HOW DO I GET RID OF MY UNDER EYE BAGS?

 How do I get rid of my under eye bags? 

Under eye bags are not always a reflection of lifestyle - if you have stayed up late, not had enough sleep, dehydrated, or have been unwell - many factors can contribute to unsightly dark rings or puffy under the eye

areas. However, there are also unavoidable genetics, as well as aging, which can contribute to under eye bags and these unfortunately can not be greatly altered by diet or lifestyle. The ‘bags’ are actually herniated fat which tend to worsen with age. 

There are many products on the market which claim to reduce or cover up under eye bags and/or dark circles however if you feel these are not providing the results you are looking for then perhaps we have the answer…

Ocean Clinic can offer both surgical and non surgical solutions to improving the under eye area. Depending on your situation, which we would analyse individually with you, we would be able to decipher the correct procedure/s to suit your needs. 

Surgical options for removing/reducing under eye bags…

Lower Blepharoplasty 

This is the most common procedure used to address under-eye bags. This is a surgical procedure which involves an incision to remove or reposition either the fat and/or the skin situated under the eyes. The two basic approaches to lower blepharoplasty; one is the trans-conjunctival method whereby the fat is removed from the inside of the lower lid. The second is to create an incision directly below the lash line which cuts through both skin and muscle - this goes around the eye to elevate the skin/muscle flap in order to reveal fat pockets beneath - these are subsequently removed and the incision is secured with tiny sutures. This does produce a fine scar, and so, often the first, trans-conjunctival approach is selected. 

How is the eyelid surgery/blepharoplasty performed?

This kind of procedure is mostly performed under deep iv sedation (Twilight sleep) combined with loco-regional anesthesia or purely under local anesthesia. You will sleep throughout the procedure, but you will be able to move arms and legs like in normal sleep, which lowers the risk for thrombosis. The procedure is generally pain free and takes between 1-2 hours.

Ocean Clinic experience in eyelid surgery

Our surgeons performed more than 1000 blepharoplasty procedures within the last 10 years. Our clinic is a worldwide leader in combining surgical periorbital rejuvenation techniques with Facial fat grafting for re-volumizing of the ageing orbit and skin resurfacing with Peels to address the skin texture of the periorbital /eyelid region to remove imperfections like age spots and discolorations in one single treatment session. Many of these techniques have been published in international peer-reviewed journals and are on the forefront of new field of 3-dimensional facial rejuvenation.

Blepharoplasty aftercare

Most eyelid procedures at Ocean Clinic Marbella are performed under local anesthesia with intravenous sedation. This concept allows for a complete painless procedure with patients being sedated only for their comfort. Postoperative pain in eyelid surgery is rare; patients only have a slight feeling of pressure around the eyes for 24-48hrs treated with oral pain medication.

Most patients can go home on the same day and come for a check -up the day after; stitches are removed after 7 days. During the first 4 weeks postoperative our patients will be referred to our unique physiotherapeutic aftercare for quicker recovery and less swelling. Heavy objects beyond 5kg should not be lifted and sports involving weights avoided for a minimum of 14 days.

Non surgical lower lid options

Surgery may not be for you for a multitude of reasons; reluctancy for incisions, severity of your case, cost, recovery time, etc. There are quite a few options for reducing eye bags without the surgery. Dermal fillers can be used to fill areas surrounding the bags in order to smooth out the area and create an even appearance. This is a temporary solution and would need to be readdressed or ‘topped up’ over time. When skin quality is part of the problem, energy-based laser treatments are highly effective ways to reduce the appearance of eye bags; they work by encouraging the tissue to strengthen and for the production of collagen to be stimulated. This can also be helped by injecting biostimulators, or monofilament threads, into the surrounding areas which also promote the production of collagen, or cosmetic injections to relax the muscle in surrounding areas and create a smoother texture and even skin tone. Each patient would be analysed individually and quite often a combination of the possible treatments used to achieve the best results for that person’s unique case. 

At Ocean Clinic we would highly recommend a consultation to determine which procedure/s would be the most effective for you after a full analysis of your personal requirements. Contact our clinic today to find out more. 

Lip flips may be trending on social media, but are you a good candidate? 

Trends in the plastic surgery world are often brought about by influencers on social media - once you’ve seen a certain procedure done successfully multiple times, it starts to stick and interest increases. The conversation surrounding such trends is made possible by platforms such as Instagram and Tik Tok, for example Lip Flips are currently a huge trend in cosmetic procedures - it is not a new concept at all, it has just been given far more exposure in recent times and therefore popularity has increased. 

WHAT IS A LIP FLIP?

The lip flip is a relatively new option in lip augmentation and, similarly to using fillers, involves injectables being placed into the lip to create a fuller appearance.

LIP LIFT PROCEDURE - WHAT DOES IT ENTAIL? 

The lip flip is a quick, non-surgical procedure simply consisting of injections being placed into the muscles above the upper lip. No anaesthetic is required for the procedure and it takes minutes to achieve.  The injectables placed into the orbicularis oris muscles causes them to relax, the lip then naturally ‘flips’ slightly outwards to create a fuller effect using only the existing lip itself. The effects are noticeable very quickly - it takes only 5-7 days to see the full effects of the lip flip procedure and they last for around 3-4 months (metabolism depending). 

WHAT IS THE RECOVERY LIKE FOR A LIP LIFT?

Great news! There isn’t any recovery time. The only possible thing that may take a little getting used to is sipping through a straw or other reasons to tightly pucker the lips, but this won’t take long to rectify itself. You may experience very mild swelling or bruising which will also pass rapidly. 

WHAT IS THE DIFFERENCE BETWEEN LIP FILLERS AND A LIP LIFT?

Lip fillers add volume to the lip whereas the lip lift simply uses the existing volume by pushing it forward to create a fuller effect. The natural size of your lip does not change with a lip lift, it is just shifted to make it look more plump and pronounced.  Both procedures last for around the same amount of time and sometimes the practitioner may suggest a combination of the two to achieve optimal results. 

HOW DOES A LIP FLIP LOOK?

As mentioned above the lip lift uses an injection to relax the muscles in the upper lip, which then causes the lip itself to flip forwards. This creates a subtle, fuller looking lip and a more pronounced profile as it protrudes forward slightly more than before. Obviously all people will get a different result depending on their existing lip. 

WHAT ARE THE BENEFITS OF A LIP FLIP? 

With the lip flip there’s no recovery time, no anaesthetic, no drastic alteration, minimal swelling or side effects, the result is rapid, and it is affordable.  If you aren’t happy with the outcome - within 3-4 months you can choose to do it differently, or not at all! 

AM I A GOOD CANDIDATE FOR A LIP FLIP?

If you have a ‘gummy’ smile, are unhappy with ageing lip lines (barcode lines), want a subtle (yet obvious to you) change, want a fuller lip but would rather not have surgery, or prefer not to have fillers to alter the size of your lips, then yes this could be the option for you. 

Lip flips are an ideal solution for someone whose muscle around the mouth area pulls the lip in or under, or when smiling the lip is pulled up high. This overactive muscle is weakened by the injectable and therefore the lip movement reduced / relaxed resulting in a more attractive smile. 

IS A LIP FLIP SAFE?

Yes, a lip flip is safe, it is just the same as any similar injection. There is a very slight risk that the smile could become asymmetric - however, this is minimal. Ensure that you choose a board-certified, experienced practitioner to carry out the procedure. 

You may experience very minimal bruising just at the site where the injection was placed, this should heal within 1-2 days. 

DOES A LIP FLIP LAST FOREVER?

No, the lip flip will only last as long as the injectable stays in your system. The body will naturally ‘outgrow’, or reject, it over time. Most people see results for up to 3-4 months, but it varies from person to person depending on their individual metabolic rate. 

 

GLYCOLIC ACID OR HYALURONIC ACID ~ WHICH IS BETTER FOR ANTI-AGING?

 GLYCOLIC ACID OR HYALURONIC ACID ~ WHICH IS BETTER FOR ANTI-AGING?

Just because they share the word ‘acid’ in the name does not mean that they do the same thing - the ingredients and effects of each are actually quite different. Which one should you use for anti-agile purposes? Let’s look in more detail at hyaluronic and glycolic acid…

What is Glycolic acid? 

Glycolic acid (read in more detail in our previous blog for more information - here) is derived from sugar cane and is one of the most widely used AHAs in skin care products, it has the smallest molecules of all AHAs which allows for optimal exfoliation and absorption into the skin. Glycolic acid works by increasing the speed at which our cells rejuvenate or replace themselves. It works by dissolving the ‘glue’ that holds skin cells together - meaning that by using glycolic acid we can shed our dead skin cells faster than we would do so alone.

What is Hyaluronic acid?

Hyaluronic acid is a clear, sugar-based substance which is naturally found in our bodies - it is highly concentrated in our eye fluids, joints, and skin. It works by binding to water and helping to retain moisture (it can hold up to 1,000 times it weight in water), promote and protect collagen and provide flexibility and lubrication to said areas of the body. It keeps our skin looking plump and hydrated, as well as function at its best. When our natural store of hyaluronic acid begins to deplete naturally with age, we start to lose firmness and the skin becomes less able to retain moisture.

How do Hyaluronic acid products work? 

To reap the benefits of hyaluronic acid there are different ways to use the products on the market. To achieve long lasting and effective results, hyaluronic acid-based fillers are injected into  various layers of the skin. Otherwise, products can be applied topically as drops, moisturisers or creams. However, unless the product is effective, if it is not able to be absorbed by the skin, it will simply sit on top of the skin and provide a very limited and temporary amount of hydration. So the product must be of a certain standard and molecular structure in order to have the desired effect. The desired effect being that it stimulates collagen production, increases moisture levels, and strengthens the skin barrier - it should serve to make the skin stronger, firmer, and deeply hydrated on a cellular level.

How do Glycolic acid products work? 

Glycolic Acid can help our skin by hydrating it, smoothing out fine lines and wrinkles, improving our skin tone and texture, reducing the effects of sun damage, brighten the skin, reducing pre size, preventing ingrowing hairs, shed dead skin cells quickly, clear out pores which can help with spots and acne. 

Contrary to some reports, within a skin care ointment or cream, Glycolic Acid will not remove scars, it can have an effect on pigmentation  (such as slightly lightening a darkened patch of wounded skin), and improve a raised or pitted scar but will not remove them completely. 

There are plenty of over the counter options when it comes to choosing your product containing glycolic acid, generally these will come in varying strengths up to 10%. There are also stronger versions (up to 30%) which are present in a light chemical peel, though these are not advisable at home but by a professional practitioner or aesthetician. A dermatologist can administer an even stronger chemical peel including glycolic acid of up to 70% strength. 

The format in which you choose to apply glycolic acid to the skin completely depends on your personal skin type and needs. You may be content with an over the counter product containing a light percentage of glycolic acid to brighten your skin and give you a healthy glow, to give a smoother skin texture, prevent breakouts and even reduce fine lines. Other skin types may require a more professional approach and a stronger treatment. 

So which one do I choose for anti-aging purposes? Hyaluronic acid or glycolic acid?

In a nutshell, use both! Glycolic acid can be harsh on some skin types and, depending on the strength, your skin can take some time to adapt to using it so gradually build up the use of it over time. Beginning at 2/3 times a week and moving up to 4/5 if there is no sign of irritation, for example. Slowly increase over time until you can use it daily. If at any moment the skin becomes irritated then stop for a rest and begin the process again after a week or so at a lesser level. Glycolic acid works as an exfoliant and serves to improve skin tone and texture - this can mean that fine lines, wrinkles, sun damage / spots, etc can be reduced or improved over time. Hyaluronic acid works as a great source of hydration for the skin and promote collagen while reserving moisture. Both naturally occurring ingredients work well as individual skin treatments yet the two together can achieve smoother, healthier, more radiant looking skin. 

How to use both Glycolic acid and Hyaluronic acid together…

Due to the two products not being in competition with one another for their beneficial properties, they compliment each other really well when used in a personal skin care routine. The glycolic acid is your exfoliator revealing that radiance that has been hiding under the dead skin cells, and the hyaluronic acid is your day cream, gel, serum or mask, which locks in all that necessary moisture to keep your skin plump and hydrated. Rinse your face with water after using any glycolic acid product before moisturising with a hyaluronic acid based product.

Bottom line - use both! 

To speak to our skin care specialists and learn what is best for your skin type, please contact Ocean Clinic today. 

Combining Plastic Surgery with Non Surgical Treatments for best results - as recommended by Ocean Clinic, Marbella

 

Combining Plastic Surgery with Non Surgical Treatments for best results

A simple mistake when contemplating cosmetic treatments is to separate the worlds of plastic surgery and non-surgical procedures. Though there are some mighty differences between the two when it comes to recovery time, cost, and invasiveness, (as well as results) the two are not exclusive; in fact for optimal results, often the best option is to combine the two. 

This synergy is a highly effective method to achieve the desired overall outcome of many types of treatments to various areas of the body, especially in the field of anti-aging. These combinations also seemingly produce the most natural looking results due to the cumulation of each side of the surgical fence. Having plastic surgery can produce certain outcomes, as does nonsurgical treatment, however the two together can take the result that one step further. 

Dr. Kai Kaye, plastic surgeon, and Dra. Gabriela Casabona, dermatologist & head of aesthetics, both from Ocean Clinic, Marbella, suggest that the concept is to achieve a holistic regeneration approach, some layers can be treated surgically and others non-surgically; combining the two creates better results.  The following are some examples of combination treatments, as per their recommendation, which offer great synergy and impressive results…

Upper Blepharoplasty (surgical) combined with cosmetic injectables and fillers. Upper blepharoplasty is a surgical procedure which removes excess skin from the upper eyelid. When eyelids age or become ‘heavy’ the skin can start to fold and show, even hang over the eye and give an unwanted/uncomfortable appearance. Combining this procedure with cosmetic injections to tighten the muscles around the brow to create a lifting effect, as well as fillers to volumize the forehead and temples, gives an all round lift to the eye region and creates a natural, youthful, lighter look. 

 Co2 laser / peeling with Blepharoplasty. Again blepharoplasty can be combined with a non surgical treatment to create optimal results. Upper and lower blepharoplasty (lower being the use of various surgical treatments of the lower eyelid / eye-bag area), is often carried out alongside a Co2 laser treatment which serves to resurface, or remodel the skin. Laser skin resurfacing, also known as laser peeling, is a safe and effective method for improving the skin’s appearance. The laser reduces the appearance of wrinkles and any other minor skin issues; liver spots, sun damage, superficial scarring, etc.  The blepharoplasty procedure removes any excess skin, muscle or fat, tightening and rejuvenating the eye area whilst the laser fine tunes the skin around the eyelid areas, a perfect match to create a youthful, healthy, appearance with no excess skin or eye bags; a perfect match. 

Lower Blepharoplasty with Fillers to the Mid-face and Tear Trough. This time we are focussing on the lower eyelids where many people suffer with eyebags, dark circles, hollowing under the eyes, etc. Once the lower lids are corrected surgically via a lower blepharoplasty procedure, the fillers in the mid face and tear trough serve to complete a balance of volume and lift. This combination creates smooth, tightened and rejuvenated skin across the whole area.

Liposuction with radiofrequency skin tightening. As the liposuction procedure serves to remove excess unwanted fat from problem areas, the radiofrequency treatment helps to target deep fat tissue at a safe temperature which stimulates the natural elimination of fat cells. The two combined create optimal body contouring results. Liposuction is the surgical removal of fat deposits via a cannula using various kinds of suction techniques. Ocean Clinic offers various types of liposuction, the favorite often being the water-jet assisted version for minimal bruising.  

Jawline Mini Lift with Ulthera (for younger patients). Whilst the majority of people having face or neck lifts is generally associated with an older age group, there is a growing number of patients in their younger years who are opting for surgery. Due to their cases being less ‘severe’ than with older generations, people in their forties, for example, often have more subtle procedures which help to prevent and reduce their aging process rather than going through a major transformation at a later date. 

A mini lift at the jawline is a good example of this, as the skin begins to loosen and sag in this area it is the beginning of our aging process which over time worsens. To operate at an earlier age preserves those youthful looks, the surgery is far less intense, plus the results are more natural.

This procedure  is a combination treatment where, surgically, only the jowling of the mandíbule (skin excess forming jowls) is addressed, with a small incision around the inferior base of the ear/earlobe, while all other laxity in the neck or the mid face is addressed with High Intensity Focussed Ultrasound (HIFU). The HIFU treatment we use at Ocean Clinic is an Ulthera device, which achieves neocollagenesis in all levels and layers of the skin and serves to lift and tighten alongside the surgery itself to achieve the most natural, youthful and long lasting look. The Ulthera device is the only one that has ultrasound technology which allows us to actually see which layers we are treating, making the procedure more effective. 

Microneedling with Facelift - Modern Facelift and neck lift procedures are the cornerstone of facial rejuvenation. The techniques have evolved over the last 50 years and recently saw the integration of novel techniques like facial fat grafting and skin resurfacing techniques (Microneedling or Peeling) that contribute towards more natural,  more complete results. 

Microneedling is a non-surgical skin treatment involving the insertion of fine needles into the skin to improve collagen production in order to regenerate our skin and maintain a more smooth, even tone as well as youthful appearance. When used in combination with a facelift the results are considered  more natural and longer lasting as the skin continues to create collagen over time. It can also be used in association with nano-fat (full of stem cells, stromal vascular fraction cells, growth factors) and other active ingredients such as hyaluronic acid, vitamin C; exosomes that can boost the needle effect promoting a more long lasting stimulation of collagen. 

Bottom Line - there are many layers to our physical anatomy as there are to our wants and desires, when it comes to physical improvements this must be recognised, analyzed and many times a multi-faceted combination of treatments realized to achieve the optimum results. Therefore plastic surgery and non-surgical treatments are quite often “better together”. 

Contact Ocean Clinic, Marbella to discuss your next steps. 

What is HEAT? - Find out more on the latest concept in Aesthetic ~ Cosmetic treatments

What is HEAT? - the latest concept in aesthetic, cosmetic treatments… examples on how it is applied at Ocean Clinic, Marbella by Dr. Gabriela Casabona.  

‘HEAT’ is a concept created to make the best choices for an individual patient, using the least amount of product to achieve the best results in the shortest amount of time - thus making the treatments as highly effective as possible. 

Heat stands for 'Highly Effective Aesthetic Treatment', which is of course always the aim - however we administer a treatment, whatever that treatment is, we want the results to be the most effective possible. 

“Throughout my career I have learnt to recognize that many products can be delivered using the same device; a cannula to administer a filler for example, but if you do not study and understand the behaviour of each product inside the body, how it reacts, where it is positioned, the layer at which you administer it, etc. you can end up using much more product, achieve the same results maybe, but with a far less effective outcome. So HEAT, for me, means that I know exactly where my target is, how my product will behave once inside the treatment area, and how to get the best use of the product using the least amount possible within the least amount of time possible (least number of sessions, least amount of product administered and achieve the best results).” Says Dr Gabriela Casabona, head of aesthetic department, Ocean Clinic, Marbella. 

HEAT and Injectable fillers ~ To illustrate how to apply the HEAT concept within her practice, Gabriela explained that if, for example, she was setting out to achieve projection of the zygoma area (cheekbone area) using fillers, she would opt for injecting a bolus - the cannula is placed at a deeper layer and kept still while the filler is administered, to achieve a static ‘bolus’ of product which keeps its shape and position - “if I want to save product and create the optimum effect, I need to locate the exact layer and use the right amount of product to create a perfect bolus and achieve the right amount of projection. If I were to use retrograde technique (instead of a bolus) - this is where filler is injected in traces, small amounts over an area as the cannula moves - the same amount of projection would not be achievable using the same amount of product, it would need much more”, she explains.    HEAT and biostimulators ~ When it comes to biostimulators, another example of applying the HEAT concept is that some biostimulators accumulate in an area and create volume - but if we want a rejuvenation/regeneration effect in the tissue, we need the product to spread, we don’t want an accumulation, we want to rejuvenate the whole area. To know which product to select for which area, and how to apply it most effectively is vital to the HEAT concept.   HEAT and Ultherapy ~ If a patient was undergoing Ultherapy to achieve a non-invasive facelift, the practitioner would analyze and target the SMAS (Sub-Muscular Aponeurotic System) - a thin layer of strong connective tissue on the face. The SMAS is vital in anti-aging medicine as it is probably the most important support structure of the face. It surrounds and connects to both deeper tissue and the muscles that are responsible for our facial expressions. "I have to target the whole fascia system, the SMAS, and the skin. If I don’t use an ultrasound to locate the SMAS I will assume that a patient’s will lie at around 4.5mm, if she actually had her SMAS located at 3mm, for example, then I would have gone in too deep, administered the energy at a level where the result would not be as effective as at the correct level. When I look at the result, it won't be as good as if I had gone to the correct target to achieve lifting", says Gabriela. HEAT and Neuromodulators ~ When we inject neuromodulators there are two main decisions: where we inject to be most effective and how much product to apply. For best longevity my neuromoduator needs to be injected into the muscle. At Ocean Clinic we apply the HEAT concept, mapping our patients with USG. This means we can define precisely where the muscle is and how deep to inject - this aids in choosing the right needle and points at which to inject. This gives a better effect with less risk of heavy forehead or misplacements of points with the need for touch ups.  For more information on our HEAT concept, aesthetic and cosmetic treatments, please contact Ocean Clinic, Marbella today.  ReplyReply allForward

Study shows temporal fillers can lift & volumize other regions of the face...

Full-face effects of temporal volumizing and lifting techniques

Soft tissue filler injections are constantly on the rise in popularity due to their effectiveness in alleviating the signs of facial aging. Every patient requires a tailor-made treatment as needs, severity, and expectations all vary considerably from person to person. 

Generally, the aim of an injectable filler treatment is to increase the volume of a particular area of the face. It is not often that the effects of this injection on the rest of the face is recognised or realized. This can be due to limited knowledge of how particular regions of the face can affect others, or because usually it is applied to the target area and so this is what is under assessment. 

A separate, recent study by Gabriela Casabona and colleagues revealed the effects of injecting filler into regions of the face in a specific order, the order used reduced the amount of filler required in subsequent areas as well as improving the overall result. Another study found that injecting particular areas of the temple region had a lifting effect in the mid and lower face, plus the jawline. 

The following study was carried out to investigate the facial volumizing and lifting effects of fillers applied to the temporal region.

Typically when fillers are applied to the face the outcome is more or less predictable, the site where the fillers are injected becomes fuller - more voluminous. However, recently, new techniques have emerged for targeting the temporal region (area of and surrounding the temples) which have been noted to have aesthetic outcomes beyond the temple itself. 

This study was designed to quantify, or measure, just how much effect the three different temporal injection techniques (using hyaluronic acid-based soft tissue filler) had across the entire face. 

Fourteen cauacasian patients’ (between the ages of 39-62) post-filler results were analyzed and reviewed to note the effects of the techniques used; injections were applied to three different layers of the skin (supraperiosteal, interfascial* and subdermal) in the temporal region and the assessment was given in terms of increase in the temple volume, the visibility of the temporal crest, the visibility of the lateral orbital rim, the eyebrow positioning, the severity of the lateral canthal lines (crow’s feet), the volume of the mid-face, and the contour of the jawline.

Technique (a) - supraperiosteal needle injection of the anterior temple, (b) - interfascial cannula injection of the anterior temple, and (c) - subdermal cannula injection of the posterior superior temple. 

The results showed that the supraperiosteal injection technique had the greatest influence on improving the temporal volume (25.0%), the temporal crest (33.3%), and the lateral orbital rim visibility (31.0%) scales but had no effects in other facial regions. So the supraperiosteal injection technique is simply localized to the injection site. The interfascial injection technique revealed good effects on improving temporal hollowing (23.3%) but had an even greater effect on the crow's feet (26.8%) and on the position (lifting) of the eyebrow (33.3%). The subdermal injection technique had its greatest effects in the lower face by improving the contour of the jawline (26.8%) as well as improving the lower cheek fullness scale (14.3%). 

To achieve the results from the study there were eight ‘scores’ given when reviewing the patients’ records. Images from various angles were used to retrieve the scores. Before, directly after, and four weeks after the treatments the same angled photographs were taken of each patient and evaluated by the physician treating the patients, the patients themselves, and two experienced, medical independent observers. The treatment consisted of the three different injection techniques performed during one treatment session, using the same sequence of injections and the same amount of the same filler. 

The results of this retrospective image analysis confirmed the exceptional role of temporal soft tissue filler injections for aesthetic facial treatments.  The primary goal of the treatment was in fact correction of the temporal region, following this anatomic regions in close proximity to the temple were assessed, including the temporal crest and the lateral orbital rim (closer to the eye). The forehead, the periorbital region (around the eyes), and the midface were then assessed for any improvement. This is where the brow position, crow’s feet, and lower cheek fullness scales were evaluated. Following this the jawline contour was evaluated. All the scores noted from these anatomical assessments contributed to the analysis of the local, regional and panfacial influence (effect) the three techniques had. 

Assessment scores were evaluated on images by the treating physician and by an independent observer whereas the aesthetic improvement 4 weeks after the last treatment was assessed by the treated patient and by two independent observers based on retrospective image analysis.

The results showed that the supraperiosteal injection technique had the greatest influence on improving temporal volume, the temporal crest and the lateral orbital rim when compared to the other techniques. This is most likely due to the fact that the product is administered deeper into the temporal fascia in this treatment. 

When analyzing the inter fascia injection technique, this was found to improve temporal hollowing but had a greater impact on the crow’s feet, and an even bigger effect on the eyebrow positioning. It also had a significant effect on the midface as well as the temporal crest visibility but no change in the lateral orbital rim. It just shows how important the anatomical understanding of the face is when applying injections, the location of the product vastly affects the response by the rest of the face. For example, the inter fascial technique is applied superficially to the deep temporal fascia which can therefore influence the position or tension of the overlying fascia…this fascia is also linked to muscle which will be affected by the application of the soft tissue filler. Knowing such effects is the science and knowledge being acquired by such studies. These new findings can deliver far greater precision, accuracy and more specific results whilst using less product. 

The subdermal product placement in the superior and posterior temple had its greatest effect in the lower face by improving the contour of the jawline, followed by the lateral midface where the lower cheek fullness scale was improved. Slight influences were detected in all of the other scores except in the visibility of the lateral orbital rim. This evaluation reveals that the sub-dermal injection technique can also induce aesthetic effects beyond the temple and into the lower face. 

From an anatomic perspective, this is conceivable as the product is injected superficial to the superficial temporal fascia and into the subdermal fatty layer with its respective superficial in-ferior temporal fat compartment..

 

From these results the study group concluded that in future, injection algorithms could potentially combine the three injection techniques to provide a multi-layered approach, tailored to accommodate the individual patient’s aesthetic requirements. 

*Patient data were eligible for review if the following criteria were fulfilled: Treatment for bilateral aesthetic temporal volume loss with minimally invasive procedures, no additional facial soft tissue or neuromodulator treatment during the evaluation period, complete post treatment assessment scores, and evaluation of the aesthetic outcome by independent (the non-injecting) physicians and the patient themselves after the treatment. This study (retrospective data analysis) was conducted in accordance with regional laws (Brazil) and good clinical practice. Patients unwilling to provide access to their medical records were not included in this analysis

*The fascia is the overlying tissue over a muscle or bone. 

*All the studies mentioned above provided plausible evidence that the lateral face and especially the temporal region have the potential to influence the middle and the lower face if injected with hyaluronic acid–based soft tissue fillers. 

For more information on our aesthetic department or for a consultation please contact us at Ocean Clinic Marbella.