"The interesting case: Combination treatment - a small alternative to a facelift"
"The interesting case": Combination treatment
in ÄsthetikaForum, February 2012
By combining various procedures and substances such as a volume filler, native hyaluronic acid, cross-linked hyaluronic acid and botulinum toxin-A, treatment effects can be achieved that come close to the effect of a facelift, as the following case study shows.
The 72-year-old woman wanted a facial rejuvenation but did not want to undergo a facelift. Fig. 1 shows the findings before the treatment: the wrinkles on the forehead and the transverse chin crease are clearly developed. There are also pronounced nasolabial folds, mentolabial folds and radial lip wrinkles with a narrowing of the upper lip. The loss of volume as a result of the age-related loss of fatty tissue is particularly pronounced in the cheeks and zygomatic region. The jaw contour is also no longer clearly defined on both sides.
Based on the findings, the patient was recommended a combination therapy consisting of a volume filler, a hyaluronic acid filler, native hyaluronic acid and botulinum toxin-A. The treatment was carried out in three sessions and an additional follow-up appointment was arranged. In the first treatment step, the glabellar region and the forehead were treated with botulinum toxin-A (the preparation used was Bocouture®) (see large V on Figure 2, 5 IU were administered per point). In addition, 1 IU was injected laterally on both sides in the brow area. In the same session, 3 IU were injected into the tip of the chin. Two injection points with ½ IU per point were injected on both sides of the upper lip at the level of the lip red/lip white border to correct the mimic portion of the radial lip wrinkles. In addition, treatment with native hyaluronic acid (Hyal-System®) was carried out in the first session. The cheek region was treated with wheals (Fig. with larger marking circles). After one week, the patient was called in for the second time. She received a repeat of the area treatment with Hyal-ACP®. At the third visit one week later, volume augmentation with calcium hydroxyapatite (Radiesse®) was performed. For this, 0.4 ml was applied to both sides of the zygomatic region, 0.7 ml to the nasolabial folds, 0.3 ml to the marionette lines and a further 0.3 ml was used to restore the contour of the lower jaw. Finally, 0.3 ml was injected into the transverse chin crease.
In addition, the radial upper lip wrinkles were augmented with a total of 1.0 ml of a hyaluronic acid filler (Belotero® Basic) during this session. The patient is called in again after four weeks to check the effect of the treatment and after four months for a first top-up treatment with native hyaluronic acid. Fig. 2 shows the treated regions, Fig. 3 the patient after the treatment. Such a significant effect would otherwise only have been achievable in this patient with a facelift.
Source: ÄsthetikaForum, February 2012