aesthetic medicine of the nasolabial furrow

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Le Dr Hilligot effectue des injections d'acide hyaluronique du sillon nasogénien à son cabinet à Paris, sans douleur, sans éviction sociale, les résultats étant presque immédiats et durables grace à une technique originale d'injection en multicouche.

sillon naso génien par le Dr Patrcie Hilligot chirurgien esthétique à Paris

Sommaire :

• Qu'appelle t-on sillons nasogéniens ?

• Pourquoi les sillons nasogéniens ou sillons labogéniens se marquent-ils avec l'âge ?

• A quel âge se constituent les sillons nasogéniens ?

• Comment combler les sillons nasogéniens en médecine esthétique ?

• Qui est autorisé par la loi à effectuer des injections de produits sous la peau et notamment l'injection d'acide hyluronique ?

• Combien de temps le comblement des sillons nasogéniens par injection d'acide hyaluronique dure-t-il ?

• Consentement éclairé à signer par le patient avant toute injection d'acide hyaluronique.

• Photos avant / après d'injection d'acide hyaluroniques.

What are nasolabial folds?

Two in number, the nasolabial folds:

– form the junction between the upper lip and the cheeks;

– extending from the nostrils upwards to the level of the buccal commissures downwards (“corners” of the mouth);

– can join the “Marionette Lines” of the Anglo-Saxons, furrows which extend downwards from the mouth commissures

anatomie du sillon naso génien par le Dr Patrcie Hilligot chirurgien esthétique à Paris

What are nasolabial folds?

or do labiogenian furrows mark with age?

SNGs (or labiogenian furrows) gradually deepen over time, sometimes from the age of 30, as a result of the progressive sagging of the skin and fat from the cheeks on the upper lip which remains fixed. The upper lip elongates a little over time but it nevertheless remains relatively fixed compared to the cheeks because of its particular anatomical structure: little fat under the skin and fairly thin adhesions between the skin and the underlying orbicularis muscle.

In addition to the effects of gravity on the different anatomical structures of the cheeks and the upper lip, other factors intervene in the constitution and deepening of the NGS:

–genetic factors: skin tone and cheek fat thickness;

– facial mobility factors: frequency and intensity of facial expressions, seeing smiles or laughter.

qu'appelle

pourquoi

What are nasolabial folds?

age

Usually, the NGS begins to form gradually around the age of 30.

Everything most often starts around the nostrils where a kind of triangle is formed: this is what I called the perinastril triangles.

At first, this triangle is very light, shallow, and appears only as a shadow, especially marked in certain positions of the face (see the diagram on the anatomy of the NGS).

When the sagging of the cheek intensifies, the SNG itself hollows out more or less deeply, associated or not in its center with a small superficial wrinkle.

Subsequently, the SNG can come into contact with the subcommissural furrow of the "corner" of the mouth (or Marionette Line of the Anglo-Saxons) which usually begins to mark around forty.

The injection of hyaluronic acid is the usual medical treatment, especially at the beginning in young patients.

Subsequently, other treatments will be discussed according to everyone's desire, especially concerning the durability of the result: injection of tissue inducer (Ellanse*), injection of fat or lipofilling, tightening of the cheeks and cheekbones with threads tensors or by temporal or cheek lift.

The injection of hyaluronic acid is not always the best solution, especially when the NGS are very marked, hence the interest of consulting a surgeon who is alone capable and able to perform all the treatments of the nasolabial folds and not only injections which nevertheless remain the most usual treatment.

For each nasolabial fold, its treatment.

What are nasolabial folds?

comment combler

Several possibilities exist to fill the nasolabial folds:

injection of hyaluronic acid by needle or cannula;
injection of tissue inducer: Ellianse;
fat injection: lipofilling;
resorbable or non-absorbable tensor threads
finally, cosmetic surgery: temporal and/or cheek lift.

Under no circumstances is the injection of botulinum acid or Botox* effective in treating this area.

The injection of hyaluronic acid remains the simplest and fastest medical treatment to implement, without major risk when the doctor is experienced. Nevertheless, it should be known that the results of filling, classically, disappear after 12 months, sometimes less, and sometimes very fortunately much more.

What are nasolabial folds?

autorise

Classically, the injection of hyaluronic acid is a technique of aesthetic medicine, "gentle", without surgery, very frequently performed and, in the vast majority of cases, benign when it is performed by a physician qualified and experienced in injections.

Never get injected in a beauty salon by a beautician.

Legally, any crossing of the skin is a surgical act, except crossing by a needle which remains an authorized act for a non-surgical doctor or a nurse.

Indeed, serious complications are always possible in the absence of precise knowledge of the fine anatomy of the face and its variations.

Because, if the injection of hyaluronic acid is a technically simple act, “there is no minor surgery”. This means that any surgical procedure, no matter how small, such as an injection, must be performed with the same meticulousness, the same mastery and the same knowledge of the anatomical elements of the face and its variations.

I repeat, the injection of hyaluronic acid can be the cause of serious immediate complications but fortunately extremely rare in expert hands.

These serious immediate complications are almost all related to vascular problems leading to necrosis of the skin due to ignorance of the anatomy, knowing that this varies according to each individual.

The injection of hyaluronic acid is a simple technique, almost magical, but which always requires careful attention in order to obtain the desired result in the absence of any complications.

What are nasolabial folds?

temps

Typically, the swelling effect of injecting hyaluronic acid into the NGS lasts around 12 months.

In fact, this duration is variable according to various factors:

Nasolabial fold depth and patient age: very deep nasolabial folds in elderly patients are more difficult to fill and the duration of action of the acid is shorter. We must speak to the patients about it from the outset and possibly offer an alternative such as a surgical facelift.
the mobility of the nasolabial fold according to the intensity and frequency of facial expressions and each person's smile;
the type of hyaluronic acid used and especially its polymerization: highly polymerized hyaluronic acids tend to last longer but cannot be used superficially
the technique of injection in several planes, and in particular my original technique in 3 planes and with the needle;
the injection of two types of hyaluronic acid: highly polymerized in depth, or even an "Ellianse" type tissue inducer and when the nasolabial fold is very pronounced, and a less polymerized hyaluronic acid on the surface.

These devices make it possible to increase the duration of the filling up to 3 or even 4 years.

In fact, in many of my patients, there will always be a residual filling, a residue after the injection of hyaluronic acid. I used to tell my patients “that their nasolabial folds will never be as deep as before…

What are nasolabial folds?

consenement

The type of product injected or hyaluronic acid (reliability of the brand, type of polymerization, specificity…) the indications, contraindications and possible adverse effects of injections of hyaluronic acid or tissue inducer have been widely exposed to me .

Numerous and precise questions concerning my medical, surgical and aesthetic history were asked to which I answered precisely and frankly.

In return, I was able to ask all the questions I wanted and I was given clear, personalized and precise answers.

The following concepts were precisely explained to me:

– hyaluronic acid is a biocompatible, bioresorbable, more or less cross-linked gel of non-animal origin;

– hyaluronic acid is injected, depending on the case, into the skin (superficial, medium or deep dermis), into the subcutaneous fat, or even in contact with the bone;

– hyaluronic acid is useful for correcting fine lines, wrinkles, folds and furrows of the face and neck or for increasing the volume of the lips, cheekbones, chin, angle of the jaws, temporal regions, even to treat dark circles or modify certain slight defects of the nose;

– hyaluronic acid has only a temporary effect. The average life is 8 to 12 months. In fact, its lifespan depends on the type of skin of each person, the age, the area or areas of the face treated, the type and quantity of product injected, the injection technique of the practitioner ;

– in some cases, the duration of action of the product may extend over more than a year;

– in the lips, their significant mobility and vascularization typically tends to reduce the effect of injections at around 6 months;

– the relatively frequent adverse effects occurring immediately after the injection are as follows: redness, bruising, small hematoma at the injection site, erythema, oedema, itching, pain on pressure.

These reactions disappear within a few days but may persist for a week.

I am aware that exceptional cases have been reported in the literature: persistence of inflammatory reactions beyond a week, formation of granulomas or nodules at injection sites, abscess formation, appearance of areas of necrosis glabellar region or nose, hypersensitivity reaction and changes in skin color at injection sites.

Any side effect must be reported very quickly to Doctor Patrice Hilligot who will have to remedy it with an appropriate treatment for each. In any case, the treatment of these side effects can take several months and be difficult.

It is also important to know that in the event of very marked furrows or wrinkles, or following a first injection session, a second close session around 4 to 6 months must be planned. At the level of the forehead, it may be, in case of relative effectiveness of the first injection of hyaluronic acid, an additional injection of botulinum acid (Botox).

The recommendations before injecting hyaluronic acid or tissue inducer are as follows:

– one week before treatment: avoid taking aspirin or anti-inflammatories;

– in the hours following the injection, avoid alcohol consumption, sun exposure, excessive contraction of the muscles of the face, the sauna, the hammam, violent sports, sun exposure, make-up. Massage softness of the injected areas is advised.

I authorize to be photographed by my practitioner for the purpose of medical documentation and research.

I trust Doctor Patrice Hilligot to use all the means at his disposal in order to approach as closely as possible the result that I have explained to him.

Patient name:

Done in Paris on the

Signature preceded by the words "read and approved"

What are nasolabial folds?

photos