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The Mid Face Rejuvenation Minimally Invasive Techniques
By Raffi Dishakjian M.D.
The mid face is traditionally one of the most overlooked areas in facial aesthetic rejuvenation. While traditional facelifts correct gross laxity of facial structures (skin, muscles and ligaments), they do not address the underlying volume loss that the aging face suffers, specially in people who maintain their ideal body weights in their 40's, 50"s and beyond. Not only is a facelift associated with high cost, downtime, risk of scarring and nerve damage, it also often result in a "hollow" or "skeletonized" look if volume loss of the mid face is a significant underlying problem.
Fat is perceived as aesthetically undesirable in the popular culture, yet it has a critical role in the appearance of the youthful face, including not only the cheeks, but also the temples, chin, lips and forehead. In the youthful face the high cheek fat pads give the face its oval shape. As we age, the cheek fat pads shrink in size and migrate down with gravity, resulting in early jowling and exposing the lower eyelid fat margin. Thus the aging face often loses its oval shape to appear empty in the mid-face and square in the lower face. The aesthetic importance of the cheek fat pad volume is most readily app-reciated by noting the improvement of the mid face contours while smiling.
In some patients, simple volume augmentation of the mid face alone will make a huge difference in rejuvenation. In others, additional procedures (like invasive and non-invasive facelift procedures, laser resurfacing, Bot-ox ® and or photofacials) may be needed for optimal results.
There are a variety of techniques for mid face augmentation including fat grafting, facial implants and injectable fillers. While fat grafting with one's own fat may offer the longest lasting correction, it has its downsides, like significant downtime (about 2 weeks or more) and the need for repeat procedures (~50 % of implanted fat may not survive). The longevity and efficacy of this procedure is also very technique dependent.
Facial implants, on the other hand, are made of surgical grade silicone rubber and placed through the mouth right over the bony structure of the cheek. While they may give the patient a long term volume correction, these implants can have significant downsides. These include a prolonged recovery time (~2 weeks downtime), prolonged swelling and numbness, bleeding, infection, over/under correction and migration/movement of the implant. In addition, since the bone and soft tissue structures of the face keep changing with age, permanent facial implants that may be perfect at 40 may be inadequate at 65 and may need to be changed or removed.
Needle based injectable fillers are an attractive alternative to the above discussed options. The two main FDA approved products that are useful for this purpose are Sculptra® and Radiesse ®. Both are considered relatively long lasting particle based fillers. Once injected into tissues, these carefully designed microscopic particles stimulate the collagen producing cells of the body to deposit a matrix of additional collagen fibers around them, leading to long lasting volume correction. Experience has shown these fillers to be remarkably safe over the long term, with the effects lasting from 1-4 years, depending on the product and the patient. Since these particles are eventually completely absorbed, there is little concern of long term effects and migration of the product with aging. In addition, the minimally invasive nature of the procedure decreases the associated swelling, bruising and downtime and therefore the volume correction can be done in stages so as to avoid overcorrection or to address any imperfections.
When addressing mid facial aging and volume loss, volume augmentation recaptures the fuller, more youthful version of one's face without the unnatural look that results from a surgical facelift procedure.
Raffi Dishakjian M.D. specializes in minimally invasive facial rejuvenation techniques at Nu Vela Esthetica in Porter Ranch, CA. He is a Board Certified physician and a member of the American Academy of Cosmetic Surgery and has extensive experience with needle based fillers for facial rejuvenation. To learn more visit nuvelaesthetica.com or call 818-832-4500 for a free consultation to discuss you facial rejuvenation needs.
Nutrition Scene with David Allen
Trick or treat? Halloween is frightening to a lot of us. There are images of children and adults stuffing their faces with sweet treats and running wild on a sugar-high frenzy.
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