A case study of a woman of color in her early 70’s who was interested in non-surgical facial rejuvenation.
As do all of my patients, she wanted an improvement that was natural in appearance. She did not want to look “injected”
As we analyze her face in figure 1 we see that the eyebrow are flat with a slightly strained look and the volume loss that accompanies normal aging has led to a downturn at the corners of her mouth, some deepening of the nasolabial creases and some flattening of the cheeks.
This is easier to see in a “chin down” view in figure 2.
When we view the oblique views (figure 3 and 4) we again note a strained look with tension of the corrugator muscles between the brows ( the ones that cause the “11’s” ) and a sad look due to flattening of the eyebrows. The flattening of the cheeks and corners of the mouth are also more evident in these views.
In figure 5 I have shown the placement of 20 units of Botox to the corrugator muscles. I did not treat the upper mid forehead because in her 70’s she has some brow ptosis and if the middle forehead drops too much and the lateral brows go up too much than we can get an undesirable “Mephisto” or “demon brow” look. But treating just the corrugators relaxes the tense look and gives us just the right arching of the lateral eyebrows to remove the sad look. At the same time as the Botox was placed, I also placed some Resilient Hyaluronic Acid 3 to the corners of her mouth. The RHA collection is the newest technology in Non Animal Stabilized Hyaluronic Acid (NASHA) fillers and was brought to the US by REVANCE in November. It is made in Switzerland and has been used in Europe for the past 6 or so years. In addition to lasting as long as the Allergan Juvederm products in head to head testing, it is strong but very flexible. It is called a “dynamic” filler because it does not look stiff or “bunchy” when placed in parts of the face that move such as the cheeks or nasolabial creases, and can be placed a little more superficially than a less resilient filler. They are calling motion of the face the forth dimension- we want our patients to look good not just at rest but also as they move over animate the face. We have all seen patients with “golf ball” or “apple cheek” deformities from fillers that are distorted in the cheeks with smiling.
She came back 2 weeks later and in figure 7 I placed some of the RHA 4 to her cheeks and RHA 3 to the corrugator area and nasolabial creases.
Seen 2 weeks after this second treatment in figures 8, 9 and 10 we can see a more youthful, happier and “rested” appearance. She looks better, but without looking at her original photos you would not be sure why.
She is seen smiling before in figure 11, and after treatment in figure 12. Her face looks absolutely natural on animation. The RHA fillers are “resilient” and in addition to being flexible have incorporated well into her tissues. Doctors in Italy and England have reported that the RHA3 and RHA 4 have been lasting 22 months or more in their experiences over the past 6 years. There has also not been any reported formation of late nodules, a problem that has been seen with some other NASHA fillers.
It is wonderful to have this new “tool” in our toolkit to treat our patients.