Wrinkle Fillers
Botox, Collagen, Hylaform, Radiesse

Wrinkles are, unfortunately, an inevitable part of getting older. While they are a natural occurrence, it does not mean that they cannot be reduced or removed. The most important thing is to first establish what type of a line or wrinkle you have, as the treatments can be quite different.

There are three distinct types of wrinkles that I see - dynamic lines, static lines, and fine line creepiness. A dynamic line is a wrinkle that is formed by the contraction of facial muscles, such as the horizontal forehead lines from raising the brows, crow's feet, and the worry lines between the brows. Static lines are those that are present without moving the face, such as the folds from the corner of the nose to the edge of the lip (nasolabial folds), or from the lip to the chin (marionette lines). After long periods of time, dynamic lines can become static after they etch the skin and don't disappear when you are relaxed. Fine line creepiness, the tiny texture lines that can be seen on the lower eyelids and elsewhere, occurs from sun damage to the skin structure itself. Sometimes a patient has all of these wrinkle types, but only certain ones are bothersome. To remove all lines completely can sometimes leave a very unnatural appearance.

When we sit down together, I will listen to your concerns, do a full evaluation, and help you determine which lines to reduce or remove. Computer imaging and before and after photos will also be shown. I will explain the risks and benefits of each option so that you may make an informed decision. Some can be done at the initial visit, while others require a separate appointment.

For dynamic lines, such as crow's feet and the forehead, the best option is Botox. Botox is a medication that is injected with a tiny needle into the muscles that are causing the lines, and relaxes them, which softens the wrinkles. Depending on how it is administered, it can totally freeze the muscle, or just weaken it a little for a more subtle result. The effect takes 3-7 days to set, and usually lasts for 3-6 months. No allergies have been reported. Although many physicians offer Botox, the results can be very different. Some will dilute it so that they keep the cost lower, but the results do not last as long. How you inject it can be the difference between a natural enhancement and a noticeable and obvious frozen appearance.

For static lines, like the folds around the nose and mouth (nasolabial folds), I often can refill them with an injection. The most popular is collagen, a protein that has been used for more than 20 years. As 3% of people are allergic, 2 tests 2 weeks apart are done to insure you have no bad reaction. An anesthetic cream is placed on the skin, and 20 minutes later, the material is injected directly under the fold. Correction is instant, a mild redness persists for a few hours, and the results last for 4 months on average. Other longer lasting injections are, or soon will be, available, and we can discuss them if it is appropriate for you. One that bears mention is Radiesse, a calcium based paste that has been used in the body safely for many years. It is injected in the same manner as collagen, but requires no skin testing, as you cannot be allergic. The material can last more than one year . While a single Radiesse injection is more costly than collagen, over the course of years, Radiesse is much more cost effective, especially when you add in the time it takes to visit the physician. Additionally, Hylaform and Restyln is another new option that we can discuss on your visit.

Another option for static lines is permanent implants. Several companies now make Goretex implants, which are soft and have been used in the body for decades in hernia repair, blood vessel bypass, and pacemakers, specifically for these problems. The procedure is done under local anesthesia, and requires one tiny stitch at the top and bottom of each fold. The stitches stay in for 4-5 days, and antibiotics are given. The results are permanent. I often recommend that you try first with collagen, to make sure you like the result, before proceeding with a longer lasting injection or implant.

For fine lines, often skincare products, microdermabrasion, and chemical peels can be helpful. They depend heavily on how many and how deep the lines are, your skin type, and the location. I will give you more details based on your exam.

It is wonderful to have so many tools at my disposal, surgical and non-surgical, to offer you a customized solution for your concerns that can fit your lifestyle and desires perfectly. Even as I update this information, other advances are being made. It is certainly worthwhile to come and visit me to discuss the latest safe options.