Question:
I know that Juvederm is made of hyaluronic acid. What is its purpose in the natural world, and how does that relate to cosmetic treatments?

Answer:
Hyaluronic Acid is a carbohydrate, more specifically a sugar. Its function in the body is, amongst other things, to bind water and to lubricate movable parts of the body, such as joints and muscles. Its consistency and tissue-friendliness allows it to be beneficial in skin-care products as an excellent moisturizer. Because HA is one of the most hydrophilic (water-loving) molecules in nature with numerous benefits for the human body it can be described as "nature’s moisturizer".

Although Hyaluronic Acid (HA) can be found naturally in most every cell in the body, it is found in the greatest concentrations in the skin tissue.  Young, healthy-looking skin contains an abundance of a natural hyaluronic acid (HA). But as you age, sunlight and other factors can reduce the amount of HA in your skin. The lack of HA causes your skin to lose structure and volume. It creates unwanted facial wrinkles and folds, like those parentheses lines around your nose and mouth. More important than just filling folds or lines on the face, fillers can be used to restore volume. They create balance and harmony of the facial features as well as to bring out youthful contours.

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Question:
What is the difference between Botox and injectable fillers such as Restylane and Juvederm? What is the best option for minimizing lines in my forehead and neck?

Answer:
Botox is a muscle relaxant. In general it works best on the upper half of the face and typically last for 3-4 months. Botox is a great option for softening lines in the forehead. Injectable fillers such as Restylane and Juvederm work by “filling in” lines and wrinkles. It in general does better on the lower half of the face and typically last 9-12 months. The neck area is generally not ideal for either, although the vertical bands the run up the neck can be treated with Botox. Both Botox and injectable fillers can be done in the office with minimal downtime; both have greatly expanded are options for treating early facial aging in the office.

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Question:
Are chemical peels still used today? You don’t hear much about them anymore. What are they good for treating and are other things like injectables fillers better?

Answer:
Although chemical peels do not get the same press as newer cosmetic treatments such as lasers and Injectable fillers, they are a proven technique. Chemical peels provide different degrees of skin resurfacing depending on their depth. Superficial peels can be used to "freshen up" the skin with minimal downtime. Medium depth peels can provide more results, such as getting rid of brown spots and improving skin texture. With better skin improvement comes more down time, up to a week. Deeper peels have become much less commonly used, mostly because of unpredictabilaty, which is an issue for all peels. With the increased risks of deep chemical peels, most have felt other options, such as CO2 laer, provide a more consistent and thus safe option.

Chemical peels are still a very cost effective way for skin rejuvenation. Selecting the right option begins with a consultation with your facial plastic surgeon.

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Question:
I would like to get injectable fillers in my face. I would like to plump up both my lips and my nasolabial folds which have gotten quite pronounced. I would like hyaluronic acid because the reports that I read indicate it is longer lasting than collagen. Is hyaluronic acid appropriate for both areas?

Answer:
Hyaluronic acids are the number one filler right now as well as Dr. Hamilton’s favorite for many reasons. One is that the are so versatile- they are great for both enhancement of the lips as well as softening the nasolabial folds. In addition, the hyaluronic acids are long lasting (9-12 months compared to 3-4 months for traditional collagen), natural (HA is a natural component of skin) and reversible. Options include Juvederm Ultra, Juveder Ultra Plus, Juvederm Ultra XC, Juvederm Ultra plus XC Restylane, Perlane, Prevelle Silk as well as others.

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The great thing about today’s injectables is the minimal downtime. Dr. Hamilton does recommend that patients apply ice to the treated areas for the first day/evening, but make-up can be applied shortly afterwards. For those who do bruise, we can assist with make-up to help camouflage the areas. With today’s injectable fillers, most patients are back to regular activities the next day with the benefit of their new look!

Posted by Mark M. Hamilton M.D. FACS

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