Facial Rejuvenation with cosmetic fillers a good option for fine wrinkles

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Facial Rejuvenation with Cosmetic Fillers
The very first signs of aging are the appearance of wrinkles on the cheeks and eyelids that are accentuated with smiling. With each passing year, as these facial wrinkles become progressively deeper with new lines beginning to appear, it is important to understand any underlying cause of the wrinkles before going for a rejuvenation treatment.

Types of wrinkles
The wrinkles can generally be classified as- dynamic wrinkles, static wrinkles and wrinkle folds. Most people have a combination of all three types of facial wrinkles, especially with advanced age. Regardless of your wrinkle type and your desired degree of correction, there is always a solution available for you as discussed below.

Dynamic wrinkles
The wrinkles that appear on the face can either be dynamic or static. Most common dynamic wrinkles appear between the eyebrows, across the forehead, and on the cheeks near the outer corners of the eyes, referred to as “crow’s feet”. These wrinkles can be corrected by weakening the muscles causing them. Muscle weakening done prior to the wrinkle formation is able to prevent them altogether.

Some of the muscles can be weakened permanently through surgery alone, or by injecting Botox into specifically targeted muscles to temporarily decrease the muscle action for approximately 3-4 months.

Botox Injections
The cosmetic form of botulinum toxin, manufactured by fermentation of Clostridium botulinum often referred to by its product name Botox®, is a popular non-surgical cosmetic surgery procedure. The injection has the capacity to temporarily reduces or eliminate frown lines, forehead creases, crows feet near the eyes and thick bands in the neck.

The mechanism of the action of toxin depends upon blocking the nerve impulses and temporarily paralyzing the muscles so that the wrinkles are removed giving the skin a smoother, more refreshed appearance.

Static Wrinkles
Static wrinkles are caused due to lack of elasticity of the skin caused from sun damage, smoking, genetics, poor nutrition, or from prolonged dynamic wrinkling. Static facial wrinkles are permanently visible regardless of muscle contraction, such as wrinkles on the cheeks and around the eyes.

Techniques that increase the thickness of the skin or remove the damaged skin are effective wrinkle treatments for static wrinkles. Laser skin resurfacing and deeper chemical peels remove the damaged skin and stimulate new collagen formation to improve the skin’s appearance, elasticity and thickness.

Topical creams and ointments such as Tretinoin (Retin-A), Vitamin C, serum, and new collagen growth factor formulas are good maintenance systems to restore and maintain the skin’s youthfulness.

Wrinkle folds
The third type of wrinkles, called wrinkle folds, are often due to sagging of the underlying facial structures, most notably causing the deep grooves between the nose and mouth known as the naso-labial groove. Surgical procedures such as face lifts, midface lifts, cheek lifts, and neck lifts offer the best corrective measures for these problems.

Alternatively, the folds can be camouflaged temporarily by plumping up the groove from beneath with substances like collagen or some other FDA-approved cosmetic fillers such as those discussed below. These dermal fillers typically last for anywhere from 3 to 9 months, depending on the material used and the location of the injection.

The recent trend of having a more natural look as against the "done" look offered by previous plastic surgery has led to an explosion in the field of cosmetic fillers.

While fillers will not replace the need for a face lift here are numerous applications of cosmetic fillers that create a subtle, beautiful and natural appearance. Fillers can be used for anything from smoothing out a little wrinkle to evening out a deep furrow to correct hollowness around the eyes, add fullness to thin lips, or balance a disproportionate face and to restore fat which is naturally lost from the face with aging.

Most of these cosmetic fillers can be classified as temporary (lasting a few weeks or months), semi-permanent (6-12 months) to permanent.

The material for these fillers is derived from various sources-- animal sources, donated human sources (yours or someone else's), or are they can be completely synthetic. Some of these cosmetic fillers are injected, while some are surgically implanted. The range in cost for one treatment can vary between a few hundred to a few thousand dollars. The information given below can help you in making your decision during your consultation with the plastic surgeon for an affordable plastic surgery.

Temporary injectable fillers
The very first signs of aging are the appearance of wrinkles on the cheeks and eyelids that are accentuated with smiling. With each passing year, as these facial wrinkles become progressively deeper with new lines begining to appear, it is important to understand any underlying cause of the wrinkles before going for a rejuvenation treatment.

Retin-A treatment

Bovine Collagen
Collagen is simplest and least expensive, injectable filler.

Location for the surgery In the office
Need for a skin test Yes, most people are allergic to bovine collagen
Time Required for the procedure 5 to 15 minutes
Need for anesthetic With or without the anesthetic or nerve block
The period of its lasting 2-4 months
Cost $200 to $400

CosmoDerm or CosmoPlast (FDA-approved for cosmetic corrective use) is human-derived collagen and is considered to be safer than bovine-derived collagen. Cosmoderm is used for minor skin defects; CosmoPlast is used for defects that are more serious. Overcorrection (injecting more of the dermal filler substance than what is typically needed to produce a positive outcome) is needed to achieve ideal results.

Lasts: 3 to 9 months

Restylane and Perlane
The newest and most exciting additions to the line-up of temporary, injectable fillers are Restylane and it’s thicker counterpart, Perlane both of which made from hyaluronic acid, a natural substance that creates volume in the skin.

Restylane is derived from bacteria and is used for more superficial wrinkling. Perlane is meant for use on deeper wrinkles. Overcorrection (injecting more of the dermal filler substance than what is typically needed to produce a positive outcome) is generally not needed with these substances, as it is for collagen or fat injections.

Restylane and Perlane can last from six months to one year.

One of the main advantages for hyaluronic acid fillers is that they do not pose an allergy risk.

Location for the surgery In the office
Need for a skin test No
Time Required for the procedure 5 to 15 minutes
Need for anesthetic A nerve block, topical cream anesthetic or a freon spray to numb the injected area. An injected local anesthetic or sedative drugs.
The period of its lasting 12 months
Cost Cost: $500 to $1000 /treatment

Permanent Fillers
As an alternative to injecting a substance that your body will eventually absorb, another class of fillers involves injection of a permanent substance. When this foreign substance is injected, the body naturally forms scar tissue around it to protect it from entering other areas of the body. This scar is made of collagen, which is a filler all by itself.

However, since the foreign substance is not biodegradable, it will stay in your body presumably forever. It can be an ideal permanent solution to your facial contouring, until it is not recognized by the immune cell of the body to cause excessive scars, creating firmness, lumpiness, inflammation, and migration of the substance. And since it is permanent, it is very difficult to remove if problems do arise. There are nearly 20 types of permanent injectable fillers, but the most commonly used are Silicone and Artecoll (made from the same chemical as plexiglas), though neither one of these is approved for use in the United States.

Permanent Filler Implants
Instead of injecting a filler through a needle, a minor surgical procedure can be performed in the office operating room to place a permanent implant. (These filler implants are not to be confused with facial implants used for cheek, chin, jaw, or midface augmentation). Filler implants are most commonly used for lip augmentation, but can sometimes be used to fill in the naso-labial grooves around the mouth. They can be shaped like tiny threads or strands, hollow tubes, or flat sheets of material that are trimmed to fit. The more commonly used filler implants are Gore-Tex and Softform. The procedure to place the implant is performed with local anesthesia, and swelling may be evident for several days. These implants can usually be removed if you decide you don't like the look, but otherwise they are permanent.

Natural Fillers
The final class of fillers comes directly from your own body, so there is no chance of rejection. Once the material is harvested, it is tested and processed to remove any substance that could cause an allergic or infectious response. Longevity of these human-derived products varies widely, as does the cost. The more popular ones are Alloderm (implanted), Fascian (injected), and Cymetra (an injectable form of Alloderm

Fat transfer
Fat transfer is a method whereby your own fat is removed from one area and then injected into the area where fullness is desired. It is an excellent alternative to fillers from outside sources, and is one of the more permanent wrinkle treatments.

Also known as fat grafting, fat transplantation, autologous fat transplantation, fat injection, or microlipoinjection, the procedure involves suctioning small amounts of fat, usually from the abdomen or flanks, processing it in a centrifuge to separate the fat from other substances, and then injecting the fat into the face for the desired effect.

Fat is most often used to fill in "sunken" cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimize forehead wrinkles and to enhance the lips.

The procedure: After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat is withdrawn using a syringe with a large-bore needle or a cannula (the same instrument used in liposuction) attached to a suction device. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site.

As with collagen, "overfilling" is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this overcorrection of newly injected fat may temporarily make the face appear abnormally puffed out or swollen.

Location for the surgery In the office
Need for a skin test No
Time Required for the procedure 5 to 15 minutes
Need for anesthetic Local Anesthesia
Side effects Some swelling, bruising or redness in both the donor and recipient sites
Care Staying out of the sun until the redness and bruising subsides - usually about 48 hour
The period of its lasting From several months to forever. Repeated injections may be necessary.
Cost Cost $2000 to $4500 /treatment

Dermal Grafting (does not require FDA approval for cosmetic corrective use) is tissue harvested from a patient and reinjected as a filler. It usually results in a scar at the graft site (where the tissue was removed).The grafted skin is then processed and formed to fit the area where it will be injected. A tiny point in the wrinkle or line is opened to create an area where the skin implant is placed. Because it is a graft, far less reabsorption occurs than with other dermal fillers such as collagen or fat.

Isolagen and Autologen

Both of these are grown from patient’s skin that has been removed surgically and then sent to a lab for processing and replication before surgical re-implantation several months later. Because of the work involved by the lab for storage and processing, this option costs several thousand dollars. As with all self-derived fillers, there is no risk of allergy or rejection, and no skin test is required. Longevity of these products varies from 6 months to several years or more.

Because the material is from the patient’s body, little risk of allergic response exists. Clinical trials are taking place in hopes of obtaining FDA approval. Research has shown it to be effective and it can last for up to 4 years.

Alloderm (FDA-approved for cosmetic corrective use) is processed from donated human cadaver tissue prepared in such a way that it retains its underlying structure. It has been used for a variety of surgical reconstructive procedures to replace lost, damaged, or diseased tissues. For wrinkles, it is considered stable and may last from 1 to 2 years, though controlled studies are not available

Cymetra is is a micronized version of Alloderm. This material is rehydrated with lidocaine in the physician’s office before injection so the procedure is far less painful. Because it is human derived, no skin test is required by the manufacturer. Clinical trials of 200 patients to date show no evidence of allergic reactions, however, transient bruising, redness, and swelling occurred at a rate of 2.1%, side effects that are true for most dermal fillers. Cymetra is not recommended for use between the eyes or around the eye area but is effective for nasal-labial folds and lip enhancement.

Sculptra(FDA-approved to restore or correct facial fat loss (lipoatrophy) in people with AIDS) is non nanimal-derived poly-L-lactic acid (PLLA) and is related to alpha hydroxy acids. It is not approved for wrinkles or general cosmetic use in the US but it has been used in 30 other countries as a dermal filler for several years. It can be used for wrinkles and acne scars as well as for general improvement in facial and lip contour. Results are not immediate and usually require multiple, biweekly treatments. It can last up to two years but usually requires touch-ups.

From injectables to implants, from complete face lift to eye brow lifts the options for facial contouring are seemingly endless. Consultation with your plastic surgeon helps you to choose the right treatment for you.

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