3Lift technique for introducing fillers into the nasolabial folds and middle third of the face

Author: Kieren Bong – plastic surgeon, clinical director of the Essence Medical Cosmetic clinic in Scotland (UK)

The nasolabial folds are two longitudinal grooves that extend from the wings of the nose to the corners of the mouth. The deepening of these folds is one of the main signs of facial aging. Accordingly, reducing the severity of the “nose lips” allows you to give the face a more youthful and fresh appearance. There are many techniques aimed at correcting this type of wrinkle, each of which has its own limitations.

Anatomy of nasolabial folds and factors influencing their severity

A clear understanding of facial anatomy is a key aspect in the effectiveness of anti-age procedures, including those involving the introduction of fillers into the nasolabial folds. The nasolabial lips are located in the middle third of the face and run diagonally from the wings of the nose to the corners of the lips. They deepen when smiling as the facial muscles—the zygomatic major, zygomatic minor, and levator labii superioris—move the upper lip in a superolateral direction. When we smile, the upper lip goes under the malar fat compartments, which protrude forward.

The lateral nasal artery is located in close proximity to the nasolabial fold - 2-3 mm above the depression near the wings of the nose - and is the main source of blood supply to the tip and wings of the nose.

Nasolabial folds are absent in early childhood, but with age they become noticeable even when the face is motionless. Such changes are caused by various factors, including:

• loss of facial tissue volume;
• ptosis of the malar fat compartment;
• collagen atrophy in the dermis;
• loss of skin elasticity.

The severity of nasolabial folds also depends on the tonic activity of the facial muscles, which can be clearly seen in the example of patients with facial nerve paresis - their nasolabial folds disappear.

The severity of nasolabial folds also depends on the tonic activity of the facial muscles, which can be clearly seen in the example of patients with facial nerve paresis - their “nasolabial folds” disappear

Some of the above factors can be neutralized by injecting HA fillers into the nasolabial folds. The following issues are discussed in more detail below:

• 3Lift technique;
• patient selection;
• practical guide to filler injection;
• choice of filler and technique, restrictions after the procedure.

Technique 3 Lift : injection of fillers into the nasolabial folds and middle third of the face

One of the components of the approach to correcting nasolabial folds is the restoration of volume in the area of the fold itself or in combination with volumization of the middle third of the face. To do this, Dr. Bong uses the latest line of Teosyal RHA dermal fillers to address the problem of dermal atrophy associated with aging, which also plays a significant role in the formation of nasolabial lips. Restoring contour and volume in the middle part of the face provides a lifting effect and, accordingly, allows you to “smooth out” nasolabial folds.

The 3Lift technique uses a new line of hyaluronic acid-based dermal fillers – Teosyal RHA. The 3Lift structured approach is based on reducing the severity of nasolabial folds, and the treatment protocol is individualized for each patient and includes the use of one of the following products:

• filler RHA3 with lidocaine;
• filler RHA4 with lidocaine;
• filler PureSense Ultra Deep with lidocaine.

RHA fillers are injected medial to the nasolabial folds into the middle or deep layer of the dermis. For patient comfort, RHA fillers include an anesthetic.

RHA dermal fillers integrate well into tissues due to their unique molecular structure, which is ensured by Teoxane's patented manufacturing technology: long chains of HA molecules are retained, allowing the formation of a mobile 3D network and providing the viscoelastic properties of HA. As a result, hyaluronic acid is able to maintain tissue architecture, volume and hydration.

In practice, the unique molecular structure of RHA fillers provides excellent resistance to repeated movements of facial muscles during emotional expression. The duration of the effect of such fillers is 6–12 months, sometimes longer.

In what cases is it advisable to correct nasolabial folds with fillers?

When using RHA fillers, the following factors must be taken into account:

• patient's skin quality;
• depth of nasolabial folds;
• patient expectations;
• duration of correction results;
• possible risks and contraindications.

To assess the condition of the face, it is necessary to objectively determine the degree of loss of tissue volume in the area of the nasolabial folds and the middle part of the face as a whole, as well as their structure, symmetry and proportions.

A photo of the patient before the injection of fillers into the nasolabial folds before drawing up a treatment plan will help demonstrate to the patient the features of his face and explain the rationale of the chosen rejuvenation plan.

For the 3Lift technique, patients with mild to moderate nasolabial swelling are suitable candidates. For patients with deep nasolabial folds and a high degree of skin laxity, it is better to recommend surgical rejuvenation methods.

The goal of the 3Lift technique is to reduce the severity of nasolabial lips, not eliminate them completely.

A practical guide to the injection of fillers into the nasolabial folds and middle third of the face

The 3Lift technique uses a microcannula with a blunt tip. Features of filler injection:

• in case of a slight loss of volume in the middle third of the face and a low degree of severity of the nasolabial folds, RHA3 filler is injected into the fold itself;
• in case of a slight loss of volume in the middle third of the face and moderate severity of the nasolabial folds, RHA4 filler is injected into the nasolabial fold and the middle part of the face;
• In case of moderate loss of volume in the middle third of the face and moderate severity, Ultra Deep and RHA4 fillers are injected into the middle part of the face, and RHA3 filler into the nasolabial fold.

RHA4 filler is injected into superficial fatty compartments, and Ultra Deep filler into deep fatty compartments.

The filler injection points are determined depending on the severity of the nasolabial fold and the degree of volume loss in the middle third of the face. When choosing an injection site, it is important to consider the fact that restoring contour and volume in one area can improve the condition of the adjacent area. For example, the appearance of nasolabial folds can be reduced by injecting fillers into the jaw and zygomatic areas, especially in patients with mild to moderate volume loss and minimal or no shifting of fat compartments in the midface.

Selection of fillers and injection technique, restrictions after the procedure

The injection of fillers into deep fat compartments provides an upward lifting effect, while linear injection provides a lateral lifting effect.

• For deep fat pads, use the bolus injection technique and RHA4 or PureSense Ultra fillers.
• For superficial fat pads, use the retrograde linear injection technique and RHA4 filler.
• For nasolabial folds, use the retrograde linear injection technique and RHA3 filler.

Instead of PureSense Ultra Deep filler, you can use PureSense Ultra.

The amount of product administered to each area is selected individually for the patient, taking into account:

• degree of volume loss in the midface (with or without displacement of fat compartments);
• bone tissue structure;
• desired result;
• severity of nasolabial folds.

Limitations after correction of nasolabial folds with fillers:

1. You must avoid deep tissue massage for two weeks.

2. Do not apply makeup until the next day after the procedure.

3. Avoid touching the injection sites.

4. If any problems arise, you must contact your doctor.

The effect of correction of nasolabial folds with RHA dermal fillers lasts on average for 9–12 months

After the procedure, the patient comes for a re-examination to evaluate the results. The effect of correction of nasolabial folds with RHA dermal fillers lasts on average for 9–12 months (this period varies depending on a number of factors). After 6–12 months, a second consultation is carried out to determine the feasibility of additional correction.

Source: estet-portal.com