Which signs of ageing can injections correct ?
Facial ageing changes the skin, fat compartments, muscles, ligaments and skeleton. Volume loss, wrinkles and sagging do not progress at the same rate in every patient. A medical examination identifies what contributes most to an aged appearance and what can actually be improved by an injection.
These anatomical changes are described in a review of the ageing of facial structures. In particular, they explain why filling a fold directly is not always sufficient : the fold may be associated with loss of support, tissue displacement or several mechanisms at once.
Botulinum toxin to soften expression lines
Botulinum toxin is used to soften certain wrinkles caused by repeated contractions of facial muscles, particularly forehead wrinkles, glabellar lines and crow’s feet. It acts by temporarily reducing the activity of the muscles responsible for these wrinkles.
Before treatment, the doctor examines the face at rest and in motion to adapt the doses and injection points. They consider eyebrow position, asymmetries and muscle strength. The objective is to soften wrinkles while preserving natural expressions. Deep wrinkles already visible at rest may, however, persist despite treatment.
The first effects appear after a few days and results generally last three to six months, as explained by theAmerican Academy of Dermatology’s information on botulinum toxin.
Hyaluronic acid to restore volume and reduce hollows
Hyaluronic acid injections restore volume lost with age, reduce certain hollows and redefine facial contours. They may also be used to perform non-surgical lifting when sagging is moderate and associated with loss of tissue support.
With ageing, facial fat compartments gradually lose volume and some tissues sag. The cheekbones become less prominent, nasolabial folds become more pronounced and the facial oval loses definition.
Non-surgical lifting techniques, particularly the 8-point lift developed by Dr Mauricio de Maio, rely on hyaluronic acid injections in strategic areas of the face. The objective is to restore certain support points to obtain a lifting effect without surgery. However, this approach cannot correct significant sagging or substantial excess skin.
Treatment must be adapted to the anatomy and the cause of the changes observed.
The FDA factsheet on fillers notes that the result depends in particular on the tissues, type of gel and volume used.
Sculptra to stimulate collagen and improve cheek wrinkles
Sculptra is an injectable treatment based on poly-L-lactic acid that gradually stimulates collagen production. It is used to improve skin firmness and density, soften certain cheek wrinkles and restore volume lost with age.
The clinical data presented by the FDA on Sculptra concern, in particular, the correction of cheek wrinkles.
Unlike volumising hyaluronic acid injections, its action primarily relies on stimulating new collagen production. Results appear gradually in the weeks and months following injections. The volume visible immediately after the session is mainly associated with the dilution fluid and does not correspond to the final result.
Sculptra may also alter facial volumes and contours. Its indication must therefore consider facial morphology, loss of tissue support and the degree of sagging. It is not intended to correct substantial excess skin.
Which injections for thinner, crepey or dehydrated skin ?
Skinboosters, Profhilo, mesotherapy and polynucleotides are used to improve different aspects of skin quality, particularly hydration, suppleness, texture and fine lines.
Skinboosters and Profhilo, lightly cross-linked hyaluronic acid, mainly improve skin hydration and suppleness. Mesotherapy relies on multiple superficial injections, particularly of non-cross-linked hyaluronic acid, to improve hydration and complexion radiance. Polynucleotides are studied for their action on skin repair mechanisms, elasticity and fine lines.
These treatments improve skin quality, but cannot restore lost volume or correct significant skin sagging. They are also ineffective against pigmentation and persistent redness, which require specifically adapted treatments.
The choice therefore depends on the change to be corrected and the desired result. The indications for each technique are detailed on the page which injection improves skin quality.
Can injections correct a sagging facial oval ?
Hyaluronic acid injections improve the definition of the facial oval when sagging is mild to moderate and accompanied by a loss of volume or tissue support.
Non-surgical lifting techniques involve injecting hyaluronic acid into specific areas of the face to restore certain support points and obtain a lifting effect. In particular, they improve facial contours and reduce certain jowls.
When sagging is significant or excess skin is present, injections reach their limits. Adding more hyaluronic acid may then weigh the face down without correcting the sagging. A surgical facelift may be more suitable in these situations.
This point is explored in the guide to situations in which hyaluronic acid injections have limitations.
Should several injections be combined to rejuvenate the face ?
Combining several injectable treatments allows different signs of ageing to be addressed when their indications complement one another.
Botulinum toxin softens wrinkles caused by muscle contractions, while hyaluronic acid restores lost volume and improves support in certain facial areas. The two treatments can therefore be combined when a patient has both expression lines and volume loss.
However, it is not necessary to perform every injection in the same session. Dr Romano may begin by treating the most important changes and then assess the result before considering other corrections.
The choice of treatments, their order and the intervals between sessions depend on facial anatomy, the products used and the desired result. The objective is harmonious rejuvenation without unnecessarily multiplying injections.
How should a rejuvenation plan suited to your face be chosen ?
A rejuvenation plan must be personalised according to facial anatomy, signs of ageing and the patient’s request. Age alone does not determine the treatments needed. After age 50, for example, a targeted correction may be sufficient, while certain changes are not addressed by injections.
The consultation defines several essential points :
- Define a priority. Specify the change that bothers you most : an expression line, a hollow, a contour or the skin’s condition. After assessment, Dr Romano will give you her opinion on what needs priority correction.
- Take previous injections into account. Knowing the products used, quantities injected, areas treated and procedure dates allows new corrections to be adapted. In particular, hyaluronic acid may persist in the tissues beyond the apparent duration of the result.
- Assess results before continuing. A follow-up after treatment assesses the corrections made and determines whether additional injections are genuinely necessary.
At Dr Valeria Romano’s practice in Geneva, the choice of treatments is also based on assessing medical history, contraindications and the risks specific to each injection.
The objective is to offer measured corrections suited to the face’s needs while preserving its proportions and natural expressions.
