Tweak of the Week: Mid-Face Volume Enhancement by Dr Kate Goldie with BELOTERO® Volume

What is the secret of natural-looking cheek enhancement? For this week’s Tweak of the Week, I went to Harley Street to visit Dr Kate Goldie, one of the leading aesthetic doctors in the UK.

Dr Goldie lectures on injection techniques to medical professionals around the globe so I wanted to ask her about how she achieves outstanding results with injectable filler.

Dr Goldie performed the treatment on a middle-aged woman who was concerned about loss of volume in her mid-face. She used BELOTERO^® Volume for the treatment, a hyaluronic acid dermal filler that is specifically designed for replacing lost volume with natural-looking results.

You can watch the video to see how it went, or read the transcript of our talk, below.

This video is sponsored by Merz Aesthetics UK&IR

Alice Hart-Davis: Hi, my name is Alice Hart-Davis and welcome to this week’s Tweak of the Week. Now I’ve come to Harley Street (with my mask) to talk to Dr Kate Goldie about mid-face volume. She’s going to be doing a Tweakment with BELOTERO® Volume, that’s a filler that’s used in the mid-face, and if you come along with me we will go and meet Dr Goldie, meet the patient and watch the treatment and you can see exactly what it’s like. So, come on in.

AHD: I’m here with Dr Kate Goldie who is an advanced practitioner of aesthetic medicine and we are going to be talking about fillers and, with fillers, the key thing is, “how do you get it right in the mid-face?” which I ask because most middle-aged women can see the volume going in their faces but they are terrified of looking odd, so, what’s the key to getting it right?

Dr Kate Goldie: It’s kind of the “big secret” where, if you don’t read the face right [read your own face or the practitioner reads your face], you can end up looking: 1. The mid-face can look like everyone else’s mid-face or 2. Having fillers in the mid-face can make people look worse not better. So, enhance the cheekbones, but if all the soft tissue around it has lost some volume but you make the bones come out more, then the change between bones and underneath it can be more. So it can actually make people look more gaunt.

AHD: Sort of pronounced and yet gaunt at the same time?

KG: Yes, it’s all about how the mid-face connects with everything around it and also how that person’s mid-face would have looked before so that you can trace back and see [what it was like before] so that you only put back what was there. That’s your ideal scenario. What ageing can do of course is that people don’t recognise themselves so one of our aims in the clinic, for example, is for people to have some treatment, look at the mirror [and say] – and this is my best result – “I totally recognise myself. That is what I look like”. This is what I think good mid-face treatment is, the cornerstone of that.

AHD: Thank you. I needed to ask why you choose to have BELOTERO^® Volume?

KG: So, I have used it for a long time. What it specifically does well is to be able to do deeper injections but the transitioning thing on top. So, with one filler you are able to do structure and curve and the other thing is you use it just under the skin and, when you use it just under the skin, you can make shapes, you are going to see that. It is about using what is special about it to make sure that the patient that we have looks like themselves at the end of it.

AHD: That’s great, thanks Kate let’s go and find our patient.

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MEET THE PATIENT

AHD: [To patient, Susan] Now, your face looks fab to me, what is it that you see that you want treating?

Susan (patient): I think as women we are very critical of our skin and especially in lockdown I think I seem to be spending so much more time looking in the mirror or on Zoom meetings and things like that. So, for me, I want to enhance the best bits and therefore not enhance the bad bits.

AHD: Ok, so what are you hoping for in terms of change today?

S: Just a little brightening, a little refinement. I don’t like these lines here [points to nasolabial folds] or these lines [points to marionette lines]. Also I am noticing that I’ve got more “jowly” if that’s the right word.

AHD: Great well let’s see how it goes and what Kate can do.

KG: You can already see when you look at Sue’s face how she has got great features, she has a lovely expression and she has a harmony to her face, so these are things we don’t want to mess with. That’s where we start. Particularly with what we are doing we are going to look at her mid-face, and when we say mid-face what that means is her cheeks but also the bit below it. That is really important. From the side what you actually see is that this curve [points to area of mid-face with white mark-up pencil] has remained nicely preserved, what’s happening is that all of the side of Sue’s face has become more of a straight line. This is straight [points to side of face]; this is a curve [points to apple of the cheek]. So the front of Sue’s face compared to the back of it – curved and straight – this is a classic way that people age. What we need to do is not add here [points to apple of the cheek where it is still curved] but we need to support all of these areas of the face [pulls back on side of face where it is straight]. That’s what we are going to do.

AHD: Wow. OK.

KG: [Marking up the face with a white pencil] So the whole thing will be curved but the support from here [points to area of the mid-lower face] means that this [jowls] will be lighter. And, in addition to that, when we do this so imagine it is going to be that sort of shape [drawing on face] that this will also frame Sue’s eye. We need to just re-frame the eye, support the tissue and support the lower face and that’s what we are going to do.

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THE PROCEDURE

KG: [Injecting] So here, for those interested, we are placing the gel deeply to add structure to support the face and we are just injecting slowly. Remember, we are just replacing tissues and structural tissues where there’s a lack of structure, very gently just into the lower part of the temple, which will help re-frame the eye. That’s one injection. And we have almost like a C shape of support. The other thing we have learnt over the years and that is, like a sculptor, putting it there is only one part of the job, the other part is to hold and mould. So remember this BELOTERO^® Volume will integrate with all your tissues.

AHD: OK, and how long do you have that you can mould it for?

KG: We usually think it’s about the time during the time of treatment. I like to do it straight away because you see what you are getting. It really is sculpting. OK, so we did structure and now we are going to do shape. So the shaping is putting BELOTERO^® Volume really just underneath the skin. I am very gently moving around just placing it underneath the skin, remember, HA is a natural substance, hyaluronic acid, which is where it normally would be, and the BELOTERO^® Volume is one of the few volumisers we can use like this. It works so well underneath the skin and you can’t see it afterwards. What you really want to have is to be able to use it in a way that you can’t see any area between treated and untreated. This is healthy for the skin – it adds support; it helps cell to cell communication; it increases collagen; it softens some of those curves.

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RESULTS

AHD: So Susan what do you think? What do you see?

S: Wow. It’s just so soft.

KG: The idea was to read Sue’s face, create that little structure and shape around here [points to cheeks with marking pencil]. You can see it on both sides. Smile for me. You can see the whole face. This is even directly afterwards. And also you see that when we do the lateral side, the sides of the face, it helps support the jowls, so what should happen, and we can see it, is that it flows from the temples, a soft flow. A softening of the transition between the cheek and the mid-face; just a little softening of the marionette. All of that is one flow and utterly natural.

AHD: Thank you and thank you so much Susan for letting us film that.

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AHD: So that was this week’s Tweak of the Week. That was just fascinating seeing how a few carefully placed injections can structure the face and then support all the way round the sides and what I hadn’t realised is that Susan, the patient, was needle phobic, yet she found it comfortable enough so pain wise I’d say that’s pretty low and also aftercare all she has got to do is keep it clean, a clean mask is what she has gone away with, and look after the area and not push it around for the next 24 hours while it settles. It was a brilliant demonstration of how injectable filler can be used to give a real softening of the face and restructure it but in a way that looks entirely natural. I hope you enjoyed that.

Before and after treatment with Belotero Volume with Dr Kate Goldie