The importance of using a whole face approach Midface Rejuvenation
Transcription
The importance of using a whole face approach Midface Rejuvenation
12/4/2013 Midface Rejuvenation with bolus injection technique: Impact on Tear Through & NLF My experience with Allergan portfolio innovations based on VYCROSS technology. Koenraad De Boulle MD Sharm El Sheikh, November 27th 2013 The importance of using a whole face approach 1 12/4/2013 1973 2013 2 12/4/2013 Vycross Technology Voluma Volbella Volift Volbella Volift Voluma Primary usage Fine lines Medium-sized skin depressions Enhancement of the lip area Deep skin depressions Face contouring Restore volume of the face Implantation depth Superficial to Mid-dermis Lip mucosa Deep dermis Lip mucosa Subcutaneous Upper-periosteal Deep dermis HA concentration 15 mg/mL 17.5 mg/mL 20 mg/mL Gel Hardness [1](G’ @ 5Hz) 200Pa 250Pa 320 Pa Compression[1] 17 gmf 23 gmf 39 gmf Duration Up to 12 months[2] Up to 12 months[4] Up to 18 months[3] Needle size 30 G ½” 30 G ½” 23 G 1” (2mL syringe) 27G ½” (1mL syringe) Duration Lift capacity [1] TR896 and TR897 reports, Internal data. [2] Eccleston D, Murphy DK, Clinical, Cosmetic & Investig Dermatol 2012, 5, 167-172. [3] Raspaldo H, J Cosmet Laser Therapy 2008, 10(3), 134-142. [4] Technical Report RE1210037, Internal data. Implantation depth 3 12/4/2013 Midface Revolumizing • Considerations about – Revolumizing – Bolus technique – Versatility in use of Voluma – Impact on other features – Before and afters What are we talking about? • “Re-volumizing” – Increasing (sub)cutaneous volume by injecting a biocompatible substance aiming to restore the fullness of young and attractive facial features De Boulle K 4 12/4/2013 What are we talking about ?? • “Bolus technique” – Single injection with needle – Deposition of substance in one specific location – Substance: Vycross technology in Voluma® Versatility 1. 2. 3. 4. 5. 6. 7. 8. Mid face Cheekbone Temple Eyebrow Pre jowl sulcus Chin Nose Earlobe 3 4 2 1 5 7 8 6 5 12/4/2013 Addressed issues • Mid face contouring, volumizing and rejuvenation: – most popular – techniques • possibilities of injections – Needle or cannula – Bolus technique Addressed issues • Mid face contouring, volumizing and rejuvenation: – most popular – techniques • possibilities of injections – Needle or cannula – Bolus technique 6 12/4/2013 Why mid face with bolus? • Proficient method of restoring malar contour and convexity • Creates a support and anchor point for lower third of face • Global, 3-dimensional approach to natural rejuvenation: recommendations for volume restoration Raspaldo, Gassia, Niforos J Cosmet Dermatol. 2012 Dec;11:279-89 • Lifting vector for the lower face • Injectable Fillers for Volume Replacement in the Aging Face Greco, Antunes, Yellin Facial Plast Surg 2012;28:8–20. Why bolus? • Standardized technique easy to replicate – 1-2-3 injection points – A Prospective, Observational Study of the Volumizing Effect of Open-Label Aesthetic Use of Juvéderm® VOLUMA® with Lidocaine in Mid-Face Area Philipp-Dormston, Eccleston, De Boulle J Cosm Laser Therapy Accepted for Publ Oct2013 • • • • Limited trauma Limited areas for mistakes Immediate result and gratification Immediate resuming of daily activities 7 12/4/2013 Where bolus? 1 3 2 1. lateral zygomatic region 2. zygomaticomalar region 3. anteromedial cheek Explaining the technique 8 12/4/2013 Technique Before and after: overview 9 12/4/2013 Before and after: detail Explaining the technique 10 12/4/2013 A typical female patient What’s bothering her? 11 12/4/2013 Assess from different angles HA with bolus approach 12 12/4/2013 Mid face revolumizing: Mid face revolumizing: 13 12/4/2013 Tear trough softening Tear trough softening 14 12/4/2013 Stab quickly Inject slowly Tear Through Softening 15 12/4/2013 Tear Through Softening A typical male patient 16 12/4/2013 Assess from different angles Mid face revolumizing : bolus 17 12/4/2013 Mid face revolumizing Extra benefits of zygomatico-malar enhancement • • • • Lifting effect in adjacent areas Improvement of ogee curve Softening of tear through Softening of nasolabial folds 18 12/4/2013 Midface revolumizing T. Fisher 1 cc/malar side bolus 19 12/4/2013 Cheek enhancement De Boulle, Aalst Belgium Cheek enhancement De Boulle, Aalst Belgium 20 12/4/2013 Cheek enhancement De Boulle, Aalst Belgium Voluma/Volift for dermal/fat atrophy in end stage dermatomyositis 21 12/4/2013 Patient satisfaction Philip-Dormston W, Eccleston D, De Boulle K, Hilton S, van den Elzen H, Nathan M Prospective, open label, multi-centre, study N= 115 single treatment with Juvéderm® VOLUMA® with Lidocaine 2ml or 1ml or a combination of both Accepted for publication Oct 2013 J Cosmet Dermatol Patient satisfaction Philip-Dormston W, Eccleston D, De Boulle K, Hilton S, van den Elzen H, Nathan M Objectives: subject / physician reported satisfaction (immediat after – D 21) • 5 point Subject Satisfaction Questionnaire (SSQ) improvement in volume loss (Mid-Face Volume Deficit Scale) perceived smoothness of result of injections assessment of pain ease of use and overall satisfaction with the outcome • through an Injector Satisfaction Questionnaire (ISQ) 22 12/4/2013 Subject’s overall satisfaction 95.6% (n=110 out of 115) of subjects were delighted/happy with the overall experience immediately after treatment, 93.7% at 21 days post treatment (n=105 out of 112). Subject’s perceived smoothness of result 96.5% considered the immediate results smooth to extremely smooth 95.6% considered the results at day 21 smooth to extremely smooth 23 12/4/2013 Study Subject Safety Procedure and product well tolerated No device-related AEs reported In total, 5 procedural-related AEs were reported • • • • • oedema/swelling n=3 (1 patient reported both) hematoma n=1 pain on injection n=1 considered not or probably not related to the product. none were considered life-threatening. 24 12/4/2013 Chin – pre jowl sulcus Chin – pre jowl sulcus 25 12/4/2013 Lifting the lateral brow: Volift® Lifting the lateral brow: Volift® 26 12/4/2013 Lifting the lateral brow: Volift® Volift® treatment examples Supra orbital hollow with remaining horizontal frown lines : cannula Marionette lines : needle Accordion pleads on the cheeks: cannula 27 12/4/2013 How to do this? part 1 How to do this? part 2 28 12/4/2013 How to do this? part 3 Final Case Study 29 12/4/2013 30 12/4/2013 31 12/4/2013 32 12/4/2013 33 12/4/2013 Conclusions Midface rejuvenation with bolus technique Need for careful assessment and realistic objectives Easy procedure Predictable outcome and duration of effect Favorable safety profile Extremely rewarding for patients and practitioners 34