Injectable Fillers
Injectable Facial Augmentation
Facial
Injectables
As more and more injectable materials become available,
there is a great deal of confusion about what each one
does, which injection to get, and for what purpose.
The following may clarify some of the confusion and
provide valuable information for someone who may be
considering an injectable material.
Currently, demand for injectable materials come from
people looking for a treatment for fine lines or wrinkles,
enlarging lips, and improving the appearance of scarring.
Injectable materials offer a “non-invasive”,
inexpensive, “quick-fix” that many people
find to be an extremely easy way to have smoother, younger
looking skin.
Fillers
Most injectable materials work by actually plumping
up the skin and are more popularly known as “fillers”.
These materials are actually injected with a needle
under the skin to correct wrinkles, frown or smile lines,
or even a depressed scar.
Perlane* and Restylane
Two of the newest of the injectable “fillers”
are Perlane and Restylane. They are made from a formulation of Hyaluronic
Acid (HA) in a gel base. The difference between the two is the thickness
of the gel particles, enabling them to be used for different applications.
Hyaluronic acid is a naturally occurring substance in the body,
and is gradually reabsorbed, giving long lasting results. Both Perlane
and Restylane are currently FDA cleared for use in the U.S.
Restylane can be used for fine wrinkle correction, for example around
the mouth, forehead lines and smile lines. Restylane is injected
into either the upper or middle dermis of the skin. Restylane can
be used for all types of wrinkles, such as peri-orbital lines (crow’s
feet) and worry lines, or glabellar lines. Also, it may be used
for the lips, the vermilion border and for slight volume augmentation.
. Restylane has been used in Canada and Europe for many years with
much success for the immediate treatment of wrinkles. Studies have
shown that injectable Restylane may last from 6 months to 15 months.
Perlane, the thicker of the two, can be used for shaping facial
contours, such as cheeks and chin, correcting deep folds, and for
volume augmentation of the lips. Perlane is injected into the lower
dermis of the skin to correct deeper folds in the skin and to augment
lips when more volume is desired. Perlane has been known to last
up to a year and a half. For best results, Perlane and Restylane
may be used in combination with each other to fill both the fine
and deeper lines.
Highly recommended with wonderful safety profile. Least costly
and great duration!
* Perlaned approved in May 2007
Juvéderm™
Juvéderm™ is a smooth consistency gel made of hyaluronic acid—a naturally
occurring substance in your skin that helps to add volume and hydration.
Your healthcare professional eases Juvéderm™ injectable
gel under the skin to provide a smooth, natural look and feel—so
everyone will notice (but no one will know)! In fact, studies show
superior results of Juvéderm™ compared to a collagen-based
dermal filler.* And, almost 90% of all study volunteers who were
treated with both Juvéderm™ injectable gel and another
dermal filler* preferred Juvéderm™! In addition, Juvéderm™
injectable gel is the first FDA-approved hyaluronic acid dermal
filler that is proven to be safe and effective for persons of color.
Artefill
As of today, the only permanent injectable filler is Artefill. Artefill
has been used for several years in other countries, with much success.
Artefill is a mixture of bovine collagen (75%) and tiny plastic
PMMA spheres (25%); as the collagen is absorbed, the body surrounds
the plastic spheres with its own connective tissue and collagen
over 3-4 months resulting in a long-term and possibly permanent
fix for wrinkles. Since this filler is permanent, physicians may
have some reservations regarding the use of it. Since it contains
bovine collagen, it will require an allergy test prior to use.
Radiance/Radiesse
Radiance is also a relatively new injectable that has been FDA approved
for soft tissue augmentation, and other medical uses. It has been
used in Europe for years for cosmetic purposes. However, it has
been only recently that it has been considered for cosmetic use
in the U.S. Radiance is Calcium Hydroxyapatite, a synthetic material,
suspended in a gel that when injected correctly, can be a very successful
filler material. However, we have seen many problems with this material.
We have unfortunately had to excise this hardened material from
the soft tissues of many patients. We do not routinely use this
treatment, although it find a role in a select group of patients
who have acne scars. Although studies show that it can last anywhere
from 6 to 12 months, the probolems with this material in certain
patients may not be worth it.
Collagen
Bovine collagen preparations, Zyderm and Zyplast, were, until recently,
the most commonly used injectable fillers. The two differ in the
thickness of the preparation, determining the preferred usage, whether
for fine wrinkles, or deeper applications. The main reason that
Collagen is no longer the “popular” choice is considering
the cost, the results (although attractive), were not very long
lasting. Collagen can last anywhere from 3 to 6 months at best,
you would then need to be re-injected. Moreover, since collagen
is derived from cows, a skin test must first be administered in
your forearm to test for allergies. You will then need to follow
up in 2 weeks to have the tested area examined and you may be injected
if you are a candidate.
The makers of Zyderm and Zyplast, have come up with newer collagen
based materials called Cosmoplast and Cosmoderm, made from human
collagen, that do not require the skin test. However, like bovine
collagen, they are not very long lasting.
Non-Fillers
BOTOX® Cosmetic
Possibly the most popular of the injectables
is NOT a filler material at all. BOTOX® Cosmetic
actually works by paralyzing facial muscles that create unwanted
furrows or lines in the face. BOTOX® Cosmetic can be used to treat the creases
in the forehead, lines beside the eyes known as crow’s feet,
and the frown lines in between the eyebrows. BOTOX® Cosmetic
is fast and simple and can leave you looking younger, natural and
more relaxed. Botox is a natural, purified protein produced by the
Clostridium Botulinum bacterium that has been FDA approved for facial
cosmetic purposes. It is injected into the muscle from a very tiny
needle. Botox results can last from 3 - 11 months. This is one of
the best treatments available for the treatment of upper facial
lines and wrinkles.
THE PREOPERATIVE FEATURES
- There are distinctive features of deep furrows or
creases in the lines that run from the nose to the mouth.
These may be uneven from side to side.
- These deep furrows may or may not be associated with
deep wrinkle lines within the texture of the skin and
usually at the depths of the furrows.
- There may be prominent folds or bulges present just
inside or next to the furrows.
- These folds may be associated with loose hanging
skin and extra fat. If you can pull up and back on your
facial skin and see these folds improve greatly, then
there is loose skin.
- The desire to have less deep furrows, less wrinkle
lines, tighter skin and a smoother surface.
- These folds or furrows may be associated with jowls,
or excess skin and fat along the jawline.
- These folds or furrows may be associated with down
turned corners of the mouth.
- Folds and furrows that make you look sad or older.
- Desire for a softened more youthful appearance in
this area.
THE PROCEDURE
- A spectrum of options may be available depending on
your anatomy and the degree of correction desired. These
range from filler materials, to implants, to facelift
procedures.
- Excellent filler materials are present and range
from Collagen, Perlane, Restylane and Radiance.
- Implants include Gortex, Alloderm, Advanta and others.
- Facial procedures include minimal incision facelift,
cheek lift, and regular facelift.
- Anesthesia can be none, local or MAC depending on
the procedure employed. The surgery can take anywhere
from 15 minutes to two hours.
- Incisions may not be necessary (for injections) or
well hidden inside the lips or hairline.
THE RECOVERY
- You can go home immediately or at most after several
hours.
- You can shower the day after surgery.
- Minimal discomfort that is mostly gone by the third
day and easily controlled by medications.
- Swelling which is mild to moderate and peaks at two
days then disappears rapidly over the next week.
- Minimal or no bruising which is greatest at two days
then disappears rapidly by three to five days.
- Resume most activities immediately, or at least within
the first week, and most by at least three weeks.
- No stitches to remove, they are all dissolvable.
THE RESULT
- You can retain your natural features, and have a
softened more youthful look.
- A very natural result, which is smooth but still,
moves naturally when you smile.
- A softened and beautiful balance to compliment your
other facial features and proportions.
- Natural and presentable appearance within hours,
or at most, after the first week that just gets better.
Treatment Related Questions
How long will a treatment session take?
In general a treatment takes 10 minutes. The
time can differ somewhat depending on the correction to be performed.
How is a treatment done?
During treatment the crystal-clear gel is injected into
the skin in tiny amounts with a very thin needle. The
gel then gives natural volume and smoothes out the wrinkles.
What can be treated?
These products can be used for smoothing out folds and
wrinkles, lip enhancements and shaping of facial contours.
How soon can I see the results?
The results can be seen immediately.
What will I look like after the treatment?
Immediately after the treatment you can expect slight
redness and swelling. This is a normal result of the injection.
The inconvenience is temporary and generally disappears
in a day or two. If the inconvenience continues or if
other reactions occur, please contact your physician.
The initial swelling after lip treatment may last longer.
Some patients experience swelling for about a week and
the lips can look somewhat uneven during this time. This
means that the result directly after the treatment should
not be looked upon as the final result.
Does it hurt?
For wrinkle treatments no pain relief is generally necessary,
however it can be easily arranged at your request. When
enhancing the lips, pain relief in the form of a local
anesthetic is often used.
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