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FACIAL AESThETICS

VOLUMISATION

Continuing her introduction to facial aesthetics, Tracey Bell looks at products which contour and add volume to the face

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or years I was taught to fill and chase lines and wrinkles with hyaluronic acids, fillers and other materials. But for deeper wrinkles and furrows these products offered little value when trying to volumise and contour the face. And with years of experience, practise and the ability to look subjectivity at patients, the key to rejuvenation and sculpting is simply that - volumisation and contouring.

By replacing and restoring the fat, bone and muscle that is lost in the mid part of the face, any problems in the lower part will minimise and true reinvention or rejuvenation of the face starts to become easier.

These products should not be used by a novice (some, such as fat transfer, I don’t do myself) but as a clinician you should

know about them. Once you have mastered the art of the cheek enhancement, then temple restoration, the main factors when treating a whole face will be contouring and volumisation.

There are two important factors to consider when restoring a face.

1. Canvas (the skin). Improve the texture, tone tonicity of the skin and all of your work will look better.

2. Are lines static or dynamic? Static lines are those present when assessing the patient at rest. These lines are best treated with fillers, volumisers or peels. Dynamic lines appear with facial expression, they normally occur in the upper part of the face, forehead and crows feet, these lines are best treated with Botox (botulinum toxin).

ThE IMPORTANCE OF VOLUME Many of the changes we see in facial ageing result from the shrinkage of the underlying dermal tissues, shifts and atrophy of fat pads, alterations in bone and cartridge and muscle contraction.

When we are young it is the robust, heartshaped fat pads which sit directly over our cheek bones which give our faces fullness.

As we age they suffer from atrophy and sink downwards and inwards towards the nose, causing the tell tale signs of ageing.

When this happens we see eyelids which are hollow, darkened and crinkly or bulging, as well as pronounced smile lines on the side of our nose and drooping ‘marionette’ or sad lines, at the corners of the mouth and chin.

The weight of the fall accentuates the unsightly

Tracey Bell, BDS (Hons) Manchester, has aesthetic centres in the Isle of Man and Liverpool, which specialise in facial aesthetics and cosmetic dentistry. www.traceybell.co.uk

Clinical diagnosis is the key to good aesthetic treatment

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Figure 1: Pretreatment

Figure 2: A slow natural result following two Sculptra treatments

jowls along the jawline. The key aim of volumisation is to replace this.

Here’s a look at some products to consider in volumisation.

1. Hyaluronic fillers (Juvederm Voluma, Restylane SubQ) 2. Sculptra - a product of poly-lactic acid that works deep in the dermis to produce collagen. Normally a course of three sessions is required.

3. Fat transfer - fat is removed through other parts of the boy and later used for facial rejuvenation in areas such as the cheeks.

excellent and long lasting.

The main benefits are: • it restores the facial volume loss • it has a smooth consistency, thicker product can last up to 15 months • the results are instant, long lasting and natural • it produces an instant lift to the lower part of the face.

JUVEDERM VOLUMA In my practice Voluma is a key to any part of my treatment planning and it is one of my ‘true loves’. Voluma is an injectable hyaluronic acid produced to restore volume to the chin, cheeks and cheekbones.

Its main effects are to: • restore deep volume loss and smooth the mid face • restore sunken areas around the cheek bones and cheeks • restore and produce youthful contour in the jaw and chin.

The product is part of the Juvederm family and produced by Allergan. Experience is required to inject and the product is inserted using a cannula or needle. I prefer a cannula to minimise bruising and to ensure the product is deposited evenly. The product is provided in 2ml syringes. The results are

RESTYLANE SUBQ This product is very similar to Voluma in terms of clinical indications placement and results. My preference always comes down to the support of the company, training/ education and follow-up, not only for myself but also my team. SubQ is inserted into the skin using a cannula and creates beautiful long-term results. It can also be combined with Q-Med’s other products such as Restylane, Perlane, or Syno Vital.

SCULPTRA Sculptra is an injectable volumising treatment that stimulates the regeneration of the body’s own collagen to smooth out wrinkles and restore lost facial volume to give a fuller, younger-looking face. Sunken cheeks, temple, indentation and hollows under the eyes regain lost volume over time by Sculptra’s ability to produce collagen. Sculptra provides a gradual and significant increase in skin thickness improving the appearance of the folds and sunken areas with volumising effects which

have been clinically proven to last 23 months.

Sculptra is a synthetic injectable known as poly-l-lactic acid. Poly-l-lactic acid is biocompatible (a material that does not harm the body) and has been used in medicine since 1999. In 2004 the product was approved in the United States for large volume corrections for facial fat loss and was subsequently approved for restoring volume for cosmetic purposes.

Training is very important in Sculptra; generally the product is mixed at least 72 hours before use and the product is injected deep over a period of three months at monthly intervals. The treatment regime I commonly use on a first consultation is five vials over three appointments.

FAT TRANSFER

So many people have wished the proportions of their body were different, wanting to move fat from one area to another. In a way this is what fat transfer does. The procedure involves the removal of fat from one part of the body separation preparation and then effectively it is transferred into the facial volume loss on the face. There are advantages and disadvantages to this procedure. The advantages I would say are a natural result in the longer term. The disadvantage is that over correction is often needed due to ‘fat death’ and that is obviously a surgical operation.

CONCLUSION In my practice facial volumisation is part of my core business. Whatever age the patient, in general they all present with some form of facial fat loss and devolumisation. I do believe that a clinician with a good eye who bears in mind canvas, lines and volume can crack the art of volumisation.

www.injectablebeauty.co.uk To ask a question or comment on this article please send an email to: comments@ppdentistry.com ppd

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