Botox
Botox, also called Botox Cosmetic, is actually Botulinum toxin. It has been used for decades and when injected properly is extremely safe. Generally, it is used for correction of certain moderate to severe wrinkles, such as the frown lines between our eyebrows or Crow’s feet lateral to your eyes. It is a temporary solution and lasts for about 3 to 4 months. However, if it is injected every 3 months for about a year, the muscle atrophies and you can maintain the effect by having the injections every 5 to 6 months, in our experience.
Botox Cosmetic is also used in “off label” areas, such as the turned down corners of the mouth, the wrinkles of the upper lip and certain wrinkles of the lower lid and cheek quite successfully.
How does Botox work?
Botox blocks the nerve impulse to the muscle relaxing the muscle. The contracting muscle creates the wrinkle. So when it is relaxed, this in turn relaxes the overlying skin and wrinkle. After Botox injection, it takes about 4 to 5 days for the full effect of the Botox to take place. Only the muscles in the immediate area of the injection are affected.
How safe is Botox?
There have been reports of complications with Botox, but these have been when used in high doses for large muscle spasms, such as seen in cerebral palsy patients. In the smaller does used in cosmetic cases, the complications have been when the doctor used a non-approved product, which is to assume it is not accurately prepared and the dose is unknown.
Botox Cosmetic has an excellent safety record and has bee referred as the “aspirin of the 21st Century.”
How is Botox injected?
We use a 31-gauge needle, which is not much larger than a hair, and to further reduce any discomfort, we apply a numbing cream followed by ice. Patient say the discomfort is minimal.
Juvederm
Juvederm comes in three forms, Juvederm, Juvederm Ultra, and Juvederm Ultra Plus. Each succeeding one had a longer duration. The Juvederm UP will last up to a year, and this is the one we almost exclusively use. Juvederm’s are made from hyaluronic acid, a natural substance in our bodies. The official approval by the FDA is for use in the nasolabial creases or folds, often called the “smile lines.” We also sue it “off label” for other areas, such as the Marionette lines beneath the corners of the mouth, wrinkles un the upper and lower lips, to increase the volume in the lips and other areas of depression. These products are fillers, and they are injected in the wrinkles themselves to increase the volume and lift the wrinkles.
How is Juvederm injected?
A very small needle is used to inject the Juvederm after applying an anesthetic cream followed by topical ice to further numb the area. For lip enhancement, dental blocks are used to avoid any excess discomfort.
Restylane
Restylane is another hyaluronic acid product used for filling and dermal lifting certain wrinkles. Restylane is also commonly used to “plump up” both upper and lower lips. Like Juvederm, it is not made from animal parts and requires no skin test.
How does Restylane work?
The Restylane, with a vary small needle, is injected directly into dermis of the wrinkles, thus elevating and diminishing the wrinkles. It us uniquely effective, of label, for depressions and shadows under the lower eyelids, as well s the nasolabial creased, Marionette lines and more. Restylane and Botox are probably the most common injectable products use in the U.S.A, Both are supremely safe, although some skill is required from the plastic surgeon to assure smoothness and natural appearance.
How long does Restylane last?
Typically, 6 to 9 months. However, if a second injection is used between 4 and 6 months, it is said the duration is 18 months.
Sculptra Aesthetic
Sculptra Aesthetic, former called Sculptra, unlike the HA’s (hyaluronic acids) such as Juvederm and Restylane, is more of volumizer, which still helps with wrinkles. Imagine a deflated beach ball, which will have folds and wrinkles. If you fill it up, it is smooth gain. The result of injecting of Sculptra is very similar.
How does Sculptra work?
Sculptra is a powder that we mix with water to allow injections. The powder is poly-L-Lactic acid, a biodegradable, biocompatible synthetic material that has been used by physicians for decades. It’s mode of action is to stimulate you to produce more of your own collagen, which in turn re-volumizes your face. It will last up to two years, which is longer than any other product with the exception of Artefill.
Why is increasing the volume of the face so important?
The aging face is a result of several simultaneous processes:
- Loss of elasticity
- Loss of the volume of the skin thickness and underlying fat
- Loss of bone thickness
Often the loss of volume is more significant than loss of elasticity. The Sculptra is very effective in replacing the lost volume. This increase in volume diminishes the shadows that occur with age and elevates the face. Sculptra is also injected on the bone to increase the thickness of bone, as bone loss is a major cause of volume loss with age.
What are other benefits of Sculptra?
Rather than simply filling wrinkles, Sculptra can change the shape of a face back to more youthful shape by replacing the lost volumes that occur with the aging process. The process of correction is over a month or two, because it stimulates you to product your own collagen, which take more time.
Is Sculptra safe?
Sculptra is extremely safe, but it must be injected correctly. If not, small nodules, usually temporary, may occur, particularly around the lower lids if injected there. Training sessions are necessary for anyone to purchase and use Sculptra. Dr. Finger has been a national trainer for Sculptra for 6 years.
Artefill
Artefill has been injected over 25,000 patients since the FDA approved it in February 2007. It consist of 20% polymethylmethacrylate microspheres (PMMA) and 80% bovine collagen. It also contains 0.3% Lidocaine to decrease any discomfort.
What are the benefits of Artefill?
The benefits are the long lasting results and the safety profile. We consider Artefill a permanent filler, meaning it could last over 5 years. It is particularly useful in those stubborn smile lines, the nasolabial creases., while it can be injected off label in other area as well. Since only 20% of the product is PMMA, later injections may be necessary to achieve the look you want.
Combination therapy using injectables for rejuvenation
Often combinations of Botox, Sculptra and even an HA (Restylane or Juvederm) or even Artefill are used simultaneously to achieve the best and longest lasting result for patients. Your plastic surgeon can best assess the various combinations for you with the advantages and disadvantages.
