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.


With this new understanding, we create a new approach to treating wrinkles. This approach consists of stretching the skin, as we mentioned before; make a correction in the muscles that cause the wrinkle, if it is a dynamic wrinkle; or fill the groove, making the wrinkle disappear.

If what causes wrinkles, is the contraction of the muscles that are below them, then weaken or paralyze them, we will be diminishing or fading. This can be achieved with Botox injections. If the wrinkles are not completely caused by a contraction of the muscles, or if it is not advisable to resort to the paralysis of the muscles, different substances can be used to fill the wrinkle. Among the materials used to fill wrinkles are human collagen (injections or sheets) or synthetic substances. Some manufactured substances are similar to the tissues present in the human body (Restylane, Radiance); other substances are completely foreign to the human body (Silicone, 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.

The lines that are formed between the eyebrows can be corrected in a similar way to those on the forehead. In fact, it is in this area where Botox is most used. The fillers that can be used in this area are Collagen, Restylane and Radiance. Before this material can be injected, it must be rehydrated.

Restylane (hyaluronic acid) is a substance that is present in the skin. Because pure hyaluronic acid, when injected into the skin, tends to dissipate rapidly, the structure of the molecule must be modified. The molecules of hyaluronic acid, are unified, thus decreasing the rate of absorption and maintaining the results for a longer period. Restylane is used exclusively as an injectable material.

The third option is Radiesse, made from calcium hydroxyapatite, a molecule found in bones and corals. Its particles are small enough to be injected.


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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