Definition and Causes of Wrinkles
The goals of facial rejuvenation are to improve skin quality and reduce the amount of wrinkling. In general, wrinkles can be classified into two main types: fine and deep. Fine wrinkles are usually the result of excessive sun damage and/or simple aging. Deeper wrinkles are a result of dynamic forces from underlying muscles, gravity, and reduced skin elasticity as we age. When muscles contract, they shorten in length and because of attachments to the outer skin layer, folds or wrinkles occur. The nasolabial fold is a natural fold extending from the sides of the nose to the corners of the mouth. This is accentuated when we smile. In youth, these folds are not as noticeable but as we age, these folds get deeper and more prominent due to years of muscular contraction. Other areas that exhibit this progressive wrinkling are the brow and the outer corners of the eyes (crow’s feet). Gravity and poor skin elasticity from aging cause the descent of all tissues: muscle, skin, and fat – this can produce wrinkles, especially in the corners of the mouth. Jowling and neck sagging is also a result of gravity effects.
Fine wrinkling can be improved with a good skin care regimen and minimizing sun exposure. More definitive treatments involve surgery by either chemical peeling or laser resurfacing. The most dramatic improvements for deep wrinkle correction occur through surgical face, neck, or brow lifting. However, deep wrinkling can also be treated by either reducing the muscular contraction or “filling” the crease.
BOTOX® Cosmetic is an injectable cosmetic product that contains the biological compound, botulinum toxin. When injected into the human body, the toxin temporarily paralyzes the targeted muscle; thus, the wrinkling generated from its contraction has been eliminated. The effects of BOTOX® Cosmetic usually last between 3 and 5 months. The most common areas for BOTOX® Cosmetic injection are the forehead, brow, and outer eyes. Judicious injections around the lips can also be of benefit.
Restylane®, Juvederm Ultra®, and Juvederm Ultra Plus®
Cosmetic Fillers and Injectables are best used in the nasolabial folds, the corners of the mouth, cheeks, forehead, brows, and lips. Each of these procedures differ in cost, ease of injection or transplantation, potential for sensitivity, duration of effect, method of injection, and type of anesthesia. The concept of synergism is important. Fillers when used in combination with muscle paralyzers, offer superior results in wrinkle improvement than if each was used alone. For example, one effective combination is the concurrent treatment with Restylane® and BOTOX® Cosmetic.
Fat, harvested from a patient’s own body, can be processed and injected as a filler (please see, “Fat Transfer/Injections” for more detail). Approximately 50% of transplanted fat will survive and last.
Hyaluronic acid (HA) is a synthetically made compound (not an animal product) that is similar to the natural substance found in our joints and soft tissues. It is quite effective and lasts from 6 to 12 months. Most of Dr. HA’s are injected at the dermal level and are effective for both fine and deeper wrinkles. They are also Dr. Ha’s preferred filler for lip augmentation. These fillers come in a variety of molecule size as well, with the larger molecules having claims for increased longevity. Dr. Ha’s are manufactured by several different companies. The ones that Dr. Ha advocates for and offers as fillers include Restylane®, Perlane®, Juvederm Ultra®, and Juvederm Ultra Plus®.
Radiesse® is a soft-tissue filler composed of calcium hydroxylappatite. These are calcium microspheres that are suspended in a thick water-based gel. Radiesse® injections are indicated for treatment of facial wrinkles and contour depressions (fat atrophy). Like other fillers, it is an injectable product that can be administered in the office under local anesthesia. It is injected in the sub-dermal layer (deeper), unlike HA’s, which are injected directly into the dermis. It has touted advantages over other fillers in that it has better efficacy for deeper wrinkles and potentially lasts longer (1+ years). Radiesse® works particularly well in the deep wrinkles of the cheeks and peri-oral area. It can also be beneficial in augmenting the outer border of the lips.
Indications for the use of Sculptra
Sculptra® Injections are an enduring treatment for restoration and/or correction of the signs of facial fat loss, or lipoatrophy. Facial fat loss, or lipoatrophy, is the loss of fat beneath the skin, which can result in sunken cheeks, indentations, and hollow eyes. Sculptra® is injected below the surface of the skin in the area of fat loss
What it is made of
Sculptra® is composed of poly-L-lactic acid, a synthetic material, and is not made from human or animal sources. 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.
Benefits and Treatment Results
It provides a gradual and significant increase in skin thickness, improving the appearance of folds and sunken areas. No skin testing is required. Unlike most fillers which provide an immediate effect with a limited duration, Sculptra works through gradual soft tissue building over a period of time and over several (typically 3) treatment sessions. At the first treatment visit, it may appear that Sculptra® worked immediately because of swelling from the injections and the water used to dilute Sculptra®. In a few days, when the swelling goes down and the water is absorbed by the body, you may look as you did before your treatment. Sculptra® takes time to gradually correct the depression in your skin. Patients with severe facial fat loss may require 3 to 6 treatment sessions. Treatment results will differ for each person but the results can last up to 2 to 3 years. Touch-up treatments may be needed to maintain the desired effect. Dr. Ha prefers this product for areas of volume loss, typically in the peri-oral and cheek areas. It is particularly useful when attempting to contour or augment larger surface areas of the face.
All cosmetic fillers and injectables, while deemed non-surgical procedures, still have potential complications. Fortunately these are rare, mostly minor, and mostly temporary. These include sensitivity, nodule formation, palpability, skin redness, allergic reaction, lumpiness, migration, pain, extrusion, and scarring.
Silicone Injections- Not FDA approved and Dr. Ha does not do
One wrinkle filler that Dr. Ha DOES NOT inject is silicone. The FDA currently DOES NOT approve the practice of silicone injections in the U.S. Multiple studies show a significant incidence of complications with silicone injections. The silicone used in foreign countries or in the U.S. black market is often mixed with additives such as other types of oils, paraffin, and even peanut butter – these are often referred to as “sakurai” formulas and are even more dangerous. These incite a very aggressive inflammatory reaction by the tissues that can cause swelling, infection, redness, and pain. Hard knots can develop around any injected silicone, which are extremely difficult to remove. The silicone can also migrate through the skin causing extrusion and gangrene. Nerves and muscles can be permanently injured, and the resultant scarring is often irreversible or irreparable. There are cases after cases documented of patients undergoing multiple surgeries (15 to 30 or more) just to remove the material, even with “medical grade” silicone; these patients are scarred for life, permanently disfigured. Several deaths are reported every year that can be attributed to the complications arising from the injection of silicone.