Minimum programme for female patients

The treatment programme is usually very individual by nature, but the priority area for correction is the cheekbone, especially the apex point. However, it is sometimes possible to obtain highly effective results by correcting the apex point alone, allowing the interplay of light and shade to create the effect of volume. The product is inserted supraperiosteally via a combination of cannula techniques in order to recreate the volume of the lateral cheekbone area as opposed to that of a needle vertical dot 8 and bolus technique to highlight the apex point.

Optimal programme for female patients

This programme includes volume restoration of all areas. Cheekbones and cheeks can be volumised for the beautification of the face and for the recreation of the ideal mid-face area. Markers of ageing, such as grooves and folds, can also undergo volume restoration for the reshaping of the ideal mid-face, which is the key point of a youthful face.

The main strategy of treatment is to start from the lateral parts of the face towards the mid-face, from the upper face down to the lower face. This strategy aids in the optimisation of the quantity of product and the possibility of combining hyaluronic acid with high cohesivity with products of less cohesivity.

Of course, for different levels of tissue it is better to use a suitable product; for example, deep supraperiosteal injections with hyaluronic acid of high cohesivity and viscosity for the cheekbone area, while for the sub-dermal tissues it is possible to use a hyaluronic acid of medium viscosity.

Minimum programme for male patients

This programme aims to make the face look healthy, sometimes younger, with the priority area being the cheek, especially the transition from the lower eyelid to the mid-cheek. Taking into account all specialities of treatment for the male patient, such as not painful, completed in one treatment, and with visible results, the best solution is a monophasic highly cohesive filler consisting of low molecular weight (short chain) hyaluronic acid. This solution of product, which optimally combines both viscosity and cohesivity, helps to achieve a lifting and volumising effect at the correct points. It is possible in this situation to use the dot technique with a cannula in accordance with the principles of the LIFT©Concept8,9. It is safe, without any risks of complication, such as haematoma, ischaemia, or without danger of hypercorrection. This technique demands a good knowledge of facial anatomy and a deep understanding of where the product must be injected. The product should be inserted very carefully and superperiosteally into the deep fat compartment, in the appropriate quantity. Additionally, for a more natural effect, two insertion points should be used (the cheekbone point and universal point) to achieve the best result.

Optimal programme for male patients

The optimal programme is designed to treat the full face by lifting and volumising the cheeks and lower face (i.e. chin and mandibular line). These are the areas that make the face more muscular and strong. It is possible to suggest a different strategy for the correction of the male face in comparison with the female face, particularly from the lower face to the mid-face. Furthermore, this correction will not feminise the male face. It is also necessary to take into account the facial asymmetry of the male.

Figure 6 Optimal programme for the male patient (left) before and (right) after volumetric correction with 4 ml of monophasic highly cohesive hyaluronic acid filler

Figure 6 Optimal programme for the male patient (left) before and (right) after volumetric correction with 4 ml of monophasic highly cohesive hyaluronic acid filler

In this instance, the best solution is to use a greater quantity of product in comparison with women, with preference given to a hyaluronic acid of high viscosity and cohesivity, and a combination of different techniques. Beginning with the mandibular line, inserting the product deeply and supraperiosteally, using a combination of bolus, dot, and line techniques. The preference of the author is to use cannulae  because  the correction is neither aggressive nor painful. The correction of the mid-face is possible using the dot or bolus technique into the deep fat compartment.

Conclusions

There are many differences between the genders: aesthetic, anatomical, and psychological. Therefore, the strategy for volumetric correction of male and female patients will be also different in their specifics, such as goals, areas for correction, products, quantities, and correction techniques. Volume restoration of the male face is a rewarding procedure for both the doctor and for the patient. In spite of the increasing number of male patients in the aesthetic field, the priority of female patients is beyond all question.