Botulinum toxin has been used safely and effectively for years to treat muscular conditions and address cosmetic concerns of the face. In 2002 the FDA approved the use of botox for specific facial, cosmetic reasons. I use botox to cause a temporary paresis in selective facial muscles in order to relieve the wrinkles created by the muscle activity, to relieve the tension component of migraine headaches and to diminish facial spacticity caused by facial nerve dysfunction. The wrinkle relief is particularly effective for the wrinkles around the eyes, between the eyes and on the forehead caused by the orbicularis oculi, the procerus, the corrugator and the frontalis muscles. The paresis becomes apparent within 72 hours of the injection with full effect noted in one week; the effect may last up to six months, but most patients get injections every three to four months. This is an outpatient procedure, requires no anesthesia and has no downtime.
No downtime lasers: The new NLite™ wrinkle reduction laser treatment is an outpatient procedure, which requires no anesthesia and has no real downtime. This laser was developed in Great Britain and was released in the United States in October 2000 with FDA clearance. The laser uses yellow light to penetrate the skin and excite the small blood vessels in the upper dermis without damaging the superficial skin. This excitation causes a proliferative response of the fibroblasts stimulating the new deposition of collagen. The new collagen fills the wrinkle from the inside. Studies from Europe have shown excellent change in skin characteristics and wrinkle depth. The side effects noted are minimal redness, which resolves within 24 hours and mild purpura. The maximum effect is noted between one and three months after the procedure.
Injectable fillers allow the surgeon to specifically place an augmentative substance under the skin with a small needle. Collagen injections represent the most well known injectable filler. The two major downsides to collagen are the potential for an allergic reaction to the material even after a negative skin screen has been performed and the fact that a significant number of people will process the material very quickly and show only short-term results. At the Atlanta Center for Facial Plastic Surgery, we have stopped using collagen and use Sculptra™ and a hyaluronic based product as our fillers.
Sculptra™ is injectable filler designed to augment and smooth facial contours. The substance is extremely safe, can be used on anyone without a skin test and can be injected in the office under local anesthesia only. The material is a type of sugar molecule very similar to what is found in dissolvable sutures. The material itself stimulates the body to produce its own collagen. Duration of effect varies form patient to patient but most will get two to three years of augmentaion form the injection. The material is different from the hyaluronic acid products in that it is a result which must be built. Usual three to four injection six weeks apart are required to see significant augmentation. Side effects are mostly from the needle, but there is a remote possibility that you could fell this under the skin. Therefore, I do not recommend this product in the lip, but it is very effective for the lines around the mouth.
Restylane™ and Juvederm™ are hyaluronic based injectable fillers. There is very little chance of allergic reaction because hyaluronic acid occurs naturally in our bodies; therefore, test spots are not required. I liken the injection of these fillers to putting air in tire � as the amount of augmentation is controlled by the amount of filler injected. Very natural augmentation can be obtained with duration of effect usually around 6 months depending on the patient and the material is chosen. I particularly like these materials for lip augmentation and melolabial fold softening.
Skin care: Improved skin care is a central concept for nearly every patient seen. Skin care can be used to prepare the skin for surgery, assist the healing process after surgery, and enhance one�s appearance with or without any other intervention. Great skin care can refresh the tone, color and texture of the skin. It can reduce lines and wrinkles, and it can restore the skin�s health and beauty.
To be most effective, a skin care program needs to have three central components, all performed on a daily basis. The first step is exfoliation. Exfoliation is the removal of the superficial layer of the skin. This can be accomplished mechanically with gloves, cloths or gentle sponges or chemically with refined acids such as alpha and beta glycolic acid. The exfoliation step renews the skin by forcing skin turnover and maintaining consistent epidermal height. In general this prevents uneven, dull skin. The second step in skin care is rejuvenation. Rejuvenation is the process by which we restore collagen, elastin and order to the skin. As we age and are bombarded by the sun, our skin loses collagen and elastin faster than it can be replenished. Skin products that include vitamins, retinols and/or acids can stimulate the body to produce the lost components and demonstrate less disorganization. The last step is protection. This involves moisturizers and sun screen. The face needs to be protected from water loss and sun damage at all times.
Skin care programs can be as simple or as a complex as the person using the products can tolerate. We feature skin care lines predominantly which have superior ingredients and produce excellent results. The kits are very easy to use and contain all natural ingredients. The SesDerma (link) line is produced in Spain and offers advantages in individuals with pigmented and oily skin. After spending time analyzing your face, our staff will make recommendations for the appropriate products for you.
Resurfacing: Skin resurfacing is the process by which the skin is smoothed and refreshed. It can be accomplished by a variety of techniques. The central principle is that the deeper the injury to the skin the longer the recovery and the greater the change. Choosing the correct technique for each patient requires an honest evaluation and discussion with a physician capable of doing all the techniques.
The CO2 laser has been refined over the last several years to produce an excellent tool for resurfacing. The laser provides accurate and consistent removal of skin. The operator can precisely control the depth of the injury by varying the power of the laser and the number of passes made. The laser has a secondary benefit of causing contraction and synthesis of collagen in the dermal layer of the skin providing a tightening effect. The healing process requires intense patient participation and is the major downside to this procedure.
Chemical peels can provide the continuum of skin injury depths. By varying the agent and the time of skin exposure, the physician/aesthetician can obtain different levels of effect from just the very top surface to a major depth similar to the CO2 laser. With the different levels the recovery time and overall result will vary. The most common peel that we do at the Atlanta Center for Facial Plastic Surgery is a Jessner�s/ TCA peel. This peel can be done as outpatient with minimal to no anesthesia; it provides a medium depth injury allowing a significant result while minimizing downtime. Most patients should expect 5 days of active healing and an additional 5 days of mild redness, which can typically be covered with makeup. The peel can be repeated at six month intervals for more dramatic effect and costs significantly less than the CO2 laser treatment.
Power Peel™ is a brand name of microdermabrasion. This technique allows the top layers of the epidermis to be removed in a very controlled fashion. By repeating the technique over time, changes in skin texture, contour and color can be obtained. The procedure takes approximately 45 minutes and requires no anesthetic. The patient typically has an erythematous glow after the procedure and can return to work that same day with no downtime.
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