Hyaluronic acid (HA) is the commonly used filler in today's cosmetic
care. The
nasolabial folds(parentheses in between nose and lip),
marionette lines (lines extending from lip corner to chin side),
cheek lines,
neck lunes, and other wrinkle lines are parts that are treatable with HA fillers.
nasolabial folds HA filler injection before
after
downtime: puffy&tender for few days,
if bruises observed, take around 1 wk.
HA fillers are not only good for wrinkles but also capable of filling
in dents of body parts or expanding parts that are needed to be expanded.
Usually parst such as
lips, sunken cheeks or cheekbones, sunken temples, chin, lower eyelid circles,
lower eyelash base enhancement (a popular demand from Japanese clients) , and also
breast for enlargement.
HA has been around for about 30 years, but still is a popular item among
clients and doctors because of its convenience. In this long history of
this filler, some alternatives sprang up, but did not succeed due to their
unwanted effects. So that is why HA is still the main substance in use
for these concerns.
HA filler has evolved to different kinds of brands and types, and the followings are the main brands used which names are already more well-known than the actual name of the substance 'hyaluronic acid' itself:
Juvederm
Juvederm is the most common name now among dozens of HA brands that exist because of its tactics in selling its products to the public. It is produced by the company called
Allergan which is famous of its Botox brand.
Juvederm
VOLUMA is the thickest in concentration among the line-up of the brand, then
Juvederm
VOLBELLA and comes Juvederm
VOLIFT (named in the States as
VOLLURE) as the thinnest of them all. These 3 are the newest generation of Juvederm, older one includes Juvederm Ultra & Ultra plus.
And recently, Juvederm released their newest product called
VOLITE, a low-concentrated hyaluronic acid filler to treat neck's horizontal lines and facial fine lines and loosening, parts that require finer treatment for satisfactory results.
neck Volite before/after
facial Volite before/after
These new ones last longer than the old generation, reported to show effect for
1 to 1.5 years, though might vary in the amount injected.
Effect lasting period might be around a year but the actual HA substance
stays in the tissue for around 5 years, while it is gradually excreted
from the body. It is designed not to cause severe reactions to human body,
but there are rare allergic reactions observed within this period of time.
Reactions such as obvious lumps and redness of the injected area are the
common symptoms. This can be dissolved and subsided by injecting HA dissolving
solution called hyaluronidase.
Besides allergic reaction, skin and other tissue necrosis (death) are
also the concerns of HA injection. When injected, HA rarely gets inside
a blood vessel that may clog it and cause the problem. To avoid this, injection
of the filler with blunt cannula is the best prevention available. If this
side effect occur, a remedy using hyaluronidase is done to revive the damaged
tissue.
Teosyal(Teoxane)
Teosyal is the most used hyaluronic acid filler lately. It has the
longest lasting effect among the latest brands, produced by the Swiss company
called
TEOXANE.
Teosyal has a lot of options in its hyaluronic acid concentration and
cross-linking technology. The most long-lasting
RHA series, then more elastic
Kiss series for lip filling, and the low-concentrated
Redensity series for fine lines on neck and around eyes.
cheek Teosyal RHA injection before/after
neck Teosyal Redensity injection before/after
downtime: puffy&tender for few days, if bruises observed, take around 1 wk.
The longest effect sustainability observed in highly-concentrated products
is around
1 to 2 years, though might vary in the amount injected.
Effect lasting period might be around a year or two, but the actual
HA substance stays in the tissue for around 5 years, while it is gradually
excreted from the body. It is designed not to cause severe reactions to
human body, but there are rare allergic reactions observed within this
period of time. Reactions such as obvious lumps and redness of the injected
area are the common symptoms. This can be dissolved and subsided by injecting
HA dissolving solution called hyaluronidase.
Besides allergic reaction, skin and other tissue necrosis (death) are
also the concerns of HA injection. When injected, HA rarely gets inside
a blood vessel that may clog it and cause the problem. To avoid this, injection
of the filler with blunt cannula is the best prevention available. If this
side effect occur, a remedy using hyaluronidase is done to revive the damaged
tissue.
Restylane
Restylane brand is the original producer of HA filler. Around 25 years ago, a Swedish company started the brand and, after that, has been taken over by an American firm. It is kind of being left behind by the famous Juvederm but still in vast use around the globe. It is reported to have a shorter effect duration than Juvederm, from 6 months to a year.
Restylane injection, same as Juvederm brand, needs careful observation of allergic reaction and tissue damage.
Botulinum toxin injection is the first treatment choice for expression lines, such as
forehead lines,
frown lines,
crowsfeet lines (smiling lines at outer corners of eyes), and
lower eyelid lines. It is also used to suppress
excessive perspiration of armpit and limbs and to
reduce hypertrophic appearances of certain parts such as calf muscle( for slimming down), masseter muscle(chewing
muscle) in the lower jaw, and others. Recently Botox treatment is also
popular for treating dilated pores which is called
MicroBotox, according to Japanese clinics' terminology.It is injecting micro amounts
of Botox within skin layer in a wider area such as cheek and nose to stop
sebum fats secretion through pores.
forehead botulinum toxin injection before/after
downtime: injection redness for few hrs., sometimes bruises might appear
that takes 1wk. to fade away
Botulinum toxin has plenty of brands worldwide, and the most famous one
is the original
Botox brand from Allergan company.
Other 4brands are approved by the FDA and one of them called
Dysport is available in our clinic. It is more like a generic drug of Botox from
Ipsen, a British company. While Botox own 50%of the share in the US, Dysport
comes nearly 50%, according to recent statistics.
Botulinum treatment shows its effect at the earliest on the 2-3rd day,
sometimes may take a week, and completes around a 2-week period. 3−4 months
later effect may start fading and might completely go away around 6- 8th
month.
Rarely seen allergic reaction might be observed partly on the area injected.
Pregnant or expecting to be pregnant individuals are not good candidates
for this treatment.
Pricing
|
|
Botox |
Botox |
Dysport |
Dysport |
|
|
without tax |
with tax |
without tax |
with tax |
wrinkle lines |
forehead |
\18000 |
\19800 |
\10000 |
\11000 |
|
glabella(btw brows) |
\18000 |
\19800 |
\10000 |
\11000 |
|
crowsfeet |
\18000 |
\19800 |
\10000 |
\11000 |
|
lower eyelids |
\18000 |
\19800 |
\10000 |
\11000 |
|
nose bridge |
\18000 |
\19800 |
\10000 |
\11000 |
|
upper lip |
\18000 |
\19800 |
\10000 |
\11000 |
|
lower lip |
\18000 |
\19800 |
\10000 |
\11000 |
|
chin |
\18000 |
\19800 |
\10000 |
\11000 |
micro Botox |
upper cheek |
\50000 |
\55000 |
\30000 |
\33000 |
|
lower cheek |
\50000 |
\55000 |
\30000 |
\33000 |
|
neck(platysma) |
\60000 |
\66000 |
\40000 |
\44000 |
|
nose |
\40000 |
\44000 |
\20000 |
\22000 |
|
others5×5cm |
\40000 |
\44000 |
\20000 |
\22000 |
reduction/lift |
slant eye correct. |
\18000 |
\19800 |
\10000 |
\11000 |
|
alar reduc. |
\18000 |
\19800 |
\10000 |
\11000 |
|
nosetip elevation |
\18000 |
\19800 |
\10000 |
\11000 |
|
gummy smile correc. |
\18000 |
\19800 |
\10000 |
\11000 |
|
lip corner lift |
\18000 |
\19800 |
\10000 |
\11000 |
|
masseter muscle |
\50000 |
\55000 |
\30000 |
\33000 |
|
lower jaw+masseter |
\80000 |
\88000 |
\50000 |
\55000 |
|
sternocleidomastoid |
\80000 |
\88000 |
\50000 |
\55000 |
|
trapezius m |
\100000 |
\110000 |
\70000 |
\77000 |
|
calf m |
\100000 |
\110000 |
\70000 |
\77000 |
sweat control |
armpits |
\80000 |
\88000 |
\50000 |
\55000 |
|
palms |
\100000 |
\110000 |
\70000 |
\77000 |
|
soles |
\120000 |
\132000 |
\80000 |
\88000 |
|
forehead |
\60000 |
\66000 |
\40000 |
\44000 |
|
temples |
\60000 |
\66000 |
\40000 |
\44000 |
|
head/etc10×10cm |
\60000 |
\66000 |
\40000 |
\44000 |
|
|
|
|
|
|
|
|
|
|
|
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deep plane full facelift before after
downtime: swelling&bruises last for 2to3 wks., bandage&band compression
needed for at least 5d.
Even how filler/injectables, lasers, and thread lifts are evolving to a newer level, still surgery is the best procedure to correct loosening of the aging skin. Maybe in the future, a better-than-surgery non-surgical method comes out, but for the time being, surgical facelift still reigns.
Especially the
Deep Plane Full Facelift, the procedure which undermines or undercuts through the deep plane located
underneath the SMAS(superficial muscular aponeurotic system) at the cheek
part and the platysma band(muscular drape along the neck). Upon undermining
this layer widely, 4 ligaments that fasten the skin side to the deeper
facial muscles are also cut and released to fascilitate lifting of the
SMAS-platysma complex. This procedure differs a lot from the traditional
skin-lifting method which just mainly pulls skin unnaturally tight. Deep
Plane Facelift corrects skin loosening by
repositioning skin to a new level, not by unnatural tightness, but in a natural fresh
and younger skin appearance. The deep plane is a sparse or less-dense layer
which is easier to undercut and open than the subcutaneous(subskin) level,
the fact that requires this method just half length of the traditional
approach wound along earfront. Removes not only
cheek sags, but also
chin and neck's.
Incision in front of the ear is for cheek tightening,
minimal incision at back of the ear is for the chin/neck sagging.
Actual method:
After
minimal wound incision, extensive undermining or undercutting of the deep plane layer takes place, cutting through and releasing the retaining 4 ligaments:
zygomatic ligament(retains upper cheek sag),
maxillary ligament(fastens the persistent nasolabial folds or the "parentheses"
that connects nose and upper lip),
mandibular ligament and
masseteric cutaneous ligament(the two which are responsible of the "bulldog" saggy jowls).
The SMAS-platysma complex is pulled and tucked in the direction of temporal
region and ear respectively. Then the skin flap is also pulled mildly and
suspended in similar directions. Cheek fats are suctioned if needed to
be reduced.
deep plane full facelift before after
downtime: swelling&bruises last for 2to3 wks., bandage&band compression
needed for at least 5d.
Since suspension of the deeper SMAS and platysma tissues is already
tight enough, unnecessary over-pulling of the skin can be avoided to achieve
a natural youthful looks.
Even done in a wider manner, this procedure requires less wound approach,
and this tactic needs about 2 hrs. or something, a big relief from the
longer 3-4-hour traditional one.
Postoperatively, less swelling is anticipated, but still requires a night of bandage and band compression for the remaining days of a week.
1 week later is stitch removal, face washing might be possible 2-3 days postoperatively. Swelling and bruises take 1-2 weeks.
<cosmetic surgery simple tips>
This procedure is undoubtedly a challenging one for a cosmetic surgeon,
ranking it as the
3rd barrier of his/her carreer. Similar to what is mentioned in lower eyelid Hamra
method (details
here ), it is the question of whether you can show a satisfactory effect or
not that really gives you sleepless nights in starting this procedure during
your early days. Pulling the structures gently might give you faster recovery
but not a gentle outcome, and if you tighten it as hard as you can, surgical
wounds sometimes take weeks to recover and can be stretched wider in not
a good appearances. Over this you have to deal with your time also, because
even the highly trained ones take 2-3 hours as the fastest to finish both
sides, those who are not take the whole day or maybe the whole day is not
enough, the reason why some do the other side on another day. This procedure
is certainly the one that tests the surgeon's technique, speed, and refinement,
somewhat like an event that requires all of what you have obtained or mastered,
and sometimes even those you have not yet.
Minilift incision is done mainly just at ear's front to focus on the
tightening of the cheek skin.
deep plane mini lift before/after
downtime: swelling&bruises are observed for 1to2 wks., bandage&band
compression needed for at least 5 d.
It's a mini version of the
Deep Plane Full Facelift(mentioned above). Skin incision is just half of the full one, but ligaments cutting and SMAS plication are performed. Also fats are suctioned if needed.
Recovery time of mini lift is relatively minimal than that of full lift, including swelling and bruises withdrawal. Bandage and band compression can be shortened to about 3-4days. Stitch removal is done after a week.
Pricing
|
|
without tax |
with tax |
Facelift |
full |
\650000 |
\715000 |
|
+cheek lipo |
\680000 |
\748000 |
|
mini |
\450000 |
\495000 |
|
+cheek lipo |
\480000 |
\528000 |
|
neck lift |
\450000 |
\495000 |
|
mini necklift |
\200000 |
\220000 |
general anesthesia: \50000(with tax \55000)
The latest thread lift available, using
dissolvable sutures. The procedure is as easy as filler injection, meaning less swelling and
less needle points.
N-COG thread lift before/after
downtime: puffy for few days to 1 wk., if bruises present, need 1to2-wk.
for recovery
Thread lift method is only recommended to the ones who are not willing
to undergo surgery lifts or to those who just have minimal loosening. An
alternative of surgical method, but its effect is not as good.
N-COG spiral has cogs or spikes along its thread that are aligned in
spiral manner.
The procedure lasts for about minutes, as similar as filler injection's duration, and only deals with a small one needle point in each area(not including local anesthetic injections). It is made of dissolvable thread that dissolves within half a year, then the stimulated collagen production holds the effect for a while.
Why use dissolving thread instead of permanent one? It is because permanent
threads had issues when they were used in the past. Permanent threads are
usually used in other surgical method without any problem in leaving them
inside the human body, but since thread lifting is done with a certain
amount of threads under the very shallow skin layer, they sometimes cause
problems later on such as infections, abcess, stretching sensation, or
maybe noticeable thread rims on skin surface.
Just one visit, basically no check-ups and no stitch removal on coming
days, and if you need more pulling, you just can add some touch-ups months
later.
Actual method:
As shown in the diagram, 2 threads at the upper cheek and 3 near the
jowls, 10 in total of both sides. Threads are inserted below deeper level
of the subcutaneous(subskin) fat layer to tighten sagging facial skin by
suspending the SMAS(superficial muscular aponeurotic system, muscle fascia
or covering) at this level.
1 to 2 threads can also be used as a trial but cannot expect that much
effect.
Neck sag can also be treated with this procedure with at least 2 or
3 threads at each side. The platysma band(muscular drape along the neck)
is suspended by threads to stretch saggy neck.
Fox Eye Lift or Cat Eye Lift can also be performed with thread lift. 2 to 3 threads on each side are needed to pull eye's end corner for a youthful image result.
Sometimes done together with Botox brow lift technique to enhance more
fox-eye-like looks.
jowl&neck thread lift before/after
downtime: puffy for few days to 1 wk., if bruises present, need 1to2-wk.
for recovery
fox eye thread lift before/after
downtime: puffy for few days to 1 wk., if bruises present, need 1to2-wk.
for recovery
fox eye thread lift+Botox brow lift before/after
downtime: puffy for few days to 1 wk., if bruises present, need 1to2-wk.
for recovery
How Effective is N-COG Thread Lift
PDO Mono Thread Lift(Shopping Lift)
Mono thread lifting uses
absorbable PDO(polydioxanone) thread to tighten shallower layer of subcutaneous(underskin)
tissue, whereas N-COG thread(mentioned above section) works deeper. This
thread lifting is to tighten finer wrinkles and sags on cheeks and other
parts of face and body. Several number of tiny threads are introduced one
by one with a tiny needle, the reason why sometimes the procedure is called
cosmetic acupuncture. It is as simple as it sounds from its another Japanese name called 'shopping lift'.
cheek shopping lift before/after
downtime: puffy for few days, if bruises present, need few d. to 1 wk.
for recovery
PDO Mono Thead Lift is only recommended to the ones who are not willing
to undergo surgery lifts or to those who just have minimal loosening. An
alternative for surgery, but effect is not as good.
PDO Mono Thread, as shown in the pic, has no cogs or spikes along
The procedure lasts for about minutes, as similar as filler injection's duration, and only deals with tiny needle points in each area. It is made of dissolvable thread that dissolves within half a year, then the
activated collagen production holds the effect for a while.
Why use dissolving thread instead of permanent one? It is because permanent
threads had issues when they were used in the past. Permanent threads are
usually used in other surgical method without any problem in leaving them
inside the human body, but since thread lifting is done with a certain
amount of threads under the very shallow skin layer, they sometimes cause
problems later on such as infections, abcess, stretching sensation, or
maybe noticeable thread rims on skin surface.
Just one visi, basically no check-ups and no stitch removal on coming
days, and if you need more pulling, you just can add some touch-ups months
later.
Actual method:
As shown in the diagram, lower cheek needs 10 to 20 threads on its side
and upper cheek 10 to 15, introducing them in a
network manner to enhance tightening of the area.
Forehead needs 10 to 20 threads on its side, and middle part 10 to 15.
Neck sag requires 20 to 40.
Anesthetic cream or tape is usually used. In extensive area, minute amount
of local anesthetic is more comfortable.
forehead lifting bef/aft
downtime: puffy for few days, if bruises present, need few d. to 1 wk.
for recovery
The latest thread lift using absorbable biocones, instead of cogs,
to tighten up the skin .
cheek&neck Silhouette Lift before/after
downtime: puffy for few days, is bruises observed, take around 1 wk. to subside
Instead of needle points, Silhouette Lift threads are introduced through
bigger slits where they have to be tied together for pulling loose skin,
so it requires at least 2 threads in each area.
Pricing
|
|
without tax |
with tax |
N-COG |
1 thread |
\20000 |
\22000 |
PDO Mono Thread |
10 threads(trial) |
\30000 |
\33000 |
|
20 |
\50000 |
\55000 |
|
40 |
\80000 |
\88000 |
|
60 |
\120000 |
\132000 |
N-COG + Mono |
NCOG4+Mono20 |
\130000 |
\143000 |
Silhouette Lift |
1 thread |
\40000 |
\44000 |
|
|
|
|
Med-Jet
The latest needle-free injector that introduces substances through skin
via an ultra-fine(0.03mm) stream of liquid.
Mainly used for local anesthesia.
Pricing (10% tax not included)
|
without tax |
with tax |
|
Med-Jet |
\5000 |
\5500 |
|
|
|
|
|
|
|
|
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