Wrinkle Reduction by Injection

 

 

 

 

 

 

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Years of squinting and other facial muscle movements can take their toll on the eye area, leaving crow's feet and other noticeable lines

 

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After treatment, the skin around the eye area appears smoother and more taut.

 

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Lines and creases that form around the mouth are usually caused by gravity and a breakdown of tissues beneath the skin.

 

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The lower face appears firmer and smoother after treatment with injectables. Lines around the mouth are filled in and nearly imperceptible.

 

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With regular follow-up treatments, your refreshed look can be easily maintained.

If You're Considering Injectables...

As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling, chewing and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow's feet or facial creases over the areas where this muscle movement occurs.

Soft-tissue fillers, most commonly injectable collagen or fat, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be used alone or in conjunction with a resurfacing procedure, such as a laser treatment, or a recontouring procedure, such as a facelift.

If you're considering a facial-rejuvenation treatment with collagen or fat, this brochure will give you a basic understanding of the procedure - when injectables can help, how the procedure is performed, and what results you can expect. It may not answer all of your questions, since a lot depends on your individual circumstances. Please ask your doctor if there is anything about the procedure you don't understand.

Afraid Of Needles?

If you are afraid of needles, let me tell you a little secret.  I'm afraid of needles too!  So I go to great lengths to minimize the anxiety and pain of injections.  I use a special device that temporarily numbs the skin while I'm giving injections.  Some patients tell me they didn't even know I gave the injection already.  Come and see for yourself.

Knowing Your Options

Injected collagen and fat are primarily used to improve the appearance of the skin's texture. They can help fill out deep facial wrinkles, creases and furrows, "sunken" cheeks, skin depressions and some types of scars. They can also be used to add a fuller, more sensuous look to the lips.

Injectables are usually not sufficient for severe surface wrinkles on the face. Instead, your plastic surgeon may suggest a resurfacing technique, such as chemical peel, INFINI, or laser treatments. Rather than filling in facial lines, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance.

Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery, such as a facelift or browlift. Injectables are sometimes used in conjunction with facial surgery procedures; however, injectables alone cannot change facial contour the way surgery can.

Keep in mind that a plastic surgeon is a specialist that can offer you the full gamut of the most advanced treatments ranging from cosmetic surgery, refinishing techniques, laser therapy, injectables and the use of other fillers. You and your surgeon may determine that a single procedure or a combination of procedures is the best choice for you.

ASPS brochures are available on chemical peel, dermabrasion, laser treatments, facelift and browlift. If you and your doctor think that one of these other procedures might be more appropriate for you, ask your plastic surgeon to provide you with a copy.

A Word About Other Types of Fillers

This page deals with the two most commonly used types of injectable fillers, collagen and fat. However, to a lesser extent, a number of other filler materials are also being used for facial-rejuvenation purposes. They include: Fibril, a gelatin powder compound that's mixed with a patient's own blood and is injected to plump up the skin (similar to injectable collagen); and Gortex, a thread-like material that is implanted beneath the skin to add soft-tissue support.

Each of these options has its own set of risks and benefits. If you're considering any of these alternative filler treatments, tell your doctor.

What to Expect from Treatment

The most important fact to remember about injectable fillers is that the results are not permanent. Injected material is eventually metabolized by the body. You should not expect the same long-lasting results that may be gained from cosmetic surgery.

In some individuals, the results may last only a few weeks; in others, the results may be maintained indefinitely. Researchers believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all play a role in the injected material's "staying power." However, the precise reason for the variation of results among patients has yet to be identified.

If you've had short-lived results from fat injections, you shouldn't necessarily assume that collagen injections will work better for you. And, conversely, if you've had disappointing results from collagen, don't assume that injected fat is the answer. Although it's true that some individuals' bodies are more receptive to one substance than the other, others may find that neither substance produces long-lasting results. Sometimes one substance may work better than the other for a specific problem.

Risks Related to Injectables

When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature. Still, individuals vary greatly in their anatomy, their physical reactions and their healing abilities. The outcome of treatment with injectables is never completely predictable.

Collagen: Allergic reaction is the primary risk of collagen. To help determine if you are allergic to the substance, your surgeon will perform an allergy skin test about a month before the procedure. After the test is performed, the test site should be watched carefully for three or four weeks, or as long as your surgeon advises. Any sign of redness, itching, swelling or other occurrences at the test site should be reported to your surgeon.

Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare.

Fat: Allergic reaction is not a factor for fat because it's harvested from a patient's own body. However, there is still a small risk of infection and other infrequent complications.

Planning for Treatment

Facial rejuvenation is very individualized. That's why it's important to discuss your hopes and expectations with a board-certified plastic surgeon who has experience with many different types of surgical and non-surgical facial procedures.

In your initial consultation, your plastic surgeon will evaluate your face - the skin, the muscles and the underlying bone - and discuss your goals for the surgery. Your doctor will help you select a treatment option based on your goals and concerns, your anatomy and your lifestyle.

Your surgeon will ask you about your medical history, drug allergies, and check for conditions that could cause problems, such as active skin infections or non-healed sores from injuries. Collagen injections are generally off limits for pregnant women, individuals who are allergic to beef or bovine products, patients who suffer from autoimmune diseases, and those who are allergic to lidocaine (the anesthetic agent contained in the syringe with the collagen material). For more specific information about the contraindications and risks of collagen use, ask your doctor for the manufacturer's brochure for patients.

Insurance usually doesn't cover cosmetic procedures. However, if your injectable treatment is being performed to treat a scar or indentation from an accident or injury, you may be reimbursed for a portion of the cost. Check with your insurance carrier to be sure.

Where Your Treatment Will Be Performed

Injectables are usually administered in a surgeon's office-based facility. If, however, you are being hospitalized for a facelift, necklift, browlift, or any other procedure, your injections may be administered in the hospital as well.

Types of Anesthesia

Collagen: Because the anesthetic agent lidocaine is mixed in with collagen, additional anesthetic is usually not used. However, if you are especially sensitive to pain, your doctor may use a topical cream anesthetic or a freon spray to numb the injected area. Or, you may elect to have an injected local anesthetic or sedative drugs.

Fat: Both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you elect to use sedation, be sure to arrange for a ride home after your treatment.

The Treatments

Dermal fillers fall into three common categories: hyaluronic acid fillers (Juvederm, Restylane, Silk, Belotero) collagen (Cosmoderm), or synthetic materials (Radiesse, Bellafill, Sculptra). Short duration fillers last approximately 3 months while the longest lasting temporary fillers can last 5 years or more. Each type of filler has advantages and disadvantages. Which filler to use and where is best determined after consultation with your physician.

Filler Options

Juvederm Ultra

Juvedérm® is an injectable facial filler used by dermatologists and plastic surgeons for the purpose of softening deep folds and reducing wrinkles. It is mainly composed of hyaluronic acid (HA), which is a substance normally found in the skin, muscles, and tendons of mammals. Hyaluronic acid binds and absorbs water, and the lack of this substance leads to dry and wrinkled skin. As people age, the skin produces less HA which results in drier, thinner looking skin filled with wrinkles. Juvéderm® rejuvenates the skin by restoring volume and hydration, giving you a fuller and healthier complexion.

Juvedérm® is different from other fillers in that it is the only HA filler approved by the FDA to last up to a year.   Juvéderm® is also manufactured using the unique Hylacross TM process which creates a very smooth consistency. Other HA fillers, on the other hand, have a granular consistency to them.

Juvéderm® treatments typically last about nine months, but results may vary for each patient. Treatments can be repeated once the effects of Juvéderm® wear off, and touch-up treatments every six months will keep the treated area looking naturally rejuvenated.

Juvéderm® requires very little downtime. Like most fillers, it is typically recommended that you avoid strenuous activity and excessive sun exposure for the 24 hours following the procedure. It is also recommended that you do not consume any alcoholic beverages for the next 24 hours.

 

Juvederm Ultra Plus

Juvéderm Ultra Plus® is a thicker gel and is often used to add volume to larger areas and deeper lines in your face.

 

Juvederm VOBELLA XC

Juvéderm VOLBELLA XC is an injectable hyaluronic acid filler that offers correction of lip lines and addition of lip volume. The lip enhancement is natural appearing and lasts through one year in most patients.  VOLBELLA uses patented VYCROSS technology from Allergan that yields smooth yet long lasting results.

 

Juvederm VOLUMA

Juvéderm Voluma® is the latest of the Juvéderm® range of hyaluronic acid fillers FDA approved and specifically designed to restore volume in areas of volume loss for up to two years. Common areas include the cheeks, cheekbones, and chin. Additionally, due to its versatility it is also suitable for adding definition to the jaw line.

 

Restylane and Perlane

Restylane, like Juvederm is composed of hyaluronic acid gels that add volume and fullness to the treated area. Restylane® is a natural, synthesized and fully degradable substance and requires no allergy testing prior to treatment.  Perlane® differs from Restylane® in that the gel particles are larger than those in Restylane® and are therefore often more effective in treating deeper wrinkles and folds. As such, Perlane® can be injected as a base filler with Restylane® and Juvederm® added to enhance the overall natural appearance.

 

Restylane Silk

Restylane Silk has recently been approved for release in the United States! It's the first and only FDA-approved product specifically designed for subtle lip enhancement and the smoothing of wrinkles and lines around the mouth in patients over 21 years of age. Just like the other members of the Restylane family, Restylane Silk is a clear gel formulation of hyaluronic acid — a sugar that is naturally present in your skin. Like other areas of the face, the lips and skin surrounding the mouth show signs of aging as an individual gets older. This often results in lip thinning, lost shape and an increase in vertical lines above the lip.

Restylane Silk is designed specifically to provide natural-looking results in these areas. That's why it's made of smaller, smoother particles than those used in otherRestylane products. Restylane® Silk's unique particle gel formula, along with an ultrafine needle designed for improved accuracy, helps give you softer, more precise results — just what you need for a natural-looking smile.  59% of patients treated with Restylane Silk maintained lip fullness six months after treatment  

 

Radiesse

Radiesse®, a natural byproduct of human bones, is a mineral- like compound (calcium hydroxylapatite) made of calcium-based microspheres, that provide immediate volume and lift to the treated area of the face. This filler not only reduces wrinkles caused by loss of collagen, it stimulates the body’s collagen production for long-lasting results. Producing immediately visible results, Radiesse® injections are highly effective for, lifting nasolabial folds around nose and mouth, cheek augmentation, chin augmentation and hand rejuvenation. Radiesse treatments last about 12-13 months.

 

Bellafill

Bellafill® is approved for the correction of facial wrinkles known as nasolabial folds, or smile lines, and the correction of moderate to severe, atrophic, distensible facial acne scars on the cheek in patients over the age of 21 years. It is also the only dermal filler established safe and effective for the correction of nasolabial folds through 5 years.

Bellafill® is a polymethylmethacrylate (PMMA) collagen filler. You can expect to see visible correction with the very first treatment. The collagen in Bellafill® provides immediate volume and lift while the PMMA microspheres remain in place and create a matrix that supports collagen production in your skin for lasting improvement.

Bellafill® has been approved by the FDA for the correction of facial wrinkles known as nasolabial folds or smile lines since 2006. Bellafill® requires a skin test to identify patients who may be allergic to the lidocaine or collagen in Bellafill®

Dr. Cappuccino is a certified Trainer for Bellafill, meaning he instructs other physicians and nurses in the proper technique for Bellafill.

 

Belotero Balance

BELOTERO BALANCE® is a hyaluronic acid (HA) injectable filler that completely integrates into the skin tissue.2,3 While some fillers are designed to rebuild facial volume and structure,BELOTERO BALANCE specifically treats moderate-to-severe etched-in lines and wrinkles such as vertical lip lines above and around the lips.

 Only BELOTERO BALANCE is created using the proprietary Cohesive Polydensified Matrix (CPM) process.  This produces a smooth, flexible gel which blends into the natural structure of your skin and gently fills stubborn etched-in lines and wrinkles.  Belotero typically lasts approximately 4 months.

 

Fat

In the medical world, the fat-injection procedure is known as autologous fat transplantation or microlipoinjection. It involves extracting fat cells from the patient's abdomen, thighs, buttocks or elsewhere and reinjecting them beneath the facial skin. Fat is most often used to fill in "sunken" cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimize forehead wrinkles and to enhance the lips.

The procedure: After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat is withdrawn using a syringe with a large-bore needle or a cannula (the same instrument used in liposuction) attached to a suction device. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site.

As with collagen, "overfilling" is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this overcorrection of newly injected fat may temporarily make the face appear abnormally puffed out or swollen.

After treatment: If a larger area was treated, you may be advised to curtail your activity for a brief time. However, many patients are able to resume normal activity immediately. You can expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. You should stay out of the sun until the redness and bruising subsides - usually about 48 hours. In the meantime, you may use makeup with sunblock protection to help conceal your condition.

The swelling and puffiness in the recipient site may last several weeks, especially if a large area was filled.

Results: The duration of the fat injections varies significantly from patient to patient. Though some patients have reported results lasting a year or more, the majority of patients find that at least half of the injected fullness disappears within 3-6 months. Therefore, repeated injections may be necessary. Your doctor will advise you on how to maintain your results with repeat treatments.

Your New Look

If you're like most patients, you'll be very satisfied with the results of your injectable treatments. You may be surprised at the pleasing results that can be gained from this procedure.

Disclaimer: Before and after images shown are all actual patients of Dr. Cappuccino, however individual results may vary and specific outcomes are not guaranteed