Facial Contouring in Asian:Introduction & Trend in Hong Kong

322nd & 323rd HKDU Sunday Symposium

Speaker: Dr. Lam MeiPresident, Hong Kong Medical Aesthetic Association

林薇醫生Dr. Lam Mei, May

核准刊載資格:香港大學內外全科醫學士, 英國卡的夫大學臨床皮膚學碩士, 英國格拉斯哥皇家醫學院皮膚病科文憑, 香港中文大學社區老年醫學學士後文憑, 香港家庭醫學學院家庭醫學文憑, 愛爾蘭皇家內外科醫學院兒科文憑

組織:主席香港醫學美容協會President of Hong Kong Medical Aesthetic Association (HKMAA)

Email: maylamdr@gmail.com

Indication for “Facial Contouring”

• Against aging face

– younger looking

• Improving the asymmetrical face

– more beautiful

• balancing the facial proportion

– more attractive

Treatment options for “Facial Contouring”

• Non-surgical methods

– Botulinum toxin

– Dermal filler

– Collagen stimulator

– Laser

– Chemical peel

– Energy-based machine

– Orthodontic treatment

• Surgical methods

– mid-facelift, neck lift, brow lift

– upper/lower blepharoplasty

– Rhinoplasty

– orthognathic surgery, genioplasty

– Lip augmentation/lip reduction

– Liposuction

– Fat transfer

Treatment options for“Facial Contouring”

How do we aged?

Stuzin JM, Baker TJ, Baker TM. Refinements in face lifting: enhanced facial contour using Vicryl mesh incorporated into SMAS fixation. Plast Reconstr Surg 2000; 105:290-301

How do we aged?

• 1) Skin

• 2) Fat Compartment

• 3) Superficial muscular aponeurotic system(SMAS) layer

• 4) Mimetic Muscle

• 5) Skeletal Bone

Skin aging

Fisher GJ, Varani V, Voorhees JJ. Looking older: fibroblast collapse and therapeutic implications. Arch Dermatol 2008; 144:666-672

skin thickness , breakdown of collagen/elastic

Wrinkle

Skin laxity

melanocyte activity

Skin pigments and pre-malignantchange

Dermis hyaluronic acid

Skin turgidity, dehyration of skin

Skin aging

Fat CompartmentAtrophy & Redistribution in aging

Safi Kang. A noval facial fat transfer technique with a concept of volumetric lifting

Safi Kang. A noval facial fat transfer technique with a concept of volumetric lifting

Fat CompartmentAtrophy & Redistribution in aging

Superficial muscular aponeurotic system(SMAS) layer

SMAS layer aging

• Connective tissue fibre

• Loss of elasticity by aging

• Loss of elastin

• Ptosis of facial volume esp. midface/Nasolabial fold

How do we aged?

Source: “The Anatomic Basis of Midfacial Aging 2” Allan E. Wulc, Pooja Sharma, and Craig N. Czyz

Aging in mimetic muscles

Aging in mimetic muscles

• Increase resting tone of muscle with aging

• Repeated contraction of mimetic muscle

• Change in fat distribution (static lines/folds)

Skeletal bone aging

• Midfacial soft tissue malposition

• Sclera show

• Tear trough deformity

• Deepening of nasolabialfold

An Algorithm of Facial Aging: Verification of Lambros’s Theory by Three-Dimensional Stereolithography, with Reference to the Pathogenesis of Midfacial Aging, Scleral Show, and the Lateral Suborbital Trough Deformity Joel E. Pessa, M.D.

Facial Contouring: non-surgical method

– Botulinum Toxin

– Dermal filler

– Collagen stimulator

– Energy-based machine

Botulinum Toxin

• Botulinum toxin (BTX) is a neurotoxin protein produced by Clostridium Botulinum and related species

• There are two main commercial types: botulinumtoxin type A and botulinum toxin type B

• 5 registered neurotoxin in HK:– Botox

– Dysport

– Siax

– Xeomin

– BTXA

• All are botulinum toxin A

Facial contouring

• Wrinkle (dynamic line)

– By mimetic muscles

• Contouring

– By masseter muscle/temporalis

– Mentalis m.

– Platysma m.

Aging in mimetic muscles

Facial Contouring: non-surgical method

– Botulinum Toxin

– Dermal filler

– Collagen stimulator

– Energy-based machine

Dermal fillers

• Biodegradable– Hyaluronic Acid

• Eg. Restylane, Juverderm, Teosyal, Emervel etc..

– Injectable Collagen (out of fashion)• Eg. Evolence

– Calcium hydroxylapatite• Eg. Radiesse

– polycaprolactone (PCL) • e.g. Ellansé

–自體脂肪移植 (Fat Transplant)

Dermal Filler

• Non-Biodegradable (controversial)– Injectable silicone

• Very rarely been used worldwide

– Polyacrylamide – PAAG• Eg. Aquamid• Eg. Amazing Gel in China

– Polymethylmethacrylate - PMMA• Eg. Artecoll

• S.E.– granulomatous reaction, migration,

cellulitis,ulcerations and disfiguring scars, toxic to healthy tissue (PAAG), carcinogenic (PAAG)

Hyaluronic acid

NASHATM (Non-Animal Stabilized Hyaluronic Acid)

largemediumSmall to medium

small

Source: www.juverderm.com

Fat Compartment Aging (Volume loss)

Facial Contouring: non-surgical method

– Botulinum Toxin

– Dermal filler

– Collagen stimulator

– Energy-based machine

Poly-L-Lactic-Acid ( PLLA)

• Injectable poly-L-lactic acid – Bioabsorbable– has been used for decades in dissolvable stitches– Replaces lost collagen in the area of treatment

• FDA approved, result last up to 25 months• ‘liquid facelift’• Does not contain human, animal, or bacterial

components• Does not require allergy testing prior to

treatment

Poly-L-Lactic-Acid ( PLLA)

Facial Contouring: non-surgical method

– Botulinum Toxin

– Dermal filler

– Collagen stimulator

– Energy-based machine

• Mono-polar radiofrequency (Thermage™)

• High-Intensity Focused Ultrasound (Ultherapy™)

• Microneedle Fractional RF (Infini™, Scarlet™)

• Fractional laser (ablative: CO2/ErYag, non-ablative: 1440nm, 1540nm)

Energy-based machine

• Non-invasive facelift

• Heat up skin/Subcutaneous fat/SMAS layer

– Create micro-coagulation zone

– Trigger wound repair response

– fibroblast stimulation, collagen reformation

“Evaluation of a Microfocused Ultrasound System for Improving Skin Laxity and Tightening in the Lower Face” Georgette et al.,Aesthetic Surgical Journal 1Sep2014

Energy-based machine

Mono-polar RF

• Thermage

– FDA clearance for non-invasive, energy-based eyelid treatments.

– Non-invasive treatment of wrinkles and rhytids

– Temporary improvement in the appearance of cellulite

High-Intensity Focused Ultrasound

• FDA cleared Ulthera™ System

– lifting of lax submental(beneath the chin)

– eyebrow

– neck tissue

Source: http://www.ultherapy.com/Ultherapy

High-Intensity Focused Ultrasound

Source: http://www.ultherapy.com/Ultherapy

Microneedling Fractional RF

http://www.usa.lutronic.com/infini

http://www.usa.lutronic.com/infini

Microneedling Fractional RF

Fractional laser resurfacing

• Non-ablative vs ablative

• Indications

– Wrinkles

– Acne atrophic scar

– Skin tightening

• fractional photothermolysis

– microscopic treatment zones (MTZs)

Facial Contouring:Current Trend in Hong Kong

• Prefer Less to no down-time

• Lunch time procedure

• Prefer non-invasive to minimal invasive options

• Prefer natural and gradual effect

• A taboo

• Male clientele

• Wider age range

• Selfie and photogenic

Facial Contouring:Current Trend in Hong Kong

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