Le Vieillissement Esthétique

When cosmetics are no longer enough, there are solutions in aesthetic medicine. Without requiring an operation – we are then in cosmetic surgery – these are less invasive procedures but which are carried out in a medical office. For this, it is essential to go to a dermatologist, a doctor or a cosmetic surgeon, the only ones who have a good understanding of the skin and facial anatomy.

Structural aging of the face, much deeper than the skin

The face is a superposition of plane: bony relief, muscular envelope, fatty layer and external envelope. Each layer interacts with the layer above and below. The aging of the face is therefore not limited to that of the skin. This explains this gradual shift in areas of the face over the years.

• Under the skin, the fatty volumes sag: the temples and cheeks hollow out; hollow circles and bags appear; the upper eyelids droop; the valley of tears appears by fatty sliding; the lips become thinner, the mouth sags and folds of bitterness are created at the corners; the fatty volumes of the lower face slide, defining the jowl and the chin.

The muscles, under the fat, shorten, which freezes them in contraction, leading to the appearance of expression lines: crow's feet, forehead, frown lines and turn of the mouth.

The bony relief , at depth, thins and recedes. Shadows appear on the face. The cavities where the eyes are housed enlarge, they fit into the orbits. The malar bone (under the cheekbones) resorbs, leading to the loss of tissue in the soft parts of the middle third of the face and the formation of the nasolabial fold. The jaw and chin are reduced: the oval becomes blurred.

What are the possible treatments ?

The injections

Botulinum toxin : taken from a bacteria, it is used to reduce excessive muscular contractions responsible for expression lines: crow's feet, forehead, frown lines. It is also used by certain experienced practitioners, off-label (marketing authorization), in the lower face (corners of the lips, vertical wrinkles above the upper lip, platismal cords of the neck). The result is seen in a few days and lasts six months.

Hyaluronic acid : it is a natural constituent of the human body, which swells with water, particularly present in the skin to which it gives its plump appearance. Reproduced by biotechnology, it is versatile in injection. From now on, the doctor chooses from a range of hyaluronic acids which ranges from hyper fluid to very dense, depending on whether he wants to improve the quality of the skin, fill in wrinkles and hollows or restore volumes lost in depth. The immediate correction lasts from nine months (lips) to twenty-four months (dark circles).

Its various forms:

• Mesotherapy: this revitalization treatment combines fluid, or free, hyaluronic acid with a rejuvenating cocktail (vitamins, trace elements, etc.) in multi-puncture or microneedling (a roller or pen with multiple, tiny needles) in the dermis more or less deep to deeply rehydrate, plump the skin and restore radiance.

• Skinboosters: a very slightly cross-linked hyaluronic acid, which rehydrates and plumps up slightly withered skin, bringing a boost of radiance to the youngest.

• More or less thick (crosslinked) and flexible hyaluronic acids are injected on the surface to correct crow's feet, frown lines, fine wrinkles on the forehead and around the mouth, more in depth to restore volumes lost with age in the nasolabial folds, cheekbones, valley of tears. Or create one: correct a nose, project a chin, plump lips

Peeling, the eraser of imperfections

Depending on its strength, it ranges from a radiance boost to the elimination of spots, melasma and redness, even wrinkles. It will both strongly exfoliate and stimulate the dermis.

Deep peeling with phenol is now quite rarely practiced, which results in social exclusion for three weeks.

We prefer superficial peeling with TCA (trichloroacetic acid) which reduces fine lines, spots and acne scars on thick skin, or with glycolic acid for thinner ones. The doctor applies a preparative solution to the face and then the chosen acid peel before rinsing it and applying a soothing cream. Allow for redness for 24 to 48 hours for the lightest, a week of healing where the skin feels tight and flaky for TCA, with application of healing cream several times a day. SPF 50 sunscreen required for one month.

The resurfacing laser

We know the laser for hair removal, correction of spots and redness, but it can also improve the visible signs of aging. It can smooth the skin, reduce wrinkles and cause tension by stimulating fibroblasts (cells that produce collagen in the skin).

The ablative laser (CO2, Erbium) acts like a peel and abrades the skin down to the upper dermis, which requires social exclusion for more than a week.

The non-ablative or micro-ablative fractional laser (Fraxel, Nd-Yag) “hits” the skin as if through a sieve and creates discontinuous “wells”, which makes it possible to increase the energy per pulse and achieve the skin deeper. The areas between the wells retaining all their healing and pigmentation capacities, the consequences are simpler and the risks reduced. The results are visible in a few weeks for the ablative, two months for the fractionated. To be carried out in the middle of winter because you have to avoid the sun for almost 3 months

Radiofrequency for relaxation

To combat the beginning of sagging, monopolar or bipolar radiofrequency, which uses electrodes applied to the skin to be treated, stimulates the formation of new collagen in the dermis by heating it strongly. The latest generation of radiofrequency, called transcutaneous fractional, creates coagulation points directly in the deep dermis by electrical micro-impacts made with ultra-fine needles. The effects are visible between one and six months later and last up to one or two years (the time for the creation of new collagen)

Interview with Dr Jung Hamoude who enlightens us on the evolution of his patients' expectations and gives us some advice

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