Cosmetic medecine

DEFINITION :
These are filling products that can be injected, either to remodel certain parts of the face or to obtain the filling of wrinkles, furrows or other depressions of the face. An injection session can be done on its own can be or in parallel with injections of Botulinum toxin to reduce the tone of some muscles responsible for the appearance of wrinkles.

AIMS :
An injection of fillers proposes to correct, by a simple and rapid means, certain signs of aging or disgrace present at the level of the face, by filling or giving volume where necessary.

The most frequently made corrections can be divided into four categories:

• Furrows: nasolabial folds (from the nose to the corner wing of the mouth), marionette lines (the corner of the mouth on both sides of the chin), lip and chin groove…
• Fine lines and wrinkles: forehead, “frown lines” (between the eyebrows), “crow’s feet” (around the eyes), cheeks, chin, “pleated sun” around the mouth.
• Lips: redraw the hem (outline), thicken if they are too thin, or make them look fuller
• Depressions (troughs) or volume of lacks: cheekbones chin and jaw outline, cheeks, nose, scar Aftereffects (acne, chicken pox, trauma …)

Usually these misfortunes will not disappear completely but will be considerably mitigated by the injections. The correction is only temporary and the treatment must be renewed to maintain the result.

Injections, both in women and in men, can be performed as early as 30-35 years old.

PRINCIPLES
The basic principle is theinjection of a fluid in the thickness of the skin or the subcutaneous space to create a volume offilling or augmentation.
Biodegradable products are used . They will gradually and totally be reabsorbed.

BEFORE THE INJECTION :
A specific interrogation will be carried out to find out possible side effects to certain products (example: allergies), to detect elements implying a particular caution (example: herpes in case of labia and peribuccal infections).

No aspirin-based medication and no anti-anflammatory should be taken during the 3 days preceding the injection.
It is best not to drink alcohol or be highly exposed to the sun the day before and the day of the session.
Anesthesia
Usually injections are practiced without anesthesia.

We can plan one of the existing methods :

– Emla* Cream: apply a thick layer on the areas to treat at least one hour before the injection.
– Real local anesthesia : obtained by injecting an anesthetic at the beginning of the session itself ensures total insensitivity.

THE INJECTION :
In practice, there are several techniques for injections, and every physician will adopt a method that is safe and that he adapts to each case to get the best results. The amount of product required (number of syringes) is of course varied depending on the number of areas to be treated.
In some cases it is preferable to consider another session a few days or weeks after the first one in order to optimize the result.

AFTER THE INJECTION :
There might be an appearance of edema (swelling) and reddening of the skin. However, the size and duration of the swelling and reddening vary from one patient to the other.

THE RESULT :
A delay of a few days is necessary to appreciate the final result.
The immediate result after treatment is therefore not a reflection of the final result. The injections will have corrected disgraces, thus redrawing in a discreet and natural way the aged and tired appearance of the face. It should be noted that filling injections, in contrast to Botulinum toxin injections, do not impair the mobility of the facial muscles and therefore do not reduce facial expressions.

DEFINITION :
The botulinic toxin is a substance which decreases the muscle contraction by acting at the level of the neuro-muscular jonction (myorelaxing action).

In practice, the more usual indications for botulinic toxin aesthetical injections are the wrinckles between the two eyebrows, the frontal lines and the crow-feet wrinckles.

PRINCIPLES :
The main goal, we want to reach, is to obtain a decreased muscular action at the level of the forhead and the eyebrows, in order to decrease either the horizontal wrinckles and the vertical ones, done by muscles contraction. Such a use allows to smooth the skin reliefs and so to get a rejuvenative effect due to the muscular tension release.

OBJECTIVES :
This treatment main goal is to improve wrinckles and fine lines, when in a resting position and not to avoid muscle contraction. It is better for a first session moderately effective than too efficient: in fact, we do not seek an optimal result from the first injection.

BEFORE INJECTING :

No special preparation is required. We must also respect the following contra-indications :

• Certain neuromuscular deseases, like myasthenia
• Pregnancy and breast feeding
• Known hypersensibility to botulinic neurotoxin A or to serum-albumin and present treatment with aminosid group

TYPE OF ANESTHESIA
No anesthesia is required.

INJECTIONS PERFORMANCE
The tratment is done in the doctor’s office.This treatment consists on a serie of facial injections. The needle is fine and the injections are usually less painful.

AFTER THE OPERATION : THE FOLLOW-UP
During the two hours following the injections, it is advised not doing itense sport and not lying down. It is also advised to avoid facial manipulation or massage for 24 hours following the session.

On the other hand, during the three days following the injections, it is strongly recommended to contract the injected muscles, three times a day, for about 5 seconds per muscle.

THE RESULT :
The expected result consists of wrinckles decreasing with small motions keeping; it is obtained within 3 to 15 days following the injections. The result obtained after the first session stays 3 to 6 months averagely, after what the injection can be renewed.

On the other way, we must remark that if we stop injecting, the treated muscle will go back to its normal function, from before the injections.

DEFINITION, AIMS AND PRINCIPLES
The principle is an autograft of fat cells from fat harvested from the patient.

Lipostructure can be used for many depressions (troughs) which can be natural or post-traumatic or iatrogenic.

1. Aesthetic indications:
   • The filling and smoothing of certain wrinkles, especially of the face.
   • Restoration of volume and shape to the face.
2. Indications for reconstructive surgery :
   • Filling of a depressed zone resulting from injury
   • Correction of irregularities following a liposuction procedure.
   • Correction of wasting after triple therapy for HIV + patients.

Before the surgery :
A preoperative check up will be carried out as prescribed. An anesthesiologist will see you in consultation.
Smoking cessation is recommended.
No aspirin-based medication should be taken during the 10 days preceding the operation.

HOSPITAL STAY AND TYPE OF ANESTHESIA

Type of anesthesia : Local anesthesia with sedation given by intravenous drip is the usual choice for lipostructure. One can also use local anesthesia alone, or general anesthesia.

Hospital stay : The procedure is carried out on an outpatient basis.

THE SURGERY :
We can however give you some basic points : The harvesting of fat is carried out atraumatically through a tiny incision hidden in the natural skin creases, using a small canula. Re-injection is carried out through 1mm incisions using micro-canulas. Tiny particles of fat are re-injected at different levels and in multiple divergent directions. This increases the surface area in contact with the implanted cells and receptor tissue and ensures the survival of the grafted fat cells.

AFTER THE OPERATION :
After the operation pain is usually mild. Swelling usually takes 5 to 15 days to disappear completely.

Bruising appears on the injection sites: it disappears 10 to 20 days after the procedure.
Once the swelling and bruising have settled the final result will begin to be visible 2 to 3 weeks after the procedure.

THE RESULT :
The final aspect will not be visible before 3 to 6 months.
It is most often satisfactory, whenever the indication and the technique have been respected.