"Hydraulic lifting". Booster therapy without papules for prolonged hydration and lifting

Natalya Mikhailova, Candidate of Medical Sciences, dermatovenerologist, cosmetologist, associate professor of the Department of Skin Diseases and Cosmetology of the Federal Postgraduate Educational Institution of the Russian National Research Medical University named after. N. I. Pirogova, President of the National Society of Mesotherapy (NOM) and the Eurasian Association of Injection Techniques Specialists (EOSIM), member of the American Academy of Dermatology (AAD) and the American Society of Laser Medicine and Surgery (ASLMS), member of the expert council of HUGEL PHARMA companies (Korea) , Laboratoires GERnétic Synthèse (France), SuissElle (Switzerland), Laboratory THOSCANE

This unique procedure is suitable for different morphotypes of aging, demonstrating not only a bright immediate effect, but also pronounced delayed results - due to its impact on several aging mechanisms simultaneously.

An important feature that patients pay attention to after the procedure is the lack of need for rehabilitation. The pace of life is accelerating: we began to do many things on the go, we combine several tasks at the same time, even on weekends we live according to a schedule. And there is absolutely no time left to properly rest or get yourself in order. What can we say about procedures that require long-term recovery - many patients cannot even imagine how to drop out of social life for several days.

In this case, the ideal choice is the “Hydrolifting” procedure, which quickly won the love and trust of cosmetologists thanks to a large number of striking effects:

• instant filling and lifting;
• strengthening of the ligamentous apparatus;
• improvement of skin turgor and tone;
• prolonged hydration;
• prevention of aging and gravitational ptosis.

Coping with these tasks is possible only with the ideal combination of the right drug in the form of partially stabilized hyaluronic acid and specially selected anatomical injection points. The drug must contain high molecular weight hyaluronic acid of the pharmacopoeial class: this guarantees the implementation of the necessary effects and safety when administered subcutaneously, since the technique involves injections into the projection of the ligamentous apparatus of the face.

And thanks to the sufficient duration of biodegradation, partially stabilized hyaluronic acid allows you to launch the synthesis of new collagen fibers and achieve prolonged hydration. In this case, the drug should not contain cross-linking chemical agents, for example, BDDE, the breakdown products of which may have sensitizing properties [2].

The “Hydrolifting” procedure uses HYALUFORM® Deep booster (Lab. THOSCANE, Russia), which meets all the requirements described above. It contains partially stabilized hyaluronic acid with a concentration of 2.5% (25 mg/ml) in a volume of 2 ml.

What are the advantages of this drug? Like other products in the HYALUFORM line, it is made from pharmacopoeial grade hyaluronic acid. Due to the uniform molecular weight distribution, all molecules have the same
size - 2 million Yes. This guarantees uniform biodegradation and unidirectional action of the
each molecule.

Secondly, it is the stitching mechanism. In the production of partially stabilized HYALUFORM® boosters, a unique technology of solid-phase modification of hyaluronic acid molecules is used, which ensures an increase in the period of its biodegradation in tissues in the absence of cross-linking chemical agents. Thus, the use of solid-phase modification during the manufacturing process makes the drug effective and safe for injection at any level.
It is the unique combination of properties of HYALUFORM® Deep booster and a special administration technique that guarantees the highest results and predictability in the post-procedure period.

The beginning of aging in many people is often marked by similar manifestations - blueness under the eyes, initial signs of the appearance of a mid-cheek furrow, shallow nasolabial and labiomental folds, the first "jowls" - characteristic signs
tired morphotype. It is for such patients that “Hydrolifting” HYALUFORM® Deep booster is the procedure of choice. In addition, this method is suitable for other morphotypes of aging - for the purpose of prolonged hydration and strengthening of the ligamentous apparatus.

Procedure: “Hydrolifting”.
Indications: predominantly tired morphotype.

Decreased moisture and skin tone. Manifestations of chronoaging - folds, “jowls”.

Goal: strengthening the ligaments of the face. Creating a lifting effect due to filling and mechanical support of tissues. Prolonged hydration and improvement of skin quality.
Drugs and equipment:
• HYALUFORM® Deep booster (Lab. THOSCANE, Russia);
• needle 30G × 4 mm, 2 pieces;
• POSTINJECT Сream (MESALTERA by Dr. Mikhaylova, Lab. THOSCANE, Russia).

To achieve maximum results, injections are carried out at points to a depth of 4 mm. A 30G × 4 mm needle is inserted perpendicular to the skin over its entire length; the direction of the needle cut does not matter.
This level of injection allows you to simultaneously moisturize the skin, stimulate the activity of fibroblasts in the reticular layer of the dermis, and also, due to long-term biodegradation, stimulate the formation of new collagen fibers at the site of the injected bolus [3], which strengthens the ligamentous apparatus of the facial skin (Fig. 1).

RICE. 1. Mechanism for stimulating collagen synthesis. Injected bolus of hyaluronic acid (blue) mechanically
stretches fibroblasts (FB), changing their shape. In response to mechanical stimulation, the fibroblast produces
new collagen fibers into the surrounding intercellular space.

The first and second points are projected onto the mental ligament. It is actively involved in the mechanism of formation of “jowls” and the labiomental fold (Fig. 2) [4]. Filling this area will smooth out the transition between the chin and the jowls, which will create a natural and beautiful oval of the face.

Point 1 - located within 1 cm from the bony edge of the lower jaw in the projection of the mental ligament. The bolus of the drug is 0.1 – 0.2 ml, depending on the severity of the “jowl”.

Point 2 is 1 cm below and lateral to the corner of the mouth. The bolus of the drug is 0.1 ml. The injection should not be given very close to the corner of the mouth (Fig. 3).

Point 3 - at the base of the nasolabial fold, the volume of the drug is 0.1 ml of the drug. Please note that it is in this area that the facial artery is located as close as possible to the skin in the superficial fatty tissue. As a result, it is necessary to carry out an aspiration test (Fig. 4 A).

Point 4 is the point of mimic crease of the nasolabial fold, the volume of the drug is 0.1 ml of the drug.

In order to find this point, you need to ask the patient to smile; the point is located at the site of the maximum crease (Fig. 4 B).

In order to mark subsequent points of the middle third of the face, an auxiliary zygomatic line is required, drawn from the wing of the nose to the stem of the ear helix, which exactly “lies” in the middle of the zygomatic arch (Fig. 5).

Point 5 - at the intersection of the zygomatic line and the vertical along the midpupillary line (in the projection of the mid-buccal groove), the volume of the drug is 0.1 - 0.2 ml, depending on the severity of the tired morphotype (Fig. 6). Injection into this point allows you to fill the deficit in the volume of the medial buccal fat pad, which creates the effect of a young, rested face.

Point 6 - at the intersection with the perpendicular to the zygomatic line from the lateral edge of the orbit, the volume of the drug is 0.1 ml (Fig. 6).

Point 7 is 1.5–2 cm lateral to point 6 along the zygomatic line, the volume of the drug is 0.1 ml (Fig. 6).

Working with points 6 and 7 highlights the zygomatic arch, creates a lifting effect, emphasizing the transition between the cheek and zygomatic areas.

Point 8 - in the area of the temporal fossa, 1.5 - 2 cm lateral to the tail of the eyebrow, volume of the drug - 0.1 ml

(Fig. 7).

The superficial fatty compartments of the temporal region are prone to atrophy, which creates an unpleasant effect in the form of retraction of the temporal region and the formation of a shadow there, significantly aging patients [5] (Fig. 8). Of course, contour plastic surgery has always been considered the procedure of choice to fill volume defects, but this procedure is not suitable for all patients. Due to the fact that HYALUFORM® Deep booster is able to attract a large amount of water, even a bolus of 0.1 ml of the drug can fill this defect and become a temporary alternative to contouring.

If there is sufficient volume in the temporal region, the doctor can move the point under the lateral edge of the eyebrow. Thus, when injecting a bolus of 0.1 ml, the effect of lifting and opening the gaze is achieved (Fig. 9).

Points 9 - two points on each side on the border of the upper and middle thirds of the forehead along the medial edge of the eyebrow and the midpupillary line. The volume of the drug is 0.025 ml or until a “tubercle” forms (Fig. 10). Injections into these points are necessary to maintain youth and moisturize the skin of the frontal area.

Point 10 - located along the midpupillary line in the projection of the tear trough. The volume of the drug is up to 0.05 ml. If the formation of a papule is noticeable, it is necessary to stop the injection (Fig. 11). Injection at this point is necessary to strengthen the orbital retaining ligament (Fig. 12) and reduce the severity of the lacrimal and palpebromalar grooves [6]. It should be taken into account that in patients prone to swelling and with hernias of the lower eyelid, this point is not injected in order to avoid
prolonged swelling.

An additional point may be located in the earlobe area. A bolus of the drug of 0.05 - 0.1 ml will be enough to fill the area deformed due to prolonged wearing of heavy jewelry (Fig. 13).

The main advantage of the HYALUFORM® Deep booster “Hydrolifting” procedure is the result “here and now”: after the procedure there are no papules or tubercles left, the effect of lifting and restoration of lost volume is immediately visible, which intensifies over several days due to the attraction of water and hydration and lasts for weeks .

In Fig. 14 shows photographs of the patient immediately after the procedure. Thanks to the properties of HYALUFORM® Deep booster and correctly selected injection points, we see a powerful lifting effect - reducing the severity of “jowls”, the depth of the nasolabial and labiochin folds. Improvements in the periorbital area are noticeable - opening of the gaze, correction of the lacrimal and palpebromalar grooves. There was a filling of the soft tissues of the temporal region and the medial buccal fat compartment.

After the procedure, the effect of moisturizing the skin and improving turgor increases for several days. Thanks to the pronounced results, you can limit yourself to one procedure; if it is necessary to prolong and enhance the effect of the “Hydrolifting” procedure, HYALUFORM® Deep booster can be repeated after 3 – 4 weeks.

“Hydrolifting” has proven itself to be an effective protocol for an older group of patients with signs of gravitational ptosis.

In Fig. 15 shows photographs of such a patient with a tendency to swelling, with oval deformation, nasolabial and labiomental folds. Immediately after the procedure, she noted a marked improvement in her appearance. Changes in the lower third of the face are especially noticeable - a more defined oval, a lifting effect, lifting the corners of the lips, reducing the severity of the labiomental and nasolabial folds.

POST-PROCEDURAL CARE
After the “Hydrolifting” procedure with HYALUFORM® Deep booster, antiseptic skin treatment is performed. Restoring cream with peptides POSTINJECT Cream promotes skin healing and helps restore hydrolipid balance after treating the skin with an antiseptic. It can also be recommended for post-procedure care.

In case of single ecchymoses at the puncture points, Keladerm cream (MESALTERA by Dr. Mikhaylova, Russia) is recommended for home care.

After the procedure, we recommend that the patient:
• do not touch your face with your hands for 15 – 30 minutes;
• do not apply cosmetics for 3 – 4 hours;
• exclude warming procedures, swimming pool for 1 week.

CONCLUSION
HYALUFORM® Deep booster procedure has become a unique technique that is suitable for a large number of patients. Each point is based on the anatomical structures of the face - ligaments and compartments, this explains the excellent long-term results. Thanks to the optimal injection depth and the duration of the bolus of HYALUFORM® Deep booster in the tissues, we obtain a complex of effects: instant lifting, strengthening of the ligamentous apparatus, improvement of turgor, tone and moisturizing of the skin. And the absence of papules and “bumps” after the procedure is more important than ever given the constant social activity of our patients.

LITERATURE
1. Hascall, V. C., Calabro, A., Oken, M. M., & Masellis, A. M. (2002). Characterization of hyaluronan synthase expression and hyaluronan synthesis in bone marrow mesenchymal progenitor cells:
Predominant expression of HAS1 mRNA and up-regulated hyaluronan synthesis in bone marrowcells derived from multiple myeloma patients. Blood, 100 (7), 2578 – 2585.
2. 1,4-Butanediol (1,4-BD). Pre-Review Report. Expert Committee on Drug Dependence. Thirty-fifth Meeting. Hammamet, Tunisia, 2012.
3. Frank Wang, MD; Luis A. Garza, MD. In Vivo Stimulation of De Novo Collagen Production Caused by Cross-linked Hyaluronic Acid Dermal Filler Injections in Photodamaged Human Skin. Arch Dermatol. 2007; 143:155 – 163.
4. Mohammed Alghoul and Mark A. Codner. Retaining Ligaments of the Face: Review of Anatomy and Clinical Applications. Aesthetic Surgery Journal 2013 33: 769 originally published online 12 July 2013.
5. Schenck, Thilo LMD, Ph. D.; Koban, Konstantin C.; Schlattau, Alexander MD The Functional Anatomy of the Superficial Fat Compartments of the Face: A Detailed Imaging Study. Plastic and Reconstructive Surgery: June 2018 – Volume 141 – Issue 6 – p 1351 – 1359.
6. Chin-Ho Wong, Michael KH Hsieh, Bryan Mendelson. The Tear Trough Ligament: Anatomical Basis for the Tear Trough Deformity. June 2012. Plastic and Reconstructive Surgery 129 (6):1392 – 402.

This article was provided by the MEDESTHETIC-PRESS Publishing House and is published with its knowledge and consent.