By Dr. Hervé Raspaldo, article published in the ”ANTI-ÂGE” Magasine | N°5 

Today,men and women like to spend a lot of time fortheir activities and just as much for their well-being. Surgeries that require a month long recovery is out of the question. Luckily, we have new injectables, new anesthetic products, and also non-invasive surgical techniques that allow us to provide very effective and natural-looking results, with a very short recovery time for the patients.

The practitioner will use a treatment combining:

• -botulinum toxin injections to improve the dynamics of the muscles aroundthe eye, which harmoniously reshapes the eyebrows archand makes the eyes look wider
• -a hyaluronic acid (HA) volumizing product to reshapethe temples, the eyebrows and the cheekbones,while still preserving the natural lookand the unique personality of each face
• -additional HA injections to reducedark circlesandthe remainingwrinkles and to moisturize the skin.

This new concept is called the “Global Approach to Facial Rejuvenation”.

It was created and presented by a group of French experts in aesthetic injectiontreatments. A scientific consensus was published in an international medical journal.

The major and revolutionary benefits of this new concept are:

• -the systematic and complete analysis of the face
• -the customized diagnosis, leading to a unique treatment proposition, tailored the eachpatient and their individual needs
• -the painless injections providing a very well-balancedand natural-looking result
• -a rejuvenated eyes area that still maintains its natural expression

These techniques are used to treat the “lion’s wrinkles” between the eyebrows, the horizontal forehead wrinkles, the crow’s feet, the dark circles, the eyebrows, the hollow cheeks and the cheekbones. The result is subtlebut noticeable: your eyes have a more youthful appearance.

Whether they are blue, brown, myopic or astigmatic, they are our connection to the world and to the others! They are often neglected, and yet they are essential and they deserve to be closely taken care of. Here are several professional tips to solve small problems and prevent big ones.

Surgery, the solution with permanent results.

After 40-45 years, you can see signs of aging in the eyes area. Above the eye, the skin of the upper eyelid and the orbicularis muscle becomes loose, and the fat forms a pocket, which makes the eyes look drooping, tired or sad, and sometimes even reduces the visual field. The dark circles become more visible, because the area under the eye loses volume, it widens, the little swellings become pockets. These phenomena are aggravated if you smoke, work a lot on a computer or cry very often…

“No make-up can totally hide these signs of aging, and moreover, make-up becomes a difficult task when the upper lid is heavier and sagging, says Dr. Hervé Raspaldo. If the problem is treated early enough, botulinum toxin can be a solution, we inject it into the eyebrow to relax the underlying muscle and liftthe tip of the eyebrow by 3 to 4 mm: this makes the eyes look wider and younger.

We can combine this product with hyaluronic acid injections around the eye, in order to restore the volume where needed”.

Hyaluronic acid is also used against dark circles, not to modify the dark color (which is only possible with laser or peeling, with various results), but to restore the muscle’s volume: the visual result is good, but is not always enough, and doesn’t last forever.

These are all treatments that can be easily performed in amedical office, withtemporary results (botulinum toxin lasts four to six months, hyaluronic acid twelve to eighteen months), and you can get them as often as necessary.

”However, when the signs of aging are deeper or more present, the ideal solution is eyelid surgery.

The excess skin and fat are removedon the upper eyelid, the skin is then stitched back, resulting in an invisible scar: it’s an outpatient procedure in a surgery block, under local anesthesia, painless. Bruising can occur for four or five days.

If necessary, an “eyebrow lift” is performed endoscopically using a small incision in the scalp. If the lower lid needs to be treated, we remove the fat and tighten the skin through the inside part of theeyelid, or, if the skin is very loose (which is often the caseafter 60 years) by an incision under the eyelashes. Again, there will be no visible scar”. The upper and lower eyelids can be treated simultaneously. The procedure has perfectly natural results, and makes your eyes look more fresh and rejuvenated. Moreover, it doesn’t require any touch-ups.

After the procedure, many women feel like they have a larger visual field, because the eyes are no longer obstructed by the heavy eyelids.

Magazine BEAUTÉ Anti-âge
Coordinator Catherine George-Hoyau

I can look younger in 30 minutes (and no knife!)
Botulinum toxin, hyaluronic acid, laser or cosmetic products?
Where, when and how? If you’re looking to make the sadness and fatigue on your face disappear, here are a few solutions…

You look really tired, says a ”well-meaning” friend. These words have an immediate consequence: maybe you manage to rule out the worst scenario (could I be sick?) but then, there you are, examining yourself in that cruel mirror that will not spare you any detail:wrinkles, loosening skin, dark circles, puffy eyes.

Many of these signs are due to multiple factors such as pollution, lack of sleep, excessive light, overweight, menopause and stress,of course. The latter is a powerful endocrine disruptor, largely responsible for the loss of elasticity and density of the skin. As stated by Dr. Hervé Raspaldo, surgeon specializing in the face and neck, ”Fatigue can be seen, but it can also affect internal organs and then reflect on the outside.”

What can we do against it ?

“Today, we are able to treat these signs,in oneor several sessions,” says the practitioner who states that40% of his patients don’t aim to look younger, but to look more rested. This means getting rid of that little something whichundermines our morale and gives us a sad and tired expression. It sounds like a nice promise, probably not cost-free, but at least we can be sure it exists !

Mirror, mirror, what do I see ?

I look sad and grim…

The causes : the nasolabial folds, which show up when the cheekbone tissue and the cheek collapse, because the fatty tissue moves downwards. Like all vertical wrinkles, these folds will quickly make you look older…

The solutions: we rebuild volume on the cheeks with hyaluronic acid, smoothing and lifting the tissues in a natural way, lasting for about a year. Correcting the vertical lines is no longer mandatory. The injection is performed with cannulas, which allows a balanced topping, without pain or hematoma. If there is too much excess skin and sagging fat, the optimal solution would be a facelift for the midface. The solution to remember: hyaluronic acids.

I don’t look friendly

The causes: tissue atrophy (ageorstressrelated, or due to smoking and hormonal disorders) and involuntary muscle contractions will all affect the lips and their contour. Lips become thinner, different marks can occur; folds of bitternesswillappear, which makes you look grim and somehow unhappy.

The solutions: the reticulate hyaluronic acid which plumps the lips andreshapes the borders. It’s an absorbable product, with resultslastingbetween 6 and 12 months. The lines on the borders are treated by “topping” with hyaluronic acid, resurfacing by chemical peel or laser resurfacing (wrinkle removal).

I look angry

The causes: a muscular hypercontraction, caused by frequent frowning, a consequence of worries and stress. This is what causes the so-called lion’s wrinkle between the eyebrows.

The solution: botulinum toxin blocks the nerve impulses to the muscles, causing them to relax. This will smooth both vertical and horizontal wrinkles and give you a rested look. It’s an absorbable product, with results lasting 4 to 5months.

I have an empty look…

The causes: fatigue, caused by lack of sleep, overwork, stress

The solutions: Hyaluronic acid works wonders on dark circles, which is a fragile area. The injection is performed with cannulas, in deep layers,for a homogeneous and natural filling. The effect lasts 6 to 12 months. For dark circles that are not necessarily associated with “hollows“, laser or peeling can be considered. If the problem concerns bags under the eyes, a surgical treatment may be needed.

I have jowls

The causes: fatty tissues that melt and age-related collagen decrease willcause sagging skin on the lower faceand the neck. The face contouring is no longer firm and sharp.

The solutions: we can restore the mandibular contouring by injecting hyaluronic acid (result lasting 12 to 18 months), but excessive injecting must be avoided, otherwise the jaw could look too square. The best way to do this is step by step, correcting each little hollow on each cheek. There are several medical devices and injections that can helpreduce fat and create a more contoured cheek. However, if the skin has lost all firmness, the only efficient treatment is a face and neck lift.

Many thanks to Dr. Claude Dalle and Dr. HervéRaspaldo, Scientific Directors of EMAA (European Masters in Aesthetics and Anti-Aging Medicine)

The aesthetic approach to smile according to the surgeon

By Dr. Hervé Raspaldo, plastic surgeon in Geneva.
Article published in «ANTI-ÂGE Magazine # 6 ”

Your smile is a complexe mix of well-being, positive nerve impulses and beautiful anatomical elements including your lips, the lips contour, your teeth and… your eyes!

Let’s see what makes a nice smile:

 1. Raised mouthcorners

2. The lips sensually stretching and revealing your teeth

3. Cheeky and shiny cheekbones

4. Malicious eyes

The cosmetic surgeon can workon each of these components, using:

1. Botulinum toxin and hyaluronic acid (HA) alone or combined for the mouth corner.

2. Hyaluronic acid to reshapeand plump lips. Several reliable and effectiveHA developed especially for lips are available today in France.

3. Hyaluronic acid for the nasolabial folds, chin and nasolabial angle (the angle between the nose and the upper lip). It should be noted that a rhinoplasty (nose surgery) also contributes to creating a beautiful smile.

4. Dental care, with the help of our dentists colleagues.

Finally, we can improve the smile by treating the eyes area:

 – Botulinum toxin inthe crow’s feet, in order to lift the tail of the eyebrows (and get the ”almond looking” eyes).

–  Hyaluronic acid using the ”topping” technique in the crow’s feet, in order to lift and plump the eyebrows (for Asian patients, hyaluronic acid injections along the lash line willsubtly volumize the lower eyelid).

– Volumizing hyaluronic acid to reshapethe cheekbones and the under eye hollows, making your smile even brighter.

Lastly, let’s not forget that lifting and lipostructure (autologous fat injection) are excellent treatments to restore a beautiful smile on a flattened face.

(By Dr. Raspaldo, this article was published in the ”Anti-Age” Magazine n°2)

Mini-lift, micro-lipostructure, botulinum toxin and hyaluronic acid injectionsto improve volumes and the facial structure

From the simplest procedure to the most complex one, there are 4 major steps involved when you want to have a thinner face and neck, and the 4 of them can be combined:

– the botulinum toxin

– the volumizing hyaluronic acid injections

– the micro-liposuction

– the mini-facelift

These non-invasivemedical methods were made possible bythe evolving knowledge,the high-valueand safe injectables but also by several practitioners’ innovative skills. There are two main categories:

– techniques with direct action on the thicknessof the face (non invasivesurgical methods),

– techniques with indirect action on the facialvolumes and the muscles’ dynamic (medical injections).

(We will not discuss the traditional thinning methods here).

The botulinum toxin

For 40 years, the botulinum toxin has been used successfully and safely all over the world to treat muscle spasms. Since 1991, the botulinum toxin has also been used in facial rejuvenation aesthetics. The product was granted theMarketing Authorization (MA) in France in 2003; it is therefore approved by the Ministry of Health for the treatment of wrinkles.

In the past 7 years,many other indications have been discovered, especially forthe lower face. We have published two major scientific studies leading to the French consensus on the use of botulinum toxin for the upper and lower face (Journal of Cosmetic Dermatology 2011, Raspaldo and coll.).

The botulinum toxin has a place of choice, before surgery, when it comes to treating the lower face and the neck. When injected carefully and in low dose into the cutaneous muscle of the neck (also called Platysma), it relaxes the depressor muscles (which“pull” the face and the neck downwards). As a result, it supportsthe so-called ”levator” muscles (that “lift” the mandibular line) and thus improves the shape of the face.

A similar treatment is used to correct the “square” appearance of the jaws: botulinum toxininjectionsin the Masseter muscle, which develops considerably when a person chews constantly. Thisis what happens in Asia or the USA where peopleoften chew all day. The botulinum toxin decreases the permanent contraction of this powerful muscle.The muscle volume goes down and the shape of the face changes.

Finally, the botulinum toxin is used in addition to a facelift, in order to maintain the relaxation of the platysma muscle, which is the depressor muscle of the mandibular line.

The volumizing hyaluronic acid

For a long time, aesthetic procedures consisted in filling wrinkles, which sometimes resulted in an increased volume in the lower face. But today’s innovative volumizing products make it possible to reshape the volumes and create a new, upward-oriented facial shape (a heart-shaped face). We work on the shadows and the lights, the full and the thin areas, the convexities and the concavities, the domes and the valleys, we increase the cheekbones projection to give the illusion that the lower face is thinner.

The method: cross-linked hyaluronic acid (Voluma type) is injected at a deep level, in order to recreate the lost volume in the midface (cheekbones and hollow under the eyes), reshape facial volumes (heart-shaped) and restore the harmony of the facial features. This concept, called”heart of face”(HeART of Face®) is based on a natural approach to facial rejuvenation. It is designed to act on three dimensions, the volumes (heart-shaped), the skin texture (by hydrating it) and when used with botulinum toxin, the face dynamic (expression lines, mimicry).

We can use the same method and products for injections in the chin, in order to improve its contour  and increase its projection, which from a profile view, will make the neck angle (or neck-chin angle) look deeper.

This is the best way to complete the facial slimming medical treatment with injectable products.

Micro-lipostructure

When the cheeks look“heavy”, partially thickened by excessive fattissue, butthe skin still has good elasticity, and no drooping skin, liposuction under local anesthesia is the perfect indication.

The method: A micro-cannula is inserted inthree entry points (under the chin and under each earlobe) after local anesthesia. The excess fat is extracted,then the skin goes back to its natural shape (as a result of subcutaneous scarring).

No bandages are needed. You will have towear an elastic dressingat night for 21 days. The three microstitches are removed on the 6th day. Bruising can occur for 7 to 15 days. It’s a painless procedure. In case excess loosening skin needs to be removed, this procedure provides optimal results when associated to a mini-lift.

Mini-lift

This is a soft reshaping of the different structures of the face and the neck (skin, muscles and fat). The use ofa video camera (or Endoscopy) has allowed great progressesin reducing scars, and increasing the precision of the procedure, because we can perfectly visualize the fine anatomy of the face and neck. Endoscopy can reduce scars and make recovery easier.

Another interesting consequence is that the procedure can be easily performed under neurolept analgesia (or local anesthetic reinforcedby sedative perfusion) and generally requires only 12 to 24 hours of hospitalization. It goes without saying that this procedure requires the same precautions as all the other surgical procedures, meaning: two prior consultations, a clearconsent, mandatory quote, pre-anesthesia consultation, a biologicalfull analysis, a fully equipped clinic and a surgery blockcomplying with all safety standards.

During recovery, edemamay occur for 7 to 15 days, possible bruising for 7 to 21 days, but little or no pain.Using these techniques can definitely provide natural and lasting results.

Nose, cheekbones, lips: By Dr. Hervé Raspaldo – Article published in the «ANTI-AGEMagazine | N ° 3»

The subtle art of a surgeonconsist in usingcosmetic surgery and injections, to make your face more beautiful and more attractive.

Rhinoplasty or nasal injections of hyaluronic acid provide very sexy looking results, as a delicate nose beautifully reshapes your face.The surgeon can gently remodel the fine cartilage that builds the nose structure, in order to refine the tip of the nose or to erase a bump.

These simple procedures fully respect the physiology of the human body, but also the nature and the environment. They help providinga natural-looking, harmonious and beautiful nose.

 Very little edema are to be expected in the postoperative period. The procedures are painless.

Precise and natural injections of hyaluronic acid and botulinum toxin are also used to totally reshape the nose and give it a graceful shape. This new nose will bring style and elegance to the whole face. There is no downtime, for there are no bruises, nor edema. You can return to your normal activity right away. The procedure lasts 30 to 45 minutes in the medical practice.

The increasing self-confidence,along with the natural-looking face will make anyone look more sexy.

(Magazine L’OFFICIEL CHIRURGIE ESTHÉTIQUE)

A beautiful mouth has a nice contour, nicely shaped vermilion borders, the lips are plump but not excessively big, adapted to the shape of the face and the personality. Reshaping the lip line, correcting the Cupid’s bow, enhancingthe lips volume involves the proper know-how and a certain aesthetic sense. Here is how Dr. Hervé Raspaldo explains it (he is a plastic surgeon specializing in the face and neck surgery).

How do you properly reshape a mouth?
Dr. Hervé Raspaldo:

First of all, we establish a precise physiological and psychological diagnosis before any procedure concerning the lips enhancement and reshaping.

Just like before any other surgical procedure, I will carefully observe the patient’s face, take note of any possible issues. I will not only examine the mouth andthe lips, but also the teeth and their position, the bone structure of the face, the nasolabial folds. I will also ask questions to determine the patient’s social environment. Knowing a few things about my patient’s psycho-sociological environment is important, it helps me understand whether she wants an aesthetic improvement or a transformation, whether she aims for a subtle improvementor a rejuvenation.

Do you say no to certain procedures?
Yes, when a patient wants a full, plump mouth and sexy lips but such a correction is not fitting the patient’s face or style.

How do you conceive the corrections? As global procedures or small successive steps?
Each case is unique. In some cases I wouldonly rehydratethe mucous membrane, if the lips are thin and the patient is no longer very young. In other cases I would work on the mouth contour and enhance thevolume.

Do you have your own specific techniques?
I focus on perfecting my gestures, choosing the right injectables (Juvederm Volbella®, the new hyaluronic acid of the Allergan Laboratory), and the injecting process, during which the product is properly and evenly spread under the mucosa. This is essential for a correct procedure if you want to leave no place for bad surprises, and preservethe natural appearance of the lips as well as a nice, soft touch.

Is there something particular about this injectable gel?
This special lip product is based on the Vycross ™ technology (patented by Allergan), based on the combination of hyaluronic acids of low and high molecular weight,which produce a fluid and cohesive gel, with increased correction comfort. It allows to reshape the lipsandthe mouth in a more precise and less painful way (because it’s more fluid and it contains anesthetics). We only need one injecting point to hydrate and reshape contours at the same time. You can see the effect immediatelyand there is norisk of over-correction,because the product will not absorb water after the injection. There will be no edema during the procedure. It gives the practitioner more accuracy. The effect lasts up to twelve months.

Do you have to use local anesthesia?
No, the product is fluid and flexible, and it already contains anesthetics, so there is no need for another anesthetic technique nor creams before the procedure.

What do you work on first ? Lip line, volume, hydration? How to you make the injections in these cases?
I always start by reshaping the vermilion border, including the Cupid’s bow, then I proceed to the hydration of the lipsif necessary. Since the gel is soft and contains lidocaine (an anesthetic), it’s a painless procedure.

How do you avoid overcorrections?
This is a key feature of this new filler. You get no surprise, no edema during the procedure, so no overcorrection, no risk of unnatural, ”duck lips” appearance.

How do you correct a mouth that has suffered from over-injecting?
If the problem is the over-injection with fillers, we must wait for about oneyear beforethe product disappears. Only then can I inject again, and reshape the mouth. If we inject too soon, the two products combined can trigger inflammatory reactions in the form of granuloma.

If the problem is due to a permanent product, only surgery will solve it. In this case, I perform a procedure on the inside of the mouth, removing what needs to be removed and reshaping the lips. After a month of edema, the lips will pressent a nice shape again.

Do you treat drooping mouth corners?
Yes, I perform vertical and horizontal injections in order to lift the lip corners and reshape a nice smile, like Mona Lisa’s legendary smile.

How do you treat the fine lines on the upper lip (the so-called ”barcode”?)
I proceed by crossed intra dermal injection. The product isfluid, so there is no risk of irregularity or bulging effect.

How do you avoid pain?
The idea is to perform anterograde and retrograde injections in a smooth way, using very fine needles (32 gauges). These are the needles used for newborns. Another technique consists in  injecting an area where fillers have juste been injected. The anesthetic contained in the product is already active in this area.

Are there any postoperative measures?
In the following 24 hours, it is recommended to putice on the lips in order to prevent edema. Exercising should be banned, as it can increases the edema risk. If you have a tendency to develop herpes, you should take an antiviral.

When can you see the results?
The effect is immediate. I very rarely re-inject fillers during the first month after the procedure. In some cases, small injections may be needed again after 3 months. Depending on the volume injected, the results last up to twelve months.

Latest trends in nose treatments

Today, no one wants to get just a ”nose job” anymore. Nose treatments are about embellishing the nose, correcting its anomalies, but fully respecting its natural uniqueness. Modern rhinoplasty has become a refined artistic procedure with a much faster recovery.

(Interview with Dr. Hervé Raspaldo, by Paule Cornille)

Whether the nose is hunchbacked, crooked, too big,too wide, too short, too hollow or the patient had a surgery that went wrong, we can make any nose look better. Sometimes,it only takes a few millimeters here or there, to reveal the beauty of a faceandthe perfection of features. The embellishment work is performed on all angles, front, three quarters and profile. A good surgeon does not only focus on the nose, but considers the face as a whole, and aims the most natural and harmonious results possible.

The practitioner uses the 3D morphing during the first consultations, in order to have a practical exchange with the patient and make useful suggestions on the different nose treatments.This technology makes it possible to clearly visualize the rhinoplasty project in three dimensions. However, before any procedure, the surgeon must check that the nasal septum is not deviated, he does this using a small endoscope and a camera. He may also use a laser to improve the air passage inside the nasal cavity,because there is nothing more unpleasant than having a nice nose but not being able to breathe.

A minimally-invasive technique

Using micro-instruments and a video camera (endoscope), the surgeon will have perfect control over his actions, making the procedure much less traumatic. All the work is done inside the nose, so there is no visible scar. There are no stitches to be removed either, they are all resorbable. This procedure has become almost painless. Some discomfort may be caused by the small cottons or absorbable pads that force the patient to breathe through the mouth the first night. There will also be a small splint to support the reshaped nose, but it will be removed on the sixth day. Since this resin splint is much more comfortable and more discreet than the old plaster molds, the patient has a nearly normal life the next day. However,exercising should be avoided for a monthafter the procedure! Oedemasand bruising can occur near the eyes forten to fifteen days, but the result can be seen after eight days.

Cryotherapy can help overcoming these small inconveniences – very cold air is sprayed on the tissues, a procedure that is also used for treating athletes’ injuries. Lymphatic drainage can also be helpful. In the last twenty years, the unpleasant nasal packings have been replaced by resorbable pads and if the nasal septum is in perfect condition, there is no need for any internal dressing. All these medical progresses have made it possible to get a better result, in a shorter time. Let’s just remember that fifteen years ago, the patient had to wait for a month before resuming normal activity, whereas today you can wear makeup the following day.

The embellishment treatment is performed on all angles, front, three quarters and profile. The morphing, a 3D imaging system allows the patient to see the reshaped nose on a screen before the procedure.

AULINE V. :  ”I really saw the difference when I looked at my pictures”

“My face is rather long,with prominent cheekbones, and I always thought that my nose, although straight, was too long and too wide to fit in. So I decided to shorten ita little, and to reduce the size of the nostrils. The procedurewas not painful.After the procédure, I only felt a slight discomfort when breathing, in the first weeks. At first, my nose was swollen and it seemed wider than before, soI was a little disappointed. But then it started to become thinner and after a few months, it had its new, permanent shape.

It didn’t look like a nose job at all, and my new nose fitted perfectly in my face, as if ithad always been like this. But I really realized the change when I looked at my pictures: I was just much more photogenic. A little later, I had another procedure to make my nostrils a little rounder, because I thought their shape was a little too sharp. It was a simple and quick procedure – using a cartilage graft behind the ear – and this improved the results even more. “

Prerequisites

 Puberty is the minimum age prerequisite for rhinoplasty. When performed correctly, the procedure can provide enormous satisfaction, both aesthetic and psychological. For an adult patient, it can make the face look younger, similar to a facelift but in a much easier way. The patient should consult one or several surgeons before considering the procedure. Once the choice is made,two preliminary consultations must be scheduled with the practitioner. The latter will use digital photos and morphing to suggest treatments,discuss the nose reshaping possibilities and understand the patient’s expectations. After the treatment has been decided, the patient will receive a complete consent document explaining the benefits and risks, as well as the costs involved. Even thoughthe risk is kept to a minimum, a period of reflection is mandatory for patients before undergoing surgery. The procedureusually lasts less than one hour and hospitalization does not exceed twenty-four hours.

Patients may stay in the clinic for one night, but a lot of them are able to safely leave the hospital in the evening, if the surgery was performed early in the morning.

Before surgery, the skin is deeply cleansed and the surgeon will have been informedif the patient has a tendency to acne or pimples. ”There are subtle ways to correct a bump on the nose, or a nose that is too long; rhinoplasty can also solve more challenging problems, like injuries caused by an accident, major congenital malformation or bad results from a previous nose surgery. In these extreme caseswe are dealing with reconstructive rhinoplasty, but despite the technical difficulties, we must always have an aesthetic approachas well”, says Dr. Raspaldo. As for the touch-ups, they are only required in 5% of the cases and must always be scheduled prior to the surgery. They are simple corrections, most often performedunder local anesthesia.

The rejuvenation techniques that bring out more beauty, without radical transformation

The forehead

The problem: horizontal wrinkles and / or lion’s wrinkles.
The solution: abotulinum toxin injection to relax the muscles. The result is not immediate, but becomes visible 2 to 15 days after the injection, and lasts for 4 to 6 months.

The cheekbones

The problem: hollow, dark circles + visible folds on the so-called ”valley of tears”
The solution: a highly volumizing hyaluronic acid injection (Voluma type), in a V-shaped area under the eye. Draw an imaginary line from the inner corner of your eye to the outer corner of your mouth. Then another line from the center of the pupil to the outer corner of the mouth.This area, which doesn’t have a particular name, is the one that will be targeted, and not the cheekbone as many people believe! If the practitioner injects too much on the outer side of your face, it can be a big mistake: it makes the face look wider. “Plumping” doesn’tmean creating a hump. The idea is only to give this V-shaped areaa “full” aspect, by injecting the product at three different levels, in order to rebuild the consistency ofthe pre-malar fat. The expanded volumes will have a lift effect on the lower face, thus smoothing the naso-labial fold! Today, we use foam cannulas for this procedure, they are much less traumatic for the tissues than a needle. The entry point is located in the cheekbone.

The problem: fatty tissue of the cheek is drooping + hollow circles + the valley of tears + deepnasolabial fold.
The solution: a malar facelift, which permanently lifts the fat onthe cheeks, in line with the pupil.

The face contouring

The problem: sagging jowls
The solution: botulinum toxin injection in the cutaneous muscle of the neck, since this muscle brings down the mouth cornersand the whole face contour. This procedure is efficient if there is no excess fat. If necessary, a hyaluronic acid (type Voluma) injection will optimize results a month later.

The problem: a double chin
The solution: liposuction or injecting desoxycholic acids (or Belkyra®)

The problem: jowls + double chin + loose neck
The solution: a mini-lift of the face contour.

The eyes

The problem: droopy eyelids
The solution: an upper blepharoplasty, a surgical procedure that consists in making an incision in the palpebral fold, removing the unwanted fatty hernia, and the excess of skin and of loose muscle.

The problem: hollow circles
The solution: a deep injection of hyaluronic acid along the orbital rimbone

The problem: eye bags
The solution: a lower blepharoplasty, using two different techniques, depending on the quality of the eyelids skin. If the tissue is still firm, the surgeon will onlyremove the fat hernia under the skin. The incision is almost invisible, located  inside the eyelids (transconjunctival way). However, it is a bit more complex if the eyelid is very loose. The practitioner must not only get rid of the fat hernia, but also remove the excess skin and muscle, and tighten the canthus (the suspensory ligament of the eyelid, located on the outside corner of the eye).

The problem: a drooping eyebrow
The non-invasive solution: a botulinum toxin injection into the orbicularis muscle of the eye, which will lift the tip of the eyebrow.
The radical solution: a temporal lifting.

The naso-labial fold

The problem: a deep fold on both sides of the mouth
The non-invasive solution: a hyaluronic acidinjection
The radical solution: a malar facelift

The mouth

The problem: wrinkles on the upper lip
The solution: hyaluronic acid injections into the lip borders to smooth them, then directly into each wrinkle.

The problem: thin lips
The solution: hyaluronic acid injection on the whole surface of the lips

The neck

The problem: visible strings on the neck (“turkey neck”).
The problem: horizontal wrinkles (“collar” wrinkles)

The solution: hyaluronic acid injections in each wrinkle.

If the skin is too loose,a neck lift will be the appropriate solution.

Article published in ”Marie Claire”

Dr. Hervé Raspaldo, plastic surgeon who specializes in surgery of the face and neck, in Geneva

(This article was published in ”Tetu”, fall/winter 2011)

A college of experts have developed aglobal approach to facial treatments, a revolutionary method to help restoring the dynamics of youth. The four practitioners who created this project explain how we can reduce signs of aging, but still preserve our natural look.

How do you explain that more and more men are getting facial injections?

First of all, because theprocedures are more simple! When men realize that their age leaves visible signs on their face, they take action. It’s not a taboo any longer.

Was this method validated?

We based our work on the opinion of around hundred practitioners, with whom we discussed practical situations, according to the methodology of the Health Authority. Several works will be published in scientific journals in the coming months.

How do you analyse the structure of the face and manage to preserve its expressions and personality?

The clinical analysis and the touch are essential. I also try to examine pictures of the patient in a younger age, to see how the face looked back then. I use a lot of morphing, 3D imaging and I compare expressions at rest and in movement.

What are the indications for hyaluronic acid and botulinum toxin?

Botulinum toxin stretches the muscles and changes their balance; it reduces the muscles’ contraction and helps preventing the sagging skin. As for the hyaluronic acid, it fills the hollows and rehydrates. Combining the two of them is a very efficient solution: the results are almost as good as those of surgical procedures.

How is you approach as a surgeon different from a dermatologist’s?

We both aim for the same result, but I would say that a surgeon is more used to considering all the elements of the face: muscles, bones, fat,and not onlythe skin. My aim as a surgeon is not simply to correct flaws, but to restore global beauty.

What gives you the greatest satisfaction?

Seing my patients happy and confident again. This difficult and very demanding profession also offered me an artistic expression. I work with different materials, just as a sculptor does, in order to bring out the beauty and provide confort to my patients.

”My aim as a surgeon is not simply to correct flaws, but to restore global beauty.”

(Interview published in ”Perfect Beauty”)

What is botulinum toxin?
The botulinum toxin is produced by the clostridum botulinum bacteria and was introduced in France in the early 1990s by the name botulinum toxin®. It’s main characteristic is that it blocks the nerve connexion under the skin and consequently preventsmuscles from contracting. As a result,the skin is smoother and more tense.

How does it work?

After a first consultation with the practitioner, the following session consists in performing five to ten injections, on the targeted areas. The procedure takes fifteen minutes and is completely painless. During the following week, it is recommended to avoid touching your face too much or sleeping on your stomach, as this may move the product which is not yet completely fixed in the muscles.

Advantages of using botulinum toxin

Botulinum toxin® has progressively replaced the frontal lift. It avoids all the inconveniences of  surgery under general anesthesia. In addition to this, the product’s effect slowly disappears in 5 to 6 months, which can be a relief for patients who are not happy with the results.

Downsides of botulinum toxin

The result is not permanent, so we must perform newinjections about twice a year. Like any other treatment, it should be used in a reasonable way, unless you want to take the risk of ending up with a ”poker” face, due to the paralyzed muscles. Moreover, excessive botulinum toxin® injections might create new wrinkles, because the facial muscles will need to find a way to express themselves. Luckily, today’s trend is to really adjust the quantities injected and avoid the ”paralyzed” look.

Results

A few days must go by before the product can act on the forehead wrinkles and the lion’s wrinkle and before the crow’s feet start to disappear. When it comes to treating the other face areas, the results are not conclusive. The mouth, for example, responds poorly to botulinum toxin®injections. Once you get the desired result, only a deep skin hydration can correct the old wrinkles’ traces.

What is hyaluronic acid?

Hyaluronic acid is obtained industrially, but it’s actually already present in the body, as a natural element of theskin and cartilage. It has a viscous consistency, it drawswater and therefore improves the hydration and elasticity of theskin.

How does it work?

A session takes about thirty minutes, and local anesthesia may be performed. Today’s new,flexible needles, such as Magic Needles or SoftFil with foam tipswill drastically reduce the pain. Moreover, laboratories producemore and more hyaluronic acids mixed with local anesthetics, which means we can have completely painless procedures. Asurgeon or anaesthetic practitioner will inject the targeted areas, generally the nasolabial folds and the wrinkles around the mouth.

Advantages of using hyaluronic acid

It’s a completely safe product, with natural origin. No recovery is needed, patients resume normal activity immediately andfinal results can be seen in aweek.

Downsides

Some patients can develop small hematoma after the injection. After 6 to 8 months, the body completely eliminates the product in a natural way, therefore injections must be repeated once or twice a year. There are a small risks of infection and small cysts, but these are kept to the minimum  by an experienced practitioner.

Results

A week after the session, wrinkles are filled. The natural volumes and elasticity of the face are restored.

By Dr. Hervé Raspaldo – Article published in ”TETU” Fall / Winter 2011

Have you had injections yourself?

Yes, I started with BOTULINUM TOXIN on the forehead 7 years ago, and I repeat the procedure every 5months. At first, I used to ask my colleagues to do the injections. Then I started doing it myself in front of a mirror. It’s not very pleasant, but injecting myself allows me to really understand what my patients feel, so I use an even finer needle. When I was 35, I used to say, just like many other people, that “I would never do injections“. However, I have never had hyaluronic acid injections.

Do your friends ask for your advice at a dinner table, for example?

Yes, three-quarters of them ask for my advice openly. Some of them prefer to come to my office for a more private consultation.

Why is it so difficult to find a man who admits having a facelift?

I treat men frequently. Actors or politicians among other patients.The demands concern mostly the enhancement or reshaping of the lower face area and the neck. Mens’ skin is thicker, there are fewer bruises. Scars are easily hidden by the sideburns. Men started with injections, then they started undergoing eyelid surgery and now they are more and more interested in facelift procedures.