Understanding Various Treatments of Facial Wrinkles
The gradual development of facial wrinkles, whether fine surface lines or deeper creases and folds, is the classic early sign of accumulated skin damage and inevitable aging. Premature aging and wrinkling of the skin may be accelerated by excessive exposure to the sun and other elements, overactive facial expression muscles, the frequent use of tobacco products, poor nutrition, or skin disorders
“I was a bit frightened to undergo surgery and wanted a less invasive procedure. I chose an injectable filler as a great way to ease myself into facial enhancement.” – h e a t h e r b . , a g e 3 7
Understanding Types of Treatments for Facial Wrinkles
Prominent forehead creases, brow furrows or eye lines (crow’s feet) produced by specific facial expression muscles repeatedly creasing the skin may be effectively treated by reducing the function of specific facial muscles. The Neurotoxins ( Botox™, Dysport™ and Xeomin™) are sterile, purified proteins produced from the bacteria, Clostridium botulinum, in the laboratory. Neurotoxins injected in small amounts into facial muscles bind to the nerve endings supplying the muscle and prevent nerve impulses from traveling to the muscle. When injected into a muscle, it weakens or paralyzes the muscle around the area injected for a typical period of several months. The resultant weakening or paralyzing effect on the facial muscle temporarily reduces or eliminates previous skin creasing and new skin creasing is avoided. Botox may take several days to have its effect, and the effect typically lasts 3-6 months, in most individuals, before full muscle movement returns. At that point the treatment may be repeated as desired.
Injectable Fillers are substances that are used by your physician to replace lost volume in certain areas of your face. When used appropriately they can result in substantial and fairly long lasting improvement. They are not replacements or alternatives to Neurotoxins in that they treat a different set of problems: deeper creases and folds that are not due to muscle activity. FDA approved fillers are a constantly changing landscape, but some of the common fillers in use today are:
Hyaluronic Acids (Juvederm™, Restylane™ and others). These products are composed of a gel like substance that is found in our bodies in between the cells. This substance is lost as we age so one can consider this as replacement therapy in a way. These fillers are soft to the touch and are used in the lips and other areas where a softer product is needed. They do not typically last as long as some of the other fillers.
Hydroxyapatitie microspheres (Radiesse™). This product is another naturally occurring compound in our body and is more of a paste like consistency. It is used in areas where a thicker, firmer filler is needed, such as the deep folds along the sides of the mouth. Most studies have found it to last somewhat longer than the hyaluronic acid products.
Poly-L-Lactic Acid (Sculptra™) This product is a synthetic polymer that has long been used in dissolvable suture material. It works in a different manner than the other fillers: it stimulates your body to generate new collagen. This product has been extensively studied and appears to last up to 4 years in some areas. It is really intended for deeper injection sites such as the cheek or temple areas and should not be used in the eyelid or lips. It requires multiple injection sessions to reach the goal of correction, where most of the other fillers can be used to obtain correction in 1 or 2 sessions.
Polymethylmethacrylate microspheres / collagen (Artefill™). This product was approved in 2006 by the FDA for the correction of wrinkles. It requires a skin test for collagen allergy. It may be able to achieve permanent correction and is intended for injection into deeper areas. It typically requires multiple injections to achieve long lasting or permanent correction.
Fat grafting creates a natural augmentation for the face using your own “filler”, it is especially useful for the lips and mouth region. Fat is usually harvested from the abdomen and about one third of the volume remains after the treatment. Fat grafting can be repeated for additional fullness.
What to Expect After Each Treatment
In comparison to typical cosmetic surgical procedures, the office time for these procedures and the subsequent recovery period until one returns to normal function are minimal. Botulinum toxin therapy typically takes a few minutes to perform, and most patients may return immediately to home or work. Minor local irritation, redness, bruising, or swelling at the injection sites are the most commonly observed side effects, all of which typically abate within a few hours. Likewise, filler injection therapy can be accomplished with a 5-15 minute procedure with similar attendant side effects. Some mild irritation, swelling or bruising at the injection sites is common but can easily be camouflaged with standard make-up, if necessary.
Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve facial scars or contour deformities resulting from injury may be covered. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.
Some fillers are better for fine lines; some are better for deeper creases and increasing facial volume. Either one may require more than one treatment session for maximum positive results.