Injection techniques: working with the lower third of the face and neck with Phillex and TwAc

In Ukraine, the Phillex and TwAc lines are represented by Medhome

The company's certified trainer, dermatologist, cosmetologist Inna Mirnova teaches how to combine these drugs using a clinical case as an example.

Today we see a 44-year-old patient. At this age, all procedures should be aimed at improving the quality of the skin. The patient also asked to work on her lips - add volume, shape and moisturize them. Therefore, for work I chose TwAc 3.0 and Phillex Sub-Q Plus from the English brand Yuma Medical.

TwAc 3.0 (HA 20 mg/ml and PDRN 10 mg/ml) has a complex effect. Hyaluronic acid in the preparation moisturizes, and polynucleotides promote cell regeneration, stimulate neocollagenesis and the work of fibroblasts, providing lifting and tightening of tissues.

Polynucleotides for the TwAc line are obtained from salmon milt. This is an absolutely safe and bioavailable substance. Each drug works with its own objectives: TwAc Eyes (PDRN 2 mg/ml) – a liquid mesopeptic drug for the periorbital area, corrects rashes and post-acne scars; TwAc 2.0 (HA 15 mg/ml and PDRN 5 mg/ml) – a bioreparant, starts hydration processes, works with fine-wrinkle type of aging, it can be used in the orbital area, nasolacrimal groove, to moisturize lips; TwAc 3.0 provides lifting of the facial contours for aging skin, restores tissue from the inside - returns volume, tightens, fights enlarged pores, dryness, rosacea, improves skin color. It can be used in the mesopile procedure in patients with thick, oily, porous skin.
To achieve the best results, the drugs can be combined in one procedure: TwAc Eyes - periorbital zone, TwAc 2.0 - face, TwAc 3.0 - neck, décolleté, hands. And also used to improve tissue regeneration in laser rejuvenation protocols and after peelings.

Procedure protocol

We do make-up removal . For the patient’s comfort, we perform topical anesthesia with Un Phill gel. Exposure for 10–15 minutes, then remove with cotton pads. The alcohol in the gel gives an antibacterial and cooling effect.

First, let's work with the quality of the leather . Linear reinforcement technique - we make injections from the angle of the lower jaw, rising to the zygomatic area, working on the area behind the ear, moving along the edge of the lower jaw.

The drug is administered intradermally in a linear-retrograde manner every 0.5–1 cm.

We also work on the submandibular area.

On the neck we use the linear-retrograde technique, leaving an average of 0.1 ml of the drug per injection, we work on the “rings of Venus” and the areas of skin between them.

After completing the procedure, we perform a light massage on Traumeel, Pantestin or Panthenol creams to distribute the drug. In total, we used 2 ml of TwAc 3.0 on the area of the lower jaw and neck.
We worked with a 25 G needle from the kit, but you can use a 27 G needle or 25 G and 22 G cannulas. In this case, we make an entry point on the most protruding part of the zygomatic arch, and using the vector lifting technique, distribute the drug over the cheek. To work on the neck, we make an entry point in the chin area and distribute the preparation with the sun in the lateral direction, then we enter from the angle of the lower jaw and spread the preparation medially vectorially.
The patient sees the result of the procedure immediately, but TwAc 3.0 has a prolonged cumulative effect, so an increase in the effect will be noted on days 7, 10, 14, 20, 30. The drug is injected once every 30–40 days, depending on how fast the rehabilitation was (if there were hematomas, wait until they all go away). On average, the course is 1–3 procedures.
When choosing a hyaluronic filler, we first of all evaluate the degree of HA purification, the volume of the drug, certification, and focus on the patient’s wishes.

To restore volume and shape the lips, we chose Phillex Sub-Q Plus (HA 24 mg/ml, lidocaine 3%). This filler is not hydrophilic, sits beautifully in the tissues, holds its shape, and does not move, which sometimes happens with softer preparations. It is dense, so we work in fairly deep layers of the red border of the lips without affecting the contour.

We carry out an audit - the remains of the hyaluronic filler injected two years ago are practically not palpable in the lips - which means we begin the procedure. We inject the drug linearly in a fan-like manner, slightly overlapping the previous “fan”, and release 0.1–0.2 ml per injection. We inspect the lips while distributing the drug. Our patient's lips required 1 ml of Phillex Sub-Q Plus.

Immediately after the procedure, the lips are moisturized and resemble a flower bud in shape.

Before after

Sometimes 3-4 days after the procedure, patients notice dry skin - this is a natural reaction to the anesthetic, we warn you about this and advise you to use your usual moisturizers. We give general recommendations.