Report Technique

■ Following surface or nerve-block anesthesia (supraorbital, infraorbital, mental) and disinfection, injection of the Hyal System into the papillary dermis via a 30-guage cannula is started.

■ The angle of insertion is normally 10-15° and the cannula should then be advanced parallel to the surface of the skin. Blanching of the skin will be visible if the injection has been given correctly. A cross-link, tunnel, or fan injection technique is used depending on the anatomical region. A serial point-by-point injection technique can also be used with appropriate indications (nasolabial). In the cheek region, a cross-link injection technique is used, i. e., following an imaginary, diagonal framework; injections are given either at every or at every second horizontal and vertical point of intersection, and the entire area to be treated is thus undermined. The needle is inserted at an angle of 10-15° and then moved so that it is parallel to the surface of the skin. This ensures the correct injection level (the papillary dermis) is reached. The injections are first made in a horizontal direction and the area being treated is then briefly compressed. The injections are then continued in a vertical direction.

■ At the sides of the eyes, the tunnel technique is most suitable. Injections are made into the upper dermis in parallel lines.

■ The cross-link technique is most suitable for treating the glabella and the upper area of the forehead because of the large area coverage. In modified form, this technique can be applied laterally.

Adjuvant Therapies

Hyal System Eyes

Hyal System

■ To achieve a rejuvenating effect in the upper perioral region, the Hyal System is injected parallel to the upper lip in droplets. Similar injections are made parallel to the lower lip to complete this treatment.

■ The Hyal System can also be used to tighten larger areas of the neck, the décolleté region and the hands, and a modified cross-link technique must be used in these areas, i.e., systematic, even, and fan-shaped injections must be given over the entire area to achieve a satisfactory result. The aim is to establish fibroblast activity and neogenesis of endogenous hyaluronic acid, elastin and collagen.

■ Depending on the size of the areas to be treated, multiple syringes of 1.1 ml may be injected. We use 2 ampules per session.

■ In young patients who still have firm skin tone, three injections at intervals of 4 weeks will be necessary initially. Subsequent injections should be repeated every 4-8 months to maintain the result. In older patients with atonic skin and insufficient elasticity, three injections should be given at fortnightly intervals and boosters should then be given every 3-6 months.

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