Objectives: The lecture will focus on the following
*Volumetric rejuvenation
*Aging changes
*Facial fat compartments
*Patient assessment
*Depth of injection
*Needles versus cannulas
*Injection Techniques
*Point lifts
*Deep lateral malar restoration
*Deep malar medial zone
*Safety concerns while injecting
Introduction: The aetiology of age-related facial changes has many layers. Multiple theories have been presented over the past 50–100 years with an evolution of understanding regarding facial changes related to skin, soft tissue, muscle, and bone. Original theories behind facial aging have focused on soft-tissue laxity, ptosis, and descent of the envelope over time on account of gravity. Gonzalez-Ulloa and Flores presented their theory on facial aging and “senility of the face” almost 50 years ago. They first described facial aging in relation to changes of the skin, descent of the soft tissues, attrition
Materials / method: Pessa and Rohrich have spent 3 decades in evaluating and studying the anatomical facial changes that occur in the facial skeleton and overlying soft tissues over time.
Original theories behind facial aging have focused on soft-tissue laxity, ptosis, and descent of the envelope over time on account of gravity. Depletion in fat compartments, resorption of bone, and loss of skin elasticity as well as thickness define age-related changes, which along with the loss of muscle tone leads to sagging
Results: Two main schools of thought characterize the soft-tissue changes observed in midfacial aging. The gravitational theory is cantered on changes in the ligamentous system of the cheek. The volumetric theory is based on the fat compartments of the face. The gravitational theory of midfacial aging proposes that vertical descent of facial soft tissue secondary to ligamentous attenuation contributes to the deep creases of the aging face.
Conclusion: In 2007, Lambros popularized the volumetric theory among plastic surgeons. In his analysis of 130 subjects, each photographed at 2 separate points in time ranging 10–56 years apart, Lambros noted that the lid-cheek junction remained stable within subjects. Furthermore, skin landmarks such as moles and wrinkles in the orbital and upper midface areas did not descend with time. Lambros reiterated Donofrio’s proposition that the changing morphology of the midface may not be completely due to gravitational soft tissue descent, but also due to the relative deflation of certain fat pads.
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