TREATMENT’S FOR WRINKLES, LINES, AND FACIAL FOLDS

(INJECTABLES, FILLERS, LASER’S/IPL, & CHEMICAL PEELS)

It is important to understand that a Facelift treats excess “hanging” skin of the face and neck. It does not treat the skin wrinkles. Vice/Versa, the treatment of wrinkles will do nothing to improve the “hanging” skin of the face and neck.

THE TREATMENTS FOR WRINKLES ARE:

FILLERS - within or under the skin. (I.E. COLLAGEN, FAT, ALLODERM, RESTYLANE (HYLAFORM) GEL).
SKIN RESURFACING/ SKIN REJUVINATION - within/on top of the skin for fine wrinkles, skin texture, brown spots, blood vessels, etc.: LASER SKIN RESURFACING (Derma-K), QUANTUM LASER/IPL (INTENSE PULSED LIGHT), CHEMICAL PEEL (I.E. BLUE PEEL).
MUSCLE RELAXATION - weakens/relaxes facial muscles to minimize wrinkles: BOTOX.

OVERVIEW: As we age, or faces begin to show the effects, such as; thinning of the lips, sun damage, and wrinkles, lines & creases from making various facial expressions (i.e. laugh lines, smile lines, crow’s feet, etc.) Soft tissue fillers can be helpful in filling these lines & creases, restoring a smoother, more youthful appearance. These fillers can be temporary or permanent. The two types of fillers are implants/graft and injectables. These fillers can be used alone or in conjunction with BOTOX®, Chemical peels, IPL treatments, and a skin resurfacing procedure, such as laser skin resurfacing for an even better facial rejuvenation treatment. The following summary describes the three categories of agents listed above.

RESTYLANE (Filler-within the skin):

FILLERS - WORKS WITHIN/UNDER THE SKIN

COLLAGEN (Filler-within the skin): This is a temporary, injectable filler, like Collagen, made from a stabilized hyaluronic acid used for the same indications as Collagen. Restylane gel adds volume to your skin structure by mimicking the hydrating effects of you skin’s natural hyaluronic acid. There is no pre-treatment skin test required before treatment. Common side effects are mild with minor bruising and swelling, which usually subsides within 1-2 days. The cost is $400.00 per “cc”.

FAT (Filler-under the skin): This can be permanent after multiple treatments. The fat transplant treatment involves taking fat from you own body and re-injecting it into facial lines, defects, or to enhance the lips. Since, the fat comes from your own body, it is safe, natural, and non-allergenic, so you can’t have an allergic reaction to it. The procedure can be done using local anesthesia or general anesthesia. After the procedure, you will have significant swelling for the first couple of weeks. You may experience some bruising, which can be covered with make-up. Any discomfort can be controlled with pain medication. Usually, over the first few months following the procedure, about 65% of the fat will be absorbed by your body. The remaining 35% will usually stay in place for years. The procedure can be repeated 2-3 times to become more permanent. The cost is $900.00 and up per area.

ALLODERM (Filler-under the skin): This is a permanent homologous collagen implant/graft that is used worldwide by plastic, reconstructive, dermatologic, oral, and cosmetic surgeons. It is mainly used in my practice to attenuate deep folds around the nose and mouth and to enhance the lips. However, it can be used in many other areas. When this material is implanted into the body, cells repopulate and blood vessels grow into the graft, and the graft becomes your own tissue. This process generally takes several months. It is a soft, pliable, natural feeling implant and is the only implant capable of regenerating normal tissue. Since it is human tissue, it cannot provoke any inflammatory or allergic response. Other types of implants, such as, Gortex and Soft Form, are available, but I rarely use them since they are foreign bodies, unlike Alloderm, and can be visible and palpable. The procedure may be repeated to achieve optimum results. This procedure can be done under local anesthesia. After the procedure, you may have mild bruising, and the implant will be palpable, and may remain swollen for several months. Any discomfort can be controlled with pain medication. The cost ranges from $950.00 - $1,250.00 per area.

SKIN RESURFACING/ SKIN REJUVINATION - WORKS WITHIN/ON TOP OF THE SKIN

ASER SKIN RESURFACING (Within/On top of the skin): Laser Skin Resurfacing is a procedure that smooths the facial skin by using a laser to refinish damaged areas, shrink fine wrinkles, and correct uneven pigmentation for a younger, smoother complexion. There are various pre-treatments and instructions given prior to and after these treatments and the effects can be lasting. Laser Skin Resurfacing (Derma-K) is the most aggressive skin treatment and requires General Anesthesia. The acute healing phase of healing usually takes 10-14 days. During this time you will be applying Vaseline on the treated area several times a day to keep it moist. Usually at about 10 days after the procedure make-up can be applied to camouflage the redness of the skin that lasts about two months. The cost is $2,900.00 for the full face.

QUANTUM LASER/IPL TREATMENTS (Within/On top of the skin): These treatments work at various degrees in improving the texture of the skin and making fine wrinkles, sun damage, and blood vessels less visible. There is no pre-conditioning of the skin and requires a series of five treatments done every 3-4 weeks. There are various instructions given prior to and after treatments to follow and the effects can be lasting. The treatments can be done while awake. A topical skin numbing cream will be applied to the skin prior to treatments. Common side effects are mild with minor redness and swelling which subsides in a few days. Occasionally, blood vessels and pigmentation may darken initially, but should subside within a couple of weeks. The cost is $400.00 for each treatment, Total: $2,000.00 for five treatments.

CHEMICAL PEELS (Within/On top of the skin): Chemical peels work at various degrees to improve skin texture, acne scarring, fine wrinkles, and sun damage. The most aggressive chemical peel that can be done while awake is the Blue Peel. An injection of Demerol can be given before the procedure to help with the discomfort. Pre-conditioning of the skin prior to treatment is required and various instructions will be given to follow. The effects can be lasting. Common side effects are minor swelling, and a brown mask will appear 1-2 days after the treatment. The mask will gradually peel off within about 6-10 days. Usually, make-up can be applied 8-10 days after the treatment. The cost is $400.00 for one area and $50.00 for each additional areas.


Diagnosis: Fine lines and wrinkles, Laxity, and Sallowness	Treatment Protocol: Obagi Nu-Derm® System Moderate Program Duration of Treatment: Photo taken at 14 weeks

Diagnosis: Moderate photodamage, Fine lines and wrinkles	Treatment Protocol: Obagi Nu- Derm® System Moderate Program and Obagi Blue Peel® Duration of Treatment: Photo taken at 12 weeks

Diagnosis: Photodamage	Treatment Protocol: Obagi Nu- Derm® System Moderate Program and Obagi Blue Peel®Duration of Treatment: Photo taken at 12 weeks

MUSCLE RELAXATION - WORKS ON FACIAL MUSCLE

BOTOX (Weakens/Relaxes facial muscles): BOTOX® is a natural, purified protein produced by the Clostridium botulinum bacterium. Very low doses are injected with a fine needle directly into overactive muscles that cause line between the brows, crows feet, and forehead lines. It usually takes effect within 7 days and lasts for about 2 to 4 months. BOTOX® is effective, but not permanent, though if you repeat the injections, the effect each time will last longer. After the procedure, you may experience some minor bruising and swelling, but this usually subsides within 1-2 days. The cost is $400.00 for the first area and $200.00 for each additional area.

MY RECOMMENDATIONS

For a temporary “quick fix” with practically no down time, I recommend the Restylane (Hylaform) gel or Collagen. Restylane costs a little more, but there is no need for a skin test to be done prior to treatments, and is less likely to cause an allergic reaction.

For a permanent result, I recommend a Fat Transplant or an Alloderm implant/graft, depending on the area to be treated. A fat transplant gives a more noticeable improvement, but there is more swelling involved during the first couple of weeks as compared to the Alloderm procedure. Certain areas on the face do not respond to the fat transplant, such as, the nasolabial folds and genomandibular folds (deep folds around the nose and mouth). In these areas, I always recommend Alloderm. Ultimately, Alloderm is less expensive than the Fat Transplant because it needs to be repeated at least once vs. Alloderm. For this reason, I recommend Alloderm for Lip Augmentation since it is more predictable.

FOR OPTIMUM RESULTS

I recommend a combination of fillers, Laser Skin Resurfacing/IPL Treatments/ Chemical Peels, and BOTOX® to maximize the treatment of wrinkles and improve the skin texture. Treating skin flaws from inside, as well as from the outside is the most effective way to maximize your results.