Isolated work with the lower face will not produce long-term results without working with the mid face. Prevention and timely correction are also important in maintaining oval shape, especially with excess subcutaneous fat. Therefore, if there are indications, it is worth starting work with the lower face without waiting for a pronounced problem to form.
In the lower face, thread lifting, instrumental techniques and botulinum therapy work well. A special place is given to methods of collagen stimulation and maintenance of the collagen pool of soft tissues of the face. However, the most effective are combined programs for oval correction using several methods and approaches. When working with older patients (65+), special attention should be paid to restoring the regenerative potential of tissues and, if possible, avoiding overly aggressive and massive instrumental interventions due to the presence of age-related somatic pathology and contraindications.
In clinical practice, preparations based on type I native collagen COLLOST® are widely used to prepare for thread, instrumental and injection collagen-stimulating procedures. Collagen in the COLLOST® product line is presented in the form of fibers with preserved transverse striation and a triple-helix structure, creating the most physiological conditions for the migration and functional activity of fibroblasts. Increased functional activity of these cells, in turn, leads to increased production of natural collagen and normalization of its metabolism in the soft tissues of the face. The COLLOST® product line offers a variety of options to choose the optimal form, dosage and concentration of the product. For older patients with reduced tissue plastic reserve, the option COLLOST® micro is recommended. This product, when injected into the dermis, forms a scaffold based on fibrous collagen microparticles, which provides maximum contact area between fibroblasts and collagen fibers, acting as a restorative therapy for connective tissue. COLLOST® micro is the product of choice for preparation for thread lifting, for enhancing the effect of collagen stimulation from the use of products based on poly-L-lactic acid, and for rehabilitation after aggressive instrumental techniques.
Photo 1. Patient — woman, 68 years old. A, c — before procedures, b, d — after 30 days
Patient — woman, 68 years old. Request for lifting and correction of the facial contour line. History: irregular biorevitalization procedures, botulinum therapy several times, no procedures have been performed in the last 3-4 years.
Objectively: tissue tone and turgor are significantly reduced, manifestations of elastosis and photodamage, subcutaneous fat is moderately expressed, grade III ptosis according to Baker. Taking into account the patient’s age, medical history, somatic status (hypertension III, risk 3, NKIIa, osteoarthrosis of major joints) and wishes, a combined regimen was proposed aimed at increasing tissue tone and turgor, correcting pigmentation, flabbiness, wrinkles and furrows.
It is important to maintain the time interval, since aseptic inflammation in the tissues continues for about a month after the procedure using poly-L-lactic acid. Administration of COLLOST® micro protein product during this period may lead to the development of undesirable effects in the form of visualization of inflammation as well as persistent papules formation. Resorption of collagen material by intrinsic metalloproteases after the procedure using native collagen occurs within a month.
After this period is completed, the procedure is repeated if necessary.
A collagen stimulator based on poly-L-lactic acid was applied at a dosage of 200 mg to the mid face and the lower face. The COLLOST® micro product was hydrated with sterile physiological sodium chloride solution in a volume of 2.0-2.5 ml. Two bottles were used for one procedure; the total dose of dry collagen substance was 300 mg. The periorbital area, the lower face, the periauricular, perioral, and submental areas were treated. For the area around the eyes, the product consumption is 0.5-0.7 ml on both sides, micropapular technique is used, strictly intradermally, 33G × 4 mm needle. The remaining volume of the preparation, about 4 ml, was used for the remaining areas. Micropapular technique, 32G needle, injection depth – dermis.
In the projection of the ligaments, the product was injected subcutaneously in order to strengthen and increase the tone of the facial ligaments.
After a course of replenishing the soft facial tissues collagen pool, the patient notes an increase in tissue tone and turgor, smoothing of wrinkles, skin microrelief alignment, and facial oval correction. The resulting effect can last for 1-1.5 years. In order to increase the effect duration and maintain it, maintenance procedures with COLLOST® micro are recommended once every 2-3 months. Repeated use of the poly-L-lactic acid based product is justified after 1.5-2 years.
Supplementing aesthetic programs with COLLOST® line products based on unreconstructed type I collagen improves the results of procedures and expands the indications for active collagenstimulating effects in older patients.
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