By Doctor Gilles Korb
The right choice of combined treatments.
The way the face ages depends on the person. My role as an aesthetic doctor is to suggest a protocol of treatments adapted to their particular case and their age. We need to treat the skin for dehydration, sagging, a thinning dermal layer, wrinkles, loss of fat and muscle, pigmentation marks, rosacea, etc. These changes are all accentuated and accumulate with age.
Age is the major criteria.
The demands and treatment priorities are not the same at age 30 as they are at age 50. Similarly, we must take into account whether the patient is happy to have an invasive procedure or would prefer a less invasive option, the procedure’s side-effects, whether downtime is required, and the patient’s budget.
Around age 30, but sometimes before, the first signs of skin sagging start of appear. The skin becomes slacker but there is no real change to the facial contours.
This is a good time to prescribe focused ultrasounds: just one session, involving no downtime or side-effects, with results becoming gradually visible over three months and lasting for around two years. A gentle peel and a few sessions of fractional radiofrequency will smooth the skin and any dilated pores, and will freshen up a dull complexion.
Around age 40, the first hint of jowls appear, with the slackening of the oval of the face, and the etching of nasolabial folds, forehead and peri-buccal lines and wrinkles around the eyes. First of all, I treat the sagging skin with a session of focused ultrasounds. An alternative option, though more invasive, is the insertion of resorbable barbed threads, which give optimum results after about a month and last between 12 and 18 months.
I then correct any lines and wrinkles using hyaluronic acid, and forehead lines and drooping eyebrows with botulinum toxin. I avoid carrying out these injections before the ultrasound treatment, because, due to the heat the ultrasounds give off, they risk adulterating the products. For the eyelids, Plexr technology gives great results, with only a few short-term scabs.
I then correct any lines and wrinkles using hyaluronic acid, and forehead lines and drooping eyebrows with botulinum toxin. I avoid carrying out these injections before the ultrasound treatment, because, due to the heat the ultrasounds give off, they risk adulterating the products. For the eyelids, Plexr technology gives great results, with only a few short-term scabs.
Around age 50, sagging becomes more significant, the face loses its volumes and the skin starts to crumple. I start by treating the sagging skin using either focused ultrasounds or barbed tensor threads. To restore the face’s volumes (cheekbones, temples, lips), I use a volumising hyaluronic acid that is suitable for the treatment area, usually applied with a cannula for a more natural result. I use the same technique for hollow under-eye shadows. I save the botulinum toxin for forehead lines, crow’s feet and marionette lines.
To renew the skin’s surface, I suggest:
– Rehydrating the skin with bio revitalising mesotherapy combined with resorbable meshing threads to densify the dermis: 3 to 4 sessions, spaced a month apart, for optimum results.
– A TCA or glycolic peel coupled with LEDs, over several sessions, providing that the patient does not mind taking some downtime post-treatment.
– Micro-needling sessions followed by a hydrating hyaluronic acid nappage
– Fractional radiofrequency sessions, with or without micro-needling, followed by LEDs. A relatively-new treatment which, in exchange for a bit of temporary redness, completely resurfaces the skin, densifies the dermis and boosts new collagen synthesis.
– Fine lines around the lips are treated either with superficial injections of hyaluronic acid (blanching) or with a few Plexr sessions
After age 50, we may also need to treat :
Pigmentation marks using depigmenting peels or pulsed light, coupled with LEDs.Â
Rosacea and vascular marks using pulsed light therapy and Yag lasers, either alternately or combined.
A double chin with 1 or 2 sessions of cryolipolysis or deoxycholate injections.
After age 60, treatments are carried out case by case, bearing in mind that the surgical alternatives to aesthetic medicine treatments (face lift, liposuction, blepharoplasty) should also be considered at this stage.
Doctor Gilles Korb
Surgeon of the face and neck, member of the French Society of Plastic and Cosmetic Surgery of the Face and Neck, member of the World Society of Anti-Aging Medicine (WOSAAM).
