JUVÉDERM® Injectable Gel
On June 5, 2006, the FDA approved the JUVÉDERM® Injectable Gel family of soft tissue fillers for facial wrinkles
and folds. JUVÉDERM® Injectable Gel is a hyaluronic acid derivative, similar to Restylane, which will have three consistencies
available. JUVÉDERM® Injectable Gel helps target wrinkles and folds of various depths.
Drs. Agarwal and Maloney, Naples Facial Plastic Surgeons, have completed their participation in the JUVÉDERM® Experience Trial (JET).
"The material has a smoother feel than Restylane," according to Dr. Agarwal.
Because of their extensive experience with injectable fillers, Drs. Agarwal and Dr. Maloney at The Aesthetic Surgery Center
in Naples began offering JUVÉDERM® Injectable Gel treatments to their patients in early November 2006, two months prior to general release
to other physicians. JUVÉDERM® Injectable Gel is the perfect "quick-fix". You will look and feel refreshed, all with minimal down time.
BOTOX® Cosmetic
BOTOX® Cosmetic is the trade name of Botulinum Toxin Type A, a purified toxin produced by the bacterium
Clostridium botulinum. In large amounts, BOTOX® Cosmetic blocks the nerve impulses to muscles, causing
a form of paralysis called botulism.
BOTOX® Cosmetic, in extremely small doses, is injected directly into the specific muscles that cause frown lines.
These isolated muscles are paralyzed by the BOTOX® Cosmetic, and can no longer contract. The action of frowning is
stopped, and frown line diminish.
Frown lines are caused by the bunching of skin from facial muscle contraction. When we frown, the
skin between our eyebrows is gathered into a fold which eventually causes a chronic furrow. This gives
our face a frustrated, discouraged, angry look which is distracting to others and a bother to ourselves.
BOTOX® Cosmetic has been shown to soften and reduce crows feet, forehead wrinkles, nasal creases, and the neck line.
Dysport (Reloxin)
Until recently, Botox Cosmetic was the only FDA approved Botulinum toxin A available as a wrinkle relaxer. Dysport (Reloxin),
which has been used in Europe since 1991, was FDA approved in the United States last week. Physicians in the U.S. will
be able to inject this product in a couple of months. The main question for patients and physicians is: How does it
compare to Botox Cosmetic?
As with most new products, there is literature to support claims of superiority of both products. The ultimate answer
will come with time, as physicians in the U.S. gain experience with the product. Here are some early claims:
- Dysport seems to spread more that Botox Cosmetic, which can be desirable on the forehead (requiring fewer injections),
but undesirable near the eyebrows.
- The dilution of each product is different, which may affect price.
- You will undoubtedly see aggressive marketing promoting Dysport, because it is the latest FDA approved product.
However, have a frank discussion with your physician to determine if their is truly an advantage to this product. I believe that
with any new product or procedure, only time will tell.
We will strive to provide you with updated information as it becomes available. One thing is for sure: Competition is healthy,
and there will be even better wrinkle relaxers in future years.
Restylane
Approved by the FDA, Restylane is designed to smooth wrinkles, sculpt lips and shape facial contours.
Restylane is a clear transparent gel composed of hyaluronic acid, a natural substance that is found
throughout your body. Restylane is not of animal or human origin, which means that there is no risk
of allergic reaction. The most common areas for a Restylane treatment are the nasolabial folds (from the
root of the nose to the angle of your mouth), the lips (to provide fullness and shape), corners of the
mouth (to restore their horizontal youthful position instead of a downturned angry position), and
glabellar lines (between the eyebrows). With its unique ability to bind with water, Restylane remains
in your skin for many months.
Perlane
Perlane was approved by the FDA in May of 2007 for soft tissue augmentation of moderate to severe facial
folds and wrinkles. Perlane is in the same family as Restylane, with a larger particle size. Because of its
larger hyaluronic acid particle size, Perlane is injected into deeper folds than Restylane. It is most commonly
used in the nasolabial folds, marionette lines, and for augmentation of the cheeks.
ArteFill
ArteFill is a filler that is injected into the dermis for correction of moderate to severe facial wrinkles
and folds. It is the first non-resorbable (permanent) filler approved by the FDA. ArteFill is
polymethylmethacrylate (PMMA) coupled with a purified bovine collagen gel carrier. The PMMA beads
form a support matrix for your own collagen, which gradually replaces the bovine collagen carrier gel.
ArteFill also includes lidocaine for increased patient comfort. ArteFill is approved to treat the nasolabial
folds that form around the mouth. ArteFill usually lasts for years, unlike many of the non-permanent injectable fillers.
Due to biological variables (each person's ability to make collagen varies), some patients may require a second
treatment to obtain optimal results. Follow up treatment is usually performed 3 to 6 months after initial
injections.
A collagen skin test must be performed one month prior to treatment. Patients with a positive skin test will
not be treated with ArteFill. Treatment involves multiple injections to the site with a very thin needle.
Anesthesia involves nerve blocks, topical numbing cream, or both. Please call our office in Naples, Florida,
to have one of our skilled facial plastic surgeons treat you with ArteFill.
Radiesse
Formerly known as Radience, Radiesse is a synthetic injectable filler that non-surgically reduces
most wrinkles, creases and scars by augmenting your body's natural collagen supply. Composed of
microspheres in a biocompatible gel, Radiesse is made from the same minerals found in our bones,
so it carries no risk of allergic reaction - just one of its advantages over alternative treatments.
Radiesse can be used on many areas of the body, but the most effective areas treated are the nasolabial
folds (laugh lines), peri-oral lines, depressed scars and oral commissures (downturned corners of the mouth).
Treatments typically take 30 minutes and require only local anesthetic. Side effects such as swelling or
bruising are minimal and should fade within a few days. Results are visible immediately after the injection
and can last upwards of one year, although the procedure can be repeated as often as you wish.
Collagen Injections
Most patients first notice fine wrinkles around their eyes, mouth, and forehead in their early
30's. Treatment for this is usually collagen injections. Since it is an office visit procedure,
it is a good beginning to facial esthetic restoration.
It should be noted that with time, some of the collagen will be absorbed by the skin. Touch-up
injections will be needed every six to 24 months. Considerably less collagen is needed in
subsequent treatments, however, and virtually no convalescence is required.
How do I know which injectable is right for me?
The choice of injectable agent is critical to the successful treatment of wrinkles, folds, and facial depressions.
An individual consultation with one of our Board Certified Facial Plastic Surgeons will give you an accurate assessment
of what will be best suited for your face. Often, a combination of agents (i.e. BOTOX® Cosmetic, Restylane, Radiesse)
may be used to achieve optimal results in different portions of your face.
How long do injectables last?
Longevity of BOTOX® Cosmetic and Facial Fillers can vary from person to person. However, in general, BOTOX® Cosmetic
lasts 3 to 5 months, Restylane and JUVÉDERM® Injectable Gel last 6 to 8 months in facial folds, JUVÉDERM® Injectable Gel
lasts 3 to 5 months in the lips, Radiesse lasts 9 to 12 months in the folds, and Artefill lasts 1 to 5 years. These ranges
are on the conservative side, and are often underestimates.
Is BOTOX® Cosmetic safe?
BOTOX® Cosmetic has an excellent safety record and has one of the highest patient satisfaction ratings of any cosmetic procedure.
Who performs the injectables at your practice?
All of our injectables are physician administered by one of our plastic surgeons. They have the skill and aesthetic training
required to provide three dimensional volumetric enhancement and facial muscle relaxation.
Do injectables hurt?
Any injection will cause mild pain. However, we use a variety of measures to minimize this discomfort. Ice, topical
anesthetic creams, and/or nerve blocks with lidocaine are all techniques used to reduce pain, bruising, and swelling.
Will I bruise?
This varies from person to person. In general, BOTOX® Cosmetic rarely causes bruising. However, facial fillers, especially
near the corners of the mouth, often result in mild bruising. Avoidance of blood thinners can help reduce bruising, as
long as you are cleared to stop these by your medical doctor. Make-up can be applied the same day for camouflage, if necessary.
How much do each of these cost?
Please call us at 239-594-9100 for a price list of all of our injectables. BOTOX® Cosmetic is priced by the unit, while the
facial fillers are priced by the syringe. Keep in mind that only one of our plastic surgeons can give you an accurate assessment
of the number of syringes or BOTOX® Cosmetic units that are needed to accomplish your goals.
I am only 30 years old. Am I too young to start?
Many lines, folds, and depressions are hereditary. It is not too early to address these. In fact, many facial fillers are
made up of natural constituents of the skin, such as hyaluronic acid or collagen. Therefore, it makes sense to restore these
to the skin.
Do injectables accomplish the same thing as a facelift?
No!!!. Injectables are often complementary to facelifts, but a needle will not restore facial fat pads, muscle laxity, or skin
laxity to their youthful positions like surgery will.
Vice versa, surgery often softens but does not eliminate deep nasolabial folds and marionette lines. In these cases, direct
injectable fillers such as Restylane, Radiesse, JUVÉDERM® Injectable Gel, or Artefill can complement surgical treatment.
Can BOTOX® Cosmetic or Facial Injectable Fillers be performed on the same day as my consultation?
Absolutely. When you call to make your appointment with one of our plastic surgeons, just specify whether you are planning on
having a consultation with or without actual injectable treatment on the same day.
