Aside from the intrinsic aging factor (genetic), wrinkles occur on some areas of the face under the combined effect of facial muscle overuse - natural or mimical expressions -, and environmental or extrinsic factors, some controllable, others not, that contribute to age our skin prematurely.
Their shape, depth and length differ from one individual to another and depend on their location on the face.
Therefore, treatment is not unique, and may consist in:

• a resurfacing treatment (laser, chemical peels or dermabrasion)
• a filling treatment (collagen or fat transfer)
• a direct surgical action on the muscles causing facial lines: brow lift or endoscopic lift to fix weakened frontalis or procerus muscles, tightening of the orbicularis oculi to correct “crow's feet”.

These procedures can be combined if necessary. In all cases, the importance of preventive treatment of early effects of aging must be emphasized:

• protection from the sun: avoid excessive exposure and systematic use of sunscreen,
• avoid smoking,
• correction of any deficiency (iron, calcium, magnesium...)
• Skin restoration by use of vitamin A acid cream and hydrating products.

The Thermage™ technique uses capacitive radio frequency to heat deep collagen fibers in the skin and underlying tissue, while cooling the skin's surface with a spray. It ensues collagen contraction in three dimensions. The patient experiences a brief but intense feeling of heat, though cooled down by the machine all along the procedure.
Compression of collagen fibers causes gradual tightening of the skin. Thermage™ works in lower dermal layers (dermis) where surface care is inoperant.
The skin is composed of three primary layers. Beneath the epidermis, the dermis consists of connective tissue and is particularly rich in collagen fibers. When these fibers are altered, wrinkles and slackening occur. The contraction of collagen obtained produces a tightening of the skin immediately visible. It is possible to treat all parts of the body rich in collagen, eyelids, jawline, neck, décolleté, arms, thighs, abdomen and lower buttocks. Unlike lasers, the procedure can be performed on women and men of all skin color. The ideal patient has little subcutaneous fat and a moderately distended skin.
The procedure takes 20-70 minutes on average, mainly depending on the size of the area treated. One session is usually sufficient to produce results. A further treatment may be undergone months or years later to rejuvenate again. Although an immediate response is visible, the majority of patients will see the most noticeable results gradually appear in the 6 months after the procedure. New and remodeled collagen continues to grow over time to further tighten skin. The effect lasts between 3 and 5 years.
Although Thermage™ can not be compared to a surgical intervention, it has real benefits:

• The result is natural. The practitioner doesn't touch anything, no incision is made. It's just a matter of strengthening, retracting and toning your skin.
• There are no contraindications, no side effects other than light swelling or redness which subside in a matter of a few days, no social eviction due to the procedure. Most patients can return to normal activity the next day.

When filler injections fall short of a satisfactory result so surgery appears to be the alternative (such as in upper eyelid surgery), Thermage™ may be a great intermediate way to get rid of peri-orbital wrinkles and skin laxity in a non-invasive fashion with an outcome quite close to that of surgery.
The treatment can be referred to as “collagen remodeling”.

Among the most effective skin surface treatments, lasers had two major drawbacks. Only light skin could be treated, and downtime lasted up to several weeks.
Fraxel™ laser is a “fractional” ablative treatment in up to 4 sessions, which targets tiny fractions of skin at a time without affecting surrounding tissue, resulting in faster body's own natural production of new collagen and skin cells. It allows a rejuvenation of the skin, without social self-eviction, side effects or pain.
All skin types in both men and women, all body parts can be treated.
Results are sometimes immediately visible, but usually it takes up to 4 sessions to get optimal outcome. In which case, follow-up sessions are planned every 1-2 weeks.
After the procedure you may have some degree of redness and sunburn sensation for a few hours. Make-up can be applied immediately. The healing process is very fast and you can resume routine activities the next day.
A genuine renewal of the skin is obtained. Skin regains an even tone, becomes smoother and less lined. Best candidate conditions for the treatment are acne scars, fine peri-orbital lines, pigmented lesions such as age or sun spots, or melasma (mask of pregnancy).
Fraxel™ treatment will make your skin glow, without damaging the epidermis. It works on darker skin types, and can be used on delicate skin areas like the neck, décolleté (chest) and hands.
It promotes the synthesis of collagen, alleviates fine wrinkles, smooths skin and gives it a lot of brightness and transparency.
The improvement is visible 1 week after each session, and the final result can be assessed after 6 months, when skin has completely healed and regenerated.
It is as effective as a carbon dioxide laser treatment but without the unpleasant consequences, such as burns or risks of hypo-pigmentation.
Fraxel™ laser can be used in conjunction with other procedures such as filling techniques (Botox™), or radio frequency devices (Thermage™), to achieve an outstanding lifting effect in all safety.

The trade name for botulinum toxin approved in France for aesthetics is Vistabel™.
Medication subject to marketing authorization, it can only be administered by a physician. It has many other indications in neurology, rheumatology, ophthalmology, pathological sweating conditions, and many other fields are constantly being explored. The areas most commonly treated are located on the upper face. As it is effective on almost any area of the face, its use requires the practitioner to have a deep knowledge of the muscular balance and a lot of dexterity.
The results are spectacular and natural. Its established versatility and its safety make it the undisputed “flagship” of cosmetic medicine.
It affects nerve transmission, without injury to the nerves or muscles.
It is usual to treat areas where expressions mark the most: at the forehead between the eyebrows (frown lines) or at the outside corner of the eye (“crow's feet”).
But it is increasingly common to treat many other sites: décolleté, neck, lower face, cheeks, the corners of the mouth, the nose tip...
Eyelids and eyebrows are an excellent indication. It is possible to use botulinum toxin to lift drooping upper eyelids, thereby giving a more radiant look to the eyes.
Botulinum toxin smooths wrinkles and gives a look rested, relaxed, while preserving the facial expressions.
The best is yet to come: more and more practitioners support the notion that aging is - among others - a phenomenon of muscular contraction. Used at low dosage and as early as 25 years, botulinum toxin provides a real preventive effect.
Treatment with botulinum toxin does not require pre-testing. There is no allergy, and the product is completely absorbable.
Most effects of the treatment are noticed after a short week (3-5 days), and are quite often spectacular though natural. They last between four and eight months.
The comparison with all other treatments, including surgery, simply highlights the unique role that botulinum toxin plays in medical aesthetics, thanks to its versatility, efficiency and reasonable price: it provides a temporary improvement in the appearance of moderate to severe glabellar lines.

Hyaluronic acid (also called Hyaluronan) has become a leading dermal filler.
It is a substance (complex sugar) naturally found in connective tissue of the dermis and an essential component of its structure.
Due to its high biocompatibility and its common presence in skin tissues, there is no side effects. Over time the body produces less hyaluronan and it degrades, causing an alteration of the skin. Gradually, the volumes are lost and wrinkles appear.
By its nature, hyaluronic acid retains water which helps to hydrate your skin and add volume.
Available in various grades of density and viscosity, hyaluronic acid (Hydrafill® Softline), can treat all kinds of wrinkles and volume loss.

Hyaluronan helps to repair drawn features and to make a tired face appear more lively and fresher, and in some cases, to restructure select areas of the face.
Treated areas include the temporal fossae, glabellar lines (frown lines), cheekbones, rings, cheeks, contour and volume of the lips (lip definition and fullness), naso-labial folds (also called marionette lines), lower cheek areas, chin and deep jaw lines. It is therefore possible to plump up both fine wrinkles and deeper furrows, and also to restore all volumes. The results are stunning and immediate.
Products with uncrosslinked hyaluronic acid are used in the Mesolift procedure for their fluidity property. Other denser products act like fat transfer, though without the inconvenience of an operation.
Hyaluronan is fully absorbable. Two sessions are often necessary to obtain a satisfactory result which lasts 8 months on average.

Both preventive and curative, Mesolift is a hydrating care, which restores firmness and elasticity to the skin. It involves sub-epidermal injections of uncrosslinked hyaluronic acid which spreads perfectly on the surface of tissues for greater efficiency. The goal is to smooth out and tone the skin. It is necessary to perform three sessions each two weeks apart. Candidate areas for the treatment are the face, neck, chest (décolleté) and back of hands. This treatment significantly improves the lasting of injectable fillers treatments.

After having been the standard injectable filler, collagen had disappeared from the therapeutic arsenal in the aftermath of the Creutzfeld-Jacob disease. A new type of collagen, totally safe and absorbable, has been recently produced by genetic engineering.

Collagen has pretty much the same indications as hyaluronic acid, but seems to be preferred in following cases:

• Lip augmentation: collagen is more malleable, thereby giving a more natural result and a suppler mouth. Also the very rare cases of lump in the lip occurring with hyaluronic acid, which is less easy to shape, do not exist with collagen.
• Dark circles plumping: results obtained with collagen appear more convincing.

However the two products have nearly the same advantages in terms of duration, safety, ease of use, and patient satisfaction.

Hydroxylapatite (Radiesse™)

Products containing calcium hydroxylapatite (bony microspheres) suspended in a gel seem to be the most interesting alternative in dermal filling.
Deemed approvable by the FDA (Food & Drug Administration), these absorbable products respond to all necessary requirements of versatility, security and ease of use.
Hydroxylapatite is biocompatible and biodegradable. It does not migrate and forms a cohesive implant, soft and natural, which remains in place between for at least several months and up to two years. for that matter, it is the key advantage of hydroxylapatite: the duration of effect obtained is longer.
Allergy test is not required. Treatment is simple and quick. Results are visible right away.
Preferred areas for the treatment are the cheekbones and hollow cheeks, the jawline and chin, as well as the perioral area to plump wrinkles, marionette and smile lines.

Polylactic acid (New Fill™)

Polylactic acid is another product commonly used in cosmetic. It has similar characteristics to that of hydroxylapatite (biodegradability). However, the result is not immediately visible.