Non-surgical treatments

Treatments without altering facial expressionIt is the time of a natural appearance. Great surgical gestures are used less and less. We are seeking a healthy, spontaneous younger look. For this reason there is a greater demand for treatments that improve the skin’s quality and appearance without altering expression and without recuperation period, requiring only maintenance treatments every 6 months.

The skin’s general appearance in the ageing process is related mainly to quantitative aspects of sunlight. However, it is also affected by other factors: genetic, hormonal (such as menopause), inadequate nutrition, toxic substances (such as alcohol or tobacco) and age.

Clinically speaking, skin ageing is characterized by skin that appears rough, with enlarged pores, pigmentation and vascular changes and a decrease in the amount and function of collagen and elastin fibres. Constant contractions of certain muscles leave wrinkles in certain facial areas.

In the last few years there has been an increase in the demand for a new generation of treatments that produce substantial improvement of visible ageing signs. These treatments, called “lunchtime treatments”, are also characterized by low risk of complication, no need of anaesthesia, and, most importantly, no convalescence period, allowing the patient to resume his/her daily routine after the procedure. They are the current trend due to the natural results they obtain and the fresh, glowing effect they have on the patient’s skin.

The ideal approach for our patients is the combination of the following techniques:

  • Botox (Vistabel).
  • Facial mesotherapy with hyaluronic acid.
  • Application of intense pulsed light.

Botox (Vistabel)

Botox, commercially known in Spain for its aesthetic ends as Vistabel, is a pharmacological compound made from a neurotoxin produced by the bacteria Clostridium Botulinum. It is the purified type A botulinum toxin.

Since the 80s this compound has been used in ophthalmology and neurology. Spain’s approval of Vistabel for aesthetic purposes came in 2004. It is also approved in 25 other countries.

Botox is indicated for the temporary treatment of expression lines

Botox is indicated for the temporary treatment of expression lines

This therapy is indicated for the temporary treatment of expression lines in the upper third of the face: crow’s feet, space between the eyebrows (frown lines), forehead wrinkles. It also allows a discrete elevation of the eyebrow’s tail, improving the expression of the eyes.

Its action mechanism consists of the neuromuscular union (in the connection between nerve and muscle) that inhibits the liberation of acetylcholine, a neurotransmitter that transports the nervous impulse to the muscle. It is effective with small doses and paralysing effects are reversible and dose-dependent.

During the procedure the mobility of the face is explored by asking the patient to gesticulate, thus observing asymmetries, paralysis or muscular hypertrophies.

The skin is cleansed and cooled with Cold-Pack. Afterwards a very fine needle is injected into the points that have been previously marked. The entire technique lasts approximately 20 minutes. The patient is then told not to touch the area for a few hours to avoid spreading the compound onto areas that have not received the injections.

As a result of the injection there can be a burning sensation, erythema, haematoma or cephalea (headache). If post-treatment instructions are not followed there is risk of local diffusion of the toxin to other muscle groups, leading to undesirable effects such as ptosis or reversible sagging of the upper eyelid (it is always reversible). There are no reported cases of systemic toxicity. The duration of the effect lasts between four to six months. Constant application prolongs the effect so wrinkles are gradually less obvious and sessions can be spaced out.

The minimum interval to perform the treatment again is 3 months.

The effect of treatment begins within 24-48 hours and reaches its peak at 2 weeks.

Vistabel cannot be used if the patient is allergic to the neurotoxin compound or its excipients or on patients who suffer from neuromuscular diseases (Eaton Lambert, Myasthenia gravis). It has not been approved for use during pregnancy, breastfeeding, or in individuals younger than 18 or older than 65 years of age. There are certain medications that can boost or decrease its effect.

As a final note, the technique is safe, simple, non-invasive and presents no alarming secondary effects. Results are fast and temporary. There is a high degree of patient satisfaction given that it leads to a serene and relaxed expression and look and attenuation of expression lines. It can be combined with other treatments such as pulsed light (IPL), radiofrequency, peelings or surgery.

Facial Mesotherapy with Hyaluronic Acid

Another widely accepted technique is facial mesotherapy with hyaluronic acid. Hyaluronic acid is the skin component responsible for tissue compactibility. It enables the three-dimensional organization of the extra cellular matrix components and can store a great amount of water around itself, allowing it to maintain the necessary hydration of the skin and subsequent turgidity that is so representative of youth.

Hyaluronic acid also recreates an optimal physiological environment for the proliferation and migration of fibroblasts and for the neosynthesis of collagen and other components of the extra cellular matrix. Not only does hyaluronic acid offer a hydrating and restructuring effect, but it is also effective in the protection of fibroblasts from the cytotoxic action of free radicals.

As time goes by, the skin’s hyaluronic acid gradually decreases, resulting in a less smooth and luminous appearance. Mesotherapy consists in infiltrating natural, highly purified hyaluronic acid that is identical to the natural polymer with a fine needle into the dermis of the face, neck and cleavage.

Before performing the infiltrations a Cold-Pack is applied to the area to minimize discomfort. The result is not immediate given that the product will be distributed homogeneously and gradually and inversely broken down by our body’s natural process, requiring the planning of maintenance sessions.

The number of sessions will depend on the skin’s condition and response to treatment but usually 2-3 treatment sessions every 3-4 weeks are programmed, after which there are usually maintenance sessions every three months.

A sensibility test is not required and is contraindicated in infected or inflamed skin areas. Secondary effects are local at the point of injection: erythema, discoloration, inflammation, echymosis. We cannot discard the possibility that granuloma may form due to the foreign body.

As a final note, we can say the technique is safe, fast and restores the skin with hydration, luminosity and smoothness. It can be combined with other rejuvenation techniques.

Application of Intense Pulsed Light

Finally, we have facial rejuvenation systems that use intense pulsed light (IPL). IPL systems are polychromatic, non-coherent light systems that emit in the 515-1200nm visible light spectrum (yellow, red and infrared). Polychromatic light destroys the vascular/pigmented lesion without harming surrounding structures (selective photothermolysis theory) and stimulates skin reshaping. It acts on three basic skin components: dermal collagen and extra cellular substance, dermal ecstatic and dilated vessels and irregular skin pigmentation.

The number of sessions depends on the skin’s condition, but 5 or 6 are usually enough. Intervals between treatments also vary but are usually 3 or 4 weeks. The procedure is not indicated in patients who are taking photosensitizing agents or who have taken Roacutan in the last few months, in pregnancy, breastfeeding, suspicious pigmented lesion or possible skin cancer. Treatment is also contraindicated in suntanned skin or in patients who plan to suntan during the course of treatment.

The procedure is very simple and does not require anaesthesia. The patient lies down and a layer of very cold gel is applied on the area to be treated. The patient’s eyes must be protected from the light. The session lasts about 20 minutes and the patient can resume his/her daily activities immediately. The skin usually presents diffused oedema and erythema that lasts a few hours (12-48). It is common for microscabs to form on the treated areas that present epidermal pigment alterations (lentigos, ephelides) but they usually disappear within 2 or 3 days. Sometimes mild or purple (purpura) vesiculous lesions appear but last only a few days. Make-up can be used starting on the first day of treatment.

IPL produces selective causes selective damage in the dermis, damaging old or aged collagen that has lost its structure. This damage prompts an inflammatory response with subsequent tissue repair and replenishment of collage , which leads to an improvement in the wrinkle appearance, close of the pores, luminosity and improvement of skin texture. IPL also breaks melanin into fragments making the skin homogenous and improving the vascular component. Nonetheless, we have other systems that do not change luminosity, pore or texture but which are specific to treat facial vascular components: Candela laser, pulsed dye laser, or laser for pigmented lesions or Alex laser.

Treatments at IML are personalised according to each patient's characteristics. You can request an informative consultation with one of our medical experts.

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