Restylane, Radiesse and Alloderm
Rejuvenating Filler options Contouring and Reducing Facial Lines
The gradual development of facial wrinkles, whether fine surface lines or deeper creases and folds, is the classic early sign of accumulated skin damage and inevitable aging. Premature aging and wrinkling of the skin may be accelerated by excessive exposure to the sun and other elements, overactive facial expression muscles, the frequent use of tobacco products, poor nutrition, or skin disorders. Fine surface wrinkles that progress to deeper creases, deepening facial expression due to repeated skin folding, and deep folds which develop with one's maturity are obvious changes which may combine to portray a less desirable appearance. Persistent facial lines, especially those involved in negative emotional expressions, may mistakenly portray to others, the look of worry, anger, anxiety, disgust or sadness, despite one's own positive internal feelings. Regardless of the cause of facial creases or folds, safe and successful treatments for reduction or elimination of these problems are now available with the help of your facial plastic surgeon. Injecting or implanting substances which either temporarily weaken the muscles or act as skin volume fillers serve to soften or eliminate the appearance of wrinkles and produce a more youthful, rejuvenated appearance.
Treatments for facial wrinkles are usually performed in the office setting which is convenient, private, and safe for persons who desire therapy. Your health, in conjunction with the appropriate therapy to achieve your goals, is given full consideration by your facial plastic surgeon prior to the any decision to undertake specific treatment. However, very few individual health problems would limit the use of these therapies due to their minimally-invasive methods of application. Your concerns and any medical requirements for each facial wrinkle therapy will be part of your personal consultation with physician.
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Understanding Types of Treatments for Facial Wrinkles
Prominent forehead creases, brow furrows or eye lines (crow’s feet) produced by specific facial expression muscles repeatedly creasing the skin may be effectively treated by reducing the function of specific facial muscles. Botulinum toxin (BOTOX) is a sterile, purified protein produced from the bacteria, Clostridium botulinum, in the laboratory. BOTOX injected in small amounts into facial muscles binds to the nerve endings supplying the muscle and prevents nerve impulses from traveling to the muscle. When injected into muscle, it weakens or paralyzes the muscle around the area injected for a typical period of several months. The resultant weakening or paralyzing effect on the facial muscle temporarily reduces or eliminates previous skin creasing and new skin creasing is avoided. BOTOX may take several days to have its effect, and the effect typically lasts 3-6 months, in most individuals, before full muscle movement returns. At that point further treatment may be elected. BOTOX directly targets the primary underlying cause of most, but not all, facial lines by directly preventing or lessening facial line formation. In contrast, an array of facial dermal fillers are available for the direct and immediate elimination or reduction of already present facial lines and wrinkles, without affecting facial muscle movement.
Injectable collagen is an animal protein filler material formulated for safe use in nearly all areas of the face, including the lips and crow’s feet. Until recently, collagen has been the gold standard filler for cosmetic use within the face. Collagen remains as an option for fine wrinkles to be filled in by the material to reduce their visibility. Other prominent facial creases and folds around the forehead, cheeks and chin can be treated as well with this material. Initial collagen allergy testing must be performed, and repeated treatments every 2-4 months are typically needed to sustain the desired result. The treatments are easily performed in the office and usually have minimal side effects.
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Restylane
Restylane, an injectable filler comprised of hyaluronic acid gelatin, has become our new premier treatment for effective and long-lasting rejuvenation of facial lines and wrinkles previously treated with collagen products. Restylane has the several exquisite benefits of six months or longer duration of effect, application to any location within the face, lack of any significant allergic response and a superior volume correction for any given amount injected over time. The basis for Restylane as an advantage for your care lies in its ability over time to optimize the water content of the skin in which it is placed or in which it resides naturally.
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Radiesse
an injectable filler comprised of calcium hydroxylapetite microparticles in gelatin, has become the most interesting innovative material we currently use as facial plastic surgeons. In contrast to Restylane, which optimizes facial volume by incorporating water into its structure, Radiesse optimizes facial volume by stimulating localized collagen formation. Radiesse incorporates your skin’s reactive production of collagen as an enveloping scaffold. This meshwork throughout the treated area is both dramatically long-lasting and effective in reducing lines and recontouring prominent facial features in fine detail. Radiesse has been demonstrated to be reliably effective for 12-18 months or more, depending upon its specific uses and placement within the face.
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Alloderm
Human collagen matrices, such as Alloderm, are implants used for the reconstruction of significant soft tissue defects and the aggressive reduction of deeper facial folds which would require repeated treatments with large volumes of other injectable fillers. Alloderm may be threaded beneath the deep creases of the brow or cheek folds or placed within the upper and lower lips, to flatten and reduce wrinkle visibility or significantly enhance lip volume. Typically, this material maintains the majority of its volume correction far beyond the duration of injectable collagens.
Another less common type of implant is a non-resorbable synthetic polymer material, ePTFE which may likewise be used in the forehead, cheek folds, and lips to produce volume enhancement and effacement of deep facial creases. This material does not incorporate into surrounding tissue, but it does not lose volume either. It provides more lasting change and may be placed during an office procedure using local anesthetic and small incisions with a relatively short recovery period.
Fat grafting creates a natural augmentation for the face, especially for the lips and mouth region. Fat is usually harvested from the abdomen and about one third of the volume remains long-term after the treatment. Fat grafting can be repeated as needed for additional fullness.
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Making the Decision for a Specific Therapy
Expectations of any facial wrinkle therapy must be realistic. While an expectation for the complete and permanent removal of facial wrinkles for those persons considering treatment may be attractive, it is unrealistic, due to the ongoing nature of wrinkle formation and the currently available methods for treatment. The patterns and severity of facial wrinkle formation are highly individual. Therefore, after consultation with your surgeon, the appropriate therapy for your specific problems must be tailored to meet your needs. Management of many facial wrinkles may require repeated treatments or the use of combinations of treatments to achieve optimal results. The goal is to improve or reduce the appearance of the wrinkle or crease. This can be accomplished by reducing skin folding caused by underlying facial muscle action, as in botulinum toxin therapy. Alternatively, the skin beneath the wrinkle can be augmented to efface the wrinkle with injected or inserted filler material. The choice of any one type of therapy depends on the location and extent of the wrinkles, the desired duration of the effects, and the tolerance for potential side effects. All of these treatments provide additional and complimentary aesthetic benefits when combined with another facial rejuvenation procedure such as facelift, browlift, blepharoplasty or skin resurfacing.
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What to Expect after each Treatment
In comparison to typical cosmetic surgical procedures, the office time for these procedures and the subsequent recovery period until one returns to normal activities are minimal. Botulinum toxin therapy typically takes a few minutes to perform, and most patients may return immediately to home or work. Minor local irritation, redness, bruising, or swelling at the injection sites are the most commonly observed side effects, all of which typically abate within a few hours. Likewise, Restylane, Radiesse, collagen or other dermal injection therapies may be accomplished with a 5-30 minute procedure with similar attendant side effects and may be provided with the use of a local anesthetic. Some mild swelling and irritation at the injection sites is unavoidable but can easily be camouflaged with standard make-up, if necessary.
Filler implant insertions typically take up to an hour to perform in the office, depending upon the number and extent of treatment locations. Several sutures are used to close the insertion site. More swelling, redness, and discomfort may accompany these procedures, which require the use of a local anesthetic. Local application of cold compresses may feel comforting. Most early swelling subsides within a day or two, though minor swelling and irritation may last for several weeks during the implant healing phase. Your activity level and medication for pain after the procedure are dependent upon your treatment and your doctor's recommendations.
If you have any questions regarding office therapies for the facial recontouring and the treatment of undesired facial lines, please feel free to email us with your questions. The information presented here cannot take the place of a personal visit with Dr. Donat to address your specific concerns, but it is intended to inform you and to answer some of the important questions we are frequently asked regarding aesthetic facial contouring and the treatment of facial lines with BOTOX, Restylane, Radiesse and Alloderm
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