Non Surgical Facial Rejuvenation









Non-Surgical Facial Rejuvenation

There are three main signs of aging in the face: the development of lines and wrinkles, sagging and relaxation of the tissues of the face, and changes in the quality of the skin (increased pore size, increased thickness, pigmentary changes, flaking, etc.).

To treat wrinkles in the facial tissues, traditional techniques have been used which require stretching the skin towards the ears, in a similar way as a fitted sheet would stretch over a bed. However, this method does not completely correct the problem. In the same way that wrinkles are still seen on a bed sheet, wrinkles are seen on stretched skin. Increasing tension even more does not provide long-term results, but a stressed skin appearance.

The second technique is used to improve wrinkles, it consists of ways to stretch deeper structures of the skin, with the aim of improving surgical results. For example, with the SMAS technique there was an improvement in the results, but the face did not always look young. Also this technique did not treat all areas of the face.

The next step in our understanding about skin laxity and wrinkles is recognizing that a youthful appearance does not necessarily come from having tight skin. The tissues that are under the skin must be llenosi to offer a youthful appearance. Keeping this in mind, the focus needs to be redirected to the vertical repositioning of fat and tissues that have been displaced under the effects of gravity.


Con este nuevo entendimiento, creamos un nuevo enfoque para tratar las arrugas. Este enfoque consiste en estirar la piel, como lo mencionamos antes; hacer una corrección en los másculos que ocasionan la arruga, si se trata de una arruga dinámica; o rellenar el surco, haciendo así que desaparezca la arruga.

Si lo que ocasiona las arrugas, es la contracción de los másculos que están por debajo de ellas, entonces al debilitarlos o paralizarlos, estaremos disminuyendo o desvanecióndolas.  Esto se puede lograr con inyecciones de Botox.  Si las arrugas no están completamente ocasionadas por una contracción de los másculos, o si no es recomendable recurrir a la paralización de los másculos, se podrán utilizar diferentes sustancias para rellenar la arruga.  Entre los materiales usados para rellenar las arrugas se encuentran colágeno humano (inyecciones o láminas) o sustancias sintéticas.   Algunas sustancias manufacturadas son similares a los tejidos presentes en el cuerpo humano (Restylane, Radiance); otras sustancias son completamente ajenas al cuerpo humano (Silicona, Acrylic Beads).


The traditional way to correct the lines in the forehead is through the forehead lift. This surgical procedure, stretches the skin and allows for correction of the muscles that cause wrinkles. Botox, injected into our office, paralyzing the muscles is also a good option. By means of the Botox, the folds that form in the front of side can be reduced, notoriously. To complete the correction, additional material may be used at the same time or at a later visit.

Las líneas que se forman entre las cejas, se pueden corregir de manera similar a las de la frente.  De hecho, es en esta área donde más se utiliza el Botox.  Las sustancias de relleno que se pueden utilizar en ésta área son Colágeno, Restylane y Radiance.  La fuente de colágeno humano es la piel o tejido conectivo de cadáveres humanos.  Antes de que este material pueda ser inyectado, debe ser rehidratado.

Restylane (hyaluronic acid), es una sustancia que está presente en la piel.  Debido a que el ácido hialurin puro al ser inyectado en la piel, tiende a disiparse rápidamente, se debe modificar la estructura de la molécula.  Las moléculas del ácido hialurinico, se unifican, disminuyendo así la tasa de absorción y manteniendo los resultados por un periodo más largo.  El ácido hialurinico se obtiene de fuentes bacterianas o del pollo.  El Restylane se usa exclusivamente como un material inyectable.

The third option is Radiesse, elaborado de hidroxipatita de calcio, una moecula que se encuentra en huesos y corales.  Sus partiulas son lo suficientemente pequeñas como para ser inyectadas.


These lines, also called smile lines, can be treated with a chemical peel. Dr. Makhlouf recommends using a botulinum toxin such as Botox, Dysport or Xeomin. Depending on the product used, the results will be noticeable between two tofive days and the patient can continue with their normal activities.


This is the fold that is obliquely marked from the inner corner of the eye and delineates the union between the skin of the eyelid and the skin of the cheek. When this fold is very deep, it gives a tired look to the face. During blepharoplasty, some of the fat can be removed to correct this groove. Options such as fat injections or fillers of hyaluronic acid such as Restylane, are more widely accepted.


This is the crease that begins at the bottom of the nose and extends to the corner of the lips. To correct it, the cheek must be lifted, a mid face lift may be required to obtain optimal results.

Another options that can be used for the correction of this fold is the use of fillers. You can inject fat, Restylane or Radiesse. As a third option, we have a minor surgical procedure that allows us to place Alloderm (human skin surface) in the area to be lifted and thus level the groove.

The right option will depend on the intensity of the fold, the patient’s preference, and the results that can be achieved.


There is no perfect solution to this problem. The treatment Dr. Makhlouf recommends is dermabrasion in conjunction with a chemical peel. Another option is to fill the lip border with hyaluronic acid such as Belotero or Restylane.


To create a full lip appearance (if you feel the lip has lengthened), a lip lift procedure can be performed with which the lip is lifted by removing the skin between the upper lip and the nostrils . This causes the teeth to expose themselves more and the lip look fuller and youthful.

Another option, which has been very successful, is to insert Alloderm (human cadaver skin), through a tunnel created on the lips, which extends from one side to the other. The incisions are not visible, and will remain inside the mouth.


These are the lines that begin at the corners of the lips and extend downward on the sides of the chin. Treatment may include a mid face or face-lift (fat or Restylane).

The advantage of using fat on the face, is that the results are more permanent. The disadvantage is that it must be performed more than once to achieve the desired results.

M. Vincent Makhlouf, M.D.


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