Skin overlying muscle in the face is susceptible to the early development of expression lines, particularly with pronounced facial expressions. Typical examples are the vertical “anger lines” between the eyebrows (Glabella lines), ‘crow’s feet’ around the outer corners of the eyes, and ‘worry lines’, the horizontal lines on the forehead. Injections can be used as a minimally invasive method of treating these lines.
Anti-wrinkle injections utilise neurotoxins to reduce muscle contraction by blocking the release of the necessary messenger substance, this is the gold standard of short-medium term beauty treatment. As a consequence of muscle relaxation, the lines are also smoothed or disappear entirely where they are not too deep. Depending on the injected amount and patient, the effects last for several months.
In addition, anti-wrinkle injections may be used successfully to reduce excessive sweating, (here mainly axilla and palms of hands), as well as for excessive saliva production. There is also potential for its usage in the treatment of tension headaches, migraines and teeth grinding.
The full effect of the treatment develops approximately 3-to-5 days after the injection and lasts around 3-to-6 months. A sustainable effect up to one year may be achieved with repeated treatment. Since there is typically only a hardly visible reddening at the injection points, you will be presentable immediately after the treatment. I conduct an initial analysis of both skin and lines, which is recorded to ensure duplication at repeat visits. I exclusively use Azzalure by Galderma.
Many different forms of hyaluronic acid fillers are available, allowing suitable products to be chosen to treat any depth of lines in the facial area. Finer fillers are suitable for the treatment of early superficial lines, lip lines, and early-onset forehead lines. Deeper lines may be treated with higher cross-linked, stronger hyaluronic acid preparations. Facial contours can also be improved by this treatment and an immediate, striking rejuvenation of the treated area can be attained in a short time. Additionally, specific hyaluronic preparations are perfectly suited to enhance lips by revitalising contours and volume.
I exclusively use hyaluronic acid products by Galderma (→Restylane).
These are non-permanent fillers which are completely absorbed by the body. This requires repeated treatment, and allows changes to be made subsequently, depending on the patient’s wishes and age. The greatest advantage is the excellent tolerability of these absorbable materials, and a very low rate of complications in comparison to permanent fillers. Depending on the area treated and the fillers used, results last between 6 and 12 months.
A painless treatment is paramount. This is achieved by applying anesthetic cream beforehand, using fillers mixed with low dose local anesthetic, and applying cooling packs to the area immediately after treatment. Swelling may still occur and last for two-three days, especially in the lip area. Patients should ideally plan treatment at times that they can accommodate this effect socially.
Alternative non-synthetic filling materials include autologous (patient’s own) fat, which allows injection of greater volumes. This is performed using the ‘S. Coleman’ technique (structural fat grafting). The fat is removed using a targeted “mini-liposuction” from one area, for example the belly or the upper thigh. This fat is then purified and injected into the areas to be treated. This is performed under a short general anesthetic.
The Coleman technique has several advantages: firstly, the injected autologous fat does not lead to any foreign body reaction. Secondly, a large amount of the injected fat adapts to the local blood supply, which allows further augmentation to be performed at a later date.
There is another method of skin rejuvenation available such as SkinBoosterby Restylane. These are also hyaluronic acid products, which are not used as fillers to increase volume, rather they improve the moisture content of large areas of the skin from the deep layers. Enhanced elasticity and suppleness of the skin can be achieved, be it in the face, hands or neckline.
In addition, the structure of the skin may be improved in certain conditions such as acne scars or UV-damaged skin. This treatment is performed by injection using a fine-tipped needle.
Several treatments (build-up and refreshing phase) are necessary in order to improve the moisture content of the skin long-term, as well as to preserve the elasticity and smoothness of the skin.