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about their concerns, so asking more detailed questions after the introduction will allow you to discover the real reasons for attending and will shed some light on their main concerns. After hearing these, I then take a full medical history and examine the face to see what changes we can establish and how can we translate the patient’s concerns into a series of physical changes that we can then try to resolve with various treatments. Once the consultation is done, information leaflets are provided to the patient with a suggested treatment plan. The patient will have a cooling-off period before they book in for any treatments.
Treatment method and rationale
Treating the Male Mid-face Dr Xavier Goodarzian presents two case studies using collagen-stimulating fillers to restore male mid-face volume Over the last decade aesthetic practitioners have seen increasingly more men come into our aesthetic practices, and for successful outcomes it’s important that we assess and treat them differently to women.1 In my opinion, men tend to have overall similar concerns as women do about ageing, with both genders generally requesting treatment for facial volume loss and sun damage. However men, unlike women, rarely come in and ask to have their faces ‘filled out’, as treatments like dermal fillers may have never crossed their minds. Instead, the way most men explain their concerns is by saying, ‘I look tired all the time’ or ‘I look like I have dark circles under my eyes’. So, by explaining the ageing process, facial volume loss and how dermal fillers can help this problem, we can often offer them a great solution. During the treatment it is of course important to respect the male facial anatomy by keeping the chin and jawline strong and reducing mid-face volume loss while keeping the treatment subtle.
Consultation In my experience, the consultation process is key to understanding the male patient’s concerns. I find men can be a bit more reserved or shy when coming into clinic,
as it’s not easy for a man to walk into a traditionally female-dominated space. Often the men who come into my clinic are unaware that other men have treatments too, so it’s always good to reassure them and perhaps show some male before and afters. Men can also be quite vague when talking
When it comes to restoring facial volume, we are confronted with two options. Do we offer hyaluronic acid (HA) fillers, or do we offer a longer lasting collagen stimulator? Personally, I am happy using either type of product, but I have to admit that I tend to prefer collagen stimulators for general facial volume correction. When there is generalised facial volume loss, I find better results can be achieved with collagen stimulators because they build over time and are longer lasting. This is preferable for male patients, as they generally want something that lasts longer and does not require six-month top ups like HA fillers. Although there are several collagen-stimulating fillers on the market such as Sculptra, Radiesse and Lanluma, I choose to use Ellansé. It is made of carboxymethyl cellulose (CMC) and polycaprolactone (PCL)
Case study 1 A 40-year-old male presented to my clinic, complaining of looking tired after a 15kg weight loss. After examination, I found that there was fat loss from the medial aspect of the mid-face and hollowing of the tear trough and nasolabial area. We decided on a treatment of 4mls of Ellansé, split into two sessions (2mls per session), six weeks apart. A combination of subcutaneous linear threading and deep supraperiosteal depot technique were used with both a cannula and a needle. Deep supraperiosteal injections are best done with a needle right down to the bone surface, while subcutaneous linear threading is best done with a cannula as it reduces the risk of bruising and, in my experience, is much Before After safer than a sharp needle. Three months later, the patient showed great improvement in the midface, correcting the volume deficit in the frontal cheek area and the nasolabial folds. He was very pleased with the result, and continues to come in for Patient before and three months after treatment with 4mls of Ellansé other treatments.
Reproduced from Aesthetics | Volume 8/Issue 7 - June 2021
