There are simple, fast and effective techniques used either on their own or in combination with plastic surgery (such as face lift, eyelids…). But their simplicity is only apparent and they require a very important technique and precision, to get the desired result.
Gore tex (SAM):
Used since the Nineties in esthetics, it is a definitive inert implant. It is easy to handle. It is presented in various forms and thicknesses which one can cut on request.
This implant is very well tolerated, solid, flexible and malleable. It requires a rigorous surgical technique.
The best condidates for the use of Gore Tex are to are the increase the lip, the filling of the nasogenian furrows and filling of « the lion » wrinkles.
The little marked superficial wrinkles are not a good use of Gore-Tex.
The most commun complications result from infection requiring the ablation of the material.
The rate of infection is estimated at 5% which is not negligible.
However the ablation of Gore-Tex is extremely easy and without after-effects.
In conclusion, Gore-Tex is an excellent definitive inert implant, whose retreat is currently important.
The Co2 pulse laser (resurfacing):
This new technique is a revolution in the treatment of the wrinkles, thanks to data processing (pulsated scanner). I get a precision in my work on the wrinkle has no equivalent, and much higher than the usual techniques that I used before (dermabrasion by rotary grinding stone or peeling).
This precision involves a high level of safety. The control of the depth of destruction of the wrinkle is automatically calculated by the laser.
The laser carries out a very localised vaporization of the wrinkle which doesn’t damage the neighbouring skin.
This gesture can be carried out under local anaesthesia for isolated wrinkles, under anaesthetic premedicated for an area (lips, eyelids). It can also be associated with surgery (face lift).
This technique has had excellent results for lip and eyelid wrinkles or “cracked” faces.
Caution: this laser is not effective on deep “muscular” wrinkles and does not correct an excess or a cutaneous relaxation, contrary to what you could read in the media.
The post-operative issues are marked by an oedema (swelling) during 8 days, requiring the interruption of socio-professional activities, then an erythema (flush) during several weeks, requiring a make-up foundation.
A solar protection (total screen cream) is essential during several months.
To conclude, this technique is a signifiant advance by its safety, simplicity and excellent results.
Fill in or fat injections:
Practised for 20 years and improved recently (Coleman’s technique that I personally practice), the technique consists of taking your personal fat by aspiration (abdomen, thigh) and to reinject it with very fine nozzles in precise zones of the face to give them volume; this volume having a rejuvenating effect (+++).
I usually inject the fat in the lower eyelid (hollow eye), the nasogenian furrows, hollow cheeks. I do not use it any more on the lips because the “acceptance” of the fat transplant is more hazardous.
Fill In is realizable under general anaesthesia, on an out-patient basis at clinic.
It can be associated with a face lift, or surgery of the eyelids.
The post-operative issues require an stopping socio-professional activity for a week because the swelling is immediate and often signifiant.
The result is durable.
Fill In can be renewed without any problem.
The botulinic toxin:
It is a drug which has been used for 20 years in the treatment of the muscular contractions of the face and more recently for the treatment of wrinkles. It is a intramuscular injection involving a paralysis of the muscle responsible for the wrinkle. There is no preliminary test, or cutaneous preparation, to carry out before the injection.
The BOTULINIC TOXIN injections are appropriate for treating the « lion » wrinkles, forehead wrinkles, « crows feet » wrinkles. It is an intramuscular injection of the product that doesn’t require any prior anaesthesia. The BOTULINIC TOXIN will involve a weakening of the contraction force of the muscle responsible for the wrinkle. This muscular relaxation occurs in a progressive way after a week and the wrinkles will diminish.
It is generaly necessary to repeat this injection six to twelve months after the first one. There is no hospitalization. And you don’t need to stop your socio-professional activities.
I use this technique for muscular wrinkles of the top of face provided that these wrinkles are not too marked. If the wrinkles are very deep surgery will be necessary.
Acid hyaluronic:
Hyaluronic acid is a transparent and viscoelastic gel presented in a disposable syringe. Its origin is not animal. It is a natural polysaccharide that plays an important role in the skin, as part of conjunctive subcutaneous tissues and is a highly biocompatible material.
Hyaluronic acid acts by increasing the cutaneous volume and makes it possible to redraw the contours of the face, to correct its folds or to reorganize it up to the level of correction wished. It is integrated with the surrounding tissues and degrades with time in an average of 12 to 18 months. There is no allergic test to practise before the injections. These injections are not painful and do not require any local anaesthesia. They are done in deep intradermical and are subcutaneous. The injections are not recommended in inflamed and/or infectious zones. After the injection you can immediately start your normal activities again. You should avoid sports and should not take any aspirine in the 12 hours which follow. The hyaluronic acid is an excellent renewable technique, without any danger but you should understand that this technique will not be able to remove a cutaneous surplus or relaxation .
Conclusion:
The various techniques which I have described can be combined or used in a specific way according to your case. They can also be used in an isolated way or with plastic surgery such as esthetic eyelids, face lift… There is no miracle treatment of wrinkles by only one technique, but a choice of techniques adapted to each patient.
I do not practise silicone injections which are not authorized in France.
Dr Thierry BONVALLOT