FULL-FACE REJUVENATION

Nurse prescriber Rachel Goddard discusses her tips for facial restoration using the Teosyal® range of dermal fillers

Figure 1 55-year-old patient before and after full face rejuvenation using Teosyal® Ultra Deep and Teosyal RHA4® from Neauvia.

ASSESSMENT, AGEING AND ANATOMY

This 55-year-old female presented to my clinic as she wanted to improve her facial sagging, jowling and wrinkling around the chin. She had no significant medical history and was last treated with dermal filler by myself in 2020.

When carrying out an assessment for all my patients, I use a 4D approach, which means looking at the patient when they’re being expressive and observing the dynamics of the face. This patient had a loss of jawline definition, weakening of the chin, volume loss in the cheeks and atrophy from deep medial cheek pads. She also had indications of atrophy of the superficial fat in her mental and mandibular areas and just a general redistribution of the downward shift of the superficial fat pads. I noted that she had quite a wide chin, so I knew I needed to be wary of this during treatment so as not to masculinise her.

TECHNIQUE AND PRODUCT SELECTION

Before performing a dermal filler treatment, I always recommend using good skincare products to optimise the results. For this patient, I suggested she use the Teoxane AHA Cleansing Gel, RHA® Serum and Advanced Perfecting Shield SPF 30 in the morning, and Micellar Solution Cleanser and Advanced Filler Normal to Combination moisturiser in the evening.

When it came to injecting, I used the ATP approach from Teoxane – looking at the assessment, technique, and product. We know that facial ageing involves every single layer and it’s the knowledge of the changes that take place at those levels which guides us on what product to use. For this patient, I chose Teosyal® Ultra Deep and Teosyal RHA®. I started by treating the mid-face, using Ultra Deep along the zygoma through three separate injection points on each side, injecting 0.1ml per point. I chose this product to give deep fat pad support, and it has a very high cohesivity with excellent lift and projection capabilities. I used a needle for this area because I find it can help make the injections very precise, and I also find I use less product than I do with a cannula.

I then put 0.2ml in the periosteum in the anterior medial cheek to give support and help to shorten the tear trough. Then I moved onto RHA®4 and used a cannula to inject 0.4ml on each side along the lateral lower cheek to give further dynamic volumisation and create lift, as well as for contouring and slimming. I used a cannula here for safety reasons. Then I moved onto the chin using RHA®4 to treat the mental crease, again with a cannula. I did a little bit of subcision here with the cannula to create more space and then I injected 0.3ml. This helped with myomodulation and meant we didn’t need to use toxin to correct her overactive mentalis muscle.

Next, I switched back to Ultra Deep to inject 0.2ml into the chin apex to feminise and round the chin. Then I used RHA®4, injecting 0.3ml into the soft tissue using a cannula to provide support and improve the quality of the skin. Next, I injected Ultra Deep with needle onto periosteum to treat the pre-jowl sulcus, using 0.15ml per side.

Finally, we moved to the jawline. If you go along the body of the mandible you can masculinise, so instead I injected 0.2ml into the angle of the mandible using Ultra Deep, creating a good lift. I made sure I was on periosteum, but I just moved a couple of centimetres above the actual angle. I then finished off the treatment by injecting 0.2ml of RH4 back into the entry point of the mandible using a cannula, into the periocular to lift the jawline.

Overall, I used just under four syringes of dermal filler, and the treatment took around 45 minutes. We achieved beautiful results immediately, and the patient was delighted. She said she felt more confident, and at seven days post-treatment she said she felt more radiant and that all her concerns had been alleviated.