Manipulation of the soft tissues to mask the signs of facial aging or augment anatomical features to improve definition and shape has become very common place. With a great track record of safety and the potential for excellent results this is hardly surprising. Injectables will never achieve some of the relatively permanent and outstanding results of Facial plastic surgery.
Not everybody needs surgery however to achieve satisfaction, particularly the younger age groups and in fact even those who have surgery can often fine tune their result with either soft tissue fillers or neuromuscular relaxants. I tell all my patients that to get the best results one always needs to select the advantages of both non surgical and surgical treatments and taylor fit these to their particular needs.
With most injectables the needles are so tiny that discomfort is minimal and even a local aneasthetic is rarely required.
These are extremely popular and in the hands of a skilled practitioner results can be staggering. Many facial lines and wrinkles are caused by the action of the facial muscles of expression pulling or wrinkling up the skin. This happens as facial skin ages and looses its natural elasticity and the muscles have to work harder to maintain the facial fat pads in position as they slowly droop with age. Botulinum Toxin A is a family of neurotoxins that can be used to soften the action of these muscles reducing the number of wrinkles, or getting rid of the ones you don’t want. Skilful application can often give really quite natural results. Like all things though if over used or poorly placed can spoil facial expression giving a paralysed and unnatural look.
Popular treatments for treatments for lines and wrinkles include Vistabel Azzalure and Dysport
These toxins are differentiated by their time to onset, duration of effect (the clinical effects of Botox are typically 3 to 4 months), and the distance of effect from the injection site. Risks include bruising at the injection site, rare chance of an infection, and the possibility of unintentionally affecting nearby muscle groups.
‘Filler’ is the generic term used to describe substances injected into the face to either fill out from underneath a deep wrinkle or scar or alternatively add volume and substance to an area of the face that with age has become depleted of volume or lost shape. When used in this manner they can also give a subtle lift. They may also be used to augment natural features that look better slightly enlarged or slightly reshaped and defined such as lips and noses.
Most modern fillers are based on hyaluronic acid (HA), which is a sugar found naturally in human skin. When first introduced, a major benefit of this filler was that allergic reactions are extremely rare, and no pre-treatment skin testing is necessary. These compounds bind water similar to the way a sponge absorbs water. Because of this, they hydrate the skin in the treated region and act as a cushion. Many manufacturers have come out with versions of HA fillers, and formulations vary with the size of molecules (governed by the amount of crosslinking) and other components of the injectate (such as local anesthetic to help decrease the discomfort associated with injections). The various formulations expand the repertoire of options available to us, as certain products are better suited for different anatomical regions. Hyaluronic acids are eventually absorbed by your body, and the length of time is dependent on a multitude of factors including the patient, the location of injection, and the particular product used. Results last from 3 months in high mobility areas (such as the lips), and up to 1 year in regions such as the nasolabial folds, with most patients experiencing the desired effects for 6 months.
A newer class of fillers has been introduced that is based on microsphere technology. Radiase is the best example of this. Microspheres are tiny round particles of solid material that are relatively uniform in size. Two formulations are FDA approved for use, differing in design and expected longevity of results. These products are used for volume replacement and for deep facial wrinkles (such as the nasolabial folds.) They are not approved for use in the lips.
Radiesse contains mirospheres are made of calcium hydroxylapatite suspended in a gel carrier. The filler is broken down by the body in two phases, first the carrier and then the spheres. During this process, collagen ingrowth occurs, which is expected to provide a long lasting effect. This prolonged degradation process makes Radiesse a longer lasting filler than those previously discussed, with expected results lasting a year or more.
Sculptra contains a polylactic acid similar to an absorbable suture used by surgeons for decades. It causeses a local inflammatory reaction encouraging the laying down of collogen fibres and helping to volumise the area it is injected into. A series of injections is usually needed and the results usually last over a year.
Although there are many options available, there is no “one best product” for any particular use. Our recommendation is to consult with an ASAPS member physician to discuss your areas of concern, and to hear the options they suggest. If you are considering soft tissue fillers, it is a reasonable practice to first try short acting agents to be certain that you enjoy the effects of treatment before utilizing longer acting agents. Your physician will have their personal preference regarding a filler or neuromuscular agent that gives good results in their hands, and together you should be able to choose a treatment regime that matches your desires.