facial contouring in asian: introduction & trend in hong kong
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Facial Contouring in Asian:Introduction & Trend in Hong Kong
322nd & 323rd HKDU Sunday Symposium
Speaker: Dr. Lam MeiPresident, Hong Kong Medical Aesthetic Association
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林薇醫生Dr. Lam Mei, May
核准刊載資格:香港大學內外全科醫學士, 英國卡的夫大學臨床皮膚學碩士, 英國格拉斯哥皇家醫學院皮膚病科文憑, 香港中文大學社區老年醫學學士後文憑, 香港家庭醫學學院家庭醫學文憑, 愛爾蘭皇家內外科醫學院兒科文憑
組織:主席香港醫學美容協會President of Hong Kong Medical Aesthetic Association (HKMAA)
Email: [email protected]
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Indication for “Facial Contouring”
• Against aging face
– younger looking
• Improving the asymmetrical face
– more beautiful
• balancing the facial proportion
– more attractive
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Treatment options for “Facial Contouring”
• Non-surgical methods
– Botulinum toxin
– Dermal filler
– Collagen stimulator
– Laser
– Chemical peel
– Energy-based machine
– Orthodontic treatment
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• Surgical methods
– mid-facelift, neck lift, brow lift
– upper/lower blepharoplasty
– Rhinoplasty
– orthognathic surgery, genioplasty
– Lip augmentation/lip reduction
– Liposuction
– Fat transfer
Treatment options for“Facial Contouring”
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How do we aged?
Stuzin JM, Baker TJ, Baker TM. Refinements in face lifting: enhanced facial contour using Vicryl mesh incorporated into SMAS fixation. Plast Reconstr Surg 2000; 105:290-301
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How do we aged?
• 1) Skin
• 2) Fat Compartment
• 3) Superficial muscular aponeurotic system(SMAS) layer
• 4) Mimetic Muscle
• 5) Skeletal Bone
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Skin aging
Fisher GJ, Varani V, Voorhees JJ. Looking older: fibroblast collapse and therapeutic implications. Arch Dermatol 2008; 144:666-672
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skin thickness , breakdown of collagen/elastic
Wrinkle
Skin laxity
melanocyte activity
Skin pigments and pre-malignantchange
Dermis hyaluronic acid
Skin turgidity, dehyration of skin
Skin aging
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Fat CompartmentAtrophy & Redistribution in aging
Safi Kang. A noval facial fat transfer technique with a concept of volumetric lifting
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Safi Kang. A noval facial fat transfer technique with a concept of volumetric lifting
Fat CompartmentAtrophy & Redistribution in aging
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Superficial muscular aponeurotic system(SMAS) layer
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SMAS layer aging
• Connective tissue fibre
• Loss of elasticity by aging
• Loss of elastin
• Ptosis of facial volume esp. midface/Nasolabial fold
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How do we aged?
Source: “The Anatomic Basis of Midfacial Aging 2” Allan E. Wulc, Pooja Sharma, and Craig N. Czyz
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Aging in mimetic muscles
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Aging in mimetic muscles
• Increase resting tone of muscle with aging
• Repeated contraction of mimetic muscle
• Change in fat distribution (static lines/folds)
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Skeletal bone aging
• Midfacial soft tissue malposition
• Sclera show
• Tear trough deformity
• Deepening of nasolabialfold
An Algorithm of Facial Aging: Verification of Lambros’s Theory by Three-Dimensional Stereolithography, with Reference to the Pathogenesis of Midfacial Aging, Scleral Show, and the Lateral Suborbital Trough Deformity Joel E. Pessa, M.D.
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Facial Contouring: non-surgical method
– Botulinum Toxin
– Dermal filler
– Collagen stimulator
– Energy-based machine
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Botulinum Toxin
• Botulinum toxin (BTX) is a neurotoxin protein produced by Clostridium Botulinum and related species
• There are two main commercial types: botulinumtoxin type A and botulinum toxin type B
• 5 registered neurotoxin in HK:– Botox
– Dysport
– Siax
– Xeomin
– BTXA
• All are botulinum toxin A
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Facial contouring
• Wrinkle (dynamic line)
– By mimetic muscles
• Contouring
– By masseter muscle/temporalis
– Mentalis m.
– Platysma m.
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Aging in mimetic muscles
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Facial Contouring: non-surgical method
– Botulinum Toxin
– Dermal filler
– Collagen stimulator
– Energy-based machine
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Dermal fillers
• Biodegradable– Hyaluronic Acid
• Eg. Restylane, Juverderm, Teosyal, Emervel etc..
– Injectable Collagen (out of fashion)• Eg. Evolence
– Calcium hydroxylapatite• Eg. Radiesse
– polycaprolactone (PCL) • e.g. Ellansé
–自體脂肪移植 (Fat Transplant)
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Dermal Filler
• Non-Biodegradable (controversial)– Injectable silicone
• Very rarely been used worldwide
– Polyacrylamide – PAAG• Eg. Aquamid• Eg. Amazing Gel in China
– Polymethylmethacrylate - PMMA• Eg. Artecoll
• S.E.– granulomatous reaction, migration,
cellulitis,ulcerations and disfiguring scars, toxic to healthy tissue (PAAG), carcinogenic (PAAG)
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Hyaluronic acid
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NASHATM (Non-Animal Stabilized Hyaluronic Acid)
largemediumSmall to medium
small
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Source: www.juverderm.com
Fat Compartment Aging (Volume loss)
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Facial Contouring: non-surgical method
– Botulinum Toxin
– Dermal filler
– Collagen stimulator
– Energy-based machine
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Poly-L-Lactic-Acid ( PLLA)
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• Injectable poly-L-lactic acid – Bioabsorbable– has been used for decades in dissolvable stitches– Replaces lost collagen in the area of treatment
• FDA approved, result last up to 25 months• ‘liquid facelift’• Does not contain human, animal, or bacterial
components• Does not require allergy testing prior to
treatment
Poly-L-Lactic-Acid ( PLLA)
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Facial Contouring: non-surgical method
– Botulinum Toxin
– Dermal filler
– Collagen stimulator
– Energy-based machine
• Mono-polar radiofrequency (Thermage™)
• High-Intensity Focused Ultrasound (Ultherapy™)
• Microneedle Fractional RF (Infini™, Scarlet™)
• Fractional laser (ablative: CO2/ErYag, non-ablative: 1440nm, 1540nm)
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Energy-based machine
• Non-invasive facelift
• Heat up skin/Subcutaneous fat/SMAS layer
– Create micro-coagulation zone
– Trigger wound repair response
– fibroblast stimulation, collagen reformation
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“Evaluation of a Microfocused Ultrasound System for Improving Skin Laxity and Tightening in the Lower Face” Georgette et al.,Aesthetic Surgical Journal 1Sep2014
Energy-based machine
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Mono-polar RF
• Thermage
– FDA clearance for non-invasive, energy-based eyelid treatments.
– Non-invasive treatment of wrinkles and rhytids
– Temporary improvement in the appearance of cellulite
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High-Intensity Focused Ultrasound
• FDA cleared Ulthera™ System
– lifting of lax submental(beneath the chin)
– eyebrow
– neck tissue
Source: http://www.ultherapy.com/Ultherapy
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High-Intensity Focused Ultrasound
Source: http://www.ultherapy.com/Ultherapy
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Microneedling Fractional RF
http://www.usa.lutronic.com/infini
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http://www.usa.lutronic.com/infini
Microneedling Fractional RF
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Fractional laser resurfacing
• Non-ablative vs ablative
• Indications
– Wrinkles
– Acne atrophic scar
– Skin tightening
• fractional photothermolysis
– microscopic treatment zones (MTZs)
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Facial Contouring:Current Trend in Hong Kong
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• Prefer Less to no down-time
• Lunch time procedure
• Prefer non-invasive to minimal invasive options
• Prefer natural and gradual effect
• A taboo
• Male clientele
• Wider age range
• Selfie and photogenic
Facial Contouring:Current Trend in Hong Kong
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任何問題?[email protected]