Cosmetic Surgery: Promises and Pitfalls™

Filler Treatments for Anti Aging Skin Care: Youth in a Syringe?

OUR APPROACH 

• Fillers are recommended only after a complete facial evaluation by one of our surgeons. These treatments are then applied when appropriate.
• Treatments are carried out by our physicians, as we believe there is risk related to any procedure and we strive to minimize this risk. Further we believe the results are technique dependent, and, therefore, the procedure isn't delegated to an assistant.
• Our selection of fillers is based on two factors: safety and effectiveness.

SYNTHETIC FILLERS 

No ideal filler is available, since most are very expensive and, more important, temporary. (Collage, Zyderm, Zyplast, Cymetra, etc.) Also, there are many new and "promising" fillers touted in the media and in advertising, however, most of these fillers are unproven and often lack FDA approval.
Recent fillers which have been released for use by the FDA are:

• RESTYLANE (Restylane website) was approved on December 12, 2003, for human use for the correction of fine wrinkles and has become the standard for other fillers to be compared to! Restylane is a crystal-clear biodegradable hyaluronic acid material which is injected into the dermal (deep layer of the skin) to fill fine wrinkles immediately.
   
  Hyaluronic acid is a polysaccaride (a type of sugar) that occurs naturally in the human body. Its most important function is to carry and bind water. Non-animal hyaluronic acid does not contain animal protein and does not require a skin test prior to use. It can be used to reduce fine wrinkles, deep folds and augmenting lip fullness. Treatments can result in temporary swelling, redness and tenderness.
   
  The duration of the effects of Restylane is reported as 6 to 12 months. However, in our experience, the duration is 6 months maximum and in a highly mobile are such as the lips, it may last only 3 months.
   
  Our experience with Restylane has been extremely positive. It is a very effective filler for deeper smile lines (nasolabial folds -- the deep lines from the nose to the side of the mouth), lip augmentation, etc. Early patient satisfaction has been impressive, with no down-time and immediately observable results -- instant gratification! The major disadvantage of this product is the short duration of its action.
   
• JUVÉDERM™ (Juvéderm website) This is the latest hyaluronic acid filler. Its use and properties are very similar to Restylane but it has the primary advantage of longer duration of action. According to the Juvéderm™ website it is the "next generation of filler" and lasts "6 months or longer." Since it is new we don't know its actual longevity. It can also be safely used in the lips.
   
• RADIESSE^® (Radiesse website) is a long-lasting synthetic filler material that is approved by the FDA as a soft tissue augmentation in two specific areas: the vocal cords and the bladder. Specific use for face wrinkles is pending, but its use "off label" is permitted. We are using this synthetic material to fill skin depressions and deep folds.
   
  Radiesse^® has immediately observable results, lasts 1.5 – 2 years and has very little risk of allergic reaction. It is calcium hydroxylapatite, a substance found in bone that is made into an injectable paste. When used in the lips, some lumpiness has been observed, therefore we are not using this material for lip augmentation. Although we have had only short term experience with this filler, we have been very impressed with the ease of administration and results.
   
  We have found this gel to be very effective for augmentation of depressions and softening the nasolabial folds ("laugh lines").
   
  See our special offer about Radiesse injections for skin wrinkles: good until August 1st, 2008.
   

Two other fillers you may have heard of:

• INJECTABLE SILICONE is NOT approved for use in the USA. And in fact the FDA in 1991 banned its use for the treatment of wrinkles. Injectable silicone tends to harden, migrate, cause skin inflammation, and other problems.
   
• FAT TRANSFER FOR AUGMENTATION OF LIPS AND DEPRESSED AREAS OF THE FACE AND BODY. We use autologous fat (the patient's own fat) for filling large defects and the lips. The use of autologous fat transfer is not a new technique, but methods vary in obtaining and injecting the fat. It is believed that the methods used may determine the length of survival of the fat cell and therefore, the effectiveness of this procedure. Our technique involves the use of "cell-friendly" cannulas, gentle gravity separation of the fat, and the timely transfer of the fat. Fat when properly obtained, handled, and injected has the potential of "taking" like a tissue graft. The major drawback of this material is the uncertainty of the graft "take" and therefore its effectiveness and longevity.

 
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