California Face & Laser Institute San Ramon Office Appointment Center |
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:: Injectable Fillers (Restylane™)
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Injectable fillers are substances that are used to fill in the lines that are caused by a wrinkle or fold and to increase 3 dimensional volume in an area that has been lost due to age or scarring. Although there are many injectable fillers, the one used most often in the United States is hyaluronic acid (Restylane™). |
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The typical areas treated are the nasolabial folds (lines from the end of the nose to the end of the lips), perioral area (wrinkles around the lips), lips, wrinkles of the cheeks, marionette lines (lines from the corners of the mouth to the jawline, accentuating the downturn of the lip leading to a look of sadness). Other areas include filling in acne scars and the "tear-trough deformity" (hollow under-eye circles). |
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Hyaluronic acid is produced by human genes inserted into a bacterium for reproduction. It is a highly "conserved" protein, meaning that its genetic composition is almost exactly the same in 97% of animal species. This gives it an extremely low incidence of allergic reactions; hence there is no need for pre-treatment skin testing. If you think of the skin as a 3-dimensional lattice with the structure composed mostly of collagen (which are like large ropes intertwined on each other) and elastin (which gives it its bounce and keeps it from getting stiff), then hyaluronic acid is the gel that is found between these structural proteins in the skin to cushion them. Thus, it has a very natural feel and cannot be seen since it is clear. Hyaluronic acid also draws water very strongly to it, yielding a larger volume effect than the material would have by itself. Restylane™ is manufactured by Q-Med (Swedish Company) and distributed in the US by Medicis.
Who is a candidate?
Anyone who wants cosmetic improvement of smile and/or frown lines, cheek wrinkles, thin or wrinkled lips, cheek or chin hollows or scars is a candidate for this procedure.
What is Restylane™ like?
Either a topical anesthetic is applied before the procedure or a nerve block is performed in the office prior to the procedure. A nerve block consists of getting a topical anesthetic on the gums and injections of anesthetic into the gum similar to a dentist visit. The latter is most often used for injections around the lips, as this is a particularly sensitive area.
The material is injected very slowly into each line or area. There is a fair bit of artistry involved in balancing the wrinkle and getting the 3-dimensional effect achieved to be aesthetically pleasing and harmonious. For lips the material is injected into the border of the lip to better define the margin and reduce the wrinkles above the lip. Some may be injected into the body of the lip to enhance the volume.
When the procedure is completed, we supply you with an ice pack and do recommend icing the area on and off during the day. Makeup may be applied immediately after the procedure, however, you need to expect anywhere from 2-5 days of swelling and redness. If a nerve block was performed, you may not be able to eat or talk well for an hour or two after the treatment.
How does Restylane™ work?
Injectable fillers work by putting volume into an area that has lost volume. When this is done artfully, the appearance of lines and areas of concavity are erased, and a much more natural, youthful appearance is created.
What type of equipment is used?
The injectable material used must be on hand and stored properly. Otherwise no other special equipment is necessary. These procedures are performed in the office.
What desired results can be expected?
The results are very gratifying for the majority of people. Filling in lost volume and wrinkles can often transform one's appearance in a very profound but natural way. Most of the time one's family and friends know something has changed but they are not sure what it is. Results for Restylane™ generally last around 4-9 months.
Are there any negatives?
The most common potential adverse events are swelling, redness and bruising. Most of the time redness and swelling is gone in 1-2 days, but it can occasionally take 3-5 days and uncommonly, an entire week. Bruising can be prevented to a large degree by avoiding aspirin, vitamin E and non-steroidal anti-inflammatory drugs (like ibuprofen) for the 7-10 days prior to the procedure. Bruises can last from 1-2 weeks, if they occur.
Very uncommon problems include lumps of material in one place or asymmetry. Occasionally the material can group in one place. This can usually be corrected either with deep massage or extrusion of the material. As noted, the material will dissipate with time.
Although a permanent filler is obviously an attractive option from an economic standpoint for you, most of these substances are not naturally occurring in your body. This means that there is an allergic potential which can occur several years later. Since the material is permanent, the allergic reaction is permanent. Also these materials can migrate over time (shift from place to place) necessitating surgical removal. Thus, CFI feels that the "temporary" fillers that can be naturally reabsorbed by your body are much safer options.
What happens after Restylane™?
After the procedure you will periodically apply ice to the treated area for a couple of hours (a bag of frozen peas or vegetables works great for this) to reduce redness and swelling You may put makeup on immediately and resume whatever activities you had planned, as long as you recognize that you will be a little swollen and red for a half a day to a few days. We usually ask you to come back at two weeks when everything is settled to evaluate your satisfaction and the results.
Is there another way to get the same effect?
Base upon our experience in this area, Restylane™ is CFI's preferred injectable material at this time. Other treatment options for reducing wrinkles, building volume and augmenting facial structure include, but are not limited to, BOTOX® Cosmetic; tissue tightening procedures (Thermage®), as well as more invasive procedures such as laser skin resurfacing (to soften deep wrinkles, although this will not replace volume).
How is this different than other procedures?
This procedure usually provides immediate gratification, although there may be a period of a few days of swelling and/or redness. It also requires a skilled provider with artistic ability to create harmonious proportions.
Can this be combined with other treatments?
BOTOX® Cosmetic is commonly performed at the same visit as injectable fillers. BOTOX® Cosmetic helps with the upper one-third of the face whereas injectable fillers generally help with the lower two-thirds. The combination provides the most immediate rejuvenation of the face that exists without significant down-time. If you are looking for a quick fix for an important event, the combination of fillers and BOTOX® Cosmetic can make you look better in 1-2 weeks.
Fillers can also be combined with any other treatment except when doing high-energy laser or radiofrequency treatments over the exact same area as the injections. Although they can be performed in the same treatment session, CFI typically recommends having the laser or Thermage® treatments first, for fear of heating up the filler inside the skin too much, possibly making it reabsorb more quickly.
What is the cost of Restylane™?
The cost of the procedure will vary greatly with how much is used. Please call CFI for a consultation. (650) 462.3161
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