RU2824703C1 - Method of preventing and correcting changes in face shape caused by aging - Google Patents

Abstract

FIELD: medicine; dermatology; cosmetology; plastic surgery.

SUBSTANCE: invention can be used for prevention and correction of face shape changes caused by aging. Performing hardware exposure using ultrasonic SMAS-lifting, which includes procedure of 80 lines using 4.5 mm attachment on each side of face and 20 lines on the mental region, of 80 lines using 3 mm attachment on each side of face and 30 lines on the mental region, from 45 lines with help of 1.5 mm attachment on each side of the face and from 40 lines on the mental region. Then, a bolus and linear retrograde technique is used to inject 1–3 ml of the filler from each side of the face into the temporal area under the ligamentous space in the projection of the hair growth zone.

EFFECT: method enables to achieve a synergetic effect of using volumetric correction and hardware SMAS-lifting and reduce injuries due to application of two techniques in one procedure and selection of optimal parameters of ultrasonic SMAS-lifting, zone and technique of filler introduction based on hyaluronic acid.

1 cl, 9 dwg

Description

The invention relates to medicine, in particular to cosmetology, dermatology, plastic surgery. It combines two mutually potentiating methods of aesthetic improvement of appearance - the introduction of fillers and hardware SMAS-lifting. The proposed method is intended to improve the condition of the skin, the ligamentous apparatus of the facial muscles, compaction of the middle part of the cheeks and jowls, as well as for volumetric correction of the temporal and zygomatic areas.

In modern cosmetology, a trend towards complex low-trauma procedures can be clearly identified. The lack of time for a course and for a long recovery after injections makes the patient want to get the maximum effect in 1 hour and for a long time. Already the next day (maximum on the third) after cosmetic, sometimes serious, interventions, the patient wants to be fully socialized. In particular, the growing percentage of male patients who are afraid of hematomas and edema plays a role.

Another trend is the patient's fear of getting an unnatural result from the procedures. Hypercorrection and delayed swelling after the introduction of fillers is what can forever push the patient away from injection cosmetology.

I would like to point out some features of aging that are clearly visible to a practicing specialist. This is a visual redistribution of facial volumes to the medial side, sometimes accompanied by an increased tendency to swelling, with long-term correction with a filler of only the middle part of the cheek, tear trough and nasolabial folds. This can be especially noticeable in a patient with pronounced superficial fat pads against the background of skeletonization of the lateral parts of the face. In our country, the deformation and tired types of aging prevail. Therefore, it is worth thoughtfully approaching the direct adaptation of foreign filler injection techniques. In many countries, the fine-wrinkle and muscular types prevail, which are less prone to swelling. Also, you should not ignore marketing and pricing. It is more convenient and profitable for the patient to receive a ready-made package of procedures at a significant discount (ideally at a fixed price, depending on the positioning and region of the clinic) in one hour and with an excellent result. And for the clinic and the doctor, this is a good way to increase productivity while simultaneously satisfying the patient.

Volumetric techniques are known that involve depositing the preparation at the level of deep fatty tissue to restore the volume of soft tissues inherent in youth. In this case, the main instrument used to introduce the implant, in particular the hyaluronic acid-based filler, is a 27G diameter, 1.3 cm long needle (Medical technology "Contour plastic surgery with intradermal implants based on hyaluronic acid" / 10 / Clinical and experimental dermatocosmetology, No. 3, 2007).

However, the use of a needle is accompanied by an increased risk of damage to important anatomical routes, since the facial part of the skull is characterized by the presence of numerous vascular-nerve bundles, often located supraperiosteally and adjacent to the level of deep fat pads. Thus, in the zygomatic, lateral cheek area there is a zygomaticofacial vascular-nerve bundle responsible for sensitive innervation and blood supply to the periorbital area, as well as branches of the facial nerve (temporal, zygomatic, buccal), responsible for the motor innervation of the same areas, branches of the transverse artery and vein of the superficial temporal artery. When injecting with a needle in the described areas, this gives in practice a high risk of developing a number of side effects and complications, such as hyperemia, hematomas, edema, embolization of an artery or vein (transverse, superficial temporal) due to the filler entering the lumen of the vessel.

The "Method of Volumetric Correction of the Zygomatic and Buccal Regions" is known under Russian Patent No. 2587847. According to this method, a hyaluronic acid-based drug is injected using a cannula. In this case, a safe access point for the cannula guide needle is selected, for which the zygomatic bone is localized by palpation and the zygomatic arch is marked. Then, the lower lateral angle of the orbit is palpated and, stepping back from it by 4 cm parallel to the lower bony orbital edge, lateral to the orbit, a safe access point for the cannula guide needle is applied with a marker in the marked area of the zygomatic arch. After that, zones with a volume deficit of soft tissues in the zygomatic and buccal regions are marked, and in the direction of these zones, markings are made of the expected vectors of the cannula passage, diverging in the form of rays from the safe access point. Then, hyaluronic acid is injected through the selected safe access point using a linear-retrograde technique in the direction of the cannula passage vectors, with a volume of the preparation of no more than 0.1-0.2 ml of filler per vector.

The disadvantage of this method is the lack of elimination of the deficit of deep fat tissue in the temporal region as the main cause of facial ptosis in patients with severe aging. As well as the risk of distortion of appearance and increased swelling.

Hardware SMAS lifting is known, in which high-intensity focused ultrasound is used to affect the SMAS layer.

Microfocused ultrasound, penetrating the muscular-aponeurotic layer, helps to restore muscle tone and normalize collagen synthesis in cells, which leads to the restoration of facial and body contours, improved skin color and the elimination of signs of aging (https://cosmosclinic.ru/apparatnaya-kosmetologiya/smas-lifting).

The advantage of this method is the reduction of facial tissues using non-invasive focused ultrasound at different levels. The disadvantage of this method is the inability to compensate for the tissue volume deficit.

Known is the patent for invention of the Russian Federation No. 2576084 "Method for prevention and elimination of changes in facial skin caused by aging", which is accepted by the author as a prototype. According to this patent, the following sequence of procedures is carried out during one session: chemical or mechanical grinding, which is selected in accordance with the changes existing in the patient, then hardware exposure to microcurrents with a frequency of 0.3 Hz, a current of 400 μA, with an asymmetric bipolar pulse shape repeating the shape of a physiological nerve impulse. Then they act with a device that provides ultrasound exposure in combination with local dynamic massage, with exposure in each of these two modes of operation of the device on each side of the face, a frequency of 10 MHz, a penetration depth of up to 3 mm. Subsequently, 7-12 epicentral lymphotropic injections of a drug selected in accordance with the individual changes in the skin of a particular patient are carried out. A month later, the session is repeated, including the entire sequence of the above procedures. The exposure time for microcurrent and ultrasound is selected depending on age.

The disadvantage of the known method is the possibility of side effects, complications and distortion of appearance, due to the fact that during volumetric correction, the zone of drug administration is not selected and there is no effect on the most common and pronounced cause of facial ptosis - on the degradation of deep fat packets and the increase in superficial fat packets. Also, the methods presented in the patent are performed using extremely rare devices and involve a long duration of procedures.

The objective of the invention is to reduce the risk of developing side effects, complications and distortions of appearance (unnaturalness) during volumetric correction by means of a correctly selected injection zone, as well as simultaneous reduction of tissues of the middle part of the cheek and jowls using hardware SMAS-lifting.

The technical result is the achievement of a synergistic effect from the use of volumetric correction and hardware SMAS-lifting, which optimizes the time spent on procedures, significantly reduces the trauma of procedures, thereby reducing the recovery time after the procedure, achieving a natural effect, and reducing the risk of unnatural distortions of appearance.

The technical result is achieved due to the fact that in the method of prevention and correction of changes in the shape of the face caused by aging, which includes hardware exposure and subsequent introduction of fillers in one procedure,

- hardware impact is carried out using hardware ultrasound SMAS lifting with an emphasis on the cheek fat packet, while using a 4.5 mm nozzle, they act in the lateral area to reduce the ligaments, and in the middle part of the cheek and the jowl area, using 3 mm and 1.5 mm nozzles, they compact the fat packets taking into account the condition of the patient's individual fat packets, specifically acting on the desired layers,

- the filler is injected into the temporal area under the ligament space in the projection of the hair growth zone using a cannula, using the bolus and linear-retrograde injection technique, injecting 1-3 ml of filler on each side of the face using two syringes with 22 G 70 mm cannulas towards the hairy part of the temporal region of the face and into the subzygomatic space, then, using the same puncture, inject 0.5 - 1 ml of filler on each side of the face towards the hairy part of the temporal region using a third syringe with a 22 G 50 mm cannula, using the linear-retrograde injection technique.

An additional difference of the proposed method is that

- SMAS lifting is performed on the Ultraformer, or Ultera, or Beeliftbee device (the Beeliftbee device was developed in 2022 in Russia and is currently undergoing certification);

- ArtFiller Volume is used as a filler;

- to correct the nasolabial folds and corners of the mouth, 1.2 ml of ArtFiller Universe is injected into the subcutaneous fat tissue using a linear-retrograde technique.

The proposed method is explained by the following illustrations:

Fig. 1 - "young" bones of the facial skull, Fig. 2 - age-related resorption of bone tissue,

Fig. 3, Fig. 4, Fig. 5 and Fig. 6 are sequential photographs of the patient’s face (G., 34 years old) before the procedure and SMAS (Fig. 3), with the filler injection vector marked (Fig. 4), immediately after the filler and SMAS procedure (Fig. 3), and one month after the procedure (Fig. 6).

Fig. 7, Fig. 8, Fig. 9 - photographs of the face of patient R., 38 years old

Fig. 7 - before the procedure, where the projection of the deficiency of deep fat packets is indicated in blue; the projection of excess subcutaneous fat is indicated in red.

In Fig. 8, the blue lines schematically indicate the vectors of filler introduction, the red lines indicate the projections of the effect of the 4.5 mm nozzle, and the green lines indicate the effect of the 3 mm nozzle.

Fig. 1 - "young" bones of the facial skull, Fig. 2 - age-related resorption of bone tissue,

Fig. 3, Fig. 4, Fig. 3 and Fig. 6 are sequential photographs of the face of patient G., 34 years old, before the procedure and SMAS (Fig. 3), with the filler injection vector marked (Fig. 4), immediately after the filler and SMAS procedure (Fig. 3), and one month after the procedure (Fig. 6).

Fig. 7, Fig. 8, Fig. 9 - photographs of the face of patient R., 38 years old

Fig. 7 - before the procedure, where the projection of the deficiency of deep fat packets is indicated in blue; the projection of excess subcutaneous fat is indicated in red.

In Fig. 8, the blue lines schematically indicate the vectors of filler introduction, the red lines indicate the projections of the effect of the 4.5 mm nozzle, and the green lines indicate the effect of the 3 mm nozzle.

Fig. 9 - after the procedure three weeks later

Facial aging is a complex, multifactorial process involving changes in bone, soft tissue, and skin. It is a complex process in which changes in one layer often trigger a cascade of changes in adjacent layers. The supporting function of bone declines as it undergoes atrophy and age-related resorption, leading to flattening and repositioning of overlying soft tissue structures.

In particular, fat pads and muscles are displaced downward and medially, changing their position in accordance with the transformation of the bone base.

From the age of 30 onwards, the proportions of the upper, middle and lower thirds of the face are disrupted: the orbit becomes skeletonized, the nasolacrimal groove is formed, the piriform opening widens, the height of the upper jaw decreases, the lower part of the forehead may become flatter, the tip of the nose drops, the columella retracts, the base of the wings of the nose widens, the eyes become visually smaller and appear rounder.

Although the magnitude of the changes observed at the deepest anatomical level is small, their impact is significant because they are amplified in the overlying structures.

Superficial fat packets are more mobile and are subject to both resting pressure and dynamic tension during contraction of facial muscles. With age, superficial packets shift and hypertrophy.

Superficial fat pads in most cases require support, lipolysis and drainage, but not volumization with filler. Deep fat pads are immobile, as they are tightly attached to the underlying bone structures. They form the contours of the face, serve as a base for superficial fat pads and a sliding plane for muscle fibers. Deep fat pads atrophy with age - the cheeks become sunken, the facial angles flatten, the temples sink in.

The peculiarity of the method is that it takes into account the condition of the patient’s fat packets and specifically targets the required layers.

In the Russian Federation, patients with a lack of tissue in the lateral region (subzygomatic region, temporal region) predominate - this is a lack of deep fat packets. Moreover, deep fat packets in these patients degrade regardless of their own body mass index and often at a fairly early age (from 25 years).

In the middle part of the face, on the contrary, there is most often an excess of subcutaneous fat tissue (SFC), represented by superficial fat packets (medial part of the cheek, nasolabial fat packet, jowl area). Visually, these overhanging fat packets create gravitational ptosis and form the nasolabial fold and jowls. In addition, their excess increases the pastosity of the tissues with each passing year. This is especially often manifested at an early age with a small size of the lower jaw (distal bite, hypognathia).

The proposed method for preventing and eliminating changes in the shape of the face caused by aging is carried out as follows: The first stage is hardware SMAS lifting with an emphasis on the cheek fat pad. The task is to use a 4.5 mm nozzle to act in the lateral area to reduce the ligaments, and in the middle part of the cheek and the jowl area using 3 mm and 1.5 mm nozzles to compact the fat pads. Basic protocol: 4.5 mm 80 lines per side and 20 lines on the chin area, 3 mm 80 lines per side and 30 lines on the chin area, 1.5 mm 45 lines per side and 40 lines on the chin area. A total of 500 lines. The protocol can be performed asymmetrically at the discretion of the doctor, if the patient's face is noticeably asymmetrical. By applying a large number of lines to the subcutaneous fat (3 and 1.5 mm nozzles) on one side of the face, it is possible to achieve stronger compaction of the medial part of the face and thus make the face more symmetrical. It is also worth noting that most patients note a decrease in facial swelling 3-4 weeks after the procedure.

Next, the injection area is pre-treated with a surgical antiseptic (Triosept Ol).

The second part of the method is volumization with fillers (expanded lifting, temporal lifting, temporal lifting, lateralization) of the lateral areas of the face at the level of deep fat packets. Introduction under the fascia, and not into the subcutaneous fat, provides a noticeable tissue lifting. This technique allows you to introduce a significant amount of filler without the risk of remote edema or distortion of appearance. Simultaneously with this, volumization of the area of the angles of the jaw and subzygomatic space is performed. Although the correction of the angles of the jaw does not actually lead to lifting, it effectively aligns the line of the oval of the face and gives more harmonious proportions.

The choice of preparation for this correction is ArtFiller Volume 3 syringes (3.6 ml). Cannulas - 22 G 70 mm and 22 G 50 mm. Cannulas 22 G 70 are installed on 2 syringes and 22 G 50 on the third syringe.

The puncture for the cannula is made in the area of the ideal location of the jaw angle, without reference to the actual location of the bone base.

They start with a 22 G 70 mm cannula. The injection start level is the superficial fatty tissue (the cannula easily lifts the tissue during the test). In the subzygomatic region, they begin to deepen the cannula to get under the SMAS (the cannula is poorly visualized during the test). In the area of the lower edge of the zygomatic arch, applying pressure with a finger on the tip of the cannula, they deepen even more and get under the fascia. The tip of the cannula ends up in the projection of the hairy part of the temporal region. The cannula is not visualized and hardly lifts the overlying tissues. At the same time, the cannula easily and painlessly for the patient slides under the fascia (for differential comparison of layers - in the subzygomatic fat, the cannula slides in this area with difficulty and with painful sensations for the patient). The injection technique is bolus and linear-retrograde. For a pronounced result, 1.2 ml of ArtFiller Volume is injected into this area on each side. Next, the third ArtFiller Volume syringe is taken. The task is to visually and aesthetically “connect” the cheekbone and jaw angle area. To do this, vectors are laid out vertically towards the hairy part of the temporal region. The injection technique is linear-retrograde. The cannula is cut down. In this case, it is necessary to emphasize the oval line of the face. To do this, vectors are laid out in the medial direction, preventing the filler from getting into the superficial fatty tissue of the jowl area. The proportion of filler distribution in the jaw angle area may vary in different patients depending on the goals and initial condition.

For correction of nasolabial folds and corners of the mouth, ArtFiller Universe 1.2 ml is used. Injections are performed in the subcutaneous fat pad. The technique is linear-retrograde.

The effect of focused ultrasound leads not only to the reduction and compaction of tissues of the middle part of the cheek and jowls, but also significantly reduces the tendency to swelling in this area.

Combining two techniques into one procedure not only provides a more pronounced cosmetic effect, but also reduces the time spent on procedures for both the doctor and the patient.

Thus, the advantages of the proposed method are:

- minimally invasive and fast recovery,

- the procedure does not cause hematomas or significant swelling - even immediately after the procedure, the patient can lead a normal life, following the recommendations,

- safety, since the risk of vascular complications is minimal,

- the effect is visible immediately and increases over 1.5 months,

- the effect lasts up to 2 years,

- a complete absence of distortion of appearance is achieved (natural result),

- the tendency to edema is reduced (and not increased, as with the introduction of fillers into the middle part of the face),

- high speed of implementation is achieved (an experienced specialist completes the procedure in 1 hour),

- suitable for long-term patient management,

- does not contradict or interfere with future surgical lifting,

- there are no restrictions on the patient's age.

Claims (6)

1. A method for preventing and correcting changes in the shape of the face caused by aging, including hardware intervention and subsequent introduction of fillers in one procedure, characterized in that - hardware impact is carried out using hardware ultrasound SMAS-lifting with an emphasis on the cheek fat packet, while using a 4.5 mm nozzle, they act in the lateral area to reduce the ligaments, and in the middle part of the cheek and the jowl area, using 3 mm and 1.5 mm nozzles, they compact the fat packets taking into account the condition of the patient's individual fat packets, specifically acting on the desired layers, - the filler is injected into the temporal area under the ligament space in the projection of the hair growth zone using a cannula, using the bolus and linear-retrograde injection technique, injecting 1-3 ml of filler on each side of the face using two syringes with 22 G 70 mm cannulas towards the hairy part of the temporal region of the face and into the subzygomatic space, then, using the same puncture, 0.5-1 ml of filler is injected from each side of the face towards the hairy part of the temporal region using a third syringe with a 22 G 50 mm cannula, using the linear-retrograde injection technique, while the basic protocol of hardware sound SMAS-lifting includes a procedure of 80 lines using a 4.5 mm nozzle on each side of the face and 20 lines on the chin area, 80 lines using a 3 mm nozzle on each side of the face and 30 lines on the chin area, 45 lines using 1.5 mm attachments on each side of the face and 40 lines on the chin area. 2. The method according to item 1, characterized in that SMAS lifting is performed on the Ultraformer, or Ultera, or Beeliftbee apparatus. 3. The method according to item 1, characterized in that the filler used is the ArtFiller Volume preparation. 4. The method according to item 1, characterized in that for the correction of nasolabial folds and corners of the mouth, 1.2 ml of the ArtFiller Universe preparation is injected into the subcutaneous fatty tissue, using a linear-retrograde technique.