The three Americans

One of the standout filler sessions featured three American experts offering their points of view on hyaluronic acid gel correction. Featuring US dermatologists Susan Weinkle, Ava Shamban, and Gary Monheit, they each shared their varying points of view on HA correction.

Weinkle lectured on her philosophy of how best to use hyaluronic acid fillers for facial and off face beautification. ‘Let’s not only make patients look younger, let’s create beauty. Youth is not always beautiful,’ she said. She showed how she performs a mandibular sweep using HA to smooth jowling and improve the projection and definition of the jawline in some patients.

She also explained how she addresses off‑face indications. ‘I am also treating chest wrinkling because women hate how their décolleté looks. If you inject HA superficially, you can smooth out sleep lines,’ she explained. ‘Nipple restoration is another good indication. I inject just a bit of HA to enhance the nipple projection. Another important application is for the hands. I will typically inject 2 ccs of HA with a cannula into the dorsal hands.’

Another interesting lecture delivered by Santa Monica dermatologist Ava Shamban, was entitled ‘Beauty is in the eye of the beholder, Aging is inevitable.’

She introduced her innovative concept called Signature Feature™. ‘You begin with what is really beautiful about the face, such as Elizabethi Taylor’s violet eyes, Catherine Deneuve’s expressive eyes, and Audrey Tatou’s wide open eyes.’ She continued, ‘Once you decide what the signature feature is, you need to reduce the background noise to focus on that key feature.’ Dr. Shamban also stressed what she calls ‘the principles of aesthetic responsibility’ defined as creating the most beautifully proportioned aesthetic results possible.

Both Drs Weinkle and Shamban described how they are using the new Teoxane RHA for patients post procedure. ‘We are seeing improvement in skin elasticity and firmness. And it is ideal for use after injections as it contains arnica to help with bruising,’ said Weinkle.

Alabama dermatologist Gary Monheit, who Dr Weinkle introduced as ‘magical with a needle,’ presented his artistry with facial injectables, specifically in the perioral area. ‘When you look at someone’s face, if you don’t go for the eyes, you go right to the mouth. The mouth is the doorway to our expression, and there is no one ideal mouth. The mouth is very important in individualising what we think and who we are. It expresses itself with movement, as in smiling, pouting, and kissing,’ he said. He advised attendees to see a patient’s mouth in action to judge if there are any lumps or asymmetries. ‘The mouth is the only structure with muscle that is not attached to bone. If you interfere with the smiling muscles — zygomaticus major, levator labii — you will interfere with the smile. We don’t want to make the mouth stiff and firm, so avoid overfilling so the muscles can react properly,’ he added.

Dr Monheit also pointed out the unique characteristics of female vs male lip aesthetics. ‘The female lip is well defined, with a visible upturned vermillion and vermillion line. The lower lip is slightly larger, with a well-defined cupid’s bow. The commissure is upturned and a youthful lip has full volume. With age, it flattens and widens. A man’s lip is bolder, and we do not want to create a cute man,’ he said.

He suggested placing a 3-way mirror in consult rooms so patients can see themselves from a lateral view. The ultimate goals of lip enhancement, according to Dr Monheit, are balance, harmony, and symmetry. ‘A perfect lip is not the goal. You have to create a lip that fits the patient,’ he added.

Are You Ready For Your Close-Up?

A neck rejuvenation session chaired by Cannes facial plastic surgeon Herve Raspaldo and Pelle Ceravolo featured a roster of plastic surgeons, dermatologists and cosmetic doctors offering varying opinions on how to address the aging neck.  London consultant plastic surgeon Lucion Ion presented 3-dimensional photos of ideal neck contours to illustrate his method for selecting the best procedure for each patient and customizing his treatment planning formula. He addressed the importance of assessing whether the patient needs neck skin excess reduction, or volume reduction only, and the need for tension and determining the degree of tension needed.

Montpelier Plastic surgeon Alain Bonnefon took attendees on a colourful journey through where he started out with his necklift techniques to where he has arrived today. Nice maxillofacial surgeon Maxime Amelie Audion showed a video of the surgical technique procedure she performs most often in her clinic to address the lower face. She pointed out that in secondary facelifts, the problem is fibrosis, and the necessity of addressing the ageing ear at the same time.

Cosmetic doctor Ghislaine Beilin from Paris gave a round up of the non-surgical procedures available to address the lower face and neck that included resorbable threads (Silhouette Soft Lift, Happi Lift), radiofrequency skin tightening (Exilis, Pelleve) and the benefits derived from combination therapy using threads for gentle lifting, neurotoxins, dermal fillers and skin tightening. Dr. Jamal Djoudi from Vouneuil Sous Biard, described his experience using resorbable threads, adding that in a heavy face, the results do not last well.

Skin Deep

A special Skin of Color Session featured some of the important challenges of treating diverse skin types. London consultant plastic surgeon Dalvi Humzah shared his insights about the globalization of beauty. To illustrate this concept, he showed the work of San Francisco based journalist Esther Honig (estherhonig.com) called ‘Before & After’ and her fascinating research into our society’s standards of beauty and how they vary across cultures on a global level. She sent her photograph to graphic designers in over 30 countries around the world with a simple request, ‘make me beautiful’. According to Mr. Humzah, each photoshopped variation on Esther’s lovely young face reflected both the personal and cultural concepts of beauty in the eyes of the designer.

Dr Philippe Hamdal-Pisal, President of the Society of Mesotherapy of United Kingdom in London, spoke about acne and post inflammatory hyperpigmentation in darker skin types. He mentioned that he recommends an SPF40 as a minimum for patients with a propensity to develop melisma, and that baseline photographs are very important to take to demonstrate the patient’s progress from treatments.

Body Heat

Plastic surgeon El Hassane Tazi from Casablanca Morocco described his total body contouring technique where he has been able to remove up to 22 litres of fat safely in a single session. He is well known for his extensive volume lipoplasty (EVL) and total body sculpting that can produce dramatic weight loss and significant health benefits for patients. Tazi also discussed a new generation of lipoplasty for the removal of subcutaneous fat, called ‘Surrounding Aspiration System for Ultrasound Assisted Lipoplasty’ (S.A.S-U.A.L.). ‘This technique and technology minimises the disadvantages and risks of both traditional liposuction (S.A.L.) and ultrasound assisted liposuction (U.A.L.), while adapting and improving on their advantages, including increased patient safety, minimized risk of skin burns and necrosis), and the ability to remove large volumes of fatty tissue (3-10 litres), higher tissue specificity, targeted at subcutaneous fat, and less vascular trauma and/or bleeding/blood loss.  We have successfully performed extensive volume fat removal or more than 10 percent of the patient’s body weight in litres of fat aspirate in one session,’ he said.

On the non-surgical scene, F.A.C.E. 2 F@CE also introduced several new fat reduction systems hailing from France using cryolipolysis technology to target fat deposits.

Same Time Next Year.