Consultant aesthetic oculoplastic surgeon Mrs Sabrina Shah-Desai explains how she used the Teoxane range for successful full-face rejuvenation
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.
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.
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.