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Cosmetic Surgery Virginia

Cosmetic Fillers

before and after

The new generation of injectable fillers has revitalized the plastic surgery industry. According to Forbes Magazine, "Twenty years ago, if you wanted to get rid of wrinkly, sagging skin, there was basically one way to do it--going under the knife for a face-lift. But today, a range of dermal fillers can be injected into those crow's feet, marionette lines, thinning lips and furrows between the brows, taking years off the face--and all can be done during your lunch hour, with no invasive surgery and little recovery time.

Volume Loss: The Greatest Contributor to Facial Aging

The primary effect of aging is the loss of facial volume and secondary sagging to specific areas of the face. This is due to the loss of elasticity related to gradual loss of elastin fibers in the deep layer of skin (dermis) that occurs with the aging process. Other factors include changes to bone, decreased facial fat and decreased muscle mass. The loss of elasticity coupled with the repeated action of the muscles of facial expression contribute to wrinkle formation and volume loss. Skin loses its ability to recoil after repeated contraction of muscles of facial expression. The role of gravity has been shown to have a less substantial role in wrinkle formation. These areas include the midface, cheek bones, jaw, brow and below the eyes.

The Filler Facelift

The Natural Facelift Option

before and after
before and after

Injectable facial fillers are cutting edge treatments which can help keep skin looking younger by restoring lost volume and filling deeper lines and furrows. They can even be used to perform a filler facelift providing comprehensive facial rejuvenation. These treatments typically involve little to no downtime, can be performed quickly and easily in the office setting, and are an excellent option for individuals who opt for a less invasive procedure. They can revitalize areas of the that face that show the most dramatic effects of aging. The correction of facial volume loss with facial filling agents can restore a youthful appearance to patients who are approximately between 35 and 55 years of age and can allow older patients to look healthy and attractive for whatever their age, and within age-appropriate parameters. Such correction has many benefits beyond cosmetic improvements. Facial volume loss can give the appearance of aging out of synch with chronology, and when severe, may give the impression of illness and physical disability that may have adverse effects with social, psychological, and economic implications.

Facial Areas Treated

- Crow's Feet Botox® treats the first cause for crow’s feet - overactive muscles and repeated contracture on the delicate eye area skin. By relaxing the muscles a little, crow's feet can be softened and sometimes eliminated. As with frown lines, using Botox® in conjunction with a filler like CosmoDerm™ or CosmoPlast™ often gives a nicer result than either one alone.

- Under the Eyes, Sunken Eyes, Tear Troughs - I am now convinced that Restylane® is the best dermal filler for treating tear troughs and periocular depressions.

- Hollow Cheeks - lost or additional can be added to lift sagging or to enhance the upper cheeks with Juverderm Ultra Plus® or Perlane®.

- Midface Radiesse® is a long-lasting (1 to 2 years) temporary facial filler with widespread international use and a long safety record. Radiesse® can be injected into the mid-face to restore volume, to blend the inner lower lids with the mid-face, to enhance the cheekbones and to help lift sagging nasolabial folds.

- Nasolabial Folds - The line from your nose to your mouth can be easily be diminished with Restylane® or Juvederm®.

- Marionette's lines, Mouth Corners - Marionette's lines are lines or grooves that run from the corners of your mouth down to the bottom of your chin. They can give your lower face a slightly saggy look, or make the corners of the mouth look frowny or downturned.
There are a couple of different good ways to treat these. Restylane® or Juvéderm® (usually used here in their heavier molecular weights, Perlane® and Juvederm Ultra Plus®) will fill these lines and give an immediate improvement.

- Nasolabial Folds can easily fill these with Restylane® or Juvéderm® or Sculptra®

before and after

- Jawline - receding or sagging skin along the jawline- Sculptra® can give very good results for sagging along the law line by replacing the volume that has been lost above the jawline (think of a deflating balloon). Sculptra® is a "volumizer", an injectable poly-lactic acid that stimulates the body's production of natural collagen. When injected in the cheeks, Sculptra® causes the body to produce more collagen, which fills the cheeks more and acts to lift the skin in the lower face and jaw line.

- Lip Enhancement/Shape - My preference is Juvederm Ultra® & Ultraplus® in the lips because it's a little smoother, less prone to bumps and causes less puffiness for the first day or two but both work well. As with the lines from the nose to the mouth, it is best to start conservatively and gradually add more if desired, rather than risk having your lips look unnatural.

- Upper Lip Lines and Lip Borders - There is no single treatment that magically eliminates these lines but a combination of a little Botox®, a little filler like Cosmoderm™, and some laser work can greatly reduce and improve them. CosmoPlast™ and CosmoDerm™ can also be very good for enhancing the border between the lip and the skin around it without adding any volume to the lips. CosmoPlast™ and CosmoDerm™ seem to do a better job at defining the lip border than the Restylane®/Juvéderm® injections in my experience.

- Nose Reshaping The nose is one of the most perceptible features of the face. It is essential to have a well balanced appearance. Juvederm®, Radiesse® and Restylane® can be utilized to restore asymmetry and correct the appearance of bumps, drooping tips without the risk of surgery. This procedure is not intended to be a replacement for surgery (rhinoplasty) to correct obstructive breathing. Problems addressed include:
- building the bridge
- correcting asymmetry
- tip enhancement
- contouring or smoothing the nasal hump

- Acne Scars can be resurfaced with an Erbium laser and or microdermabrasion and or, temporily filled with Restylane® or Juvederm®. Another method is Punch Excision This method of surgically correcting acne scars is used on deep scars such as icepick and deep boxcar scars. This procedure uses a punch biopsy tool which is basically a round, sharp "cookie- cutter" tool that comes in diameters ranging from 1.5 mm to 3.5 mm. The size of the tool is matched to the size of the scar to include the walls of the scar. Under local anesthesia the scar is excised with the punch tool and the skin edges are sutured together. The newly produced scar eventually fades and may not be noticeable. If it is noticeable, it is more amenable now to resurfacing techniques.

- Skin Texture This can be greatly improved with laser resurfacing or a chemical peel such as TCA.

sculptra