The All-Rounder Hyaluronic Acid

Does more than just smooth wrinkles

Dermatologist Dr. Birgit Buxmeyer has been a member of the Rosenpark Klinik team since 1999. In addition to specializing in surgical procedures such as liposuction and eyelid lifting, she has gained an additional qualification in Anti-Aging. At Bellari she is responsible for treatments with botulinum, hyaluronic acid, laser and ultherapy. In this C&C interview, Dr. Buxmeyer explains why hyaluronic acid is today’s material of choice in the treatment of wrinkles as well as facial skin and contour optimization:

What can one do with hyaluronic acid?

These days, quite a lot! The material has become extremely versatile and the range of products is extensive. Finer lines can be smoothed, and medium-depth wrinkles lifted, or the volume augmented for better moisture penetration of the skin and contour improvement. Hyaluronic acid is degradable in the tissues and, since it is now exclusively synthetically-produced, is very well tolerated. In the past, it was commonly extracted from cockscomb.

What are the uses of hyaluronic acid?

Thin hyaluronic acid, i.e. hyaluronic acid with little or no cross-linking, is suitable for skin surfaces in order to improve moisture penetration. It practically melts in the tissues and is a moisture booster. The thick variant provides volume, for example to hollow areas of the face. The effect is almost as good as when own fat is used. If the patient is very slim with no body fat at all, hyaluronic acid is the best alternative. Nowadays, it can even be used to treat the thin skin of the lower eyelid (Volbella by Allergan), which was not possible before.

Which corrections do women ask for most frequently?

The patients are not yet as advanced as the practitioners. Many still want to have the nasolabial folds injected. This is an antiquated method, dating back to over 15 years ago. Today the areas adjacent and corresponding to the nasolabial fold are treated. If one repeatedly injects the crease itself, over time, a sort of monkey’s nose is the result. This is because, due to age, the surrounding areas become more sunken. This must first be explained to the patients. Young women often have their tear ducts treated because they look tired. In somewhat older patients it is the cheek and temple region. This is due to the fact that not only the fatty tissue shrinks and shifts with age – the bone structure recedes as well. Often something is missing at the jaw angle, which causes the so-called marionette or Merkel wrinkles. These improve if a depot placed at the jaw angle.

What do men ask for?

In fact, only 8% of my patients are male. They often come for nasolabial wrinkles and tear duct treatments as well, to counteract the appearance of fatigue. They have to be injected in a different way than women to ensure that the face doesn’t become too feminine. That’s why cheeks are rarely an issue here; it’s usually the chin that should be more prominent, or the jawline padded out. Men are more likely to be candidates for botulinum toxin to smooth frown lines or to treat headaches.

What do you think of lip fillers?

Young women frequently come for lip augmentations and there are often discussions because they want too much of an enlargement. Not advisable in my opinion. The case is different with women around 50/60 years of age. Here, the lip volume decreases naturally with age and if the lips are already quite narrow, a little more can give the face a different look.

What is liquid lifting?

High-volume hyaluronic acid (e.g. Voluma, Belotero intense or Belotero Volume) is injected to lift certain areas and improve the contours of the face. For this reason, it’s known as Liquid Lifting. This procedure cannot, however, be compared to a surgical facelift. If one starts early and regularly optimizes just a little, the face ages differently than if one starts at 60. However, we strongly advise never to over-inject.

Why is hyaluronic acid now the gold standard for subcutaneous injections?

Because it is well tolerated, does not cause allergies or create any problems such as granulomas. Due to its wide range of possibilities, hyaluronic acid offers a solution for every problem.

What are the limits of the material?

The limits lie more in the expectations of the patient. If there is already a strong age-related elastosis, i.e. a high-tension deficit of the skin (sun damage), only a limited improvement can be achieved with hyaluronic acid. One must inject more superficially and optimize the moisture penetration.

When will one be able to socialize again?

Small bruises may occur as a result of the injection. Since the hyaluronic acid always binds some water in the tissue, there will be some swelling the next day, especially with liquid lifting. The swelling tendency varies from person to person. It is advisable to reckon with 2-3 days if a larger function is planned. A Friday appointment is always ideal.

How often must one re-inject or how long does the effect last?

Liquid lifting lasts a year or longer. Nevertheless, a follow-up treatment after nine months is recommended. Less material will be needed here than the first time. In the case of wrinkles around the lips, the hyaluronic acid is metabolized more quickly. In addition, a thinner variant is used. After six to nine months one would have to re-inject.

What do you think of hyaluronic acid in creams, ampoules or capsules?

Hyaluronic acid in a cream never goes where it should. The molecules remain on the skin where they have a moisturizing and superficially smoothing effect. But only for the time they are there. With oral hyaluronic acid, which must pass through the gastrointestinal passage, nothing at all reaches the skin.

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