Non-Surgical Treatments: Fillers and Muscle Relaxing Agents


Before and after Sculptra® aesthetic to restore facial volume.

A variety of procedures are available to treat facial wrinkles, augment lips, and enhance provide a more youthful appearance. Most of these products have come out over the past 10 years, and represent the state-of-the-art advancements. Unlike older treatments, they do not require skin testing, as there is essentially no risk of allergic reaction, and while most are essentially temporary, results can last for as long as two years, depending upon the product.

These procedures are all office-based, most taking less than 30 minutes to perform.  To reduce any local discomfort during the injections, Dr. Epstein and his associates first numb the skin with a topical anesthetic, which can be supplemented by a local nerve block injection that takes 10 seconds to perform.  While there may be a bit of pinkness to the area(s) injected, this typically disappears within a few hours, and can easily be concealed by the use of make-up.  To prevent bruising that can take longer to resolve, patients are advised to stop taking aspirin and vitamin E for 10 days prior.

Restylane®, Perlane®, Juvederm®
These products are the most popular filler agents, due to their naturalness, ease of injection, and familiarity.  Perlane® is Dr. Epstein’s favorite, because it does a great job filling in nasolabial folds (smile lines), jowls, facial indentations/defects, and is an excellent for lip augmentation.  While not indicated for finer lines around the lips, it can be used for this indication when injected carefully.  Its duration is typically 9 to 12 months.  Restylane® is quite similar to Perlane®, except it is best indicated for finer lines, and typically has a shorter duration of 6 to 9 months.  Sometimes patients will have both products injected into the same area for the maximum improvement, as the Perlane® fills in the deeper part of the wrinkle while the Restylane® goes more superficial.  Juvederm® is similar to these products, but seems to be a bit easier to inject but not as long lasting.  Another popular use of these products is as a non-surgical rhinoplasty agent, where it can do such things as fill in depressions, increase tip projection, or rotate up the nasal tip.

Radiesse®
Radiesse® is an excellent filler for deep nasolabial folds (smile lines) and jowls, and can help restore volume to the midface (see Sculptra® below).  Another indication is for facial sculpting, such as to build up the mandible or cheekbones, as well as, like Perlane®, be used for non-surgical rhinoplasty.  It is a longer lasting product than most other injectables, for it contains some calcium hydroxyapetite.  Patients can expect 9 to 18 months of duration. 

Sculptra®
In recognition of the importance that midface fullness plays in creating a youthful appearance, Sculptra® is an excellent product for helping to address this area.  The longest lasting of all the injectables, its duration is as long as two years.  Typically given as a series of 2 to 3 treatments six weeks apart, Sculptra® is a volume-enhancing agent, restoring fullness to such areas as the midface or temporal regions, and can also be used to make more pronounced the jaw or cheekbones.

Before and After Sculptra® Aesthetic. This treatmen nicely restores volume to the face, creating a more youthful healthier appearance.

Dysport® and Botox Cosmetic®
These two products are not filler agents, but instead work by weakening or paralyzing the muscles that cause wrinkles.  While FDA-approved only for glabellar winkles (the vertical lines above the nose), they are also effective in reducing crows’ feet (squint lines along the eyes), reducing horizontal forehead wrinkles, and opening up the eyes by a non-surgical browlift.  More experienced doctors like Dr. Epstein will also use these products for other indications, including reducing fine lines around the lips, treating neck bands, and restoring an upturn to the corner of the mouth.  Since the mid1990s, Botox® had no competition, but in mid 2009, Dysport® receiving FDA approval and seems to work just as well as Botox®, being temporary (3 to 4 months for Botox®), 4 months or so for Dysport®, and is a bit less expensive.

Dysport®

"Can you please forward to Dr. E and tell him I love Dysport and of course him :) Took 5 years plus off my face!"

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