Bovine collagen injections, Zyderm and Zyplast, were the only magnifying materials available in the United States for the treatment of wrinkles and grooves for two decades, and I was one of the first cosmetic dermatologists to use them when they were first introduced in 1983 Initially, injectable collagen treatments were fraught with drawbacks.
To begin with, while they were suitable for treating fine wrinkles, they were often unsuitable for treating deeper wrinkles and furrows, and were certainly of little value for facial volume and contouring. In addition, nearly 3 percent of people were allergic to the products, and two pre-treatment skin tests a month apart were required before actual treatment could begin. Finally, the benefits only lasted three to six months before retreatment was necessary. For serious wrinkles, jaws and sagging, the only means remained to go under the knife of the cosmetic surgeon, with all the associated risks and disadvantages.
Fortunately, the past five years have seen a literal explosion in the number of FDA-approved injectable fillers and volumizers in the United States – fillers for fine and moderate wrinkles, and volumizers for correcting sunken areas, recontouring surface irregularities and restore fullness to the skin. the skin. Along with Botox Cosmetic (technically not a filler, but definitely a top-notch injectable product for improving all types of expression lines, movement-related wrinkles), which was approved by the FDA in 2002, many non-collagen fillers and volumizers were introduced. These include hyaluronic acid products, such as Hylaform, Captique, Elevess, Restylane, and Juvederm, and volumizers, such as Radiesse and Sculptra. Unlike collagen, these substances, largely produced synthetically (with the exception of Hylaform which is derived from cockscomb of roosters), did not require prior allergy testing. This meant that a person could literally walk off the street and be treated the same day. Plus, their results lasted much longer, especially for the volumizers, whose benefits can last for 12 to 24 months or even longer. For that reason, they are labeled as semi-permanent rather than temporary filling material.
Between 2000 and 2005, the use of soft tissue fillers and volumizers for non-surgical rejuvenation procedures increased by an astonishing 34 percent, and it’s not surprising that the number of surgical facelift procedures declined by as much as 20 percent in about the same time period. The “liquid facelift” had come of age.
I want to make it very clear that I am not arguing that there is no longer a place for aggressive, surgical facelifting, technically known as “rhytidectomy” or “rhytidoplasty”. For extreme cases of large jaws, excessive sagging and excess skin and deep grooves, the facelift remains a suitable therapeutic option. However, I say that we now have the tools to recreate many of the benefits of facelifting without ever touching a scalpel to the face. Plus, we can even improve appearance in many ways that traditional surgery couldn’t.
We recently discovered that shrinkage of underlying skin tissue, shifts in fat deposits, and changes in bones and cartilage as we age are responsible for many of the changes we see in facial aging. In short, the robust, heart-shaped pads of fat that sat directly over our cheekbones and gave our faces fullness when we were younger not only shrink with time, but sink down and inward toward the nose, revealing the telltale signs of their fall behind in their wake. When this happens, we find hollow-looking, dark and creased or bulging lower eyelids and pronounced smile lines on the sides of our noses. The weight of this fall also accentuates the unsightly jaws along the jawline.
A traditional surgical facelift, by simply tightening the skin, can soften the lines around the nose and mouth and lift the cheeks, but it does nothing to address the underlying loss of volume and displacement. In fact, we very often saw people who appeared “skeletonized” by the operation. They were left with unnaturally tight skin that was a sure sign of “Oh, she’s had a facelift.”
It goes without saying, of course, that surgical facelifts are real surgeries that carry the risks of general or intravenous anesthesia, significant postoperative pain, bruising and swelling, extended recovery times (two weeks out of work and several months before all swelling finally goes away), scars and a significant financial outlay. Contrary to popular belief, the benefits of facelift surgery are not permanent. The operation can be repeated once or twice in your life.
Non-surgical facelifting, combining Botox Cosmetic with fillers and volumizers, addresses the core of the underlying issues: dynamic wrinkles (wrinkles caused by the muscles of facial expression) and the replacement of lost or displaced volume. A few micro-drops of Botox are quite efficient for eliminating or softening the horizontal “worry lines” across the forehead, the crow’s feet on the sides of the eyes, and the frown lines (or “frown”) between the eyes. It can also alleviate the creased “bunny lines” along the bridge of the nose and a “pebbly” chin. For deeper wrinkles, the effects of Botox can be supplemented with the use of fillers, such as Restylane or Juvederm. This combination has proven to be extremely effective and the benefits of combination therapy last much longer than if each material was used individually. These same fillers can be injected to raise the smile lines and the sad lines.
Cheeks along the jawline can be softened with Radiesse by adding volume to the indentations around the jawline, making the jawline less visible and returning the jawline to the smooth, straight line of youth. And finally, volume can be restored and re-contoured across the cheekbones with Radiesse.
To minimize discomfort, the designated areas are pre-iced with a small amount of a local anesthetic, usually lidocaine, a faster-acting anesthetic than novocaine traditionally used by dentists. Although I personally find it unnecessary, some doctors choose to apply a nerve block, ie to numb the larger branches of the nerves supplying the face, in addition to the local anesthetic.
Once the area to be treated is numb, the volumizer or filler is injected and then molded into place like clay to correct the deformity or irregularity. The whole procedure usually only takes about thirty minutes and, to the delight of the patient, the results are immediately visible in most cases. Afterward, you may experience some redness, mild swelling, and tenderness, which can last for one to three days. Occasionally you may get some bruising that can take several days to fade but can be easily covered with the right masking makeup.
Non-surgical facelifts
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