MEDI: SUBTLE CHANGES

SUBTLE CHANGES

Are we finally seeing the tail end of overfilled faces? Cosmetic Nurse Sheri-lee Knoop explains her considered and slow approach to injectables, and why dissolving shouldn’t become the norm.

Anyone who has worked in the Cosmetic Medical industry for the last 10 years knows that the thirst of patients to do more non-surgically has increased and that the demand has fuelled Pharmaceutical companies to develop better, more resilient and varied fillers that have been developed over the last two decades to increase our ability to fill, lift, inflate, define, soften and enhance tissues at several levels.

Sheri-lee Knoop

Founding Director and Principal Practitioner at Cosmetic Images.

We can now address areas of bone loss, fat loss, dermal loss, myomodulation and muscle management. We can tighten, stimulate, lighten and smooth skin. We no longer only focus on age restoration but enhancement and correction also. We used to completely freeze faces but that no longer dominates popularity.

Thirty years ago, when I began, we could only fill dermal lines and relax a limited portion of the face. We were frightened of wrinkle relaxers and were worried about using it. We were yet to discover how powerful the art of wrinkle relaxer was.

The average age of patients has also changed to a much lower age and wider range. Patients may enter a clinic as young as 17 years old and patients as old as in their 90s continue to have regular treatments. What else has changed? Social media arrived and a phone with a camera that not only could take a lot of photos at no cost, no film and no development, but from every possible angle. These factors have increased our awareness of our flaws and this can be helpful and hindering in my opinion.

From ‘overdone’ to the ‘makeunder’

Patients are much more critical of themselves than ever before due to a heightened sense of awareness propelled by social media and comparing themselves to others online that may include filtered pictures that are unrealistic. This has increased the search for more and more treatments resulting in overdone and distorted faces.

Having these faces out there in the community, however, has also scared a large proportion of potential patients away from seeking treatments as they don’t want to look “done”, unnatural or overdone. The ‘makeunder’ has been born from this. That means small amounts of work only where necessary to restore ageing or enhance the patient’s present situation, not changing all aspects of the face at once because we can.

It is the practitioner’s role and duty to fully inform the patient seeking treatment. This includes assessment of the face and ensuring all treatments are conducted safely and considering facial harmony. All faces are unique. They are genetically unique even within families. This uniqueness should be respected as nature intended. Facial harmony is important so that all aspects of the face remain in balance. It is important to fully discuss treatment plans with the patient so they are clear what can be done vs what should be done to suit their facial features. We should never just simply deliver what a patient asks for without considering if the outcome will suit them, enhance them or be in their interests. This takes extensive consultation with the patient to achieve understanding of their needs and align expectations.

Avoiding ‘over-relaxing’ muscles When treatments are done on patients that distort their natural aesthetic, this regularly leads to their unhappiness. On many occasions I have met patients that have previously been unhappy with their treatments. With wrinkle relaxer it is often an outcome of being over relaxed or negatively altering the positioning of the brow, eyelids or mid-face or lower face. Relaxing a muscle is fairly easy for anyone with basic training, however, positioning that muscle correctly and the ability to enhance how that patient looks is more difficult. I think this is the art of wrinkle relaxer. It is important that we assess what should and shouldn’t be relaxed for a particular patient.

Wrinkle relaxer can worsen a patient’s situation at times and we need to know the difference. When an outcome from wrinkle relaxer is poor, there is little that can be done but wait for the treatment to wear off. This can make patients very unhappy for months.

Before and 7 weeks after treatment using anti-wrinkle injections and filler:

BEFORE

AFTER

The era of overfilling

When fillers are used to enhance, correct or restore an area, it can lead to distortion of the face if not done with facial harmony in mind. We now have an era of overfilling that has resulted in distorted lips, cheeks and chins. As a result, the use of injectable enzymes to dissolve filler has increased exponentially. Patients get into a cycle of filler in, filler out, filler in, filler out. This is unsafe and morally wrong in my opinion. We should be protecting patients from harm and therefore we should only be using filler dissolver in an emergency situation. There should be no need to correct bad results as these should not be occurring. Filler should be injected slowly and in limited amounts to any one area and over a reasonable period of time to achieve results, not a lot injected all at once. This allows for settling and integration of the filler into the tissue and a building toward best results, not losing sight of the parameters of balance and harmony with an area of the face or the whole face.

A cheek that is too large will shorten a face and make the jawline and temple look hollow when they actually are not. A chin that is lengthened too much will make the jawline look narrow and the lips and cheeks look depleted. A widened jawline will make the cheeks look depleted. All of these situations are avoidable if full-face consultation and consideration is made before filler is injected. The younger the patient, the more facial harmony should be considered as when ageing and volume loss or deflation is yet to begin, adding even a small amount of filler could distort their face.

A clinic visit should begin with patient concerns, realistic expectation establishment, treatment planning along with interval planning, facial assessment empowering the patient’s choice, then only the execution of the plan and injections can begin. By keeping to these principals, results can be impactful and significantly improve things but not make patients look overdone.

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