Dermal Fillers: A real game changer in cosmetic surgery

March 10, 2011

Of all our posts, the one that has gotten the most buzz was about Botox 101 (First There Was Botox) So, in this post we’ll cover dermal fillers 101.  Hopefully you will find this one interesting as well. We’ll use this post as a springboard to talk about many interesting topics related to fillers .

Botox started a revolution in cosmetic surgery in the 1990′s. Dermal fillers started a revolution of their own in the mid 2000′s. Here’s the scoop on dermal fillers.

The first safe dermal filler was collagen. Collagen was injected into wrinkles to fill them out and smooth the skin. Collagen was the king of fillers until the mid 2000′s when hyaluronic filers came along.  Hyaluronic fillers last about twice as long as collagen and they are reversible.  For that reason hyaluronic fillers have replaced collagen, which is no longer available.  There are lots of different hyaluronic acid fillers.  The ones we like best are Juvederm and Restylane.  In future posts I’ll talk more about that.

Right around the time that Restylane and Juvederm became available, there was a major paradigm shift in how we view ageing of the face.  Good cosmetic surgeons started to understand that as we age, our faces loose volume.  We used to think that faces fell.  We now know that they deflate and sink inward.  I’ll talk about this in more detail in future posts.  For now just believe me, when we age, our faces loose volume.  That loss of facial volume is the main reason that most of us look older.  So, for most people, the best way to look younger is to add volume.

Before & After Juvederm Treatment

Voila! we have Restylane and Juvederm which are perfect to add volume to your face.  So rather than just using filler to erase wrinkles (which is nothing to sneeze at)  we now can also use them to add volume to our face. Adding volume in just the right places can subtract years from your appearance.

Hyaluronic acid fillers are so effective that they have become the second most popular cosmetic procedure in the US (Botox is number 1).

Let me tell you what to expect when you get a Juvederm or Restylane injection.

  1. First you will need a consultation with your doctor. At that time he/she will ask you what you would like to improve about your appearance. Then, after an exam, you’ll find out if hyaluronic acid fillers are a good idea for you.
  2. At that point, you can decide if you want to proceed with a treatment, or go home and think things over. Cosmetic treatments can be great, but they are elective. You should only go ahead if you are completely comfortable with what you have learned, and with your doctor. 
  3. If you are going to have filler injections, particularly around your eyes, you may bruise.  You can reduce the chance of bruising by stopping medications that thin the blood for a week or two before the procedure.  Some common blood thinners are aspirin, Motrin (and all of its NSAID relatives like Advil), Vit E, and fish oil.  One very important point, if you were placed on a blood thinning medication by your doctor, talk to that doctor before stopping the medication, of course. 
  4. If you decide to proceed, you’ll have numbing cream applied to the areas that will be treated.  If you are going have your lips treated, you may want a numbing injection (like the dentist would give you).  Lips can be very sensitive.
  5. The doctor will then give you a series of small injections. The number of injections and location depends on what you and your doctor are trying to achieve with the treatment.
  6. Then you can go home (or to work, or to wherever). You may have some redness, bruising or swelling right after the treatment.  It is best to avoid strenuous exercise for that day (you can bruise for a few hours after treatment and excercise can make that worse).  By the next day….back to the gym.
  7. In our office we have our patients come back for an evaluation 2 weeks after their first treatment to be sure that everything is optimal. It is worth waiting that long because it make take the filler some time to get into balance with your body.  Initially, there may be some swelling in certain areas that look like lumps.  Those usually go away during the first week or two.
  8. When you come back for your follow-up visit you may want to get a little bit more here or there to have the best possible result.
  9. If there are any small lumps or bumps those can be massaged away by your doctor.  Or they can be instantly dissolved with a small injection of a medication call hyaluronidase.  We’ll talk more about hyaluronidase in future posts.
  10. The Juvederm or Restylane usually lasts at least 6 months, in some areas of the face (like under your eyes) it lasts much longer. When it wears off you have the option to do it again.

That is my review of dermal filler basics. There is plenty of material for future posts. If you would like to learn more right now click here.

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Posted by Dr. Cohen

Dysport & Botox- Sisters But Not Twins

February 25, 2011

So which do you prefer, Skippy of Jif?  What’s better, a Mercedes or a BMW?  You know the answer, the one you like is better.  But we can all agree that the world is a better place with choices.  For about twenty years, Botox was the only choice for patients in the USA.  But in May, 2009 the FDA approved a second choice- Dysport.  Botox and Dysport are very similar medications.  They both work by temporarily weakening muscles, which allows cosmetic surgeons to use them to reduce wrinkles and give you a more relaxed, pleasant expression. (as promised in my last post…in the future I’ll talk about other neat things that these amazing medications can do).

First some background.  Dysport is certainly the new kid on the block, but it is no beginner.  It has been used around the world for about the same length of time as Botox.  Even though patients have been treated with Botox and Dysport for about 20 years,  there are no really good research studies comparing the two.  As doctors we like to rely on science.  We just don’t have the answers yet when it comes to comparing the two medications side by side. 

However, I am pretty comfortable telling you the following “facts” about these two great treatments.

  1. Both Botox and Dysport seem to be safe medications.  I believe that the majority of doctors who have experience with both feel they are equally safe.   I can tell you that my wife and I use both and we would recommend either to a family member.
  2. Clearly,  both medications are effective at weakening muscles, and if administered correctly, both give very good results.
  3. Botox takes effect in anywhere from one to fourteen days.  Dysport seems to work a little faster for most people.
  4. Most doctors that I know feel that Dysport and Botox last about the same length of time in most patients.  Usually 3-4 months, but sometimes a little longer.
  5. About half of my patients who have tried both, feel that they can not tell the difference between Botox and Dysport.
  6. About 25% prefer Dysport and 25% prefer Botox.

So how do you decide?  There is no great answer.  Some people switch from one to the other because they have not been totally satisfied with their results (this is pretty rare).  Others choose one or the other because one of the companies is offering a rebate.  Some people are just adventurous and like to try something new.  Bottom line, as long as you see an experienced cosmetic surgeon, you are pretty likely to like either…. but you may prefer one over the other. 

Choosy mothers choose Jif.  Personally I like Skippy.

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If you would like to read more about Botox and Dysport, please visit our website here.
If you would like to read the FDA approved medication guides for these treatments…..  Botox or Dysport

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Posted by Dr. Cohen

First There Was Botox

February 15, 2011

If you are taking the time to read this blog, you probably know at least a little about Botox.  In future posts I’ll be talking a lot about Botox.  In this post we’ll cover Botox 101.  That way we can refer back to this as we talk about all kinds of neat Botox topics.  The FDA has created very strict rules about informing people about Botox.  If you would like to read the FDA approved safety information about Botox, click here. 

Botox started a revolution in cosmetic surgery.  It is the mother of all lunchtime cosmetic treatments. When you get Botox, you can walk into your cosmetic surgeons office on your lunch break, get a treatment, have a quick lunch, and still get back to work on time.  The results are fantastic and the treatment is safe.  Are most patients satisfied with Botox? Yes.  Just look at the numbers.  In 2009, there were about 2.5 million cosmetic Botox treatments in America.  That is the most common cosmetic procedure performed in the US….. by a huge margin.  To give you an idea of how huge, Botox is given twice as frequently as the number 2 treatment, Hyaluronic Acid dermal fillers (Juvederm, Restylane, and some others).  Here is another fact: Botox treatments are about 10 times more common than the most popular cosmetic surgical procedure, breast augmentation.

So how does it work? Botox works by temporarily relaxing muscles.  By relaxing the right muscles, Botox can help you get rid of wrinkles that come with facial expression.  A great example of this is the vertical lines that form between your brows when you squint, or the crows feet you get when you smile.  Botox also can help with a lot of other things, from raising your brows to getting rid of the little bumps you get on your chin when you frown (we’ll talk about all the neat things Botox can do in another post).  Botox is temporary.  It last, for most people about 3-4 months and then wears off.  If you like the results, you’ll probably want to do it again.  Most people who are really in to it get Botox about 3 times a year. 

Let me tell you what to expect when you get a Botox injection. 

  1. First you will need a consultation with your Botox doctor.  At that time he/she will ask you what you would like to improve about your appearance.  Then, after an exam, you’ll find out if Botox is a good idea for you.
  2. At that point you can decide if you want to proceed with a treatment, or go home and think things over.  Cosmetic treatments can be great, but they are elective.  You should only go ahead if you are completely comfortable with what you have learned, and with your doctor.
  3. If you decide to proceed, the doctor will then give you a series of small injections.  The number of injections and location depends on what you and your doctor are trying to achieve with the treatment.
  4. You’ll feel the injections, but the discomfort should be pretty mild.  In our office we use the smallest possible needle and that helps.  We also use a messaging pillow on your neck to distract your nerves from feeling the injection….it works.
  5. Then you can go home (or to work, or to wherever).  You don’t need to limit your activity or do any special care.
  6. Depending our your biology, Botox will start to work  as soon as 24 hours or as long as 2 weeks.
  7. In our office we have people come back 2 weeks after their first treatment to be sure that everything is a good as possible. Some patient get a little bit more here or there to have the best possible result.
  8. The Botox should last at least 3 months.  In many people it lasts longer.  When it wears off you have the option to do it again.  Be warned…..if you are like most of our patients, you’ll want to do it again.

So those are the basics.   There is a lot of fun stuff we can do with Botox, so there is plenty of material for future posts.  If you would like to learn more right now click here.

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Posted by Dr. Cohen

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