Posts Tagged ‘dermal fillers’

Ask the Doctor: How Does Botox© Work?

Botox Before and AfterBotox©, or botulinum toxin, is an injectable medication that stops muscles from moving over a short-term period, usually 3-4 months. In order for muscles to move, they must receive a signal, a chemical transmitter, which attaches to a receptor on the muscle and gives it the signal to contract. Botulinum toxin stops the release of that transmitter, so the muscle cannot move. In nature, though rare, this toxin is considered one of the most deadly toxins, because it can cause the muscles that help you breath to stop working. Over time, and after having been studied and perfected for almost 50 years now, Botox has become the number one cosmetic treatment the world over. Injected in very small doses, this medication can not only treat lines and wrinkles around the forehead, between eyes and the crows feet, but can also prevent the formation of new ones!

Botox is not only a cosmetic treatment, however. The first uses for Botox were for an eye muscle condition called strabismus. Spasms of the eye, migraines, large muscle movement disorders and voice tremors can also be treated with this effective and life-impacting drug.

The indications, both FDA-approved and not approved, for this medication are ever increasing. The key, however, is to ensure your treatment is performed in the very safest way possible. In order to save money, patients may frequent medical spas, attend “Botox” parties, sign up at dental offices, or other non-surgical specialties, thinking Botox at one place is the same as any other. In truth, the risks of having an injection into the wrong muscle group, or at too high a dose, can be far too great to engage in this type of cost cutting.

Make sure you undergo your injections with a board-certified cosmetic surgeon who performs injections on a regular basis, and has the understanding of underlying facial and neck musculature before undergoing treatment. Ask any questions that may concern you prior to your treatment as well as noting any precautions for after being injected. Botox is one of the most-studied medications we use today and has positively impacted the lives of many patients, both cosmetic and otherwise. When used safely, the vast majority is extremely pleased and loves their fresher and more youthful appearance.

If you are considering Botox©, or facial fillers, let the board certified physicians of the Emory Aesthetic Center help you decide what treatment is best for you.


About Dr. Sethna

Anita Sethna, MDAnita Sethna, MD, 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.

What Are Dermal Fillers and How Do They Work?

Dermal FillersThe world of facial injectables and dermal fillers can be overwhelming with all the options seen in print and TV ads. The biggest breakdown in classes of injections are between Botox® and it’s counterparts, Dysport® and Xeomin®, (hereby referred to as “neuromodulators” because they affect muscle nerve endings) and dermal fillers such as Juvederm®, Restylane® and Radiesse®. While neuromodulators are best used to affect lines caused by repetitive muscle motion, facial fillers are best used to enhance areas of low volume or deeper folds that are present at rest. For a straightforward example, frown lines between the eyebrows, crows’ feet outside the eyelids, and lines on the forehead are ideal for neuromodulator injections because these are due to motion. Decreased volume in the lips, smile lines around the mouth, or decreased volume in the cheeks is best treated with fillers to improve volume and support soft tissue.

There are many different types of fillers available in the United States. Some are permanent, such as Artefill, but most are absorbed into your body over time. The vast majority of commonly used absorbing fillers are composed of a material called hyaluronic acid, which is part of the normal makeup of our skin. Because of this, it is easily tolerated by the body and rarely has the adverse side effects that are associated with previously used collagen fillers. The hyaluronic acid fillers that are most used include: Restylane®, Juvederm® (including Ultra and Ultra Plus), Voluma®, Prevelle Silk, Belotero® and Perlane to name a few. Some of these are available premixed with lidocaine, a local anesthetic, to minimize discomfort associated with injection.

Radiesse®, also a commonly used filler, is made of a material called calcium hydroxyapatite. It is also dissolving but tends to be thicker in composition and is only injected deeper to avoid risks of visibility or lumpiness.

Sculptra, also categorized as a filler, is best thought of as a collagen-stimulator. This is intended for patients who need larger areas of gradually increasing, more subtle volume. Because of the composition of Sculptra, it is hydrated with water for 48 hours before injecting, and then it is injected in small doses throughout the tissues under the skin. The process of volumizing takes up to six weeks for each vial injected, with the recommendation of at least 3 vials to get to full correction per area treated.

So how do you determine the ideal filler for the area you are interested in treating? The best answer is to consider carefully what areas are most bothersome to you and make an appointment for consultation with a board-certified Facial Plastic or Plastic Surgeon with experience treating the face. Depending on the area of concern, the depth of the issue and the thickness of the material, your surgeon will determine the best product for injection. Each of us has cultivated years of experience with many of the fillers available on the market, and we have individual preferences based on those experiences. Feel free to ask questions, return for a second discussion or look at photos if you deem it helpful. Ultimately, what all of us want is a happy patient, so make sure your desires are communicated effectively to ensure your best result.

The board-certified cosmetic surgeons of the Emory Aesthetic Center can evaluate and work with you to develop a plan that is tailored specifically to your desires and needs.

About Dr. Sethna

Anita Sethna, MDAnita Sethna, MD, 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.

Skin Care throughout the Stages of Life

Skin Care StagesOne thing my experience as an aesthetician for over twenty years has taught me is that each client/patient has individual cosmetic concerns and needs. As you age, as seasons change, and as you go through different transitions of life, your skin will change as well. It is important to have a relationship with an aesthetician so that he/she can help you look your best through every phase of your life. As skincare specialists, we are trained to provide the proper treatments and ingredients to your skin to allow it to be at its optimal health. Below are some general skincare guidelines we recommend for the different stages of life:

  • In your thirties it is time to get serious about your skin care. Stop using bar soap on your delicate skin. Now is the time to begin using a facial cleanser morning and night. It is imperative to wear sunscreen daily with an SPF of 30 or higher – be sure to look for one that has a blend of antioxidants and moisture. For night, we recommend using a light moisturizer containing antioxidants, retinol or Alpha Hydroxy Acid (AHA) to give your skin the help it needs to stay rejuvenated.

Having regular facials every six to eight weeks will help keep the pores clean and hydrate the skin. Also, microdermabrasion is a great way to have your skin exfoliated and give it a very refined and polished look.

With our doctors, Botox®  may be a consideration if you are starting to see fine lines around the eyes and forehead.

  • In your forties you need to step up the game on your skin care. It is time for more advanced active ingredients. You will find these products at your cosmetic surgeon or dermatologist office. It is time to utilize the assistance of a skin care specialist to recommend proper products based on an evaluation of your skin. Washing your face with a cleanser containing AHA will help with exfoliating the skin to give it a nice glow. Using an antioxidant serum like will fight against the free radicals we expose our skin to everyday. Regular use of prescription grade retinol or tretinoin will boost collagen and elastin, as well as help to slow down the hands of time.

Intense Pulse Light (IPL) is a wonderful in office treatment that can assist in removing unwanted brown spots and broken blood vessels caused by sun damage. Medium depth facial peels are also an option to help give the face a lighter, brighter, and more supple appearance.

With our doctors, dermal fillers such as Restylane® , Juvederm®  and Voluma®  can be added to the face to help soften fine lines around the mouth and other areas of the face where needed. Botox®  can soften the appearance of lines around the eyes and forehead. Deeper chemical peels performed in the operating room are done for more advanced sun damage.

  • In your fifties it’s time to fight back the hands of time. Keep in mind that at this stage the skin is dryer and more fragile. Wash your face with a gentle hydrating cleanser morning and night. Never forget your daily sunscreen with an SPF of 30 or higher. Use products with DNA repair, growth factors and stem cells that will help trigger new cell growth. Make sure to continue your prescription retinol or tretinoin to slow down the aging affects. Always use night creams rich in hyaluronic acid that will help retain moisture in your skin.

Fractional Resurfacing is a noninvasive laser treatment that can help in smoothing fine lines and wrinkles. It can assist in tightening the face and neck multiple treatments are required for best results. Intense pulse light can help the appearance of rosacea and brown spots caused by the sun. Micro-needling with a growth factor is also a great choice to help stimulate collagen production in the skin. We recommend facials every four to six weeks to help with hydration and circulation.

It may be the time to build a relationship with a cosmetic surgeon to weigh the options of a liquid facelift using dermal fillers and Botox®  injections versus taking the plunge and having surgery. Finding a physician that you trust and feel 100% confident in is very important. Take the time to get to know your surgeon so that if and when you make the decision to have surgery you will be comfortable with your choice.

  • In your sixties your skin may be much more sensitive so protection and hydration is very important. Use gentle cleansers to wash your face morning and night. Wear a sunscreen with an SPF 30 or higher daily. Using antioxidants and hyaluronic acid will help protect and hydrate the skin. Using a mild exfoliate once a week will help give your skin a nice glow. Using products with DNA repair, growth factors and stem cells will help trigger new cell growth. Applying moisturizers with ceramides will bring long lasting hydration to the skin.

Having facials on a regular basis will ensure hydration and stimulation for your skin. Hydrafacials are a wonderful way to gently exfoliate the skin and infuse the face with antioxidants and hyaluronic acid using a special machine that helps penetrate deep into the skin. For an overall rejuvenation to tighten the skin, regain elasticity, minimize pores, and soften fine lines and wrinkles, we recommend micro-needling.

With our doctors, deep chemical peels can soften or remove lines and wrinkles around the mouth and tighten the skin. Botox®  and dermal fillers are a great non-surgical way to plump up thin lips, fill the lines around the mouth and soften the lines around the eyes and forehead. Discuss surgical options with your physicians if you considering facial surgery.

Call today for a complimentary skincare consultation with one of our licensed aesthetician at the Emory Aesthetic Center Spa.


New Year Refresh: Solutions to Remove Years of Aging

Remove Years of AgingAh . . . the New Year is already upon us, and while we take time to reflect on the year that just flew by, many of us are also looking at our reflection in the mirror. Perhaps that reflection is looking a little tired . . . worn . . . older than the energy you feel inside. Now is a great time to think about what you can do to refresh and rejuvenate that reflection, and get ready for your best year. More than ever before, there are many options to help you achieve this goal.

When you want your face to glow, you can’t ignore great skin care. It is that ongoing skin care that creates a base for everything else you might do for your face. Skin care means really protecting your skin from the sun with the right kind of sun block. It means using the right kind of moisturizers to keep the skin well hydrated. It may mean using targeted cosmeceuticals like retinoids, fruit acids, and other treatments to address fine lines, pigment irregularity, or texture changes. Getting on the right skin care regimen doesn’t have to be complex and it doesn’t have to be difficult – in fact it should only take a few minutes a day – but getting on the right regimen does take expertise. Working together with our licensed aestheticians of the Emory Aesthetic Center Spa, we can help you find the right mix of products tailored for your skin type.

In addition to the base of skin care, there are exciting technologies that you can use to make significant changes in your skin appearance. Lasers, IPL (intense pulsed light), and other energy based devices can tighten skin, fade dark spots, and treat those pesky broken veins. Facial peels can also be used to the same end, but depending on your specific needs, may need to be done in a series – peels are usually milder with minimal down time but may require a building up effect over multiple treatments. Or perhaps you might be a good candidate for a surgical peel or laser that may complete the treatment in a single stage. One newer technology that we’re very excited about is micro-needling, a process that combines tiny needles to stimulate collagen formation and the penetration of growth factors to rejuvenate the skin. Micro-needling takes only a few minutes and you’ll be able to put on makeup and be out the next day.

In addition to great skin care, injectables are highly effective treatments to smooth out wrinkles, grooves, or depressions. These minimally-invasive treatments come in two main forms – those that weaken the muscles that help prevent wrinkles, and those that fill in deeper wrinkles or plump up areas of the face. The “toxins,” such at Botox®, reduce the activity of the muscles of expression. They are used primarily to treat wrinkles of the forehead, between the eyebrows, and the “crow’s feet,” which are the wrinkles from squinting that occur at the corner of the eyes. There are several types of fillers which can be chosen depending on the individual needs and areas to be treated. Typical uses of fillers are to fill out the cheeks, soften the look of bags under the eyes, or to fill in the grooves near the nose and corner of the mouth. While Botox® may take a few days to develop effect, many of the fillers demonstrate an immediate effect. Both types of injections are done during an office visit and you can resume normal activities immediately.

As wonderful as skin care and minimally-invasive treatments are, there are some aesthetic goals that only surgery can produce. Need to get rid of those jowls? Is the skin under the chin loose and saggy? Is the skin of the eyelids loose and droopy, or is the brow low? In these kinds of situations, surgery comes to the rescue. A face lift or neck lift, a brow lift, or a blepharoplasty can provide long-lasting and dramatic results, and the recovery time may be a less than you think.

Depending on your age, skin type, genetics, sun exposure, and other factors, there are many potential treatment options to help you achieve the changes you want. To get the very best results, it is important to come up with a comprehensive game plan that is tailored specifically for you and your individual needs. The game plan may include minimally-invasive treatments like Botox® or fillers, it may include surgery, or it may just require routine skin care and products. The Emory Aesthetic Center can help you pull all these pieces together to create a strategy just for you. Come in for your complimentary consultation.


About Dr. Eaves

Felmont Eaves, MDDr. 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.

Related Resources

Facial Peels versus Lasers: Which is Better?

Peels vs. LasersFacial peels and lasers fall under the category of skin resurfacing, which includes treatments that improve skin quality. The improvements range from enhancing the complexion to the elimination of deep wrinkles, and everything in between.

Skin resurfacing is recommended to improve the quality of the skin, skin discoloration, wrinkles and even to some extent to tighten the skin. These treatments are not a substitute for facial surgical procedures or even injectables and dermal fillers, but instead, are regularly recommended as an adjunct to them.

Although the final effect on the skin may be the same for facial peels and lasers, they are very different processes and there is no simple answer as to which one is best.

Both lead to the shedding of the top layer of skin and stimulation of collagen in the deeper skin layers. Facial peels do this through the application of “acid “to the skin, while lasers do it through “heat “energy released by the laser. The acid and the heat result in a “controlled burn” of the upper skin layer. The upper skin layer is then replaced by new or regenerated skin which is smoother in appearance and more even in color. The depth of this “controlled burn “is adjusted according to the condition of the skin and the depth of the wrinkles. The more marked the skin changes, the deeper the treatment and the longer the recovery.

Facial peels are compounded chemicals that are general less costly, and have changed very little if at all over time. There is a variety of peels available ranging from Glycolic acid (fruit acids) to Trichloracetic Acid (TCA) to Phenol and Croton oil peels. The type of peel, the concentration and how it is applied to the skin regulate the degree and depth of the “acid burn”.

Lasers are sophisticated and expensive machines which improve with each new model. There are a variety of lasers such as CO2, Erbium, etc., and the application can be fractioned. The energy level, degree and depth of the laser treatment can be adjusted by turning dials on the laser machine.

Both peels and lasers rely on the experience and knowledge of the practitioner applying the peel or the operator of the laser machine. Lighter peels such as Glycolic acids and lighter TCA peels, as well as some laser treatments may be undertaken in medi-spas and skin spas. However, the deeper and more invasive lasers, and higher concentrations of TCA and Croton oil peels should only be performed by a trained physician in a medical facility.

So which is better? The end results are similar and you should follow the recommendation of your doctor who will choose the modality that will, in their experience, provide you with the best results and the lowest risk. The physicians and aestheticians at the Emory Aesthetic Center are experienced in both modalities and can provide an evaluation and recommendation based on your individual skin needs.

About Dr. Nahai

Foad Nahai, MDFoad Nahai, MD, FACS is internationally recognized as an innovator in the field of plastic surgery where he has developed and refined many procedures. He has co-authored ten books and published over 190 scientific articles on all aspects of plastic surgery. The latest book he authored and edited, published in 2011, is the second edition of his three volume text entitled The Art of Aesthetic Surgery.

He has been invited to lecture and demonstrate plastic surgical procedures all over the world. In addition to numerous professional honors and awards, he is listed in the “Best Doctors in America”, the “Best Doctors in the U.S.”, Town & Country Magazine, Good Housekeeping, More Magazine and Atlanta Magazine as one of the country’s top plastic surgeons. He has been listed in W Magazine as one of the top plastic surgeons in the world. Dr. Nahai is in demand internationally to speak at plastic surgery meetings and to demonstrate surgical procedures.

Dr. Nahai served as the 2008-2010 president of the International Society of Aesthetic Plastic Surgery (ISAPS), he is a past president of the American Society of Aesthetic Plastic Surgery (ASAPS), a former director of the American Board of Plastic Surgery, and is currently Editor-in-Chief of Aesthetic Surgery Journal.

His primary area of expertise is in Face, Neck and Eyelid surgery where he has made significant contributions to the advancement of the art and science of Facial Rejuvenation.

New Uses for Facial Fillers

AestheticsSure, we’ve all seen commercials featuring fillers for those smile lines, the “parentheses” of the face, and we’ve certainly all seen photos of Hollywood starlets who have added a little more volume to their lips. But can you do anything else with fillers?

Before we get to the fun stuff, it’s important to say that much of what we discuss in the next few lines is known as “non-FDA-approved uses” for fillers. That is to say, when the FDA approved these fillers, they approved them for injection into only certain areas (lips, cheeks and smile lines for example) because those were the areas that have been tested. With time, those of us with significant experience in injectables have expanded their use to other areas that need a little volume. This experience is vital—as cosmetic surgeons, we know where the muscles and soft tissues lie, what injections would have higher risks of complications, and into what tissue plane the least likelihood of risk would be.

Drooping brows: As we age, the tail of the eyebrow can start to droop towards the eyelid. This is in part because of bone loss to the rim of the eye socket, but also because of loss of collagen and movement of the fat pads around the eye. For very significant drooping, surgery may be the only option, but for those just noticing the problem, injection of some Restylane© or Juvederm© (both hyaluronic acid injectables) into this area can give some much needed lift and open the eye area dramatically. It may take more than one injection; some injectors like to use small volumes over 2-3 times, to get a gradual result, while others may inject 1-2 syringes at one time based on their personal preferences and the patients’ degree of volume loss.

Earlobes: Many patients with elongated ear piercings and loss of volume in the earlobe feel their ears make them look older than they really are. Placing a small amount of Restylane© or Juvederm© into the earlobe can support the ear piercing, allowing the patient to make their earrings more of a feature, and sometimes even wearing earrings a little more comfortable.

Temples: Another area often overlooked is the temples. Some patients have excellent cheekbones, and excellent midface volume, but the temples are hollow and sunken. Patients who are thin in the face in general tend to lose volume in this area quite significantly. Once the temples are volumized, the results can be quite exceptional, and allow the face to become more balanced. As we indicated earlier, this is a non-FDA approved area for injection, so experience with tissue planes and injectable types is crucial to obtaining good results. Many different types of injectable agents are used in this anatomic location. The choice will depend on your surgeon’s comfort level and preference, as well as your desire for the length of the result and extent of volume loss.

Radiesse® can be used in the temples as it lasts a long time and is injected deeply, in some cases, right on the bone. Sculptra® can also be used in the temples and is long-lasting as well, but requires some homework on the part of the patient as its main goal is to stimulate the patient’s own production of collagen, not to act as a filler in and of itself. And finally, Voluma®, which can also be injected in the temples, lasts just as long as Sculptra®, but doesn’t necessarily stimulate collagen production as its main purpose.

As experience with injections increases, and trends change, as they are likely to do, more and more uses for these versatile devices is sure to arise. As with all elective procedures, it’s crucial to feel comfortable with your injector. Experience is key, and complications can occur if the best product for a particular area isn’t used, or is used incorrectly.

Here, at the Emory Aesthetic Center, our cosmetic surgeons have extensive experience and can explain the treatment and side effects. We offer a full spectrum of options and will customize a plan that best fits your needs.

About Dr. Sethna

Anita Sethna, MDAnita Sethna, MD, 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.

Juvederm, Botox, Dysport, Sculptra, Restalyne: Understanding What’s What When it Comes to Injectables & Dermal Fillers

Dermal Fillers & InjectablesWhen it comes to dipping your toes in the pond of cosmetic injectables, the choices can be intimidating to say the least. Don’t worry, you’re not alone! Many patients enter into this arena with an understandable array of questions; hopefully the following explanation can help in understanding some of the available options.

The most common question asked at the Emory Aesthetic Center is often about the difference between “Botox©” and “fillers”. The simple answer is that injectables such as Botox©, Dysport© and Xeomin© (sometimes referred to as “neuromodulators”) work at the site of muscles to stop them from moving for a period of 3 – 4 months. These injectables are best used to treat areas where lines are formed due to repetitive motion: for example, the “frown lines” between the eyebrows, horizontal lines in the forehead, and “crows feet” around the sides of the eyes. Injections can be done in other places on the face, such as “lipstick lines” around the mouth, but these must be done by a surgeon well trained in the anatomy of this area as unintended (and unwanted!) consequences could result.

All three neuromodulators (Botox©, Dysport©, and Xeomin©,) work on the same principle and give similar results but are manufactured by different companies with their own proprietary methods. The choice of which injectable to use depends on the experience and comfort of your cosmetic surgeon as well as the possible subtle differences between them. Again, results last approximately 3 – 4 months in most areas, and take between 3 – 5 days for onset after injection.

It is important to understand that treatment with neuromodulators, like Botox©, does nothing to improve loss of facial volume, but is often a critical part of a well-crafted plan to enhance your overall appearance, improve and open up the eye area, and smooth the overall texture of the skin. Some studies have shown using these injections gives your brain positive feedback and improve your mood because of the inability to frown!

Dermal fillers, on the other hand, are ideally used in areas where lines or folds are seen at rest. Commonly treated areas include the cheeks, “smile lines” that run from the nose to the mouth, hollowing under the lower eyelids, sometimes the lips and even the temple area for loss of volume.

Starting in our 30s, skin has a tendency to lose collagen. Collagen contributes to the “plump” texture seen in the skin of most teens and young adults, but is damaged over time with sun exposure and naturally decreases with age. Along with other natural effects of facial bone loss, this can contribute to areas of hollowing in the eye area, folds around the cheeks and lips and possibly the early formation of jowls.

Juvederm, Restylane, Radiesse, Voluma and Sculptra are dermal fillers, and can counteract some of these changes by adding volume to these areas of loss. The decision regarding which fillers to use, and where, is often one that is guided by your facial or cosmetic surgeon. Preferences may be based on safety profiles for certain facial areas, or personal preferences based on experience and past results.

The longevity of these fillers can vary based on many factors: where the material is injected, and how deep the injections are performed. Some of these products have subtypes that have been formulated to be thinner or thicker based on the specific need. For example, an ultra thick form of a certain filler would be great to use in the cheek area, but not ideal for the subtle volume needed to fill a lipstick line. Sculptra or Radiesse would not be indicated for injection in under-eye areas or around the lips, so these are limited to cheeks, jowls, temples or cheekbones.

All of the injectables used at the Emory Aesthetic Center are FDA approved, however it is important for patients to understand that some of the facial areas listed above are non-FDA-approved areas for injection. Over time physicians have adapted these fillers for use in many areas of the face with good results. Because of this, seeking consultation and treatment with a cosmetic or facial plastic surgeon is not only preferred, but is the safest option. Practitioners who do not perform cosmetic surgery or do not understand the underlying anatomy can cause unnecessary risk, unneeded complication or adverse effects by “experimenting” in these areas.

Although the options seem endless and sometimes confusing, make sure you seek out professional advice from someone you trust, even if it requires more than one visit to feel comfortable. The best relationships will be ones maintained with cosmetic or facial surgeons who are able to address your particular concerns to your satisfaction. Here, at the Emory Aesthetic Center, our cosmetic surgeons have extensive experience and can explain the differences between all these treatments. We offer a full spectrum of options and will customize a plan that best fits your needs.

Related Resources:

Take-Aways from Dr. Sethna’s Cosmetic Injectables & Fillers Web Chat

Dr. Anita SethnaOn Tuesday, November 19th, Dr. Anita Sethna of the Emory Aesthetic Center hosted a live chat on the topic of cosmetic injectables and fillers. Injectables and fillers have revolutionized the field of facial rejuvenation by filling in areas of the face that are missing fullness and restoring volume, without the need for surgery. During the chat, Dr. Sethna answered questions about the different types of products offered, how they each work and what provides the best individualized solution. She also shared a special offer currently being offered by the Emory Aesthetic Center for a limited time discount on dermal fillers and injectables.

There were a few questions from the chat that we didn’t have time to answer, and as promised, Dr. Sethna answered them below in this post.

My friend got Sculptra injections. What is that? Is it the same as other fillers?
Sculptra is poly-L-lactic acid. It is a collagen-stimulating product that is injected in several areas around the cheeks, sometimes temples to assist your body in producing its own collagen. The product itself dissipates over weeks and in its place is the collagen your body produced. The product takes several weeks to take effect, so it is different from traditional fillers, and should last up to 2 years based on the FDA approval. Several vials usually need to be injected to obtain the ideal results, sometimes 3 or more.

Is it true that Restalyne is painful? Which procedures are the least painful? 

Any injectable can be perceived as causing some pain just because it is placed with a small needle–the injectable itself usually is not painful. There are several steps we try to take to reduce the discomfort associated with any injectable. We can use the preparation from the company that contains lidocaine (an anesthetic that is safely used as long as you are not allergic), we can allow you to sit with topical numbing cream which we do in most cases, topical ice right before the injection to numb the skin, and depending on the area to be injected, we can use a blunt needle that requires one needle prick to allow it to go into the skin, but after that, is rounded at the edge so it causes much less discomfort during the injection. These types of blunt needles can also have the benefit of less bruising and swelling in most cases. These days, injectables tend to be pretty easy to tolerate because of these measures, and if these interventions are appropriate for you based on your consultation, they can be done without spending a lot of time in the office.

How do these products affect people of color? Should you see someone who has experience on darker skin?
Most of these products are perfectly safe for use in people of color. Seeing a physician with experience treating your particular skin type is always an option but not always feasible. That being said, there are a few issues that are more common in patients with more pigment in the skin: dark spots, dry skin, melasma, etc. that may be more easily treatable by someone with this particular experience. Topical medications such as hydroquinone and tretinoin are safe in most patients as long as you are not pregnant or breastfeeding, and can have real benefit for patients with these issues. Once you begin discussing other interventions, such as laser treatments, surgery or peels, it becomes more important to seek out people with real experience with darker skin types. Topical medications rarely cause significant issues or complications that are not reversible but surgical interventions/lasers/peels can cause irreversible damage if done improperly.

Which brand of skin care products do you prefer? 
There are plenty of excellent skin care products, pharmaceutical grade, as well as some over-the-counter. There are only a few that I believe truly need to be obtained through a pharmacy or medical-grade spa–tretinoin being one of them. There are several companies that offer these products, and under several trade names: Retin-A, Refissa, Renova just to name a few. Each may be formulated slightly differently to appeal to a different skin type. SkinCeuticals and Revision make some excellent topical vitamin C products that can help with brightening the skin and are easy to tolerate. Several companies make excellent daily sunscreens as well, but for that, i am often using CeraVe or neutrogena products that are relatively inexpensive and easy to obtain at the drugstore. Regular facial moisturizers and cleansers are also fine to obtain that way, and I alternate between some cleansers at our Spa as well as CeraVe products and sometimes Cetaphil. I firmly believe the cosmetic counters that attempt to sell very expensive anti-aging products, with no medical grade ingredients, are not worth the price consumers pay for them. They have expensive additives and perfumes that have absolutely no effect on the structure of the skin and tend to be completely ineffective. I encourage my patients to spend money on the few products that are medical-grade that can effect change on the skin, and the rest they can purchase at the drugstore. I have yet to have problems with this philosophy and it has fared well for me as well!

What creams/moisturizers do you recommend for the face to prevent lines?
Importantly, the best cure is often prevention. Using sunscreen daily (at least SPF 15 or 30 and NOT just the “SPF that’s in your makeup”) can prevent the onset or worsening of lines around the eyes and on the skin. After that, using tretinoin is a fantastic way of reducing the signs of aging. Tretinoin is a vitamin A derivative (not safe in pregnancy or breastfeeding) that resurfaces the skin, stimulates collagen and reduces dark spots/sun spots. I’m a firm believer in using these products every night or every other night to prevent premature aging. Retinols (one step down from tretinoin) are easier to tolerate in most cases and in some preparations, can be safe around the eyes as well for fine lines that are difficult to treat with other OTC preparations. The best idea is to meet with a true skin expert (medical aesthetician, dermatologist, facial plastic surgeon, etc.) to obtain the best initial advice and get a few items that will truly benefit your skin, and continue to wear daily sunscreen!

What is a Life Style Lift?  It seems too good to be true.  I’m interested in having something done on my aging facial skin.  I’ll be 50 in January.  It’s time!!
Lifestyle lift is a proprietary technique that is only taught to those people who perform it under that company’s marketing and treatment guidelines. There are surgeons who “sign-up” for this participation and are taught a specific type of facelift that has been registered. This type of surgical procedure is one that has been done by many of us for many years, but no one thought to trademark it until a few years back so that it could be marketed with a particular message and brand. In most cases, it is a short-scar facelift that has benefits in the right type of patient–very little concerns in the neck, some need for tightening along the jawline but not for a patient with excessive heaviness in the neck and jowl area. At the end of the day, whether or not one of these “short-scar” facelifts, of which there are now plenty of trademarked names, is right for you depends on your anatomy, and your desires. The right surgeon will consult with you about your concerns and be able to explain what type of surgical or nonsurgical procedures you will need to address your these areas in the best possible way. The worst decision is the one made just on price and not taking into consideration what would actually make you happy.

Can you recommend any doctors in the NY area? Atlanta is a little far to go for an injection.
There are some excellent facial plastic surgeons in the NY area: Dr. Steven Pearlman, Dr. Andrew Jacono, Dr. Thomas Romo, III, Dr. Philip Miller to name a few. I have met them personally at many conferences where they have all been speakers and have had the pleasure of hosting some at our Emory facility as well. They have phenomenal professional credentials and I would trust any and all of them to take excellent care of you!

Thank you to those who joined in Tuesday’s chat. If you missed it, you can check out the chat transcript here and you can also check out our Emory Aesthetic Center website for more information.

See you next time!

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