FACIAL ANALYSIS
Facial remodelling with volumizers is about recovering shapes and bringing back tension to anatomical layers, while paying attention not to alter patients’ traits. This requires a comprehensive facial analysis that takes into account everything that can be modified within each patient’s anatomical pattern. Indeed, both the bones and facial fat compartments undergo impacting changes with ageing. In order to obtain a natural-looking correction of these alterations, with volumizers, one of the most important tricks is to sequence treatments from the base towards the outside. After a full analysis of the deep, medial and superficial fat compartments, begin with deep deposits in the supraperiosteal layer. However, other compartments should not be overlooked. With years, the appearance of facial flaccidity is strongly related to the loss and detachment of the superficial, medial and deep fat compartments. This is the reason why weight loss sometimes accentuates wrinkles and facial flaccidity and gives a tired look. On the other side, for the same reason, plumper people seem to age better with less wrinkles.
TIP 1: START WITH DEEP FAT COMPARTMENTS
My first treatment point is in the deep fat compartments and my product of choice is TEOSYAL® ULTRA DEEP1, especially in the Sub-Orbicularis Oculi Fat (SOOF) compartment (lateral and medial parts), and the deep medial cheek fat compartment (lateral and medial parts, fig.1A). This volumizer resists displacement and helps correcting bone loss by projecting internal structures. It is safe, stable and elicits very natural results.
TIP 2: AND THEN, THE MEDIAL FAT COMPARTMENT
More superficially, the ‘medial fat compartment’ (Fig.1B) is one of the first
to suffer ptosis very early on, accentuating under eye circles and nasolabial folds. For this compartment, I choose TEOSYAL RHA® 41 for its versatility and adaptability to facial movements. It accompanies muscle dynamics without deforming tissues, and allows physicians to avoid extreme facial remodelling and unnatural outcome.
TIP 3: STRENGTHENING FACIAL LIGAMENTS
Strong osteocutaneous ligaments between the periosteum and the skin help soft tissues resist gravity and remain in their anatomical position. They prevent the descent of facial fat between the superficial and the deep fascia. A loss of support by the zygomatic ligament elicits the descent of the malar fat pad, increasing nasolabial fold prominence; while a loss of support by the masseteric ligament may lead to the descent of fat towards mandibular borders. These are the two most important ligaments to consider in order to achieve a good tensor effect in facial volumization. Depending on each case and the objective pursued, I use TEOSYAL RHA® 3 or 4. I use the latter to provide a greater volume in mobile areas. It is usually placed at the base or the medial zone of the retaining ligaments. Its viscoelasticity provides great cushioning and is particularly adapted to dynamic areas of the face.
AND ONE LAST TIP…
A final trick for volumization is to use the vectors in the Superficial Muscular Aponeurotic System (SMAS) or deep dermis. I always trace these out based on the patient’s observed facial dynamics and respecting the nasojugal crease of the face.
Fillers of the TEOSYAL RHA® line, thanks to their high stretch and strength provide gels with mechanical resilience, which opens doors for holistic and dynamic aesthetic outcomes. This three-dimensional concept that brings together anchor points, ligaments and vectors opens up entirely new treatment options previously hardly achievable with classical hyaluronic acid fillers. With good anatomical knowledge and aesthetic judgement, following these simple tricks and tips and using this qualitative line of products, possibilities are virtually endless!2
About Dr. Juan Miguel Perez Diaz, MD
- Cuban native, studied medicine at the University of Valencia, started to work in Aesthetics in 2000, and founded his own clinics in Alicante & Madrid.
- Has developed two different techniques, BIvectorial & Regeneration, for fillers injections.
- Frequent speaker at national & international congresses
- Approaches aesthetic medicine through Advanced Diagnosis & Coaching
- Training through a YouTube channel & masterclasses all over Spain
1. TEOSYAL® ULTRA DEEP, TEOSYAL PureSense® ULTRA DEEP (Containing Lidocaine) and TEOSYAL RHA® 1 to 4 are trademarks of the firm TEOXANE SA. TEOSYAL® ULTRA DEEP, TEOSYAL PureSense® ULTRA DEEP
and TEOSYAL RHA® 1 to 4 are class III medical devices and are regulated health product bearing the CE marking (CE0086) under this regulation. For professional use only. Please refer to instructions for use.
2. A thorough knowledge of facial anatomy and injection techniques is mandatory
3. Dr. Perez Diaz’s personal opinion and experience. TEOSYAL RHA® 3 instructions for use recommend a deep dermis injection with a 27G needle.
4. Ramanadham R. & Rohrich R. Newer Understanding of Specific Anatomic Targets in the Aging Face as Applied to Injectables: Superficial and Deep Facial Fat Compartments—An Evolving Target
for Site-Specific Facial Augmentation. Plast Reconstr Surg. 2015; 136:49S-55S