A youthful healthy appearance is important to everyone, so many people start to look for some form of treatment, when they begin to notice the visible signs of ageing. This is when most people start to use cosmetic products or undergo treatments.
There has been a lot of research in the modern era on the concepts and science of beauty.
The face is one of the most complex regions in the human body and research continuously reveals new insights into the complex interplay of the different participating structures.
Aging occurs in all facial structures such as bone, ligaments, muscles, fat, and skin, however the onset and the speed of age-related changes vary between each specific structure. This gradual change is different for every individual and a person’s ethnicity can also impact the speed and type of change.
Therefore, scientific knowledge of skin and age-related anatomy is especially important for any professional’s work when trying to restore a youthful face and recreate the lost Facial Triangle.
A face which is balanced and symmetrical, with smooth skin can be achieved with a combination of relatively straight-forward cosmetic treatments
- The Skin
- Anti- Wrinkle
- Dermal Filler
Botulinum toxin is a potent neurotoxin that is widely used to treat a few medical conditions including neuromuscular disorders, pain, eye disorders, and facial rhytids(fines lines)
The main areas of target include:
- Horizontal forehead lines
- Glabeller area-frown lines
- ‘Crow’s feet’ – wrinkles at corner of eyes.
- ‘Bunny lines’ at the sides of the nose
- Necklines – horizontal and vertical (Nefertiti Neck Lift)
- Marionette lines- to lift upturned corners.
- Jaw Slimming
- Underarm excessive sweating
Dermal Filler is the most common aesthetic procedure to help restore the lost volume or fat due to the ageing process. It can also be used to enhance features of certain areas like lips, cheeks, jaw line, chin and nose. The most commonly used fillers are made using Hyaluronic acid, which is naturally found in healthy skin and works due to its ability to bind with water. The effects of fillers can last 6 to 9 months.
They can also be used for profile balancing, contouring and reshaping features to help balance the facial proportions.
Areas that can be treated include:
- Lips 2. Chin 3. Cheeks 4. Jaw 5. tear trough 6. temple 7. forehead 8.brow 9. nose.
Pre-treatment preparation is important to minimise risks and unwanted side effects. Patients must be fully informed to ensure that their expectations are realistic.
Written informed consent must always be obtained, and pre-treatment photographs should be obtained when possible. A complete medical history is always necessary and should cover allergic or hypersensitivity reactions to any substance, including anaesthetics.
The skin can be broadly classified into three layers:
- Subcutaneous layer.
The Epidermis is the outermost layer whose main function is to act as a barrier.
The dermis is clinically a very important layer of skin, because this is the layer where most treatments are targeted. The dermis supports the epidermis and provides elasticity. The root of hair follicles, blood vessels, nerves, sweat glands and sebaceous glands are present in this layer.
The Subcutaneous layer is the deepest layer of the skin just above the facial muscles. Its role is to provide a cushion to external force, preserve body heat and retain moisture.
Elastin, Collagen and Hyaluronic acid are the three main components of skin, most skin and anti-ageing treatments are used to repair, enhance, or optimise the production of these three components.
- Elastin is a protein forming the main constituent of elastic connective tissue and its primary function is the elasticity of tissues.
- Collagen is another type of protein found in skin, bones, muscles, and tendons. The word collagen is derived from the Greek word kolla which means glue producer. It forms a scaffold to provide strength and structure for healthy joints and skin elasticity, or stretchiness. Vitamin C plays a vital role in the formation of collagen.
- Hyaluronic acid molecule is one of the main components of connective tissue, forming a gel type support that surrounds the cells and its main function is to help retain water in the skin and eyes as well as lubricating joints. Hyaluronic acid and Retinol are the two of the most popular products used to moisturise dry skin, with retinol boosting collagen production.
Botulinum toxin BOTOX® works by blocking release of a chemical from the nerve end thus reducing the action of the injected muscle. The effects of BOTOX® injections can take up to 2 weeks to kick in, and are obvious for 3 to 4 months, but in some cases may last for 6 months or longer. It is used to weaken or relax muscles thus preventing lines and wrinkles from appearing and prevents damage to the collagen due to repeated movement such as frowning. It also softens existing lines, therefore restoring a more youthful look.
- use the muscles we have injected an hour after treatment, because this encourages a quicker uptake of the product.
- lie down for 4 hours
- undertake excessive exercise for 24 hours.
- rub your face for 24 hours.
- use makeup or any products for 24 hours
As with most medical treatments avoid having alcohol on the day of the treatment.
- Are there any side effects from Anti-wrinkle treatments
- Are there any side effects from Dermal Fillers
This is relatively a very safe procedure but Anti-wrinkle treatment- BOTOX® is a prescription only medicine and must only be prescribed after a face-to-face assessment of a person by a medically qualified, and licensed practitioner. The assessment must include assessing the patient for the Body Dysmorphic Disorder BDD. General side effects include malaise, nausea, influenza-like symptoms, severe headaches, and exposure keratitis and rashes. Ptosis; dropping of the eyebrow or eye lid is an important side-effect occurring in patients treated for forehead or frown lines which can last for several weeks. Other not so common side effects are:
- Redness: can take 24-72 hours to resolve.
- Swelling: can take 3-5 days to resolve.
- Bruising: bruising appears immediately after the injection; it resolves within 5 to 10 days.
Patients who are pregnant or breastfeeding and are NOT recommended to have Dermal Filler treatments as well patients who are immunocompromised or with autoimmune diseases or receiving certain drugs, such as interferon should avoid Dermal Fillers
Patients should be instructed not to take any medication that might increase the risk of bleeding during the 10 to 14 days prior to treatment for example Nonsteroidal anti-inflammatory drugs eg Aspirin or Ibuporfen. Alcohol or vitamin complexes containing vitamin E should also be avoided.
The ACE (Aesthetic Complication Experts) Group recommends avoiding treatments for 2 week before and 2 weeks post Covid-19 vaccine, due to some patients becoming unwell post vaccination.
Patients with rosacea are at higher risk of post-injection erythema and should be warned about this prior to treatment.
Another common skin condition affecting the epidermis is psoriasis, a multifactorial immune-mediated reaction resulting in skin itching, redness and thickening, dermal fillers can precipitate psoriatic flareups.
Other inflammatory skin reactions such as hypertrophic, keloid scarring and post-inflammatory hyperpigmentation can be initiated by a dermal filler. Injecting a filler into a blood vessel can cause vascular occlusion (blocked blood vessels) which leads to diminished or no blood supply to a particular area of the skin causing necrosis (skin death) resulting in permanent scarring and serious infections. Injections and other treatments must only be carried out by a trained medical profession who is aware of the risks including Vascular Occlusion. There are reported cases of immediate permanent BLINDNESS after use of dermal filler in certain areas.
A granulomatous reaction can be defined as a chronic inflammatory response that appears at all injection sites at the same time or at least 2 months after treatment and it can persist for at least further 2 months.
Dermal fillers based on Hyaluronic acid are preferred for high-risk areas like the nose, because in cases of mis-injection, vascular occlusions or other complications, hyaluronidase can be administered to rapidly break down the hyaluronic acid, thus significantly reducing the risk of any permanent damage. The clinic and the practitioner must adhere to all safety protocols as established by the ACE Group, to avoid any risks.
Hyaluronic acid may cause adverse side effects or allergic reactions, all patients will be expected to do a patch test before they start using any new skin product.
People who are administered injections containing hyaluronic acid may experience the following side effects, which should clear up within a week.