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Facial Aging is a continuous process throughout life, already starts in the 20’s and advances progressively during life due to the physiologic changes of the skin and underlying tissue. It’s most noticeable on the face and neck where personal and environmental factors can accelerate these changes giving an impression of aging and worried look because of wrinkling and skin atrophy. Innovative measures and treatments like Dermal Fillers and Botox are designed to revitalize your skin and expression giving back a look of youth and freshness.

During the course of this aging process the general outline of the face changes from a triangle with the apex pointing downward to a trapezoid or rectangle due to sagging skin and downward descent of the cheek soft tissues.   With time, the effects of gravity and the longitudinal pull of muscles cause drooping or sagging of the skin and deeper structures of the forehead, cheeks, eyelids, nose, chin and neck. The result is wrinkles and jowls in the face.

The aging process in the face is accelerated by:

* smoking
* genetic predisposition
* emotional stress
* diseases
* dramatic changes in weight
* exposure to extreme climates eg. chronic sun, cold temperature or wind.

Aging occurs at different rates from person to person.  It is related to a combination of loss of bone, fat, collagen and elastin, each of which is related to genetics and environment.

Hyaluronic Acid occurs naturally in the deeper layers of our skin (the dermis). It helps to keep skin smooth and "plump" through its ability to hold up to 1,000 times its weight in water.   It lubricates the joints and also  plays a critical role in the rapid repair of wounds and other skin conditions.   A form of stabilized hyaluronic acid is contained in some dermal filler products that can be applied through injection with very thin needles and local anesthesia through the use of a anesthetic cream 30 minutes before the procedure. The molecule is obtained through a biochemical process from non-pathologic bacteria and this makes it very safe to use.

Elastin is a protein found in the skin and tissue of the body. It helps to keep skin flexible but tight, providing a bounce-back reaction if skin is pulled. Enough elastin in the skin means that the skin will return to its normal shape after a pull. It also helps keep skin smooth as it stretches to accommodate normal activities like flexing a muscle or opening and closing the mouth to talk or eat.  Elastin tends to deplete as people age, resulting in wrinkled or stretched out skin.  Elastin in skin products has been shown to have little effect on skin elasticity. It may form a coating on the skin that helps the skin better hold in moisture, but it will not provide more flexibility of the skin. Elastin in skin care products does not penetrate the skin layer, which would be needed in order to make the skin more elastic.

Collagen is a protein that is the main structural component of the lower layer of the skin (Dermis). Bundles of collagen molecules pack together throughout the dermis, accounting for three-fourths of the dry weight of skin. Collagen is also responsible for the skin's strength. Collagen is produced by cells called fibroblasts, which are found scattered throughout the dermis. Maintaining a healthy diet with normal levels of Vitamin C can help to maintaining the normal production of collagen in a given age but not replace the its loss with years. In the market is available Poly-L-lactic acid, which is injected in the subcutaneous tissue and is intended to restore the collagen lost.   Also the fillers with Hydroxylapatite can induce the formation of new collagen.  Other collagen fillers are obtained from processed animal or human tissue, reason why we do not recommend them.


Facial changes with aging:

30 to 40 years of age

- Upper eyelids become redundant and at the outer corner of the eyes appear crow's feet and frown lines in the forehead, as result from collagen loss (treated with dermal fillers and botox).
- Loss of fat tissue under the eyes, dark shadows cause us to look older and tired (treated with dermal fillers)
- Deepening of the nasolabial fold (Wrinkle between each side of the nose and the corners of the mouth) (treated with dermal fillers)
- Hair loss in males.
- At the bone level the base of nose gets bigger. Some changes are seen in chin area.

40 to 50 years of age

- Appearance of lower eyelid bags, glabellar lines (between the eyebrows) and forehead wrinkles (treated with dermal fillers and Botox)
- In some cases eyes appear sunken because of fat tissue atrophy in the orbita.
- Drooping of the outer side of the brows (treated with brow lift in some cases)
- Loss of fat tissue under the cheeks and temple area, resulting in concavity (treated with dermal fillers or fat tissue injections with autologous fat transfer)
- Cheek fat begins to descend downward towards the jawline, appearing jowls (treated with local liposuction and facelift, restoring of lost volume with dermal fillers)
- Redundancy of neck skin start to appear (treated with neck lift)
- Baldness in 25% of men
- Double chin appears (treated with liposuction and/or neck lift)
- Collagen and elastin levels continue to fall resulting in eyelid bags and lines start to appear in upper and lower lips (Treated with dermal fillers)
- Platysmal banding appears in the neck (Treated with neck lift and platysmal plasty)

50 to 60 years of age

- Drooping of the eyebrows and tip of the nose
- Thinning of the lips (treated with dermal fillers, fat autograft).
- Appearance of neck wrinkles, jowls (broken jawlaine) and marionette lines.

60 to 70 years and more

- Skin atrophy and substantial loss of different components like fat tissue, collagen, elastin and hyaluronic acid.
- Increase of skin pigment cell in patches, giving origin to senile lentigo.
- Baldness in 50% of men


The first step will be prevention of accelerated aging:

- Avoid prolonged exposure to the sun, cold air and wind.

- Avoid smoking.

- Use of hydrating creams and sunscreen.

- Healthy lifestyle, adequate eating and physical activity and good sleeping habits.

- Avoid chronic stress taking the proper measures for relaxing.

The second step includes the evaluation of the patient by a trained specialist and evaluate the treatment with non-surgical methods like the use of chemical peels (You can read more about chemical peels here).

Another good alternative in the second step (and with a different purpose) is the use of dermal fillers to restore lost volume and return the appearance of younger skin, fuller and with less wrinkles. An importance thing to notice is that in spite of not being a surgical procedure, involves the placement of them under the skin with very fine needles, so you should be aware that your treating doctor has the proper training and technical skills to administer these substances. Dermal fillers are non-allergenic and well tolerated by most patients, giving satisfying results.

Dermal fillers are directed to both women and men, though in men the areas to be treated are slightly different.

They are usually administered under local anesthesia or after the use of an anesthetic cream over the skin for 30 minutes.  In some cases an anesthetic block is preferred (like when going to the dentist), and then the dermal filler is applied under sterile technique. After finishing, the patient rests for a while with a cold pack on the treated area.  This procedure lasts from 20 to 30 minutes depending on the anesthesia, technique and extension of the treated area.

Hyaluronic acid gel (Restylane)











Currently there are many trademarks available, but you should know their main components, like:

- Hyaluronic acid: These are resorbable fillers made with stabilized hyaluronic acid, obtained through a biochemical process and without animal origin, between them we can find: Restylane (Q-Med), Juvéderm (Allergan), Fortelis, Esthelis, Mesolis (Anteis), Glytone (Pierre Fabre).










- Calcium hydroxilapatite: Contained in Radiesse (BioForm Medical Inc.) composed of synthetically produced smooth calcium hydroxylapatite (CaHA) micro-spheres suspended in a gel carrier. Hydroxylapatite is a natural component of human bones, and the synthetic form it's used in different biomedical applications like prosthetic implants. The form contained in dermal fillers is resorbable through time and can stimulate some degree of collagen production where was injected.

- Poly-L-lactic acid: Contained in Sculptra (Sanofi-Aventis), it's also contained in some suture materials for surgery, it's slowly reabsorbed and degraded by the body, being replaced in some degree by collagen.

- Polyacrylamide: This is a non resorbable filler contained in Aquamid (Contura Int.), consisting in a solution of water and 2,5% polyacrylamide. The effects are permanent and long lasting.

It is important to mention that every product has advantages and disadvantages and these can be discussed with the surgeons in Arcadia Clinic.

The duration of the effect is variable between patients, being from 6 months to 1 year for most, but up to 2 years with some dermal fillers.

Adverse reactions of dermal fillers are uncommon but reported time to time, being the most common local reddening and swelling that last up to a week. Less common is bruising and very rare are inflammatory reactions and skin discoloration (1 in 50.000 treatments as reported by the pharmaceutical companies).



Hyaluronic acid gels were introduced in the market in the mid-1990s and Restylane is one of the most popular products that contain it. The hyaluronic acid is from non-animal origin and stabilized with the patented NASHA technology from Q-Med AB from Uppsala, Sweden.  The Restylane range of products are characterized by a non-permanent but long lasting duration of action with good efficacy and safety during clinical testing. NASHA based gels are stabilized to result in minimal modification of the hyaluronic acid with a high degree of biocompatibility. Due to its type of degradation, the gel molecules are able to take up water as it is broken down with time, maintaining its volume.

b_250_250_16777215_00_images_stories_cosmetics_nasha_gel_web_340pxwide.jpgCurrently, Restylane has been used in more than 10 million treatments worldwide during the last 12 years.

Variations in particle size and cohesive properties of the different Restylane dermal fillers allows for specific purposes in different areas of the face and body, at different levels of the skin, with improved facial tissue augmentation and the correction of lines and folds, contouring and enhancement of individual facial aesthetics.



Areas to be treated:

- Nose to mouth lines (nasolabial folds)

- Between the eyebrows (glabellar lines)

- Lips (adding volume and shape)

- Back of the hands, décolletage, face and neck (skin rejuvenation)



Restylane Range of Products






Restylane and Restylane-Lidocaine: It is specifically designed to reduce the appearance of moderate facial wrinkles and folds, such us frown and glabellar lines. It may also be used to treat smile lines and marionette lines at the corner of the mouth. Restylane-Lidocaine is to be used as an alternative to increase patient comfort.






Restylane Perlane: Is used for the correction of deeper wrinkles and folds such us nasolabial folds. It is also a powerful tool for shaping facial contours and provide minor to moderate contouring of the cheek or eyebrow area, accentuating the existing features.

Restylane Perlane






Restylane Touch: Is designed to reduce the appearance of fine, superficial lines such as the periorbital and perioral lines. It can also be used to reduce scars.

Restylane Touch






Restylane Lipp: Is designed to meet the specific, highly dynamic demands of the anatomy of the lip. It is structured to withstand  the strains associated with the full range of mouth movements. Restylane Lipp is designed to provide lip enhancement over time.

Restylane Lipp






Restylane SubQ: Is designed for volumetric contouring of facial features. It is injected deeply to add volume, which supports the overlaying tissue to provide facial fullness and restore symmetry. This treatment is ideal for patients with flattened facial features, or those with an unbalanced or asymmetrical face. It is also suitable for patients reluctant to undergo facelift surgery or the insertion of permanent implants.

Restylane SubQ





Restylane Vital: Is a smooth NASHA gel designed to restore and maintain skin hydrobalance. It improves the elasticity and smoothness of the skin. Restylane Vital is ideal for rejuvenation of mature and photo-damaged skin. Restylane Vital should be given in a treatment cycle of 3 sessions 4 weeks apart, to be repeated after 6 months.

Restylane Vital

Restylane Vital Light: Is designed for younger, thinner skin which requires a lighter rejuvenating effect. Restylane Vital Light is a smoother and more fluid gel which adjusts well to delicate skin, being therefore more suitable for areas with thin skin such us neck, décolletage and the back of the hands. Restylane Vital Light should be given in a treatment cycle of 3 sessions 2-4 weeks apart, to be repeated after 4-6 months. Individual treatment programs can be designed according to the quality of the skin area treated.




Duration of the treatment

The treatment of Restylane, depending of the individual, lasts between 6 and 12 months.










The results are immediately visible, sometimes it can look over-corrected during the first week of treatment but this notoriously improved after 5-7 days.

Images Pre-After treatment (Provided by Restylane).

Pre-treatmentAfter treatment






























Post-treatment with Restylane Lipp











































Combination Treatments

Dermal fillers can be combined with other treatments like Botox but this requires previous planning by the treating surgeon to obtain the best result possible.


Juvéderm is a newer hyaluronic acid containing gel from Allergan company,  used to treat lines and wrinkles, as well as increase and improve volume of different facial features.


The Juvéderm® ULTRA range of products mimics the hydrating and lifting effect of your skin’s natural hyaluronic acid (HA), which keeps the skin hydrated and elastic. It fills in and smooths away facial lines and acne scars, other skin contour deficiencies, and lost volume. The most appropriate lines to treat with the Juvéderm® ULTRA range of products are those that are described as static—this means the deep facial lines you can see when your face is still. Static lines are due to lack of elasticity of the skin caused by sun damage, smoking, and unfortunately genetics. Wrinkle-relaxing treatments work in a targeted way to relax the tiny muscles that cause frown lines, smoothing out wrinkles for 4 months or longer.

Juvéderm has the advantage of including in the gel the local anesthetic Lidocaine, lowering the chances of discomfort when applying it.




Juvéderm ULTRA 2: Erases moderate lines, specially those around the lips and corners of the eyes and those very close to the surface of the skin.












Juvéderm ULTRA 3: Smooths wrinkles between the nose and the corner of the mouth (nasolabial lines) and around lips; it can be used very subtly to plump out lips in order to maintain a youthful smile.






Juvéderm ULTRA 4: Works on the most noticeable folds and lines, and improves the contour of the face.






Juvéderm VOLUMA: Is an injectable hyaluronic volumiser that re-contours the face to restore volume to chin, cheeks, and cheekbones that have become hollow or thin due to weight loss or age-related facial fat loss. Immediately after treatment, you should notice that your facial contours appear fuller and rounder giving your face a softer, more youthful appearance.






Juvéderm HYDRATE: Offers deep hydration to give you smoother, firmer skin in areas that are often susceptible to sun damage and the signs of aging— the face, neck, décolletage, and hands. Hydration is fundamental to healthy skin tone and elasticity, and maintaining a natural, healthy glow. Creams can only temporarily moisturize the skin at the surface, but Juvéderm® HYDRATE can provide the deep, lasting hydration that will give you a natural, healthy glow.






Juvéderm ULTRA SMILE: Provides full, soft and natural looking lips and smooths fine lines around the mouth area







Duration of the treatment

The treatment with Juvederm, depending of the individual, lasts between 6 and 12 months.

















Combination Treatments

Dermal fillers can be combined with other treatments like Botox but this requires previous planning by the treating surgeon to obtain the best result possible.




After the treatment with dermal fillers is expected that the area over it will be a little swollen and this is normally expected.   When looking in the mirror for the first time the treated areas may look bigger than you expected but don't worry, as soon as the swelling goes away after a couple of days you will be able to see the final result.

Between the indications to follow are:

* Don't apply make-up for 12 hours after the treatment
* Don't drink anything too hot or too cold if your lips were treated
* Use a perfume-free moisturiser if you have any dry skin
* At home, you can use a cold pack or cold object over the treated area 5 minutes every 30 minutes in the first hours.

When finishing the session, the surgeon will repeat these indications and arrange the follow up consultation in 2-3 weeks


Other component of the second stage of treatment is the use of Botox.

BOTOX® Cosmetic is a prescription medicine (onabotulinumtoxinA) from Allergan, that is injected into muscles and used to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in people for a temporary period of time.


It is administered by a physician with a proper training (like a plastic surgeon), being injected directly into the muscles between the brows and other facial muscles in different concentrations. It works by blocking nerve impulses to the injected muscles. This reduces muscle activity that causes moderate to severe lines to form on the face.

Botox is directed to both women and men for the treatment and prevention of facial wrinkles, it's been used in nearly 11 million treatments since its introduction in 2002.

Within days it is possible to observe results, you may see a marked improvement in the moderate-to-severe frown lines between your brows. Lines continue to improve for up to 30 days, and results can last for up to 4-6 months, though individual results vary.

Although the results are visible, a treatment with BOTOX® Cosmetic (onabotulinumtoxinA) will not radically change your facial appearance or make you look as if you’ve “had work done.” The muscle activity that causes frown lines between the brows is temporarily reduced, so you can still frown or look surprised without the wrinkles and creases between your brows and other facial areas.

Discomfort during the treatment is usually minimal and brief. Prior to injection, we usually anesthetize the area with an anesthetic cream or local anesthetic. The entire procedure takes approximately 10 minutes.   Side effects associated with the injection include localized pain, infection, inflammation, tenderness, swelling and bruising, that tend to be minimal in hand of experienced physicians, though it is important for you to know them.







You shouldn't receive treatment with Botox if you you have the following:

- A disease that affects your muscles and nerves (such as amyotrophic lateral sclerosis [ALS or Lou Gehrig's disease], myasthenia gravis or Lambert-Eaton syndrome).

- Asthma or emphysema

- Allergy to any botulinum toxin product

If you have any doubt feel free to consult us and ask any questions before treatment, in any case the surgeon will ask your medical history and antecedents to provide a safe treatment with the best results possible.


Botox ® Website




























































On the third stage are the surgical procedures that are involved in facial rejuvenation, explained in their respective articles:

Facelift and necklift



Rhinoplasty in some cases






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