- Botox and Facial Wrinkles
- Hyaluronic Acid Dermal Fillers: Restylane®, Perlane, Juvederm, Belotero
Botox or Botulinum toxin A is a substance produced by Clostridium bacteria that is known to inhibit muscle contraction. By using Botox to “weaken” specific muscles in the face that are creating deep wrinkles or furrows, the depth of the wrinkles can be lessened. The ideal wrinkles to treat are the horizontal forehead lines, the vertical lines between the brows, and the “crow’s feet” around the corners of the eyes.
The activity of Botox in reducing wrinkles lines is temporary, as over time, the muscle activity gradually returns. Fortunately despite the return of muscle function, the lines tend to not return as deeply once relaxed.
The treatments are repeated at 3-6 month intervals. Each patient is different in his or her response to Botox with some patients experiencing return of muscle function within 3-4 months and some having a much longer duration of results. Much of this variability lies in the concentration and amount of Botox injected, and the injection technique. It is important to target the specific muscle creating the wrinkle and thus, your physician should have thorough knowledge of facial anatomy. With repeated treatments, the interval between treatments increases. Patients who have had regular interval treatment with Botox may only need re-treatment every 6-8 months.
Botox is injected with a tiny needle, similar to that used in allergy injections. The skin can be cooled with ice or an anesthetic cream can be applied prior to injection, although most individuals do not require these maneuvers and only feel an initial “pinch” of the skin.
Dysport is Botulinum Toxin A produced by a different manufacturer. The effects are similar to those of Botox. The onset of action is slightly sooner with Dysport than with Botox and, in some individuals, the effects of Dysport last longer.
Dr. Der Sarkissian is well skilled in the use of both products with regard to placement of the injections and ideal doses and dilutions. He can discuss the benefits of each product and help in the decision regarding which product is best suited for each individual patient.
Radiesse is a filler material made up primarily of Calcium. As such, it is not recognized as “foreign” to the body and is well tolerated when injected into facial folds or when used to add volume to the cheek or jowl areas. The “spheres” of material are small enough to be able to be injected, yet large enough so that they are not eliminated over time; the patient’s own collagen will form a capsule around each sphere, maintaining the filling effect.
Radiesse is currently FDA approved for injection and has a very safe biocompatibility profile.
Unlike collagen or similar injectable materials which last on average 2-3 months, Radiesse has been shown to persist for at least 2 years and as long as 3 years in studies out of Canada and Europe where it has been used since the late 1990’s.
The technical material composition is Hydroxyapatite in a methylcellulose gel. Since it is a naturally occurring material in human bones, no allergy testing is required.
Radiesse can be injected as an office procedure using an anesthetic cream applied to the skin, using small amounts of local anesthesia prior to the injections, or mixed in with the material.
Hyaluronic acid is a naturally occurring substance that exists as a matrix between human cells.The material is synthesized in such a manner that makes it less likely to be degraded and more likely to persist. Unlike other filler products that are derived from animal sources, hyaluronic acid fillers are not animal derived.
Restylane has been used extensively in Europe and Canada since 1996 and received FDA approval for use in the U.S. in 2003. Perlane was introduced shortly thereafter and is somewhat denser than Restylane. Juvederm is a hyaluronic acid product from a different manufacturer that is very similar to Restylane and Perlane.Belotero is the newest hyaluronic acid filler that is well suited for even finer facial lines.
Restylane is ideally suited for finer lines. Perlane is best suited for providing denser support, for example, as in creating “lift” to the corners of the lip. Juvederm is similar to Restylane and Perlane and is of a slightly “softer” consistency which is desirable in certain parts of the face.
Hyaluronic acid dermal fillers can be used to fill lines and wrinkles on the face and to enhance the appearance and fullness of the lips. As the material is soft and pliable, the result is extremely natural.
An aesthetic cream is applied to the skin or a small amount of local anesthetic can be mixed with the hyaluronic acid to lessen the discomfort associated with the injection. Most patients will experience mild swelling and temporary redness at the injection site. These effects typically resolve within 1-3 days.
Most of the correction achieved with hyaluronic acid fillers will persist for at least 5-6 months with some persistent correction for as long as 8-10 months.
It is imperative to properly analyze the facial lines, folds and grooves that will be treated with fillers. Dr. Der Sarkissian will perform this analysis prior to recommending any treatment protocol. In so doing, he will not “over inflate” the face or create an “unnatural” fullness. In certain situations, he may even advise against fillers if disharmony of any facial features would be created by the addition of volume.
Sculptra™ (injectable poly-L-lactic acid) is a synthetic, biodegradable, biocompatible lactic acid polymer. Lactic acid is a naturally occurring material in human cells and as such, the body will not reject the material and no allergy testing is required. Once injected, the material stimulates production of the patient’s own collagen, thus creating volume and tightening of the overlying skin.
Used in Europe since 1999, Sculptra can help fill hollows and folds in the face by gradually increasing the thickness of the skin. It is the injectable material of choice for replacing lost facial fat as for example, in patients with lipodystrophy. Sculptra is particularly well suited for creating volume and “lift” in the cheek area.
Small amounts of the material are injected into a fold or depressio n, or into the cheek mound. Gradual thickening of the skin and underlying soft tissue is noted over the ensuing 3 to 6 weeks. At this point additional material can be injected if further correction is desired. Generally, 2 to 3 treatment sessions are recommended for full correction.
The thickening and filling effects have been shown to persist for up to 2 years after the initial injections. Because of the smooth consistency of poly-L-lactic acid and its safe biocompatibility profile, the results are soft and natural with little tendency to create clumping or nodules beneath the skin surface.