Dr. Vafa now performs a novel technique to inject Juvederm XC or Restylane in the dermis for optimal correction of dynamic facial lines. Mobile facial folds represent a greater challenge for correction using standard injection techniques. The new injection technique is named the Fern Pattern Technique. The purpose of the Fern Pattern Technique is to use a Hyaluronic Acid filler material in such a way that it becomes a skin stiffening agent, rather than a simple filler in order to provide optimal correction for lines that deepen with expressive facial movements. The Fern Pattern Technique also uses less material to provide a correction that is not visible at rest or during dynamic movement for lines that deepen during a smile, as well as the dynamic lower nasolabial fold.
Four basic injection patterns have been described using dermal fillers in cosmetic dermatology:
1. The linear threading technique: fill a fold with a singular “thread-like” shape after puncturing the epidermis once to provide linear volume.
2. The serial puncture technique: fill a fold with multiple injections of the epidermis placed in a row to provide linear volume.
3. The fanning technique: puncturing the epidermis once, “fanning” the needle in a fan pattern to provide volume in a triangular shape.
4. The cross-hatching technique: combines multiple injections of linear threading that crisscross at right angles to provide volume in a square shape.
These injection techniques introduce hyaluronic acid (HA) into or underneath the skin, and provide the physician 4 ways to restore volume deficits. For example, areas of the face that are relatively immobile, such as the top half of the nasolabial fold or the tear trough can be filled with relative ease using one of these basic injection techniques. A good correction can usually be achieved. However, none of these 4 injection patterns are satisfactory for correcting the problem of dynamic folds, such as the lower half of the nasolabial fold, the corners of the mouth, and the smile lines found in the lower lateral cheeks. These folds are quite mobile with expressive facial movements, and they present a greater challenge in providing optimal correction.
The Dynamic Nasolabial Fold
The dynamic nasolabial fold is often filled using a linear threading technique. Unfortunately, during animation there remains a tendency of the nasolabial fold to shift alongside the filler if the correction used was only a linear threading technique, which can then be easily recognized by an observer. In order to solve this problem, it is necessary to produce a broad plane across the nasolabial fold to prevent it from reappearing lateral to the filler during a smile. Many injectors attempt to use the cross-hatching technique to provide more support next to the dynamic fold, which frequently gives the appearance of an area that is overfilled at rest.
Among the most difficult wrinkles to adequately fill are the “smile lines,” which appear on the lower lateral cheek while smiling. Linear threading is usually unsatisfactory, especially during animation, and cross-hatching often results in a “pad” of filler in patients who have thin skin. In addition, even linear threading can be visible in an individual with thin skin.
The Fern Pattern Technique
To achieve correction that is undetectable at rest and during animation of a dynamic fold, Dr. Vafa uses HA not as a filler, but rather as a skin stiffening agent to attempt to increase the stiffness of the skin on either side of the dynamic line. Patients observe increased stiffness of the skin on either side of the dynamic fold after injection and a decreased ability for movement of lines in the treated area.
Fern Pattern Technique:
1. Leaves less visible dynamic skin folds and creases – which occur during facial motion – compared to traditional pattern injections.
2. Less product is used per area, so one syringe can correct an area which needed two syringes with traditional pattern injections
3. We have found that the HA lasts significantly longer because of the placement technique and location of the HA in the dermal plane. Most patients come back for re-treatment in a year.
1. The technique requires multiple small injections; therefore before the procedure we apply a topical anesthetic to the treatment area for 30 minutes, which significantly minimizes any discomfort.
About LaserTouch Aesthetics:
LaserTouch Aesthetics and laser hair removal center, located in New York City, provides laser hair removal, laser skin rejuvenation, microdermabrasion, cellulite treatment, smartlipo and other aesthetic procedures for female and male clients of all skin complexions. In order to best serve clients, LaserTouch Aesthetics utilizes the most advanced and safest laser and aesthetics technologies such as Candela GentleLASE®, GentleYAG®, Cutera® Xeo, Viora Reaction and Cynosure MPX. Services at LaserTouch Aesthetics include but are not limited to laser hair removal, ingrown hair treatment, smartlipo, laser genesis, laser vein removal, freckle removal, sun-spot removal, cellulite reduction, skin tightening, mole and wart removal, radiosurgery, chemical peels, acne treatment with Levulan, VI Peel, Botox, Dysport, dermal fillers such as Juvederm, Radiesse, Restylane, and microdermabrasion(*).
*At LaserTouch Aesthetics, Dr. Ali Vafa of New York Medical Aesthetics conducts all Botox, dermal filler, radiosurgery, mole and wart treatment, and skin rejuvenation procedures.