Consultant aesthetic oculoplastic surgeon Mrs Sabrina Shah-Desai explains how she used the Teoxane range for successful full-face rejuvenation
Assessment, Ageing
& Anatomy
A lady in her mid-40s presented
to my clinic explaining that she
felt she looked tired and older than her
friends of the same age group.
In any aesthetic assessment it’s important to
consider the anatomy and ageing cycle, as
well as lifestyle factors causing this ageing.
I determined that the patient is a smoker,
runner, has sun damage, is approaching the
menopause, and doesn’t eat very healthily,
which as well as the structural changes
to the bone and the soft-tissue anatomy,
contributes to thin and wrinkled skin, along
with an aged appearance.
The patient’s tired look was the main factor
for seeking treatment, so I considered at
how I could best address this. The majority
of the time, tiredness comes from shadows
on the face, due to deflation of soft tissue
volume. Her temples were more concave,
the tail of the brow was angled down, and the
under-eye hollow extended into the cheek.
In addition, the patient had shadows from
deepening nasolabial folds and marionette
lines. I also assessed her degree of sag;
she had mild tissue sag and I could identify
that it was mainly the volume loss that was
contributing to this tired appearance.
Through considering her ageing and
anatomy, I determined that this patient
could have really significant improvement
by treating her whole face with dermal filler,
starting with the mid-face, before moving to
the upper face, and finally the lower face. By
opening up the eye frame and changing the
light reflex you can immediately improve the
negative emotional expression of tiredness
and sadness, which is exactly what we
wanted to achieve.
Technique and product selection
It’s important practitioners take a dynamic
approach to treatment and choose products
based on the skin layers and rheology.
I started with the mid-face. The patient had
very thin skin, likely due to smoking and sun
damage, so I needed a product which would
give her volume, but also be very forgiving,
which is why I chose Teosyal RHA 4. It’s a
dynamic volumiser with great stretchability
and dynamic strength, so it projects well
to restore volume effectively but is also
mouldable and forgiving under thin skin.1
I used a bi-planar technique using a needle,
injecting both deep onto the bone to get
projection, and then into the suborbicularis
oculi fat (SOOF), as well as placing some
product in the subcutaneous cheek fat pads.
When you restore optimum volume both
deep and superficially in this manner, you
avoid alienising the face and getting those
chipmunk cheeks!
I then addressed the patient’s periorbital
area, treating her tear trough, palpebromalar
groove and superior sulcus to support the
brow using Redensity 2. I love this product
because it is specifically designed for the
periorbital area and has low hygroscopy,
which means it doesn’t swell very much. As
we know, the periorbital area is challenging
to treat and complications can occur because
of the type of product, technique, volume,
or incorrect assessment. Redensity 2 is
associated with a very low complication
profile and its rheology means it is very
spreadable,2,3 so I find Redensity 2 provides a
very natural result.
Next was her temple. I used a gunshot
technique with a needle, injecting RHA 4
onto the bone, which really helped support
the tail of her brow. Finally, I moved to the
lower face. I chose RHA 2 which is a robust
filler with great stretchability, and ideal to treat
my patient’s highly dynamic nasolabial folds,
pre-jowl sulcus and marionette area in the
subcutaneous plane using a cannula. I also
supported her radial cheek smile lines by
placing RHA 2 subcutaneously, which really
helped improve her dynamic wrinkles and
sagging jowls.
Top tips for success
The anatomy of the ageing face requires
practitioners to employ bi-planar anatomical
techniques using the rheological properties
of dynamic fillers to give natural results,
using both needle and cannulas. I believe
they should move away from only injecting
onto the bone. The TEOXANE dermal filler
range is highly versatile, and the different
products can be used well in combination
for enhanced outcomes. Practitioners must
assess the degree of sag – if treating an older
patient with moderate to severe tissue sag,
I advise combining filler with energy-based
devices or surgery for natural outcomes.
