Supporting the Face

Our understanding of volume loss has allowed us to recreate the volume in a healthy, natural manner. Specific facial fat pads disappear with age in a particular order, causing distinct signs; loss of jaw line, saggy face, tired look, nose to mouth lines and under-eye shadows. The subcutaneous fat thins leading to thinner skin and bringing fat pad loss to the forefront. Disease, smoking, UV exposure and other free-radical generating conditions accelerate the process, which normally starts at about 35 years of age.

Volume loss occurs well before the skin sags. Whilst we always think that gravity is to blame for our changing appearance, it is the support to the skin that disappears first. This is why we at Bijoux Medi Spa like to ensure that the volume of the face is addressed first in any facial rejuvenation treatment.

Volume loss can be addressed with injectable fillers. We like to use hyaluronic acid (HA) fillers to replace lost volume. Hyaluronic acid is a large sugar molecule that is naturally occurring in the tissues. It is a powerful hydrating agent and accounts for the fact that we are 70% water. The more HA we have, the more plump and hydrated the tissues are. All HAs that we use in the clinic are made in a lab using bioengineering techniques. They are not derived from animals or plants and have a long safety record - twenty years or more.

When rejuvenating a face, we like to work at the top part first in order to lift the lower face. Dealing with the lower face first can lead to the "pillow face" look so frequently ridiculed in the press. Thus we replace volume in the temples, the cheeks and the sides of the face before moving on to the lower face. By adopting this rational technique there is frequently no need to inject the lower areas and the results are completely natural.


Hollow temples make us look old. The eyes disappear, the eyebrows slope sideways and a sharp edge appears beside the eyes. By filling the temples the eyes will suddenly become part of the face again - and much more attractive. The whole face will respond by lifting. Very often the cheeks will respond and not need any treatment of their own once the temples have been replenished. It is an area that can be overlooked; frequently hidden by hair. However it is important to look at this area as a target for rejuvenation.


Even those people with good bone structure lose the fatty tissue over their cheeks, and this is the aspect that we are rejuvenating, the lateral part of the face rather than the central "apples". Replacing volume over the cheek bones themselves in a subtle way will return the face to its youthful appearance, lift the low face and enhance the eyes. Many people seeking treatment are afraid to look ridiculous. This can occur if there is too much filler in the wrong place - normally the central area and close to the eyes. We do not do this. We respect the anatomy of the face and the desires of the client.

Chin and Lower Face

However from the age of about 50 the lower face will suffer and it is important to maintain the strength of the jawline and chin, again with fillers. The chin forms an important part of the face and must not be neglected.


Big lips are no longer the in thing but lipstick lines are not attractive and respond well to gentle filling. By carefully reinforcing the border of the lips the lines can be erased and the lips defined in a totally natural manner. The surrounding lip area, often called the white lip, also shrinks with age, becoming a target for rejuvenation as part of the whole face approach. Of course lips can be restored or even enhanced with a bit more volume still within the limits of normality. We like to restore the rest of the face first so that when finally we enhance the lips they sit beautifully in the face.

Eye Bags and Hollows

The eye area is one of the first areas to show the signs of ageing. Volume loss occurs early in this area and causes the eyes to change shape from round to more elliptical, makes them sink into the sockets and can be the cause of eye hollows or bags. The eye area is delicate and is related anatomically to the cheek. Thus any filler treatments around the eyes are best preceded by adequate treatment of the cheeks, temples and upper face. Just like the lower face, when the mid face is treated the eyes themselves will respond and may not need specific eye area treatment. This is certainly the case for eye bags and hollows; volumisation of the cheeks leads to an immediate improvement in the appearance of both bags and hollows. Dark circles are also improved. The area around the eyes can be treated and respond well. Less is definitely more here, and caution the operative word. There is always a risk of bruising in this area but this can be minimised by using the microcannula to inject the fine HA filler.

Filler Facts

Fillers restore lost volume; they come in a syringe and are injected into the area where volume is required. Most dermal fillers contain lidocaine, a local anaesthetic which makes the injection totally tolerable. The needle prick can be reduced by an application of surface anaesthetic for about 10 minutes.

The results are instant, although there can be some swelling for up to 24 hours. Bruising is also a possibility, this may last longer, up to seven days.

Most areas are now treated with the microcannula; this is a very fine blunt tipped tube that is gently moved through the tissues and deposits a uniform amount of filler in its trail. The results are incredibly natural; pain, swelling and bruising are much reduced.

We use hyaluronic acid fillers to treat the face. Hyaluronic acid is the natural hydrating agent of the skin. It is a large sugar molecule and powerful hydrating agent. It is also a potent antioxidant. All biochemical processes in the body occur in water; the better hydrated we are then the better these processes are carried out. Hyaluronic acid binds water and holds it in the tissues, keeping them plump, allowing repair, regeneration and removal of waste products, and contributes to protection against free radical attack.

All the hyaluronic acid is made in a lab from the biofermentation of sugar. In order to prolong the life of the product in the body, the hyaluronic acid strands are cross-linked by a chemical process and then often intertwined to add to the 3D structure. All hyaluronic acids will contain miniscule amounts of bacterial fragments and cross-linking agent, but the ones we like to use contain the smallest amount available. These can contribute to swelling after the procedure.

People often ask “What’s the downside of hyaluronic acid?” At Bijoux we believe that there are more benefits than disadvantages. Hyaluronic acid contributes to the overall antioxidant potential, it retains the facial structures in place and stimulates collagen production via fibroblast activity. The disadvantages are bruising. Allergy to the product is unknown and the risk of infection very small. Research has shown us that regular treatments will maintain the quality of all the supporting tissues of the face, keeping it lifted and fresher for longer.


Sculptra is a different kind of filler with longer-lasting natural results.

Sculptra recreates tissue volume. It is made from poly-L-lactic acid; many lactic acid molecules strung together. The resulting molecule helps to generate new collagen deep in the tissues. Sculptra has been used for many years and the techniques of preparation and administration are constantly evolving. Problems such as pain and bruising have been eliminated with the cannula; small lumps have been minimised by the new recommended dilution. The results of Sculptra are long lasting, between 2 - 4 years and look very natural. Furthermore the results take a while to build up. The improvement is gradual as the new collagen is formed within the face. Sculptra makes an ideal general volumiser and can be combined with HA fillers for an occasional boost or to jump start the treatment.

Sculptra is injected using a cannula. This allows most of the face to be treated in one go and with very little, if any bruising. The results look great for a while but it is only when your own collagen is created that the results are durable. This generally takes 4 - 6 weeks. In general two vials are recommended for every decade of your life.