Dynamic facial sculpting for a natural look: a change of perception brings about a groundbreaking co

The field of injections includes toxins, muscle paralytics (such as Botox), intended to soften expression lines primarily in the top one-third of the face, as well as fillers (known as hyaluronic acid products). In the area of fillers we have come a long way: from filling in wrinkles to restoring volumes and specific indications such as cheeks, nose, lips, and jawline for an advanced facial sculpting. In facial sculpting we do not treat individual areas, nor do we chase after lines and wrinkles. Our job is to make the patient look more attractive based on the structure of her face, her personal experssions, and her age.

"Facial Sculpting" is personalized aesthetic medicine, yielding more natural-looking results compared to earlier methods, however it may not be sufficiently advanced in light of today's treatment options. A "sculpture" is a static work of art which starts from nothing. A face, however, is a given, dynamic creation. Therefore, in order to attain personalized, natural results, we need more than just an attractive catchphrase which doesn't address realistic needs. Those needs have brought about the breakthrough concept of "five-dimensional dynamic facial design".

The five dimensions laid out by physics are length, width, and depth (the three geometric dimensions), topped with the two modern dimensions of time and movement.

In the early days we would fill lines and use needles to inject fillers. We would puncture a single point and worked along two dimensions, since the wrinkle is essentially a two-dimensional line.

Later came the realization that wrinkles aren't the cause of an aged look; rather, they are the result of aging processes. In order to attain more natural, appropriate results in anti-aging procedures, we should address the underlying cause. This has brought us to the realization that one of the dominant processes in aging is the loss of volume, shrinking tissue, and drop due to gravity. We've therefore progressed toward volume reconstruction and lifting, working in three dimensions. When aiming for a high-quality, three-dimensional result, using a needle through individual injection points cannot give us a perfect result, because we cannot obtain a three-dimensional volume outcome using a one-dimension, pinpoint injection.

Facial design using a cannula is based on the idea of three-dimensional filling: rather than indicating injection points, we indicate a two-dimensional area we wish to cover, and then proceed with the injection procedure using a cannula. This allows us to switch from the two-dimensional demarcation to three-dimensional work, adding volume below the indicated surface.

Three-dimensional cannula work is better and more accurate. It allows us to shape and emphasize facial features on one hand, and to diminish undesired shades. However this procedure still lacks consideration of two additional important dimensions: time and movement.

Every age has its own typical facial appearance and shape. If we do not take time into consideration, we may be successful at lifting and filling, but the result won't have a natural look. The time dimension requires us to consider age-specific volume requirements, to choose fillers whose viscosity and elasticity are suitable for the patient's skin texture (which is significantly affected by time), and to the area being treated (less volume and more lifting), to avoid excessive filling, and to attain a lift effect using methods other than filler injections.

The fifth dimension is that of movement, and it is one of the most important dimensions for creating a natural-looking face. Unlike a sculpture, our face is constantly moving. One of the most important factors in preserving the natural look when working with volume involves observing "movement units". An example of important, challenging movement units are the lips, which must move naturally when we talk and smile, preserve a natural smile, avoid the "evil cat" look - the result of excess cheek volume, and inappropriate use of Botox.

In order to preserve the fifth dimension - natural movement - we must properly identify movement units, choose carefully a filler whose properties would match those of the injected area, and ensure accurate filler quantities.