Many of us would love to improve our appearance, but don’t have either the time or the inclination to have cosmetic surgery.   Fortunately, there are things that we can do to make amazing changes without surgery or a recovery period.

In this section I will explain treatment of wrinkles and creases of the upper face and then wrinkles and creases of the lower face.  The two areas are treated differently.  

Botox Cosmetic®

Crow’s Feet – Frown Lines – Forehead Wrinkles  

These problems can make you look look like you are frowning,
angry, tired, sad or generally older.

Originally used by ophthalmologists to treat nervous twitching of the eyelid, BOTOX Cosmetic^® has been used successfully for wrinkling since 1982.

BOTOX Cosmetic^® is actually a very tiny amount of botulism that is placed into the wrinkled area to flatten it. Some people wonder about using BOTOX Cosmetic^® . The best analogy I can think of is the story of Foxglove.

Foxglove is a plant found throughout Europe and, because of its beauty, was brought to North America.

The extract of Foxglove is highly poisonous. This extract was the poison used in Medieval Times for the ritual known as “Trial By Ordeal”! 

In 1775 Scottish doctor William Withering, who had written a book on botany, had a very sick patient. After telling him he was going to die, the patient went to a local gypsy, who gave him an herbal remedy.

Foxglove

He immediately got better!

Dr. Withering demanded that the gypsy show him the remedy and was surprised to discover it to be Foxglove, a plant he thought was poisonous!

After working on this remedy for 8 years, Dr. Withering brought Foxglove to the world of medicine only the name was of the medicine was changed.

Instead of Foxglove, a name known as a poison, this extract became known as Digitalis, one of the most important heart medicines of today!

BOTOX Cosmetic^® has a similar story. This medicine relaxes muscles. Creases and wrinkles are  often caused by hyperactive facial muscles. A common misconception is that the doctor should inject every wrinkle. In fact, BOTOX Cosmetic^® is used to treat the muscles causing the wrinkles. Relaxing the surrounding muscles takes the "crunch" off and allows the skin to smooth.

BOTOX Cosmetic^® is injected with a very tiny needle. After BOTOX Cosmetic^® injection, the muscles will relax and the skin will smooth out over about 5 days. The effect usually lasts about six months, and can be repeated when needed.

 There are very few side effects to this procedure. While allergy to any medicine is possible, it is rare with BOTOX Cosmetic^®. While a small amount of brow or lid droop is possible, it is unusual and can usually be avoided by not treating the area just above the outer portion of the brow. If it does happen, it goes away by itself. 

Originally used for treating nervous twitch of the eyelid muscles, it was discovered that many other areas can be helped.

BOTOX Cosmetic^® Treatment Areas

• Forehead
• Crow's Feet
• Frown Lines
• Chin Dimpling
• Upper Lip Creases - Smoker's Lines
• Down Turned Mouth Corners
• Neck Banding
• Armpit Sweating

BOTOX Cosmetic^® is one of the most popular cosmetic “mini-treatments” today. This procedure can be done on a lunch break and requires no anesthesia or recovery. Overall, the vast majority of patients love this "quick fix" and return for a BOTOX Cosmetic^® boost as soon as the wrinkles begin to reappear!

Fillers - Collagen ^®- Restylane ^®- Hylaform ^® - Sculptra ^® - Radiesse ^®

Weakening the muscle action of the forehead creases, crow's feet and frown lines with BOTOX Cosmetic^® is tremendously successful. This can not be done around the mouth or cheeks. If these muscles were weakened,  the smile and the expressions of the face would be changed. Fortunately, collagen can be used here.

Creases in the lower part of the face are best treated by filling them. Even a facelift can not flatten deep nasolabial grooves. The most popular choices for filling them are Fat and FILLERS. For large amounts, Fat can be harvested with a small suction procedure and reinjected. This fat, like collagen, will mostly dissolve over several months. For smaller amounts fillers are quicker, easier and require no donor site.

Collagen^®

is a Bovine (Cow) protein. Some people can be allergic to it and therefore a small skin test and a four week wait are mandatory. If no reaction occurs, a short office visit can result in fuller lips, smoother nasolabial folds, filled wrinkles and scars, reduced smokers' lines and a reduction in many other skin defects. This is not popular any more because the more modern fillers are longer lasting and do not have the degree of allergy problems that Collagen^® has.

Restylane ^®- Hylaform ^®

These are fillers made from Hyaluronic Acid, a substance that is naturally found in our bodies. In fact, it makes up the majority of the inside of the eye and our joint fluid as well as filling the spaces between all of our cells everywhere. These FILLERS are clear, long lasting and very forgiving. Because they are clear, they do not appear as a white substance in the beginning making them ideal for Lip Enlargement. They are actually able to be molded between the fingers for a few minutes after injecting, avoiding a lot of the early lumpiness we used to see with Collagen. They last much longer than Collagen as well. Hylaform ^® lasts a bit longer. Restylane ^® lasts many months longer.

Sculptra ^®

Sculptra ® is poly-L-lactic acid, a synthetic substance. It is not made from human or animal sources and does not have a significant degree of allergy associated with it so a skin test is not required. Poly-L-lactic acid (PLLA) is a biocompatible (does not harm the body), biodegradable (able to be broken down by the body) material that has been widely used for many years in surgical products. The effects were shown in a clinical study to last for up to 2 years after the first treatment. Sculptra ^® is different than other fillers in that it is felt to recruit your own tissue buildup over months. A minimum of three treatments is usually recommended to fill areas where the skin has thinned and fat has been lost. These treatments are usually spaced 2-4 weeks apart. While Sculptra ^®is long lasting, a small negative is that in many people small bumps can be felt under the skin and in a few people these can be seen. Most people, however, appreciate its ability to restore areas where skin thinning and fat loss are unsightly such as the backs of the hands.

Radiesse ^®

Radiesse ^® is made of very tiny, smooth calcium hydroxylapatite (CaHA) microspheres. The microspheres (particles) form a scaffold through which your body’s own collagen grows, and this produces the desired long-term effect. In my experience it is the longest lasting correction for tough areas such as the nasolabial folds (grooves coming down from the sides of the nose), cheekbones and creases in the chin area. People tend to really like this product for the fact that they can space their treatments much farther apart. Why then doesn't everyone use this? Because of its thicker consistency, it is more traumatic to inject. Most patients will have some swelling and bruising of the area injected for anywhere from a day to 2 weeks. Usually this can be covered by makeup.

General Filler FAQ's

While sometimes patients feel that their fillers did not last, we have found that the cause of this is almost always due to under-treatment to start with. If a patient says that he or she would like 1cc  and would like to treat their lips and nasolabial folds, they will unquestionably complain that the effect lasted for only a few weeks. In fact, the "effect" they saw was slight swelling from the injection, not adequate correction with fillers.

I find that to treat the lips adequately usually requires 1-1.5cc and each deep nasolabial fold requires 1.5cc. If treated properly, the results can be dramatic and last several months. Subsequent treatments require less because some of the initial treatment usually remains.

Topical anesthetic creams can be used but require hours to work so they need to be put on long before your appointment. For lip injections a small Novocain injection can be done in the area to numb the lip if you are sensitive to injections. Many ask the logic of trading one injection for another. It actually does make sense. The Novocain is injected above the lip which is less sensitive.

This procedure can be done on a lunch break and requires no anesthesia or recovery.