dr daniel lanzer - a clinical approach to the aging face
TRANSCRIPT
Clinical Approach to the Aging Face
FACESFolds Research has shown that loss of facial tissue is a major cause of ageing. The youthful convex cheek is gradually flattened and eventually becomes concave. Most fillers help correct this, especially cheek volume fillers and folds such as nasolabial
• “Man made “fillers and new Fat transfer methods /Fat banking
Angle• Assess the angle of the mouth and the lower face for facial tissue drooping. Face lifting of Skin Suture lift
will be appropriate.
Complexion• With ageing and sun damage the skin looses its fresh look and may become pigmented, thinned and
develop wrinkles. • There is a wide range of approaches for skin texture and skin smoothing, botulinum is also appropriate in
this context.
Eyes• The area around the eyes can create and aged appearance in three ways. Treatments can focus on these
changes.
Side View• A very common cause of aging is the collection of fat and loose skin around the neck that causes a loss of
the angle of the jaw, particularly side on. A relatively simple procedure is described which causes removal of fat and skin retraction.
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FF Folds
• The youthful convex cheek is lost• Shadow• Concave• Wrinkle
• Two options • Hyaluronic acid - Voluma / Q med – cannulated• Autlogous fat
Movie star with depressed cheeks
FF FoldsFat Transfer
•A- Advive• Enclosed system• Centrifuge with filter
•B – Bank• Extraction fact• Pure graft• Cryopreservative – DSMO, Humans Serum Albumin, Dextran 40• Bar code• Slow rate freeze• Deep freeze -190OC
•C – Cellbrush• Microdroplets• Controlled• 19 gauge needle
Fat Transfer
•A- Advive
•B – Bank
•C – Cellbrush
FF Folds and Filler
A-A- Advive
-Enclosed system-Centrifuge with filter
B B – Bank
• Extraction fact• Pure graft• Cryopreservative – DSMO, Humans
Serum Albumin, Dextran 40• Bar code• Slow rate freeze• Deep freeze -190OC
Why Fat Bank?
• Fat often needs to be repeated
• No further liposuction
• Own filler
• ? Role stem cells
• ? other uses
CC – Cellbrush•Microdroplets
•Controlled
•19 gauge needle
Folds
Folds and Fillers
Folds and Fillers
Folds and Fillers
Folds and Fillers
A Angle Mouth / Angle Jaw
Face Lift Assessment•Jowls, nasolabial fold, low face, squaring jaw line•Options – face lift and suture lift•SutureMirror test, non permanent. preauricular fold, neck lipoAdvantage – predicable, simple, less invasive, immediate / no down timeDisadvantage – temporary, preauricular fold, pain ear
Suture Lift
Angle Mouth / Angle Jaw
Suture lift/ facial fillers
Angle Mouth / Angle Jaw
CC Complexion
Skin Texture Assessment •Patients skin texture(olive, fair)•Dyschromia ? Pigmentation / Blood vessels / keratosis•Fine lines•Deep lines(Upper lip)•Active or static (eg eyes or pursing or smile lines)•Folds or wrinkles•Pores
Star with women skin bad
Complexion
laser resurfacing• Deep full face or localised erbium• Demarcation• Sun, fair fine or deep lines ideal
Photorejuvination • Fraxionated, Yag- Revlite, IPL• Airgent
• Lesion directed eg laser for moles, lentigenes, veins
Complexion
Complexion
Complexion
Complexion
Complexion
EE Eyes - UpperAssessment •Look straight ahead without frowning.(is the problem with brow or the skin on upper lid.)•Eye structure / brow structure(what effect will bleph have)•Assess upper medical fat•If both brow and lid assess effect one procedure(remove skin lateral – scar)
Eyes – Upper
Treatment• CO2 Laser Blepharoplasty• Brow lift• ? Suture lift• Brow non surgical – Botox
- Fillers
- Ulthera skin/muscle
Eyes - Upper
Eyes - Upper
Eyes - Upper
Eyes - Upper
Eyes - Upper
EE Eyes - Lower
Assessment •Look straight ahead and then look up(brings fat bulge forward)•Assess position fat(medical, central, lateral)•Assess skin texture lines at rest and/or squint•Assess amount loose skin(subconjunctival or excision)•Assess tear trough(? depression)•Assess surrounding anatomy(?cheeks filler, ?skin full face)
Eyes – Lower
Treatment• Subconjunctival CO2 Blepharoplasty – 3
areas fat• Erbium skin therapy• External Blepharoplasty – tighter skin
- risk: scar, ectropion, lid lag
Eyes - Lower
Eyes - Lower
Eyes - Lower
Eyes - Lower
Summary
SS Side View
Jaw Line•Liposuction• “what happens to skin”•Skin texture(wrinkling less visible)•? Permanent / knumb / hard•Combination option
Side View
Side View
Side View
Side View
Make Over
Make over
Make over
Make over
Make over
Make over