Clinical Practice Techniques
aestheticsjournal.com The positions of the 8-point lift are as follows:
1
3
2 8
4
7 5 6
THE NO-GO AREAS
Images © Dr Mauricio De Maio before
after
before
after
Patient images © Miss Jonquille Chantrey
• The first point is the junction between the cheek and the temple. It is a very specific point and treated with a deep placement of Juvederm Voluma onto the zygomatic bone, usually 0.1-0.2mL. This can help to lift the zygomatic area and restore it’s youthful curve, whilst also correcting the lid-cheek junction. • Point number two is a beautification point, positioned over the anterior aspect of the zygomatic bone. Here I would use a further 0.1-0.2mL. This also helps to support the outer aspect of the infra-orbital region and lift the mid face. • Point number three is a point in the anterior malar area, within the cheek. The deep malar fat is injected in this position, so that it acts as an anchor point to fix the face superiorly. Placement of 0.3mL of Juvederm Voluma or Volift in this position helps to support the tear trough, correct the palpebral-malar groove and can lift the nasolabial fold. • For point number four, I would switch to a lighter product such as Volift in order to minimise any external vascular compression and inject a small amount of this into the canine fossa. Between 0.2-0.3mL may be sufficient to lift the rest of the nasolabial fold. • Point number five is the oral commissure. Here, I would also use 0.1mL Volift intradermally, which helps to give the oral commissure a more supported horizontal position. • Point number six is the pre-jowl sulcus. This is the area that female patients in particular can experience early mandibular recession and is also important for patients who exhibit retrognathia. Treating this point delivers more support to the chin, and gives better definition. This is a point where I use a cannula to simultaneously support the prejowl sulcus, marionette line and deeper element of the oral commisure. My product of choice is commonly Voluma and 0.5mL can produce excellent contouring. • Point number seven varies between a male and a female. In a male, this is the definition of the mandibular angle, resulting in a square appearance to the jaw. In a woman, it may be desirable to give gentle mandibular definition, but certainly not overly project it, as this can masculinise a female face. The position where I tend to put point number seven is higher than the mandibular angle, usually approximately 2cm above, which gives a nice lift to the posterior aspect of the face. The important point to note about this point is that it needs to be very superficial in its placement. If injected deep in this area then risks could include a parotid cyst or facial nerve injury. Juvederm Voluma or Volift can be used in this area; product volume varies from 0.05mL to 0.3mL for enhanced definition. • Finally, I like to think of point number eight as a superficial zone. This tends to run from the pre-auricular area, across the parotid and then into the sub-malar and buccal areas. By treating this zone, not only can volume deficit and hollowing be treated appropriately, but a subtle lift of the buccal or jowl fat can be achieved. I always use a cannula here, gently in the subdermal plane, above the parotid fascia. This helps to minimise the risk of facial nerve, facial artery and parotid duct damage. Quantities used for this zone may be approximately 0.3mL to 0.6mL. In patients that have significant solar elastosis or weakness to the skin I would use Volift not Voluma. This area then requires massage immediately post-treatment. In points one to five I use a needle to administer the treatment, but it is important to note that you can also achieve additional improvements by using cannulas in these points, by revisiting points two and three. I return to these areas and treat them superficially with vectoring. I generally use a many vectoring techniques in my cannula work and so I incorporate this into the 8-point lift.
I don’t use all eight points in every patient. In many patients, for instance if they’re young or they have very good preservation of their facial fat compartments, then I may only treat point one and point two. Similarly, I may only use points one, two and three in a patient whose face has a tired expression. With other patients who might be financially limited we can use points one, two and eight to give a lifting effect. This technique is about precise and specific positioning and placing of the product, focusing on the cause of the descent, rather than just treating the effects of it. Communication is an essential part of the 8-Point Lift. Patients 30
must understand that if small initial quantities are used, then they may require several appointments to achieve the desired result. In the initial one-hour assessment, I consult the patient to understand what they’re trying to achieve and also discuss in detail the causes of the changes in their face. We then agree a strategy as to how quickly or slowly they want to progress. One of the advantages of this method is that the result is buildable, depending upon the expectations of the patient. In my experience, this approach results in a very high patient satisfaction rate and predictable, beautiful outcomes.
Aesthetics | March 2014