Wrinkle and Facial Volume Loss Treatment

Wrinkle and facial volume loss treatment brings together minimally invasive injectable procedures through which the doctor aims for a rested, harmonious and natural-looking face, without surgery. At Detalii Med in Baia Mare, these treatments are carried out by Dr Marius Pruna and Dr Valeria Pruna, plastic surgeons.

The most commonly used methods are botulinum toxin, which temporarily relaxes the muscles responsible for expression lines, and hyaluronic acid fillers, which restore lost volume, support certain areas of the face and soften deeper folds. The product, dose and treatment areas are chosen individually, after assessing the face as a whole.

The treatment is intended for adults who notice:

• expression lines on the forehead, between the eyebrows or around the eyes;
• nasolabial folds or lines around the mouth;
• loss of volume in the cheeks, temples or lips;
• a tired or drawn appearance of the face, as part of natural ageing or after weight loss.

It is not recommended during pregnancy and breastfeeding, where there is an active infection or inflammation in the area to be treated, in people with certain neuromuscular disorders (for botulinum toxin) or with a known allergy to any component of the product. Autoimmune conditions, anticoagulant treatment and previous aesthetic procedures are discussed at the consultation, as they may change the plan.

The treatment can soften expression lines, restore volume to areas that have lost it and improve the proportions and contours of the face, usually with a subtle change.

There are, however, limits. Injectables do not replace a surgical facelift when the skin is very lax or there is significant excess skin. Fine lines caused by poor skin quality or sun exposure often respond better to other treatments, such as skin boosters, peels or laser procedures. The effect is temporary, and very deep lines that are visible even at rest can usually only be partly softened.

At the consultation, the doctor discusses with the patient what bothers them and what they expect, then assesses the face at rest and in motion: expressions, symmetry, volumes and skin quality. Medical history, current medicines, allergies, a tendency to bruise and any previous injectable treatments, including the products used, are all important.

Based on this information, the doctor proposes a plan: which areas to treat, which type of product is suitable and whether the work is done in a single session or in stages. The patient receives an explanation of realistic results, risks and aftercare, then signs the informed consent form.

The treatment is carried out in the consulting room and usually takes between 20 and 60 minutes, depending on the areas treated. The skin is cleansed and disinfected, and the doctor marks the injection points.

• Botulinum toxin is given through a few micro-injections with a very fine needle, directly into the target muscles.
• Hyaluronic acid is injected with a fine needle or a cannula into the layers appropriate for each area, and the doctor gently shapes the product.

The patient goes home the same day.

Anaesthesia as such is not usually needed. For fillers, an anaesthetic cream may be applied about 20–30 minutes beforehand, and many hyaluronic acid products already contain a small amount of local anaesthetic. Botulinum toxin injections are generally well tolerated without anaesthetic.

Most patients return to their usual activities the same day. Redness, mild swelling or bruising may appear at the injection points and usually settle within a few days; on the lips, swelling may be more noticeable at first.

Usual recommendations for the first 24–48 hours:

• avoid massaging or pressing on the treated areas;
• avoid strenuous exercise, saunas and strong sun or heat exposure;
• after botulinum toxin, avoid lying down for a few hours, as instructed by the doctor.

Injectable treatments are considered safe when carried out by a trained doctor using authorised products, but they are not without risk. The most common effects are temporary: redness, swelling, bruising, local tenderness or, after botulinum toxin, a mild headache.

Less often, there may be asymmetry, a temporary drooping of the eyelid or eyebrow after botulinum toxin, small lumps or irregularities after fillers, infection or allergic reactions. A rare but serious complication of fillers is the blockage of a blood vessel, which requires prompt medical treatment. For this reason, the patient should contact the doctor immediately if they notice severe pain, blanching or unusual discolouration of the skin, or visual disturbances. If needed, hyaluronic acid can be dissolved with an enzyme.

The effect of botulinum toxin starts to show after a few days and is usually fully established in about two weeks. It generally lasts three to four months, sometimes longer, after which the muscles gradually regain their activity.

The result of fillers is visible immediately but is best judged once the swelling has settled, within one to two weeks. The effect usually lasts from a few months to over a year, depending on the product, the area treated and each patient's individual characteristics. To maintain it, the treatment can be repeated at intervals agreed with the doctor. A follow-up visit after two to three weeks allows any adjustments to be made.

Wrinkle and facial volume loss treatment can give a more rested and balanced appearance, without surgery and with a quick return to daily activities. The results are temporary and vary from person to person. The right plan is agreed at the consultation at Detalii Med in Baia Mare, together with the plastic surgeon, based on each patient's features and wishes.