By the doctor Massimo Gianfermi
At opposite ends of the spectrum there are: attractive women who want to enhance their beauty, and women with a more complicated face whose proportions need addressing.
These two extremes are the most challenging cases, but they are also those that give both the patient and the doctor the most satisfaction.
Working bit by bit, like a Pointillist painter
Pointillist painting might be compared to pixels in photogra- phy and to drops of hyaluronic acid in aesthetic medicine. In this way, the trompe l’œil work of an aesthetics doctor is similar to that of a painter who works using tiny strokes. In both cases, they are trying to create light and shade by modifying the subject’s proportions.
In the case of an attractive woman, after first wondering what we can do to respond to their demand for a radiance boost, by carefully examining their face we see that we can illuminate their expression, improve the line of their jaw, and give a bit more volume to the cheeks to erase the external part of the tear trough.
With regard to patients for whom we think that only plastic surgery will do the job, we can greatly improve their face with 6 to 8 syringes, and they are usually delighted with the results. MaiLi (Sinclair laboratories), with its range of new-generation fillers with extremely precise properties, allows us to carry out highly accurate, meticulous and subtle work. The OxiFreeTM cross-linking process gives their gels very interesting properties and makes them very easy to inject. There is less residual reticulating agent, therefore less inflammation. The laboratory has managed to associate two qualities: elasticity and cohesiveness. The gels are able to return easily to their initial shape and follow the movements of the face.
In the MaiLi range, Volume and Extreme are fairly cohesive and therefore offer good projection, meaning we can work on the contours to sculpt the oval or project the cheekbones, especially when large amounts of product are used.
Small touch-ups to illuminate a beautiful face
For attractive women who want a boost of freshness, I start by contouring the oval in order to provide support that compensates for the early stages of bone resorption and improves the angle of the jaw. The Extreme gel, one of the most volumising HA gels on the market, requires smaller quantities because it provides good projection while being comfortable enough for the patient when injected. The volume stays stable after injection, it is well tolerated and easy to work with. As a complement, I use the Define gel to smooth any small bumps on the nose and lift the tail of the eyebrow by injecting into the tail as well as the body of the eyebrow, to provide support and a lifting effect.
The Volume gel, meanwhile, is injected in small quantities – 0.3 or 0.4cc – into the cheekbone, where the deep fat has been resorbed, in order to erase the external part of the tear trough.
For the lips, I use Define, which integrates well with very limited post-injection oedema and results that last around a year. To correct under-eye shadows and “barcode” lines on the upper lip, Precise offers good tis- sue integration and elasticity, while remaining stable over time and not migrating. For these “barcode” lines, I use a technique that involves criss-crossed injections into the deep dermis on the upper white lip and, though less so, into the lower white lip. I start by reshaping the edge of the red lips to create a “border” then I inject in a criss-cross, retro-tracing pattern, depositing a tiny drop of gel every 3mm. I inject horizontally into the deep dermis to tighten it up and then vertically to provide support. This way, the wrinkles are filled from underneath and the dermis is thickened and smoothed.
Areas of shadow that become positive
In more complicated faces that are generally round and wide, we need to create volumes by sculpting areas of shadow in order to give the face some depth.
To do this, we need to start by slightly enlarging the horizontal branch of the jaw and increasing the height of the mandibular angle in order to create shadow. I inject 1cc of Extreme into each angle and 1cc into the chin to enhance the contrast.
Next, we can magnify the effect by creating some additional depth in the features on the inner part of the tear trough, with 0.7cc of Define, which allows us to work with great precision and subtlety. Even in the case of large cheeks, we need to suppress the tear trough, which makes the expression look tired and sad, but this time by injecting Volume into its outer part. Hollow temples, even on a round or wide face, can be filled with Volume.
This way, we illuminate the face bit by bit, by creating contrasts.
The comfort of injection, both for the patient and the doctor, and the high quality of this wide range of gels, their integration and their durability, allow us to carry out accurate treatments that offer elegant and long-lasting results.
By the Docteur Massimo Gianfermi
Graduate in plastic and reconstructive surgery, University of Picardie Jules Verne. Graduate in general surgery, doctorate in medicine. Creator and head of the plastic, reconstructive and aesthetic surgery unit at the Beauvais Hospital. Referent & teacher in aesthetic dermatology at the University Hospital of Amiens. Plastic surgeon of the face and body, aesthetic doctor in Levallois-Perret and Paris. More information on docteurgianfermi.fr