INJECTABLES AND SKIN RESURFACING TECHNIQUES

For centuries, physicians and patients have sought non-surgical therapies to remove or reduce the appearance of facial wrinkles and aging. Many materials have been tried; some with good results, others with disastrous results. Some have proven ineffective.


by Lois W. Stern1


SOFT TISSUE FILLERS


  • AUTOLOGUOUS FAT: Fat Injections involve taking fat from one part of the patient’s body (abdomen, thighs or buttocks) and reinjecting it beneath the facial skin. Fat injections are used to add volume to various areas of the face such as to fill depressed areas as nasolabial folds, crow’s feet, lips and frown lines.
    QUOTE: “As we age, we lose volume in our face. It makes good sense to replace that lost fat tissue with one’s own fat, and this procedure has the potential to be more permanent.” *
    RESULTS: Results are highly variable, lasting from months to years, but can be permanent.
    SIDE EFFECTS: Temporary swelling, bruising or lumpiness
    Minor fat transfers can result in 1-4 days of downtime before returning to work with longer at home time for extensive fat transfers.
    COMMENTS: Unlike bovine collagen, allergic reaction is not a factor as the fat is harvested from the patient’s own body.

  • RADIANCE (Calcium Hydroxy Lapatite): A synthetic form of the same material found in bones and teeth. Is used to fill nasolabial folds, frown lines, crow’s feet and lips.
    RESULTS: Likely to last 2 years or longer.
    SIDE EFFECTS: Possible temporary redness, swelling, bruising or lumpiness.

  • RESTYLANE, HYLAFORM (Hyaluronic Acid): Hyaluronic acid exists naturally in all living organisms and is a natural component of connective tissues, including the skin. For years, hyaluronic acid has been used to treat joint pain, but now also is being used aesthetically to add volume to nasolabial folds, forehead wrinkles, smile lines and lips to minimize wrinkles and lines.
    TYPES: Restylane® is a soft tissue filler made of hyaluronic acid.
    Captique™ is another soft tissue filler made of hyaluronic acid which received FDA approval in Dec. 2004.
    Hylaform® Hylaform Plus® are soft tissue fillers composed of hyaluronic acid extracted from rooster combs - both received FDA approval in 2004.
    Perlane® and Restylane® Fine Line, are two additional tissue fillers composed of hyaluronic acid used outside the United States, but are not approved by the FDA.
    RESULTS: Different formulations result in varied lasting power, anywhere from 4 months to 1 year.
    SIDE EFFECTS: Temporary redness, swelling and tenderness.
    As the substance naturally occurs in humans and all animals, allergic reactions are rare.
    COMMENTS: Touch up treatments before the product has fully dissipated tend to enhance the lasting effects.

  • HUMAN BASED COLLAGEN (CosmoDerm, CosmoPlast): Fills frown lines, crow’s feet, nasolabial folds and lips.
    RESULTS: Can last up to 6 month.
    SIDE EFFECTS: Typically no downtime following this procedure.
    Temporary swelling, redness, bruising can occur.
    COMMENTS: Because of its compatible derivation, no allergy skin test is needed prior to the injection of human based collagen products.

  • COLLAGEN (Bovine Based): Collagen is a naturally occurring protein that supports various parts of the body including skin, tendons and ligaments. Today, bovine based collagen is a less popular choice to fill wrinkles, lines and scars on the face and around the lips, because of other available options.
    QUOTE: “Bovine based products are used less today as other products, such as Restylane, yield similar results, last longer, and do not require an allergy skin test prior to use.” *
    TYPES: Injectable bovine based collagens include Zyderm and Zyplast.
    RESULTS: Results are normally immediate and can last up to 6 months. There is typically no downtime following this procedure.
    SIDE EFFECTS: Some people experience allergic reactions to bovine based collagen. Slight bruising at the injection sites is not uncommon.
    COMMENTS: Due to the possibility of an allergic reaction to bovine-based collagen, an allergy skin test should be conducted at least one month prior to these injections.

  • PERMANENT FILLERS:
    QUOTE: “Permanent fillers such as Artefill may sound like an ideal solution, but in reality, I am hesitant to use any permanent type, artificial filler. As we age, we lose face volume. The artificial filler may begin to appear as tiny bumps under the skin. ” *

  • BOTOX AND MYOBLOC (Botulinum toxin): Botulism toxins are muscle weakeners, not fillers. When injected into the muscles near a facial wrinkle, it temporarily relaxes them, resulting in a smoothing out of the overlying skin. Although Botox is only FDA cosmetically approved for frown lines, it is commonly used “off-label” to relax crow’s feet as well as vertical neck bands.
    RESULTS: Particularly effective for temporarily reducing wrinkles from the very sites of strong repeated muscle contractions as the forehead and between the eyebrows. Botox can begin to take effect in 5-7 days, with maximum effect in two weeks. The first Botox treatment typically lasts about 4 months, but its effectiveness and staying power tend to increase with subsequent treatments, when results can last for up to 6 months.
    SIDE EFFECTS to both Botox and Myobloc: Possible temporary bruising, redness, droopy eyelid, flu-like symptoms or headache.
    COMMENTS: Botulinum toxins have been used for years to treat neck spasms, cranial nerve disorders and eye spasms. The FDA has approved the use of Botox for cosmetic use in the glabellar region. All other use is considered off label. Botox® is the only form of botulinum toxin currently approved by the FDA for cosmetic purposes in the glabellar region, but two others, MyoblocTM and Dysport® are under FDA review for cosmetic use.
    Myobloc can take effect in 4-6 hours, with a maximum effect in 2 weeks. Myobloc is in use outside the U.S., but is only FDA approved for cervical dystonias in the USA, with all other uses considered off label.


SKIN RESURFACING



CHEMICAL PEELS

  • LITE CHEMICAL PEELS: Include the exfoliants already described in the COSMECEUTICALS article under Alpha Hydroxy Acids, Lactic acids,
    Glycolic acids, and Beta Hydroxy acids.They work to remove dead cells and the outer layers of thickened skin, encouraging skin turnover.

  • MEDIUM STRENGTH CHEMICAL PEELS as TCA (Trichloracetic acid)
    RESULTS: Removes the outer layer of the skin (the epidermis) and penetrates into deeper layers (the dermis). Stimulates the formation of new skin, richer in collagen and elastic fibers. Results in tauter skin with fewer wrinkles, a reduction of pigmentary changes and skin blemishes.
    SIDE EFFECTS: Temporary redness and extreme sensitivity to the sun during the heeling period, which may take 5-7 days.
    COMMENTS: TCA is currently the most commonly used medium strength chemical peeling agent, typically used in concentrations of 20- 50%. MEDIUM STRENGTH CHEMICAL PEELS should only be performed by a dermatologist or plastic surgeon specifically trained and experienced in these procedures. Anesthesia may be required for patient comfort and safety.

  • HEAVY STREGTH PEELS: PHENOL PEELS: Resurface the skin by removing rough and sun damaged skin, wrinkles, crow’s feet, age spots and other surface imperfections. Phenol is particularly useful for reducing the depth of vertical lines around the mouth, because of its ability to penetrate to the deepest layers of the skin.
    QUOTE: “Up until the last several years, the most successful phenol peel results occurred on those with fair complexions, due to the lightening effect of phenol treatments on the skin. This effect often resulted in a rather obvious contrast in skin color between treated and non-treated areas. This has changed in the last five years. As a result of a number of studies on varied phenol formulas, different formulas have been developed to accommodate various skins types, in order to avoid that bleaching effect. Plastic surgeons are now increasingly forgoing the use of ablative lasers in favor of varied formula phenol peels. I am finding that recovery is smoother, with fewer problems for the patient.” *
    RESULTS: For the first five days after a phenol peel, the aged skin continues to shed, leaving smooth, wrinkle free and even toned skin.
    SIDE EFFECTS: Temporary pain, soreness and sensitivity to the sun during the healing process.
    COMMENTS: Should only be performed by a dermatologist or plastic surgeon specifically trained and experienced in these procedures. Anesthesia may be required for patient comfort and safety.

    NOTE: All quotes in this article attributed to Dr. Leo McCafferty, Clinical Assistant Professor of Plastic Surgery, University of Pittsburgh School of Medicine, Private practice Pittsburgh, Pa., Member of the Board of Directors of the ASAPS

    You have my permission to reprint this article in part or full providing it contains the following attribution:
    Lois W. Stern is the author of the award winning book, Sex, Lies and Cosmetic Surgery, (Infinity, 2006), soon to be republished in a revised edition with a CD enclosure. Lois invites prospective cosmetic surgery patients, physicians, and media to visit her website to read other articles and/or sign up for her monthly newsletter at: sexliesandcosmeticsurgery.com

    This article is excerpted from a larger article written by Lois W. Stern, author of Sex, Lies and Cosmetic Surgery, for the Long Island Beauty Guide - 2007 annual edition.