Treatment

Figure 3 Principles of treatment for upper and lower contours

Figure 3 Principles of treatment for upper and lower contours

To investigate the IMPAC©T Concept treatment algorithm, the authors treated two patient groups. Group 1 comprised 30 female patients aged 50–60 years, who were treated following the IMPACT© Concept, where hormonal changes were taken into account and special treatment prescribed. Group 2 comprised 10 female patients aged 50–60 years, without any influence on hormonal status. The aim was to compare the differences — if any — between the results. All patients were at either menopausal or post-menopausal stages, which was the main criterion for inclusion in this study. Other criteria for inclusion were that patients had not received any medical aesthetic procedures at least 18 months prior to the study, as well as no surgical aesthetic procedures at all. All patients were randomly divided into the groups.

In line with the IMPACT© Concept, the authors recommended the following algorithm of treatment for the menopausal female patient:

  1. Consultation with an endocrinologist, with hormone replacement therapy (HRT) considered as the estriol group of drugs can influence the quality of all mucous layers, and anti-osteoporosis drugs can prevent changes to the bony structure
  2. Application of phytoestrogens to the skin
  3. Injections of non-stabilised hyaluronic acid (10 patients) were administered, especially into the vermilion and perioral areas. Three or four treatments were performed at 3-week intervals, depending on dryness of the skin and mucosa. Platelet rich plasma (PRP) therapy was carried out (20 patients) on the skin of the face and especially the mucous of the mouth, lips, and perioral skin. Again, three or four treatments were administered at 3-week intervals. The
decision as to which treatment the patients received was also made randomly
  4. Correction of the upper contour areas, including eyebrow and temporal areas. The authors used a dermal filler consisting of cross-linked hyaluronic acid, with optimum viscosity and cohesity, and with deep retrograde injections using a 25 or 27 G cannula. For the lower contour areas, such as marionettes lines and mandibular angles, the authors used multilayer retrograde and multi-bolus techniques, using either a 25 or 27 G cannula
  5. The tear trough was treated together with the mid-face, with mid-facial treatment giving excellent results for the tear trough
  6. The use of dermal fillers for the correction of the lips is carried out at the very end of the treatment course.

The patients in Group 2 were treated in the following way:

  1. Correction of the upper contours, including eyebrow and temporal areas. The authors used a dermal filler comprising cross-linked hyaluronic acid, with optimum viscosity and cohesity, with deep retrograde injections using a 25 or 27 G cannula. For the lower contours, the authors used multilayer retrograde and multi-bolus techniques, using either a 25 or 27 G cannula
  2. The tear trough was treated together with the mid-face and as in Group 1, mid-face treatment reaped excellent results for the tear trough
  3. The correction of the lips with the use of dermal fillers for this special area.

[pull_quote align=”right” ]After an adequate diagnosis was made and the recommended treatment complex was carried out, good results were achieved, with the quality of the tear trough and soft tissues greatly improving[/pull_quote]

Results

After an adequate diagnosis was made and the recommended treatment complex was carried out, good results were achieved, with the quality of the tear trough and soft tissues greatly improving. In the majority of cases, tear trough deformity was connected with mid-facial depression.

As a result of the performed therapy, all patients who were treated according to the IMPACT© Concept felt that deepness of the temporal fossa, wrinkle expression, depression of eyebrow line, chin protrusion, and ptosis were considerably lessened. Following treatment, the authors are conducting a 12-month follow-up.

With regard to mid-face ptosis, the authors used the LIFT© (Less Invasive Facial Treatment) Concept for 3D rejuvenation1. The LIFT© Concept is based on the ‘dot’ technique and is useful for a number of reasons, including that there is no risk of ischaemia or hyper-volumisation. As a result, less product will ultimately be used with this technique, making it a more cost-effective procedure. Any professional who has a good knowledge of facial anatomy can use this technique, as well as an understanding that it is best used in those patients with thinner skin, without too much subdermal fat, and with only mild volume loss and fat migration (Figures 3–5).

Figure 5 Treatment to the chin. (left) after one side has been treated and (right) after treatment to both sides

Figure 4 Treatment to the chin. (left) after one side has been treated and (right) after treatment to both sides

After the recommended treatment was carried out for Group 1, the reshaping of the contours was achieved and quality of the soft tissues becomes better. All patients were asked their opinions and the results analysed according to the Global Aesthetic Improvement Scale (GAIS). The results, analysed by the patients, were:

  • Exceptional improvement 50%
  • Very much improved 45%
  • Improved 5%
  • Unaltered 0%
  • Worsened condition 0%.

In comparison, the analysis of Group 2 patients was as follows:

  • Exceptional improvement 30%
  • Very much improved 30%
  • Improved 20%
  • Unaltered 10%
  • Worsened condition 10%.

All patients from Group 1 confirmed that any complaints with regard to dryness, flaking, and burning soon disappeared, and that the appearance of the lips met their expectations. The patients from Group 2 did not confirm a similar experience.

Injections of non-stabilised hyaluronic acid to the face  and, especially, vermilion and perioral area, were administered to 10 patients. PRP therapy, with papules injected into the face and, especially, the mucous of the mouth, lips and perioral area, was administered to the remaining 20 patients. The authors have achieved an interesting set of primary results comparing the use of non-stabilised hyaluronic acid and PRP, as well as a comparison of different manufacturers of PRP equipment, and hope to publish this in future. The authors have also started to develop their own assessment scale for the purposes of this treatment methodology; Global Assessment of Perioral Lines Severity (GAPOLS) Scale.

Figure 6 Treatment to the mid-face, (left) before treatment and (right) after treatment

Figure 5 Treatment to the mid-face, (left) before treatment and (right) after treatment

All patients and the results were further analysed according to the GAPOLS Scale. In the both groups, the results before treatment were scored as:

  • 4 = Severe wrinkles 55%
  • 3 = Moderate wrinkles 45%
  • 2 = Mild wrinkles 0%
  • 1 = Minimal wrinkles 0%
  • 0 = Wrinkles absent 0%.

In Group 1 following treatment, the results were 4 = 0%, 3 = 35%, 2 = 55%, 1 = 10%, and 0 = 0%. In Group 2 following treatment, the results were 4 = 30%, 3 = 45%, 2 = 25%, 1 = 0%, and 0 = 0%. The authors have decided to study this part of investigation in the near future and to the GAPOLS Scale, in line with the release of new dermal fillers, particularly for lips augmentation and rejuvenation.