Injectables – A Time to Review

Craig W. Colville MD, FACS

When we think of injectables or non- invasive rejuvenation for the face many different ideas and thoughts come to mind. First, let’s distinguish the difference between dynamic smoothers, or neuromodulators, and rejuvenating fillers. One treatment is going to address the muscle that is causing unsightly wrinkles, or motion in the face, and the other treatment is addressing the lines that are on the skin while the face is at rest.

The most common, well known neuromodulator in the world is Botox®. Botox was first presented cosmetically to the market in 2002 when it was approved by the FDA to temporarily improve the appearance of moderate to severe frown lines between the eyebrows (glabellar lines), however, I was utilizing Botox in my practice 5 years prior.

We now have four neuromodulators on the market: Botox®, Dysport®, Xeomin® and Jeuveau™. All of these injectables are botulinum’s with a different side chain that makes them slightly different but similar. The point of all of these products is to slow down the muscle motion which would then slow down or decrease the facial wrinkling that my patients do not want.

Over time, chronic movement can often damage the dermis, the layer of skin between the epidermis and subcutaneous tissue. These repetitive movements cause lines and creases that are undesirable to patients. These lines lead them to seek treatment. The original filler that came onto the market went to a deeper level of the skin and helped with hard lines and depressions. The fillers on the market today have become much more refined. Some fillers are softer, some are more flexible, and some give a more lifted appearance. Rejuvenating fillers were originally designed to treat the Nasolabial Folds or smile lines but are now used to treat several areas of the face such as in between the eyebrows, the cheeks, and lips (lip lines or lip volume).

As we continue to progress with different types of fillers, we also have fillers that create soft tissue volume- think of lost volume in your cheekbones, the temples of the face, or even the hands. Two common soft tissue fillers for volume are Juvederm Voluma®, Perlane® Plus, and Radiesse® is a filler to add volume to the hands.  Radiesse is made of calcium hydroxyapatite (CaHA) microspheres that work immediately upon injection and gives a long-lasting result. Many of the other fillers that we use are made from hyaluronic acid. Hyaluronic acid is a clear gel substance that is naturally produced by your body. The largest amounts of it are found in your skin, connective tissue and eyes. Its main function is to retain water. Most of the hyaluronic type fillers that I use can last several years but they typically have a softer, more natural look and can create volume restoration. For this reason, these hyaluronic type volume fillers are great for over the cheekbone, down the jaw line and in front of the jowl area. For volume lost in the cheeks or hollowed cheeks, Sculptra® is ideal. Sculptra is injected into the hollow of the cheeks and gradually restores volume over time. The correction is not immediate but very gradual ensuing over several months.

When I have a consultation with a patient and we are discussing non-invasive or injectable options, I usually suggest a gradual start. I prefer to avoid the overdone, over injected look that can be very difficult to reverse. Some patients don’t want more volume, in fact, they are looking for less volume especially in areas like the jowl, double chin, or neck. Kybella® is an injection that can dissolve adipose tissue, or unwanted fat in those areas of the lower face. Kybella can also be used off lable for dissolving fat around the bra line, anterior axilla or armpit area. To get the optimal results, Kybella is typically injected two to three times over several months.

Botox and fillers, (injectables) are wonderful for nonsurgical facial rejuvenation, but it is important to remember that this is a medical procedure that should be done by a Board Certified Plastic Surgeon, like myself, or a Certified Aesthetic Nurse Specialist that is working with me. Injections can come with side effects such as bruising and or swelling. Most of these side effects are temporary and resolve themselves within the first couple of days after the treatment. With all of my new patients, I reiterate the importance of keeping a record of where they are starting, and what their desired result is. During my consultations I prefer to utilize my Vectra 3D Imager. With a 3D image of the face or the injection area, we can track the progress and see the changes over time.

In the past 17 years Botox Cosmetic has managed to become a household name and has even been referred to as a mood booster- even the term “frown lines” is not a happy phrase. Knowing that as we age, wrinkles and unsightly lines can easily be treated brings my patients a peace of mind. If you have ever considered injectables don’t hesitate to contact my Toledo, Ohio office or on my website. I would be glad to discuss any of the above-mentioned treatment options with you and help guide you on the best treatment plan designed to give you the best results.

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