Wednesday, June 15th, 2022
As we age, the skin and supporting structures lose collagen and elastin, the things that give it strength and elasticity. Gravity and the muscles that are attached to the skin in the face stretch the skin and cause it to wrinkle. Additionally, we lose subcutaneous tissue. The result depends on which of these changes predominate. If stretch is the largest component, then surgical removal of the excess skin with a facelift, blepharoplasty, etc. is required. However, if volume loss and wrinkling are most prominent, then re-filling the area using Today’s Liquid Lift™, a nonsurgical, noninvasive procedure, is all that is needed. This works equally well for both men and women.
This approach uses a combination of skin care, Botox®, and a filler, either off the shelf or your own fat, to reverse the signs of aging. What is used, depends on the particular problem.
The most important step in treating wrinkles is beginning the use of tretinoin (Retin-A, to stimulate collagen) and Obagi®’s patented ELASTIderm® (to stimulate elastic tissue) along with basic skincare consisting of a cleanser, a pH balancer, an exfoliant, and a good zinc oxide sunblock. If the wrinkle is caused by underlying muscle action, and the muscle is not necessary for normal function, then we use Botox® to stop the muscle action on the skin. This is all that is necessary for fine wrinkles. For deeper wrinkles, we add micro-needling to increase dermal (the support layer of the skin) production of collagen to reduce the wrinkles. If the wrinkles are quite deep, we then fill the wrinkle using Juvéderm Volbella™, a filler that generally does not cause the Tyndall effect (a blue line where the filler is injected close to the surface). Previously for these deeper wrinkles, we used either a leveling peel or laser to remove the top layer of the skin to the bottom of the wrinkle allowing the skin to regrow smoothly. This, however, has a 2-3 week downtime, as opposed to the no downtime of what we do now.
Botox® can also be used to improve facial features if removing a certain muscle function allows opposing muscles to achieve the result that you desire. The most dramatic result is to open the eyes when the muscles below the brow are pulling the brow downward and removing those muscles allows the muscle in the forehead to elevate the brow and open the eye.
If the problem is related to loss of volume, then refilling that area with either your own fat or a filler corrects it. The choice of which depends on how much fill is needed, where the filler is needed, and other factors, including cost. Initially, if you wished a long-lasting result the only choice was fat. However, the newer fillers are now much longer-lasting, (one Juvéderm® Voluma) up to five years or longer. Fat is still excellent for filling large areas and is quite long-lasting. For small areas, an off-the-shelf filler is excellent, exceptionally convenient, and cost-effective.
You will frequently see these called “dermal” fillers. However, we have almost never used them intradermally and, even now, there are only a few that work well placed in the dermis without causing a Tyndall effect. Some are intended for only subcutaneous and deep subcutaneous placement but still get labeled as “dermal” fillers by many people. There are a variety of off-the-shelf fillers used. The basic types of these include:
Dr. Buchanan prefers the Juvéderm® family of hyaluronic acid fillers because of their excellent performance, safety, and because they are more long-lasting than any other comparable filler on the market.
Using the latest techniques, it is our goal to provide the desired outcome with a procedure offering the quickest recovery and optimal results. We listen to you and strive to provide a natural result with the least invasive means.
Where reasonable, before injection, we use either a local or regional anesthetic before Botox or filler injection. Other than that, there may be only a mild stinging sensation. The procedure takes about 15 minutes to an hour, depending upon what is done with essentially no downtime.
Give yourself the gift of youthful vibrance with Today’s Liquid Lift™. Also, ask about repair using the techniques for aged hands. Contact the Center for Plastic Surgery serving Highlands, NC and the surrounding community, by calling 828-526-3783 to schedule your consultation with Dr. Robert Buchanan.