Fluid Tightening: Evolution of a Revolution
by Dr. Arnold W. Klein
Dr. Arnold William Klein, MD the godfather of minimally invasive aesthetics, the man who developed the implantation techniques for bovine collagen,hyaluronic acid, the dilution and injection sites for FDA approval of Botox Cosmetic for the frown, and recently the FDA approved manner in which Restylane is used to enhance lips has now developed a new and exciting injection process for tightening the jaw line and lateral upper cheek. This is a revolutionary injection technique providing a much needed alternative for those patients who need skin tightening and where treatments of hyaluronic acids using regular injection techniques leave lumpy, uneven areas in the treated sites. These patients, up till now, had only the typical facelift as a procedures to tighten excess skin as it could not be aesthetically addressed by the serial puncture or retrograde injection of fillers. These are the common injection techniques used today. In addition, this procedure can be used on those patients who are good candidates for the traditional serial puncture procedure obtaining better and more natural results. Dr. Klein has named this procedure the Tightening Injection technique. The procedure employs a serial injection technique but instead of depositing the filler at the injection site the material is flowed under the skin to restructure the lateral cheek and jaw line area by pulling the skin along as the material flows under the skin. By holding the skin tight with the opposing hand. and employing this technique of implanting the material and using the viscosity of the material flowing it under the skin so that the material gently pulls the skin in a posterior direction over the layer of filler restoring not only volume but in effect tightening the skin back to a more youthful form allowing the patient to put off plans for a facelift. The results are amazing and patients have expressed extremely pleasure and gratefulness that they did not have to go through the expense and healing time of a traditional facelift.
he deep plane facelift was developed to correct facial changes caused by aging that are due to ptosis of midface structures (malar fat pad). The deep plane facelift also attempts to correct deep nasolabial folds. Other techniques (excluding specific midface procedures) do not adequately address these problems. The problem with this procedure is you look done. I have been interested in facial structure since I was two and one-half.In 2008 I won the Leonardo DaVnci award and was chosen one of the 10 best Architects in the World, It was a full understanding of facial structure that allowed me to learn to pull skin with filllers by flowing them. It is not a deep plane facelift but what does tightness have to do with youth. Volume with proper structure defines youth!
Actually, there are excellent options available. The midface is probably the most important area of the face that "gives away" aging. The loss and descent of facial fat volume in this area is one of the first signs of facial aging. You can't really lift the area non surgically, but there are significant things that can be done to improve the appearance. First, the tear trough and under eye area can be re-filled with Restylane and Radiesse. This is usually the first sign of aging and filling this area usually gives a dramatic improvement. 10 years in 10 minutes is not an exaggeration. Replacing the definition and prominenece of the cheekbones is also important and can be done with Radiesse or Sculptra. Volumizing the cheekbone area changes the shape of the face back to the heart shape of youth - wider at the cheekbones and narrowing at the jawline. Refilling sunken cheeks and temples is the next important step and Sculptra is a great injectable for that. The side benefit of Sculptra is that it improves the quality of the skin where it is injected. The pores are smaller and the skin becomes thicker and firmer. Filling deepened nasolabial and marionette lines with Juvederm or Radiesse is, of course, part of the equation. Hope that helps.
The filler Sculptra®, or New-Fill?, was at one time considered an important agent in managing facial fat loss in HIV+ patients. Prior to FDA approval, it was used in a clandestine manner. In clinical trials evaluating this agent for correction of fat loss in HIV+ patients although the study patients were for the most part satisfied, up to 50% of the injected individuals developed some degree of lumpiness in the treated areas. Furthermore, these lumps are often far from invisible. Nevertheless, Sculptra® received rapid track compassionate release approval from the FDA for use in patients with HIV. The panelists on the General and Plastic Surgery Device were strongly unanimous in limiting approval only for patients with HIV. At the FDA hearing, not one histologic slide showing the fate of Scupltra? upon implantation was shown. Again, how can an agent gain approval without scientific data supporting its application? According to the European literature the consequences of Sculptra® in the normal host has been very problematic (foreign body granulomas, infections, etc.) Nevertheless, the lay press,medical conferences and internet began to promote this substance for soft tissue augmentation in HIV negative patients Prospective studies for the use of this agent in individuals with normal immune functioning have now been completed in the United States and it is approved for such.
In 2000, at the World Congress of Dermatology in Paris, Pierre Andre reported cystic, nodular, and granulomatous lesions when this agent was used in individuals with normal immune functioning (non-HIV+ patients). Additionally, long-term allergic reactions have since been described, which are very difficult to manage. In another report concerning its aesthetic use in 100 patients with normal immune functioning, 20% of th treated individuals experienced significant adverse reactions. Obviously, this product is not immunologically inert as the manufacturer stated. Foreign body granulomas are being seen with this agent in HIV-positive as well as immunocompetent patients. While the manufacturer as well as investigators claim this product produces neocollagenesis or new collagen this is not what is seen under the microscope. On biopsy one sees a severe immune reaction to the product.
There is no non surgical lift. Many will advise you on some non invasive lasers, thermage. Fraxel Ultrasound a waste of money.
Make a list of what bothers you and consult with a Board Certified Plastic Surgeon (American Board Of Plastic Surgery), to discuss your options
Effective Restoration of Lip Volume and the height of the lower third of the face
LOS ANGELES (Jan. 2012) ?Throughout all races certain features of the female face have attracted men.The most important of these are luscious sensual lips.Lips are the central cosmetic feature of the lower third of the face. Well recognized in the Mona Lisa, art historians have discussed the smile of Mona Lisa for centuries but her lips, the only visible female sexual organs , are the reason the painting grabs the male eye .? For years, women have attempted to alter their appearance and restore fullness to their lips by injectables. Unfortunately, until now their were no established guidelines.
I, have recently published in the ?Journal of Cosmetics, Dermatological Sciences and Applications ? the first study that established the safety and efficacy of hyaluronic acid for lip enhancement.This pilot study was the basis on which Restylane® gained FDA approval for lip augmentation. One must remember in the aging face one must pay attention to lip enhancement but also one must be able to restore the support provided to the lower third of the face by dentition and bone structure. These are all features dependent not only on injection of the lips themselves but also on volumetric restoration of the lower third of the face.
Although dermatologic and aesthetic journals deal with substances for implantation, these journals do not, in themselves, hold information regarding distance of the lips from the chin and other architectural features of lip enhancement.The answer to this can be ccfound in the dental literature, in which many articles have addressed the proper height, size, and location of the lips as produced by dental restoration? Hyaluronic acid is a gel-like substance that occurs naturally in soft connective tissue, cartilage, joint fluid and in skin tissue. Because of this, allergies to it are extremely rare and hyaluronic acid products are materials often used for soft tissue augmentation. Unlike collagen, hyaluronic acid is identical across all species and is produced by many types of cells.
Dr. Klein?s pivotal study was a, prospective, open-label, -blinded, single-center pilot study. Hyaluronic acid was administered at the initial treatment session, with efficacy assessments conducted on day 3, through week 24.Subjects were healthy adults ages 18-75, who desired to seek lip augmentation and avoid any other facial plastic surgical or cosmetic procedure for the first 12 weeks of the study. The objectives of the study were multifold. First, the study was to determine whether hyaluronic acid was effective in lip augmentation and restoration of the lower 1/3 of the face and determine how satisfied the subjects were with the procedure. Another objective was to develop the best injection technique, which would avoid problems, yet produce superb long lasting cosmetic results. Furthermore, whether or not hyaluronic acid lip augmentation could be readily detected in the lip by the casual observer as well as incidence, duration and severity of all systemic and local adverse reactions were important goals of the study;
There were a total of 20 subjects enrolled in the study. The subjects were treated, and given a diary in which to record any local (i.e. injection site) or systemic adverse reactions for the first two weeks. They were then asked to return for a follow-up visit on the third day for a review and to see if the hyaluronic acid could be detected by both subject and blinded investigator. The subjects used a GAIS (Global Aesthetic Improvement Scale) rating system (improved, same, worse) to rate their satisfaction at each follow-up visit. Overall, all subjects were satisfied with their lip improvement. All indicated improvement in the appearance of their lips through week 12, while 74% maintained an improved appearance through week 24. Similarly, 100% of investigator assessments reported improvement through week 12, while 84% indicated maintained improvement through week 24.. This study should come as welcome news to both physicians and consumers alike. With so many variable procedures for lip augmentation having unknown results and possible adverse side effects, the use of an agent that causes little or no allergic reactions - as well as is a more natural ingredient to be used in injectables - should help to reduce the number of women who suffer the unfortunate consequences of unfounded or untested procedures for lip augmentation.
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