■ The skin must be thoroughly disinfected prior to the injection. Nerve -5, block anesthesia with 1% Ultracain and additional adrenaline can be used in patients who are particularly sensitive to pain and when treating M
large areas. Surface anesthesia with the anesthesia ointment EMLA® (lidocaine-prilocaine cream) may be given at the patient's request.
■ Hyaluronic acid and collagen are injected directly into the wrinkle using Mang's serial point-by-point technique with overcorrection. The injection should be made at an angle of 30°. The patient should be lying down and the doctor carrying out the treatment should be sitting. Overcorrection can be up to 100 %. If the injections are placed correctly, raising of the skin and a blanching effect will be visible immediately.
■ The injection should be as close as possible to the surface. The point-by-point technique is used to remove forehead wrinkles (glabella), nasolabial folds and lip wrinkles. Fine eye wrinkles are treated with linear injections. The needle is inserted superficially along the eye wrinkle and pushed forwards; when it is retracted, the material flows like water into a riverbed. The wrinkle is then massaged immediately to prevent nodules forming. In principle, all wrinkles in the face and neck area can be treated with these two techniques. The skin is always pretensioned by applying mild traction.
■ Fine corrections can be made at the end of the procedure with the aid of a magnifying glass. All nodules and necklacelike structures should be smoothed and massaged. The injectable material should spread out, almost as if in a riverbed, if an optimal result is to be achieved.
■ A high-concentration collagen is used to enlarge the lips. When carrying out lip augmentation for the first time, it is advisable to begin filling-in at the margin of the lip, i. e., at the transition of the lip from red to white. The needle should be inserted along the edge of the lip at an angle of 10-20°, starting at the corner of the mouth and working toward the center. Ideally, the material should be distributed along the vermilion border, thus redefining the contours. Up to 4 ml of collagen may be injected per session, depending on the extent of lip augmentation.
■ After the treatment is completed, dexpanthenol ointment should be applied evenly to the injection sites and the treated areas should be compressed under slight pressure for approx. 15 min. Avoid sun and alcohol for 24 h. Make-up can be worn again 1 day after the operation. The patient is also able to return to work 1 day after the operation.
This is a 38-year-old female patient with a deep nasolabial fold.
Injection of 1 ml collagen on each side.
Follow-up after four months with smoothed nasolabial fold.
This is a female patient with forehead wrinkles. Injection of hyaluronic acid.
Findings after 4 months - smoothed forehead wrinkles.
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