By Doctor Véronique Gassia
Doctors who specialise in aesthetics and have treated their patients for several years have seen and heard a wealth of useful information. This information can give them a critical and insightful view of their practice and their patients’ requirements so that they can contemplate the future with a more sustainable long-term perspective.
Sustainable aesthetic medicine can be defined as follows: fulfilling the aesthetic needs of the present without compromising our ability to fulfil the aesthetic needs of the future. It has three cornerstones: the safety, efficacy and prevention of facial aging.
According to a study carried out among 100 patients in my practice, 80% complained of negative expressions (sadness, fatigue, seriousness, worry) and 80% wanted a natural-looking result (“to freshen up my face without the changes being visible”). All of them wanted to look “well”, with these negative expressions having been safely corrected, i.e. “To look like me, only better”.
Techniques for immediate natural-looking results
In order to conserve the patient’s expressive mobility around the eyebrows and crow’s feet, we must choose injection points and doses of botulinum toxin that preserve the movement of the orbicular and frontal muscles, allowing for a spontaneous smile and the expressive mobility of the eyebrows. But it is also vital to watch the profilometric proportionality and balance when correcting the lower third of the face (correction of a retracted chin, consideration of a thinner upper lip, etc.).
To ensure that the product is invisible, choose a HA whose rheology is suitable for the topography and dynamics of the area in question, injected deeply (into the fixed deep malar fat and not the mobile superficial fat) and with suitable hydrophilicity (not too hydrophilic for the under-eye area). Using just the right amount of product also enables us to avoid visible over-correction.
How to conserve natural-looking results over the long term
All of these measures should be applied at every treatment session, but we also need to have an overall vision of the face which is not that of perfection with all flaws erased. It is vital to: respect the time intervals between each treatment (4 to 6 months for botulinum toxin and 6 to 18 months depending on the HA used); inject the minimum effective dose of product at the right depth, in the right place, and in 2 or 3 stages so that the correction is much more precise; choose a hyaluronic acid whose physiochemical properties (viscoelasticity, hydrophilicity, cohesiveness of the gel) are suitable for the injection site (under-eye area, lips, cheekbones, etc.) and the desired effect (volume, filling, hydration).
The prevention and stabilisation of aging
By observing patients who have been treated regularly for more than 15 years, and in particular those who are particularly devoted (BT twice a year, HA every 9 to 18 months according to indications), we can learn about how aging can be stabilised, how the corrective effect can be maintained without accumulation or resistance and, for certain patients who started treatment at a much younger age, the veritable preventative effects.
Prevention should ideally start before the menopause. Every year, on average, the skin loses 2.1% of its collagen, and in the first five years of the menopause it can lose up to 30%.
Doctor Véronique Gassia
Intern of the Hospital of Toulouse (1984); Deputy clinical chief of the Hospital of Toulouse; Speciality: Dermatology. Secretary of GEDEC (Group of Aesthetic and Corrective Dermatology of French Society of Dermatology).
