There are three main signs of aging in the face: the development of lines and wrinkles, sagging and relaxation of the tissues of the face, and changes in the quality of the skin (increased pore size, increased thickness, pigmentary changes, flaking, etc.).
We can pull on the skin as in a rhytidectomy; we can correct the muscles causing the wrinkle if it is a dynamic wrinkle, or we can fill up the groove, thereby making the wrinkle disappear.
If the forces causing the wrinkles are due to underlying muscle contraction, then paralysis or weakening of that muscle results in fading or lessening of the wrinkle. This can be accomplished by Botox injections.
Botox is produced from the fermentation of a strain of bacteria. It works by blocking the release of acethylcholine from the end of the nerve which is the chemical released from the nerve to produce muscle contraction. Botox is very successful in the glabellar area (frown lines between the eyebrows) in crow’s feet area; sometimes in the forehead. Botox is occasionally used for neck bands and for the corners of the mouth.
If the wrinkle is not entirely due to muscle contraction, or if complete paralysis of the underlying muscle(s) is contraindicated, a variety of substances can be used to fill the wrinkle. The materials used for filling wrinkles can include human collagen (injection or sheets) or synthetic substances. Some are manufactured substances similar to tissues normally present in the body (Restylane, Radiesse) some are substances that are completely foreign to the human body (Silicone, Acrylic beads).
As the skin loses volume and wrinkles start to appear due to the loss of the ability to produce enough of a naturally occurring substance called hyaluronic acid (HA) we can replace that substance with Restylane which is made of molecules of the same chemical attached together (polymerized)
The treatments are quick and easy and they are cost effective. Allergy testing is not required and the side-effects are minimal. Restylane is a clear non-animal biodegradable hyaluronic acid gel (HA) with an excellent safety profile. The gel is injected into the skin with a very fine needle to minimize discomfort. The effect of Restylane generally lasts about six months, but this varies depending on the area injected. It will last longest in an area which has very little motion and little circulation.
Another option for tissue replacement is Radiesse, made of calcium hydroxyapatite, a molecule found in bone and coral, the particles are small enough to be injected. I reserve the use of Radiesse to defects over bony areas and the naso-labial folds.
Although one may want filler that will be permanent in nature, the disadvantage of such filler is that, if any irregularity were to occur, it would be very difficult to correct. Any long- lasting filler will induce scar tissue formation and the amount of scar tissue and the quality of the scar tissue will vary according to the patient and, therefore, is not a controllable variable. The other advantage of using non permanent filler is that, since the aging will vary over time and over the areas of the face, adjustments are possible with subsequent treatments as the changes of aging are occurring.
If the changes are mainly in the form of pigmentary changes and in the quality of the skin I recommend the Nu-Derm program. It will replenish the collagen, correct the pigmentation and get rid of the pre-malignant cells. Nu-Derm is a series of products applied by the patient morning and evening and adjustments with regards to individual needs are made. It is useful in the treatment as well as maintenance for healthy skin.
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