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- Hi everyone this is Dan Julien, nurse practitioner for Danesthetics Medical.
Is the modernized approach of treating nasolabial folds a big fat myth? Well stay tuned I think we're
all going to learn a little something about this. I'm going to give you my techniques
on how to actually provide natural beautiful looking results for nasolabial fold correction.
So the reason why I wanted to make this video is because I myself actually fell victim to treating
nasolabial fools, in the modern way. What is the modern way? Well basically in the last few years
what we've been told is not to treat the lines itself because it's not the movement of the face
that causes these lines it's actually caused by deflation of the fat in the mid and lateral cheek,
causing the face to droop over and now we have this line. So in theory if we were to place a
volume here and here and we provide a lift then it's going to efface that line. Well I'm telling
you it doesn't work, and I felt this actually for a long time. I was treating the midface
and I would have this conversation with clients. And they would believe, me and I believed myself,
and then I'd treat the face. The mid cheek would look nice but the lines were still there.
I wanted to show you guys this really cool study that came out,
uh and it's basically by Dr Lambrose and Dr Molds and it's uh the title is "Cheek volumization and
the nasolabial fold." And basically what it states, is there were 77 clients that had fillers placed
to the mid and lateral cheeks in order to try and support or fix the nasolabial folds, and guess what?
None of them had any improvement. So there's actually two modernized approaches to treating
the nasolabial folds. One is the mid cheek lift which we know that it doesn't do anything. The
second one is to fill the piriform fosas here, down to the bone with filler. So again just to recap
basically whenever we're putting filler down to the bone here, the reason why we're doing that is
because the face kind of resorbs into itself. As we mature we lose some bony mass here in the cheeks.
It actually moves forward, we do have a hollowing here to that bone. The bone actually opens up and will
retrude on itself. So by placing filler here and here down to the bone what it does is it gives the
illusion that we haven't lost it, and poop pops it back up, and it does help this area. Now I'd like to
show you how I treat these nasolabial folds using a combination of new and old school techniques in
order to do that we have to say hey to Stewart! My man Stewart! What do we see? We see that Stewart has
a facial artery that goes all the way to the nose and we have a cutoff line usually at the
lateral iris anything medial to that is going to be superficial. When it comes to this artery
the other thing that we notice is what we see a couple arrows here, and the arrows just
indicate that the artery doesn't always lie there. It can be a little bit more north could
it could be a little more south. But in general, it kind of lies here most often.
First up,
the bolus technique at the piriform fossa. This is your new school technique and I still use this. I
think it's a great base and it's a great way to get volume nice and low to the bone and restore
what was lost with uh, our piriform here. So what I do is I actually take a needle go down to the bone .
And if you don't... I can't see.. you guys can see that right? I'm basically moving that needle
away from the artery. It's a little safer for me, the other way I can do that is actually
take a cannula, start down here go right to this piriform and place a bolus down to ,
the uh the bone as well. And what that's going to do is probably provide a 20 to 30 percent
improvement around here. But it's not going to address any uh lines or folds down below here.
Next we're going to do is actually go and take the old school technique.
I actually take my needle, I'll bend it and what I'll do is I'm going to go very superficially. And
whenever I do so, I start here, and I fan three lines doing a retrograde fashion. One, two,
three, starting at the same place. But every time I do it, once I go in, I'm actually going to aspirate
every single time. So once I'm here I'm going to aspirate, I'm going to pull back and I'm going
to wait and hold for 10 seconds.
That's it for me guys. Stay patient my website will be up shortly. Until then take care yourselves, exercise daily and please be nice to absolutely everyone. Take care!