Non-Surgical Treatments: Fillers and Muscle Relaxing Agents
Before and after Sculptra® aesthetic to restore facial volume.
Patient is shown immediately after Sculptra® to the right cheek/midface area, while the left side has not yet been treated. Note the fuller more volumized appearance which provides a more youthful look.
To treat facial wrinkles and augment lips, a variety of procedures are available to enhance and provide a more youthful appearance. Most of these products have come out over the past ten years and they represent the state-of-the-art advancements. They do not require skin testing unlike older treatments as there is essentially no risk of allergic reaction. While most are essentially temporary, results can last for as long as two years depending upon the product.
These procedures are all office-based and most take 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 to reduce any local discomfort. This can be supplemented by a local nerve block injection that takes ten seconds to perform. While there may be a bit of pinkness to the area(s), this can be easily concealed with makeup and typically disappears within a few hours. To prevent bruising, which can take longer to resolve, patients are advised to stop taking vitamin E and aspirin for ten days prior to the procedure.
Restylane®, Perlane®, Juvederm®
Due to their naturalness, ease of injection and familiarity, these products are the most popular filler agents. Dr. Epstein's favorite is Perlane® because it does a great job filling in nasolabial folds (smile lines), jowls, facial indentations/defects, and is excellent for lip augmentation. While not indicated for finer lines around the lips, when injected carefully it can be used for this indication and the duration is typically 9 to 12 months. Patients will sometimes have both products injected into the same area for maximum improvement. The Perlane® fills in the deeper part of the wrinkle while the Restylane® stays more superficial. Juvederm® is similar to these products, but seems to be a bit easier to inject and does not last as long. Another popular use of these products is as a non-surgical rhinoplasty agent which can increase tip projection, rotate up the nasal tip, or fill in depressions.
Before and immediately after "nonsurgical" blepharoplasty - using Perlane® to fill in the tear troughs
Radiesse® is an excellent filler for the jowls and deep nasolabial folds (smile lines). This can help restore volume to the mid-face (see Sculptra® below). Another indication is for facial sculpting, such as to build up the cheekbones or mandible and, like Perlane®, can be used for non-surgical rhinoplasty. This is a longer-lasting product than most other injectables as it contains some calcium hydroxylapatite. The patient can expect the injections to last for a duration of 9 to 18 months.
In recognition of the importance that mid-face fullness plays in creating a youthful appearance, Sculptra® is an excellent product for helping address this area. With a duration of as long as two years, it is the longest lasting of all of the injectables. This is typically given as a series of two to three treatments six weeks apart. Sculptra® is a volume-enhancing agent which restores fullness to such areas as the temporal regions or mid-face and can also be used to make more pronounced cheekbones and a more pronounced jaw.
Patient shown before and after Sculptra® aesthetic treatment. Volume has been nicely restored to the face, creating a more youthful, healthier appearance.
Patient shown before and after Sculptra® aesthetic treatment. Volume has been nicely restored to the face, creating a more youthful, fuller appearance.
Dysport® and Botox® Cosmetics
Dysport® and Botox® are not filler agents, but instead work by weakening or paralyzing the muscles that can cause wrinkles. While FDA-approved only for glabellar wrinkles, which are the vertical lines around the nose, they are also effective in reducing crow's feet (squint lines around the eyes), reducing horizontal forehead wrinkles and opening up the eyes by a non-surgical brow lift. More experienced doctors, like Dr. Epstein, will also use these products for other indications including: reducing the lines around the lips, restoring an up-turn to the corners of the mouth, and treating neck bands.
Since the mid1990s, Botox® had no competition, but in mid 2009, Dysport® received FDA approval and seems to work just as well as Botox®. These products are temporary, lasting typically three to four months, and are extremely effective.
Patient shown before and after Botox Cosmetic® to the forehead.
Patient shown before, two days after, and five days after Dysport® to crow's feet.
Testimonial for the patient above:
"Can you please forward to Dr. E and tell him I love Dysport and of course him :) Took 5 years plus off my face!"