Injectables

One of the areas of Aesthetic Surgery in which misconceptions have started to run wild is with respect to the use of "injectables.” In the following overview, I present my straight-forward perspective on injectables to help you better understand them and, hopefully, make a proper decision regarding their use.

 

Publicity is rampant when it comes to Botox and the injectable fillers! This represents a marketing response to the quest for eternal youth. Prospective patients have been swept up in a trend to seek Dermatologists, Aesthetic Surgeons, Ophthalmologists, ENTs and almost anyone holding a medical license, hoping that a few quick injections will restore a youthful appearance and avoid the dreaded surgical knife.

 

So what's the basis for this trend, and do the injectables live up to their hype? It's now known that there are several driving forces that create the appearance of facial aging, one of which is diminishing facial volume and another of which is decreasing skin elasticity. This opens the door for potential benefit from the use of fillers to replace lost facial volume and the use of Botox to minimize the wrinkling effect of muscle activity on inelastic overlying skin. We'll explore each in more detail.

 

An alternative to the commercial fillers is the use of fat transfer from the patient's own body as the filler method. When properly handled, this fat is living tissue and has a strong chance of "taking root" in the new location and remaining there permanently. Since acquiring the fat is a bit of a surgical procedure, the costs are higher, and the recovery is also longer. In the end, however, a fat transfer that succeeds in remaining viable stands to cost the patient much less in the long run than repeated injections of commercial filler.

 

I hope this overview provides the reader a better understanding of these various injectable choices. They allhave their limits, of course, and, in time, it will only be through a surgical lift of some type, that the desired youthful appearance can be restored.

 

 

Let's take a look at Botox. Unlike the fillers, Botox has no immediate effect. It works by pharmacologically paralyzing the muscle into which it's injected, and this action of muscle paralysis takes two to three days to fully establish itself. I find that patients frequently don't comprehend how the mechanism of Botox induced muscle paralysis will benefit their facial appearance. In fact, it won't change anything about facial appearance, if the face is expressionless and at rest. It's only during the effort of animating the face, as during surprise, anger, laughter, etc., that the expression muscles in those areas that were treated with Botox fail to contract and wrinkle-up the overlying skin. The best example of this is the laugh lines at the outer regions of the eye areas (crow's foot area), which, after Botox, fail to show additional wrinkling as laughter occurs. The cost of Botox is less than that for filler, but it often requires reinjection every four months, or so.

 

 

 

Let's now consider the aging process of facial volume loss and the use of fillers to correct it. The most obvious areas of facial volume loss are the lips, the cheeks and the sunken areas just beneath the lower eyelids (tear trough deformity). Into these areas, injection of a safe substance (filler) and subsequent smoothing does, indeed, impart a beneficial "youthful" change and, provided the volume loss has not been too extreme, a gratifying result. The question is which filler, how much is required, how long will it last and at what cost? The various commercial fillers available today can all be grouped into one of just a couple basic chemical structures, have similar duration of benefit and, because of stiff competition, have similar cost. It generally falls upon the physician to recommend and stand behind the filler of his or her choice. Benefit from the current commercial fillers ranges from six to nine months, after which repeat injection can be performed. Repeating these injections every six months, or so, can quickly become a costly affair.