By Doctor Micaël Schneersohn : A holistic approach to rejuvenation
Facial rejuvenation requires two complementary actions: restructuring the sunken areas and filling the hollowed-out areas and wrinkles. Depending on the patient’s age and morphology, two applications, two techniques, and two products will bring fullness back to a deteriorated face, reviving its lost vitality and dynamism.
Lift the upper part of the face first of all
We begin by restructuring (that is, tightening up any sagging areas) before filling the hollow areas to avoid overfilling the face, in particular the cheekbone area. It is vital not to create volume where there was none previously, and this is why patients are advised to bring along photos (unsmiling) from ten or twenty years ago. Starting with the upper part of the face enables us to clearly see the tightening effect the injections have on the lower part of the face and therefore to use less product. On a moderately hollow face or a wide or round face, calcium hydroxyapatite (Radiesse) is the product recommended to give a lifting effect without adding volume. The temples are treated first to awaken and open up the expression, then the eyebrow and the fatty cushion at the outer edge of the eyebrow, if necessary.
If the face is suffering from fat loss, volumising hyaluronic acid such as Belotero Volume or Stylage XL, Emervel Volume, etc. is injected deep into the dermal tissue. Belotero Volume can be modelled easily thanks to its high malleability.
The middle third of the face, the focus of all attention
Neither too prominent nor too flat, the cheekbones should be in harmony with the rest of the face and it is important to respect their original structure. Certain patients ask us to “create” cheekbones, but this must be avoided otherwise we get an unnatural Barbie-like effect. Instead, we must re-align the lower eyelid with the cheek by smoothing out the under-eye shadows, which will re-energise even sunken faces. If the patient has sagging cheek fat, we inject on either side to “drown it out”. The tear trough is often sunken and flat, which means it needs filling in order to achieve gentle projection. This is done using a cannula with the aim of creating volume, or indeed not, depending on the hollowness of the face. An injection at the start of the nasolabial folds is sometimes necessary to complete this restructuring. If the cheeks are hollow, an intense filler applied to the deep dermal layer achieves volume while naturally adapting to the facial expressions, thanks to its high elasticity.
Lifting without creating volume using the “Trigger Zones” technique
If the face’s volumes are correct but a lifting effect is needed, this “Trigger Zones” technique, carried out with a needle, enables us to lift a sagging area, point by point. Bolus injections of Belotero Intense are administered deep into the dermal tissue. A first bolus is applied to the outer edge of the cheekbone, then one on top of the cheekbone, and another at the start of the tear trough in order to give the tissue points to which they can anchor themselves without creating volume. We then finish off with an injection at the top of the nasolabial fold and another at the top of the oral commissure. One or two syringes are needed. We can also complement this with a bit of Radiesse in different areas, as these two products go together well thanks to their high elasticity, on both thinner and thicker skins.
The lower part of the face, the grand finale of rejuvenation
Once this has been carried out, we can accurately assess the needs of the lower third of the face. First by lifting and restructuring, then by filling if necessary, and finishing up by dealing with residual wrinkles, in particular loose jowls and oral commissures.
The jawline is lifted using a cannula and the entry point is near the jowl. Since we do not want to make the lower part of the face heavier by adding volume, we can reshape the jawline with retrotracing injections, then lift it by injecting in upward vectors. The combination of calcium hydroxyapatite and the injection techniques used will improve sagging and gently lift the mouth by creating tension. The chin must be realigned if the jaw has moved backwards and it becomes flattened, or if the chin looks square. Radiesse administered deeply into the tissue will help move the chin forwards, followed by a few superficial injections to round its shape.
Finally, the jowls and oral commissures are treated by needle injections into the superficial dermal layers using soft hyaluronic acid.
After two months, at the patient’s check-up and adjustment appointment, we notice that the quality and elasticity of the dermis have improved, the skin is firmer and plumped up. The face looks reenergised while retaining its natural appearance in movement.
Dr Micael Schneersohn
Expert en esthétique médicale, Titulaire du DIU de médecine morpho-esthétique et anti-âge, du DIU européen des lasers médicaux, et du DIU de mésothérapie. Fondateur et dirigeant de Clinéance à l’Isle-Adam (95) en 2005, unité médicale dédié à l’esthétique et au rajeunissement.
Medical Expert in Aesthetics treatments, DIU (inter-university diploma) in morpho-aesthetics and anti-aging, European DIU in medical lasers, and DIU in Mesotherapy Medicine. Founder and manager of Clinéance at Isle-Adam (95) in 2005, a medical practice entirely dedicated to aesthetics and rejuvenation.
