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Why Use Injectables?

As we age, our faces begin to show the effects of gravity, sun exposure, and years of facial muscle movement, such as smiling, chewing and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, sunken cheeks, and facial creases over the areas where this muscle movement occurs such as around the sides of the mouth. Smoking also causes vertical wrinkles around the lips that can be corrected with injectables.

Soft-tissue fillers, most commonly injectable collagen, hyaluronic acid or fat, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers can help rectify deep facial wrinkles, fill in creases and furrows, plump up sunken cheeks, create fuller more sensuous lips, and correct skin depressions and some types of scars. Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery, such as a facelift or brow lift. Injectables are often used in conjunction with facial surgery procedures; however, injectables alone cannot change facial contour the way surgery can.

Lip augmentation is another excellent use of fillers. They can also add fullness to the lips for a lush, attractive look. For best results around the lips, injectables could be combined with resurfacing techniques, such as chemical peel, dermabrasion or laser treatments, or a recontouring procedure such as a facelift. For other areas of the face being treated with injectables, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance.

In your one-on-one consultation with our surgeons, you can discuss your desired look. Your surgeon will then recommend the procedure(s) that will best meet your preferences.

Soft-tissue fillers, most commonly injectable collagen, hyaluronic acid or fat, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers can help rectify deep facial wrinkles, fill in creases and furrows, plump up sunken cheeks, create fuller more sensuous lips, and correct skin depressions and some types of scars. Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery, such as a facelift or brow lift. Injectables are often used in conjunction with facial surgery procedures; however, injectables alone cannot change facial contour the way surgery can.

Lip augmentation is another excellent use of fillers. They can also add fullness to the lips for a lush, attractive look. For best results around the lips, injectables could be combined with resurfacing techniques, such as chemical peel, dermabrasion or laser treatments, or a recontouring procedure such as a facelift. For other areas of the face being treated with injectables, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance.

In your one-on-one consultation with our surgeons, you can discuss your desired look. Your surgeon will then recommend the procedure(s) that will best meet your preferences.

Your Options

     
 

Restylane: (technically: non-animal hyaluronic acid)

Restylane is a newer filler, ithas been used since 1996 and is also FDA approved.  Restylane is based on a non-animal hyaluronic acid which occurs naturally in the body.  Therefore, No pre-test in necessary is needed.  Restylane is a clear gel that is injected into the lips as well as wrinkles, to provide a desired augmentation.

Restylane is injected using a fine needle, and it is inserted at several points along the edge of the treatment site.  Usually a topical anesthetic (numbing cream) is used to prevent the feeling of stinging or burning as the injections are administered. Once injected it works together with your body's own hyaluronic acid and seems to last longer than bovine-derived collagen.  The gel is from highly concentrated, stabilized hyaluronic acid.

 
     

Collagen

Collagen is a naturally occurring protein that provides support to various parts of the human body: the skin, the joints, the bones and the ligaments. Injectable collagen is commonly derived from purified bovine (cow) collagen. The purification process creates a product similar to human collagen. Injectable collagen received approval from the Food and Drug Administration in 1981. It is produced in various thicknesses to meet individual patient needs.

Some collagen products may require a pre-test (meaning a small amount is injected in a hidden area and checked a few days later to confirm that the body does not reject it).  The collagen is injected using a fine needle, and it is inserted at several points along the edge of the treatment site. If a local anesthesia has not been used, you may feel some minor stinging or burning as the injections are administered. However, most preparations of collagen are combined with local anesthesia.

The target injection site are wrinkles, lines, and scars on the face and sometimes the neck, back and chest where the collagen restores fullness and tension to the skin. Collagen implantation works best for wrinkles around the eyes and mouth; it may also be used to give the lips greater fullness.

Fat

Fat-injection’s medical term is autologous fat transplantation or microlipoinjection. This procedure entails extracting fat from an inconspicuous part of your body and reinjecting it beneath the skin at the treatment site. Fat is most often used to fill in sunken cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimize forehead wrinkles and to enhance the lips.

After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat is withdrawn using a syringe. The fat is then prepared and injected into the recipient site. Sometimes an adhesive bandage is applied over the injection site. The augmentation results from fat transplantation are extremely effective in permanently filling depressions and plumping virtually any area of the body.

AlloDerm

For patients preferring to avoid having their own tissues harvested for use in lip augmentation, the use of Alloderm is a viable option. An Alloderm graft is a material that is processed from donated human tissue and is used for a broad range of reconstructive and cosmetic enhancements. It has been thoroughly screened and "freeze-dried." In preparation for use, the tissue is then rehydrated and inserted under a local anesthetic. Following transplantation, AlloDerm begins to incorporate into the patient's own tissue and gives a soft, natural look to the lips.

     
 

Planning for Treatment

As with all cosmetic procedures, meeting your unique needs and preferences are paramount. That's why you’ll meet one-on-one with your board certified plastic surgeon to discuss your hopes and expectations.

In your initial consultation, your plastic surgeon will evaluate your face and/or lips and discuss your goals. Your plastic surgeon will help you select a treatment option based on your desired results, your treatment preferences, your anatomy, and your lifestyle.

Collagen injections are not utilized on pregnant women, individuals who are allergic to beef or bovine products, patients who suffer from autoimmune diseases, and those who are allergic to lidocaine (the anesthetic agent contained in the syringe with the collagen material).
Insurance usually doesn't cover cosmetic procedures.

However, if your injectable treatment is being performed to treat a scar or indentation from an accident or injury, you may be reimbursed for a portion of the cost. Check with your insurance carrier to be sure.

 
     

Potential Risks

When qualified practitioners administer injectables, complications are infrequent, and if they occur, are usually minor. All of the Changes surgeons are board-certified plastic surgeons, and the procedures are performed in a state licensed and Medicare certified surgical center, along with skilled anesthesiologists. These credentials help ensure the highest standards of care and your utmost safety.
Individuals vary greatly in their anatomy, their physical reactions, and their healing abilities. The outcome of treatment with injectables is never completely predictable.

Collagen

Although not common, some patients have allergic reactions to collagen, but a patch test usually determines if there will be an adverse reaction. After the test is performed, the test site will need to be watched carefully for three or four weeks, or as long as your surgeon advises. Any sign of redness, itching, swelling or other occurrences at the test site should be reported to your surgeon. Collagen injection treatment is not suitable for children, pregnant women, or anyone with a history of autoimmune disease.
Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare.

Restylane

Generally, we found Restylane to be very safe. The most commonly observed side effects are temporary redness and swelling at the injection site, which typically resolve in less than seven days. Avoid exposure of the treated area to excessive sun and UV lamp exposure and extreme cold weather until any initial swelling and redness have resolved. Safety has not been established for use during pregnancy, when breastfeeding, or in patients under 18 years.

Restylane contains trace amounts of gram-positive bacterial proteins and is contraindicated for patients with a history of allergies to such material.

Fat

Allergic reaction is not a factor for fat because the patient’s own fat is used. However, there is still a small risk of infection.

Alloderm

Allergic reactions to or rejection of Alloderm are very rare and for most patients, the risks are negligible.

     
 

Anesthesia Options

Because the anesthetic lidocaine is mixed in with collagen, additional anesthetic is usually not used. However, if you are especially sensitive to pain, your doctor may use a topical cream anesthetic or a freon spray to numb the injected area. Or, you may elect to have an injected local anesthetic or sedative drugs.

For fat transplants, both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you elect to use sedation, be sure to arrange for a ride home after your treatment.

 
     

Post-Operatively

Immediately following treatment, you may notice some minor discomfort, stinging or throbbing in the injected area. Occasionally, some bruising or swelling will occur, and will last from a few days up to a few weeks, depending on the size of the area filled. Any redness that appears in the injected site usually disappears within 24 hours. The extent of these symptoms depends upon the size and location of the treated area. In some individuals, particularly fair-skinned patients, this redness may persist for a week or more. Tiny scabs may also form over the needle-stick areas, but generally heal quickly.

No bandaging is needed and you are free to eat, drink, and wear makeup with sun block protection shortly thereafter, however it is best to stay out of the sun until the redness and bruising subsides. If any symptoms persist, contact your surgeon.

Results

The longevity of collagen and Restylane’s results vary depending on the patient's lifestyle and physical characteristics as well as the part of the body treated. Generally, the injected material is likely to be absorbed faster in areas that are more affected by muscle movement, such as the mouth. Though some patients have reported results lasting a year or more, most patients find that maximal fullness lasts approximately 3-6 months. Therefore, repeated injections may be necessary. Your doctor will advise you on how to maintain your results with repeat treatments.

"Overfilling" is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this intentional overcorrection of newly injected fat may temporarily make the face appear abnormally puffed out or swollen. However, after the swelling subsides, the amount of fat permanently retained produces the desired results.

Injected fillers are primarily used to improve the appearance of the skins texture. Fillers can be collagen or hyaluronic acid (a natural substance found in the body, some are safe processed materials such as Restylane). It can help fill out deep facial wrinkles, creases and furrows, skin depressions and some types of scars. It can also be used to give a fuller, more sensuous look to the lips. Fillers are occasioanlly not sufficient for severe surface wrinkles on the face, such as multiple vertical "lipstick lines" that sometimes form around the mouth.

Before Treatment

Prior to the start of treatment you will be seen in the office for a consultation and evaluation by our physician. At this time you will discuss with the doctor your goals and desires for treatment and go over any concerns or questions you may have. You may also be given a skin test to assure that you do not have any allergy to the injection.

     
 

The Procedure

The filler is injected using a fine needle inserted at several points along the edge of the site. Overfilling is necessary to allow for absorption in the weeks following treatment. You may feel a slight stinging or burning as the site is injected however, most people report the injections to be of only minor discomfort.

After Treatment

Most patients resume normal activities following treatment in spite of some temporary puffiness over the area. Generally, within a few days this will resolve and the material is no longer visibly distinguishable from the surrounding skin.

Results of filler Injections

The results of your injection will vary for each individual as will the length of time it will last. Some patients have reported their treatment lasting a year or longer, while others report a duration of only 3-6 months. Therefore, repeated injections may be necessary. Dr. Matouk will discuss with you how to maintain your results with repeated treatments.

Lip Lift and Other lip enhancement options

In specific cases, Dr Matouk will discuss with you other options.  This may be a “lip lift” where the lip edges are brought higher by removal of a small strip of skin from an imperceptible area.