Lip augmentation and correction of nasolabial folds with hyaluronic acid

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• Contour plastic surgery of nasolabial folds

The appearance of such a pronounced marker of age as nasolabial folds is a great disappointment not only for women, but also for men who care about their appearance. A face with pronounced vertical facial wrinkles between the wings of the nose and the corners of the mouth looks tired and sad. To fill these skin creases with fillers, contour plastic surgery of the nasolabial folds is performed.

Contour plastic surgery of nasolabial folds: indications

Like any other types of beauty injections, nasolabial contouring has no medical indications. This procedure is performed solely at the request of the patient to correct age-related facial skin defects.

Injection correction of nasolabial folds is recommended when the first signs of their deepening in the nasolabial triangle appear, the appearance of facial wrinkles and the skin losing its elasticity.

Contour plastic surgery of nasolabial folds can be performed on patients of any age, but most often this procedure is in demand among women and men after 30-35 years.

What problems does contour plastic solve?

1. Filling nasolabial folds
2. Filling of labiomental folds
3. Raising the corners of the mouth
4. Lip augmentation
5. Enlargement of cheekbones
6. Filling fine wrinkles on the forehead and bridge of the nose
7. Filling fine lines around the eyes
8. Filling the lacrimal and nasal grooves
9. Non-surgical blepharoplasty, correction of dark circles under the eyes
10. Nose shape correction
11. Cheek augmentation
12. Filling ring-shaped wrinkles on the neck and décolleté
13. Eyebrow lifting
14. Filling purse-string wrinkles around the lips
15. Filling wrinkles on cheeks
16. Treatment of stretch marks and atrophic scars

Below are some results from our patients:

Contour plastic surgery of nasolabial folds: goals of the procedure

Fillers intended for contouring contain hyaluronic acid, a substance whose characteristics are similar to the tissues of the human body, so its rejection is excluded. Thanks to the action of hyaluronic acid, skin cells are saturated with moisture, the synthesis of elastin and collagen is stimulated. These processes ensure the hydration and elasticity of the facial skin - they acquire a fresh, healthy appearance. At the site of filler injection, the skin texture is leveled, wrinkles are filled, which significantly rejuvenates the overall appearance of the face.

Injection correction is absolutely safe, does not cause allergic reactions and is easily tolerated by patients.

Lips

1. Lip rejuvenation without changing shape and volume - carried out using hyaluronic acid injections . The effect is the elimination of fine wrinkles, improved lip color, lips are always moisturized. The duration of the effect is up to 4 months.

2. Changing the shape and volume of the lips. It is carried out using high-density hyaluronic acid injections . You can change the shape itself, raise the corners of your lips. The effect lasts up to 4-5 months.

3. The corners of the lips can also be raised using the injection muscle relaxation procedure.

Contour plastic surgery of nasolabial folds: contraindications

The list of contraindications for injection correction of nasolabial folds is standard and minimal. The procedure cannot be performed if the patient has the following pathologies:

• active inflammatory processes in the affected area;
• allergic reactions to filler components;
• chronic diseases in the acute stage;
• skin diseases in the area of ​​proposed injections;
• malignant neoplasms of any location;
• hemocoagulation disorders;
• autoimmune diseases.

In addition to the above conditions, contraindications to contour plastic surgery are: pregnancy, breastfeeding, menstruation and elevated body temperature due to influenza and viral diseases.

Correction of nasolabial folds: procedure progress

Before directly starting to inject filler into the nasolabial folds, it is important to decide on the correct treatment strategy, because in this case there are 2 options for correction. The first option is that the filler is injected directly into the area of ​​the nasolabial folds, using one of the injection techniques or a combination of them. The second option is that filler can be injected into the cheekbone area, which will increase their volume and tighten the skin + straighten the nasolabial folds.

In patients with pronounced cheekbones and round cheeks, it is best to actually correct the nasolabial folds themselves, however, in patients with thin cheeks and a small amount of soft tissue, it is better to inject filler into the cheekbone area, because this will give the best aesthetic result. Or a combined correction option is possible, when filler is injected into both the cheekbones and nasolabial folds (the choice of correction option will depend on the severity of the result you expect to see and your budget).

Above, we allowed ourselves to say that this is a fairly simple technique even for novice cosmetologists. This is true if we consider the complexity of correcting nasolabial folds with the correction of other areas of the face. But this relatively simple technique also has subtle points, some of which can make the procedure more effective, while others can lead to complications. Particular attention here should be paid to the upper third of the nasolabial fold, where the angular branch of the facial artery passes, and it is very important not to damage it and avoid embolism (24stoma.ru).

Contraindications to the procedure –

We should not immediately start injecting fillers into the nasolabial folds. At the first stage of communication with the patient, we must assess the medical history and the presence of contraindications to the procedure, after which the patient must fill out an informed consent form for filler injections. There are a number of contraindications for the use of fillers based on hyaluronic acid (including for the correction of nasolabial folds) -

• pregnancy and lactation,
• oncology (even if clinical recovery is achieved - at least 5 years must pass from this moment + permission from the oncologist has been obtained, since there is evidence that injections of hyaluronic acid can contribute to relapse),
• against the background of acute infectious diseases,
• inflammatory processes in the area of ​​intervention,
• autoimmune diseases,
• tendency to form keloid scars,
• if the patient was previously injected with semi-permanent and permanent fillers in this area, or fillers of unknown origin.

In addition, if you have a pathology of the thyroid gland, then this can also be regarded as a relative contraindication. Against the background of this pathology, the destruction of fillers in tissues occurs much faster compared to ordinary patients, and therefore the duration of the effect can be several times shorter. The risk group also includes patients who often use corticosteroid ointments on the skin of the face (they develop granulomas much more often), people who abuse tanning, as well as patients with diabetes.

Choosing a filler for the procedure –

To correct nasolabial folds, denser fillers are used than, for example, to correct superficial wrinkles or to increase lip volume. The final choice will depend on the severity of the nasolabial folds: the deeper they are, the denser the filler with hyaluronic acid should be used. For example, for moderate folds you can use fillers Juvederm Ultra 3, Juvederm Volift, Restylane, Belotero Balance.

For deep folds – Juvederm Ultra 4, Restylane-Perline, Belotero Intense. All of the fillers listed above have FDA recommendations for the correction of nasolabial folds (with the exception of Juvederm Volift, as it is a recently introduced drug). There are a number of cheaper fillers - such as Princess Volume, Hyalax Base and others - that can also be used. However, these fillers are less flexible and behave worse in mobile areas; when used, gel displacement may occur more often.

As for the required volume of filler, usually 1.0 ml of filler is enough to correct moderately severe nasolabial folds (0.5 ml on each side). It is best to choose fillers without lidocaine for correction, because... the latter can lead to temporary whitening of the tissue at the injection site (especially with superficial injection), simulating ischemia, which is a symptom of vascular complications of the injection and requires urgent cessation of the procedure.

However, not only HA-based fillers, but also semi-permanent/permanent fillers can be used to correct nasolabial folds. Their undoubted advantage is their longer-lasting effect, but at the same time, the number of complications after their use reaches, according to various authors, even about 40-50%. Therefore, we still recommend using safer bioresorbable fillers based on hyaluronic acid.

Anesthesia –

If a 13 mm needle is used to correct nasolabial folds, then anesthesia is carried out using a cream or gel containing the anesthetic Lidocaine (the concentration of which in products of different brands varies from approximately 5 to 12%).
The cream is applied to the surface of the skin at the site of intended injection for about 20-25 minutes, after which it is washed off, and the skin is treated several times with antiseptic solutions. If the cannula technique is used, the injection site is numbed with an injection of local anesthetic. This again can be either Lidocaine, or Ultracaine, or some other anesthetics without or with a small content of vasoconstrictor components. Below we will look at the techniques of working with a needle and cannula separately.

Injection techniques (needle) –

In order to remove nasolabial folds, the linear-retrograde technique and its variations are used. For injections, a 13 mm long needle or a long flexible cannula can be used. The use of a needle implies that after injection, the needle moves parallel to the skin in the middle or deep layers of the dermis to the end to its entire length, and the material is removed with a retrograde movement of the needle back. We consider correction of nasolabial folds with a needle to be preferable, because... this anatomical area is relatively safe, and the needle is much easier to control in the tissue.

a) The first version of the classical linear technique implies that the filler is removed along the nasolabial fold, i.e. along it. To do this, needle injections are made at certain intervals of 13 mm to go through the entire length of the nasolabial fold (just short of reaching the wing of the nose, as well as the corner of the mouth). The first injection is made 13 mm from the wing of the nose, and at this moment it is very important to do an aspiration test. Injecting the needle to its full length each subsequent time, we should not immediately begin to remove the material, but first carry out a small separation of the tissues with characteristic movements of the needle (this is necessary for good distribution of the material).

Linear technique for correcting nasolabial folds: video

A complicated version of this technique is a fan technique (Fig. 3), when from one injection point not one linear pass is made with a needle with the material being removed while the needle moves retrogradely backwards, but several passes are made without completely removing the needle from the skin, each time changing its direction . Moreover, each time, remember to separate the tissue a little with a needle before removing the material. Do not forget about the aspiration test to prevent embolism of the angular branch of the facial artery, which runs near the wing of the nose.

b) The second option is to use a linear-retrograde technique in such a way that the material is removed perpendicular to the direction of the nasolabial fold in tracks of 10-12 mm (Fig. 5). First, we stretch the skin with our hands to completely smooth out the nasolabial fold. Next, we make sequential injections, moving in the direction from the wing of the nose to the corner of the mouth, perpendicular to the direction of the nasolabial fold. The material is removed by retrograde movement of the needle; each needle injection takes approximately 0.03 ml of filler, the distance between injections is 1.0-1.5 mm. In total, each nasolabial fold usually requires about 15-20 needle passes.

Important: there are a number of clinical studies comparing the effectiveness and duration of the results of the two above techniques. Moreover, for clarity, in the same patients, the correction was carried out as follows: the nasolabial fold on the left was filled with a linear technique along the direction of the fold, and on the right side, a linear technique with a perpendicular direction of injections was used. Below you can see the results of these techniques in before and after photos of patients (Fig. 5-6). Photos of patients are taken from a clinical study, which can be viewed here.

Please note that the appearance of those nasolabial folds (see Fig. 5-6, after 4 weeks), the correction of which was performed perpendicular to the direction of the fold with injections, is somewhat better than where the classic linear injection technique was used in the direction of the folds. However, the advantages of both techniques can be used simultaneously by using a third correction option.

c) The third option is a combination of the first two techniques. This option first involves a linear passage with a 13 mm needle along the entire length of the nasolabial fold (do not forget about separating the tissues before removing the material), after which we pass perpendicularly several times, leaving the so-called “stiffening ribs” at a distance of 5 mm from each other. Do not forget about the depth of needle insertion, so if the material is removed too superficially, both contouring of the material and its translucency through the skin are possible (Tyndall effect).

Injection techniques (cannula) –

To remove filler into tissue, not only 13 mm long needles can be used, but also long cannulas (have a blunt end). This method has the following advantages: firstly, there is only one injection point on each side, and secondly, there is less risk of damage and embolism to blood vessels. The insertion point for the cannula is near the corner of the mouth. The injection site must be numbed with an injection of local anesthetic.

Next, using a needle, we create a puncture in the skin and the direction of insertion of the cannula, and only after that we insert the cannula into the tissue, moving it to the base of the nasolabial fold at the wing of the nose. Before removing the material, it is advisable to separate the tissues by moving the tip of the cannula. Next, we make several passes (fan technique), removing the material with a retrograde movement of the cannula back. A digital passage of the excretion area is required.

Correction of nasolabial folds with cannulas: video

How is contouring of nasolabial folds performed?

The choice of filler suitable for solving the patient’s problem is made by a cosmetologist.

Before the procedure, the doctor conducts a consultation and explains all the nuances of the procedure. Then he removes make-up from the patient’s face.

In the area of ​​injection, the cosmetologist applies markings with a marker and disinfects the skin.

An anesthetic drug is first applied to the area of ​​the face where injections are intended.

The main stage of contouring is the targeted injection of filler into problem areas. Upon completion of the procedure, the skin is treated with disinfectants.

The duration of the procedure is 30-60 minutes.

Complex cases of correction –

In some cases, the volume of overhanging tissue in the cheek area is so large that correction may require a whole bucket of fillers. We have already said above that this happens in two groups of patients, and in particular in the presence of pronounced “fat bags” in the cheek area. In this case, it is optimal to achieve a reduction in adipose tissue using lipolytic injections (approved for use on the face) + plus the parallel use of vascular drainage drugs.

The second group of patients are patients with deformational (edematous) type of aging. Such patients usually always have problems with the spine in the cervical-collar area, and due to prolonged spasm of the muscles in this area, the venous outflow in the soft tissues of the face and neck is disrupted. As a result, microcirculation and lymphatic drainage are disrupted, which lead to the development of interstitial edema, primarily of subcutaneous fat. As a result, the volume and mass of tissue increases, which leads to gravitational ptosis, including in the area of ​​the nasolabial folds.

What to do in this case. In order to fully solve the problem, you need to normalize venous outflow, microcirculation and lymphatic drainage. This is done by conducting a course of capillary mesotherapy/lymphatic drainage vascular injection, which will remove interstitial edema, thereby reducing the volume of soft tissues of the face (including the severity of nasolabial folds). And only after this should the question of the need for further correction of nasolabial folds with fillers be resolved.

But you must understand that only the use of capillary mesotherapy in patients with the edematous type of aging (without correction of problems in the cervical-collar area) will only give a temporary effect. Treatment should include not only periodic courses of therapeutic massage and acupuncture, but even, for example, the correct choice of office chair if you have a sedentary job, is critically important. You can’t even imagine how quickly the wrong chair can lead to problems with the spine, and, as you now understand, even aggravate the aging of the face.

Effect and rehabilitation after contour plastic surgery of nasolabial folds

Contour correction of nasolabial folds is characterized by an immediate effect. The severity of nasolabial folds becomes less noticeable. The skin of the face is refreshed and acquires a healthy tone. The effect of the procedure lasts for almost a year, after which contour plastic surgery can be repeated.

In order for the results of the procedure to last as long as possible, the cosmetologist gives the following recommendations:

• After the procedure, self-massage of the treated area should be avoided;
• do not use decorative cosmetics for a day after correction;
• for two weeks after contouring, avoid warming procedures - baths, saunas, electrical procedures;
• during the summer months, do not stay in direct sunlight without first treating your facial skin with sunscreen;
• If hematomas appear, apply Arnica and Traumeel S to the skin.

By following the above rules and careful care, you can significantly increase the durability of the results of contour plastic surgery of the nasolabial folds.

How is the procedure performed?

Correction of nasolabial folds with fillers is carried out in a cosmetology office under completely sterile conditions. After superficial cleansing and moisturizing the skin, the specialist applies an anesthetic cream to the working area, which ensures comfort during the procedure. The cream is safe, its active action is manifested upon penetration into the skin, providing a barely noticeable cooling sensation with an analgesic effect.

The doctor injects filler into the nasolabial fold so that it evenly lifts the skin in the required places, providing a clear contour with the correct shape. The characteristics of the patient’s skin must be taken into account in order to minimize harm, including calculations for the rehabilitation period. Special thin-diameter needles are used, which minimizes microtrauma to the skin.

In the first 2-3 days after correction of the nasolabial fold, slight swelling may occur. During this period, the use of cosmetics is not recommended, you should refrain from massaging the area, and you should not show excessive facial expressions. It is necessary to exclude overheating (hot shower, bath, bathhouse, sauna), taking anticoagulants, and serious physical activity. You should avoid solariums or sunbathing on the beach for about 2-3 weeks. After the procedure, the doctor will give detailed recommendations based on the specific situation.

Contour plastic surgery of nasolabial folds: prices at the Sharm Gold clinic

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Prices for services

Patient N., 30 years old, complained of deep folds in the nasolabial area. In our clinic, correction was carried out using hyaluronic acid.

Before the procedure 2 weeks after the procedure

The most frequently asked questions about contouring of nasolabial folds

No special preparation is required for the procedure. It is enough for the patient to stop drinking alcohol and taking medications with a blood-thinning effect 2-3 days before the procedure.

When choosing a filler, the cosmetologist takes into account the severity of the nasolabial folds, the condition of the epidermis at the site of the intended injections, as well as the desired duration of action of the filler.

This procedure can be performed on patients who have reached the age of majority. However, most often it is in demand among men and women after 35-40 years, when the skin loses its elasticity and presents its “surprises” in the form of unaesthetic folds on the face.

The price of the procedure depends on many factors. But, first of all, it depends on the cost of the filler for injection into the problem area.

The Sharm Gold clinic is one of the leading clinics in the field of plastic surgery and aesthetic medicine in Moscow. The cost of contour plastic surgery of nasolabial folds in the clinic is approximately from 9,800 to 20,000 rubles.

Injection correction of nasolabial folds does not involve long-term rehabilitation, as it is a minimally invasive intervention. However, it will be possible to evaluate the result obtained only after a few days, after the swelling has subsided and the hematomas have disappeared.

Side effects of contouring

Side effects when filling wrinkles are quite rare and can be easily corrected. As a rule, they are associated with an incorrectly selected drug, violation of the technique and depth of administration, and excessive administration of the gel. The manifestation of undesirable reactions will be contouring or clumping of the drug, determining it by touch. If the procedure is carried out correctly, you should not feel the presence of the drug in the skin. In such cases, you should contact a specialist to correct the result. If necessary, rapid resorption of the gel without visible manifestations is possible with a single injection of a resorbable drug.

How does injection contouring work?

The filler is injected under the skin using a syringe or cannula. The active substances of the drug begin to act immediately.

Facial contouring with fillers allows you to tighten the oval of the face, remove nasolabial folds, smooth out marionette lines and purse-string wrinkles, lift the corners of the lips and correct a “weak” chin, correct the lips and nose, “raise” the cheekbones, etc.

1 Chin correction

2 Increase in lip volume

3 Getting rid of nasolabial folds

If we talk about body correction, plastic surgery with fillers is successfully used to enlarge and correct the contours of the breasts, add fullness and roundness to the buttocks, and improve the shape of the legs.

Intimate contouring is used to solve both medical problems (muscle weakness, decreased libido, lack of sensitivity or pain during sexual intercourse) and aesthetic problems (shape correction, tissue rejuvenation, work with scars, etc.).

Advantages of the drugs used

If previously synthetic substances, such as silicone, were used for such procedures, today all fillers used are natural and absolutely safe. Unlike previous options, they are able to be eliminated from the body naturally. This means that no additional surgical interventions will be required. The risk of any complications is also minimal.

Other advantages of fillers include:

• their introduction does not cause discomfort;
• reduced risk of allergic reactions;
• due to their composition, they have an additional rejuvenating effect on the skin.

To select the appropriate drug, you must contact our Clinic in advance and undergo a consultation with a specialist. During the conversation, he will be able to collect anamnesis, and the patient will ask all the questions that interest him. As a result, the doctor will select the most effective and safe drug, taking into account the individual characteristics of the patient.

Recovery after the procedure

In the first 24 hours after filler injection, certain recommendations are followed. During this period you will need:

• exclude the use of any cosmetics;
• avoid active facial expressions;
• Avoid rubbing your face.

For several days you should avoid exposure to ultraviolet rays and playing sports. It is necessary to temporarily postpone other cosmetic procedures. Non-steroidal anti-inflammatory drugs should not be taken for two weeks.