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Smoothing Lines & Wrinkles

“Our clinic’s work reflects the rigorous German ethic – honest and high quality with creative attention to detail and an emphasis on safety. Realistic and never overdone.”

Dr Stefanie, MD, Dermatologist®

smoothing-lines-and-wrinklesOne of the three key areas of non-invasive Aesthetic Dermatology is smoothing facial lines and wrinkles. There are three different types of facial wrinkles which each largely determine the kind of treatment.

Firstly, ‘dynamic lines’ (or ‘mimic lines’) are caused by the contraction of underlying muscles. They include ‘frown lines’ (glabella lines) between the eyebrows, ‘worry lines’ on the forehead, ‘bunny lines’ on the nose and ‘crow’s feet’ at the outer eye corners.

The second group, ‘static lines’, are independent of muscular movement. They can develop on their own (‘primary static lines’) or from long-established dynamic lines (‘secondary static lines’).

Lastly, gravitational folds are usually deeper furrows resulting from a combination of loss of volume and gravitation. A prime example of these are nasolabial folds running from your nose to the corners of your mouth. What happens is that as we get older, our faces tend to lose fat and first to go are the fat pads in our cheeks. This loss of volume leads to an envelope of loose skin which gravitation pulls downwards – hence the folds.

smoothing-lines-and-wrinkles2Botulinum toxin (often referred to as ‘Botox’ after its first brand name) is a substance that, when injected into a muscle, will temporarily stop it contracting. This is why botulinum toxin is an excellent treatment for dynamic facial lines. It has been used in cosmetic treatments for more than 25 years now and in the right hands is a safe and highly effective non-surgical solution for certain types of wrinkles. The great thing about cosmetic botulinum toxin is that it works at the root cause of dynamic lines by preventing the muscle from doing the very movement that’s causing the problem. For this reason, botulinum toxin also plays a useful wrinkle-prevention role in people who tend to over-use certain facial muscles.

It takes on average about five days for botulinum toxin to start kicking in. The effect on the muscle is fully reversible and lasts about three to six months and patients usually come for top-ups two to four times per year. However, many patients report that in time the intervals between clinic visits get longer, as the muscles seem to ‘learn’ not to do the wrinkle-causing movement so much. We are essentially re-training your muscles.

Ideal lines for botulinum toxin treatment include ‘crow’s feet’, ‘frown lines’ between the brows and ‘worry lines’ across the forehead. We can also perform a gentle, non-surgical brow lift with botulinum toxin and soften the downward pull of the corners of your mouth, so you lose that grumpy look.

It’s important to know that for botulinum toxin to be optimally effective, you should start treatment when the line is still ‘dynamic’ and not yet ‘static’. You can test this in the mirror by stretching the wrinkle between two fingers. If it disappears completely, it’s still ‘dynamic’ and easily treated. But if stretching the skin only softens the line, then it’s starting become ‘static’ and additional treatment may be needed. In these cases we can offer a filler or HA Skin Boosters as a follow-up treatment two weeks after botulinum toxin.

In our clinic we use both traditional Botox® (which is also marketed as Vistabel® for cosmetic purposes) and a new generation botulinum toxin, called Bocouture® (which is the same as Xeomin®). This a purified form of botulinum toxin, developed in Germany.

Usually injections with botulinum toxin only cause very mild discomfort and an anaesthetic cream isn’t routinely needed – unless you really would prefer one. But rest assured, our Doctors have a gentle injection technique to maximise your comfort.

smoothing-lines-and-wrinkles3Dermal fillers are the main solutions we use for ‘static lines’ and ‘gravitational folds’. They are injected directly beneath a line or fold to fill the depression it makes in the skin. There are countless fillers on the market and new ones are constantly being released. That’s why it’s so important to know which ones have the best safety records and give the best results.

Think of fillers as belonging roughly to either ‘permanent’ or ‘temporary’ groups. Temporary fillers are preferable for several reasons. Firstly, our face changes with time and aesthetic treatments must be adjusted to keep pace with these changes. A permanent filler couldn’t allow for this adjustment – you’d be stuck with it forever, like it or not! And while you may have been pleased with the initial result, it might look unnatural or out of place years down the line as your face ages further. The other reason is that various scientific studies have shown that permanent fillers are associated with a higher risk of unwanted side effects and problems.

For all these reasons, we only use gold standard non-permanent fillers containing hyaluronic acid. Hyaluronic acid fillers include Restylane, Belotero, Voluma and Juvederm.

Hyaluronic acid (HA), also known as Hyaluronate, is an important physiological substance that all skin contains naturally. Its key roles are to maintain the plumpness and moisture that help keep the skin surface smooth and lifted. However HA levels decline with age. We inject fillers containing sterile, transparent hyaluronic acid gel, which are degraded over time by your body’s natural enzymes, just as happens with your natural hyaluronic acid. An extra advantage is that there is an ‘antidote’ for hyaluronic acid fillers – an enzyme called hyaluronidase. So if for some reason you would like us to dissolve your filler, we can do that easily – not something you can say for other fillers.

Fillers can be used for all sorts of lines and wrinkles, from deep nose-to-mouth lines to superficial ‘lipstick bleed’ lines around the mouth. The effect is instantly visible, although there may be some temporary swelling and bruising. Occasionally we might need more than one session to obtain an optimal outcome. How long the effects last depends on the individual patient, their lifestyle, age and the areas injected. But they usually last around six to nine months. In certain areas of the face, such as when treating crow’s feet, a filler will last longer in combination with botulinum toxin (‘Botox’).

You’ll also be pleased to hear that we offer several forms of effective pain prevention. Most of the fillers we use already contain a local anaesthetic, so often no extra is needed. We also often use a very special ‘magic’ needle (blunt cannula), which is non-traumatic and slightly flexible, and tends to cause less discomfort and bruising than traditional sharp, rigid needles.

In most cases however, we apply an effective numbing cream (or very occasionally a dental block). Our high-grade numbing cream is applied about an hour prior to your procedure, in order to numb the skin effectively, so make sure to ask our receptionist about a ‘numbing slot’ also! A dental block is a local anaesthetic injected inside your mouth – similar to those at the dentist’s – to completely numb certain areas of the face.

We can also address fine lines and crinkling of larger skin areas and overall loss of skin elasticity, for example on the cheeks. To do this, we perform a HA ‘Skin Booster’ treatment, ‘Medical Needling’ or a ‘GF Gel Needling Lift’. See Improving skin surface and texture for details of these procedures.

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