A 51-year-old female patient presented to my clinic with concerns about the appearance of her lower face and volume loss in the mid-face, feeling that she looked quite skeletal. When performing a consultation, I never sit in front of a patient and say ‘you need XYZ’, because I do not want them to leave feeling more self-conscious than they were when they arrived. So, I always ask the patient what their problem area is, and then after assessing them properly I suggest treatment options.
I also look at them in three dimensions – from the front, the oblique and the side – taking into consideration how they look both when static and in animation. It’s important to note what the patient looks like when they’re smiling and moving to see how different areas of their face interact with each other.
I then consider the face in thirds – upper, middle and lower – to see if there are any jarring or big contrasts between them. Next, I observe whether there’s any asymmetry between the left and right sides of the face.
Throughout the assessment, I always explain to the patient what I’m seeing when I’m seeing it, and educate them on what treatment options might be the most beneficial as a result. From this, I determined that the patient had had poor lower face skeletal contour, with a small and retrognathic chin, gravitational descent of the superficial jowl fat pad, poor anterior projection of her mid-face with focal volume loss in the deeper fat compartments. These regions were going to be my primary targets for treatment with a view to progressively improve other areas accordingly afterwards.
Product selection and technique
In terms of technique, I first wanted to create a structure and outline before I focused on volume loss, so as to make her face look more balanced and the proportions harmonised. To do so, I injected 2.4ml of Teosyal PureSense Ultra Deep in the chin and posterior jawline, and then multi-layered that with 2.4ml of RHA 4. I chose this product due to its unique rheological profile dedicated to respecting facial expression. Therefore, it can be used in the areas that traditional fillers can’t as these run the risk of becoming visible when the patient animates. When injecting, I was aware that her jowl fat pad had hypertrophied over time, meaning I needed to blend the other aspects of her face into the jowl fat pad to avoid any harsh contours and shadowing.
I also injected 1.2ml of PS Ultra Deep into the deep static fat pads in the mid-face to create some extra anterior projection and lateralisation, getting a taper and turning her longer, more oval face shape into a heart shape. For any of the deep periosteal work, I used a needle but for multi-layering, I used a microcannula to help create that soft contouring. After the initial treatment, the patient had a follow-up session four weeks later so I could perform some small maintenance tweaks. Here I injected 1ml of RHA 2 to address the perioral lines and deeper folds, and 3ml of the Redensity 1. treatment to improve her overall skin quality.
Results
Both the patient and I were delighted with her results. When the patient first presented to my clinic, I found her demeanour could be considered quite harsh or somewhat abrupt, however when she came back for the review appointment she was softer and more personable. She explained that as her appearance had changed, this had translated into other areas of her life and had impacted how people responded to her/how she approached people. She also noted that she was a lot more confident in herself as a result.
Top tips for success
Remember that you are a medical professional and not a vending machine – what the patient is asking for does not mean that is what you have to give them. Assess them properly and decipher what the best treatment options really are depending on their individual anatomy. You should also always explain to your patient why you’re choosing the treatments you are, so that they can fully reflect on everything and make an informed decision. This will help build trust too, so it’s good for patient retention.
Finally, I recommend following the principles of anatomy, technique and product. This is so that you can stand there and explain to your patient why you have chosen to treat the areas you have treated, why your techniques are beneficial for them and why you have chosen the products you have. I believe it is important to use a product portfolio where each product is designed for different indications of the face, to elevate the results.
This advertorial was written and supplied by Teoxane
Teoxane.com/uk
