If you ever look at a young person you will see how soft their skin is, how plump it is and how it recovers from each move and every gesture, how unblemished and how perfect the features.
Clean, bouncy and as inviting as a hotel bed with new duvet and freshly ironed sheets. Plump is the right word – all the tissues supporting the skin are firm and healthy; the fatty layer, the blood vessels, the supporting collagen fibres and the "ground substance", the hydrating gel.
Youth is wasted on the young, or so they say. Slowly and imperceptibly the supporting layer starts to lose its fullness.
Like an apple drying in the fruit bowl the skin starts to sag, to line and pucker, eventually overhanging its bony margins at the jaw line and in the cheeks. In the absence of severe weight loss or other accelerating elements (smoking, sun exposure, extreme illness) volume loss precedes loss of elasticity by about seven years.
Most lines on the face are caused by the underlying loss of volume. Look at the face of somebody overweight – they have few (if any) lines and their face is still round and plump. Up till recently we used to fill the lines themselves, but now this new understanding has allowed us to replace the underlying volume disturbance and achieve better, more natural and longer lasting results.
Some lines still need filling, or the individual may desire a fast-fix
in the short term - cheek lines, nose to mouth lines and lips,
for example. These areas are subject to constant movement and micro-trauma in the skin. The newest generation of flexible hyaluronic acid fillers suits these areas very well by minimising the micro-trauma to the skin-filler interface. Fillers such as Esthelis (marketed as Belotero in the UK) are the flexible fillers that we use for these particular areas. Cheek lines, crows feet, forehead lines, lipstick lines, lines on the chest/décolleté all respond well to fine flexible fillers.
Cheeks
Cheeks are a sign of both youth and beauty. The cheeks highlight the eye area by catching the light. Together with the eyebrows they frame the eye, drawing the viewer's eyes to their target.
Regardless of bony structure, the cheek area will disappear with age, leaving tell-tale signs – crow's feet, nose to mouth folds, loss of facial balance, heavy jawline and the "banana", the fold above the nose to mouth area.
Young people have voluminous cheeks, as well as "pretty" people, and a loss of cheek volume can be quickly and easily restored with
a filler. Longer-lasting products such as Restylane Sub Q and Voluma are used to build up the cheek area and lift the jawline. Both Sub Q and Voluma are designed to give instant results and last about one year.
Lying close to the bones of the face is yet another layer of fatty tissue. This, too, disappears with age, weight loss, smoking and sun damage and can lead to a very craggy look with chiselled features. The answer here is restoration of the deeper fat stores, only possible with Sculptra.
The other area that forms part of the face is the chin. Even with good dentition this shrinks, pulling back the lower frame of the face and causing stubborn marionette lines. This area must not be neglected when treating with fillers.
Volume loss is not always appreciable, but once noticed it is difficult to ignore. Volume loss makes us look tired and older and makes us “disappear” in a crowd. Volume turns heads and speaks, well, volumes!!
Lips
Lips, like the cheeks, are a sign of youth and fertility. The fleshy red aspect is due to circulating oestrogen , the female sex hormone. Young women have rich, fleshy red lips and this is a sign of their oestrogen level (=fertility). When red lipstick was first introduced, it was banned by the Pope on the grounds that it excited and incited men to sin. That may have been the case, but in fact we enhance our lips for ourselves, not for the men.
Lips require their own special filler. We use Surgilips (0,8ml) or Restylane Lipp (1ml) to replace the lost volume in the flesh, under the skin of the lips or in the border. By placing the filler in different areas of the lips we achieve different results; a well-defined border, fleshy strawberry lips, soft, voluminous lips or a combination of all of these.
You can imagine that the lips are sensitive. We always offer a dental anaesthetic for the treatment of the upper and lower lip. This takes five minutes to perform and leaves the lips numb for about 45 minutes, ample time to perform the treatment. Once the lips have regained sensation, the lips might feel a little sore. They will certainly be swollen and will remain swollen for the next 24 hours. Rarely a bruise occurs, so please bear this in mind when planning treatment.
All of the fillers that we have described up till now are based on the natural hydrating substance of our skin, hyaluronic acid (HA). HA has been used as a filler substance for over fifteen years and technology has allowed the product to be made so that it is totally compatible with the human body. HA is a large sugar molecule that attracts water; it is a hydrating and lubricating agent and is identical across the mammalian and bird species. The first HA fillers were derived from the comb of the cockerel but nowadays all HA comes from bacterial fermentation (the standard process for all biological substances). It has even more exciting properties which will be explored in the Restylane Vital section. |
