The global treatment approach for the face and neck – anti-aging the anti-aging guide anti-wrinkles anti-aging aesthetic medicine

The global treatment approach for the face and neck – anti-aging the anti-aging guide anti-wrinkles anti-aging aesthetic medicine


The holistic treatment approach for the face and neck

It is now possible to mix several techniques such as botulinum toxin, fillers, light, peelings or lasers to restore freshness to facial and neck expressions.

Each product available on the market has intrinsic qualities with palettes of consistency that can be very diverse and that can be used according to the needs of each patient. For example, when we talk about fillers there is of course its own fat (but lipofilling is considered a surgical procedure) and especially the large series of synthetic products where there is not simply the acid hyaluronic acid (with an ever-increasing number of specialty names) but also polylactic acid (Sculptra®), tricalcium betaphosphate (Atléan®), polycrylamide gels (Aquamid®, BioAlkamid®), polymethylmetacrylate (Artecoll®/ Artefill®) and others more recent or to come… If we dwell on Sculptra, the latter has neo-collagenesis properties belonging to the group of fillers known as stimulators. This function of generating new collagen has the advantage of giving a result that lasts very well over time and can be useful, for example, in the case of thin cheeks or temples.

Botulinum toxin gives very appreciable results in the upper 1/3 of the face, particularly in the glabella (the only officially recognized indication in the MA). However, it can also be used with precaution, preliminary anatomical study and complete information for the patient in other areas: for example, it is possible to raise a drooping nose tip with botulinum toxin or raise a corner of the mouth. The toxin can sometimes help to define the facial contour by drawing the oval of the face, by reducing hypertrophy of the masseters (responsible for a large and square face often due to nocturnal bruxism), by relaxing the muscles of the chin. She can also clear tight strings at the neck. All these indications must be practiced on a case-by-case basis. Ditto with fillers, often reserved for the lower 2/3 of the face but which can be justified to reduce a few deep wrinkles on the forehead or crow’s feet, to plump up an eyebrow that is emaciated.

Association of non-invasive and invasive techniques

Many techniques can be proposed to rejuvenate a face that can be imagined as a bed with a box spring (the bones of the facial skeleton), a mattress (the muscles and fatty tissue) and a sheet ( the skin). With the fillers and the botulinum toxin we “restore” the box spring and the mattress but the sheet must also be refreshed and for this we can resort to more or less strong surface techniques. In light techniques, we will note the LEDs which stimulate and give energy to the skin, the light peels which strip it superficially or the IPL which cleans the spots. With higher intensities, non-ablative fractional lasers will force the skin to regenerate in several sessions (25% at each session on average). Finally, fractional ablative lasers destroy the skin and force it to regenerate in depth, just like full lasers, with the risk of being a little traumatic.

A new category of treatment has existed for a few years, the purpose of which is to contract the collagen fibers of the skin and the supporting tissue: it is radiofrequency and ultrasound. Their action can help perfect the results by redrawing an oval, contracting the skin of the neck and toning the whole of the skin of the face.

The so-called invasive approaches are, for example, facelifts or tensor threads. These techniques, which take place in the clinic and under anesthesia, are similar to surgery and can sometimes lead to unnatural results because it is always difficult to subtly treat a patient lying down and intubated under anesthesia.

Understand the factors of aging

In general, it is important to understand that aging influences bones, muscles, fatty tissues and skin at the same time, but not necessarily at the same rate on these different tissues. In the case of significant bone loss in the jaw, certainly fillers can be useful, but a good anatomical assessment should make it possible to judge the usefulness of dental treatment or even prior orthodontics or orthodontics. concomitant in order to restore the initial width of the jaw and the design of the oval that accompanied it. Ditto for the cheeks or the chin for which it is possible to implant silicone prostheses as one would do for a breast augmentation. In the case of a double chin, the radiofrequency associated with filling can play a role of trompe l’oeil but if the skin is too loose, it will be necessary to perform liposuction and a cervical lift. Finally for eyelid surgery (blepharoplasty), the indications remain more restricted than one imagines with for the lower part a risk of digging the orbits. For the upper eyelids, there is sometimes a possibility of raising the eyebrows by injecting botulinum toxin, which can clear the eyelid sufficiently without having to operate on it.

This global approach is the only sensible way to preserve the harmony of a face and remain totally natural. Any aesthetic consultation must start with a diagnosis of the entire face. The practitioner must detect anything that is unsightly by choosing priorities that will be more or less important depending on the case. For example, if a patient wishes to plump up her lips but has taken a lot of sun in her life, it is recommended to treat the skin first to lessen the effects of the sun before starting to fill.

Our profession has taught us anatomy and thanks to experience, growing demand from patients as well as extensive international research and studies, a new science has been born: “the anatomy of aging”. This knowledge allows us to have an in-depth view of the signs of aging which often play out subtly over a few millimeters, hence our know-how to assess the strengths of a face and not focus on what patients consider as faults. When I work on a face, my concern is not to cause dissonances and I try my best to recreate a lost harmony (which I study on the photos of the young patient) as well as to restore light to the face. A young face takes in a lot of light and one of the signs of aging is a darkened face. For me, the safest and least invasive remedy is to treat the upper 1/3 of the face with botulinum toxin. The luminous and therefore rejuvenating effect is often spectacular.

We have in our hands a whole panoply of products that we must use like a painter on his canvas, relying on an implacable science that is anatomy and medicine. In addition, our patients also have the possibility today of taking charge of themselves early by maintaining a youthful capital and opting for prevention-correction such as small fillers at the right time in their lives.

To remember

To treat a face, it is possible to mix synthetic products such as hyaluronic acid, polylactic acid or botulinum toxin which restore the skin, LEDs which stimulate it, peels which clean it, lasers which regenerate and ultrasound or radiofrequency which will contract it.


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