Visual diagnostics in the practice of a cosmetologist

Polina Laiter , medical cosmetologist PME, specialist in the field of restorative cosmetology and natural rejuvenation of the face and neck, author of the Reface Laitlift System layer therapy method (Israel).

Laws of biomechanics in cosmetology

The concept of “dental-facial system” includes: skin system, musculofascial, bone, occlusal (bones, occlusion of the upper and lower jaw, temporomandibular joints, teeth), vascular, central and peripheral nervous systems, postural (head position in space). All these systems are closely related to each other structurally and functionally and are united by the laws of biomechanics. What does a modern cosmetologist need to know about biomechanics? All deformations in biosystems are associated with such biological processes as:

• muscle contraction;
• deformation of tendons, bones, ligaments, fascia;
• movement in the joints of not only the face, but also the body.

The object of study of biomechanics is biomechanical movement , or more precisely, biotensigration , that is, the unhindered movement of the entire biosystem as a whole, the movement of individual parts of the system relative to each other, the deformation of the system, the position and equilibrium of the system in space. The structural theory of facial aging suggests that over time, for various reasons, the muscles of the face and neck generally do not stretch, but spasm and shorten. These changes lead to changes in muscle tone, distortion of the tension of the tissue field of the face and neck, changes in the position of the bones of the facial skull and temporomandibular joints, migration of submuscular fat deposits, and muscle imbalance.

A change in the tone of even one muscle disrupts the balance of the entire muscle and bone structure of the face and neck . This leads to blockage of the lymph nodes and contributes to the accumulation of excess fluid, causing swelling. If the stage of edema is very pronounced, very long-lasting, or is regularly renewed, then the edema, turning into stagnation (lymphostasis), disrupts the mobility of myofascial structures, and the muscle cannot perform its function completely and throughout the contraction or stretching. As a result, myofascial structures weaken, which invariably leads to disruption of microcirculation and the launch of a mechanism of tissue damage that changes the biochemical, neurophysiological and mechanical properties of tissues along the vector: inflammation (edema) – fibrosis – sclerosis. As a result, premature aging of the tissue occurs.

This cycle not only forms external signs of aging, the so-called “age shadows” (folds, “bags”, furrows, wrinkles), but also leads to a deterioration in the barrier functions of the skin, disruption of nutrition, hydration and regeneration of the skin due to impaired blood circulation, venous and lymphatic drainages. Biomechanical changes in the face and neck will certainly affect the ability of tissues to recover after any invasive influences, especially those that will add long-term post-traumatic swelling to the existing lymphostasis. It turns out that age-related changes in the face and neck are not only a skin condition, but also:

• development and location of bones and temporomandibular joints;
• the condition of the muscles that ensure their movement and the connection of the muscles with other muscles of the face and body, and the joints with other bones and joints;
• spatial position of the head relative to the body;
• state of the vascular and nervous systems;
• stage of tissue damage to soft tissues.

The importance of biomechanical correction

Some experts will argue that injection methods of rejuvenation are the main ones in aesthetic correction, some will argue that the aesthetic effect of rejuvenation can be achieved only by influencing the skin with devices or drugs, and some will say that only deep peeling and plastic surgery can cope with all these age-related changes. And they will all be right in their narrow direction, which does not consider the face as part of the dentofacial system, in which all elements of the system must be interconnected and balanced.

Without detracting from the advantages of injection, hardware and surgical correction, I want to emphasize that the competent work of a cosmetologist with the biomechanics of the face and neck solves those issues that simply cannot be resolved by other methods of aesthetic correction. And the restored biomechanical balance of freedom of movement of the structures of the face and neck helps to avoid or at least significantly reduce the number of possible side effects and complications from such invasive treatments as contouring and plastic surgery. For certain types of aging, biomechanical correction is a priority type of intervention. By limiting ourselves to invasive types of correction, we risk getting results that are not complete, not stable, and often leading to complications (if not in the present, then in the future).

Systemic therapeutic thinking

This is not the first time I have encountered the fact that many cosmetologists are somewhat “slow” when it comes to visual diagnosis of manifestations of age-related aesthetic deformations of the face and neck and dysfunctions of the subcutaneous structures that cause them. More precisely, they are limited to visual diagnosis of changes in facial skin. But to understand the causes of age-related deformations, which of the effects (cutaneous, injection, hardware, surgical) should be used to solve this or that age-related aesthetic dysfunction, this is not enough. Nor is it enough to really evaluate the possibilities of various types of influences, not paying attention to the enthusiastic promises of unrealistic aesthetic effects.

I call this understanding “Systems Therapeutic Thinking,” which is based on a number of anatomical, physiological, and biomechanical guidelines. And first of all, the fact that everything in the human body is interconnected and a change in one system will cause a cascade of reactions in other systems. To establish the cause, determine the solution, build a strategy and create an algorithm for an anti-aging care procedure and an algorithm for a program of procedures, it is necessary to collect an anamnesis, conduct a diagnosis, using systemic therapeutic thinking. It is important to determine exactly what contribution to the overall picture of aesthetic age-related changes in the face and neck is made by changes in skin texture, what by tissue damage to soft tissues, and what by changes in the craniofacial architecture of the face and neck.

Visual manifestation of changes in skin texture:

• presence of pigmentation, dull color
• violation of the barrier properties of the skin (dryness, flaking, tightness, etc.)
• signs of skin dehydration (yellow skin tone, sagging, decreased tone, deeper and longer wrinkles)
• hyperkeratosis
• skin dermatoses
• neoplasms
• the severity of the vascular pattern

Visual manifestation of tissue damage to soft tissues:

• presence of pastosity, swelling of tissues
• fibrosis
• ptosis
• displacement of fat packets

Visual manifestation of changes in craniofacial architecture:

• muscle strain
• distortion of the tension of the facial tissue field (asymmetry)
• eye size and symmetry
• head position
• condition (height) of the shoulder girdle
• neck length
• facial patterns
• change in postural system
• change in the occlusal system (bite)

Problems of an aesthetic nature may be associated with pathological processes in the dental system. Therefore, during an external examination, it is necessary to evaluate the following parameters: facial symmetry, height of the lower and upper thirds of the face, severity of chin and nasolabial folds, position of the corners of the mouth, position of the lower jaw (bite), protrusion of the ears and violation of their position in the vertical plane. Taking into account the visual manifestations of these parameters in the client, the specialist can analyze, think systematically and, therefore, choose the optimal solution for the aesthetic correction of age-related changes.