Advertorial: Case Study: Full-face Rejuvenation

23 May 2022

Dr Jeremy Isaac explores his tips for facial restoration using the TEOXANE range of dermal fillers

Assessment, ageing and anatomy

This 48-year-old peri-menopausal patient presented to my clinic because she felt reserved and self-conscious about her appearance, wanting to look fresher and younger. She had undergone no previous aesthetic treatments in the past and there were no contraindications found following a medical consultation.

The face was assessed using a global full-face approach. It was clear that the forehead, temples, mid-face and jawline were all showing the paradigm of ageing. The upper face appeared quite skeletal with temporal hollowing and there was the presence of decent, deflation and disproportion in the mid-face. Through dermal filler treatment, the aim was to achieve an overall softening of the face, developing feminine curves rather than sharp angles. The goal was a natural, subtle accentuation and avoiding abnormal exaggeration, our patient’s greater fear. I always begin treatment from the upper face, working through to the lower face. It is important to ensure the upper face is supported and elevated first as it has a direct impact on the anatomy and appearance of the mid-face. I then augment the mid-face before the lower face.

Technique and product selection

I choose the Teosyal RHA dermal filler range for their rheology. The genesis of the resilient hyaluronic range is to mimic natural hyaluronic acid. The TEOXANE range is the first resilient hyaluronic acid dedicated to facial dynamics2 and has an unparalleled viscoelastic region making the hydrogel very dynamic. The consequence is the gel is capable of stretch and compression with excellent biomechanical endurance, enabling it to mimic the natural movements of the face. They also have an excellent safety profile, and all the products in the range are approved by the US Food and Drug Administration.1

For this treatment, I used both needles and cannulas. I believe it is important for practitioners to be able to use both instruments to achieve a multi-layer approach. To access the superficial fat for example, you need a cannula to ensure you are in the correct tissue plane and when targeting the deep fat compartments of the face, then a needle or cannula could be used to access these anatomical landmarks.

I started with deep compartments and used the whole of the Teosyal RHA toolbox. By placing the right product in the right plane we were going to get the right outcome. A total of 7.8ml of product was used to get this outcome.

RHA 4 was used in the mid-face and multi-layered into the deep and superficial compartments. The target for the injection was the anterior mobile face and the lateral aspect of the periauricular area. The volume loss of ageing seen in the temple, jawline, pre-jowl sulcus and chin were addressed using RHA 4. RHA 3 was used in the marionettes and RHA 2 was injected into the body of the lips. RHA 1 was used to augment the depleted upper cutaneous lip with a cannula and the perioral rhytids effaced using a flat blanching technique. In her review, the patient said she was very happy with the outcome. She’s got so much more confidence because of having this treatment, saying she feels she can face the world again. In my assessment, I deemed no further dermal filler treatment was necessary.

Top tips for success

It is important to understand the patient’s list of priorities when it comes to treatment and know what they want to achieve for their final outcome. Don’t rush your treatments because hyaluronic acid products react differently amongst individuals and consequentially, you may not need as much product as you may think. As hyaluronic acid takes on 1,000 times its weight in water, underestimate what you think you may need and then review. Remember, it is better to do a touch-up than overtreat and have to electively dissolve the product. Finally, for excellent aesthetic outcomes, it is essential to understand the anatomy and the stage of ageing of the patient to have a skillset of techniques to address the patient’s concerns and products with rheological properties you can trust within the targeted tissue. Each product has different characteristics and acts differently so choose dynamic products above the SMAS and more static products for the deep fat compartments for a natural outcome.

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