Full-face Rejuvenation

Case Study: Full-face Rejuvenation

Nurse prescriber Rachel Goddard discusses her tips for facial restoration using the Teosyal® range of dermal fillers

Assessment, ageing and anatomy This 55-year-old female presented to my clinic as she wanted to improve her facial sagging, jowls and wrinkling around the chin. When carrying out an assessment for all of my patients, I use a 4D approach, which means looking at the patient when they’re being expressive and observing the dynamics of the face. This patient had loss of mid-face volume due to atrophy of the deep and superficial fat. There was a loss of jawline definition due to atrophy of the superficial jowl fat and jowls caused by the weakening of the pre-masseteric and mandibular ligaments, and there was dynamic dyschord and reduced anterior projection of the chin. I noted that her chin was wider than the female ideal, and this needed to be taken in to consideration when treating so as not to masculinise her.

Technique and product selection Before performing a dermal filler treatment I always recommend using good skincare products to optimise the results. For this patient, I suggested she use the Teoxane AHA Cleansing Gel, RHA® Serum and Advanced Perfecting Shield SPF 30 in the morning, while using a combination of RHA® Micellar Solution and Advanced Filler Normal to Combination moisturiser in the evening. Skin quality can also be improved with a course of Teosyal® Redensity 1. When it came to injecting, I used the ATP approach from Teoxane – looking at the anatomy, assessment, technique and product. Having a robust knowledge and understanding of the anatomical changes we observe in our patients guides our choice of product so that we can achieve optimal results. For this patient, I used a combination of Teosyal® PureSense Ultra Deep (PS Ultra Deep) and Teosyal RHA® 4, using a multi-layering technique for some of the treatment. I started by using PS Ultra Deep to provide anterior projection and lift to the cheek by treating the deep cheek fat and lateral SOOF. I used three separate injection points on each side, injecting 0.1ml per point down to periosteum. I chose this product as it has a very high cohesivity with excellent lift and projection capabilities. I used a needle for this area because

I find it can help make the injections very precise, and I also find I use less product than I do with a cannula. I then injected 0.2ml on to periosteum in the anterior medial cheek to give support and help to shorten the tear trough. Then I moved onto RHA® 4 and used a cannula to inject 0.4ml each side along the lateral lower cheek to blend in the transitions of the superficial fat compartments, restoring natural volume and confluence. Then I moved on to the chin using RHA® 4 to treat the labiomental crease, again with a cannula. I used

Before After

Figure 1: 55-year-old patient before and after full face rejuvenation using PureSense® Ultra Deep and Teosyal RHA® 4 subcision here with the cannula to create more space and then I injected 0.3ml. This helped with myomodulation and meant we didn’t need to use toxin to correct her overactive mentalis muscle. Next, I switched back to PS Ultra Deep to inject 0.2ml to the pogonion to create projection and more feminine proportions. Then I used RHA® 4, injecting 0.3ml into the soft tissue using a cannula to provide support and balance. Next I moved onto injecting PS Ultra Deep with needle onto periosteum to treat the pre-jowl sulcus, using 0.15ml per side. Finally we moved onto the jawline. It was important to avoid increasing the patient’s bigonial width as this would masculinise her. I injected 0.2ml PS Ultra Deep onto periosteum, ensuring that the injection point was superior to the angle of the mandible. I then used this injection site as an entry point for a cannula to inject 0.2ml of RHA® 4 in to the pre-auricular area to lift the jawline further. Overall I used just under four syringes of dermal filler, and the treatment took around 45 minutes. We achieved natural looking results, and by improving areas of projection, light reflection was increased, giving the patient a youthful, rejuvenated appearance.

Top tips for success Knowing your anatomy inside out and using the ATP approach is very important to ensure that you are choosing the right products. The rheology of the products is also very important to understand for creating the right treatment plan – make sure every plan you make is individualised and specific to that patient. That’s the beauty of the Teosyal® range – you’ve got deep static fat support, lift and projection with Teosyal® PureSense Ultra Deep, then the resilient hyaluronic acid in the RHA® range, which offers a product for all areas of concern from lips to superficial volumisation.

Rachel Goddard is an independent nurse prescriber who has specialised in medical aesthetics since 2004. She is a country expert for the Teoxane Medical Faculty. She is director of Totally Aesthetics and Rachel Goddard Aesthetics in Manchester. Qual: RGN, INP, MSc, PgCert

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