How to determine the aging look?
When we look at faces, the middle of the face is the focus of attention-eye, cheek and nose. The different of young and old faces are the volume, skin, fat tissues and bone. As aging takes place, you will notice the changing of youthful triangular to inverted triangular shape as well as losing of smooth curves at brow, temples, cheek and jawline. For the midface, increasing the skin laxity with atrophy of cheek fat pad descends toward the nasolabial folds. As a result, cheek flatten and the hollow around the lower eyelid ( tear trough) becoming more prominent creating deepen nasolabial folds. For lower face, descending of lateral fat pads and skin laxity worsen the jowling and mariotte lines.
Decades ago, the only way to reverse aging and sagging face is surgical facelift. Hence, you many see a drastic changes from ugly to youthful look. Many may be traveling searching for the best surgeon. A long downtime like bruises, long healing time, swollen and poor healing may be a consideration for this procedure.
What would help to restore youthful look?
Thanks to latest technologies, the invention of injectable filler. A non-invasive, no downtime treatment which can be delivered during lunch hour. It allows us to restore the volume losses, reduce the fine wrinkles, re-shapen, refine and improve the feature of appearance. Hence give the confident of outlook.
Filler able to plump up the face, it works in a special way and many people may get addicted and fall in love with filler. Most of us are familiar with the celebrities gorgeous looks and wonder what had happened with the overstuffed and un-recognized outlook. What had gone wrong?
Doctor, I want more!
Filler can be disastrous if not done correctly. Filler are meant for structural support and volume restoration. When patient or doctor chasing after the fine lines and lifting effects may ended in overfilled syndrome.
If injecting filler over cheek to create a significant lift, resulting projection of cheek greater than the it was in youth, the shape of face will change unnaturally. In addition, too much of filler under the hollow of under eye, it pushes the lower eye lids upward resulting in smaller eye. Overfilled of the face completely changes the facial proportions and balance, which results in the patient looking “fake” or “plastic” and unlike her/himself.
As a doctor, patient education and expectation needs to be managed during the consultation especially who has been overexcited of filler works. What the patient wants, commonly will not deliver the desirable result because they are not train to appreciate the golden ratio of face and to create a golden ruler to understand harmonies of the face.
Some patient requested doctor to inject for an apple cheek, turning themselves becoming twin of famous celebrities but they will not able to anticipate the final result. So as a practitioner, we should emphasis the way and technique which could give the desirable outcome and at the same time we also need to assess the patient with underlying psychiatric disorder.
Why chipmunk look?
It is very easy to inject more when the results are good and satisfied but more not always better.
- There is a limit how much you could do per area – Too much filler injected at one time for the first visit will freak you Always underfill than overfilled! Insufficient of volume can always re-fill during the next visit. Seek for a professional who well trained to be conservative and deliver the correct amount needed in one go rather than too much volumes to make the face looks puffy than refreshen. This commonly happened over cheek, temples, lip and chin.
- Incorrect type of filler – Dermal filler has move on recents years with softer, springy and easy to mold. Brands like “Juvaderm, Restylane, Belotero” has improved with çross-linkage” HA that comes with different type which lasts up to 12 months. The longer the products, the thicker of the filler. Incorrect type of filler used in unsuitable place will make you look older and odd. Sensitive area like under-eye should choose a softer filler, otherwise it will give an additional sausage – like appearance.
- Incorrect injection plane-Aging does not occur uniform in all areas of face, and the fat tissues is fully compartmentalized. Each individual is aged in different pace. Hence correction of each compartment needs to be tailored individually. Too superficial placement will result in bumpy or lumpy appearance during expression. The tyndell effect is when a products is injected under the skin and produces a bluish hue due to the way the light is reflected.
- Assessment of face with movement. Rather than just keep adding, an expert aesthetician will help the patient to understand the balance and symmetry of a beautiful face. Its rather important to remind the doctor to do a proper assessment with an expression prior to injection.
How to treat overfilled syndrome?
Injecting non-permananet filler like hyaluronic acid products are the most forgiving. Why? Hyaluronic acid is naturally occurs throughout our bodies in connective tissues and important to our cartilages and skin.
By injecting with hyaluronic acid filler, it easily dissolved by a substance calls hyaluronidase. It able to dissolved any filler injected like overfilled syndrome, tyndell effect, irregularity of filler placement and it also important to be used during blood vessel occlusion.
The injection of hyaluronidase able to deliver immediately dissolving effect and continue to improvement after few days. Unfortunately, patient who injected with permanent or unknown substances are not easily or impossible removed using hyaluronidase.
Common side effects of hyaluronidase are allergic reaction, redness, swelling and bruises.
What to consider before dermal filler?
- Is the doctor qualified?
Doctor who spent years during the medical school responding well in anatomy and handling complications. However for the untrained injector, might not be able to delivery a natural looking and knowledge of facial anatomy. Its extremely important to inquire an aesthetician who is credentialing with sense of art to deliver the balance and facial harmony yet treating the face as a whole and understanding how injection could deliver the lift, re-shapen and anchor the lower sagging face.
- What brand of injections will you be using and why?
There are several different brands and important to ask your doctor what brands the doctors use and why. Juvederm, Restylane or Belotero are FDA-approved products for facial augmentation. Do not venture into non-FDA approved filler. The complication is unpredictable like granuloma, inflammatory nodules, sterile abscess and prolonged redness.
- Permanent VS non-permanent filler?
Choosing the non- permanent filler is more forgiving and able to remove it anything when things gone wrong but not on permanent filler.
- Which type of filler to use?
Each of the brand filler has their own range. Softer filler uses in very thin area like under the eye and in fine line treatment whilst harder filler is designed for area which needs more holding power, facial contouring and enhancement. Choosing the wrong range of filler under eye would create the sausage like appearance or bulging of the filler during facial movement.
Written by Dr Michelle Lai
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