Cosmetic surgical procedures can produce profound, long lasting changes in facial appearance, but are invasive and have an associated recovery period. Many patients who are just beginning to show signs of facial aging desire improvement, but cannot justify the cost or time investment required for surgical intervention. For these patients, the rapidly expanding repertoire of injectable treatments is perfect to suit their needs. Injectables can be utilized during an office visit, rather than requiring a trip to the operating room. With some treatments, no anesthetic is necessary, as the needles utilized are so small that discomfort is minimal. With others, topical anesthetic agents or nerve blocks may be utilized, depending on the patient’s preference and the sensitivity of the region being treated.
From the standpoint of using minimally invasive techniques to treat facial wrinkles, there are two general classes of injectables:
BotoxThe first option, which is most appropriate for active lines or age associated wrinkles that are just starting to appear, is to temporarily weaken or paralyze the muscle that is causing the wrinkle. Botulinum Toxin type A is a family of neurotoxins that block nerve signals that cause muscles to contract. The toxin works directly where it is placed, and thus can be artistically used to alter facial expressions. Botox CosmeticÂ® is widely recognized, and was the first neurotoxin to be approved for cosmetic use in the United States. Risks include bruising at the injection site, rare chance of an infection, and the possibility of unintentionally affecting nearby muscle groups. Specific risks should be discussed with your injector when considering treatment.
Soft Tissue Fillers
The second class of injectable treatments are the soft tissue fillers. This group is rapidly expanding, and many options are available. These injectables are more useful for treatment of firmly established wrinkles or larger lines of facial aging (such as the nasolabial folds). Fillers restore volume to the face and can add structure as well. Depending on the type of filler and the depth at which it is injected, you can smooth out fine lines on the surface of the skin, fill out deep lines (eg: nasolabial folds), augment soft tissues (such as the lips), or even effectively augment facial bone structure. All of these injectable fillers are placed by an injection, so the group carries usual risks of bruising, lumpiness, redness, product specific adverse reactions, and in rare cases local infections.
Many options are available in the filler class, with clinical differences being predominantly governed by how long the effects last, as well as how the filler “feels”. Generally speaking, very soft fillers (that are best for locations such as the lips) tend to have a shorter duration of effect, while fillers that last longer tend to have more structure and are better suited in regions where they will not be palpable (such as the nasolabial folds).
A more recent class of fillers is based on hyaluronic acid (HA), which is a sugar found naturally in human skin. When first introduced, a major benefit of this filler class is that allergic reactions are extremely rare, and no pre-treatment skin testing is necessary. These compounds bind water similar to the way a sponge absorbs water. Because of this, they hydrate the skin in the treated region and act as a cushion. Several manufacturers are coming out with versions of HA fillers, and formulations vary with the size of molecules (governed by the amount of crosslinking) and other components of the injectate (such as local anesthetic to help decrease the discomfort associated with injections). The various formulations expand the repertoire of options available to your injector, as certain products are better suited for different anatomical regions. Formulations with smaller particle sizes tend to be softer and smoother, and work well in regions such as the lips. Larger particles have more structure, and are best suited for deep folds such as the nasolabial creases. Hyaluronic acids are eventually absorbed by your body, and the length of time is dependent on a multitude of factors including the patient, the location of injection, and the particular product used. Results last from 3 months in high mobility areas (such as the lips), and up to 1 year in regions such as the nasolabial folds, with most patients experiencing the desired effects for 6 months.
Radiesse contains mirospheres are made of calcium hydroxylapatite suspended in a gel carrier. The filler is broken down by the body in two phases, first the carrier and then the spheres. During this process, collagen ingrowth occurs, which is expected to provide a long lasting effect. This prolonged degradation process makes Radiesse a longer lasting filler than those previously discussed, with expected results lasting a year or more.
KYBELLA®, the first and only FDA-approved injectable treatment to improve the appearance of moderate to severe fat beneath the chin by physically destroying fat cells in the treatment area.
Submental fullness can impact men and women, and can be influenced by several factors such as genetics, weight gain and aging, and can be resistant to diet and exercise. According to a 2015 survey by the American Society for Dermatologic Surgery, nearly as many aesthetically-oriented consumers are bothered by submental fullness (67%) as by lines and wrinkles around the eyes (69%).
When injected into subcutaneous fat, KYBELLA® causes the destruction of fat cells. Once destroyed, those cells cannot store or accumulate fat.
KYBELLA® can cause serious side effects, including nerve injury in the jaw (which can cause an uneven smile or facial muscle weakness), and trouble swallowing. The most common side effects are swelling, bruising, pain, numbness, redness, and areas of hardness in the treatment area.
Who should not receive KYBELLA®?
Before receiving KYBELLA®, tell your healthcare provider about all of your medical conditions, including if you: Have had or plan to have surgery on your face, neck, or chin; have had cosmetic treatments on your face, neck, or chin; have had or have medical conditions in or near the neck area; have had or have trouble swallowing; have bleeding problems; are pregnant or plan to become pregnant (it is not known if KYBELLA® will harm your unborn baby); are breastfeeding or plan to breastfeed (it is not known if KYBELLA® passes into your breast milk; talk to your healthcare provider about the best way to feed your baby if you receive KYBELLA®). Tell your healthcare provider about all the medicines you take, including prescription and over-the counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take a medicine that prevents the clotting of your blood (antiplatelet or anticoagulant medicine). You should not receive KYBELLA® if you have an infection in the treatment area.
The most common side effects of KYBELLA® include: swelling, bruising, pain, numbness, redness, and areas of hardness in the treatment area. KYBELLA® can cause serious side effects, including nerve injury in the jaw (which can cause an uneven smile or facial muscle weakness), or trouble swallowing. These are not all of the possible side effects of KYBELLA®. Call your healthcare provider for medical advice about side effects.
Talk to Dr. Timek to determine if KYBELLA® might be right for you, or learn more about KYBELLA.®