WHO IS THE FACIAL SPECIALIST ? HYALURONIC ACID FILLERS : OPTIMISATION OF AESTHETIC DENTISTRY AND PATIENT LOYALTY
Figure 5 . Aesthetic sub regions of the lip and perioral region . The perioral region is subdivided in at least ten sub regions with very different characteristics from one another and which require different therapeutic approaches . The main aesthetic sub regions of the lip are : the naso-labial fold ( 1 ), the white upper lip ( 2A ), the red upper lip or upper vermillion ( 2B ), the lip white roll ( 2C ), Cupid ’ s bow ( 3 ), the philtrum ( 4 ), philtrum ’ s pillar ( 5 ), the white lower lip ( 6A ), the red lower lip or the lower vermillion ( 6B ), the labio-mandibular fold or puppet fold ( 7 ), and the labio-mental fold ( 8 ). Each one of these areas has particular anatomic characteristics : skin , subcutaneous tissues , muscles , fat , movements and mimic . The therapeutic options will be different for each different area . Drawn by Aldo Zupi using ZygoteBody™ 3D Anatomy Viewer . Zygote Media Group Inc ., American Forks , UT
the majority of the cases , the dermis . Within the dermis , the specialist can choose to use the superficial portion just below the epidermis , or a deeper portion , above the subcutaneous fat . The dermis has variable thickness depending on the anatomic area , the age and the degree of aging . The same happens in the epidermis . The skin can have minimum thickness in areas such as the periorbital one where it does not go over a millimetre or it can get to a few centimetres in areas such as the back or in areas subject to constant friction . However , there are general parameters that can be applied safely in all situations . The depths in which we act can be divided in two layers : a superficial layer , generally 1-2 millimetres deep , and a deeper layer , usually never superior to 5 millimetres . The injection depth depends on the depth of the flaw . Small superficial wrinkles must be treated with superficial injections and with small quantities of material . If the line is deeper , the injection will need to be deeper too , as the quantity of skin to lift is bigger and wider . Even deeper is the area of injection for deep and not elastic wrinkles . A larger amount of material is required and the surface of the tissue to lift is wider . This is the first rule to follow to choose the right depth where to operate . The second rule is just as simple . Each area of the face has skin of constant
thickness and , therefore the dermis can be found at a known depth . We can easily subdivide three areas in which the skin is usually thin . In these areas , we will hardly go at a depth greater than 1-2 mm . This applies especially to the so-called “ white roll ” of the lip . It is an important area because it will almost always be treated in our patients . To areas with thin skin oppose areas with thick skin . In these areas , generally , we inject at least at 2-3 mm of depth and in some cases even deeper . It is important to remember that almost the whole perioral region has a relatively thick skin and sometimes , when facing deep and “ ancient ” wrinkles , it is necessary to go very deep . We must always associate the concept of stickiness or density or reticulation of the HA used to the concept of depth . This way , the tissues will be “ lifted ” more naturally . How should the HA filler be placed ? A dentist is used to inject anaesthetics or other drugs . The technique is exactly the same . Once , the needle has been inserted and we have reached the desired depth , we will inject the quantity of filler we believe is right . The general rule is to usually under dose the injection . A correction , in fact , is always possible . On the other hand , the “ subtraction ”, even if possible , is a lot more complicated . Anyway , we will inject the quantity of HA desired in small spots along the wrinkle or the line we want to increase . The distance between spots is not very important . We can add material where and when we want if necessary and , if required , we could use the same site of injection . This way , with small and aimed corrections , we will achieve to fill or lift a wrinkle . The “ spot technique ” allows an extremely precise correction . However , it requires , patience and precision . For those … in a hurry , the linear technique consists in the injection of a “ strip ” of HA at the bottom of the wrinkle or along the line we want to increase . The technique is very simple . You will need to penetrate in the skin at an angle of about 45 ° for the necessary depth . As we know , the depth can be of just a few millimetres ( 1 or 2 ) or even half a centimetre or more . Once we have reached the desired depth , we will move the needle until it is parallel to the skin . We will proceed along the line we want to fill up for the whole length of the needle . At this point we can start to inject the filler and , at the same time , we retract the needle . In this way , we release a strip of HA like the trail of a plane or of a boat , which will fill the line or wrinkle . Like in the “ spot technique ”, we can go back to the same area as many times as we think it is necessary , lengthening or increasing the volume of the strip . Below , are briefly mentioned the techniques usually used for the common imperfections of the face are briefly mentioned ( labial wrinkles , thin lips , malar region and crow ’ s feet ). The labial wrinkles are formed around the mouth and generally have a vertical movement . They are usually the result of mimic and aging . This imperfection is usually known as “ barcode ”. Different factors , such as smoking can speed up the formation
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