Dr Sandrine Sebban presents a procedure to restore facial volume using hyaluronic acid with no downtime
There is a non-surgical, non-invasive facelift alternative that requires no downtime and that is perfect for patients who do not want to undergo surgery or for whom surgical facelift procedures are contraindicated. This protocol involves hyaluronic acid injections using a cannula inserted into a single point on the side of the face. It is used to elevate sagging tissue by restoring the bone and fat volumes lost through ageing.
Developed and standardised by Dr Sandrine Sebban, the STOP Facial Ageing Method™ establishes a rigorous procedure to address volumetry as well as the interrelationship between different treatment areas.
A revolutionary innovation
The STOP Facial Ageing Method™ protocol combines two complementary techniques—Deep One Point (DOP) and Superficial One Point (SOP) — promoting spectacular facial rejuvenation with very natural, comprehensive results.
The DOP technique works on the deep plane to restructure facial architecture by restoring volumes and treating ptosis (whether minor, moderate, or severe).
The SOP technique acts on both the superficial and deeper hypodermic planes to add volume and provide optimal tissue hydration.
Scaffolding: a pre-established framework that guarantees successful injection
The secret behind the STOP Facial Ageing Method™ is an indispensable ‘scaffolding’ technique that is used to prepare the face for volume restoration. The practitioner uses a pre-established framework, based on precise anatomical parameters, to divide the entire face into a series of grids. These grids then enable specific injection sites to be identified.
Each half of the face is delineated by a vertical line that extends from the top of the forehead, passes through the nasal bridge, and ends in the middle of the chin (Vertical Midfacial Line, V1). The outer boundaries are represented by the scalp line and the ears (Figure 1).
Upper Third: the upper limit of this section is represented by the Scalp Line (H1), whereas the lower limit is defined by a line that passes through the middle of the pupils and the outer corner of the eyes (Midpupillary Line, H2).
Middle Third (the most complex facial zone): to facilitate treatment, this section must be divided into two parts—the upper middle third and the lower middle third.
Upper middle third: the Midpupillary Line delimits the upper limit of this section, which includes the orbito-malar and zygomatic regions.
Lower middle third: the upper boundary of this section is the line that passes through the nasolabial angles and the middle part of the tragus (on each ear); the lower boundary is delimited by the Midlabial Line, which extends from the outer corner of the lips to the base of the earlobes (Midjugal Line, H3).
This third of the face includes the nasolabial folds, the upper perioral area and upper lip, and the midjugal area.
Lower Third: the Midlabial and Midjugal Lines delimit the upper boundary of this third of the face. The lower limit corresponds to the oval line of the face, which extends from mid-chin to the mandibular angle.
The lower contour of the face is divided into three equal parts, delimited by the Vertical Midfacial Line (V1) and two lines that run parallel to V1, drawn from points V2 and V3.
The scaffold’s creation enables the therapeutic facelift to be conducted according to a basic standard procedure. Physicians can restore facial volumes easily, safely, and harmoniously thanks to these innovative guidelines.
Cutting-edge techniques that are both painless and effective
The STOP Facial Ageing Method™ uses a patented “pilot” needle known as the SoftFil® EasyGuide. This needle enables the practitioner to gently create a pre-hole puncture and insert the cannula in a single gesture, making the process effortless for the practitioner and virtually painless for the patient.
The needle’s innovative ergonomics, V-shape, and lateral double grips ensure stability and offer the practitioner an excellent view of the injection site. The needle’s cut and open axis allow the practitioner to position the cannula with precision and then gently guide it to the desired depth and location for tissue injection.
A single point of injection
The STOP Facial Ageing Method™ involves hyaluronic acid injections using a cannula inserted into a single point on the side of the face.
But how is this point determined? First, it is necessary to locate point X. This point is found at the intersection of the Oblique Line, which passes through both the inner canthus of each eye and point O (positioned two-thirds of the way down the oval line, in V3), and the Midjugal Line. The single cannula insertion point (E, Entry Point) is located 5 mm behind this mark on the Midjugal Line. (Figure 2)
The non-surgical facelift protocol is conducted in a physician’s office and consists of three successive steps corresponding to the three treatment phases—one DOP phase and two SOP phases. Each of these phases involves cutting-edge hyaluronic acid injections, the specific properties of which are perfectly adapted to the various regions to be treated.
DOP (Deep One Point) technique: Deep Plane Treatment
Targeted facial areas: middle and deep planes
Using a cannula that is 6-7 cm in length (22G to 25G), the practitioner injects cohesive hyaluronic acid, which has good projection properties, into the deep plane, near the subperiosteal layer.
In the upper third of the face, the boluses are located on the Axis of Rejuvenation, which passes through the nasolabial angles and the top of the helix. Generally, three boluses are administered (B1, B2, B3).
If dark circle treatment is necessary, four micro-boluses are injected in the suborbital region (MB1, MB2, MB3, MB4). A hygroscopic hyaluronic acid, with crosslinks adapted to the periorbital region, is then used.
In the lower third of the face, the boluses are mainly injected in the mandibular branch (B4, B5, B6, B7, B8).
Results: the lifting effect is instantaneous, facial architecture is restored, and the oval line of the face is more pronounced.
SOP (Superficial One Point) Technique — Deep Hypodermic Plane
A 25G to cannula is introduced into the deep hypodermis and nappage is applied in a “fanned” pattern to the middle and lower thirds of the face, avoiding the sub-orbital region and jowl area. So as to respect facial dynamics, a hyaluronic acid with good elasticity is chosen (Figure 3).
Results: volumes are restored, superficial wrinkles are smoothed, and a remarkable lifting/firming effect is achieved through reharmonisation of the skin’s surface.
SOP Technique — Superficial Hypodermic Plane
Using a 27G cannula and hyaluronic acid with little or no crosslinking, a superficial hypodermic nappage is applied in a “fanned” pattern to the middle and lower thirds of the face. The suborbital region is avoided and, if necessary, the upper perioral area and bitterness folds (puppet wrinkles) are intensively treated.
Results: the face is hydrated and radiant, wrinkles and fine lines are filled.
In sum, the combination of DOP and SOP techniques work in harmony to maximize the overall beautifying effect and restore the facial triangle.
Benefits of the STOP Facial Ageing Method™
- The method’s protocol is standardised and reproducible.
- Error/overcorrection risks are eliminated.
- Treatment is fast (less than one hour).
- The procedure is virtually painless, is compatible with an active lifestyle, and involves minimal side effects.
- Results are instantaneous and last 15-18 months, depending on the hyaluronic acids used.
- Niamtu J 3rd. Filler injection with micro-cannula instead of needles. Dermatol Surg. 2009 Dec; 35:2005-8. doi: 10.1111/j.1524-4725.2009.01323.x
- Prager W, Agsten K, Kravtsov M, Kerscher PM. Mid-Face Volumization With Hyaluronic Acid: Injection Technique and Safety Aspects from a Controlled, Randomized, Double-Blind Clinical Study. J Drugs Dermatol. 2017 Apr 1;16:351-357
- Hexsel D, Soirefmann M, Porto MD, Siega C, Schilling-Souza J, Brum C. Double-blind, randomized, controlled clinical trial to compare safety and efficacy of a metallic cannula with that of a standard needle for soft tissue augmentation of the nasolabial folds. Dermatol Surg. 2012 Feb; 38:207-14. doi: 10.1111/ j.1524-4725.2011.02195.x. Epub 2011 Oct 19
- Pessa JE, Rohrich RJ. Discussion: Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg. 2012 Jan; 129:274-5. doi: 10.1097/PRS.0b013e 3182362be2
- Wan D, Amirlak B, Rohrich R, Davis K. The Clinical Importance of the Fat Compartments in Midfacial Aging Plast Reconstr Surg. 2013 Dec; 1: e92. doi: 10.1097/GOX.0000000000000035 PMCID: PMC4174112
- Lorenc ZP, Lee JC. Composite Volumization of the Aging Face: Supra-Periosteal Space as the Foundation for Optimal Facial Rejuvenation. J Drugs Dermatol. 2016 Sep 1; 15:1136-41
- Surek CC, Beut J, Stephens R, Jelks G, Lamb J. Pertinent anatomy and analysis for midface volumizing procedures. Plast Reconstr Surg. 2015 May; 135:818e-829e. doi: 10.1097/PRS.0000000000001226
- de Felipe I, Redondo P. The Liquid Lift: Looking Natural Without Lumps. J Cutan Aesthet Surg. 2015 Jul-Sep; 8:134-8. doi: 10.4103/0974-2077.167267
- Hoffmann K. Juvéderm Voluma Study Investigators Group Volumizing effects of a smooth, highly cohesive, viscous 20-mg/mL hyaluronic acidvolumizing filler: prospective European study. BMC Dermatol. 2009 Aug 27;9:9. doi: 10.1186/1471-5945-9-9
- Buntrock H, Reuther T, Prager W, Kerscher M. Efficacy, safety, and patient satisfaction of a monophasic cohesive polydensified matrix versus a biphasic nonanimal stabilized hyaluronic acid filler after single injection in nasolabial folds. Dermatol Surg. 2013 Jul;39(7): 1097-105. doi: 10.1111/dsu.12177. Epub 2013 Mar 18.
- Lee SK, Kim HS. Recent trend in the choice of fillers and injection techniques in Asia: a questionnaire study based on expert opinion. J Drugs Dermatol. 2014 Jan;13(1):24-31.
- Bass LS. Injectable Filler Techniques for Facial Rejuvenation, Volumization, and Augmentation. Facial Plast Surg Clin North Am. 2015 Nov;23(4):479-88. doi: 10.1016/j.fsc.2015.07.004