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Author: Dr. Shinya Sasagawa
Chairman, Shingetsukai Medical Corporation
Houreisen Skin Clinic — Osaka / Tokyo / Nagoya
Specializing in nasolabial fold and wrinkle treatments
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This case features a man in his 30s who received a combination of aesthetic treatments at Houreisen Skin Clinic in Tokyo.
His concerns included expression lines, nasolabial folds (smile lines), loss of skin firmness, uneven skin texture, redness, dullness, and mild skin laxity. Rather than relying on a single procedure, we selected several treatments to address these concerns together.
Specifically, we performed botulinum toxin (Botox) injections for the glabella (between the eyebrows), bridge of the nose, crow’s feet, and under-eye area; hyaluronic acid filler injections for the nasolabial folds; and a combination of Sunekos, Lumecca, InMode Forma, and Jalupro Super Hydro.
The overall appearance of the face is influenced by more than wrinkles alone. Skin texture, elasticity, facial volume, laxity, and uneven pigmentation all contribute to the way a face looks. Our goal was to improve the overall balance of his face while preserving a natural appearance.
Key Points of This Case
- Combination treatment tailored to multiple concerns in a man in his 30s
- Botulinum toxin injections for expression lines between the eyebrows, across the bridge of the nose, at the outer corners of the eyes, and under the eyes
- Hyaluronic acid filler to soften the appearance of the nasolabial folds
- Sunekos and Jalupro Super Hydro to address skin hydration, texture, and firmness
- Lumecca IPL to target visible redness and uneven skin tone
- InMode Forma radiofrequency treatment to address skin firmness and mild laxity
- An emphasis on overall facial balance rather than dramatic changes to one feature
目次
Before Treatment
Midface at Rest and During Facial Expressions
Before treatment, wrinkles became more pronounced when the patient made facial expressions.
Forehead During Facial Expressions
Expression lines are common when the facial muscles contract. Areas frequently treated with botulinum toxin include vertical frown lines between the eyebrows, horizontal lines across the bridge of the nose, crow’s feet, and fine lines beneath the eyes.
Repeated facial movements may gradually make these wrinkles more noticeable, sometimes even when the face is at rest. Botulinum toxin injections reduce the activity of selected facial muscles and can soften certain expression lines. The suitability of treatment depends on facial anatomy and muscle movement.
Nasolabial folds differ from expression lines. Where a crease is associated with facial volume loss, hyaluronic acid filler may help support the area and soften its appearance without eliminating natural facial contours.
To address skin tone, texture, firmness, and laxity as well, the following treatments were used in combination.
Lumecca — IPL Photofacial Treatment
Lumecca is an intense pulsed light (IPL) treatment used for concerns such as sun spots, freckles, redness, and uneven skin tone. The light targets pigment and superficial vascular changes. Depending on the patient’s skin condition, treatment may help improve the appearance of discoloration and overall skin tone.
Downtime is often limited, although temporary redness, warmth, darkening of treated pigmented spots, or swelling may occur.
InMode Forma — Radiofrequency (RF) Skin Tightening
InMode Forma delivers controlled radiofrequency heat to the skin. It is used to support skin firmness and improve the appearance of mild laxity, facial contours, and skin texture by encouraging collagen remodeling. Discomfort and downtime are generally limited, but individual responses vary. Multiple sessions may be recommended depending on the treatment plan.
Jalupro Super Hydro — Injectable Skin Booster
Jalupro Super Hydro is an injectable skin booster containing non-crosslinked hyaluronic acid, amino acids, and peptides. It is used to address dehydration, fine lines, and reduced skin firmness, with the aim of supporting improved skin texture and elasticity.
Sunekos — Injectable Skin Booster
Sunekos combines non-crosslinked hyaluronic acid with six amino acids in a specific ratio. It is used as a skin-quality treatment for concerns such as fine lines, reduced elasticity, and age-related changes in skin texture. The formulation is intended to support the skin’s extracellular matrix and overall hydration and firmness.
Two Months After Treatment
Midface at Rest and During Facial Expressions
Approximately two months after the combined treatments, expression-related wrinkles appeared less pronounced. The patient’s skin also appeared smoother and firmer, contributing to a refreshed overall appearance.
Forehead During Facial Expressions
Wrinkles were also less noticeable when the patient contracted the facial muscles around the forehead.
Before and Two Months After: Detailed Comparisons
Overall Facial Appearance at Rest
Midface During Facial Expressions
After treatment, the expression lines appeared softer. Botulinum toxin was used to reduce excessive muscle movement, while Sunekos and Jalupro Super Hydro were included in the plan to address skin quality and firmness.
Right Eye Area During Facial Expressions
Fine lines around the eye appeared less noticeable, giving the area a smoother, more refreshed appearance.
Left Eye Area During Facial Expressions
Right Outer Eye Area at Rest
Even with the face at rest, lines around the right eye appeared softer after the combined treatments, which included botulinum toxin and Sunekos.
Left Outer Eye Area at Rest
Right Cheek at Rest
Before treatment, the cheek showed visible pigmentation, dullness, enlarged-looking pores, and some loss of firmness. At the two-month follow-up, the skin appeared more even in tone, with an improvement in the appearance of pores and overall texture.
Lumecca IPL was selected to address pigmentation and visible redness, while InMode Forma RF was used to address firmness and mild laxity. These treatments were part of an overall combination plan, so the contribution of each individual treatment cannot be determined from the photographs alone.
Right Nasolabial Fold at Rest
Before treatment, the nasolabial fold was more noticeable even at rest. Following hyaluronic acid filler treatment, the fold appeared softer and the area around the mouth had a smoother contour.
Left Nasolabial Fold at Rest
Treatments Performed: Details and Possible Side Effects
Botulinum Toxin Injections (Allergan / Coretox)
How it works: Botulinum toxin reduces the release of acetylcholine from nerve endings, helping relax selected facial muscles and soften expression lines.
Possible risks: Pain, swelling, bruising, allergic reactions, asymmetry, an unnatural feeling during facial expression, and eyelid drooping (ptosis).
Hyaluronic Acid Filler (Allergan Vycross Range)
How it works: Hyaluronic acid filler is injected into selected areas to restore or support volume, soften folds, and improve facial contours.
Possible risks: Pain, swelling, bruising, unevenness, asymmetry, palpable lumps, discomfort, allergic reactions, infection, and vascular occlusion. Vascular occlusion is a serious complication requiring urgent medical attention.
Sunekos (Injectable Skin Booster)
How it works: A formulation of non-crosslinked hyaluronic acid and six amino acids is injected with the aim of improving skin hydration, texture, firmness, and the appearance of fine lines.
Possible risks: Pain, swelling, bruising, redness, allergic reactions, lumps, and discomfort.
Lumecca (IPL Treatment)
How it works: Broad-spectrum light is applied to the skin to target pigment and superficial vascular changes, potentially improving the appearance of dark spots, uneven tone, and redness.
Possible risks: Redness, stinging, a feeling of heat, swelling, post-inflammatory hyperpigmentation, blistering, and crusting. Pigmented areas may temporarily appear darker after treatment.
InMode Forma (Radiofrequency Treatment)
How it works: RF energy heats the skin to encourage collagen remodeling and improve the appearance of firmness, mild laxity, and skin texture.
Possible risks: Redness, warmth, swelling, burns, and, in rare cases, blisters or pigmentation changes.
Jalupro Super Hydro (Injectable Skin Booster)
How it works: An injectable formulation containing non-crosslinked hyaluronic acid, amino acids, and peptides is used to support skin hydration, elasticity, and texture.
Possible risks: Pain, swelling, bruising, redness, allergic reactions, lumps, and discomfort.
Treatment Overview, Pricing, and Risks
| Treatments | Botulinum toxin injections / Hyaluronic acid filler / Sunekos / Lumecca / InMode Forma / Jalupro Super Hydro |
|---|---|
| Treatment Areas and Goals | Botulinum toxin was used between the eyebrows, at the bridge of the nose, around the outer corners of the eyes, and beneath the eyes; hyaluronic acid filler was used for the nasolabial folds. Sunekos and Jalupro Super Hydro were selected to address skin texture and firmness; Lumecca for uneven tone, discoloration, and redness; and InMode Forma for skin firmness and mild laxity. The treatment plan was tailored to the patient’s facial balance and concerns. |
| Price | Costs vary depending on the procedures, products, treatment areas, and amounts used. Please refer to our current price list for details. |
| Downtime | Injectable treatments may cause temporary redness, swelling, puffiness, bruising, or tenderness. After Lumecca, redness, warmth, and temporary darkening of pigmented spots may occur. After InMode Forma, redness or warmth may develop. Recovery varies from person to person. |
| Main Risks and Side Effects | Botulinum toxin: Swelling, bruising, asymmetry, altered facial expression, eyelid ptosis, etc. Hyaluronic acid filler: Pain, swelling, bruising, lumps, contour irregularities, infection, vascular occlusion, etc. Sunekos / Jalupro Super Hydro: Redness, swelling, bruising, pain, lumps, etc. Lumecca: Redness, warmth, hyperpigmentation, hypopigmentation, blisters, etc. InMode Forma: Redness, warmth, swelling, burns, etc. |
| Clinic | Houreisen Skin Clinic (this case was treated at our Tokyo clinic) |
Results vary between individuals. The photographs show the overall outcome after several procedures; they do not establish how much improvement was produced by any single treatment. Please consult a physician about suitability, expected outcomes, and risks.
If you have concerns about dullness, dryness, loss of firmness, wrinkles, or other facial changes, please feel free to contact us. We also welcome patients who are unsure which treatment would be most suitable for their concerns.
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