Dermal Fillers - Injectables
Facial wrinkles and creases are part of the natural aging process. The damaging effects of the environment also play a role in this process. Changes in our appearance occur as the collagen and elastic fibers in our skin begin to wear out. Fittingly, our first fillers were made from collagen, a protein naturally found in the skin of all mammals. These fillers created excellent results but the improvements didn't last very long and some people had allergic reactions to the collagen. It has been over 20 years since Collagen was first used, and there have been significant advances in the development of other products.
Fillers are injected under the dermis layer of the skin to correct wrinkles and fine lines and to add fullness to areas of the face such as the lips, cheeks and forehead. Today, the list of available products is quite long and can be confusing. Dr. Friedlander will explain the advantages and disadvantages of each after she examines you. She offers several different products which can be applied to the face achieving excellent results in a variety of areas.
All of the fillers except for fat come from the manufacturer in prefilled syringes. They are injected using fine needles, and contain lidocaine, a local anesthetic, making the treatment virtually painless. There may be redness or mild swelling that occurs after the procedure. Patients apply ice packs immediately afterwards and may resume normal activities after a short while.
Fat is filler, although technically not a dermal filler. It can be used in many areas of the face or body to improve wrinkles or contour deformities associated with scars. As we age, there is a natural loss of volume creating a hollow or deflated appearance. Fat can be used to augment these areas and restore facial fullness. It can also be used elsewhere on the body. Fat is a natural filler, harvested from excess body stores. It can be harvested in small quantities for facial transfer, or it can be harvested during routine liposuction and transferred to the face. It is natural, and has no risk of allergic reaction. The body recognizes the fat and nourishes it during healing. Much of the fat will survive the transfer process. As aging continues to occur, additional treatments will be required to maintain the improvement.
Hyaluronic acids are a group of naturally found carbohydrates in the body that hydrate the skin and help to replenish the natural volume. These products are not animal derived and are not associated with allergic reactions.
1) Juvederm® - Juvederm® is modern gel filler known for its flexibility. It is manufactured by the creators of Botox and Latisse, and is intended to improve facial wrinkles and folds. It is available in several formulations. Juvederm® Ultra is used more superficially to treat moderate and finer lines. Juvederm® Ultra Plus is intended for deeper use in more severe lines. They are an effective choice for vertical lines around the lips as well as deeper nasolabial folds (parenthesis or smile lines). They can also be used to enhance facial features or to add volume to the lips. Treatment is quick and easy. The product now contains lidocaine, a local anesthetic which results in a relatively painless treatment. The wrinkles are instantly improved and the lines are smoothed away.
2) Restylane® - Restylane®, like Juvederm® is a natural product intended to improve the signs of facial aging. It can be used in the same areas as Juvederm® but it is better suited for use in the tear trough region. It too, contains lidocaine, a topical anesthetic, rendering the treatment virtually painless
3) Belotero Balence® - Belotero Balence® is the newest addition to the HA fillers. Like the others, it will instantly plump the skin and fill the lines on the face when injected. It is a soft cohesive gel that quickly integrates into the skin, smoothing lines and wrinkles. Its properties make it uniquely suited for treating fine lines around the mouth and treating the deep groove under the eye called the "tear trough". Like the others, it too can be used in the nasolabial folds.
Radiesse® is excellent filler offering total facial contouring or augmentation of large areas. Radiesse® consists of calcium hydroxylapatite granules which are naturally found in the body. Because the product is not animal derived, there is little risk of an allergic reaction. It is mixed with lidocaine which allows a relatively painless treatment. It can be used to improve deeper folds and wrinkles such as the nasolabial folds, and to provide soft tissue augmentation of the cheeks and chin. Radiesse is ideal for restoring mid facial volume in patients who do not want, or are not ready for a face lift. It is considered a semi-permanent filler which may placed deeper in the tissue than the HA's and confers longer lasting results.
Artefill is the newest generation of FDA approved fillers to enter the market. It is intended for use in the nasolabial areas, and can be used to augment the marionette and jowl area. It consists of PMMA (polymethylmethacrylate) microspheres suspended in a highly purified bovine collagen gel. The PMMA microspheres are permanent and cannot be degraded by the body. Early on, as the collagen in the Artefill corrects the wrinkles, the PMMA microspheres provide the support needed for long term correction. Over time, the surrounding bovine collagen is gradually replaced by your own collagen conferring permanent status to the product, unlike the other dermal fillers which are absorbed after 9-18 months. Be advised that the body is not static. The normal aging process continues, so it is important to take a proactive approach and take appropriate measures to counteract the signs of aging.
Like the other dermal fillers, the Artefill is pre mixed with lidocaine, a local anesthetic which makes the treatment virtually painless. Artefill does contain a highly purified form of collagen. There have been reports of allergic reactions to collagen, and a skin test is performed at least 4 weeks prior to your treatment to ensure that you are not allergic to the collagen.
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