Injectables

Types of Dermal Fillers – Benefits and Risks

Dermal FillersThe world of facial injectable treatments can be overwhelming with all the options seen in print and TV ads. New injectable materials seem to come out almost weekly. Here is a run-down of the dermal fillers we most often use, where we use them, and some common side effects.

Hyaluronic Acid (HA)

The most frequently used dermal fillers are made of a material called hyaluronic acid (HA). Hyaluronic acid is a chemical structure found in our bodies — so most individuals tolerate the filler well, without side effects. The chemical structure of the molecule can be processed in different ways, giving us the ability to manipulate the thickness, the amount of volume and the longevity of the effects on your skin.

This versatility is important because, depending on your particular area of concern, you may desire one benefit of the treatment over another. For example, you may desire additional volume and want the treatment to last a long time, but not need fine lines to be treated. On the other hand, you may desire smoker’s lines around the mouth to be improved, but not want a lot of volume or swelling in the mouth area.

Hyaluronic acid fillers come packaged in a variety of forms: Juvederm, Volbella, Juvederm Ultra Plus and Voluma, Restylane, Restylane Silk, Restylane Refyne/Defyne, Lyft and Belotero. Your facial cosmetic surgeon will recommend the use of particular kinds of HA fillers based on the treatment area, as well as your desired outcome, preference, and experience.

Side Effects of HA

Hyaluronic acid is a water-loving (hydrophilic) product, which means one expected side effect is swelling. The degree of swelling experienced after HA treatment varies. You’ll most likely experience swelling on the first day after injections, with a drastic reduction after that.

Follow these tips to help reduce swelling during the first day and night after facial injections:

  • Keep your hands off the area injected
  • Keep your head elevated while resting and sleeping
  • Limit alcohol and salt intake
  • Use cold compresses on the affected area

Rarely, patients are hypersensitive to this product and can exhibit an allergic response. If you experience any significant swelling, itching or redness at the injected areas, you should contact your surgeon. The biggest benefit to HA fillers is that with another enzyme injection, they can be dissolved, making this filler reversible.

Other Types of Dermal Fillers

Although HA fillers are the most common, other fillers may be useful for specific treatment areas:

Artefill

Permanent fillers, such as Artefill, can be helpful for areas with deep folds and are unlikely to change dramatically over time, such as the lines from the nose to the mouth (called nasolabial folds). The downside to permanent fillers is that if there is a reaction or a less than desirable result, the process is not reversible.

Radiesse

Radiesse is a temporary thickener made of a material called calcium hydroxyapatite. It’s longer lasting than HA fillers, and not dissolvable.  Your plastic surgeon may recommend Radiesse for deeper injection areas such as the lines from nose to mouth (nasolabial folds), cheeks and deep temple injections. One risk of using Radiesse is possible injection into a blood vessel, which can affect blood supply to a specific area of skin, causing serious complications. In some cases, Radiesse injection made too close to the skin can cause lumpiness under the skin. When used correctly, however, this filler can be very beneficial for reducing deep folds and providing volume.

Sculptra

Sculptra is collagen-stimulator filler intended for patients who need to gradually increase volume in larger areas. Before injection, Sculptra is hydrated with water for 48 hours. It’s then injected in small doses throughout the tissues under the skin in the treatment area. You can expect it to take between three to six weeks to see full results. Benefits include a more natural-appearing result and gradual increase in volume rather than abrupt change. The downside is that results can take several months to become apparent.

Which Dermal Filler is Right for You?

A board-certified facial plastic surgeon with experience treating the face can help you determine the best derma filler treatment for your most bothersome areas. The best filler product will depend on the area of concern, the depth of the issue and the thickness of the material. The experienced cosmetic surgeons at Emory Aesthetic Center have years of experience with fillers and individual preferences based on those experiences. Feel free to ask questions, return for a second discussion or look at photos to help you make your decision. Ultimately, our goal is ensuring your best result.

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Get Your Face Holiday Ready

Nonsurgical facial procedures to get your face holiday ready. Emory Aesthetic Center can help you glow this holiday season.With the weather getting colder and the holidays approaching, this is a great time for facial procedures that will give your skin a special glow. There are several nonsurgical treatments that can leave you radiant and require little to no downtime.

Injectables (BOTOX®, Dysport®) – Botulinum toxin

Botulinum toxin is an injectable substance that helps smooth facial lines caused by normal movements of expression, like when you lift your brows, frown or smile.

What can I expect?

The short injection session gives results that last about four months. There is no real downtime, you can usually go back to your normal routine immediately following the injections. You’ll see full results in 5-10 days.

Dermal fillers

Dermal fillers are injectable products used to fill deep wrinkles or add volume to the face, including the cheeks, eyelids, lips, nose, chin, jawline and temporal area. They are popular non-surgical options to rejuvenate and reshape the face. Hyaluronic acid fillers (including Restylane®, Juvederm®, Voluma® and Belotero®) are most commonly used.

What can I expect?

The injection session takes about 30 minutes, depending on the areas being treated. You’ll see results immediately and you can resume your activities the same day. You might have mild swelling, redness or bruising for a few days following the procedure, but it can usually be covered with makeup.

Fractional laser resurfacing

Fractional laser resurfacing uses a gentle laser that penetrates beneath the top layers of skin to promote collagen production. It’s ideal to treat minor wrinkles, large pores, uneven skin pigmentation and poor skin tone. Although you can see results with just one session, you’ll see the best results if the procedure is repeated every 4-6 weeks.

What can I expect?

Fractional laser resurfacing takes about 45 minutes and requires a numbing cream or local anesthetic to reduce discomfort. You can expect some swelling and redness for about two days. Your skin tone will be darker (like a sun tan) for about three days. Sun protection is recommended after the procedure. In 5-7 weeks you’ll notice rejuvenated skin.

Photofacials/IPL therapy

Intense pulsed light (IPL) is used to treat redness, brown spots, spider veins and rosacea. It prompts the body to produce collagen and can reverse signs of sun damage like dull skin and fine wrinkles.

What can I expect?

You should refrain from sun exposure and tanning for at least 4-6 weeks before the treatment to avoid hyperpigmentation. During the procedure, your skin will be cooled to help prevent discomfort. Depending on the areas being treated, a session lasts 30-60 minutes. There may be mild swelling or redness for a few hours. You should limit your time in the sun and use sunscreen after the procedure.

Hydrafacial

Hydrafacial involves a multi-step treatment that cleanses, exfoliates and removes impurities and dead skin cells. It then infuses nutrients in the skin including antioxidants, peptides and hyaluronic acid. This medical facial treats environmental damage, reduces fine lines, firms the skin and increases skin hydration. A light chemical peel is included to improve skin texture without any post-procedure skin flakiness.

What can I expect?

A Hydrafacial session is very relaxing and lasts about 45 minutes. There’s no downtime and your skin immediately looks cleaner and more hydrated.

Facial peels

Facial peels, also known as chemical peels, are used to remove layers of damaged skin. It treats signs of skin aging caused by sun damage and other environmental conditions. Two to three days after application, the old skin will gradually flake and “peel” off to reveal more even and fresh skin. There are several kinds of chemical peels, including glycolic acid, salicylic acid, retinoid acid, TCA and modified Jessner’s peel.

What can I expect?

A chemical peel session typically lasts 30-45 minutes. If you get a superficial peel, you may have flakey skin for 2-3 days. If you get a medium peel, you may require 5-7 days of downtime as your skin recovers and sheds the superficial layer. Crusting and scabbing may occur; you’ll be instructed how to clean and moisturize your face. Limited sun exposure and sun protection is recommended after the procedure. Within a week you’ll see bright new skin.

Emory Aesthetic Center

The expert cosmetic surgeons and licensed aestheticians at Emory Aesthetic Center can help you choose the best facial procedures to address your goals. During your consultation, you will learn about different options and choose one based on your needs, lifestyle, and budget. Let us help you get holiday ready.

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Injectables: When’s the Right Time Start?

Emory Aesthetic Center helps you determine the proper time to start Botox© or fillers based on your age. Prevent and treat signs of aging with injectables.How young is ‘too young’ to start injectable treatments for your face? When are you ‘too old’ to benefit from injectables? The truth is, if you’re not happy with what you see in the mirror, it never hurts to talk to an expert about your options.

As for clear-cut parameters regarding age, they rarely exist. Whether you’re 25 or 85, cosmetic injectable and filler treatments can have excellent results. The key is to use the proper treatments at the proper time.

Preventing and treating fine lines with injectables

Botox© can be very helpful, even at an early age (late 20s up to mid-30s), to prevent and treat the finer lines that come with repeated contraction of facial muscles. These lines are often found between your eyebrows, on your forehead or around your mouth and eyes. If lines are present even when your facial muscles are at rest, it may be time to consider treatment.

With consistent Botox injections, deep lines fade into finer lines, and fine lines may disappear completely! With just a few injections, you’ll notice subtle lifting that makes you look bright and refreshed. Younger patients usually need injections two to three times a year. If you’re over 40, you’ll typically need four to five treatments a year to maintain results.

Adding lip fullness

Fillers can be used to add natural-looking fullness to your lips. If you’re in your 20s or 30s, you may just want plump lips to ‘up your style.’ Or, if your lips have thinned with age, this is an excellent opportunity to restore your youthful appearance.

You don’t have to be fearful of an ‘overdone’ look similar to those you’ve seen in the tabloids — adding a very small amount of definition and a ‘bee-stung’ appearance goes a long way toward giving you a more youthful look. The procedure is simple, requiring only a topical anesthetic, and results lasts 4 months or more.

Filling in hallowed under-eyes

Loosing volume under your eyes can result in ‘sunken in’ eyes and dark circles that leave you looking tired. You can experience this at any age, but it tends to happen as you get older. Dermal fillers are used to fill in the area under your eyes creating a brighter, more youthful appearance.

Adding facial fullness

If you’re in your mid 40s or older, you may benefit from added volume and lifting to your mid-face region. Fillers, are used to lift and subtlety reposition drooping cheeks to decrease the appearance of jowls and lines around your mouth.

The process of injecting these types of fillers also stimulates collagen production. This means with time, you can be left with slightly more collagen in your tissue than before you got the injections. If you continue to get them, you may even need less product, less often — an added benefit to your wallet.

Finding the right surgeon

Injectables can bring years of youthfulness back to your face with minimal downtime and maximum reward. Schedule a consultation with a facial plastic surgeon to talk about your options. Make sure you ask how many times your surgeon has performed these procedures, what kinds of risks or side effects are common and what can be done about any complications.

Emory Aesthetic Center

The highly-skilled team at Emory Aesthetic Center offers a broad range of nonsurgical and surgical options for facial rejuvenation.

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Your Age Defying Questions Answered: Secrets to Defying the Aging Process

facial-rejuvenation-emailAging is a part of life. And yes, your appearance will change as you get older. But that doesn’t have to be a bad thing. Aging gracefully is about allowing the best version of yourself to shine through, and there are countless facial rejuvenation tools and treatments to help you do just that.

During our live chat on Tuesday, July 19th, Emory Aesthetic Center plastic surgeon, Dr. Felmont Eaves, answered all of your questions about helping to defy the aging process. Dr. Eaves discussed everything from skin care products to injectable treatments to cosmetic surgical options, such as Botox®, facelifts and eyelid lifts.

Below are just a few questions we were unable to respond to due to the large number of questions we received. For a full listing of questions and answers, please read our chat transcript. It is full of useful tips and answers that may be relevant to you. You may also visit emoryaesthetic.org for a full list of services and treatments offered by the Emory Aesthetic Center.

Question: How do I minimize dark circles beyond getting more sleep?

Dr. Eaves: There are two reasons that we may develop dark circles under the eyes. The first reason is that there is a dark tone to the skin itself. That is a difficult problem to treat, as currently we don’t have a great solution to dark circles. Sometimes bleaching creams containing hydroquinone can help, but that isn’t always successful. And chemical peels typically don’t work in this situation.

The other reason for dark circles, however, is the shadowing caused by bulging fat pads of the lower lids. Either surgery to remove or reposition the lower lid fat, or an injection of filler into the depressed area underneath the prominent fat – can soften or eliminate that shadow.

Question: What’s the best way to help with my lower face sagging without injecting a bunch of fillers?

Dr. Eaves: In the right patient, fillers can be great, but when the face truly begins sagging (not just deep folds by the mouth), then surgery is required to make truly significant changes. With a lower face lift (which typically includes tightening the neck as well) the jowls can be reduced, the cheek contours can be improved, and deeper folds/wrinkles around the mouth can be softened. It can provide dramatic, long lasting results, and recovery is generally relatively quick.

Question: How can you stop sagging eyelids?

Dr. Eaves: Sagging eyelids are generally treated with a blepharoplasty (an eyelid tuck and eyelid lift). Blepharoplasty can be used to treat the upper eyelids, the lower eyelids, or both, and are often combined with other areas of facial rejuvenation, such as a facelift, neck lift, and brow lift. Sometimes a sagging upper eyelid also has a component of malposition, where it isn’t just saggy skin. In those cases the lid can be repositioned while the blepharoplasty is being done.

Facial Rejuvenation – Secrets to Defying the Aging Process

facial-rejuvenation-emailAging is a part of life. And yes, your appearance will change as you get older. But that doesn’t have to be a bad thing. Aging gracefully is about allowing the best version of yourself to shine through, and there are countless facial rejuvenation tools and treatments to help you do just that. Join us for a live chat with Emory Aesthetic Center plastic surgeon, Dr. Felmont Eaves, on Tuesday, July 12, 2016 at 12:00 p.m. EST as he discusses solutions to help defy the aging process. From skin care to injectable treatments to cosmetic surgical options, Dr. Eaves will walk you through all of your options and answer any questions you may have. Register today.

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About Dr. Eaves

eaves-iii-felmontDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

Botox® for Men: Looking Good Isn’t Just for Women

Get rid of crow’s feet, a furrowed brow or sunken eyes in minutes. More men are using toxin injectables and fillers to look younger.Women aren’t the only ones who want to look better. According to the American Society for Aesthetic Plastic Surgery (ASAPS), men received nearly 600,000 injectable procedures (such as Botox® and fillers) in 2015.

If you’re a man who wants to look your best, clearly you’re not alone. Maybe it’s time to look for ways you can put your best face forward.

What are Injectables?

Injectables are cosmetic treatments that are injected into your body to improve your appearance without surgery. There are two types of injectables: neurotoxins (e.g. Botox®) and dermal fillers.

Neurotoxin Injectables

Neurotoxins  (also called toxins) are used treat deep lines caused by repetitive movements, such as smiling. Botox® is one of the most powerful neurotoxins in use today. Some people refer to Botox® to describe all cosmetic injectable treatments, but it only represents one substance.

This type of injectable is often used to treat:

  • Crow’s feet
  • Forehead wrinkles
  • Furrow lines between the eyebrows

It only takes minutes and you’ll have absolutely no downtime. You can expect to see full results in two to seven days. Results typically last three to four months and sometimes up to six months.

Dermal Fillers

There are different types of dermal fillers, but the most common contain hyaluronic acids (HAs). Fillers  add volume to address common aging problems like deep wrinkles, loss of fullness and sagging skin.

Fillers are used to treat:

  • Folds between the nose and lips (nasolabial folds)
  • Lips
  • Marionette lines (from corner of the mouth to the chin)
  • Sunken temples
  • Under eyes
  • Vertical lines around the mouth

Like injectables, fillers take just minutes, and you’ll see results right away. There may be a little bit of swelling and occasionally some light bruising. Typically, you can expect to get back to work the next day. The type of filler used and the area of the body it’s used on determine how long your results will last. For example, fillers in the folds around your mouth may last six to nine months, while fillers underneath your eyes may last a year or longer.

Who Should I Trust for Injectables and Fillers?

Don’t sacrifice quality for cost. The process seems straight-forward, but performing injectable treatment properly requires a great deal of skill and in-depth knowledge of facial anatomy. Look for a qualified cosmetic surgeon.

Thinking about Getting Injectables or Fillers?

Emory Aesthetic Center offers a variety of injectable procedures and other options to keep you looking your best.

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Or call us at 404-778-6880 to schedule your personal consultation

About Dr. Eaves

eaves-iii-felmontDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

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Facial Rejuvenation- Secrets to Defying the Aging Process

Learn the secrets to defying the aging process with facial rejuvenation. Renew your face with tips from a board-certified cosmetic surgeon.Aging is a part of life. And yes, your appearance will change as you get older. But that doesn’t have to be a bad thing. Aging gracefully is about allowing the best version of yourself to shine through, and there are countless facial rejuvenation tools to help you do just that.

Facial Rejuvenation Starts with Skin Care

Skincare is the first and most important step of facial rejuvenation. You don’t need to ditch your current products and spend a fortune on complete skin care “systems” to get good results.

A licensed aesthetician can help. Find someone who’s willing to listen to your concerns and offer advice to help you get the results you want within your budget.

These products can help you look your best:

• Sunscreen. Use sunscreen every day to prevent aging sun damage, such as dark spots and fine lines.
• Vitamin C. Apply Vitamin C to your skin to reduce the effects of sun damage and significantly brighten your complexion.
• Tretinoin (Retin-A). Use a Retin-A product to penetrate the deeper layers of your skin and stimulate collagen production. It also works as a mild daily exfoliant.
• Prescription medicine. Ask a dermatologist about certain prescription medicines (such as hydroquinone), which can lighten dark brown spots, patches and hormone-induced darkening.

Chemical Peels and Micro-Needling

Minor procedures for facial rejuvenation such as mild to medium facial peels (also known as chemical peels) and micro-needling can do wonders to kick-start a healthy routine and help your skin care products to work even better. Regular peels can help keep your skin texture looking younger as you age.

Injectable Treatments

You may get great results from fillers and/or Botox© if you have these early signs of aging:

• Mild volume loss
• Fine, early creases around your forehead and/or between your eyes
• Crow’s feet

Most patients have more than one of these signs, plus others such as loose skin and fat build up. You may need a multi-step action plan for facial rejuvenation to tackle multiple concerns.

Cosmetic Surgery

If you’re trying to use fillers or Botox for something that really requires cosmetic surgery, you probably won’t be happy with the results.

For example, if you have extra skin or fat around your eyelids and use Botox to lift your eyebrows, you may end up with an unnatural, arched expression. If you use an injectable filler to add a significant amount of volume to your jawline, you may look more “puffy” than youthful.

There are many surgical procedures that can help you put your best face forward. Talk to a board certified cosmetic surgeon to learn which procedures may be right for you.

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About Dr. Sethna

anita-sethna-avatarDr. Sethna understands that facial plastic and reconstructive surgery demand a marriage of science and artistry, and she enjoys using precision, skill, and vision to make her patients’ dreams reality. Dr. Sethna’s meticulous attention to detail and her passion for maintaining a natural look ensure optimum results for her patients.

A dedicated teacher, Dr. Sethna is devoted to assisting residents in facial trauma or reconstructive cases at Grady Hospital. She relishes the opportunity to educate residents and medical students in all aspects of patient care. Dr. Sethna has a strong interest in several areas of facial plastic surgery research and has presented at national meetings on the importance of resident and fellow education in rhinoplasty techniques and adjunctive measures to decrease discomfort during cosmetic procedures.

Takeaways from the Emory Aesthetic Center’s Getting Ready for the Holidays Live Chat

eac-holiday-260x200Thank you to everyone who joined us on Tuesday, October 13th, for our live online chat on “Getting Ready for the Holidays”, hosted by Emory Aesthetic Center’s facial plastic surgeon, Dr. Anita Sethna.

Believe it or not, the holidays will be here before we know it. In this live chat, Dr. Sethna provided advice and answered questions on how to get your skin glowing for the festive season. She discussed effective non-surgical treatments that will give you a brighter, rejuvenated look. She also answered questions around cosmetic surgical options and recovery to ensure your are ready just in time for the season. Here are just a few highlights from the chat, including one question we didn’t have a chance to answer:

Question: Can you perform a nose job with injections? My friend said that he had it done and I can see a difference.

anita-sethna-avatarDr. Sethna: Non-surgical rhinoplasty is a relatively new concept in injectables, but not one that should be taken lightly. There are no FDA-approved injectables for injection into the nose. That being said, in very select cases either after a rhinoplasty has already been done, or if a small issue in the bridge needs to be corrected, injection of a hyaluronic acid filler (juvederm , restylane for example) can be injected to correct the concern. A rhinoplasty surgeon familiar with the anatomy and blood vessels of the nose should be the one performing the injection. The risks of improper placement or unintended consequences can be severe in the nasal skin if performed by an untrained individual. As always, a consultation with a rhinoplasty expert to determine whether your concerns are even amenable to non-surgical (injectable) rhinoplasty is recommended prior to any interventions.

Question: What is the simplest thing someone can do to look fresher and rejuvenated?

anita-sethna-avatarDr. Sethna: On a daily basis, skin care is probably the easiest and biggest bang for your buck. The ingredients that are most helpful are tretinoin, or some type of retinol, that is essentially a daily exfoliant that is helpful in stimulating collagen and removing surface dead skin cells.

 

 

Question: When would you recommend a chemical peel and what does it best treat? Wrinkles? Complexion? Wondering if I should have one.

anita-sethna-avatarDr. Sethna: There are many different types of chemical peels and many different concentrations that can be used to achieve a different type of cosmetic result. Very limited amount of down time can be achieved with a lower concentration of peel solution and can improve overall brightness of the complexion and possibly improve the appearance of darker spots or age spots. If deeper wrinkles are present or overall skin tightening is desired, most of the time a deeper peel will need to be performed in an operating room or under sedation, with a recovery time of closer to seven days. Most peels can be repeated to get more drastic results and can be repeated with varying intervals depending on the depth of the original peel. Ultimately, the best recommendation on whether or not it will be helpful will be to come in for a consultation to address what your overall goals are and whether a peel could accomplish those.

If you missed out on this live chat, be sure to check out the full list of questions and answers on the chat transcript. You can also visit emoryaesthetic.org for a full list of services and treatments offered by the Emory Aesthetic Center.

If you have additional questions for Dr. Sethna, please feel free to leave a comment in our comments area below.

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or call us at 404-778-6880 to schedule a consultation.

How to Prevent and Treat Crows Feet

happy-ladyCrow’s feet, or laugh lines around the eyes, can be a challenging area to treat from a cosmetic perspective. On one hand, expressions of joy transmitted through the eyes are beautiful in their own right, but deeper lines and creases in this area can often draw attention to the changes associated with aging and loose skin.

My personal approach is to attempt as much as possible to prevent the lines from becoming deep, or in some cases, even forming to begin with. There are two main methods to achieve this – skincare to plump and stimulate collagen (such as tretinoin or Retin-A©), and Botox® (or equivalent Xeomin® or Dysport®) to reduce the muscle movement in the area and thereby reducing crease patterns. These options can be started at any time, even in the early 30s before real creases have begun. A combination of treatments early can prevent the formation of obvious deeper creases. At this stage, Botox can be performed as little as twice a year before creases have actually formed.

Once the creases are present, the above combinations of skincare and Botox can still make a significant impact and can lessen the appearance of lines around the eyes. Often, this is all that patients are interested in so that they can still appear to have movement while improving their overall appearance. If a more drastic improvement is needed, a series of peels or even fractional laser treatments can be undertaken. The choice of intervention depends on the comfort level of the surgeon and the amount of downtime or recovery the patient is able to give.

If a week of downtime is tolerable, fractional laser resurfacing can be performed relatively aggressively to specifically treat the area around the eyes. Makeup can typically be worn to reduce the appearance of redness during the recovery period. Because we usually cannot be aggressive enough with one treatment to wipe out these lines, a repeated treatment may be needed 3-6 months later. During that period of recovery, Botox can be used to give the skin a continued break from creasing as well.

Facial peels can also be performed, often at varying depths, depending on the amount of recovery or downtime afforded. Often, a peel will have 3 days of recovery and can be repeated every 4 to 6 weeks for a total of 3 to 4 treatments to allow improvement in this area. It is a slower, but less intensive treatment plan. Continuing skincare and Botox through this period will also boost results.

All in all, a multi-pronged approach is often needed to treat the eye area. The good news is that crow’s feet respond to treatment quite well if all options are utilized. Other treatments, such as fillers, can be used as well if indicated, but are not routine as they can be fraught with unexpected complications. With judicious use of Botox and a rigorous skincare routine early, an ounce of prevention is definitely worth a pound of cure.

Come meet with one of the board-certified physicians of the Emory Aesthetic Center. We can discuss your goals and determine what combination of treatment is right for you.

appt

or call us at 404-778-6880 to schedule a consultation.

About Dr. Sethna

anita-sethna-avatarDr. Sethna understands that facial plastic and reconstructive surgery demand a marriage of science and artistry, and she enjoys using precision, skill, and vision to make her patients’ dreams reality. Dr. Sethna’s meticulous attention to detail and her passion for maintaining a natural look ensure optimum results for her patients.

A dedicated teacher, Dr. Sethna is devoted to assisting residents in facial trauma or reconstructive cases at Grady Hospital. She relishes the opportunity to educate residents and medical students in all aspects of patient care. Dr. Sethna has a strong interest in several areas of facial plastic surgery research and has presented at national meetings on the importance of resident and fellow education in rhinoplasty techniques and adjunctive measures to decrease discomfort during cosmetic procedures.

Ensuring Safety with Dermal Fillers and Botox

botox-injectionWith the prevalence of advertising injectables, and with specials running on every corner, it can be difficult to make a decision regarding where, when and who should be performing your nonsurgical facial rejuvenation.

The most common question I get from my patients is whether or not Botox® and dermal fillers are safe to use in the long-term. This is a reasonable question – after all, there is no shortage of exposures these days that we later discover have been harmful to us all along. But I reassure my patients that Botox (and its counterparts, Dysport© and Xeomin©, which I will refer to under the heading of Botox for simplicity) has been used in the treatment of facial wrinkles since the 1980s and 1990s – although it was only approved in 2002 for cosmetic use. We have therefore been watching the effects and risks of this potent and effective treatment for over 30 years now. There are also few other medications that have been studied quite as much as Botox for both cosmetic and non-cosmetic uses.

Dermal fillers, you may be surprised to know, have been used in their collagen form since the 1980s. The problem with using collagen fillers was that it required allergy testing and the effects of the filler only lasted about 3 months. With the onset of hyaluronic acid fillers, and some of the other longer lasting options available, results can last from months to years depending on the type and placement. Hyaluronic acid options are generally considered extremely safe, as this is a component of our own cellular structure and therefore does not require additional allergy or skin testing. It also has an excellent safety profile because it can be dissolved if the need arises by injecting an enzyme that breaks up the filler.

The issues of primary importance when you are contemplating who or where to have your treatment are the experience of the injector and where the product is obtained. Reputable physicians and surgeons will obtain the product directly from the manufacturer, not a discounted offshoot. There is little the consumer can do to ensure this other than to ask if the product has been obtained from the manufacturer and not a third party. This guarantees the product is pure and sterilely packaged.

The other issue is to have your treatments performed by someone who is comfortable not only with the methods and materials, but someone who has experience dealing with complications. Botox used for cosmetic purposes has risks of local bleeding or bruising, and diffusion into surrounding structures. This can lead to eye drooping or changes in mouth position if injected in these areas. In most cases, for cosmetic uses, the risk of breathing difficulty or swallowing problems does not reasonably occur.

Fillers can carry other risks. As with Botox, some of the common risks are bleeding and bruising. These are temporary and most often do not interfere with the final result. However, fillers should be considered an injectable implant. Sterile technique should always be used – cleaning the face with alcohol to remove all makeup, avoiding touching of the face after preparation and keeping needles and products packaged sterilely until use. Local infections can occur and can result in delayed results or other complications if sterile technique is not used.

Finally, injections of foreign materials into blood vessels can be dangerous and can cause changes in the surrounding tissues in a dramatic way. This can, in many cases, be avoided with proper attention to the anatomy of the face and knowledge of safe areas to inject fillers. Notably, in the U.S., silicone is not FDA-approved for soft tissue injection. Make sure to ask your injector if the product that is being recommended is FDA-approved for facial injection and whether there are specific risks associated with these injections. You can also ask if they can be reversed if a poor outcome or complication occurs. You should always be asked to sign a consent form prior to injection of a new product. Please take the time to read the consent forms. Many patients feel that since these products can be obtained at a spa or without “surgery”, the risks are minimal and not worth reading about in detail. Injectables are still elective procedures and carry risks associated with them. Make sure you understand what the risks are before embarking on this journey.

The overwhelming majority of patients obtaining Botox or dermal fillers are exceedingly pleased with their results. The risks of some of the more worrisome complications is quite low – 0.0001% in some of the available literature. Once you are aware of the possibilities, you are an informed consumer. Be sure to ask questions of your injector and preferably consult a surgeon familiar with the anatomy and soft tissues of the face that utilize injections in their practice on a daily basis. Injectable treatments can be powerful tools for nonsurgical facial rejuvenation with tremendous success.

Let the board certified physicians of the Emory Aesthetic Center provide you with a complimentary consultation to assess your needs and help you think through the options. We will help choose an approach personalized to you and your needs.

404-778-6880
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About Dr. Sethna

anita-sethna-avatarDr. Sethna understands that facial plastic and reconstructive surgery demand a marriage of science and artistry, and she enjoys using precision, skill, and vision to make her patients’ dreams reality. Dr. Sethna’s meticulous attention to detail and her passion for maintaining a natural look ensure optimum results for her patients.

A dedicated teacher, Dr. Sethna is devoted to assisting residents in facial trauma or reconstructive cases at Grady Hospital. She relishes the opportunity to educate residents and medical students in all aspects of patient care. Dr. Sethna has a strong interest in several areas of facial plastic surgery research and has presented at national meetings on the importance of resident and fellow education in rhinoplasty techniques and adjunctive measures to decrease discomfort during cosmetic procedures.