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Monday, Aug. 14, 2017



A look at cosmetic procedures

Would you like to add lift and volume to your face without surgery? There are alternatives that may be right for you.

Traditionally, fillers have been injected into the lines around the mouth and in the lips to add volume and smooth wrinkles. Correction of volume loss in the mid-face with fillers has become increasingly popular in the recent years. As we age, we lose bone mass in certain parts of the face, and fatty tissue begins to slide downward, giving a “sunken in” appearance in the cheeks and temples as well as a less defined jawline and jowls.

Certain fillers can be placed in the midface, along the jawline, and in the temple area to restore a youthful appearance and correct these natural anatomic changes that occur with time. Determining the best treatment option will depend on factors like age, amount and location of volume loss, need for immediate versus more gradual results, and whether a patient is an appropriate candidate for surgery.

You may wonder what types of fillers are available and what they do. Fillers containing hyaluronic acid such as Juvederm, Restylane and Belotero can be placed in the lines and wrinkles of the face to give a smoother appearance to the skin.

These products can also be injected into the lips to add volume and improve the vertical lines around the mouth.

Thicker hyaluronic acid fillers like Juvederm Voluma and Restylane Lyft, as well as fillers containing calcium hydroxylapatite such as Radiesse, are often used to restore volume to the mid-face. Sculptra, or poly-l-lactic acid, is an excellent and more global approach to adding volume to an aging face.

It acts by stimulating your own collagen production, and although it takes a couple of months and typically two to three treatment sessions to achieve the desired endpoint, it provides patients with long-lasting and natural results. Your doctor may even choose to treat you with multiple different fillers depending the areas that need correction as well as your individual needs and expectations.

Depending on your choice of filler, results may last anywhere from six months to two years as your body naturally breaks down fillers in a gradual fashion. In the hands of an experienced injector who has extensive knowledge of facial anatomy, fillers may be injected safely with minimal risks or side effects.

The most common side effects associated with filler injections are bruising and swelling following the procedure. These typically resolve in a matter of seven to 10 days and are more commonly seen in patients who are taking blood thinners, such as NSAIDs, or certain herbal supplements. Patients may rest assured that this will resolve, and makeup can be used to camouflage the bruising. I do not advise patients to undergo treatment with a filler if they have a special event coming up within a week since bruising may not be resolved at that point. More uncommon side effects include nodule formation, inflammatory or allergic reactions, infection and injection into a blood vessel. Fortunately, these events are quite uncommon.

Other noninvasive procedures may be coupled with fillers to achieve optimal treatment results. Neurotoxins such as Botox or Dysport are extremely helpful for smoothing “11” lines between the eyebrows, horizontal lines in the forehead, and wrinkles around the eyes called crow’s feet. Dissolving fatty tissue under the chin with deoxycholic acid, or Kybella, or freezing it away with Coolsculpting can provide a more defined contour to the jawline and profile. A series of treatments with a noninvasive radio frequency device such as Exilis Elite can help to tighten the skin on the neck, jowls and upper eyelids of patients with mild to moderate skin laxity. Patients with severe volume loss and very loose skin may require a surgical procedure and even a combination of surgery, laser skin resurfacing, fillers and neurotoxins to achieve optimal results.

The most important thing to remember when considering these cosmetic procedures is that there isn’t a cookiecutter approach that can be applied to each patient. Before making a decision based on online articles or recommendations, schedule a consultation appointment with a trained physician to discuss your treatment options. As a dermatologist, I recommend seeking treatment from a physician who is experienced in these procedures and board certified in a core cosmetic specialty.

Sarah Baker, MD, is a board-certified dermatologist with Ark-La-Tex Dermatology and is part of the Willis- Knighton Physician Network.

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