Facial rejuvenation

Cosmetic procedures have to deliver a natural fresh look. The positive facial expressions should not be eliminated after treatment of dynamic wrinkles with botulinum toxin A. Movements of the forehead by elevating the eyebrows, and the resulting horizontal forehead lines reflect interest in what someone else is saying or doing. These are the „good wrinkles“. In contrast: frowning and producing vertical wrinkles between the eyebrows – the “bad wrinkles” – is not desirable. Removing of the frown lines gives the whole face a relaxed look. We all agree: “Nobody really needs to look angry!“.

“Botox” is actually a proprietary name for botulinum toxin A, a natural product of particular bacteria: Clostridium botulinum. This bacterial toxin is used by physicians for medical indications as well as for aesthetic reasons. It can be administered in minimal amounts directly to the targets: muscles or sweat glands. Botulinum blocks the release of acetylcholine, a neuronal messenger. Therefore the signals for muscle contraction or sweat production are not transmitted to the targets – muscles remain relaxed amd sweat glands produce no sweat. Botulinum toxin A has been used medically for over 30 years; thus we have a good feeling for its precise use, action and side effect profile. I only use the licensed and in Switzerland approved products for treating wrinkles and axillary hyperhidrosis.

Botulinum is injected into the mimic muscles and surrounding tissue with a very fine needle and in very low doses. Multiple little injection points are needed to achieve the desired results. The injections are nearly painless and an anaesthetic is not required.

Initially you notice just nothing! After about 30 minutes redness and minor swelling around the injection sites disappear. At this point active muscle contractions are recommended – raise your eyebrows or frown repeatedly in the first hours. But keep your hands off! – no facial massage or other cosmetic treatments in the first 24 hours after treatment. The muscle relaxing treatment effects appear slowly after 1 week, and maximum results are seen after 14 days. An evaluation of treatment effects is done after this time earliest. The Botox-effect is most impressive after the very first treatment – you actually cannot frown and look angry any more. People around you will notice a “new” relaxed person – “You look so fresh and rested“. This very pleasant situation last for about 4 months. After this period of time the positive effects begin slowly to disappear, and the treatment should be repeated. Regular treatments lead to a permanent smoothening of the skin. Wrinkles cannot appear or progress anymore – this is known as botulinum prophylaxis.

Botulinum alone cannot prevent or hide skin aging. After the mid-30s regular skin booster therapy with hyaluronic acid can counter the increasing dehydration  and loss of skin elasticity. The texture and spotting of the skin can also be improved with lasers and peelings. Wrinkles, lines and folds, as well as volume loss can be improved by augmentation with hyaluronic acid fillers.

A healthy life style also has a positive influence on the skin. Too little sleep, lots of stress, and too much sun exposure, as well as alcohol and nicotine, all accelerate skin aging and should be avoided as good as possible. In addition good skin care is absolutely essential.

I look forward to give you my individual recommendations in a personal consultation.

There are static wrinkles, which are lines that become more and more prominent during aging, such as the nasolabial folds or sleeping lines on the cheeks, and on the other hand dynamic wrinkles, which arise due to mimic expression. The vertical frown lines between the eyebrows are the typical dynamic wrinkles. They are best treated with botulinum. The fine lines and the static wrinkles are a sign of skin moisture loss. They are usually best treated with hyaluronic acid. To restore volume in the case of sunken cheeks or to balance deep folds, such as prominent nasolabial folds, there are several options including hyaluronic acid, calcium hydroxylapatite (Radiesse®) and autologous fat. Hyaluronic acid is the material of choice for lip volumizing and contouring. In addition, both hyaluronic acid and autologous fat are used in hand rejuvenation. I always use non-permanent, resorbable fillers. These materials are completely removed by the body over a distinct period of time. They have to be injected repeatedly, but this allows an adjustment to ongoing age and patient’s desire. The greatest advantages of resorbable fillers are a good compatibility and low complication rates, compared wirh permanent fillers.

Hyaluronic acid is a natural tissue component found in all mammals and in some bacteria. The hyaluronic acid product we use is synthesized by streptococcal bacteria. It is a long-chained sugar molecule which is able to bind large amounts of water. We take advantage of this high water-binding capacity, using non-linked products for a superficial skin booster effect, and cross-linked products with higher stability to restore volume and volumize. Hyaluronic acid is well-tolerated and completely degraded by the body – it is a resorbable filler. The duration of effect varies depending on the type of hyaluronic acid product used for best for the different indications. Hyaluronic acid as a skin booster should be repeated every 4 months. The products used for treating folds and wrinkles most often have to be reinjected after 6 months. Volumizing products have good effects up to 2 years.

The filler: Radiesse® (calcium hydroxylapatite) consists of calcium and phosphate ions (microspheres) in a gel matrix. It is a synthetic product, but is completely degraded by the body (resorbable) and has a longtime duration up to 2 years. Calcium hydroxylapatite causes mild burning sensations after injection, and a little more swelling compared with hyaluronic acid products. The microspheres bind to the connective tissue fibers and cause collagen neogenesis in the subcutaneous tissue. I use this filler for treatment of deep folds and volume restoration only.

The treatment of fine wrinkles and moisture loss has been revolutionized by the hyaluronic- skin booster – technique. Non-crosslinked hyaluronic acid is either injected directly under the skin, using a fine, blunt cannula in a fan shaped technique, or it is injected into the superficial skin layers using a very fine, sharp needle. Fine lines and wrinkles can be treated most precisely with cross-linked hyaluronic acid products, using point or linear technique and a fine needle. “Tower technique” is fantastic to reduce even deep wrinkles, or volumeloss of the cheeks and corners of the mouth. In this procedure slender “hyaluronic acid towers” are placed vertical and narrow in the tissue, starting from the depth. This structure supports and stabilizes the skin above the treated tissue. The “Windmill technique” is optimal for volumizing a whole face. A thin, blunt cannula is used to augment cheek area and nasolabial folds, dark circles under the eyes, lips and corners of the mouth, jawlines and even temples. The filling material is evenly injected in a clockwise rotation into the adressed regions of the face and the different tissue layers.

All these injection techniques can be carried out without local anaesthesia, with topical anaesthetic cream or in some cases with local anaesthetic injection points. Some hyaluronic acid products already contain lidocaine, providing their own local anaesthetic effect.

Immediately after the treatment the desired augmentation effect is visible. In addition, there is some redness and swelling, which usually disappears after 1-2 days. Cooling and mild massages are recommended. The long-term effect of the treatment can be evaluated after 14 days. In this interval a minimal „too little“- or „too much“- result will compensate. Bruising can usually be covered with make-up. Volume restoration of the cheeks, lips and rings under the eyes produces a more youthful, healthy and natural appearance. Treating wrinkles and folds with hyaluronic acid makes the facial expression softer and more youthful. The hyaluronic – skin booster makes the entire skin glow, as fine wrinkles disappear and the tissue is rehydrated.

Regular treatment with botulinum produces long-term smoothening of the facial skin – fine dynamic lines do not have any chance to develop or become prominent – botulinum prophylaxis. The skin texture and spotting can be improved by lasers or peelings. Skin tightening with Sofwave is perfecting any augmentation treatment.

A healthy life style has a positive influence on the skin. Too little sleep, lots of stress, and too much sun exposure, as well as alcohol and nicotine abuse, all accelerate skin aging and should be avoided as much as possible. In addition good skin care is absolutely essential.

In a personal consultation the different treatment options with fillers are discussed, and I will recommend you the best approach in your individual case.

A skin like milk and honey – yes, who wouldn’t like that! But life does not pass by without leaving traces. Not only wrinkles and folds are among the signs of skin aging, but also increasing coarseness, teleangiectasia on cheeks and nose (couperose), and irregular pigmentation, especially in areas exposed to sunlight such as face, décolleté and back of the hands. The modern devices for laser therapy and PRP treatment make it possible to blur the traces of time with gentle methods. After repeated applications, the skin becomes overall finer in texture and more even in coloration.

After venous blood draw from the patient (about 15 ml), this sample is immediately centrifuged in order to isolate the platelet-rich plasma (PRP) from the supernatant. This PRP contains multiple growth factors in high concentration, such as: EGF (Epidermal Growth Factor) and VGF (Vascular Growth Factor), which stimulate the body’s own regeneration and cell metabolism. PRP is either applicated to the skin by means of medical microneedling, or injected selectively with a very fine needle. This causes a stimulation of new collagen formation and thus an improvement of skin structure over a 6 months period. Before the PRP treatment the skin is anesthesized with a local anaesthetic cream.

The skin is slightly red and minimally swollen for about 24 hours after the treatment. Applying an antiseptic cream twice a day prevents possible skin blemishes or infections. Make-up may be reapplied after approximately 12 hours. Consistent sun protection should be ensured with daily application of a sun protection product (SPF 50) for 4 weeks. For skin rejuvenation, a minimum of 3 treatments every 4 weeks is recommended, and additional therapies may be given if there is a good response. A treatment cycle can be repeated twice a year.

Regular skin booster therapy with hyaluronic acid can counteract the progressive loss of elasticity and hydration in the skin delaying further skin aging. Regular treatment with botulinum leads to a permanent smoothing of the facial skin and mimic wrinkles – the so-called botulinum prophylaxis. The treatment of static wrinkles, such as nasolabial folds, or compensation volume loss can also be carried out by filler injections.

In addition, lightening of brown pigmentary spots or irregular hyperpigmentations, as well as minimizing teleangiectasia or couperose by laser treatment have a favorable effect on the overall skin quality and expression. Good skin care and light protection are highly recommended as well.

I would like to give you my recommendations in a personal consultation.

When facial skin starts to loose elasticity and sag or droop – there is now a non-invasive, no downtime approach! Intense ultrasound beam technolgy is able to turn back the clock of skin aging a bit. With Sofwave skin tightening is possible in one single treatment, and the result is a more youthful appearance and a high patient satisfaction.

Sofwave treatments are already available in the USA since 2019. Sofwave has been proven to be a safe and effective treatment method, and is approved for skin treatment in the U.S. and the European Union by the authorities there. Ultrasound energy is delivered to the dermis (subcutaneous tissue) at a targeted depth of 1.5 mm via a handpiece placed on the skin with seven integrated parallel transducers. The integrated active contact cooling allows the precise introduction of controlled energy doses into the skin, while at the same time providing a high level of patient comfort, and protection against overheating of the uppermost skin layers as well as the surrounding structures. The many thermal micro-injuries caused by heat immediately trigger a shrinking of the surrounding collagen fibers (collagen shrinking) and activate a repair mechanism in the longer term, which induces the production of new collagen fibers and thus naturally strengthens the skin.

Is anaesthesia necessary?

In order to better tolerate the heat effect of the ultrasound in the skin, it is recommended to take a pain medication (for example: ibuprofen or metamizol) about one hour before treatment start. The application of a local anaesthetic cream on the treatment areas is also helpful for a relaxed treatment session.

What happens afterwards?

This procedure produces an immediate effect with improvement of skin tone and contours, as well as a late effect that increases over weeks and months with skin structure improvement, tissue firming and tightening effects. A more prominent contouring of the jawline, a softening of the nasolabial fold and a slight lifting of the eyebrows are the desired effects that can be achieved. Ultimately, the decisive factor for the success and sustainability of the result is the body’s own collagen production. There is no need to plan for downtime or reduced sun exposure after the treatment. We recommend the use of moisturizing serums and creams containing hyaluronic acid to promote the skin’s regeneration processes and the formation of new collagen. It also makes sense to support collagen neogenesis with a course of concentrated collagen protein and hyaluronic acid components – administered orally, in powder or liquid form – over a period of 3 months. Make-up can be reapplied immediately.

Injection of fillers to restore volume is the best way to correct volume loss and at the same time tighten the skin by expanding the tissue beneath it. That’s called volume lifting! Sunken cheeks or deep nasolabial folds can be harmonized.

In a personalized consultation, I will be happy to discuss which procedures are most appropriate for you. In some cases, a face lifting may be the right decision in order  to achieve the goal.

A healthy life style also has a positive influence on the skin. Too little sleep, lots of stress, and too much sun exposure, as well as alcohol and nicotine, all accelerate skin aging and should be avoided as much as possible. In addition good skin care is absolutely essential.