FILLERS: HYALURONIC ACID

Fillers are now essential in the management of facial aging in order to restore the harmonious contours of the face.

The need for a precise aesthetic diagnosis is obviously the essential prelude to correctly establishing the techniques and products to be used. With this in mind, it is necessary to differentiate the melting of volumes and the reduction in skin tone in the alteration of the contours of the face so that the dermatologist can adopt the best strategy and allow to correspond to your expectations and that the patient can have understood the limits of the techniques that we offer.

The logic of restoring soft and natural facial features with nuance is a basic rule to avoid the consequences of excessive injections and their risk of leading to cartoonish results.

The use of gels based on hyaluronic acid is essential because of their effectiveness and their safety as a dermal implant.

The other filler gels, both slowly absorbable and tissue inducing, offer another treatment possibility but they impose more technical constraints to obtain the desired result.

Why inject according to your aging?

The aging process:

The freshness and youth of a face are linked to the harmonious conjunction of the following essential elements:

A soft, smooth, relaxed skin surface with a radiant complexion;

An oval of the toned and curved face as well as the eyelids – source of the radiance of the eyes;

A harmony of curves and typically youthful volumes characterized by:

The roundness and convexity of the shapes – perfectly visualized in children -;

General ascending lines; a young face is in fact a firm and curved face, smooth, round and full on all levels of the face.

The beauty of a face depends on the harmony of the volumes of the two main pillars of its framework: the mid-facial T-zone and the lateral zone of the cheekbones.

How does time progressively mark a face?

The three-dimensional analysis of the facial aging process is fundamental to choosing the appropriate correction techniques.

The face modifications are in fact the result of variously associated components:

Alteration of the skin surface 

Frowns of muscle origin located in the upper third of the face (glabella, forehead, crow’s feet): they are corrected by botulinum toxin.

The superficial degradation of the integument (pigment spots, erythrocouperosis, fine lines, helioderma, etc.): it is repaired by targeting lasers (pigmentary and vascular) and “resurfacing” techniques (light repetitive peels, medium or deep peels, ablative lasers ).

The loss of the oval under the effect of gravity by reduction of the contour and skin tone. Its restoration is based at the beginning on the radiofrequency medical technique and at the advanced stage of ptosis on the centro- and / or cervico-facial surgical lifting.

Flattening or deepening of facial curves by melting the volume of juvenile “curves” linked to the involution of the entire tissue thickness (dermis, hypodermis, muscle and bone), particularly in certain key areas of the face. The restoration of these volume losses is based on injections of fillers.

Polymerized hyaluronic acid (or hyaluronan) gels are the products of choice.

Why hyaluronic acid?

The concept of injecting an implant into the skin imposes a reflection on the criteria to be required of a filling product:

-Security using a safe and widely experienced product

-Rheological characteristics close to those of the skin

– Predictable biodegradability

-The good integration of the product into the skin

Hyaluronic acid is the reference product: it is the most injected filler product, it offers optimum safety.

What is hyaluronic acid?

Hyaluronic acid is above all a biological molecule. Its total mass is around 7 to 8 grams in an adult, 50% of which is found in the skin and especially in the dermis which is located under the epidermis – which is the surface structure of the skin.

It has been identified in all vertebrate tissues without specificity of species or organ (therefore theoretically without risk of allergization or foreign body reaction).

Hyaluronic acid is a hygroscopic macromolecule which allows the capture of large amounts of water and ions to maintain turgor and hydration of tissues. Hyaluronic acid is present in many biological processes, lip injections cost remain to be discovered according to specialist biologists.

Products based on hyaluronic acid are the most commonly used for many reasons: ease of injection, availability of a sufficient range to treat the various parts of the face, ecological logic (hyaluronic acid is already a physiological component of the dermis), cosmetic performance with semi-slow biodegradability allowing sufficiently long stability of the result, optimal safety due to very good integration of the product, total absence of risk of major side effects (given the hindsight), and finally the availability of hyaluronidase to melt any inappropriate corrections.

What are the potential side effects?

In exceptional cases, hyaluronic acid-based gels may be the object of an allergic rejection manifested by an inflammatory skin granuloma in the injection area. This allergy is obviously not linked to the hyaluronic acid molecule but to its crosslinking. Without therapeutic action, the granuloma would disappear spontaneously with the complete biodegradation of the product. It disappears in a few days after the injection of hyaluronidase intended to degrade the implant. Hyaluronidase can also be used when the injection has been excessive and a source of aesthetic disgrace.

How does an injection work?

After an aesthetic assessment during a consultation with the dermatologist, a treatment program will be established, informing the patient about the quantities of product and the areas to be injected in order to optimize the result as much as possible.

A quote and an information form are provided. The injection will only take place a second time after a reflection period. The patient first submits the estimate and the signed information documents.

Most hyaluronic acid products now contain an anesthetic. However, the dermatologist may offer local anesthesia by application for a few minutes of an anesthetic cream or sometimes additional anesthesia by injection for certain locations.

The injection takes place in several stages with different techniques according to the products and the operators, some use a cannula.

Whatever the Dermatologist’s technique, the result will be immediate and will improve in the following weeks. Some hematomas can occur in certain locations. They regress in a few days, the patient can use makeup the next day to possibly camouflage them.

A healing ointment may be prescribed to improve the process, and sometimes homeopathic derivatives. These hematomas are infrequent but it is advisable to provide for this possibility in social life the days following the injections.

How long does it last ?

Products based on hyaluronic acid have an average durability of 9 months, gradually degrading to disappear. There is therefore a need to perform maintenance by regular injection. The absorption of this product is also a guarantee of safety.