chin.

The Botulinum toxin and the different hyaluronic acids each have a specific and complementary effect. Therefore, they are often used together, which leads to better results than those obtained with each product separately. This is especially true for cheekbones, the glabella or the corners of the mouth. The results last longer, the HA is resorbed slower due to aprior injection of botulinum toxin, and the facial natural expression is preserved, because the procedure uses lower doses of toxin, supplemented by HA in residual wrinkles.

This global therapeutical approach also takes into consideration the epidermis (superficial peel, mesotherapy) and the dermis (pulsed light and photodynamic therapy, radiotherapy or radiofrequency, carboxytherapy).

It is recommended to start with botulinum toxin injections, in orderto relax the muscles and restore their natural balance. The face looks more openand relaxed. The cross-linked hyaluronic acid restores the three dimensional facial volumes (heart-shaped, HeArt of face®) and provides a more harmonious face contour. Amonth later, the hyaluronic acid injectionswillhelp filling the residual lines.

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