Rationale
The best approach for practitioners would be to understand the rheology of the hyaluronic acid (HA) fillers that they are using, and to ensure that the smallest aliquots are injected to produce the most aesthetic outcome. Developed from ‘The Starter Face’, where two syringes of either Stylage® XL or Stylage® XXL were used in 10 strategic points all over the face to create small volume lift and blend areas of deep lines.
The eight-point technique was modernised with some modifications of volume to give more support to midface structures such as the superficial and deep malar fat pads. I trialled this eight-point protocol on patients with mild to moderate volume loss using two 1ml syringes of Stylage® HA volumising filler.
The fillers
Stylage® XL contains 26mg/g of HA in a dense matrix with high viscosity and elasticity. Stylage® XXL contains a dose-reduced amount of HA at 21mg/g with higher viscosity and elasticity to create additional volume in areas of severe volume deficit. Both are suitable for this procedure. Stylage® XL is indicated for temples, cheeks, chin and jawline, while Stylage® XXL carries the same indications plus an additional indication for volume creation in areas of the face where severe volume loss is found.
Patient selection
- All patients generally over age of 35 with mild to moderate facial volume loss.
- Male and female equally.
- Patients that need a little bit of a lift in all areas of the face.
- Good option for first-time filler patients.
- Creates a subtle result which must be communicated to the patient at consultation with management of expectations.
- May be repeated >6 months.
- Excellent option for budget constrained patients.
The procedure
- A combination of techniques can be used for filler placement: needle to periosteum or cannula, however a shorted cannula is recommended such as 38mm to 40mm as small volumes may be lost within the lumen of the cannula.
- The skin is to be cleansed and disinfected appropriately.
- The areas of concern should be marked out with specific consideration to the position of the deep malar fat pad.
- Injections to be performed slowly ensuring that volumes are placed in the correct areas.
- Uses two syringes of Stylage® volumisers – either XL, XXL or combination of both.
- Not recommended to use a non-volumiser due to risk of migration.
- Ensure that volumes are sufficiently massaged to avoid the formation of palpable lumps.
Conclusion
The eight-point approach allows for minimal amounts of high-viscosity HA filler to be placed in key areas of the face to allow for midface volume replacement and to blend key areas of the face where deepening of folds and creation of shadows can be identified in the lower face. The approach allows for the gentle filling of these areas to blend light reflection and smooth out shadows.
Declaration of competing interests: The author is an international KOL for Vivacy.
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