Plastic Surgery
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Patient’s interest in defying facial aging continues to grow. Emphasis on beauty and youth continue to drive patients to seek cosmetic procedures. The area of largest growth has been in the arena of less invasive office based procedures with no down time. They present minimal risk and are highly effective, and can effectively mitigate the undesirable effects of facial aging. Botox has been in the forefront for years as a substance that when used properly can reduce the signs of facial aging especially in the forehead, around the eyes, and around the lips. The most commonly used facial fillers are hyaluronic acid based such as Juvederm, Restylane, and Perlane. Their individual properties differ somewhat as do their duration of action.
What has changed in the past year or two is a multidimensional approach to treating the aging face with a combination of mobility restriction, volumizing and contouring which can lead to very satisfactory mitigation of aging in the face.
When I evaluate a patient I consider the three dimensional changes that have taken place in the aging process and what combination of treatments will make the greatest difference. Sometimes it’s botox or filler alone, but most of the time the combination will give much more satisfying results.
It also goes without saying that the three dimensional sensitivity of the injector will make a big difference in achieving a natural outcome. It is also important to point out to patients where the conservative measures will fall short and surgical procedures such as eyelid surgery, facelit, fat injection or liposuction will be better suited to accomplishing desired goals.
In all aspects of facial rejuvenation an artistic sensitivity will lead to a more natural satisfying result.
posted by
Dr. Elliott - Plastic Surgery
Blog
filed under:
Botox, Facial Fillers
Recently in my practice I have seen an increase in demand for facial fillers. In our current economic climate patients are postponing surgical procedures because they can’t take time off from work and economic uncertainty has frayed consumer confidence to proceed with luxury expenses.
In spite of current conditions patients still want to do ‘something’ to look better, temporize and feel better about themselves. Fillers have a wonderful role to help achieve these goals.
With aging or just genetic bad luck, smoking or excessive sun exposure there are specific areas in the face that predictably deteriorate. The most common areas I inject are the naso-labial folds the lip lines, the lips, the marionette lines extending down from the corner of the mouth, and the deep lines that can develop between the eyebrows or forehead and the hollows under the eyes.
There are a wide range of products used by physicians to fill these areas. The two broad categories are temporary and permanent. ArteFill and silicone are permanent fillers. Silicone is not FDA approved but is used in an off-label manner. Suffice to say that these fillers can be problematic, with formation of permanent lumps, migration of lumps or granuloma formation. For those reasons I avoid their use in my practice. The semi – permanent fillers, Radiesse and Sculptra have similar issues therefore I prefer to avid them.
In the category of temporary fillers there is collagen and hyaliuronic Acid.. Collagen doesn’t last long enough to make it cost effective. This leaves us with the hyaluronic acid fillers of which there are many; Restylane, Perlane, Juvederm, Hyalaform, Elevess, Puragen, and Prevelle. I have found that for my patients, Juvederm and Restylane have worked the best and have a high level of patient satisfaction. In some areas it is combined with Botox Injection to assist in minimizing lines and creating a more rested, youthful appearance.
Like everything else in plastic surgery, injection of fillers have to be performed with skill and artistic tastefulness. Many offices relegate injection to assistants or nurses. I do it myself, and approach every patient for filler injection individually. We have all seen the “sausage” or “ducks” lips that denote a poor understanding of facial esthetics.
Fillers when performed well can offer great satisfaction both as a stand alone office procedure or as an adjunct to facial surgical procedures. It must be performed skillfully and safely, choosing fillers that are both effective and have minimal potential complications.
posted by
Dr. Elliott - Plastic Surgery
Blog
filed under:
Facial Fillers, Juvederm, Restylane
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