Facial Contouring in Asian: Introduction & Trend in Hong Kong 322 nd & 323 rd HKDU Sunday Symposium Speaker: Dr. Lam Mei President, Hong Kong Medical Aesthetic Association
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: maylamdr@gmail.com
Indication for Facial Contouring Against aging face younger looking Improving the asymmetrical face more beautiful balancing the facial proportion more attractive
Treatment options for Facial Contouring Non-surgical methods Botulinum toxin Dermal filler Collagen stimulator Laser Chemical peel Energy-based machine Orthodontic treatment
Surgical methods Treatment options for Facial Contouring mid-facelift, neck lift, brow lift upper/lower blepharoplasty Rhinoplasty orthognathic surgery, genioplasty Lip augmentation/lip reduction Liposuction Fat transfer
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
How do we aged? 1) Skin 2) Fat Compartment 3) Superficial muscular aponeurotic system (SMAS) layer 4) Mimetic Muscle 5) Skeletal Bone
Skin aging Fisher GJ, Varani V, Voorhees JJ. Looking older: fibroblast collapse and therapeutic implications. Arch Dermatol 2008; 144:666-672
Skin aging skin thickness, breakdown of collagen/elastic Wrinkle Skin laxity melanocyte activity Skin pigments and pre-malignant change Dermis hyaluronic acid Skin turgidity, dehyration of skin
Fat Compartment Atrophy & Redistribution in aging Safi Kang. A noval facial fat transfer technique with a concept of volumetric lifting
Fat Compartment Atrophy & Redistribution in aging Safi Kang. A noval facial fat transfer technique with a concept of volumetric lifting
Superficial muscular aponeurotic system (SMAS) layer
SMAS layer aging Connective tissue fibre Loss of elasticity by aging Loss of elastin Ptosis of facial volume esp. midface/nasolabial fold
How do we aged? Source: The Anatomic Basis of Midfacial Aging 2 Allan E. Wulc, Pooja Sharma, and Craig N. Czyz
Aging in mimetic muscles
Aging in mimetic muscles Increase resting tone of muscle with aging Repeated contraction of mimetic muscle Change in fat distribution (static lines/folds)
Skeletal bone aging Midfacial soft tissue malposition Sclera show Tear trough deformity Deepening of nasolabial fold 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.
Facial Contouring: non-surgical method Botulinum Toxin Dermal filler Collagen stimulator Energy-based machine
Botulinum Toxin Botulinum toxin (BTX) is a neurotoxin protein produced by Clostridium Botulinum and related species There are two main commercial types: botulinum toxin type A and botulinum toxin type B 5 registered neurotoxin in HK: Botox Dysport Siax Xeomin BTXA All are botulinum toxin A
Facial contouring Wrinkle (dynamic line) By mimetic muscles Contouring By masseter muscle/temporalis Mentalis m. Platysma m.
Aging in mimetic muscles
Facial Contouring: non-surgical method Botulinum Toxin Dermal filler Collagen stimulator Energy-based machine
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)
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)
Hyaluronic acid
NASHA TM (Non-Animal Stabilized Hyaluronic Acid) small Small to medium medium large
Fat Compartment Aging (Volume loss) Source: www.juverderm.com
Facial Contouring: non-surgical method Botulinum Toxin Dermal filler Collagen stimulator Energy-based machine
Poly-L-Lactic-Acid ( PLLA)
Poly-L-Lactic-Acid ( PLLA) 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
Botulinum Toxin Dermal filler Facial Contouring: non-surgical method 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)
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
Energy-based machine Evaluation of a Microfocused Ultrasound System for Improving Skin Laxity and Tightening in the Lower Face Georgette et al.,aesthetic Surgical Journal 1Sep2014
Mono-polar RF Thermage FDA clearance for noninvasive, energy-based eyelid treatments. Non-invasive treatment of wrinkles and rhytids Temporary improvement in the appearance of cellulite
High-Intensity Focused Ultrasound FDA cleared Ulthera System lifting of lax submental (beneath the chin) eyebrow neck tissue Source: http://www.ultherapy.com/ultherapy
High-Intensity Focused Ultrasound Source: http://www.ultherapy.com/ultherapy
Microneedling Fractional RF http://www.usa.lutronic.com/infini
Microneedling Fractional RF http://www.usa.lutronic.com/infini
Fractional laser resurfacing Non-ablative vs ablative Indications Wrinkles Acne atrophic scar Skin tightening fractional photothermolysis microscopic treatment zones (MTZs)
Facial Contouring: Current Trend in Hong Kong
Facial Contouring: Current Trend in Hong Kong 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
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