A multidisciplinary approach to aesthetic enhancement

Dr Bryony Elder, Kirsty Devine, and Stephanie Winter describe a protocol that addresses immediate and long term aesthetic goals

Skin specialist Stephanie Winter’s journey towards her desired aesthetic transformation is not merely a story of cosmetic procedures; it’s a testament to the power of multidisciplinary treatments and the patience required for comprehensive changes to manifest across one’s appearance. From her initial concerns about sagging skin, jowls, and deep nasolabial folds to her eventual radiant glow and refined features, Winter’s path underscores the importance of a holistic approach to aesthetics.

Her journey began in October 2022, when she first sought assistance at Ametrine Aesthetics. Her primary concerns were sagging skin, jowls, dullness, deep nasolabial folds, and excess volume in the submental region. A previous aesthetic history revealed sporadic neuromodulation and deoxycholic acid treatment. After utilising a facial assessment scale, it was determined that a multifaceted approach was required to treat skin, lacking radiance and glow, skin sagging, volume loss and expressionate lines and wrinkles. A staged treatment plan implemented for Winter was crafted to address each concern comprehensively, considering both immediate and long-term goals.

The initial phase involved precise bolus injections of Restylane Lyft, strategically placed in the anteromedial cheek, zygomatic projection and pyriform fossa, and a cannula techique for the prejowl sulcus. This approach restored lost volume and provided subtle lifting effects, laying the foundation for subsequent enhancements.

Before

After

Recognising the importance of skincare in maintaining and enhancing results, Winter underwent a significant change in her skincare routine. Incorporating retinol, trichloroacetic acid peels, active ingredients, and hydration protocols was crucial in improving skin texture and tone and reducing pigmentation. This shift towards a more comprehensive skincare regimen complemented her aesthetic treatments and promoted long-term skin vitality.

As Winter progressed, additional interventions were introduced to refine and enhance her facial features.

ADDITIONAL INTERVENTIONS

In 2023, we planned and treated with non-surgical rhinoplasty to address nasal asymmetry and dorsal irregularities, achieving nasal contours using a cannula and Restylane Lyft. Alayering technique was employed in cheek augmentation using Restylane Volyme in the superficial medial cheek fat pad and zygomatic arch enhancement with Restylane Defyne, enhancing facial volume and definition.

This particular technique was integral to the understanding of the physiology of ageing. Winter had already undergone deep bolus treatment of the mid and lateral cheek, which restored the deep fat pad, which had depleted and undergone atrophy over time. In addition to the more profound tissue change, the superficial fat pads had undergone a more noticeable change; the nasolabial fat pad had dropped forward, losing volume superiorly and splitting from the medial cheek; this, in addition to the medial cheek fat pad also undergoing atrophy created the nasojugal groove which can often be seen as a continuation from the medial tear trough. The general loss of volume in the anteromedial cheek occured in the deep and superficial fat pads; the collapse of the nasolabial fat pad made the nasolabial fold appear more profound and more shadowed. Therefore, restoring the deep tissues with bolus deposition of a high g prime and projecting dermal filler aimed to provide the ‘scaffolding’ to the midface. In combination with a more flexible, dynamic filler that can be found within the OBT range at Galderma, this allowed us to create natural and long-lasting results by focusing on the anatomy and understanding the underlying tissues in both a static and dynamic state.

Further enhancements included chin augmentation with Restylane Lyft for projection and apexification to define the contours of her jaw and mask the additional volume in her submental region. Restylane Lyft was placed on the mandibular rim in the menton and supplemented by an additional bolus of Restylane Lyft in the pogonion to create the forward projection. This not only rebalanced the proportions of the face, both AP and front-on, but also acted as a retainer of the skin, which had begun to sag and droop anterior to the jowl. Restylane Kysse was used with cannula in the pre-jowl sulcus to blend the border from the jowl to the newly augmented chin. The reasoning for Restylane Kysse was that the dermal filler is very flexible; however, it can create volume and is perfect in the region of the lower face, especially the region of the orbicularis oris.

Tear trough augmentation was conducted with Restylane Eyelight. Winter was categorised as Hermand’s class two tear trough. Therefore, the medial tear trough was treated with a cannula and micro boli of 0.03ml in the lateral tear trough, deep down to the orbital rim.

We lifted Winter’s brows by utilising neurotoxin treatment. We used Alluzience in the glabella and frontalis regions, accompanied by a lateral brow lift. On the frontalis, it was decided to allow maintenance of the lateral brow by injecting 1cm above the central area of contraction on the lateral brow. The chemical brow lift was opted to release the depressor activity of the superior orbicularis oculi. Alluzience in the medial portions of the frontalis allowed for preservation of the lateral fibres to assist with the effect of the chemical brow lift.

These interventions targeted specific concerns and synergistically contributed to overall facial balance and the appearance of being ‘awake’.

Before

After

FINAL TOUCH

The final touch in Winter’s transformation journey was lip enhancement performed by Kirsty Devine. She used Restylane Kysse to achieve natural-looking, voluminous lips that complemented her facial features. Devine performed a combination treatment of medial lip fanning and tenting, combined with micro-boli in the medial tubercles of the upper lip and fanning in the lower lip, to create shape and definition to complement her chin augmentation.

The journey of treatments exemplifies the collaborative efforts of various specialists, each contributing their speciality to achieve a unified, natural, and dramatic aesthetic outcome.

Winter’s journey reminds us that aesthetic transformations are not instantaneous, but a gradual process that unfolds over time. It underscores the importance of patience, persistence, and trust in realising aesthetic goals. By embracing a multidisciplinary approach and prioritising personalised care, individuals like Winter can embark on a transformative journey that transcends mere aesthetics, empowering them to exude confidence from within.