Non-surgical wrinkle treatment and lip correction
Overall, medical treatment of facial wrinkles is divided into three broad categories, depending on their location and the quality of the skin to be treated. Lines in the lower face: - the creases from nose to mouth or chin (nasogenian furrows) - radiating fine lines above the upper lip. Lines in the upper face: - forehead - between the eyebrows (frown lines) - crows' feet Lines due to skin quality - ageing - solar elastosis (sun-induced loss of elasticity)
	Treating lines in the lower face
	Treating lines in the upper face
	Treating lines due to skin quality: LASER RESURFACING

Treating lines in the lower face

Injection techniques are used to fill wrinkles caused either by reduced muscle and/or skin tone or by slackening of the same muscles.

Locally injected products fall into two categories:
- rapid resorption products
- slow resorption products.

1. Rapid resorption products: HYALURONIC ACID

If you wish to fill out your facial furrows to improve the outline of your lips, the answer is Hyaluronic Acid.
This is a stabilised medical implant that is found naturally in all living tissues. It is natural and perfectly safe due to its non-animal origin, meaning that there is no risk of an allergic reaction.

Use:
- lines between the eyebrows
- nose to mouth creases (nasogenian furrows)
- lip corners
- lip correction and filling.

No preliminary test is needed, which means that small injections may be made directly into the skin.

Treatment: Hyaluronic Acid is injected intradermally. The treatment takes around 30 minutes and the result is immediate. Wrinkle filling does not generally need anaesthesia but it is still possible to apply a topical anaesthetic if necessary.

Side effects: the treated area may be slightly swollen and a slight redness may last between 12 and 24 hours.

Duration of results: in contrast with permanent implants, Hyaluronic Acid gives you the choice of renewing the treatment when the effect wears off. It lasts between three months and one year.

And the final result is that the implant is fully degraded and resorbed in the tissue, leaving neither fibrosis nor waste material.

2. Slow resorption products:

This wrinkle filling implant consists of Hyaluronic Acid that will be resorbed (like Restylane) and small fragments of an acrylic hydro-gel, which will not be resorbed and will create a fibrosis after filling.

Indications
All superficial and deep facial wrinkles
Lip correction and filling.

Side effects
Possible light bruising, temporary swelling

Complications
Slight inflammatory reactions are possible but rare.

Advantages
Correction is durable over time (around two years).

Treating lines in the upper face

These lines and wrinkles are due to facial expressions and involuntary movements; repetition results in breaks in the skin manifested by the appearance of wrinkles. The most popular medical treatment today is Botulinum Toxin, which is the name given to Type A botulinum toxin, a purified toxin produced by a bacterium called Clostridium Botulinum.

1. Principle

Very small doses of Botox are injected directly into specific muscles, weakening them and resulting in the disappearance of the wrinkles.

2. Indications

Botox is used for lines of expression or those due to muscular action. In fact the action of the muscles can cause or exacerbate skin breaks or facial lines:
- vertical lines between the eyebrows
- horizontal lines on the forehead
- crows' feet (a good example).

3. Where it is injected

- Between the eyebrows: these frown lines are due to the action of the muscle known as the "corrugato"; injecting Botulinum Toxin directly into this muscle weakens it so that the line disappears.
- Crows' feet: these lines are due to hyperaction of the orbicular muscle of the eyelids; injecting Botulinum Toxin into this muscle removes the lines.
- Horizontal lines in the forehead, due to hyperaction of the frontal muscle.

4. Duration of the results

The treatment practised today takes only a few minutes. The effects begin to appear within three days and are at their maximum on the fifth day after the injection. They gradually decrease after four to six months and the muscular action reappears. After a few injections, muscle contraction is gradually reduced and repeat injections are smaller and at longer intervals.

5. Who can inject Botulinum Toxin

In France, only a doctor experienced in the treatment of wrinkles may give these injections.

6. How Botulinum Toxin has been tested

Botulinum Toxin has been used since 1980 to treat strabismus (squinting) and blepharospasm (eyelid tics). It was first used for treating wrinkles in 1989 by Dr Carruthers of Vancouver.

7. Side effects

There may be a few side effects after the injection, such as small bruises and a feeling of discomfort. No ocular problems or permanent side effects have been described in medical literature.
In about 1% of cases there may be a slight droop to the eyelid, but this is temporary, lasting no more than three weeks.

Treating lines due to skin quality: LASER RESURFACING

Most aggression to facial skin is due to exposure to the sun, leading to a loss of elasticity and the appearance of fine lines, freckles and splotches, giving it a "crumpled" look and speeding up the ageing process. These time-induced problems can now be treated with laser.

1. Technique

Laser actually means light and is in fact only a clever combination of light and air and, depending on the gas this light passes through, the light ray takes on different properties. Laser abrasion is used to "refresh" the skin.

A wrinkle is actually two mountains on either side of a valley:
- either the valley is injected with a filling agent (e.g. hyaluronic acid)
- or the mountains are levelled: this is the case of laser treatment, which vaporises a certain quantity of skin every time it passes.

Another property of the laser is that it causes the skin to retract through the formation of new collagen fibres (shrinking), which considerably regenerates the cutaneous tissue, giving the skin a firmer, smoother and younger look.

There are two types of laser:

a) Ultrapulsed CO2 lasers (first generation) substantially abrade the skin. The heat they generate causes the formation of collagen fibres. This type of laser is intended for deep wrinkles and skin that has lost its elasticity. The CO2 laser is generally used to treat the entire face, the eyelids or the area around the mouth.

b) Erbium Yag lasers (second generation) abrade less deeply and do not cause the skin to retract. They are reserved for isolated superficial lines, and therefore younger skins.

2. Results

Vertical lines around the mouth are a good indication for laser treatment, which gives excellent results. Postoperative redness lasts longer than on the eyelids, around three or four weeks, but may be camouflaged by the eighth day with specifically formulated makeup.

For those with very lined skin, treatment of the entire face (laserbrasion) has more serious consequences. The face remains red and swollen for four days, and then the redness gradually subsides during the following month. For cases requiring more postoperative care, "nursing" is very important but the result is exceptionally harmonious because the entire face looks younger and wonderfully refreshed.
The skin, firmer and more toned, is undoubtedly of better quality.

When only a few facial lines need to be abraded, new generation Erbium lasers are used and here the redness disappears rapidly, after three or four days, at the same time as the treated lines.

3. Risks of laser treatment

Any candidate for this type of treatment must above all find a doctor with lengthy experience of lasers.
The risk most often encountered, for brown or olive skin, is hyperpigmentation (brown spots), which disappears after a few months. But this risk is minimal if the skin is carefully prior to treatment, using suitable depigmentation products.
Another risk, among those suffering from cold sores (herpes virus) is that an attack may occur around the mouth if it has not been curbed by preventive treatment.

4. Conclusion

Laser Skin Resurfacing treatments are today perfectly codified and make it possible to regain a toned and youthful skin.