Plastic Surgery is no longer a purely surgical specialty. We now have many procedures that produce almost the same and, in some cases, even better results than we previously achieved only with surgery. They also frequently allow us to greatly improve on the results of surgery. Nothing yet, other than surgery, can tighten skin for longer than a few months, but we can reduce fat, stop progression of aging and hide many of the results of aging with lasers, injections, and skin care with excellent results. Fillers can reinflate areas, effectively tightening the skin. Botox can reduce or eliminate wrinkles and stop their cause, allowing skin care, fillers, and other modalities to further correct them. Where, before, we used these modalities as standalone procedures, we now combine them and advanced skin care to achieve better, more natural and longer lasting results. Below is information about some of these procedures
It depends on your goals, your problem, and the cause of the problem.
If you simply want to do something about your crow’s feet, then BOTOX Cosmetic injections are a simple answer. If you want to erase the lines and creases on the lower face and around your mouth, then the various Juvéderm fillers offered at Center for Plastic Surgery are the way to go. If you want to return volume to sunken cheeks, Juvéderm Voluma is the answer (having previous to 2015 used Radiesse for this but finding Voluma safer and less expensive per month lasted). Juvéderm Volbella, Juvéderm Vollure, and Juvéderm Ultra can add shape and volume to your lips as well as your cheeks. Volbella and, occasionally, Vollure can erase wrinkles and stiffen the skin to reduce wrinkle formation. Fat injections provide the longest lasting results with up to three quarters of the injected fat becoming permanent.
If you’re seeking body contouring through fat reduction, our Zerona treatments use laser energy to shrink fat cells, thus slimming your contour.
If you’re interested in the effects of a surgical facelift without any incisions, Dr. Buchanan can use a variety of Juvéderm fillers and fat grafting to rejuvenate areas of your face that have lost volume due to declining collagen production, sun damage, and loss of fat, bone, and muscle mass. These liquid facelifts can last for a number of years, depending on the filler and where placed and have essentially no downtime or recovery.
So, what’s the right non-surgical procedure for you at our Highlands office? Why not schedule a consultation and discuss your goals so we can match you and your desires with the right non-surgical option.
Before receiving any of our non-surgical offerings for the first time, Dr. Buchanan consults with you. This is important so that we understand what bothers you and your goals or what you’d like to achieve.
Dr. Buchanan views all of our consultations as a complete give and take of information between you and him. He will ask you to start detailing what bothers you and you would like to address. He will then ask you to talk about what you would like to avoid (down time, bruising, pain, etc.) and how you think he can achieve these things with our non-surgical options.
With this information, Dr. Buchanan will examine you, looking to match the perfect non-surgical treatment to your needs. Throughout this he’ll discuss what he sees and share this with you. He’ll talk about what our various treatments can achieve. He’ll discuss how each treatment is performed. And he’ll discuss any risks involved and recovery.
Throughout your consultation, Dr. Buchanan encourages you to ask all questions or voice any concerns you have. At the conclusion of your consultation, you should know exactly what the next step will be, should you decide to go ahead with one of our non-surgical treatments.
We have patients who lump fillers (at our office the Juvéderm Family) and neuromodulators (BOTOX Cosmetic) together, but they are actually completely different in how and where they work.
Non fat fillers are frequently called dermal fillers, but, until very recently, almost none were actually injected into the dermis, the support layer of the skin. They were originally called this because they were made from animal dermis and collagen. Originally, when injected into the dermis they frequently caused a blue or greenish line called the Tyndall effect. Newer fillers, however, have almost eliminated this problem and we can now use them to fill lines and achieve results much like we previously did with leveling peels and lasers, but with minimal or no downtime compared to about two weeks or longer for laser and peels. When injected beneath a wrinkle, crease, or in an area that has lost volume, they simply “fill” the space, pushing the skin or superficial dermis back upward and erasing or diminishing the crease or area of volume loss. Our numerous filler options each target a specific area.
Fillers treat wrinkles known as “static wrinkles.” These wrinkles are caused by sun damage, declining collagen production, personal habits, simple aging, and muscle action over time. Static wrinkles are permanent etched lines in the skin caused by previous muscle contractions and loss of collagen and elastic tissue within the dermal layer of the skin. Before treating these lines with a filler, we generally begin use of tretinoin (Retin-A) and Obagi’s ELASTIderm in order to stimulate the body to produce new collagen and elastic tissue within the dermis. We also recommend micro-needling to further stimulate collagen production. These help the body use some of the hyaluronic acid in the filler to make its own collagen and replace what we injected. Over the years we have found we inject the wrinkles only twice at most before getting a permanent correction.
Almost all fillers used today are made from compounds generally found within the body naturally. The majority of fillers today are made primarily from hyaluronic acid, the precursor that the body uses to make collagen, which hydrates, plumps, and firms the skin.
Fillers presently used in our office:
A previous filler used to fill the face and other areas (and why we switched to Voluma):
BOTOX Cosmetic is a neuromodulator, botulinum toxin type A. Back in the 1950s it was discovered that when a miniscule amount of the toxin was injected into a muscle, it temporarily stopped the muscle from contracting. BOTOX was developed out of this research and was first approved by the FDA for the treatment of involuntary eye muscle spasms originally used only in children. However, as it became more common to treat eye muscle spasms in adults, an ophthalmologist in Toronto Canada had a patient say that she loved the result of loss of wrinkles around her eye also. The ophthalmologist and her husband, a dermatologist, begin using it on other muscles and published a paper in the early 1990s. It was then that Dr. Buchanan and many other physicians began using it to reduce wrinkles cosmetically. It became famous in 2002, however, when the FDA approved BOTOX Cosmetic (the same product, just repackaged) for use on the upper third of the face for wrinkle treatment. It has been the world’s most popular cosmetic procedure every year since.
When we make expressions, such as frowning, squinting, showing surprise, and others, muscles around our eyes, between our eyebrows, and on our forehead engage. Over time these contractions begin to create wrinkles on the surface skin above the muscle. These wrinkles are known initially as “dynamic wrinkles.” These are crow’s feet next to the eyes, the 11s between the eyebrows, and forehead lines. When BOTOX Cosmetic is injected into the muscles that create these wrinkles, it blocks the nerve messages from the brain to the muscle. Since the muscle doesn’t receive the message to contract, it stays relaxed and the wrinkle on the surface skin doesn’t form. This lasts for 2-8 months depending on the individual. At that point, the muscle will begin to contract again, and the wrinkle will return. Then, another BOTOX Cosmetic session with Dr. Buchanan will maintain your results.
Botox now has essentially two uses. First, it can eliminate dynamic wrinkles, those that are present only when the underlying muscle is functioning. It will not eliminate static wrinkles, those that are present when there is no underlying muscle action, but it can help in their improvement. To treat static wrinkles, we start with what we call Basic Skin Care Plus. This is the skin care that everyone needs daily plus tretinoin (Retin-A) to stimulate collagen within the dermis and ELASTIderm to stimulate conversion of some of that collagen to elastic tissue. It is loss of collagen and elastic tissue that occurs naturally past about 25 years of age that is partially responsible for development of the static wrinkles. Adding these two components to the skin can, if given enough time and there is no further muscle function, eliminate the wrinkles. Usually, however, we improve the process by filling the static wrinkle to reduce it and also using micro-needling to further stimulate collagen production. There is minimal downtime associated with this. Although leveling peels or laser can do the same thing, both have significant prolonged down times. Adding Botox further improve the effectiveness of the other treatments as it prevents the muscle from re-creating the wrinkle.
BOTOX Cosmetic injections take just 15-30 minutes, and there isn’t any downtime. No wonder BOTOX Cosmetic is so popular.
Fat grafting can do everything that use of an off the shelf filler can do except fill static wrinkles. It used to be exceptionally popular since the results are essentially permanent and the initial fillers available lasted only a short time. However, it has become less so with the development of your fillers which now can last many years in certain places. However, if you need a significant amount of fill, fat grafting becomes more economic. Fat is more expensive for small amounts since it involves not only the injection but extraction and processing of the fat. The price point of filler and fat grafting essentially meet at about 5-7 mL of which ever filler is used. Larger amounts of fat become more reasonable than the cost of filler. Also, if you are looking for the longest lasting option, then fat grafting is the obvious choice.
As stated above, we now use most of these modalities in combination. In fact, we call the combination of these Today’s Liquid Lift since they can almost provide the same results as a surgical lift. We do not usually talk about Botox unless we also talk about skin care since the two are significantly intertwined in both preventing and correcting wrinkles. If you are trying to reduce static wrinkles, then use of a filler such as Volbella and micro-needling are also essential.
No. These are short appointments. All the Juvéderm fillers provide instant results. BOTOX Cosmetic takes about 7 hours to 7 days to fully relax the injected muscles and provide results. As soon as your appointment is over, you can go right back to work or your other normal activities. There isn’t any recovery or downtime.