Plastic surgeons, as the name implies, is a specialty of physicians who are surgeons foremost. However, sound clinical judgment is needed in order to safely practice plastic surgery and provide effective care. Board certified plastic surgeons are the most qualified physicians to offer you the known spectrum of non-invasive techniques or surgery if necessary to address the problem. Such matters include non surgical techniques. Plastic surgeons have expertise in non-surgical as well as surgical management of difficult wounds, scars, and disfigurement. In recent years, advances in medicine have allowed plastic surgeons to broaden non-surgical techniques to include the management of aesthetic problems. This allows us to provide more options to our patients who may not be candidates or desire surgery. The advantage to receiving non-invasive procedures from a plastic surgeon is that we feel that by being able to offer the entire spectrum of treatment, this truly gives the patient all of the current treatment options, whether surgical or non-surgical. The patient is making an informed decision based not on the limitations of your physician, but rather on his or her individual needs and expectations.
Three of the more common non-invasive procedures performed in the office are Botox®, Restalyne®, and RadiesseT injections. The use of these products has decreased the need for older generation agents such as collagen except in very selective cases. This is primarily due to the reproducibility and longevity of results in addition to the extremely low incidence of allergic reaction which eliminates the need for testing. These are three entirely different agents used to address wrinkles, folds, and loss of fullness in the facial areas. A brief description of each is provided below. As with all elective injections, patients with known hypersensitivity to bacteria, severe allergies or history of anaphylaxis should not undergo these procedures. Patients with known history of hypertrophic scars or keloids should also be carefully advised of risk prior to undergoing injections with implants or fillers.
Botulism toxin A injections are used in aesthetic surgery to diminish or eliminate minor wrinkles (rhytids) of the forehead, around the eyes, between the eyebrows and the corners of the mouth, dimples of the chin and skin bands of the neck. The advantages of Botox® is that it is generally safe, with relatively few contraindications. It is quick, and simple to perform with minimum downtime or bruising. It provides a fairly predictable result which can be duplicated quite easily. It can be performed in the office and requires only Tylenol for pain. Many patients are able to undergo Botox® injections during a "lunch session" and return to work without any difficulty. Botox® is administered with a small needle placed superficially in the skin which is treated with a topical anesthetic cream. Most patients rate Botox® injections on a pain scale of 1-10 as a 2 and the discomfort should not last more than a few hours. The maximum effectiveness of the injection may take 7 to 10 days. The cost of Botox® varies because the effectiveness of the active agent is dependent on the amount that it is diluted and the timeframe from initial dilution. Therefore, you may not receive an effective dosage if you are treated by a physician who excessively dilutes the product or attempts to perform the procedure more than 3 days after dilution. The disadvantage of Botox® is that it has a transient period of effectiveness which is more difficult to maintain after multiple injections as your body may develop a mild resistance to it. This may result in either shorter duration of effectiveness and/or greater need for the product to produce similar results. Botox® is not effective for larger folds such as the nasolabial fold which extends from the nose to the corner of the mouth. Botox® injections will also be ineffective in eliminating permanent wrinkles that are present when not animating, such as permanent frown lines. It is, however, effective in providing transient elimination of unwanted frown or smile lines in the forehead, brow, eye or lip areas. Botox® injections are an effective means to diminish or eliminate fine wrinkles in these areas for 3 to 6 months.
Botox® is manufactured by Allergen Medical and should be provided only by a specialist who receives the product directly from such providers.
Restalyne® is a non-surgical treatment for deeper wrinkles and folds of the facial areas. This includes nasolabial folds, and deep folds which persist even when not animating, smiling or frowning. It is also effective as a means of non-permanent lip enhancement. The product is an implantable gel made of hylaronic acid, a naturally occurring ground substance found in all cells. Restalyne® is manufactured in a lab by bacterial (streptococcus) cultures and therefore poses no risk of transferring disease. However, as with all elective injection techniques, patients with known hypersensitivity to bacteria, severe allergic reactions or history of anaphylaxis should not receive these procedures. Restalyne® is most effective in the treatment of deep folds such as the nasolabial fold between the nose and the mouth. It often eliminates the need to have a surgical facelift in younger, 30-40, year old populations who have deep folds in these areas. It is also very effective in treating permanent wrinkles in the forehead area and as a means of providing lip enhancement. Restalyne® is injected directly into the skin folds with the intent of elevating and smoothing the contours. It does require a 30 to 45 minute office visit and patients rate the discomfort a level 2-3 out of 10 when performed with a topical anesthetic. There will be downtime of approximately 2-3 days when some bruising and/or swelling will occur. Restalyne® may produce unfavorable nodules in patients with very thin skin. These can usually be improved by your physician if necessary. Restalyne® should provide effective treatment of deep wrinkles, folds and lip enhancement for 6 to 9 months. Restalyne® is presently manufactured and supplied in the United States by Medicis Aesthetics. More information on this product can be found on their web site.
Radiesse™ is an injectible implant composed of a naturally occurring bone substrate (hydroxylappatite) and an organic gel carrier. The base substance has been used for decades in specialties such as orthopedics, dentistry and neurosurgery as a graft to fill skeletal defects. The ability to manufacture this agent in particles less than 50 microns in size and blend it with a smooth, easily injectible gel carrier has now made it possible for use in facial aesthetics. Radiesse™ may be used instead of an implant to achieve fullness in the cheek area. It can also be used to fill small defects in the nasal, chin, and neck areas which previously could only be treated with surgery. Likewise, it is an effective means of filling soft tissue areas of depression as a result of prior surgery, scar or trauma. The most common areas of treatment are deep nasolabial folds, permanent frown lines, jowls around the chin, nasal hump deformities, and cheek enhancement. Radiesse™ appears promising as an effective long term, non-invasive means of addressing soft tissue depressions and deep folds in the facial areas. By adding bulk to areas of soft tissue loss, it provides a more youthful appearance. In addition, it improves the fullness of the face after significant weight loss. It may produce sustained improvement in these areas for up to 18 months.
Fat injections may be performed after harvest from another area of the patient's body. This technique may be used to increase volume in deficient areas of the face and neck. It may also be used to treat very deep facial folds. Injection of fat may also be used to elevate depressed scars or undesired areas of depression after liposuction. The harvest of fat may be performed under conscious sedation or general anesthetic depending on the area and volume of fat placement desired. Therefore, with the exception of very small volumes, the procedure is usually performed in an outpatient surgical facility. Compared to implants, large volume fat injection in our experience does not result in improved outcomes. Fat injections require minimum downtime as pain is usually graded 3-4 out of 10. However, you can expect considerable swelling and bruising may last 3 weeks or more. Therefore, fat injections to the facial area may leave you socially unacceptable for 3 to 4 weeks. The risk of fat injections include the loss of fat graft with secondary areas of depression, asymmetry, contour irregularity, infection, and fat resorption which may negate the initial results. In general, fat injections are not felt to be a permanent solution, and although the length of effectiveness is debatable, it is generally felt to last 6-12 months.
Treatment of spider veins is commonly performed in the office by injection of irritating or sclerosing agents which occlude the feeding vessel. The procedure takes approximately 30 minutes to perform and results are usually immediately noticeable. The risks of the procedure include partial skin discoloration, temporary blister formation and need for more than one injection.
Thread lift is the insertion of a nonabsorbable suture through the skin in order to simulate the lifting of skin performed during a facelift. It does so through minimum incisions and without excision of skin. It has the advantage of decreased expense and down time compared to standard facelift. The procedure is also potentially reversible. The disadvantage is that the procedure may not be effective in patients with significant skin laxity or poor bone or facial fat support. The time frame in which the thread lift will provide effective improvement is unknown but is not expected to last beyond 3 to 5 years. Dr. Coleman is a certified practitioner of the Contour Thread Lift. ®