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Hydration treatment

Profhilo® is a unique skin remodelling treatment designed to rejuvenate your skin giving you a refreshed and luminous glowing complexion. This is the perfect treatment if your skin feels dehydrated, dull, tired and lacks volume and elasticity. From the age of 30 skin begins to lose a significant amount of collagen, elastin and hyaluronic acid (HA). This treatment will stimulate the production of collagen and elastin with a slow release of HA which significantly improves the appearance of fine lines and wrinkles. Profhilo® gives your skin a huge hydration boost whilst improving the overall tone and texture of your skin with natural and subtle results.

How does Profhilo® work?

Unlike Dermal Fillers, Profhilo® does not add volume, think of it more as a huge boost of hydration from within. This injectable treatment has a very high concentration of HA which is injected into the skin through five different key points on each side of the face. A unique aesthetic treatment, Profhilo® works in stages and normally requires two treatments with a four-week interval. You will see some results instantly after the treatment, but the final result will be visible after 4-8 weeks . Profhilo® remains in the skin for around 28 days after, working hard to stimulate four different types of collagen and elastin as it slowly releases hyaluronic acid. Within the first few weeks you will see intense hydration, smoother and tighter skin and a glowing complexion.

Profhilo® is delivered for the face in five injections on each side of the face. However, Profhilo® can be used with very good result for improving the skin at the neck and décolleté.

Why choose Profhilo?

We start losing a significant amount of collagen, elastin and Hyaluronic Acid after we reach 30, which means we start to see the signs of ageing in the form of fine lines, wrinkles and slightly lack-lustre skin. At this age, we should start to consider preserving ourselves, therefore Profhilo® is advised for individuals from around the age of 30 upwards, who wish to target ageing skin.

Profhilo® is also an excellent choice for you if you don’t want to add volume to specific areas (if this is the case, it is more likely that dermal fillers would be the right treatment for you), as it instead provides volume and hydration across the skin, giving an overall rejuvenated appearance.

There is no age upper limit either. In fact, in older patients, we have often seen more dramatic results. However, if you’re over 60 your treatment does need to be managed carefully – for example, if there are deep folds present or the skin has lost elasticity, then combination treatments that include Profhilo® may be more suitable. This is why having an expert consultation at Bangor medical Aesthetics prior to treatment is so important!

If you’re looking for very subtle results, this treatment delivers.

However, if you’re looking for rejuvenation and lifting of the face, neck or any other area, then a combination approach with antiwrinkle injections , fillers, PDO threads and Profhilo could be recommended.

Book an appointment for consultation.


PDO Treads Lift

Until recently, the only way to address problems caused by facial skin laxity-such as jowls and drooping cheeks-was facelift surgery. After all, while skin resurfacing treatments can help to restore some degree of firmness, once loose skin is present, only a scalpel can truly remove it.

Actually the approach is on relying on injectable compounds and skin resurfacing until facelift surgery becomes absolutely necessary.

However not everyone needs or is willing or able to have surgery. If you're in this group, you'll be happy to know that a new type of procedure has been developed to fill in the gap between noninvasive facial rejuvenation and facelift surgery: The "thread lift

What is a PDO thread lift?

A thread lift is a type of procedure wherein temporary sutures are used to produce a subtle but visible "lift" in the skin. Instead of removing the patient's loose facial skin surgically, the cosmetic surgeon simply suspends it by stitching up portions of it. This has the effect of pulling the skin back slightly and therefore lifting and tightening the face. In addition to being ideal for lifting the skin, threads combat aging in another way: by provoking the body's "healing response" and causing the body to direct large surges of collagen to treated areas. This is important because of the vital role collagen plays in the aging process.

Collagen helps support "growth factors" that greatly influences the condition of our skin. In addition to being used for wound healing, collagen helps to keep our skin strong, voluminous and supple. As we get older, our bodies gradually produce less and less collagen, which leads to an 80% reduction in skin thickness by about age 70. This loss of volume and strength is a large factor in the creation of excess skin and wrinkles. As the skin grows weaker, it's no longer able to support the tissues beneath it adequately, meaning that gravity pulls it downwards and stretches it. Infusing the skin of the face with fresh collagen when the signs of skin laxity are still mild can help to both reduce looseness (by thickening and hydrating the skin) and prevent it from getting worse (by strengthening the skin).

In other words, this process provides ongoing and progressive rejuvenation for the facial tissues. Patients who have a thread lift for the purpose of stimulating collagen will notice a gradual improvement in their skin's tone and firmness. While their threads are in place, the body's healing response will be constantly activated because the body will want to "heal" the sutured areas and expel the sutures. The body is biologically programmed to react this way when it senses any foreign object present within the dermis. Fortunately, because the threads placed under the skin during a thread lift are so small, the patient will not feel any of this happening. Most people cannot feel their sutures at all once the skin has healed around them.

Why having a thread lift instead of surgery?

For many patients, the biggest advantage of having a thread lift rather than a facelift is the greatly reduced recovery time associated with thread lifts.

Thread lifts can be performed under local, rather than general anesthesia, meaning that thread lift patients can drive themselves home and look after themselves immediately after having their procedure. While some patients will experience a little bit of soreness, redness and swelling after having a thread lift and therefore wish to take the rest of the day off, most can return to work immediately. Strong pain medication is seldom needed after having a thread lift, making it easier for patients to return to their normal routine.

While thread lift recovery is not particularly intensive, patients will still have to take a few minor precautions while healing. It's important to make sure that you don't rub your face vigorously while cleansing it or applying moisturizer for at least a week after having threads placed. You should also try to prop your head up slightly so that you don't roll over directly onto your face while sleeping.

Thread lifts are low risk, thanks to how noninvasive they are. There is virtually no risk of scarring, severe bruising, bleeding or other complications after having a thread lift. In rare cases, patients may experience irritation, infection or their sutures becoming visible under their skin. If this occurs, however, the sutures can simply be removed and the patient's face will return to its prior state.

Finally, because thread lifts are much easier to perform than facelift surgery, they are much more affordable.

Advantageous though thread lifts are, it's important for patients to maintain realistic expectations for this procedure. While thread lifts certainly produce visible changes, they will generally only lift the face by a few Millimeters up to 1-2cm. As such, they create a more subtle and natural looking end result than facelift surgery. Thread lifts are therefore best suited to patients who are dealing with mild to moderate, rather than severe, signs of skin laxity.

The ideal thread lift candidate is usually in his or her late thirties to early fifties, whereas most patients over the age of about 55 will benefit more profoundly from facelift surgery. Thread lifts can, however, provide a facelift alternative for older patients who are unable to have surgery for medical reasons. Because thread lifts can be performed under local anesthesia, many people who have age-related conditions that make them ineligible for surgery (like high blood pressure, type two diabetes and cardiovascular disease) can safely have this treatment. If you have any outstanding health conditions, make sure to talk to your doctor about whether or not a thread lift might be right for you.

It's important to understand that while no lifting technique can produce permanent results, thread lift will generally last from one to three years. However, because the thread lift procedure is so low-risk, patients who like the results of their thread lift can usually opt to have a fresh set of temporary sutures placed once their old sutures are absorbed by the body.


Dermal Fillers

Dermatological procedures which are considered as being minimally invasive, such as those using injectable fillers based on hyaluronic acid, revolutionized aging treatment, especially of the face. By promoting the replacement of lost volume and attenuating grooves and wrinkles, they ensure a more youthful appearance and certain functional recovery of facial aesthetics.

There are many materials successfully employed for soft tissue augmentation, such as autologous fat, collagen, and hyaluronic acid, among others. Each substance has its own characteristics that, case by case, make it the best choice, or not, indicated for the treatment of a certain individual. All need skilled physicians for their application. These techniques may be implemented for furrows, wrinkles, depressed scars, facial defects, atrophy of the lip, and skin roughness in the aging patient. Each of the materials may be highly effective when used for its correct indications and applied by skilled physicians.


Hyaluronic acid

Purified hyaluronic acid fillers are a very good choice for the correction of wrinkles and scars and are giving a high rate of satisfaction among patients. By the use of a well-tolerated, non-surgical method, with a low index of local inflammatory reaction, and which does not require a sensitivity test, it presents immediate and satisfactory effects and has a duration of up to one year.

Reports state that a retouch after 2–4 weeks may provide better results and may make the filler last as long as 18 months.
Isolated for the first time in 1934 from the vitreous humor of bovines, hyaluronic acid has been used since then in its native form, more frequently in ophthalmologic surgeries as a substitute for the vitreous humor or in retinal detachment, and in ortho- pedic surgeries as replacement of the synovial liquid in illnesses of the joints.
Hyaluronic acid is a glycosaminoglycan component of the extracellular tissue of various human organs, present with the same composition in all living beings.

N-acetyl-D-glucosamine, with molecular weight proportional to the number of repetitions of these disaccharides.

The natural unmodified form of this acid is a linear molecule, biocompatible, with low potential for allergic and immu- nogenic reactions. Being a negatively charged polyanionic polymer at physiological pH, it has a strong affinity for water, a characteristic that explains its great hydration capacity. One gram of hyaluronic acid can bind up to 6 L of water, and this binding occurs through the formation of a hydrogen bridge with the carboxyl group of the hyaluronic acid molecule. It has a tissue half-life of 1–2 days, being easily removed through enzymatic degradation in the liver to carbon diox- ide and water. Free radicals are essential cofactors in this degradation reaction.7 The body of an adult individual has about 15 gm of hyaluronic acid, of which approximately 50% is located in the skin.

Due to its viscoelastic properties, it is the main substance found in the dermis.
The ideal filler must be biocompatible, nonallergenic, nonmigratory, and must provide lasting and reversible effects. Hyaluronic acid is the filler that closely meets these characteristics, and consequently, is being increasingly used in everyday practice by dermatologists and plastic surgeons.

The hyaluronic acid used in the manufacture of fillers may be of animal origin, from the rooster’s crest, or nonanimal origin, obtained by bio-fermentation. The most widely used process utilizes fermentation of nonpathogenic Streptococcus bacterial strains that, due to not having antigenic specificity, have a low potential to cause allergic or immune reactions. Hyaluronic acid must undergo a purification process to eliminate the largest possible amount of protein derived from bacteria in order to reduce the antigenic potential and prevent hypersensitivity reactions.7 Commercial preparations based on hyaluronic acid provide the product as sodium salt – sodium hyaluronate.9 Being a water-soluble polymer, hyaluronic acid is quickly eliminated when injected into normal skin. To increase its time of permanence in the tissue, a chemical process called “crosslink” is performed, whereby an artificial modifica- tion through the addition of chemicals alters its physical and mechanical properties. These modifying chemicals are called crosslinkers.11 The most currently used crosslinker is 1,4-butanediol diglycidyl ether (BDDE), which forms irreversible carbon bridges between the hyaluronic acid molecules, causing an increase of the in vivo duration of the product.8 The crosslink transforms the linear chains of hyaluronic acid into a three-dimensional structure that is more resistant to enzymatic degradation, while maintaining its biocompatibility. Thus, a water insoluble gel is formed and remains stable in the tissue. It is slowly resorbed over a period of months through an isovolumetric degradation.9 Another type of artificial connection, called dangling type link, occurs when the crosslinker molecule binds to hyaluronic acid via one of its ends, leaving the other end loose. It does not provide the hyaluronic acid with so much resiliance, but is considered when the hyaluronic acid’s degree of modification is quantified. This type of connec- tion is capable of changing the structure of hyaluronic acid, but it is not as effective in preventing its degradation. The degree of crosslinking is one of the factors responsible for the durability of the product.8,9 There are also natural chemical links, ie, weak chemical links formed, for instance, by hydrogen bridges or by the crosslinks between the polymers of hyaluronic acid them- selves (mechanical interlocking).9 To the extent that the density of crosslinks increases, the distance between the segments shortens, thus thickening the gel and making it more difficult to mold. Lower density of crosslinks will form a smoother gel (“softer”).8 Thus, the firmness of the gel is directly proportional to its crosslink density.10 A higher crosslink percentage with covalent bonds is found in firmer gels, while the high number of dangling bonds is most commonly found in thinner gels. The degree of crosslinking is defined by the ratio between the number of molecules of the crosslinking agent that form crossed links with the number of disaccharides of hyaluronic acid.8,9 For instance, in a 10% crosslink, 10 crosslink bonds are expected for every 100 units of disaccharides that form the hyaluronic acid chain.

Concentration is another factor that influences the con- sistency of the final products, ie, the measured amount of hyaluronic acid contained in the gel, expressed in mg/mL. This amount comprises both soluble molecules (free par- ticles of hyaluronic acid) and insoluble particles (related to the crosslink). Addition of free hyaluronic acid in the gel is done to facilitate passage of the filler through a needle by reducing the extrusion force.8 With the same number of crosslinks or crosslinking percentage, higher concentrations of hyaluronic acid will result in a thicker gel. Gels with a higher rigidity have a better ability to withstand the dynamic forces that occur during movements of facial muscles; thus being more suitable for filling deeper and sharper grooves, such as nasolabial and nasogenian folds. Thinner gels are better suited for areas with static and superficial wrinkles, where resistance is lower, such as periorbital and perioral The elastic component, represented as G’, is another important physical property. It reflects the ability of a gel to resist deformation when a force is applied against it. In practical terms, a gel with a greater elastic component will be firmer and stronger and will undergo fewer changes in shape when pressure is applied to it. Clinically, this gel will have a greater ability to generate volume and support. Additionally, it will have increased ability to withstand the daily dynamic forces, such as movements of facial muscles, therefore, it is more suitable for areas such as the nasolabial and nasogenian grooves. On the other hand, gels with lower elastic modulus will be more appropriate for areas that do not suffer as much pressure, such as lachrymal fold and lips. A more fluid gel in an area that suffers high pressure would not resist deformation and would be pushed towards the area of lowest resistance, resulting in worse clinical results and lower procedure durability.

The gel’s binding capacity with water, which is the intrinsic characteristic of hyaluronic acid, is influenced by several already mentioned properties. The crosslink density directly affects this ability to absorb water. With a greater amount of crosslinks, the chains of hyaluronic acid will be closer and less flexible, making the connection with the water more difficult.11 The presence of dangling links, which do not alter the structure of hyaluronic acid so intensely, may contribute to the gel’s swelling. Moreover, insofar as we have a more concentrated gel, ie, with a higher quantity of repeating disaccharide units, we expect more water mole- cules to bind with the polymer. Due to its hygroscopic property, hyaluronic acid can still increase its volume by 10%–15% after application. It is important to stress that the gel may or may not have reached its binding balance with water during the manufacturing process. A fully hydrated gel would have theoretically reached its maximum hydration capacity and, therefore, would not cause severe swelling after being injected into the dermis, while a gel that has not yet reached this balance would tend to swell more after the injection.

The association of these physicochemical properties will provide the product’s final features, including its durability; although, a reduced durability may occur in cases of uncontrolled hyperthyroidism; menopausal or postmenopausal women using oral hormone replacement and suspending the medication; heavy smokers; and patients who, soon after the procedure, undergo a dental treatment resulting in significant local inflammation and manipulation

The available commercial formulations of hyaluronic acid present great diversity as to the physicochemical properties of its products. Hyaluronic acid must pass through customized processes specific to each manufacturer, which will determine its features. The commercially available skin filling products based on hyaluronic acid, according to the manufacturing tech- nology, can be divided into biphasic or monophasic. Biphasic gel is heterogeneous and, when applied, forms hyaluronic acid protuberances in the dermis and subcutaneous tissue. The dif- ference between the product presentations depends on the size of the particles. Monophasic gel is homogeneous and could be further divided into monodensified and polydensified, where the latter would have a second crosslinking phase, differing from the former in the way it integrates the tissue. The knowledge of these characteristics will help to better guide the clinical recommendation for each product.

At Bangor medical aesthetics we use all the range of Stylage® products with local anaesthetic.

The Stylage® product line is manufactured by Vivacy laboratories (Paris, France), and the concentration of hyaluronic acid in the products indicated as fillers varies from 16–26 mg/dL, covering many different clinical indications. In its crosslinking process, the company uses IPN-like® technology This patented technology, as described by the manufacturer, results from the association of two or more monopha- sic hyaluronic acid chains previously crosslinked. These hyaluronic acid chains bind to each other through weaker links, the hydrogen bridges. In this way, an interaction between molecules occurs, promoting greater cohesion of the gel without the need to add higher amounts of chemical agents. Therefore, a more resistant gel, and at the same time, with more flexibility, will facilitate its injection.

Another distinguishing feature of this line of fillers is the presence of mannitol, a type of sugar incorporated into the gel with the purpose to act as an antioxidant.


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