This procedure involves the injection of Botulinum Toxin or BOTOX® to reduce and/or remove worry and frown lines, "crow's feet", laugh lines, and other aging wrinkles almost anywhere on the face. It is widely used and is considered a safe.

The procedure physiologically weakens facial muscles beneath the skin that are related to expression lines. The contractions of those muscles result in wrinkles. BOTOX® blocks the impulses from the nerve to the facial muscles thereby relaxing them. The result is that the pull of the underlying facial muscles relaxes causing the skin to flatten to a smooth, unwrinkled look.

BOTOX®, a registered trademark of Allergan, Inc., works to soften the "worry lines" of the lower forehead, between the eyes (glabella), deep forehead creases, smile lines lateral to the eyes, and the vertical "smoker's" creases of the upper lip. It is also very effective in suppressing tension headaches and some types of migraine headaches. It also controls hemi-facial spasm and excessive sweating of underarms and palms.

SOFT TISSUE AUGMENTATION

Soft tissue augmentation is accomplished by various implantable substances that add bulk to tissue.  There has been a great evolution of new products.   Augmentation is either by injectable substances or by various implantable materials.  Each offers advantages and disadvantages and the choice of the material to use will depend on the perceived defect to be repaired, the desired result, possible complications, duration of effect, cost and recovery issues. 

GORTEX, SOFTFORM, ADVANTA

These are brand names for forms of woven Teflon that fall into the implantable filler category.  The differences in these products has to do with density, softness and shape.  Teflon is available in many forms. One is a paste that was commonly used to correct defects of the vocal cords, as a thin fabric used in clothing, as sheets, strands, or tubes used in implants, or as a mesh used in hernia repair.  It has been used as an implantable substance in man for over 25 years in applications such as arterial grafts.  It has been used to correct cosmetic deformities and to add bulk to tissues for over 15 years. 

Our bodies do not usually recognize Teflon as a foreign substance, so reactions to it are rare.  In facial plastic surgery, it is used most often to fill defects such as deep creases.  It does not absorb, so the correction should be permanent. Insertion is a minor surgical procedure done under local anesthesia.  Often there is a stitch or two that has to be removed a week later. 

Advanta is a 3rd generation material in this class and is the first artificial lip enhancement implant that has less than a 10% extrusion rate. (See the pictures above). 

COLLAGEN and other INJECTABLES

Collagen injectables such a Zyderm and Cosmoderm are no longer used in my practice. A newer product, Evolence, is also not used as other newer products offer easier introduction, longer life (of the implant) and less allergic potential. 

RADIESSE, a new injectable filler has been approved by the FDA for some soft tissue augmentation procedures.  It is a paste of calcium hydroxyapatite, a material found in bone and teeth.  It has been used in Europe for several years to enhance lips and fill deep facial creasing and its effects last for several years.  Allergy testing is not required.  Use for cosmetic purposes is considered "off label", but it has been proven safe in other areas and has been used in one form or the other for decades. Its most common use in my practice is to fill soft tissue defects of the cheeks and to fill in nasolabial lines.  Lip enhancement is no longer done with this filler because of inconsistent results.  It takes a couple of years for Radiesse to absorb completely although the visible effect rarely lasts more than a year.

RESTYLANE, PERLANE & JUVENATE

The products consist of stabilized hyaluronic acid which is a natural  component of our soft tissue.  The hyaluronic acid in these products is derived from non-animal sources and recombined for increased stability and extended tissue life. Juvenate differs from Restylane in that it is stabilized chemically with more cross links.  It requires less volume of injection to get the same result and theoretically should last longer.

Compared to Zyderm,  Restylane's augmentation effect lasts  2 to3 times as long (8 to 9 months on the average in one study and 6.4 months in another).  It is used to augment lips (improve contour and fullness), correct "smokers" lines of the upper lip, fill in deep nasolabial folds, erase smile lines, fill in the oral commissure (marionette lines), and erase worry lines from the forehead. 

The advantage of these products over collagen products such as zyderm is an extended effect and not needing a pre treatment skin test as allergic reactions have not been a problem. Another advantage is that it is not permanent.  Aesthetic values change over a period of time (I remember doing lip reductions in the 70's).  Styles change and permanent enhancement may not be for you.  The disadvantage is a longer period of swelling and redness (sometimes up to one week instead of one day) and the need for local anesthesia block prior to the injection of the implant material when used in the lips.  Restylane is for superficial lines.  Perlane, made by the same manufacturer, is for deeper lines.

SCULPTRA

This is a polymer of lactic acid and has been approved from the FDA for use in reversing the soft tissue wasting seen in AIDS. It is considered off label to use it in non aids patients, but I have found it to be well tolerated in my patients.  It is effective in filling in soft tissue defects in the face by attracting collagen, not by a direct filling effect.  It requires several treatments over a 3 to 6 month period and results in a lasting (not permanent) filling of the defect.

ARTEFILL

is a new permanent injectable filler that has just become available in the U.S.   It has been used very successfully in Canada and Europe for several years.  It is made up of Polymethylmethacrylate  (PMMA) beads suspended in Bovine Collagen (as a delivery system).  Its allergenisity is low, but skin tests are suggested as in zyderm use.  The collagen component absorbs, but the beads of PMMA are permanent.  Tissue filling is incremental.  Areas to be filled are not overcorrected and repeat fillings after 2 to 3 months are suggested until the desired results are obtained. Although the product is not absorbed, the effects are not permanent as aging changes progress according to ones own genetic code and environmental factors. 

ALLORDERM

is collagen in tissue form.  Specifically it is acellular human collagen.  Treatment to remove all the living cellular components of the tissue creates a relatively safe implant.  It has good bulk and has been used in lip enhancement, deep creases, and post surgical defects.  It often is completely absorbed within six months, but occasionally can give a lasting result.  Insertion is done in a similar manner as the SAM implant, a minor surgical procedure.

The Obagi "Blue Peel" is the final step in a skin care regimen to correct many aesthetically unpleasing skin conditions. Treatment begins with the 'Nu-Derm' system. The Nu-Derm uniquely combines specially developed products with medical supervision and counseling to treat your skin from the inside out. This system works on the surface to smooth roughness and correct damage, such as uneven skin tones and hyperpigmentation. It penetrates below the surface of the skin to stimulate proper cell renewal, improving circulation and helping restore your skin's natural moisture.

We will prescribe the Nu-Derm products designed for your skin type and condition, and will determine the proper course of action for you. During the treatment, you will experience three distinctive phases in the restoration of your skin health:

It is easy to maintain your new, healthy, younger-looking skin for a lifetime. Your skin health routine will be second nature to you.  And with our help, it will be simple to develop a maintenance regimen that fits your skin type and the nature of your skin problems. 

The Obagi BLUE PEEL is a 1-4 step application of blue solution mixed with TCA (Trichloracetic Acid). These applications will lead to the removal of thin surface layers of aged and damaged skin. Layers of dead skin cells exfoliate and are replaced by healthier ones allowing the skin's own clarity and tightness to resurface.

Who should consider an Obagi Blue Peel? Anyone with the following skin conditions:

• Blemish-prone skin
• Wrinkles
• Pigmentation problems
• Sun damage
• General poor skin quality

Obagi Blue Peel SHOULD NOT damage your skin. Complication rates are very low and will be discussed and clarified before the procedure is done. TCA will not cause toxic internal effects because it does not absorb through the skin

TCA Skin Peels can effectively improve many conditions, includingdull weathered skin, freckling blotchy pigmentation (including the mask of pregnancy), sun damage (including precancerous lesions), fine wrinkles and shallow acne scars.

TCA is a non-toxic chemical which has been used to perform skin peels for more than 30 years. Unlike some other types of peels, TCA peels have the additional advantage of creating a fresh natural appearing complexion, while preserving the normal skin color. For this reason, TCA peels are often referred to as "freshening peels".