radiesse injection vectoring

®

Guidelines for injection techniquesComplete facial rejuvenation using the 3D ectoring Lift

Injection_Technique_Guidelines Vector_RZ_R.indd 1Injection_Technique_Guidelines Vector_RZ_R.indd 1 21.03.11 17:4121.03.11 17:41

®

Fixed areas Mobile areasF1 M2 F3

THE AGEING PROCESS AND TISSUE MOBILITY

The human face does not age uniformly. We can distinguish fi xed areas and mobile areas:

1. Fixed areas (F1 and F3):

Fixed areas of the face will mostly stay in position.

They preserve the identity of the person.

They function like anchor points for the skinand the muscles.

Also the supporting ligaments provide extrastructural support.

2. Mobile areas (M2):

In between the fi xed areas of the face, we fi nd mobile areas more subject to gravity.

Tissue mobility is greater in the medial areas (central zone).

The most important are the facial fat compartments that gradually get more separated and displaced. Volume loss also adds to the ageing process.

Other factors of ageing include sagging skin and laxity in the facial ligaments.

FAT COMPARTMENTS

Facial fat was once thought to be a confluentmass that was eventually weighed down by gravity, creating sagging skin, wrinkles and sulci.Actually we have facial fat compartments.

Fat composition varies from compartment tocompartment:

More dense and less mobile as you approachthe pre-auricular or lateral cheek aspects.

Midline of the two sides of the face is just theopposite: fat is less dense and tissue has thegreatest mobility.

Facial ageing is, in part, characterised by howthese separate compartments change as wegrow older.


2 Dimensional (2D)

Surgical Rejuvenation

Lateral lift

Vertical lift

3 Dimensional (3D)

Facial Vectors for Rejuvenation

Lateral lift

Vertical lift

Volume (projection)

12

3

4

®

RETAINING LIGAMENTS

The retaining ligaments of the mid-lateral facemaintain the skin in its normal anatomic position,but they become less tight during the ageingprocess.

1 Orbital retaining/malar ligaments = responsible for malar mounds

2 Zygomatic ligaments = responsible for mid cheek ptosis (creation of nasolabial folds)

3 Masseter-cutaneous ligaments = responsible for cheek hollows, marionette lines,oral commissures

4 Mental ligaments = responsible for pre-jowl sulcus

WHAT IS A 3D VECTOR?

The changes in the face due to ageing can bedenoted as the “negative vectors of ageing”:

A vector is a quantity with a certain (negative) direction and magnitude.

They can be visualised by a line or an arrowpointing downwards and inwards to show thedirection of the facial changes.

Since they have an anatomic basis, they arepredictable and common to all individuals.

Since volume loss contributes to the ageingprocess, we speak about three dimensional(3D) negative vectors:

Lateral tissue ptosis

Vertical tissue ptosis

Volume loss

The correction of these vectors in reverse direction (positive vectors) requires from thepractitioner a comprehensive vector and volume analysis:

Just augmenting lines or folds does not address the underlying issues of fat displacement.

Objective of treatment should be to restore each fat compartment to its original position,providing a lateral and vertical lift; and providing a 3D-correction by the restoration of volume loss:

The displacement of soft tissue (negative vector) that occurs under the infl uence of gravity is conditional on laxity being present.

Correction of laxity in the vector of displacement (positive vector) nullifi es the effect of gravity.


* Alternatively to the two needles (28G needle (27G inner lumen) 0.75”, 27G needle, 1.25”) provided by Merz Aesthetics, you may inject with one of the Merz Aesthetics cannulas available in the following sizes:

- 25G 2“ (50 mm) - 27G 1.5“ (38 mm) These ultra thin wall cannulas can deliver excellent cosmetic results

with less trauma for the patient (likely less hematoma, less bruising). At the same time they minimise the downtime for the patient

and consequently lead to increased patient satisfaction.

1:1 TRAINING OPPORTUNITY If you are interested in exchanging clinical works and best practices on a personal 1:1 basisin your office, please ask your dedicated account manager for further information on our Field Clinical Specialist trainings.

®

GENERAL BEST PRACTICE GUIDELINES WITH REGARD TO THE USE OF RADIESSE®

Points to note before injecting with Radiesse®

Before the injection

Consult with patient and identify area(s) to be injected and discuss desires and expectations.

Obtain patient consent on appropriate form.

Take photographs before and after the injections.

Provide some level of anaesthesia (Merz’ Anaesthesia Guidelines).

Use a non-permanent skin marker or white make-up pencil to mark areas to be treated (if necessary) with patient in upright position.

Prep skin with alcohol or skin cleanser of choice.

Performing the treatment

Open the Radiesse® foil package. Note there may be a few moisture droplets inside, which is normal.

Affi x the needle or cannula* of choice and always prime the needle or cannula before injecting.

Inject fi ne threads in multiple passes in a retrograde fashion; no need to remove needle from the skin between threads.

Massage and mould injected areas to smoothen any subtle irregularities; be mindful where multiple products have been injected.

For further information please consult Radiesse® Instructions For Use (IFU) enclosed in the package.

Discard any unused product.

After the treatment

Inform your patient of post-treatment measures.


5. For the cheeks, temporal hollows and liquid face-lift: mark the zygomatic arch borders.

12

3

4

5

Supraperiosteal injection

epidermis

dermis

subcutis

muscle

bone

epidermis

dermis

subcutis

Subdermal injection

®

MAPPING THE FACE

1. Mark the infraorbital rim. Contra-lateral side may differ. If the level of the two rims differ, lower the line of the higher rim to match the level of the lower rim.

2. Mark the infraorbital foramen. Use cotton-tipped applicator to find this subtle depression under the tissue. Patient will feel and verbalise nerve irritation.

3. Draw the medial canthal line, parallel to the patient’s nasolabial fold. Product placement should stay lateral from this line.

4. Mark the inferior cheekbone border by drawing a line from the peri-alar triangle to the tragus.

General rule of thumb Above this line, inject supraperiosteally (onlay implantation) and subdermally only for lateral zygoma

enhancement when blending surrounding areas.

Below this line inject subdermally.


1

2

1

3

2

1

2

Lifting of the nasolabial fold Lifting of the marionette fold Lifting/contouring of the jaw line

®

APPLY A COMPREHENSIVE APPROACH – THE 3D- ECTORING LIFT

Linear threading and fanning technique

27G needle, 1.25” 27G cannula, 1.5” (38 mm) 25G cannula, 2” (50mm)

To reverse a negative vector - Injection technique using a needle:

Map the face (see Mapping the Face), determine your injection points and mark your target area for correction.

Choose your anchor point superior and lateral to the target area. Pull the skin at your anchor point to ensure you are targeting the tissue appropriately.

The greater the tissue laxity in the central zone, the greater the need to begin your fi lling near the base of the tragus (laterally) to help anchor the tissue.

Aim 0.1cc long support threads (to act as struts) toward the target area you wish to correct/lift.

Support threads should stay aimed towards your marked target.

Advance to your next insertion point, medial, to place more support threads, keeping threads aimed towards your marked target.

Support threads have maximal impact when they stay as close as possible to the area you are restoring/lifting.

Placing strains of Radiesse® into the skin stimulates collagen neogenesis with subsequent tissue retraction and lifting of the target area

Injection technique using a cannula

Map the face (see Mapping the Face), determine your injection points and mark your target area for correction. When using a cannula, compared to a needle, only two insertion points are needed to perform a full liquid face-lift.

Choose your anchor point superior and lateral to the target area. Pull the skin at your anchor point to ensure you are targeting the tissue appropriately.

The greater the tissue laxity in the central zone, the greater the need to begin your fi lling near the base of the tragus (laterally) to help anchor the tissue.


1

2

®

Infi ltrate the skin with lidocaine for your two insertion points (see Anaesthesia Guidelines).

Make the insertion point with a 27G or 25G needle. Insert the needle into the dermal/subcutaneousjunction or subcutaneous space and move the needle from left to right. Lift skin up with needle(with the bevel up) and retract from skin.

Insert the cannula at the fi rst insertion point. By pulling the skin up with the non-dominant index fi nger and thumb, you can advance your cannula easier through the insertion point and skin.

Aim 0.1cc, long support threads using fanning technique (to act as struts) toward the target area you wish to correct/lift, starting top down.

From a second insertion point, using the fanning technique, further lift and augment the face.

SUMMARY

Using the vectoring technique allows you:

to follow a full facial rejuvenation approach

to achieve great results using less product

to provide anchoring support and to avoid the weighting down of tissue in the mobile areas of the face.


03/1

1

Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt am Main, Germanywww.merzaesthetics.com


radiesse injection vectoring

Health & Medicine