Many patients develop wrinkles that begin to be more noticeable over time. Specifically, the skin ages by losing its underlying supporting structure, which is known as soft tissue atrophy. Soft tissue atrophy is one of the most prominent signs of the aging face. There are a myriad of options available for the treatment of atrophy, and they are collectively referred to as soft tissue augmentation. The ideal products for soft tissue augmentation are natural feeling and long lasting. We offer a number of treatment options that are designed to tailor to your individual needs. The most common areas affected by soft tissue atrophy, and the resultant aging appearance, are the nasolabial folds (creases running between the nose and the side of the mouth), marionette lines (creases from corners of the mouth to the chin), lips, chin, cheeks, under the eyes, corners of the mouth. These lines can be ‘filled’ in to soften the appearance of the lines and smooth the skin. Fillers can also be used to restore volume loss in the hands.
Hyaluronic Acids: Restylane, Restylane Lyft, Juvederm XC, Juvederm Voluma XC, and Belotero
We now finally have a long lasting, safe way to improve wrinkles with minimal downtime. Restylane, Juvederm, and Belotero are natural occurring hyaluronic acid products that produce superb, reproducible results that last six to twelve months. They can be injected in a 15-30 minute session to dramatically decrease the appearance of wrinkles, restore volume, eliminate some scars, and augment or contour the lips and cheeks. Two major types of wrinkles can be treated with Restylane, Juvederm, and Belotero: the “smile line” or dynamic wrinkle, and the static wrinkle, caused by aging, overexposure to the sun, and/or cigarette smoking. Soft tissue injections are also used in conjunction with Botox/Dysport/Xeomin to improve the furrow that develops between the eyebrows (glabellar wrinkles), the lines that run from the nose to the corner of the mouth (nasolabial fold), to restore volume in the cheeks, and to diminish the appearance of acne scars. It is also used to fill in and augment thin lips, sunken areas on the cheeks and chin, and to correct the sad expression that appears at the corners of the mouth (marionette lines) with advanced age. Restylane and Belotero are excellent in masking the appearance of under eye bags, and filling in the depression in this area called the ‘tear trough’. Occasionally, our physicians will use topical or local anesthesia to make the procedure more comfortable, especially when treating the lips. Restylane, Juvederm, and Belotero are quite technique dependent and Dr. Daniels is skilled at the art of injecting these materials. Hyaluronic acid filler results typically last between 6-12 months.
Radiesse is a volumizing filler made from tiny calcium-based microspheres suspended in a water-based gel. The calcium microspheres are similar to calcium hydroxylapatite, the same mineral as bone, which makes it well tolerated in our skin. The filler remains soft and over time, the body absorbs the microspheres and gel, leaving behind only natural collagen. With a longevity ranging from 10-15 months, Radiesse is a nice option for those patients who seek a longer lasting correction. Radiesse is extremely useful for correcting the nasolabial folds, marionette lines, jowls, and jawline contours, as well as augmenting the mid cheek to create a more youthful mid face. Radiesse filler typically lasts 10-15 months.
Sculptra is a unique type of synthetic facial injectable referred to as a biostimulator. It is made from poly-L-lactic acid. Poly-L-lactic acid is biocompatible (a material that does not harm the body) and biodegradable (able to be broken down by the body). Sculptra is resorbed over a matter of months, and stimulates your own collagen to grow which remains in place for years. Sculptra is a safe, synthetic, and biocompatible material that is injected below the surface of the skin in the area of fat loss. It provides a gradual and significant increase in skin thickness, improving the appearance of folds and sunken areas. Sculptra is an enduring treatment for restoring volume loss of the cheeks, temples and moderate to severe facial folds. Facial fat loss and redistribution results in hollow cheeks, indentations, and folds. Sculptra is approved by the FDA for the correction of shallow to deep nasolabial folds. In addition, it is approved for the restoration of facial fat loss in people with human immunodeficiency virus. It has been used extensively for healthy individuals with facial fat loss or redistribution. At your first treatment visit, it may appear that Sculptra worked immediately because of swelling from the injections and the water used to dilute Sculptra. In a few days, when the swelling goes down and the water is absorbed by your body, you may look as you did before your treatment. Sculptra takes time to gradually correct the creases and folds in your skin. Repeat treatments are usually performed every 3-6 weeks, and patients usually require 3 to 4 treatment sessions before seeing optimal results. Treatment results and longevity differ for each person. In one clinical study, results with Sculptra lasted longer than 2 years after the first treatment session. Touch-up treatments are usually needed to maintain the desired effect.
Bellafill is a long lasting collagen-based dermal filler comprised of 80% puriﬁed collagen and 20% PMMA (polymethylmethacylate) microspheres. The PMMA helps to stimulate the production of your body’s own new collagen. Bellafill is indicated for the correction of nasolabial folds and moderate to severe, atrophic, distensible facial acne scars on the cheeks. It may take up to 3 treatments spaced 6-8 weeks apart to achieve optimal results, however results can last for 2-5 years.
How do I know which filler to choose?
During your consultation, your skilled physician will evaluate your skin and help you decide which filler and how much will be necessary to achieve your goals. Although filler treatments are extremely safe there are areas of the face where only certain fillers should be used. Dr. Daniels will help navigate this process.
What are the risks associated with filler treatments and are they safe?
Fillers are extremely safe materials that are synthetically made to be compatible with our bodies. These materials have been studied and tested for years, and have proven to be safe and effective in smoothing lines and restoring volume loss. Redness, swelling, and bruising are common after filler treatments. Rarely, the material can bead, however this is correctable with gentle massage. Even more rare, is the risk of compression of blood vessels, which can cause tissue breakdown or scarring. Dr. Daniels is skilled at the art of filler injections and will do everything possible to minimize these risks.
How do I prepare for my filler treatment?
Soft tissue augmentation is a safe, effective, and relatively quick in office treatment. Bruising from filler injections is not uncommon, and therefore unless advised otherwise by a physician discontinue all mediations which might thin the blood and contribute to bruising such as, Aspirin, Aleve, Motrin, Ibuprofen, Fish Oil, Vitamin E, “G” supplements (ginko, ginseng, garlic), St. John’s Wort and other non-steroidal anti-inflammatory medications like Celebrex. Prior to the appointment, some patients who bruise easily choose to apply or take Arnica in an effort to decrease bruising. Eating pineapple for a few weeks prior to your treatment is a natural way to decrease the incidence of bruising. There is mild discomfort with filler injections and therefore your physician will provide you with an anesthetic cream to apply to the area to be treated one hour prior to your visit. In addition, most of the fillers have lidocaine in them to make your treatment more comfortable.
How do I care for the treated area afterwards?
It is normal to have redness for a few hours and swelling for a few days after filler injections. Bruising is common after soft tissue augmentation, and therefore we recommend ice packs for several hours after your treatment to minimize this. We ask that patients refrain from exercise for 36-48 hours to avoid excessive swelling and bruising. In addition, we caution those who wear a C-PAP mask for sleep apnea or use swimming goggles to avoid firm pressure in the area where filler has been injected.