DO FACIAL LIGAMENTS AFFECT INJECTABLE FILLER PROCEDURES? A Study by Gabriela Casabona MD

 LIFTING vs VOLUMISING - A Study Led by Gabriela Casabona MD, Ocean Clinic. 

Injectable fillers are becoming more and more popular and a regular treatment for helping to alleviate the signs of ageing, especially in the face where volume has been lost over time (in varying layers from bone to skin), and soft tissue begins to sag. The application of soft-tissue filler replaces this lost volume reflating the targeted facial fat compartments, restoring tension in ligaments, and giving the face a fuller, back-to-youth appearance. The science behind injectables is intricate and ever-evolving and continuously being studied to perfect the art.  

Recently the concept of the line of ligaments has been introduced as a factor to consider when trying to achieve optimum results. The facial layers are arranged differently - medial vs lateral - to the anatomical makeup of ligaments. Medial layers are angled obliquely and lateral are parallel to the skin surface. Placing soft-tissue fillers respecting these anatomical landmarks could possibly result in different effects. Medial injections could result in volume, and lateral injections could produce lifting effects. 

To test this theory, our head of aesthetics department, Gabriela Casabona MD, recently published a study on soft-tissue facial fillers and the difference between lifting and volumising in minimally invasive procedures when respecting the facial ligaments. 

The focus of the study was to analyse soft-tissue facial fillers applied, to a split face, in varying sequences. The analysis looked at applying different methods to either side of the same face in order to actually see and monitor the difference, if any. 

Twelve patients (9 female, 3 male - 32-48 years old) from the Ocean Clinic received injectable soft-tissue fillers, as treatment for a lack of volume in the midface area. The patients were given the same fillers all at the same six sites on the face but in different sequences in order to see if this had any effect on the results. Half the face was treated in one sequence, the other half using a different order of sequence, but always at the same 6 points. All twelve patients had never received any previous surgical or non-invasive procedures to the area in question. 

On each side of the face three points were targeted lateral to the natural line of ligaments, and then three more points were located medial to the line of ligaments. On the right side of the face the lateral points were injected first and the medial second, on the left side of the face the medial points were injected first and the lateral second. Basically the same procedure was carried out on either side of the face but in reverse order to see if the sequencing itself had any effect on the results. 

The products used during the study for the volumizing procedure were JuvédermVolbella® (palpebromalar groove and tear trough) and JuvédermVoluma® (all other facial regions) (Allergan®). 

Gabriela, the physician for the procedures, treated and analysed the hollowness and fullness before and after the treatment. The score of which was part of the assessment as was the GAIS scale, also assessed by Gabriela. All analyses were performed using SPSS Statistics 25 (IBM, Armonk). The volume injected was measured overall and for each individually injected location. 

The Results

There was no aesthetic difference to the sides of the face post-treatment - both sides of the face looked equal both before and after the procedure in all patients. However there were some differences noted as to the amount of filler required to achieve the results in the varying sequences. 

The study revealed thst if the lateral injections are performed first, the volume needed to be injected into the medial points is significantly less. The same phenomenon was observed for the laterally located injection points. The total injected was significantly less when the lateral points were performed first. Often an injection point is chosen specifically for the aesthetic outcome and does not consider the local underlying anatomy, during this study the anatomy was a factor in the desired otcome to specifically investigate the layered arrangement of the face. The targeted injection points were based on the specific arrangement of the underlying anatomy of the face in combination with a desired (aesthetic) outcome. 

Conclusion

The results of the study emphasise the importance of respecting the underlying anatomy of the face, the layered arrangement of the facial soft tissue and ligaments, when performing minimally invasive soft-tissue filler injections. Target injection points lateral to the line of ligaments first reduces the volume needed to symmetrically and aesthetically appealing fashion, and volumizes the infraorbital and upper cheek region. Injections lateral to the line of ligaments result in a stretching effect of the midfacial fat compartments. Conversely, injecting the midface medial to the line of ligaments requires an increased amount of product required to achieve a desired aesthetic outcome if lateral injection points were not targeted first. 

For more information on our aesthetic department or injectable fillers please contact Ocean Clinic today. 

Why is Local Anaesthetic Trending for Plastic Surgery Procedures?

Why local anaesthesia is trending in plastic surgery over general anaesthesia...

A version of anaesthesia is always given when there’s an incision involved - nobody is expected to be happy with feeling pain or discomfort, so general anaesthesia has long been a preferred option for these reasons.

Many surgical procedures are carried out using general anaesthetic, but in fact a large number of these can be done using only a local anaesthetic. Many surgeons around the world are beginning to reduce the use of general anaesthesia, when not absolutely necessary, for a range of reasons.

What is the difference between local and general anaesthetic?

General anaesthetic, administered either intravenously or via inhalation, affects the whole body and causes a loss of consciousness, whereas local anaesthetic is administered to create an absence of pain in a specific location of the body (without a loss of consciousness). 

Why choose local over general anaesthetic? 

General anaesthetic, as safe and effective as it is, can add a level of stress on the patient’s body as well as potential added side effects when regaining consciousness. Other reasons are that once a patient is under general anaesthetic and unconscious there is a reportedly higher risk of bleeding, bruising, swelling and recovery. If a patient has an adverse reaction to general anaesthetic, there is risk of vomiting which could potentially tear any sutures. Some surgical procedures need to use general anaesthetic and the risks are minimal, however if there is an option to use local only, then why not? 

Some patients prefer the idea of being able to stay ‘awake’ or lightly sedated during the procedure, however many feel that being able to wake up when it’s all over is the preferred, more comfortable option. 

Some of the popular procedures which only require local anaesthetic, or what is known as ‘twilight’ anaesthesia (applied intravenously, twilight anaesthesia induces sleep without the risks that general anaesthesia can carry, side effects are minimal and patients often feel rested afterwards) include facelifts, lip, chin and cheek augmentation, eyelid surgery and brow-lifts. 

A large majority of plastic surgery procedures could be done using local anaesthetic but in general it comes down to the patient’s physical situation, as well as their preference. Considering the best method for each individual is the primary concern. The main objective is that the patient is safe, comfortable and feels no pain. 

Does the cost differ with general or local anaesthesia?

Usually the complexity and materials required for general anaesthesia do raise the cost somewhat in comparison to local anaesthesia. An experienced anaesthesiologist must administer it and be present to monitor the patient’s progress. 

Which plastic surgery procedures are popular using local anaesthetic?
Upper Eyelid Blepharoplasty

This does not appeal to some people due to the proximity of the surgery being so close to the eyes. Despite this, the removal of excess skin of the eyelids is a popular procedure using local anaesthetic. The procedure is relatively quick and straightforward covering a small section of skin and the patient would have no feeling here at all,  making it a good candidate for local anaesthesia. Lower lid is not as recommended as it is a trickier procedure. 

Removal of Buccal Fat 

Buccal fat is basically excess fat in the cheeks, to remove this a small incision is made in the mouth. A numbing injection of local anaesthetic is all that is required for this procedure but some people may still prefer general as the pressure involved can be disconcerting and therefore stressful if awake. Still, this is a very popular one for the local fans and oral medicine can be taken to help the patient to relax. 

Facelift, fat grafting, browlift…

Most surgeries that involve facial skin can be achieved pain-free under a local anaesthetic. As with any of the surgeries mentioned, the patient will feel the first set of numbing injections, but feeling during the rest would be undetected. 

Liposuction

Liposuction under local anaesthetic in an isolated, small, relatively superficial area of the body, such as the upper arms and chin for example, works well. The fat in these types of zones is fairly easy to remove and the suction less aggressive than in the tummy or larger areas. The procedure works in exactly the same way whether using general or local anaesthetic so there is no compromise when it comes to the treatment. The only feeling that would be different if awake is the insertion of the anaesthetic,  and that the senses are still fully functional, so you’d be able to hear the noise of the suction and any pressure applied during the procedure. 

Lip Lift

A lip lift involves the removal of a thin strip of skin, just below the nose, to reduce the length between nose and upper lip by raising it slightly. Many surgeons actually report that it is better (for them) to carry out this procedure under local anaesthetic due to the absence of the breathing tube needed under general aneasthesia which can obstruct their view and perspective.  This is a pretty quick procedure which will not involve any pain once the area is totally numbed, and so it is a popular one for local anaesthesia. 

The Bottom Line

A large majority of plastic surgery procedures can be done using local anaesthetic but in general it comes down to the patient’s physical situation, as well as their preference. Considering the best method for each individual is the primary concern. The main objective is that the patient is safe, comfortable and feels no pain. 

Can injectables reduce anxiety? New studies reveal interesting findings...

 Recent study claims neuromodulator injections could reduce anxiety by up to 72%! 

Neuromodulator injections are best known for being an anti-wrinkle treatment, however there are other, less famous uses for them. Other effective uses are the treatment of migraines, excessive sweating (hyperhidrosis), crossed eyes (strabismus), and an overactive bladder. Recent studies, undertaken to note any side effects in patients, revealed that a pattern emerged when it came to those that previously suffered with anxiety. During the study, scientists found that regardless of where the injection site was, anxiety symptoms were significantly reduced. 

It is suspected, but not yet proven, that the toxins may affect the nervous systems that control our mood and emotions. It is also speculated that the relaxation of the muscles causing us to have wrinkles may also contribute to relieving anxiety, if it were those lines that were causing added stress to the person then their removal, or reduction, may well also reduce the anxiety they caused. However, the fact that the site of the injection proved irrelevant seems to negate this idea. 

Currently it seems that it doesn’t matter which site is injected to have the effect, however more studies will need to be conducted in order to specify which are the most effective in easing anxiety. This will be analysed during clinical trials to establish the best, if any, site for the injections. 

Studies are generally carried out in order to focus on any negative side effects people may encounter after having received such injections, there are a number of diverse effects being reported and so the FDA has the objective of identifying these that had not been detected during initial clinical trials. There is plenty of documentation on the potential dangers such as swelling, pain, headaches, drooping eyelids and dry eyes, for example. 

One study author recognised that such effects were well-documented but what about researching the idea of positive side effects? This did not seem to be something that had been as deeply investigated. Abagyan, a professor at the University of California San Diego (UCSD)  felt there was a need to research the beneficial effects of the injection. With millions of people a year having these injections, surely this could mean a lot to many if there are added benefits!  

Two physicians from Germany joined the research which was carried out at the Skaggs School of Pharmacy and Pharmaceutical Sciences at UCSD. The team took information from the FDA’s Adverse Effect Reporting System database which gave them access to over 16 million reports of varying effects of the injections given for a variety of reasons. 

On analysing the data, using mathematical algorithms, the researchers searched for a reduction in anxiety or anxiety-related disorders in comparison to a control group who had not received the injections, as well as those who had received other treatments for these conditions. 

The results showed that those who had received injections were reporting significantly less anxiety issues than those being given other treatments. Some showed up to 72% lower anxiety risk in treated patients being treated for; facial muscles for cosmetic use; facial and head muscles for migraine; upper and lower limbs for spasm and spasticity; and neck muscles for torticollis (also known as wryneck, a twisting of the neck). 

The same team of researchers has previously published other findings using this database to report that these injections can also be effective in treating depression.  

Although researchers don't know the specific molecular mechanisms by which this type of treatment reduces depression and anxiety, they might be different between the two conditions.   

Read the full, published scientific report here.

For more information on neuromodulator injections, and other cosmetic treatments and procedures, please contact us @ocean_clinic today.

 

Liposuction Recovery: what to expect

 

Recovering from Liposuction: all you need to know...

As one of the most popular cosmetic surgeries worldwide, Liposuction is performed thousands of times a year in Europe. Anyone considering liposuction must absolutely see a board-certified plastic surgeon, research the procedure and know what to expect from the surgery before going ahead. Liposuction should be something that will bring you body-confidence, in a safe and effective manner. It is a straightforward procedure with fairly low recovery time but it still involves major surgery and so it is vital to know how to prepare and manage this. Here we cover the post-op recovery outline for patients to keep in mind if considering liposuction.  

What is liposuction?

Liposuction is a body contouring, surgical procedure performed in order to permanently remove fat cells from certain areas of the body. At Ocean Clinic we use Water-Jet Assisted Liposuction (WAL) as it is a more gentle technique which helps to minimise swelling and bruising, pain, irritation and damage to blood vessels. 

Common areas for liposuction include: 

• abdomen

• hips

• buttocks

• thighs

Immediately after surgery and a few hours later you should experience some soreness. This can be reduced by encouraging blood circulation, so getting up and walking around gently is encouraged. 

 

Liposuction Recovery : Days 1 - 7

Pain Management

There will be some discomfort over the first few days after having had liposuction and there may well be prescribed medication to take to manage this as well as any swelling. This will all be outlined by your doctor for your individual case. 

Healing Aids

Compression garments are worn in order to aid swelling reduction as well as keeping everything in its new place. This should be worn as much as possible (not when bathing) or as instructed by your surgeon. Any incisions and drains will also need attention which your doctor will outline for you. 

Rest and Recuperation

Rest is imperative during these days to allow your body to recuperate, adjust to its new form and allow everything to settle. Asking a friend or family member to help to do the regular day-to-day would be advised to ensure you encourage the healing process effectively, though you may be able to manage light household activities, desk work, showering and driving at around 24hrs post op. 

Liposuction Recovery : Weeks 1 - 2 

At roughly the one week mark you should be feeling fit and able to return to ‘normal’ working life if this entails an office-type position. If work entails physical labour, this may not be advisable for about one more week. Your doctor can assess your individual recovery speed; this is just a general guideline. Your recovery garment should still be worn to ensure optimum results, as well as a more rapid recovery. 

Pain, swelling, discomfort and any soreness should be greatly reduced in most patients by the end of the first week or two. You could also opt for lymphatic massage at this point, to aid with the swelling.

Liposuction Recovery : Month 1 - 2 

There should be no more pain or discomfort at all during this period of your recovery, although there may be slight swelling or bruising at any surgical sites, though these ought to be minimal by now if present. This is the time that your results should be shining through, although try to be patient if you are still experiencing any swelling, it varies from person to person. Light exercise can now be entertained with caution, and do speak to your doctor before embarking on any intense activities. 

Liposuction Recovery : Month 2 + 

From this point on you should be, or start to be, feeling fully recovered and your final results should be emerging. The compression garment can now be discarded even if you are still experiencing slight swelling; again, speak to your doctor for individual assurance. Exercise can now resume as normal. 

Be aware of your body, how you feel and pay close attention to your surgeon’s advice, have patience if you feel your recovery is taking longer than you hoped and allow your body to take the time it needs to adjust to its new shape and size. 

Talk to us! 

Contact our expert team of professionals HERE for a consultation or any further information on Liposuction.  

Is Your Decolletage Ageing You?

 

Is Your Decolletage Ageing You?

Facelifts and breast surgeries are among the most popular cosmetic procedures, but what about the bit in between?

Despite the lack of attention given to the chest, it can be a big giveaway about a person’s age - and make people appear older than they really are. That’s because this area gets a lot of sun exposure and is subsequently prone to wrinkling, sagging and discolouration.

The decolletage, which can include part of the shoulders, cleavage, and collarbone regions, provides a ‘frame’ for the face and the bust. It is an area that is on show a lot of the time yet it is one we frequently neglect to take proper care of. Many people forget to include this important area in their skin care regime, failing to moisturise or apply daily sun protection.

If you have damage to the decolletage area, don’t despair, there are cosmetic treatments that can help. Surgically, this is a difficult area to treat; because this part of the body is prone to scarring, it’s not suitable for ‘lifting’ in the same way the face and neck are.

However, there are a variety of alternative treatments that can help improve the appearance of the skin. Read on to find out more…

Injectable filler

To fill deep lines in the chest, injectable filler such as JUVEDERM, Restylane or Emervel can be used. This is the same filler that is used in the face, but may be diluted for use on the chest, since the skin here is very thin.

Filler is used to plump out the depressed areas and is usually effective and long-lasting (up to two years). This treatment generally requires 1-3 sessions, each taking less than 20 minutes.  

Platelet Rich Plasma

To improve the texture of the delicate skin of your decolletage, platelet rich plasma (PRP) offers a non-surgical option.

PRP involves injecting a patient’s own blood into the superficial layers of the skin. The blood is first spun in centrifuge to separate the platelets and make a plasma rich in growth factors.

The growth factors stimulate the production of collagen, facilitating the repair of damaged skin. PRP therapy will enhance skin texture, tone and luminosity. Skin renewal is continual for about three months after the procedure, with results lasting up to 18 months.

Radiofrequency

Venus Legacy is a revolutionary radiofrequency treatment system, which can be used all over the body, including the chest, to tighten lax skin and smooth out wrinkles.

Using radiofrequency to painlessly heat the tissue triggers both the tightening of existing collagen and production of new collagen, helping to rejuvenate the skin. For general skin tightening and smoothing, noticeable results can be achieved in just five 30-minute sessions.

Mesotherapy

Mesotherapy involves tiny superficial injections of hyaluronic acid filler - a water-loving molecule that occurs naturally in the body.

Once injected into the epidermis and mesoderm (middle layer of the skin), the hyaluronic acid molecules start to swell with water, absorbing up to 200 times their weight.

This procedure plumps and rehydrates the skin and encourages rejuvenation by promoting the production of collagen and elastin. Mesotherapy is an ideal treatment for the face, neck and decolletage.

Chemical Peel

A chemical peel can be used to resurface the decolletage skin, improving the appearance of lines and wrinkles, as well as skin pigmentation and blemishes.

A chemical solution is applied to the chest to strip away layers of old, damaged skin to make way for new cells. The process is similar to a snake shedding its skin to reveal a bright, new appearance.

Peel "depth" or the number of skin layers removed, is determined by both solution ingredients and concentration. A superficial peel can be performed on an outpatient basis, whereas a deep peel, which can be used to treat deeper wrinkles, will require an overnight stay at the clinic.

Fat transfer

Fat transfer, or fat grafting, involves using a patient’s own fat as a filler. Fat is harvested from elsewhere on the body, such as the tummy or flanks, and re-injected into the chest where deep wrinkles are present.

It works in the same way as synthetic filler but provides an all-natural alternative, which can be a permanent solution. Since fat contains living stem cells, they can find a new blood supply and live on long-term as vascularised tissue.

Additionally, stem cells have a rejuvenating effect on the skin, significantly improving skin quality, texture and tone.

Which treatment is right for me?

If you are unsure which of these treatments is best for you, book a consultation at Ocean Clinic Marbella and we can advise based on your specific requirements. It may be that a combination of treatments will give you optimum results.

To maintain your results following treatment, ensure you apply a minimum of SPF 30 (50 is preferable) sun protection to your chest daily and, if you sleep on your side, try to get used to sleeping on your back. Squeezing the cleavage together as you sleep can exacerbate the development of wrinkling.

Contact Ocean Clinic today to find out more...