[Duhan Plastic Surgery Wrinkle Removal] - [Wrinkle Removal Treatment Methods]

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Wrinkle Removal Procedure Guide

Forehead wrinkles, frown lines, crow’s feet, under-eye wrinkles, mouth wrinkles, and more

are corrected simply, naturally, and without side effects

using fat grafting, fillers, Botox, lifting, and similar methods.

Wrinkle areas that can be corrected

◇ Shallow or deep wrinkles on the forehead

◇ Expressionless wrinkles or expression lines around the eyes

◇ Nasolabial folds around the mouth

◇ Sagging or wrinkling of the cheeks

◇ Vertical glabellar lines or indentations between the eyebrows

◇ Sunken wrinkles under the eyes

◇ Other facial wrinkle lines

◇ Sagging or wrinkling lines on the neck

Facial wrinkles by area

Four treatment principles that improve satisfaction with wrinkle correction

1. Choose a treatment method that is simple and allows an immediate return to daily life

2. Choose a method with low treatment cost

3. Choose a treatment method with no side effects or aftereffects

4. Choose a method with excellent treatment results to maximize satisfaction

Facial wrinkles are corrected using the appropriate method according to their depth and severity.

It is not possible to say that one specific method is better.

In some cases, better results are achieved by combining two or more treatments.

Wrinkles are treated by combining six methods—fat grafting, botulinum toxin (Botox), filler (Juvederm), skin boosters, Endotine lifting, and HIFU (ultrasound fat-reduction lifting)—depending on the patient’s condition.

Forehead wrinkles

In the case of shallow wrinkles, Botox and filler (Juvederm) injections are combined to correct forehead wrinkles, or only one of them is used alone.

Botox temporarily paralyzes the frontalis muscle of the forehead so that facial wrinkles cannot form, while filler (Juvederm) corrects fine wrinkles in a neutral facial expression.

However, in the case of deep wrinkles, fat grafting is needed for correction.

Frown lines

In the case of shallow wrinkles or expression lines, fillers or Botox may be used for correction, while in the case of deep wrinkles or indentations, fat grafting is used.

Sometimes fat grafting is performed while using Botox as an auxiliary treatment.

Crow’s feet wrinkles

Expressionless wrinkles are corrected with fillers, and when expression lines are severe, Botox is used together.

The difference between filler and Botox is that wrinkles present in a neutral expression are effectively corrected with filler, while Botox is used for expression wrinkles because they occur when smiling.

The mechanism of Botox involves paralyzing the facial muscles so that expressions cannot be made.

Under-eye wrinkles

If there is an indented wrinkle line under the eyes, fillers should not be used.

Using filler under the eyes can cause contour irregularities or paleness, so in the case of indented under-eye wrinkle lines, correction should be done only with fat grafting.

Even if there are slight fine wrinkles, fillers usually produce the opposite effect, so fillers should not be used even for minor fine wrinkles.

Mouth wrinkles

For nasolabial folds around the mouth or wrinkle lines at the corners of the mouth, fine wrinkles may be corrected with filler, but in most cases wrinkles are corrected with fat grafting.

Example of Endotine lifting for sagging cheeks

Example of HIFU lifting procedure

Facial wrinkles are corrected using the appropriate method according to their depth and severity.

It is not possible to say that one specific method is better.

In some cases, better results are achieved by combining two or more treatments.

Wrinkle removal treatment methods

The treatment method for wrinkles is selected according to the area, the pattern of the wrinkles, and their depth.

Either the most suitable single method is chosen,

or two or more methods are combined for treatment.

Forehead wrinkles

1. Surgical method

Endotine fixation procedure

In the case of wrinkles caused by sagging of the forehead skin, correction can be performed with a frontalis muscle procedure.

A small incision is made in the scalp, an Endotine fixation pin is anchored to the bone, and then the scalp is pulled and fixed to the Endotine loop.

It has the effect of pulling the frontalis muscle and lifting sagging eyebrows upward, but the effect of smoothing wrinkles is limited.

0 2. Injection therapy

Botox

For expression wrinkles, botulinum toxin (Botox) is injected to temporarily paralyze the frontalis muscle of the forehead so that expressions cannot be made.

The effect is temporary, and after about 3 to 6 months the drug wears off and expressions return to normal.

However, it does not improve wrinkles in a neutral facial expression.

0 Filler (Juvederm)

For neutral-expression wrinkles or fine wrinkles, forehead wrinkles can be simply corrected with filler (Juvederm).

While Botox corrects expression wrinkles, filler is effective for improving wrinkles visible in a neutral facial expression.

Unlike Botox, the more filler is used, the more the effect accumulates and improves.

0 3. Fat grafting

Fat grafting

This is effective for deep wrinkles.

When wrinkles are deep, Botox or filler is often not enough.

In such cases, fat grafting can correct forehead contour irregularities or indentations while also softening wrinkles.

Frown lines

1. Surgical method

Corrugator muscle resection

Under the eyebrows is a muscle called the corrugator muscle that forms frown lines between the eyebrows, and these wrinkles can be removed by selectively resecting this muscle.

For resection, an incision must be made in the scalp and the procedure performed while confirming with an endoscope.

The disadvantages are significant swelling, and indentation occurs in the area where the muscle used to be after resection.

If performed incorrectly, the sensory nerves of the forehead may be damaged, causing sensory disturbance in the forehead.

Because of the burden of surgery, this is not a commonly performed method.

0 2. Injection therapy

Botox

Mainly used for expression wrinkles, and is not effective for neutral-expression wrinkles.

0 Filler (Juvederm)

Mainly used for thin neutral-expression wrinkles. After the procedure, facial expressions can still be made, and the recurrence of wrinkles depends on the habit of making expressions.

It should only be used for fine wrinkles; it is less effective for thick wrinkles.

0 3. Fat grafting

Fat grafting

This is effective for deep wrinkles.

When wrinkles are deep, Botox or filler is often not enough.

If the frown lines are deep or indented, correction with fat grafting is recommended.

0 4. Combination treatment method

Combined Botox and filler procedure

Botox and filler are used together so that expression wrinkles are corrected with Botox and neutral-expression wrinkles with filler.

0 Combined Botox and fat grafting procedure

Botox and fat grafting can also be combined, and Botox paralyzes the expression muscles until the grafted fat has taken root well, preventing wrinkles from forming while the fat is settling.

Because the survival rate is better than with fat grafting alone, the improvement in wrinkles is greater.

Crow’s feet wrinkles

1. Surgical method

Orbicularis oculi muscle resection

This method makes an incision in the temple area, peels back the skin, and then resects the orbicularis oculi muscle that creates expression lines around the eyes.

Because of the cost and the need for surgery under general anesthesia, it is a burdensome operation and is not a method commonly used today.

Before Botox became widely available, it was used to address expression wrinkles around the eyes, but now it has been replaced by Botox or filler and is now rarely performed.

0 2. Injection therapy

Botox

It paralyzes the orbicularis oculi muscle around the eyes so that expressions cannot be made, so it is mainly used for expression wrinkles and is not effective for neutral-expression wrinkles.

The effect lasts about 3 to 6 months, after which the expression wrinkles return to their original state.

0 Filler (Juvederm)

Mainly used for neutral-expression wrinkles, and because it does not paralyze the muscles like Botox, facial lines do not change after the procedure.

The recurrence of wrinkles depends on the habit of making facial expressions.

However, even if wrinkles reappear, they do not return to their original state and recur only mildly, so the more the procedure is repeated, the more the effect accumulates and the wrinkles gradually become lighter.

0 3. Combination treatment method

Combined Botox and filler procedure

Botox and filler are used together so that expression wrinkles are corrected with Botox and neutral-expression wrinkles with filler.

Using both together is more effective than using filler alone, but it involves a cost burden.

Nasolabial folds around the mouth

1. Surgical method

Alloderm insertion procedure

Alloderm, a processed human skin tissue, may also be used for grafting.

As a biomaterial, it has the advantage of causing almost no side effects.

However, it is difficult to correct wrinkle lines precisely, and because a large amount is absorbed, the treatment effect is not very good.

It also has the disadvantage of being expensive.

It is not commonly used these days.

0 2. Injection therapy

Botox

Botox is often used on the forehead, around the eyes, and between the eyebrows, but when used around the mouth it can cause unnatural movement of the mouth and awkward facial expressions, so in principle it is not suitable for treating mouth wrinkles.

0 Filler (Juvederm)

It can be used for fine wrinkles.

However, it is less effective for thick wrinkles, and there is a higher chance of side effects if a large amount is injected.

Since fine nasolabial folds are usually rare, filler is not used very often for correction and is more commonly used as an auxiliary method with fat grafting.

0 3. Fat grafting

Fat grafting

This is the best method for correcting mouth wrinkles.

Because the amount of fat to be grafted can be adjusted according to the depth and shape of the wrinkles, it is an effective treatment method.

Most mouth wrinkles are corrected with fat grafting, and in some cases, filler is used as an auxiliary treatment when fine wrinkles are also present.

Endotine lifting procedure to improve sagging cheeks

1. Design is marked on the temple and cheek areas.

2. Local anesthesia and sedation anesthesia are administered.

3. A horizontal incision of about 2 cm is made in the temple area.

4. Dissection is performed above the periosteal layer.

5. An endoscope is used to check whether there is bleeding in the dissected area.

6. Endotine is inserted and pulled upward.

7. Endotine is fixed and sutured to the fascia.

8. The scalp is sutured.

9. Elastic tape is applied.

Endoscopic Endotine lifting procedure for sagging cheeks

The incision area is designed, and the location where Endotine will be inserted is checked and measured for length.

Sedation anesthesia and local anesthesia are administered.

Because sedation anesthesia is used together, there is no pain at all.

The incision is small and located in the scalp, so there is no scar or hair loss.

After the incision, blunt scissors are used to dissect above the fascia without bleeding.

After dissection, an endoscope is used to confirm accurate dissection and any bleeding.

After dissection, Endotine is inserted to lift the sagging cheek.

Endotine is firmly fixed to the fascia, and the scalp is sutured.

Elastic tape is applied to prevent swelling and sagging.

The tape is removed after 2 to 3 days, and hair washing is possible starting 4 days after surgery.

The stitches are removed after 7 days.

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