How can facial rejuvenation be achieved?

There are no techniques that, when used alone, can offer satisfactory results in correcting age-induced damage to the mid-face. Over a short period of time, dozens of procedures have been introduced, with only small differences between each. Just as ‘many roads lead to Rome’, a favourable result can be achieved in different ways with variable results. This article will discuss the most important options, suggest correct indications for each technique, and list their advantages and disadvantages4.

Dermal fillers

Dermal fillers work by providing support for facial structures, while botulinum toxin reduces the mimetic effects. In combination, these products can be used effectively to reshape and rejuvenate the face and neck. Dermal fillers can be used throughout the face to:

  • Raise the eyebrows
  • Fill the tear trough
  • Reshape the nose
  • Lift the nose tip
  • Fill nasolabial folds and oral comissures
  • Fill the cheeks
  • Raise the cheekbones
  • Reshape the jaw line.

This ‘minimal approach’ offers a faster, less painful, and less costly alternative or complement to surgical facelifts. The dermal filler material should be extremely viscous and elastic, such as in the case of the calcium hydroxylapatite-based dermal filler Radiesse (Merz Aesthetics, San Mateo, CA.). Radiesse stands out because of its high-level of viscosity and the absence of any hygroscopic effect5.

Hyaluronic acid (HA) is, at present, the gold standard of dermal fillers. The range of HAs launched on the market may present some differences in terms of viscosity and duration; however, the safety standards are very high, as stated in Raspaldo’s article6. For over 10 years, HA has been used in aesthetic dermatology throughout Europe. This agent is safe, and physicians can choose from a wide range of HAs to enhance the face. They also have the option of a new series of low molecular HAs with Juvéderm VYCROSS™ technology from Allergan, which allows us to better manage the entire face with different concentrations of HAs and a variety of viscosities.

The author first began to fill wrinkles, but new procedures progressively allowed the option to restore facial volumes. However, it is important to bear in mind that successful aesthetic treatments also require some level of artistic talent in order to achieve a natural overall look.

Figure 1 (left) Patient with multiple signs of skin ageing and sagging of malar and jowl area, as well as severe resorption of fat compartment, and (right) patient after treatment with the Juvéderm® family of dermal fillers. A nice aesthetic result is achieved and can be improved further with three Fraxel® treatments (Solta Medical, Inc., Hayward, CA.)

Figure 1 (left) Patient with multiple signs of skin ageing and sagging of malar and jowl area, as well as severe resorption of fat compartment, and (right) patient after treatment with the Juvéderm® family of dermal fillers. A nice aesthetic result is achieved and can be improved further with three Fraxel® treatments (Solta Medical, Inc., Hayward, CA.)

Better knowledge of physiologic HA functions will offer physicians the possibility to discover and propose refinements in anti-ageing techniques7. HA is a polysaccharide that occurs naturally in the dermis. As a dermal filler, it produces a natural look and structural mobility. Furthermore, its high water-binding capacity works to restore the hydrated, elastic volume of the dermis. HA requires no skin testing and is available around the world in a variety of shapes and types. Follow-up procedures a few weeks after the initial treatment can optimise results and lengthen the duration of the effects of these products, which can range from approximately 3 to 12 months (Juvéderm ULTRA VOLUMA, VOLIFT, and VOLBELLA; Allergan, Irvine, CA.).

HA is a suitable ‘lunchtime’ procedure because it allows the patient to go back to work and has no down time. It is typically associated with less pain and mistakes can be better corrected, which makes it a good choice for fearful patients. Combining a number of dermal fillers can require less quantity of product and provide a longer-lasting result. As the skin is an anisotropic and viscoelastic material, using these products in combination takes advantage of their hydrophobic and hydrophilic properties. This association mimics the natural composition and biomechanics of the skin, and can provide better and longer-lasting results. It must be underlined that there are long-lasting HAs such as Juvéderm VOLUMA, and reabsorbable materials that last longer and can be used in the mid-face and chin, or in the mandibular line.