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.

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.

By Dr. Hervé Raspaldo, article published in the ”Anti-Âge magazine” #1

The signs of aging will show up as dynamic wrinkles and linesin the upper face, and as volume loss changes in the middle and lower partof the face. Fillers (such as hyaluronic acid) and botulinum toxin have led to the development of minimally invasive procedures and a three-dimensional approach to facial rejuvenation: it’s a faster, less painful and less expensive alternative to the face lift; this approach can also be a perfect complement tosurgery,if the later is needed. Today the aesthetic face care is global and no longer focuses on removing wrinkles alone. The global purposeis to reshape the volumes and recreate a well balancedface, according tothe following criteria: soft and round face contours, convex cheekbones and well-drawn mandibular contour.

Using innovative products, we cangive the face its ideal shape, a heart-shaped contour, with the heart base inthe upper face area, while the tip points downwards (this shape is usually reversed with age).

As a facial esthetics specialist, Ihave developedaprocedurecalled Faceculpture®, based on a natural approach to facial rejuvenation and acting on 3 levels,the face dynamics (expression lines, mimicry), the heart-shaped volumes (HeArt of face®), and the skin texture: the botulinum toxin injections are meantto erase hyperdynamic wrinkles, restore harmonious volumes and fill wrinkles and lines, but also to hydrate the tissues.

 There are 2 types of injectables:

The Botulinum toxin

It relaxes the muscles, restores the esthetic balance of the face and stops the progression of the expression lines. For the upper face area, it is injected into the hyperdynamic muscles (which are responsible for the horizontal wrinkles on the forehead), the glabella, the nose, the crow’s feet (at the outer corner of the eyes), and the lower eyelid. It can also help repositioning the saggingeyebrows and improve their shape. As for the lower part of the face, botulinum toxin helps repositioning the tip of the nose, or treating dilated nostrils, fine lines, mouth lines, a gummy or an asymmetric smile,other asymmetries of the face, prominent masseters, the orangepeel aspect on the chin or the dewlap.

Dermal fillers

They restore volumes. There are several types of derma fillers: some of them are temporarily effective andresorbable, like the hyaluronic acid, the collagen, the calcium hydroxyapatite and the polylactic acid. Others are non resorbable and permanent, like the polymethacrylate, and the silicone.

The hyaluronic acid(HA) is currently the most frequentlyused filler, because it has a highfilling quality,natural resorption and it’s perfectly safe. Injections compensate for the age-related volume loss. There are different ranges of hyaluronic acids with different viscosity levels, adapted to different treatment areas and they can be used simultaneously for one patient:

 – The low viscosity products are particularly adapted to the so-called ”topping” technique, usedfor the treatment of fine lines,dark circles or hollow eyes.

– The medium viscosity products can reduceface wrinkles (perioral wrinkles, lip contour, nasolabial folds, mouth lines, forehead wrinkles).

– The high-viscosity products restore volumes in the cheekbones, cheeks, temples, nose and chin.

The Botulinum toxin and the different hyaluronic acids each have a specific and complementary effect. Therefore, they are often used together, which leads to better results than those obtained with each product separately. This is especially true for cheekbones, the glabella or the corners of the mouth. The results last longer, the HA is resorbed slower due to aprior injection of botulinum toxin, and the facial natural expression is preserved, because the procedure uses lower doses of toxin, supplemented by HA in residual wrinkles.

This global therapeutical approach also takes into consideration the epidermis (superficial peel, mesotherapy) and the dermis (pulsed light and photodynamic therapy, radiotherapy or radiofrequency, carboxytherapy).

It is recommended to start with botulinum toxin injections, in orderto relax the muscles and restore their natural balance. The face looks more openand relaxed. The cross-linked hyaluronic acid restores the three dimensional facial volumes (heart-shaped, HeArt of face®) and provides a more harmonious face contour. Amonth later, the hyaluronic acid injectionswillhelp filling the residual lines.

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ust like your body, your face can be sexy too. There are numerous techniques available that reshape the nose, enhance the cheekbones, and plump up the lips. A global approach for the whole face that combines injections of hyaluronic acid, botulinum toxin and surgery, making you feel beautiful and boosting your self-confidence.

For the nose: surgical or medical rhinoplasty
Everybody knows about surgical rhinoplasty, but did you know that medical rhinoplasty also exists? This procedure uses filling products, and is suitable for patients w Medical rhinoplasty, unlike surgical rhinoplasty, enable us to improve the shape of the nose without resorting to plastic surgery. Although it cannot compare with reparative surgery for changing the shape of the nose, it can be used for small imperfections and altering the dynamic anatomy of the nose. It can rectify any anomalies resulting from repeated operations on the nose, when further operations would prove difficult, as well as some minor deformations. Patients undergo this type of procedure to rectify skin indentations on the bridge or tip of the nose, slight asymmetry at the tip, a slight bump that alters the curve of the nose, a flat bridge, etc…
On the technical side, it involves injecting hyaluronic acid to straighten the line of the nose by subtly filling and thus erasing any hollows, or to open up the nasolabial angle while rounding the tip of the nose. The pressure from inside helps to raise the tip of the nose by lifting up the cartilage on the side of the nostrils, which will consequently “roll” upwards.
To gently shape the thin cartilage that makes up the framework of the nose, the surgeon slims down the tip and erases any bump. The procedure causes little swelling and no pain.

For the cheekbones: malar implants and fillers
The cheekbones can lose volume and this highlights the nasolabial fold, causing bags under the eyes. There are two ways of making the cheekbones look good again : implants and fillers.
Cheekbone implants are called malar implants, and are slid into place through the mouth. Patients must undergo a full dental examination beforehand in order to avoid all risk of infection.
Beautiful cheekbones can also be achieved using carefully-placed injections of hyaluronic acid to gently increase the volume of the cheekbones. This technique is suitable for correcting the thinning of soft tissue, but less so for treating weak bone structure.

For the lips: plumpling and shaping with fillers
Here too, the use of fillers injected into the lips is recommended. The lips may be naturally thin or have thinned out over time. Hyaluronic acid is a quick and efficient technique used to plum up the lips in a shapely and natural way.
Hervé Raspaldo
Specialist in Surgery of the Face and Neck in Cannes since 1992. Fomer Hospital Intern and Former Registrar of the University (1984) and Hospital practitioner. Member of the American Academy of Plastic and Reconstructive Surgery – Office of the European Academy of Facial Plastic Surgery