• #2-2. Achieving Simultaneous Volumization and Lifting Effects with SMAS Tightening Technique


    This means that if we can create an oval and smiling face using minimally invasive treatments, it would have universal appeal where people of all races, ages, sexes, cultures and trends will be drawn to it. Also, preserving the unique individual characteristics of each patient would maximize the aesthetic outcome of minimally invasive treatments.


    Hyaluronic acid (HA) soft-tissue fillers, which are most frequently used among fillers, are divided into biphasic filler with good lifting capacity (elasticity) and monophasic filler with good cohesivity (viscosity). There is a misconception that the biphasic filler has particles whereas the monophasic filler is a consistent gel form without particles.


    However, microscopic examination shows all fillers are comprised of gel particles. The monophasic filler is very smooth to the touch, so it can be thought of as having no particles. It is incorrect to divide fillers into particle and non-particle fillers. Therefore, I categorize fillers based on the consistency; firm filler and soft filler.


    Combining the two types of HA filler in different treatment sites, layers and goals can successfully bring volumization as well as a lifting effect that creates a subtly smiling countenance. This also helps create a natural V-shape of the lower face. As I have discussed in the article on botulinum toxin treatments, botulinum toxin injection can be combined to reduce masseter muscles, parotid and submandibular gland hypertrophy, and lower cheek sagging and jowls. It can also be used to tighten the skin, smooth out the bumps on the chin, counteract muscles that are involved in making a sad or grumpy face  (Image 3) and to maximize the aesthetic outcome of an oval and smiling face. Personally, I call this combination therapy of soft-tissue filler and botulinum toxin “Oval Face Treatment.”


    Image 3. Roles of Toxin for SMAS-Tightening Technique.

    1. Relax the Depressors to Create a Youthful and Smiling Facial Shape.
    2.Reduction of Lower Facial Hypertrophic Structures.
    3. Skin rejuvenation.


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    To create this oval and smiling face, it is crucial to understand how soft tissues change when the face is smiling. When we smile, the lower face becomes narrow and tight and the muscles move upward, making the face appear naturally oval. In a smile, soft tissues in the anterior malar area have anteriosuperiror movement and those in the paranasal and perioral area have laterosuperior movement. Therefore, manipulating these soft tissue changes through soft-tissue filler and botulinum toxin treatments can help create a natural looking inverted egg shape of the face and a more inviting countenance (Image 4).


    Image 4. Oval and Smiling face.
    1. Oval Face Shape-Proportion Change for Midface & Lower Face
    ·Increase volume for midface
    ·Reduce volume for lower face and make lower face look slimmer
    2. Smiling Face-Soft tissue movement
    ·Anterior malar area → anterosuperior movement
    ·Paranasal & perioral area → laterosuperior movementtight


    -To be continued

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