WHO IS THE FACIAL SPECIALIST? HYALURONIC ACID FILLERS: OPTIMISATION OF AESTHETIC DENTISTRY AND PATIENT LOYALTY
Figure 5. Aesthetic sub regions of the lip and perioral region. The perioral region is subdivided in at least ten sub regions with very different characteristics from one another and which require different therapeutic approaches. The main aesthetic sub regions of the lip are: the naso-labial fold( 1), the white upper lip( 2A), the red upper lip or upper vermillion( 2B), the lip white roll( 2C), Cupid’ s bow( 3), the philtrum( 4), philtrum’ s pillar( 5), the white lower lip( 6A), the red lower lip or the lower vermillion( 6B), the labio-mandibular fold or puppet fold( 7), and the labio-mental fold( 8). Each one of these areas has particular anatomic characteristics: skin, subcutaneous tissues, muscles, fat, movements and mimic. The therapeutic options will be different for each different area. Drawn by Aldo Zupi using ZygoteBody™ 3D Anatomy Viewer. Zygote Media Group Inc., American Forks, UT
the majority of the cases, the dermis. Within the dermis, the specialist can choose to use the superficial portion just below the epidermis, or a deeper portion, above the subcutaneous fat. The dermis has variable thickness depending on the anatomic area, the age and the degree of aging. The same happens in the epidermis. The skin can have minimum thickness in areas such as the periorbital one where it does not go over a millimetre or it can get to a few centimetres in areas such as the back or in areas subject to constant friction. However, there are general parameters that can be applied safely in all situations. The depths in which we act can be divided in two layers: a superficial layer, generally 1-2 millimetres deep, and a deeper layer, usually never superior to 5 millimetres. The injection depth depends on the depth of the flaw. Small superficial wrinkles must be treated with superficial injections and with small quantities of material. If the line is deeper, the injection will need to be deeper too, as the quantity of skin to lift is bigger and wider. Even deeper is the area of injection for deep and not elastic wrinkles. A larger amount of material is required and the surface of the tissue to lift is wider. This is the first rule to follow to choose the right depth where to operate. The second rule is just as simple. Each area of the face has skin of constant
thickness and, therefore the dermis can be found at a known depth. We can easily subdivide three areas in which the skin is usually thin. In these areas, we will hardly go at a depth greater than 1-2 mm. This applies especially to the so-called“ white roll” of the lip. It is an important area because it will almost always be treated in our patients. To areas with thin skin oppose areas with thick skin. In these areas, generally, we inject at least at 2-3 mm of depth and in some cases even deeper. It is important to remember that almost the whole perioral region has a relatively thick skin and sometimes, when facing deep and“ ancient” wrinkles, it is necessary to go very deep. We must always associate the concept of stickiness or density or reticulation of the HA used to the concept of depth. This way, the tissues will be“ lifted” more naturally. How should the HA filler be placed? A dentist is used to inject anaesthetics or other drugs. The technique is exactly the same. Once, the needle has been inserted and we have reached the desired depth, we will inject the quantity of filler we believe is right. The general rule is to usually under dose the injection. A correction, in fact, is always possible. On the other hand, the“ subtraction”, even if possible, is a lot more complicated. Anyway, we will inject the quantity of HA desired in small spots along the wrinkle or the line we want to increase. The distance between spots is not very important. We can add material where and when we want if necessary and, if required, we could use the same site of injection. This way, with small and aimed corrections, we will achieve to fill or lift a wrinkle. The“ spot technique” allows an extremely precise correction. However, it requires, patience and precision. For those … in a hurry, the linear technique consists in the injection of a“ strip” of HA at the bottom of the wrinkle or along the line we want to increase. The technique is very simple. You will need to penetrate in the skin at an angle of about 45 ° for the necessary depth. As we know, the depth can be of just a few millimetres( 1 or 2) or even half a centimetre or more. Once we have reached the desired depth, we will move the needle until it is parallel to the skin. We will proceed along the line we want to fill up for the whole length of the needle. At this point we can start to inject the filler and, at the same time, we retract the needle. In this way, we release a strip of HA like the trail of a plane or of a boat, which will fill the line or wrinkle. Like in the“ spot technique”, we can go back to the same area as many times as we think it is necessary, lengthening or increasing the volume of the strip. Below, are briefly mentioned the techniques usually used for the common imperfections of the face are briefly mentioned( labial wrinkles, thin lips, malar region and crow’ s feet). The labial wrinkles are formed around the mouth and generally have a vertical movement. They are usually the result of mimic and aging. This imperfection is usually known as“ barcode”. Different factors, such as smoking can speed up the formation
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