Wrinkling, sagging, and sun damage are all natural signs of aging which inevitably begin to show on our skin with time.  As we age, our skin is exposed to environmental pollutants and the sun’s ultraviolet rays. The skin cells gradually lose their ability to produce hyaluronic acid. The skin tissue becomes dehydrated and the collagen and elastin fibers lose their structure, resulting in a loss of skin volume and the formation of the facial wrinkles folds that are common characteristics of aged skin. Fortunately, there are non-surgical options available to help you counteract these effects and can fill the gap between skin care products and a full-fledged surgical procedure. Neurotoxins (such as Botox and Dysport) and injectable dermal fillers are two options that can work in combination or separately to improve the appearance of lines, wrinkles, creases, and sunken facial areas. Injectable dermal fillers can also be used to augment facial structures such as cheeks or lips to give a fuller, more youthful appearance.

If you are considering a cosmetic injectable procedure, it is important that you be in good physical health and that you have realistic expectations for your procedure’s outcome.  Patients should understand that most injectable products provide only temporary results and, while they can improve or reduce the appearance of wrinkles and creases, most are not able to fully eliminate wrinkles. During a consultation with Dr. Hamilton or his nurse, Michelle, we will consider several factors in order to determine the specific injectable(s) that are right for you.

Appointments for dermal fillers can last 45-60 minutes to allow time for topical anesthetics to be used and/or anesthetic injections to enhance the comfort of the procedure. Very fine needles are used for these procedures, but the patient should have an expectation of some discomfort, temporary swelling, and possible bruising at the injection sites. There is very little recover or downtime associated with injectable procedures.

Neurotoxins
Neurotoxins can temporarily relax and reduce a variety of facial
wrinkles caused by facial muscle movement. Botox Cosmetic is the more commonly known neurotoxin with a long and proven safety record and a very high rate of patient satisfaction. Dysport is a newer product to the U.S., but has been used for several years in Europe.  Over the next year, other neurotoxin products are expected to be approved by the FDA as well.

These neurotoxins are produced from the bacteria Clostridium botulinum and are sterile and purified and do not cause systemic effects. They work by blocking the neurotransmitter receptors for acetylcholine that generates muscle contraction. The effect, however, is temporary lasting 3-4 months for most patients.

Botox or Dysport treatments take only 10-15 minutes and do not require an anesthetic. We do use ice for most treatments to increase the comfort level of the patient and reduce the chances of bruising. It takes most patients 7-10 days to see the full effect of the treatment. This treatment is ideal for wrinkles and creases such as the lines between the brows, crow’s feet, or forehead lines.

If you are considering a treatment with Botox or Dysport, it is important that you be in good physical health. This treatment is not indicated for patients with ALS, myasthenia gravis, Lambert-Eaton syndrome, or other neuromuscular disorders. If you are lactose-intolerant, you should not have treatment with Dysport.  For more information, please go to www.BotoxCosmetic.com or www.Dysport.com

Dermal Fillers
Over the last several years there has been an evolution of injectable dermal fillers from collagen to more “permanent” solutions. Due to its lack of duration and issues related to allergic sensitivities, collagen is no longer the preferred class of fillers.

Fillers made from hyaluronic acid (a natural complex sugar found in all mammals) are probably the most popular at this time and do not require skin testing prior to the procedure. Hyaluronic acid is s major component of the connective tissue matrix in the dermis- the dense, inner layer of the skin beneath the epidermis. The matrix is made up of hyaluronic acid as well as two connective fibers – collagen and elastin.  By its nature, hyaluronic acid retains water like a sponge, absorbing more than 1,000 times its weight. This helps to attract and maintain water within the extracellular space, hydrating your skin, and increasing its volume and density. Hyaluronic acid is also involved with the transport of essential nutrients to the skin’s viable cells. Hyaluronic acid provides volume, helping to contribute to the improvement of the skin’s overall appearance. This filler class includes names such as Juvederm Ultra, Juvederm Ultra Plus, Restylane, Perlane, and Prevelle Silk.

Juvederm Ultra and Juvederm Ultra Plus have been FDA approved to last up to one year. We use Juvederm Ultra and Ultra Plus for a variety of deeper facial wrinkles, filling the nasolabial folds (the lines between the nose and mouth) and marionette lines (the lines between the corners of the mouth and chin). We also use Juvederm products for cheek and lip augmentation as well as correcting deeper acne scars. Juvederm Ultra and Juvederm Ultra Plus have been found to last up to 1 ½ years with a “touch-up” treatment at 6-10 months after the initial treatment. Juvederm product results are smooth and have a high rate of patient satisfaction. For more information on Juvederm Ultra and Juvederm Ultra Plus, please go to www.Juvederm.com.

Restylane was one of the first hyaluronic acid fillers approved in the U.S.. Perlane is made by the same company as Restylane, but is used for deeper folds. Although Restylane and Perlane have FDA approval to last 4-6 months, we have found they generally have a duration of around 4-6 months. Restylane and Perlane are preferable if someone wants to “try” a dermal filler (such as lip augmentation), but are just not sure they are going to like the result for the long term. For more information on Restylane and Perlane, please go to www.RestylaneUSA.com.

Prevelle Silk is a newer hyaluronic acid dermal filler that has a finer consistency and can be used for finer lines like those around the lips. Prevelle Silk has a 4 month duration on average. Sometimes we use it in combination with other dermal fillers to produce optimum correction. For more information on Prevelle Silk, please go to www.Prevelle.com.

Radiesse is in a different class of dermal fillers as it is made from a calcium base. It is used for deep facial folds, such as the nasolabial folds and marionette lines. Radiesse can be used for cheek augmentation, but is not indicated for lip augmentation. Radiesse can last up to one year or more. For more information on Radiesse, please go to www.Radiesse.com.

Artefill is the first non-resorbable (permanent) FDA approved injectable filler in the U.S., although its safety has been proven through 15 years of use in Europe. Artefill is made with a unique microsphere-enhanced collagen and is considered to be a more “permanent” solution to deep facial folds. The collagen gel in Artefill is absorbed by the body while the microspheres remain in place to provide the support the skin needs for long-lasting wrinkle correction. With Artefill, the patient will see immediate results and the results continue to improve over the course of several months.  Artefill does require a skin-test prior to treatment. For more information on Artefill, please go to www.Artefill.com.

Sculptra is a newer facial injectable treatment indicated for the correction of shallow to deep nasolabial folds and other facial wrinkles. It works gradually to replace the collagen that is lost during the aging process. SculptraAesthetic contains poly-L-lactic acid, or PLLA, which is biocompatible (meaning “does not harm the body”). PLLA has been used for many years in dissolvable stitches and medical implants and has been used cosmetically in Europe since 1999.  Sculptra does not require skin testing prior to treatment and, usually, takes a series of treatments to obtain optimum results. For more information Sculptra, please go to www.SculptraAesthetic.com.