Dazzling with a little cosmetic help

It’s the little things that count.

With the holidays just around the corner, many of us are so focused on others that we forget about ourselves. There are a number of smaller treatments and procedures that are available that can fit into this season and it seems appropriate to review some of them at this time. If recovery and downtime are critical concerns, the best approach to consider are the so-called lunchtime treatments, consisting of micropeels, relaxants and fillers. All are relatively fast treatments that do not require anesthesia and we’ll review each in turn.

Two of the most important things we can do to maintain the appearance of our skin is to avoid prolonged and unprotected sun exposure and to stop smoking or better still, never start it. The three factors that have the most negative effect on the appearance of our skin are sun exposure, smoking and aging, and only two of these are under our own control. On the proactive side, a good regimen for skin care should include washing to remove the top layer of dead skin and moisturizing to prevent skin damage. Often, adding topical medications including retinoic acid to increase skin turnover and hydroquinones, or so called “bleaching agents,” to even out the pigment in our faces can be extremely helpful. Combining these with a micro-dermabrasion and one of the physician-prescribed skin care regimens can optimize the results. The nicest part is that other than micro-dermabrasion, these treatments can be done in the comfort of your own home.

Arguably the most significant medical breakthrough in improving the appearance of aging or damaged skin was the recognition that muscle relaxants, properly used and in safe dosages, could remove natural skin lines and creases. Certain areas on the face, such as the brow, glabellar area (base of the nose), and Crow’s feet areas (laugh lines around the eyes) are all in fact the result of hyperactivity of the muscles of facial expression. Generally not critical for function, these muscles help animate our faces, and are used in expressing feelings and emotions. When these muscles are hyperactive, the overlying skin forms creases or lines at right angles to the action of the muscles. For many of us, these chronic lines make us appear tired, angry or older. The muscle relaxants, such as Botox and now Dysport, cause the activity of the treated muscle to weaken for about three months. The overlying skin creases soften or disappear and so with a quick injection the skin appearance can be significantly improved. Treatments are done in the doctor’s office and take 10 to 20 minutes to complete and typically cost $300 to $400 per area treated. We use a topical anesthetic at the injection site and tiny insulin syringes for the injection so there is minimal discomfort during the procedure and almost none afterwards. Patients can resume their normal activities later that day and can return in about three months for another injection if they choose to repeat the procedure.

The next breakthrough was the development of filler injections that were made of hyaluronic acid, the other major component of subcutaneous tissue. The most frequently used agents are Restylane and Juvaderm, and they function similarly. A topical anesthetic is applied to the area to be treated and then the filler is mixed with local anesthesia and is injected with a small needle under the skin. The most commonly treated area is the nasolabial folds and marionette lines, which are “valleys” between the nose and upper lip and alongside the lower lip. These perioral lines are treated with one to two syringes of the filler. The effects are immediate and can be quite dramatic. Ice is applied to the injected sites to prevent bruising and the patient can resume normal activities that same day as there is essentially no recovery period. The effects usually last around six months, and patients are charged by the syringe, anywhere from $500 to $700.

The fillers have also been used to augment the lips and fill in hollow areas below the eyes, but patients should be aware of the possibility of overfilling and lumpiness in these areas. In case of a problem the filler will be gone in about six months, so the effects are not permanent. If you are really unhappy with the results of the injection, an injection of a hyularonidase can speed up the resorption of the filler. That being said, the ease of injection, generally excellent results and minimal discomfort and post-treatment problems have all combined to make the filler injections one of the most common plastic surgical procedures performed today.

I would like to complete this column with a review of an intriguing, new approach to correct the loss of contour and fullness associated with aging. These injectables fill in depressed areas by stimulating the bodies’ own production of collagen to replace the missing tissue. The most commonly used treatment in this category is Sculptra, and because its effects can last up to two years, it is becoming an increasingly popular choice in cosmetic surgery.

Treatment sessions take about 20 minutes each and usually three sessions are required to complete the course of treatment. The Sculptra is mixed with local anesthesia before injection to minimize any discomfort during the procedure. The result can last up to two years, after which the treatment cycle can be restarted. Areas that are treated include the nasolabial folds, cheeks and temporal area (which can be particularly dramatic). Afterwards, there are no limits on activities, though patients are asked to massage the area for five minutes, five times a day, for five days (the rule of fives). Like any other procedure, there are potential side effects, which should be considered before proceeding with treatment. In addition to redness, discomfort or bruising at the injection site, small lumps can sometimes be noticeable under the skin. Thus it’s very important to investigate the background and training of your treating physician. For the well-chosen patient, treatment can restore a more youthful appearance with minimal downtime. Each treatment session costs from $800 to $1,200.

Along with a good skin care program and where necessary laser rejuvenation and Botox, Sculptra can play an important role in nonsurgical facial refreshment.

Please send any questions or comments to mrosenberg@nwhc.net.

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