What areas of the face can be improved by the use of minimally invasive cosmetic techniques?
The face basically has two areas: the upper area, which is primarily treated with botulinum injections, and the middle and lower area, which can benefit from filler injections.
How does botulinum work?
Botulinum's mechanism of action is very well know: it prevents the passage of signals from the nerve to the muscle, and therefore blocks the contraction of the muscle being treated.
Certain muscles, especially the corrugator muscle, which forms the vertical furrows above the roots of the nose and between the eyebrows, are completely paralyzed, while others, such as the lateral muscles of the eyelids, are simply weakened.
This means that small lines above the muscle – those that are formed by contractions of the muscle – tend to even out gradually. The results are not immediate: the effect on muscle contractions can be seen in between 2 and 5 days, while the positive effect on the appearance of wrinkles is visible in 5 to 30 days: the more the wrinkle is resting, the more gradually it evens out. In addition, the position of certain anatomical structures, such as the eyebrows, is also affected, because as this muscle, which tends to stretch the eyebrow downwards, becomes weaker, the end of the eyebrow will move upwards.
In what areas of the face is it used?
Botulinum (and we are only discussing botulinum here: we will discuss fillers later) is used exclusively on the upper part of the face. I shall explain the reason for this now.
The main effect is on vertical wrinkles between the eyebrows. The result that is visible in 5 to 6 days immediately gives one a more relaxed, happier and less frowning appearance. The effect on the wrinkle happens later, in the weeks that follow, but it is a really effective result that people very much appreciate.
Another area that benefits greatly from botulinum is the upper portion of the forehead: that is, the horizontal lines that form when the eyebrows are raised. The effect in this area of the upper portion of the forehead is very positive, because the intermediate portion of the forehead is left intact, and the eyebrows can still be raised.
The third area that benefits from botulinum injections is beside the eyelids. Here we see considerable improvements - not total, but significant - in the so-called crow’s feet and, as I explained above, in the raising of the ends of the eyebrows. Sometimes, when the end of the eyebrow lifts up, a small wrinkle is produced above it. This can be irritating, and some people ask for this little wrinkle to be corrected. This can be achieved simply by a very small injection of botulinum above the end of the eyebrow so that it is lowered slightly.
Where else can botulinum be used?
In theory, botulinum can also offer good results in the lower third of the face around the lips and on certain folds in the neck, but it can cause many problems in these areas, and so we prefer not to use it, because the interference with muscular movement can lead to asymmetry when smiling, speaking, pronouncing certain sounds and drinking. Botulinum is therefore used exclusively in the upper third of the face.
What problems can botulinum cause?
Problems are very rare, and usually absolutely temporary. The most frequent, obviously, is ecchymosis or small bruises, which are especially caused by injections into the lateral portion of the eyelids, because the skin is very fine in this area, and so very small bruising may occur. If the bruise is quite conspicuous it is preferable not to expose it to the sun for a few days. Problems with asymmetries when opening the eyelids are far rarer: when we inject into the upper portion above the eyelids to reduce contractions of the corrugator muscle, a small amount of the drug may come into contact with the elevator muscle of the eyelid and weaken it. This presents as a reduced opening of the eyelid on that side. It is a very rare phenomenon (in approximately 1% of applications), and may last for 2-3 weeks. It can mostly be compensated for - that is, corrected - with eye drops that improve the tone of a small muscle that substitutes the eyelid’s elevator muscle.
Other minor problems may occur when an injection is made into the lower portion of the eyelids to improve the lower part of the crow’s feet. There may be minor swelling at the point of bags around the eyelids because the slightly weakened muscle drains less of the liquid that forms in this area. In this case, the remedy is a simple massage which a patient can give herself to drain the liquid away while waiting for the muscle to regain movement.
Other minor problems might occur in persons who are obliged to adopt a frowning expression for work motives. Clearly, because the corrugator muscle has had an injection and this movement is reduced, they will not be able to form especially sad or contrite expressions.
In a very small percentage of cases, there may be immune resistance, and the effect of the botulinum will not be as marked as it is in other persons.
There are also certain counter indications: these are neuromuscular disease, which is rare, but must be brought to the attention of the doctors, and certain treatments with antibiotics that interfere with the botulinum treatment.
One final issue that the doctor needs to be told about is treatments using anticoagulant substances or drugs, because they might encourage bruises or haematomas.
Despite these rare problems, are injections advisable?
This is a procedure that offers considerable satisfaction. It is really viewed as absolutely physiological and natural. It provides a fresher, younger, less worried appearance, which is why the number of people undergoing this treatment over the years has increased progressively and rapidly worldwide.
What can be done with filler?
The use of fillers is mainly concentrated on the middle and lower third of the face, although they can also be used to support and complement botulinum in the forehead area. Unlike botulinum, the results of which appear over time, fillers have an instant result. What doctors usually do, therefore, is to treat one side with the patient and check the results with the patient to see if it is what the patient wants and is sufficient, and then replicate the treatment on the other side, or add a little more product if the patient thinks the result is not yet perfect.
The areas that benefit the most are those around the lips: that is, around the mouth, in particular the furrows between the lips and the nose, which are known as the nasogenian furrows, the furrow beneath the lateral part of the lip, and areas below the eyelids that may be impoverished.
In addition, the area around the chin and the lips and certain small corrections to the nose can benefit from injections of hyaluronic acid.
What types of line show improvement?
Small surface wrinkles - let’s call them superficial creases in the skin - show little improvement after injections of hyaluronic acid, while the major improvements are to furrows and deeper lines, such as nasogenian or sub-labial furrows. These are therefore the areas that benefit the most.
What about the lips?
The lips see great benefits, but with certain problems: the vertical furrows - the so-called "barcodes", improve greatly, although they will not disappear completely. Treatment of "barcodes" inevitably means that the red part of the lips are enlarged slightly, because otherwise when volume is added above the red portion, the lips flatten out. It is therefore necessary to restore projection to the red portion, the so-called "vermillion", of the lip. This causes a moderate, and usually well-accepted, increase in volume to the lower or upper lip, depending, obviously, on which lip is being treated. The problem with treating lips is that aside from the volume that is actually injected, there is quite significant swelling in the first 72 hours. This means that due to the swelling, the volume will undoubtedly appear greater during these first 72 hours compared with the actual amount of the drug that has been injected, and the lip may have an unnatural appearance.
In addition, injections into the lip are painful, and so a compress of anaesthetic cream should be applied and kept on for about an hour and a half with a kind of occlusive medication, or the injection of hyaluronic acid should be preceded by an injection of a local anaesthetic.
How long do reabsorbable fillers last, and what problems can they lead to?
In the first place, we can state that they are totally safe substances, because hyaluronic acid is already present in the connective tissue in our organism. It is reabsorbed within 7-10 months, but after this time, it usually leaves the subcutaneous tissue richer and better hydrated, and so the results are not totally lost.
Any problems are associated solely with the injection: there may be a bruise at the entry site of the needle, and if a little blood escapes deep inside, it may be possible to feel, but not to see, subcutaneous nodules, which are reabsorbed just as a bruise would be, and so within 10-12 days. If there is deep-seated effusion, there may be an extremely slight asymmetry in the treated areas. This type of substance cannot cause other kinds of problem.
Can the results be disappointing?
The results will always depend on the amount of filler that is injected.
Clearly, if we attempt to test too large or too wide an area using a phial containing less than one cubic centimetre of product, the results in each of the treated areas will be inadequate, but if we focus, and assess our treatment in certain areas together in front of a mirror, and use the correct amount of product, the change we will achieve even with just one cubic centimetre of product will be truly noteworthy.
So do you suggest I undergo this treatment?
Absolutely yes, because the results will undoubtedly be beautiful and natural, and will give the face a more relaxed, younger appearance. The great benefit of having a treatment during a cruise is the opportunity to use the MSC AUREA SPA wellness centre, and therefore the services of staff who have received a totally specialized and exhaustive training, and who can offer completely satisfying results, complementing the relaxed appearance one always gets from a cruise with an even younger and more attractive look.