By the Doctor Hugues Cartier
A symbol of grace and femininity, the neck and decolletage area is difficult to treat due to the specific quality of its skin. Thinner and less elastic than the skin on the face, it contains fewer sebaceous glands which makes it prone to dehydration. Medical aesthetics protocols are more limited in terms of focusing on the skin quality. Using a tissue inducer offers visible and long-lasting results.
First stop: rebuilding the skin density
As it ages, the skin becomes thinner, dries out and becomes wrinkled. Before considering options such as threads or even a maxillofacial lift to tighten up the neck, the most sensible approach is to work on the skin quality and its thickness in order to tighten up the skin and correct any skin depressions, ptosis and wrinkles.
Collagen inducers are a suitable solution for these problems. Lanluma (Sinclair laboratory) fulfils these requirements by stimulating collagen production. This new range of poly-L-Lactic acid (PLLA) filler products fulfils the demands of patients (and doctors) seeking to treat sagging, a loss of tonicity, folds, wrinkles and lines, while boosting the skin’s density.
This biostimulator increases tissue thickness without immediately increasing its projection or volumes, as is the case with hyaluronic acid. Lanluma is a new-generation PLLA with extremely small particles. It is easily prepared with a PPI solution and creates a completely homogenous and fluid emulsion, which makes it easy to inject subcutaneously. Quick to prepare, the product is easy to place in areas of the face and body. If I had to describe it, I would say that Lanluma is a “skin volumiser” that is injected into the deep dermis.
I recommend injecting it using a cannula then massaging the area to evenly distribute the product. Since the particles are very fine, it can be evenly distributed. Instead of filling, it restructures the dermis, and its collagen-inducing properties are much greater than those of hyaluronic acid. It recreates volume in the skin and improves the structure of sagging skin that has lost its density. The PLLA particles act deep within the skin to stimulate the natural collagen response, thus recreating natural volume.
Treatment techniques using this innovative product
For the neck it is vital to avoid the thyroid area. This is why this technique requires specific training, since the neck is a very complex area to treat, and it is essential that the practitioner has perfect knowledge of its anatomy.
I go from the submandibular area to two-thirds of the way down the neck. In order to avoid touching any veins, I recommend using a 22 or 23g cannula. The posterior limit of the treatment area is the vertical line of the ear, and we stop at the median zone to avoid the thyroid. Any crinkling under the chin can also be treated.
I recommend starting the treatment by making an entry hole along the posterior-middle edge, a third of the way along the upper line of the sternocleidomastoid muscle (SCM) to allow for injection into the posterior and anterior faces of the neck in order to avoid the jugular vein and the superior auricular nerve.
For the neck, like for the decolletage, we inject in a retrotracing fan pattern between the deep dermis and the platysma, making long lines. The patient lies down with their head gently tipped backwards, turning it to one side and then the other. The most important thing, in my opinion, is the distribution of the product, which is why I recommend massaging the area after injection to spread it evenly. Since the product is fluid and homogenous, it is easily distributed and creates no irregularities or granulomas.
With regards to its dilution, Lanluma is ready in 10 minutes and left to rest for one hour (according to the product instructions).It can either be diluted with 15ml of PPI per blister or with 30ml of PPI, depending on the treatment area, the skin quality and the extent of the wrinkling. For the decolletage, I recommend diluting it in 30ml, and for the neck it depends on the thickness and condition of the skin. The treatment should be repeated 2 to 3 times, spaced 2 to 3 months apart. The collagen induction occurs over time and the results can last up to 24 months.1
Lanluma is a very useful addition to the portfolio of rejuvenation products for the face and body and has an excellent safety profile. Its slow breakdown is a bonus for patients and doctors who are seeking visible and long-lasting solutions.
Dr Hugues Cartier is a dermatologist in the north of France.
He is the former president of the laser group of the French Society of Dermatology, SFD.
He is also the vice president of the French Society of Aesthetic Medicine, SFME and is the scientific coordinator of IMCAS.
More information on dermatologie-arras.com/medecins/dr-hugues-cartier/
