why and how to treat them? – anti-aging the anti-aging guide anti-wrinkle anti-aging aesthetic medicine

why and how to treat them?  – anti-aging the anti-aging guide anti-wrinkle anti-aging aesthetic medicine

To improve a face, limit the effects of time or reduce certain disgraces, it is possible to use injectable products of the filler type or botulinum toxin. These two techniques can be combined. These medical procedures can sometimes have side effects.

Side effects or complications are of two types: there are those that we expect and those that are a bad surprise. It should be noted from the outset that by using the recommended products, i.e. non-durable fillers such as hyaluronic acid, calcium hydroxypatite, polylactic acid or botulinum toxin, there is no has in practice only few risks, especially because of the non-persistence of these products. Side effects, if any, will be limited.

Botulinum toxin is used in aesthetics to reduce muscle contraction of the muscles of the upper part of the face, the muscle responsible for the wrinkle between the eyebrows called the frown line. Currently it is also used by some experienced practitioners to improve the whole face. However, if its use on the upper part of the face (forehead, crow’s feet and frown lines) can be sufficient for a satisfactory correction, at the level of the middle and lower part of the face and neck small doses are used, which explains that this technique must be associated with filler injections for a good result. These dose differences are linked to the complexity and interactions between the different facial muscles: at the level of the forehead and around the eye there are few muscles, whereas in the middle and lower part of the face, the muscles are numerous and overlapping, which explains all the facial expressions we can do. The principle of the toxin will be to make a very precise injection.

What are the risks ?

They are transient, rare but can be annoying. Local redness or ecchymosis (blue) at the injection site, swelling around the eyes which can settle in 4 to 5 days and decrease in a few days or weeks, sensitivity disorders with feelings of tension in the forehead or fixity, fleeting eye or facial pain. Sometimes, it is an imperfection of results with persistence of fine lines, asymmetry, raising of an eyebrow, disorders of mimicry. These imperfections will be quickly corrected either by an injection of toxin or by other techniques (filling). Finally headaches, drooping of the eyebrow or eyelid, dry eyes are possible and exceptionally allergies, nausea, fatigue, flu syndrome, skin or mouth dryness. All of these effects are transient.

Botulinum toxins that can be used in aesthetics are currently 3 in number in France (Vistabel, Azzalure and Bocouture). This act is reserved for certain medical specialists (plastic, reconstructive and aesthetic surgery, dermatologist, face and neck surgery, maxillofacial surgery and ophthalmologist).

The most used fillers (also called “fillers”) are based on hyaluronic acid. There is currently a very wide choice (more than 100 possibilities) and some products contain an anesthetic (Lidocaine) to limit pain. Side effects are categorized by time to onset. They can be immediate (up to 1 week), semi-delayed (1 to 3 weeks) or delayed (late 3 to 24 months). Immediate incidents can be expected. Indeed during the trauma of the bite, it is possible to have pain, redness, small bleeding or swelling (oedema). Sometimes it’s a surprise effect or a more rare incident such as a hematoma, an allergy, hypersensitivity, an outbreak of pimples (folliculitis), an outbreak of herpes, an itching sensation (pruritus). At the level of the lips there can be a sometimes sensitive swelling (inflammatory oedema) which can last 2 to 3 days. Finally, if the doctor uses a local anesthetic there is a very low risk of an allergic reaction. Sometimes there may still be an over-correction compared to the expected effect (especially lips or dark circles).

The semi-delayed reactions are essentially greyish pigmentary traces, over-corrections, asymmetries, non-specific inflammatory phenomena.

Finally, late reactions such as redness, nodules, allergy, abscess are exceptional. It is important to warn your practitioner and return to see him in the event of a side effect, so he can manage it quickly.

How to prevent these complications?

The practitioner carries out a preliminary consultation during which he examines your skin, asks you about your treatments and explains possible incidents. To avoid inconvenience, it is not recommended to take aspirin or anti-inflammatories before the act (risk of hematoma), as certain drugs can cause reactions (interferon). After an act of filling, it is better to limit the gymnastics (the grimaces), the sauna or the hamman for example a few days the time that the product takes its place.

How are these complications listed?

Serious complications must be declared to the AFSSAPS whose site also classifies fillers and gives simple advice: doctors also declare to the firm that supplied the product. All the effects, whatever they may be, can be declared to associations of “expert” doctors who not only take note of the effect but also help the practitioner to manage this effect in the best possible way (Vigipil for example brings together dermatologists throughout France and ensures vigilance for all dermatological aesthetic procedures: peeling, laser, filling, etc.). When a product causes too many reported side effects, it can be taken off the market. This is the case of an injectable, different from hyaluronic acid, which last year after being put on the market for a few months caused unexpected reactions (nodules in particular). The injecting doctors quickly declared the effects and the marketing was stopped throughout Europe. However, we must regret the current European law which on the one hand requires long and expensive clinical studies for an AMM (marketing authorization) and this is the case for botulinum toxins and on the other hand the notion of DMI (implantable medical device) which does not make clinical trials mandatory but simply rules on the correct rules for manufacturing the product.

It is difficult to have a very precise number of cases because not all the effects are declared, especially since both the toxin and the hyaluronic acid give few serious or lasting effects.

The Order of Physicians does not play any particular role. On the other hand, he can provide the patient with the doctor’s specialty.

Aesthetic procedures aim to satisfy patients in realistic proportions. It happens that the expected effect is not achieved and that the results obtained increase, on the contrary, pre-existing psychological disorders. But most often the rejuvenation obtained is satisfactory and the patients wish to maintain it. The disadvantage is that you have to start over for the toxin twice a year and for the injectables every year or so. This maintenance allows you to keep your appearance in good shape and to slow down aging. The notion of product safety, efficacy and tolerance are currently the criteria of choice for doctors. There is of course an economic notion, but a good product always requires a certain price, a competent practitioner… and safety is priceless.

To remember

Injectable products such as hyaluronic acid or botulinum toxin can cause unforeseen complications during an injection. They are generally transient, rare but can be troublesome. One of the great advantages: their resorbable aspect. In the event of serious complications, it is possible to make a declaration to the AFSSAPS.

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