You stand in front of the mirror in your bathroom every morning and wonder, “Why don’t I look on the outside as young as I feel on the inside?”
There are many factors that affect the way we age. Genetics, nutrition, normal ageing, and sun exposure are the major causes of the changes in the mirror. Over time, these factors cause a loss of volume as the underlying collagen, hyaluronic acid, and elastin fibers begin to deteriorate and fat stores in the face decrease. This most commonly occurs around the eyes, mouth, cheeks, jaw line, brow, and bridge of the nose, producing crow's feet, laugh lines, folds and furrows on the forehead, and "hills and valleys" on the lower third of the face. Soft tissue facial fillers have the unique ability to fill and contour these changes.
Fillers can be placed into the lips to create a fuller, more youthful look, or in the hollows of the cheeks to reduce a gaunt appearance. Facial scarring from acne or injury also responds well to soft tissue filler techniques. A variety of facial fillers have been developed that address a wide range of cosmetic aging changes. Sometimes more than one filler may be used to achieve the best results. Facial fillers can gradually bring the face into better balance, creating an overall rejuvenated appearance.
Collagen
Collagen products give structure to the skin and are used to add volume to lips and to plump up lines and furrows in the face. Collagen products currently on the market are made from human or porcine (pig) collagen. These collagens typically work very well are well tolerated with few side effects. They tend to last from 3 to 6 months before retreatment is required. Most collagen products used today do not required a pretreatment skin test.
Hyaluronic Acid
Hyaluronic acid is a natural component of human skin and is the framework in which skin cells live. There are several hyaluronic acid products available today. All hyaluronic acid products bind water and give the skin volume. These fillers can be used to fill hollow areas of the face, plump lips, and fill lines and furrows. Hyaluronic acids typically last from 3 – 12 months depending on the type used.
Autologous Fat
Fat from you own body, typically from the lower abdomen, can be harvested by liposuction and reinjected into your face to reduce deeper wrinkles and replace volume in the aging face. Some percentage of the fat will thrive and some will die and be resorbed by the body. Because of the unknown, it must be done slowly and with multiple injections.
Poly-L-lactic Acid
This filler is used to replace lost facial fat, giving the face a more youthful appearance. It was first developed and FDA approved to improve facial wasting in AIDS patients. It is now widely used for facial contouring for cosmetic purposes and lasts 2 or more years in most patients. This treatment required vigorous massage of the treated areas to avoid developing small bumps under the skin.
Calcium Hydroxyapatite
This product is suspended in an aqueous gel and then injected in areas of the face needing more volume. It is a semipermanent filler. There have been incidences of bumps called granulomas associated with this filler causing it to lose favor over other fillers.
Implants
Polymers and collagen-related implants offer a longer-lasting option for diminishing deep facial grooves and folds, particularly around the mouth, nose, and lips. The material is inserted under the skin as strips, threads, or hollow tubes that serve as a permanent filler. These substances also can form the foundation into which other injectable fillers may be added. These implants can sometimes feel firm in the tissue that is unpleasant to some patients.
Silicone Oil
Silicone oil as a facial filler is an off-label use of the product. However, it is becoming widely popular as a more permanent filler that feels natural in the tissue and gives a very natural result. Technique of injection is very important in getting good results. It must be injected by the micro-droplet technique to avoid bumps that can be troublesome. Your body does not resorb silicone oil, therefore it should be done in small amounts over multiple sessions. Silicone oil stimulates your body to build its own collagen in the area of injection to plump and smooth the area.
What is coming?
New and improved fillers are constantly being researched, tested, and evaluated. Other types of hyaluronic acid products which may last longer may be offered. Hybrid fillers, which contain small spheres and collagen, are another form of partially permanent filler.
The procedure, costs, and need for retreatment varies depending on the filler chosen. We welcome your calls to discuss what fillers we currently have available. (916) 564-8888
JUVE'DERM™ ULTRA AND ULTRA PLUS
Juve'derm™ Ultra and Ultra Plus are probably the best hyaluronic acid based products available on the market today in this office’s opinion. It tends to be smoother to inject, more comfortable for the patient, and have less post treatment redness and swelling. According to company testing, it also lasts longer that other hyaluronic acid fillers.
Juve'derm™ is injected with a very small needle into the dermal layer of the skin. Topical anesthetics, nerve blocks, and other local anesthetics may be used to make the injections nearly painless. A patient should be able to undergo treatment and return to work using makeup to mask any redness. Local anesthetics may keep the areas of treatment numb for a few hours making it difficult to talk similar to going to the dentist.
Juve'derm™ is manufactured from buffered hyaluronic acid derived from Streptococcus equi bacteria mixed with other ingredients to make it safe and of a consistency for injection. It is used to temporarily improve moderate to deep facial lines. It is available in two consistencies, Juve'derm™ Ultra for finer lines and Ultra Plus for deeper lines.
You may experience sensitivity, discomfort, swelling, or redness at an injection site immediately following injection that may last for 1 to 7 days or longer. It has been reported in comparative studies that Juve'derm™ causes milder symptoms than some other types of hyaluronic acid skin fillers.
This treatment is not permanent. More than one injection session may be required to achieve the desired result. Touchup treatments are usually required at 6 to 12 month intervals to maintain results. Each treatment is at an additional cost.
Juve'derm™ is not recommended in those patients with a history of autoimmune diseases, serious allergic reactions (including anaphylaxis), or allergy to gram positive bacterial proteins. Use in patients with a history of keloid scar formation, hypertrophic scarring, and pigmentation disorders has not been studied and untoward effects, if any, are unknown.
Patients who undergo laser resurfacing, chemical peeling, or other treatments that may affect the dermis of the skin may experience an inflammatory response in the areas of treatment with hyaluronic acids. Also, you should not undergo treatment with an injectable hyaluronic acid after such treatments until you are completely healed.
If you are pregnant or trying to become pregnant, or if you are breast feeding, you are not a candidate for hyaluronic acid fillers. Patients receiving immunosuppressive therapy for any reason are also not good candidates.
Anyone with a skin inflammation, pimple, cyst, rash, hives, or any infection should not have Juve'derm™ until those conditions have completely healed.
Any injection carries a risk of infection or reaction to the injection process such as mild bruising, slight blush, itching, or firmness at the injection site. If I have a history of facial herpes simplex (cold sores), the injection could produce an eruption.
Although unlikely, if the needle used for injection should accidentally pierce a blood vessel, a scab, scar, or temporary discoloration could develop. If material is accidentally injected into a blood vessel, a blockage of blood flow to the area could result and surrounding tissue may die. This could leave a permanent scar. Injected Juve’derm™ may infrequently present as a raised area or bump which may persist as long as several months.
Any persistent reactions to the treatment should be reported to the doctor or physician assistant. Allergic reaction can cause prolonged redness, swelling, itching, and/or hardness at, or near, the injection site lasting from a few months to over a year.
In rare cases, scabs and skin sloughing at the site have resulted in a shallow scar. Also rarely, abscesses form at the site. This may be associated with antibodies and can recur. These may develop weeks or months after injection and can result in hardening and/or scars.
Other systemic complaints have rarely been reported following injection of Juve'derm™. These may or may not be related to the injection and include sinusitis, upper respiratory infection, acne, depression, bronchitis, headaches, and other complaints.
Adverse reactions may occur in patients with systemic connective-tissue disease such as rheumatoid arthritis, juvenile rheumatoid arthritis, systemic lupus erythematosis, scleroderma, and inflammatory disorders such as polymyositis and dermatomyositis (PM/DM).
Because Juve'derm™ is relatively new and still undergoing testing, there is a possibility that other complications unknown at this time may develop in the future.
Juve'derm™ is currently approved by the FDA (Federal Drug Administration) for use in moderate to deep lines or folds on the face such as those between the lateral nose and mouth (nasolabial folds). Use in other areas, including lips, is considered an “off label” use.
The use of aspirin, many anti-inflammatories, St. John’s Wort, and high doses of vitamin C and/or E within one week of injection can increase bruising at the injection site.
Applying a cold compress after injection may reduce swelling and bruising. You must avoid rubbing or pressing the area for at least 6 hours after injection. You must avoid exposure of treated areas to extreme heat, i.e., tanning beds, heat lamps, and sun.
We have attempted to give you all the available information regarding Juve'derm™. It is important to realize that this product has been used in thousands of patients with very good results and high patient satisfaction.
Please call the office with any questions you may have about this product. We will be happy to set up a consultation for you regarding this and other fillers. (916) 564-8888
SCULPTRA®
Sculptra® is a facial contouring filler made of poly-L-lactic acid in suspension. Sculptra® therapy is designed to help correct skin and contour depressions, such as creases, wrinkles, folds, scars, hollow eye rings, degenerative skin aging, and facial lipoatrophy (loss of fat).
Sculptra® is approved by the Food and Drug Administration (FDA) for the treatment of lipoatrophy (loss of fat) in people with HIV (AIDS). It has not specifically been tested or approved at this time for general cosmetic use. It has safely been used for cosmetic purposes in European countries since 1999. Using Sculptra® for cosmetic reasons is not illegal and is considered an “off label” indication. Approval for cosmetic use is currently pending with the FDA.
Sculptra® is not a skin filler like collagen and hyaluronic acid. Sculptra® is a collagen stimulator. Its presence in tissue stimulates your body to make its own collagen over time. Therefore, it takes 3 to 6 weeks to see the correction after each treatment, and it will take multiple treatments (2 to 4 or more) to achieve the desired result. The exact number of treatments can not be estimated because it depends on the patient’s specific collagen response to the injections. Multiple treatment sessions become costly as you will be charged for each one.
There will be initial swelling after the injections that will give an appearance of fullness in the area that may or may not be pleasing to me. However, it will resolve after several hours to a few days as the water in the product is absorbed from the tissue. Bruising and swelling can be significant and can last 2 weeks or more. Your face may look like nothing was done after this resolution of swelling. It will take 3 to 6 weeks for any correction from the injections to be apparent.
Usual immediate side effects from the injections will include one or more of the following: swelling, redness, bruising, pain, itching, tenderness, and/or discoloration which will typically resolve in 1 to 15 days, but it may take much longer.
Infrequent risks include infection, over-correction, small bumps (micro-nodules) under the skin that may or may not be visible and may or may not resolve over time without treatment. Rarely, larger bumps under the skin (granulomas) may be visible and may require treatment. Any cost related to this treatment is not included in Sculptra® therapy fees. Ther are other rarely reported adverse events associated with Sculptra®.
Allergic reactions, while rare, may cause prolonged redness, itching, swelling, or hardening of the skin around the injection site. These reactions can last 3 to 4 months, and rarely, more than a year. It is important to advise Dr. McMenamin of all known allergies and sensativities. Sculptra® is not allowed in women who are or think they may be pregnant or are breast feeding.
Sculptra® is not permanent. Studies have shown it will last from 1 to 2 years on the average and may last longer. Infrequently, it could last less than 1 year. "e;Touch-up"e; treatments may be required in the interim, each at an additional charge to you.
Aspirin, anti-inflammatory medications, many vitamins and herbal supplements, alcohol use, and smoking can increase the risk of bleeding, bruising, infection, and other side effects. You should abstain from these products for at least one week before treatment.
After the Sculptra® treatments you will be required to firmly massage the area(s) of treatment for 5 minutes, 5 times a day, for 5 days. Massaging is vital to preventing “bumps” and to promote evenness in the areas of treatment. Massaging may also alleviate feelings of fullness or thickness that is not uncommon in the areas of injection.
We would be happy to answer your questions regarding the use of this product and how it may benefit you. Please call the office to make a consultation. (916) 564-8888
