Posts Tagged ‘injectables’

Facial Rejuvenation: Temporary versus Long Lasting Effects

temporary-vs-permanentLike most things in life, when considering a cosmetic procedure to rejuvenate the face, there are many things to take into account. For instance, some procedures are less invasive and have minimal recovery time; others are much more invasive and may require several weeks to fully recover. There is also the cost factor to think through as well. The right procedure for you will depend on many of these factors, along with the goals that you have.

For most patients, this comes down to a question of “Do I need surgery, or will non- (or minimally) invasive procedures give me the results that I’m looking for?”. There is no doubt that non-invasive or minimally-invasive procedures are inherently attractive as an option. They usually offer minimal or short-term discomfort, there are no scars to heal and fade, and patients don’t generally have significant bruising or swelling. Also, the cost of a single minimally invasive treatment is usually significantly less than that of a more aggressive, comparative surgical procedure. Examples of minimally invasive treatments include injectables like Botox© and dermal fillers, lasers and Intense Pulsed Light therapy, high grade skin care products, and skin treatments like chemical peels, facials, or micro-needling. These are some of the most common treatments performed in aesthetic centers.

So with all these great attributes and options for minimally invasive treatment, why do patients still often choose surgery? There are several reasons.

First, minimally invasive treatments are usually temporary. For example, Botox© (and similar products such as Xeomin© and Dysport©) do a great job of relaxing the muscles that create the wrinkles between the eyebrows (“the 11’s”), across the forehead, and in the corners of the eyes (“crow’s feet”). However, these muscle relaxers typically work for 3-4 months and then the effect wears off. This requires the patient to come back to the office for repeat injections. Dermal fillers typically last longer. Depending on the type of filler and the area treated, effects may last anywhere from six months to a couple of years. Some patients simply prefer something more permanent, and they want to avoid repeat treatments.

A second reason is that some aging changes cannot currently be corrected by anything but surgery. Examples include the development of jowling or of significant skin looseness in the neck area. Although some companies might hawk a magic cream or energy device to handle these kinds of issues, these don’t really work and the solution is a facelift (which includes lifting the neck). A facelift can dramatically improve these areas, and the results last for many years. Other examples of changes that require surgery as opposed to non-surgical treatments include significant droopiness of the brows or eyelids.

As plastic surgeons, we are reluctant to call the results of facial rejuvenation surgery “permanent,” although in many ways they are. Let’s say a patient undergoes a facelift and loves the improvement in skin tightness, the jowls, the neck contour, and the folds around the mouth. Once healed, these results will look good for many years. However, over the course of these years, the aging process will continue – skin will become more lax, and tissues may start to droop a bit. At some point, typically after 7-10 years or more, the patient may want to undergo additional surgery to treat these changes. But even at ten or more years after surgery, results are better than they would have been without surgery in the first place. The tendency for some recurrence over time varies by the different area of the face being treated. Brow lifts, upper eyelid tucks, and the neck portion of a facelift tend to last a long time and require repeat surgery less often, or never. Some recurrence of laxity in the lower face, however, is more common. Therefore, many patients may consider a secondary face lift 7-10 years or more after their first procedure. Of note, this secondary procedure may not need to be as extensive as the first procedure.

A third consideration is cost, and there is no doubt that surgical procedures typically cost significantly more in the short term. However over the years the cost of maintenance by means of repeated non-invasive treatments will continue to rise, often to the point that surgery can be far cheaper in the long run.

Finally, it is very helpful to think about temporary (typically minimally invasive) treatments and long lasting treatments (typically surgery) not as an “either or,” but as a “yes, and”. In other words, many patients benefit from both. For younger patients who are not yet ready for surgery, the less aggressive and temporary treatments are an ideal option. For older patients who are undergoing surgery, minimally invasive treatments can enhance and help maintain their results. It is extremely common that we “mix and match” various surgical and non-surgical procedures to offer patients the combination of treatments that will give them the best results.

If you are wondering about temporary versus long lasting treatments, and non-surgical versus surgical, the board certified physicians at the Emory Aesthetic Center can perform a comprehensive skin and anatomical assessment, and can help you think through the options and choose an approach personalized to you and your needs.

 

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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.

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.

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.

404-778-6880
emoryaesthetic.org

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.

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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.

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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