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Dermal Fillers: What areas can we treat?

For those of you that have attended our Foundation and Advanced Botox and Dermal Fillers courses, you will be aware that dermal fillers are used to introduce volume back into areas of the face that have lost volume during the ageing process. When it comes to dermal filler training, there’s a lot to cover, do you know your Juvederm Ultra 2 from your Ultra 4? And what about knowing your marionette lines from your tear troughs?

Where can dermal fillers be used?

Dermal fillers have a wide multitude of uses from the obvious to the not so obvious. If you have a patient that is interested in having dermal filler, we advise that you get them to attend an initial skin consultation with you before having the treatment. This will allow you to find out more about the patient’s medical history, and the look that they are hoping to achieve.

Tear troughs Cosmetic Courses;Picture showing Tear Trough Treatment Before & After

These are the lines under your eyes that make your eyes look tired. A loss of volume in the area, a loss of tissue elasticity or a mild reduction in bone density could all be causes of concern. By using an advanced technique, dermal fillers can be placed in either the tear trough itself, slightly lower in the cheek area, or indeed a combination of both to achieve brighter, more rejuvenated eyes.

Naso-labial folds
Commonly known as the smile or laughter lines, these are the two skin folds that run from each side of the nose to the corners of the mouth. If you are bothered by your nasolabial folds, and wonder what to do to improve the area then filler is perfect to fill out these folds, and partnered with cheek filler the face will appear much younger looking.

Mouth corners

Sometimes the corners of your mouth can droop leaving you looking unhappy. Dermal filler can be placed below the corners of the mouth with a small amount directly into the corners of the lips.

Marionette lines
Marionette lines run between the corners of the lips down towards the chin and jaw giving a puppet-like effect. As we age, our facial bones become smaller resulting in lines like these appearing. Dermal filler is great for filling in these lines making them less prominent.

Cheeks

As you age you lose an amount of subcutaneous fat which can result in a loss of volume and elasticity to the face. This in turn highlights hollow cheek bones, and the presence of excess skin resulting in sunken cheeks. This can cause someone to appear gaunt and tired-looking. Dermal fillers can be injected into this area to plump out the face with natural volume and a gentle lift. This is an advanced technique and is offered at one of our specialist training days.

Lips & vermillion borderCosmetic Courses; Image showing Lip Fillere treatment before & after

A celebrity favourite and probably the most well-known use of filler. The lips can be injected with dermal filler either in the body of the lip to boost fullness or the border of the lips to increase definition. This treatment is ideal for correcting thin lips but can also help solve problems with a downward smile and the need to lengthen the mouth.

Chin augmentation

A perfect alternative to a surgical chin implant, is a non-surgical chin augmentation which is achieved with dermal fillers. Fillers will help define your jaw line and although only a temporary solution it is a great way to see what can be achieved surgically if you are unsure.

Smoker’s lines

These are the vertical lines above the lip that appear when you pout. They are mostly caused by regular lip movements but are also called smokers lines, because regular smoking means pressing the lips together.  If your lines are deep enough then they can be drastically reduced with a small amount of injectable filler to achieve a smoother appearance.

Nose
Have you heard of the lunchtime nose job? Dermal fillers can now be used to straighten out any lumps or bumps in your nose without the need for any surgical downtime. Fillers are injected into the nose to smooth out slight bumps in the bridge of the nose, or rectify a crooked line of the nose (particularly in profile view) and even cartilage irregularities at the tip of the nose all in less than 15 minutes! This is another advanced course available for those that have been practicing in dermal filler for a while.

Hands

Hands are a new use for fillers, patients have found that the use of the fillers in their face is great for concealing their real age, but then it is often their hands that give it away. Ageing hands lose volume and the skin appears thinner. Having filler injected into the skin on the back of the hands can make them appear plumper and less veiny.

So now you know your areas, let’s look at the product that we use on our training days at Cosmetic Courses:

Juvaderm®  Vycross Range

The Juvaderm® Vycross range is a smoother gel which means you get a comfortable treatment. The risk of bruising and swelling is reduced as is any discomfort as anesthetic is added into the formulation of the filler. The Vycross range provides subtle and natural outcomes due to the smoothness of the gel making it easier to inject with precision.

The Vycross range has 3 different forumulas;

Juvederm® Voluma 

Juvederm® Voluma is a much thicker hyaluronic acid gel which has been made by altering the cross-linking technique used in Ultra to create a more viscous result. Voluma can be used for recontouring and restoring the face in the case of age-related volume loss. Designed for deep volume restoration to re-contour the face in areas such as the cheek bone and chin regions.

The effects of Juvéderm® Voluma® last for approximately up to 18 months.

Juvederm® Volbella
Launched in Paris Juvederm® Volbella® is specifically designed to enhance lip volume and define lip contours, with a completely natural look and feel.  The filler has a smooth, liquid consistency for a smoother look and the addition of lidocaine anaesthetic makes the treatment even more comfortable in an otherwise uncomfortable area.

The effects of Juvederm® Volbella® last for approximately up to 12 months

Juvederm® Volift®
This revolutionary dermal filler is produced using VYCROSS™ technology. This creates an ultra-smooth gel for natural appearance with minimal swelling and bruising. It is best used for smoothing nasolabial folds and facial contours.

The effects of Juvederm® last for approximately up to 15 months.

Juvederm® Hydrate Cosmetic Courses; image showing dermal filler product Juverderm Hydrate

The Juvederm Hydrate is used to improve skin hydration and restore elasticity which is lost through ageing. It works by replacing hyaluronic acid but unlike traditional filler it acts as a hydrating agent attracting and keeping moisture within the skin to achieve that healthy natural glow. Juvéderm® Hydrate is most commonly used for very fine lines and wrinkles associated with ageing. It has also been recommended as an early treatment for crow’s feet and fine lines around the mouth.

The effects of Juvéderm® Hydrate last for approximately four to 6 months

Juvederm® Ultra is our most common dermal filler. The filler contains non-animal hyaluronic acid with the addition of 0.3% lidocaine which is a local anaesthetic to make you feel comfortable both during and after the treatment.
There are actually four different formulations for Juvéderm® ULTRA available;

Juvederm® Ultra 2 is a highly cross-linked formulation which is used for the subtle correction of medium facial lines, in particular those around the corners of the eyes and those very close to the surface of the skin. It can also be used to around the lips to enhance natural lip contour.

Juvederm® Ultra 3 Cosmetic Courses; image showing dermal filler product range Juverderm Ultra 3

Ultra 3 is another highly cross-linked formulation but is instead used for more versatility in contouring and volumising anything from moderate to medium facial lines and skin depressions, in areas such as the nasolabial folds. It can be used subtly in lips to enhance lip contour, increase volume and maintain a youthful smile.

Juvederm® Ultra 4 [image]

Ultra 4 is a highly cross-linked robust formulation used for volumising and correction of medium to deep folds and wrinkles, including adding volume in the cheeks and chin improving contour to the face.

Juvederm® Ultra SmileCosmetic Courses; image showing dermal filler product range Juverderm Smile

The newest arrival to the Juvéderm® ULTRA family the Juvéderm® Ultra Smile is based on the Ultra 3 product but it is specifically targeted for use in the lips. It works by providing fuller but softer and natural looking lips and smooths fine lines to fully enhance the mouth area for a fresh new look.

The effects of Juvéderm® Ultra Smile lasts approximately up to 18 months

If you would like to find out  more about our Advanced Dermal Filler Training Course and the product range that we use, you can call the team on 01844 390110 or email [email protected]. 

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The differences between Male and Female Ageing

Male and Female Ageing

As technology has advanced, it has become more apparent that in society we are more obsessed with how we look. Mobile phones, iPads and tablets, make capturing the moment even easier with the rise in ‘selfies’ and social media sharing. Within the aesthetic industry, there has also been a shift. Over 90% of procedures performed in the UK in 2015 were non-surgical, and approximately 800,000 of those treatments were for Botox and filler treatments. Many clinics are also reporting that they have seen an increase in the volume of male patients that they are now Image showing Peter Andretreating with in their clinic, showing that it is not just woman that are interested in anti-ageing treatments. This could be due to more male celebrities admitting to having treatments, such as Peter Andre and Shane Warne having a little ‘Brotox’ here and there.

One of the questions that we at Cosmetic Courses have been asked by our delegates over the past few months is; are there any differences between the male and female ageing process?

In essence, the ageing process itself is more or less the same, but it is worth noting that there are significant differences between both sexes anatomy, and care should therefore be taken when carrying out aesthetic treatments to ensure a natural and harmonious look is achieved to suit both sexes.

The areas that we believe need to be treated differently for Males and Females are the following:

  • Forehead
  • Eyebrow
  • Cheek
  • Nose
  • Jawline and chin
  • Peri Oral Area

The Forehead

Picture showing the difference between male and famle supraorbital ridgeThis is one of the most important areas for rejuvenation, but there are noticeable differences between the sexes. Anthropologists use the forehead as an indicator to determine the sex of the skull. It has been observed that a female skull has more of a flat supraorbital ridge, with a smooth convexity up to the hairline, whereas the male skull has a more pronounced supraorbital ridge with some concavity before the forehead becomes flatter towards the hairline. This skeletal structure is what influences the soft tissues and the overall position of the eyebrows.

Eyebrows

The male eyebrow is flat and tends to sit along the supraorbital ridge whereas the female brow arches at a 10 -2- degree angle with a tail that is more superior to the head.

The aim of aesthetic treatments is to restore a more youthful and natural looking appearance. To treat this area for a female it may require forehead re-volumisation and a bit of brow lifting to maintaining that feminine look, but applying the same technique for males, it could result in over feminising, and portray an unnatural. To stay respectful of the male gender, it is advised to not lift above the supraorbital and to only elevate the ptotic brow to ensure the most natural look is achieved.

Cheeks

Male and Female AgeingThis is an area that is extensively covered in female rejuvenation, but it does come with limited descriptions when it comes to males. Females have a rounder and fuller cheek due to having a thicker fat compartment in the medial area compared to the lateral area. In regards to female ageing, a fuller cheek gives a more youthful look, referring back to the triangle of youth – everything is more pert and smoother. Male cheeks tend to be flatter and more angular due to a thinner layer of subcutaneous fat. The technique used to treat this area have slight differences, and the volume of product used needs to vary. To keep the ‘flatter’ cheek look for male patients, product should only be used to replace the volume loss. Females can have slightly more product used, and this can be replaced more often to maintain the fuller cheek look.

Nose

Image showing Naso LabialThere are more subtle differences between the sexes in this area. There are 2 angles that are used to determine the ideal nose shape: Naso-labial Angle and Naso-frontal angle.

Naso Labial is the angle between a line drawn from the lip border to the base of the columella to the nasel tip. This angle is slightly more obtuse and slightly upturned for females, and it’s also necessary to consider your patients cultural and ethnic differences when treating this area.

Image showing the Naso Frontal AngleNaso Frontal is the angle at the radix, the lowest point of the nasal bridge formed by a line running from the radix to the glabella and from the radix along the dorsum of the nose. This position of the radix is important between males and females. Females are normally in line with the lash line whereas males are at the level of the tarsal fold.

Jawline and Chin

Both masculinisation and feminisation techniques can be used within this area. Toxins can be used to narrow down the masseter or curve the chin, and Dermal Fillers can widen the jawline, increase definition or add a sharper gonial angles as well as flatten or enlarge the chin area.  Different cultures and ethnicities have different representations of what they believe is an attractive jawline, so it is useful to be aware of this when treating patients. The Hollywood ideal is a defined as a strong wide jaw for males whereas females have a softer narrower pointier chin.

Perioral Area

Treating this area is a more common request in females rather than males. Male skin within this area is thicker than in females, who tend to suffer more with smokers lines and wrinkling. This area benefits from toxin, filler and skin resurfacing treatments for both sexes. If treating a male patient, we suggest you treat with caution.

Male and Female AgeingWhen treating both the female and male face for any aesthetic treatment, it is important to book them in for a full consultation, to undertake a facial analysis. Within this consultation, grade the upper, mid and lower face in terms of structure, proportion and symmetry. Within our training, we advise that you take photos of all your patients and keep these as a record to show before and after treatment– it also helps to show the patient how far they have come on their treatments with you.

At Cosmetic Courses, we offer an advanced Botox and Dermal Filler training Course which offers more advanced techniques. If you would like to find out more about the course, or have any questions, please call the team on 01844 390110 or email [email protected]

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Facial Rejuvenation: Complimentary Surgical & Non-surgical Approaches

Latest developments in facial rejuvenation surgeryFacial Rejuvenation

Non-surgical skin treatments and surgical facial procedures often go hand-in-hand. The former, if begun early enough, can be a preventative to ward off the necessity for the latter until much later. Or, they can be used to compliment each other: there is little point a patient saving up and spending their hard-earned savings on that facelift only to reverse the effects by failing to pamper their skin.

Recent figures have shown a 50% increase in the number of people undergoing facial rejuvenation procedures during the last year. Why are more people considering these forms of treatment? Many people tell Cosmetic Courses’ founding Surgeon, Mr Adrian Richards, that they don’t like having their photograph taken and feel as if they would like to look fresher and less tired. Patients often tell him that they believe their face looks far older than they feel.

In the UK, most patients considering any form of treatment want to look as natural as possible. Treatments can realistically make you look as you did 8-10 years ago.

To achieve a natural fresh appearance it is important to address each of the following: The skin, active wrinkles caused by muscle contractions and gravity changes. For some people dramatic improvements can be achieved with skin treatments which involve minimal downtime and cost.

Skin treatments alone can make you look much fresher and brighter. These treatments may consist of Microdermabrasion, Genuine Dermaroller Therapy, or perhaps a light chemical peel. These all work in different ways to removes fine wrinkles, reduce pore size or cause mild skin contraction. Combined, they are highly effective to make the skin look fresher and more youthful.

Active wrinkles caused by muscle contraction are typically found between the eyebrows (frown lines), on the forehead and below the temple (crows feet). As these lines are caused by muscle contraction they are best treated by selectively reducing the overactive muscle activity in these areas. This best performed with small injections of botulinum toxin or dermal fillers into specific muscles.

Gravity changes include descent of the cheek region which causes deepening of the lines which come down from the nose to corner of the mouth. Other changes include loss of the jaw line and jowl formation. The neck skin can also loosen and the sharp angle between the neck and chin is lost.

Gravity changes are best treated with Surgery as the muscle layers of the face need to be repositioned in their previous position. In the forties and early fifties it is often best to have a Mini-face lift (MACS-lift). This elevates the cheek, jowl and neck regions and restores a more youthful face shape.

Most people in their mid to late fifties or older are more suited to more traditional face lift techniques (SMAS-lifts).

These techniques specifically tighten the neck and jowl regions.

Cosmetic Courses offer a Professional Development Section in conjunction with our sister company, Aurora Clinics. This aims to provide support and information about Surgical procedures to enhance the non-surgical training which you can gain with Cosmetic Courses.

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Glycolic Skin Treatment

Now is the perfect time for a facial peel, in winter the skin can appear dull and ashy in appearance. Facial peels are a great way to rejuvenate the skin to reveal younger looking more radiant skin. Vegetable peel facials offer the same benefits as other chemical treatments like microdermabrasion. All facial scrubs and chemical peels can be used in combination with at-home methods like peel off masks.

Facial peels can repair damage to the skin caused by air pollution or overexposure to the sun. People who benefit the most from chemical peel treatments are those with mild to moderate acne, certain thyroid conditions which may cause a dull complexion. Menopausal women also benefit greatly from chemical peels to counteract the lax or sagging skin that occurs during menopause.

Chemical peels use glycolic acid as an exfoliating agent to chemically remove surface dead skin cells and improve the texture of facial skin. Alpha hydroxy acids (AHA) and beta hydroxy acid (BHA) are often used in chemical peel treatments. AHA and BHA are acids that occur naturally in fruits and vegetables. There are other acids that can be used in chemical peels that are derived from natural sources such sour milk- it produces lactic acid which was used as a beauty treatment by the Egyptians. AHA is the most popular because of its molecular structure; it can penetrate the pore and remove the dead skin cells to accelerate the exfoliation process. Glycolic acid stimulates collagen growth and does not cause any visible peeling. Chemical peels should only be performed by a licensed dermatologist. Only your dermatologist knows the proper concentration of glycolic acid to apply to improve the appearance of the skin.

During the chemical peel process, AHA is the form of glycolic acid is applied directly to the skin. The face is prepared for the treatment by using a pre-peel cleanser. The glycolic acid should only be left on the skin for a few minutes.

You must use sunscreen for 2-4 days following treatment and you should avoid intense sunlight. You may start to wear make-up, 24 hours after treatment. Treatment may consist of a series of acids peels for an interval of three to six weeks to achieve total skin rejuvenation.

Follow all instructions by your dermatologist and if you experience any side effects after a chemical peel, such as brown discoloration of the skin. Contact your dermatologist immediately.

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Carboxytherapy : A painless cure for skin ageing

The method of cutaneous and subcutaneous administration of gaseous carbon-dioxide for cosmetic therapy, that is, to improve the texture and quality of skin is called carboxytherapy. The idea preliminarily originated in France in 1930s when it was observed that taking a bath in pools rich in gaseous carbon dioxide helps in rapid healing of wounds. This benefit of carbon dioxide gas is now used in cosmetic therapy. Carboxytherapy is reported to have beneficial results in improving blood circulation, restoring skin’s elasticity, lessening of fat cells and reduction of cellulite.

The injection of carbon dioxide gas through the skin cells helps to dilate the blood vessels, resulting in improved flow of blood and oxygen through the skin. Carboxytherapy, in a way, makes the human heart to pump more oxygen in the blood by injecting a small amount of carbon dioxide. The blood vessels, in order to nullify the presence of carbon dioxide, carries more oxygen following a physiological principle, generally termed as ‘oxygen off-loading’. As a consequence, worn out cells of the skin gets rejuvenated. Thus, this therapy is used to minimise wrinkles and ageing of the skin.

Along with skin rejuvenation, carboxytherapy is used against :

1. Dark under-eye circles : Carboxytherapy improves the capillary network of the lower eyelid, thus increasing the blood circulation

2. Stretch marks : The injection of carbon dioxide gas helps in collagen formation of skin, thus helping in building the collagen matrix and increasing the thickness of the skin.

3. Fat and cellulite reduction : A specific technique of injecting gaseous carbon dioxide into the fat cells is used, such that, the gas becomes toxic to the fat cells making them burst and subsequently eliminate from the body.

These applications of carboxytherapy makes it one of the most popular skin rejuvenation treatment. It is considered a breakthrough in cosmetic therapy. This treatment with carbon dioxide is least invasive. The patients will only bear a bruise at the spot of injection for a few days, and are generally prescribed not to involve in any vigorous exercises for a couple of hours after the treatment.The period of treatment depends on the severity of the problem. Six to twelve treatments, of fifteen to thirty minutes each, spaced one week apart, yield desired results. However, proper caution are advised to be taken and persons with breathing problems or asthma are generally suggested to refrain from carboxytherapy.

Find out more about training with Cosmetic Courses.

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Microdermabrasion and Chemical peels

Microdermabrasion and Chemical peels are two very common skin rejuvenation techniques. Although they can both treat acne and signs of aging, it is helpful to understand the differences between the two procedures before consulting a medical professional and investing in a treatment.

Do not be overwhelmed by the term microdermabrasion. To break it down, the procedure is just a light abrasion of the top layer of the skin. Most people look to microdermabrasion to treat acne and other surface blemishes. The procedure propels micro aluminum oxide crystals at the skin to exfoliate the surface and rid the skin of dead cells. This also clears out dirt particles and blemish-causing elements. Some microdermabrasion treatments use a technique without crystals, but this is the most common form. Because this procedure affects the top layers of skin, it’s considered to be generally safe. Some patients may have redness on the skin for a few hours after the procedure.

One drawback to microdermabrasion is that is only temporary. Treatments usually only last a few months before the effects wear off and patients must undergo the same procedure again. If your skin concerns are more surface-level in nature, though, this may be a good option for you. Although more intensive treatments last longer, they can often irritate the skin. If you suffer from whiteheads, blackheads, or just dull skin, then irritating the skin may actually cause more problems.

Chemical peels are usually more intensive, but the same treatment techniques can be applied in different depths depending on your needs. Some chemical peels have a very fast recovery time, while deep peels may require months of healing. This often depends on the skin conditions the patient wants to treat. Like microdermabrasion, chemical peels can treat acne and freshen up dull skin. Deeper peels, however, can also improve the look of wrinkles and photo-aging.

The peel treatment uses chemical solutions to actually intentionally damage the skin, but in a controlled manner. Different chemicals affect the skin in different ways, and several peels may be required to reach the desired result. Peel procedures are safe and commonplace, but deeper peels may require anesthesia and the monitoring of vital signs. If this worries you, then it may be wise to start with microdermabrasion. Chemical peels can last for years. Patients will need to have repeated procedures eventually, but maintenance is much easier than with microdermabrasion.

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