Posts Tagged ‘injectable fillers’
Thursday, January 5th, 2012
Q: Dr. Eppley, I had my buccal fat pads removed nearly fifteen years ago at age 31 for some facial sculpting. Now that I am older, I look completely different. My face is very flat and not as attractive. What can I do to look like before? What are my choices for making my face now a little fuller?
A: As you have aged, your face likely has lost overall fat and the prior removal of the buccal fat pads has only accentuated this natural fat involution process. There are several options available to consider for facial volume restoration. The first approach is fat injections which focuses on replacing like with like. The only question is how much fat will survive after transplantation. This is an overall facial volume approach. The next approach is focal or spot treatment, just adding volume to the buccal or submalar area. This could dbe done with either submalar cheek implants or injectable fillers. The real value of injectable fillers in your case, in my opinion, is to be an initial test to determine if augmentation of this area is what you are looking for. It serves as a test to determine if more formal augmentation (implant) is worthwhile.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek implants, dr barry eppley, fat injections, indianapolis, injectable fillers
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Wednesday, October 19th, 2011
Q: Dr. Eppley, I am 38 years old and have had very noticeable nasolabial folds for the past several years. I have had injectable fillers, specifically Juvederm Ultra XC, placed into them with some improvement. I also had my cheeks injected also. Now, less than 6 months after the injections, my nasolabial folds are just about back again. I would like to something that is more permanent and may even have a greater effect. Do you think a cheek lift will work? Or should I just wait until I am older?
A: Deep nasolabial folds at a young age can be a very difficult problem. Some facial shapes and skin types are simply more prone to them and, if this is an issue at the young age of 38, it is going to continue to be a long-term facial issue. Injectable fillers for the nasolabial folds offer both advantages and disadvantages. Their advantage is that they work when properly placed. There is great debate of the many fillers as to which one is better but none has ever been shown to be really be ‘better’, they all work. Some simply last longer at a greater price. They work instantaneously and generally have no significant problems. Their disadvantage is that they are not permanent. No injectable filler is permanent, no matter what is said by some. However, a cheek lift is not the solution either…for now. You are too young to justify such surgery and it is not a permanent solution either. You would be best served to continue with injectable fillers at this point even though they have limited duration. The effectiveness of cheek or midface lifts depends on mobility of the cheek tissue across the zygoma or cheekbone. I doubt if you have much of at your age. This is why such cheek lifts are years away for you.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek lifts, dr barry eppley, indianapolis, injectable fillers
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Monday, September 19th, 2011
Aging is inevitable and it begins to appear first around the eyes. While eyelid and brow lifts provide immediate and significant improvements, many would prefer to lessen these eye flaws without the costs and recovery of an operation.
There are a variety of non-surgical eye treatments combining neurotoxins, fillers, lasers devices and topical products. Which ones are used often follows the age of the person. Those in their 30s and 40s usually just need Botox to control their frowning and squinting wrinkles. Fillers and light and laser treatments are added for those in their 40s and 50s. At age 50 and beyond, surgery is needed to remove extra upper eyelid skin and lower eyelid bags. But these non-surgical treatments are still needed to preserve one’s surgical investment.
Botox is the most known name when it comes to facial wrinkle reduction by injection. But it is not alone as two other injection drugs, Dysport and Xeomin, are also available. While there are some that believe one is better than the other, they all are really comparable. They all take a few days to a week to start working and their effects will last from three to four months. One is not more powerful than the other nor does one cost less. These injections are given by the unit and the cost per unit varies for each one but so does how they are prepared. As such their treatment costs are all about the same.
While Botox is the most common non-surgical eye treatments, injectable fillers can also play a role. Many people will develop shadowing and tear troughs under the lower eyelid, sometimes as early as the late 30s. This can be treated with fillers to plump the area out. While they are over a dozen types of injectable fillers, the hyaluronic acid-based fillers (e.g., Restylane and Juvederm) are preferred. They can be delivered under the thin tissues of the lower eyelids with a low risk of lumps and irregularities.
While eye wrinkles can be held in check with Botox and fillers, they can not reverse certain skin problems. Blood vessels and brown spots can be removed with pulsed light treatments. These are often confused with lasers which they are not. When it comes to improving skin texture and reducing fine lines and wrinkles, laser resurfacing can provide improvements beyond what an eyelid lift can do.
Topical skin care products complement eye the benefits of injectable and energy treatments. The skin around the eyes is so thin that it responds well to many Vitamin C, retinoid and antioxidant-containing products. A new topical product, Latisse, is great for thinning eyelashes and eyebrows and it works like nothing else. Eyelashes and eyebrows can become one-third longer and thicker in a few months.
While surgery may be needed or inevitable for some, younger and less tired looking eyes may be just a few injections or the wave of a laser wand away.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: botox, dr barry eppley, indianapolis, injectable fillers, laser resurfacing, latisse
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Tuesday, April 5th, 2011
Q: Hi there. I see that you list Evolence filler on your website and wondered if you are still offering this? Also, do you offer Selphyl (“filler” using patient’s own blood plasma)? I am interested in these options for superficial glabellar wrinkles. I prefer using natural, non-toxic products. Botox is not something I am interested in at this time. Thanks!
A: The injectable filler Evolence has been pulled from the market and discontinued from being manufactured by J & J in 2009.
Selphyl and Platelet-Rich-Plasma/Acell mixtures are procedures that I do but neither would be a good option for superficial facial wrinkles. That is not what they are intended to be used for as the needles for injections are bigger than that of the fine wrinkles.
For glabellar wrinkles, the use of any type of injectable filler, without prior treatment with Botox is a wasted effort and exactly the opposite of what should be done. You must first control the muscle activity first, otherwise the unchecked muscle motion will make the injectable filler disappear quite quickly. There are no permanent injectable fillers and muscle action working against them makes them dissipate much quicker than normal.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, injectable fillers
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Monday, December 27th, 2010
Q: Is there no way to bringing out the midface with dermal fillers? Are the results not so good as with implants? What is the material of which midface implants are made of? What the advantages and disadvantages of injectable fillers vs implants for midface deficiencies?
A: For midfacial deficiency, albeit of the cheeks, maxilla, or paranasal region, synthetic implants are the preferred treatment. They are far superior to injectable fillers in both results and cost effectiveness. Injectable fillers are intended to treat small soft tissue deficiencies of the facial skin such as wrinkles or folds. They were never intended to be used for more significant bone-based facial deficiencies but rather to be placed into or just under the skin. The sheer cost of placing large volumes of injectable fillers down at the bone level would quickly equal or come close to the cost of implant surgery. When you factor in that they are all temporary, the value proposition of injectable treatments for facial skeletal deficiencies becomes quite poor.
Most facial implants, including those of the midface region, are primarily composed of solid silicone. Silicone is one of the most biocompatible of all implant materials and also offers the largest array of facial implant designs. All midfacial implants are introduced and placed through incisions inside the mouth so there is no external scarring with their use.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, injectable fillers, midface implants, plastic surgery
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Monday, October 25th, 2010
Q: I live in New Jersey and loved reading your advice articles on injectable fillers. I am a 42 year-old female with dark circles under my eyes with hollowing, upper lip wrinkles, and horizontal forehead ceases. I would love to know if you could recommend a skilled Dr in my area who could do my eyes? Thank you for your time.
A: Injectable fillers can be used to create a variety of instantaneous facial effects by adding volume under the skin. While once limited only to lessening the depth of the nasolabial folds or increasing the size of one’s lips, their uses are being expanded. One of these newer areas is around the eyes, specifically for hollowing of the lower eyelids or treatment of the tear trough depression. This lack of volume can be one of the contributing factors to the appearance of dark circles under the eyes. Suborbital injection filling is one of the more technique sensitive (trickier) areas to inject well however. There is definitely much greater risk of bruising due to the many blood vessels in this area. Missing all of them can not always be predicted. Proper placement of the filler in the deeper tissue level down to the bone is important to not only get the best fill but to avoid lumps of the material if injected just under the skin. For those physician injectors that regularly perform blepharoplasty (eyelid) surgery, they will more likely feel comfortable placing the injectable filler into the proper tissue level. They will also be in better position to judge whether an injectable filler is the best treatment option and how it might compare to other methods of treatment such as fat grafting.
Dr. Barry Eppley
Tags: dr barry eppley, indianapolis, injectable fillers, injectable fillers for eye hollowing
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Monday, October 25th, 2010
Q: I am interested in what a limited facelift or lifestyle lift might do for me or if I can get away with fillers or something like that. What is the comparative recovery time? Costs? How long do they last?
A: One of the common misconceptions in management of the aging face is that injectable fillers and some form of a facelift treat the same problems. They do not and, as a result, are not comparable treatments. They are often companions (done together or in separate stages) but are never substitutes for each other. Injectable treatment are for the central part of the face and do things that surgery generally can not either achieve or do very well. These include Botox for forehead and eye wrinkles and fillers for nasolabial fold depth reduction and lip wrinkle reduction and lip size increase. Any form of a facelift deals only with the sagging skin and excess fat in the neck and jowls, lower third of the face sagging.
There are procedures touted as ‘liquid facelifts’ but these are a bit (or maybe a lot) misleading and are associated, in my opinion, with a relatively poor value. By using injectable fillers, the sides of the face and cheeks can be puffed up which does create a mild temporary lifting effect due to the expansion of the tissues. The operative word is temporary (six months or less) and, when one compares the cost of numerous syringes of injectable fillers, one could already be more than halfway to one of the variations of a facelift. This injectable approach will also do nothing for the neck area which is the primary target of facelift surgery.
For the patient with lesser amounts of facial aging, the combination of a limited facelift (aka Lifestyle Lift) and injectable fillers can create a very dynamic effect by being able to treat the entire face more effectively. There is a very definite role and benefit to injectable fillers but their results are not comparable to facelift surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, injectable fillers, lifestyle lift, limited facelift, plastic surgery
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Sunday, October 3rd, 2010
Q: I am 55. I love wearing pierced earrings. I notice that they are sagging a little bit. I wonder if putting filler in the ear lobes is the best action to take, or would it just allow me to wear heavy earrings and destroy the cartilage that much faster?
A: The earlobe, unlike the rest of the ear, is only composed of skin and fat. It does not contain any cartilage which would give some stiffer support. This is why earlobes get stretched out, sag with aging, and even develop splits or tears in them from earring wear. If they had cartilage in them, none of these problems would develop.
Your question is based on the concept of adding a ‘stiffener’ to the earlobe to make it more resistant to sag or to be able to wear heavier earrings.While injectable fillers are quick and easy to do, and they can immediately make the ear lobe bigger, they will not make it more resistant to the pull effect of earrings. Injectable fillers are soft and much more like ‘jello’. The one exception to that would be the injectable filler, Radiesse, which has tiny ceramic particles in it and is more like toothpaste than jello. If you were to consider an injectable filler into the earlobe, Radiesse would be the one of choice.
The best long-term approach to prevent earlobe sag or stretching is to place small curved cartilage grafts beneath the underside of the piercing hole. This is done through a small incision on the back of the ear. The graft is harvested from above from the backside of the concha. One conchal harvest is enough for both sides. This then makes the earlobe more like the rest of the ear as the ear cartilage graft directly resists earring wear better.
Dr. Barry Eppley
Indianapolis Indiana
Tags: cartilage grafts to the ear, dr barry eppley, earlobe sagging, earlobe stretching, indianapolis, injectable fillers, plastic surgery
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Monday, September 13th, 2010
This advertising phrase has been used countless times in the world of cosmetic surgery. I usually just gloss over it and write it off as exuberant advertising. After all, very few things in life of any value can really be obtained in just five minutes…even a good cup of coffee takes almost that long to get. But seeing this phrase as the main topic on the cover of a major magazine of good reputation made writing about it irresistible.
The concept of the ‘5 Minute Facelift’, beyond the slathering on of alleged beauty crèmes that ‘really work’, relates to the contemporary use of injectable fillers. Not to be confused with Botox (which paralyzes small areas of facial muscles) which is also injected, fillers add volume to the face underneath the skin. Most commonly used for the lips and the facial parentheses (a.k.a. lip-cheek grooves), it has become more widely used for many other areas of the face. Since one’s face is known to lose fat as we age, plumping up the face with fillers can have some rejuvenative effect. Inflating the face pushes out the skin and accounts for the claims of ‘making wrinkles disappear instantly’.
The allure of the 5 Minute Facelift, however, must be looked at more closely to see if it is real. The five minute part for any injectable treatment is not exactly accurate. Since placing the material requires multiple needle sticks, most people would prefer to take a little longer…if they could be numbed up for it. Getting good local anesthesia before having your face injected is appealing to just about everyone. As I always say…nobody ever says they are too numb. (or conversely, can I have just a little more pain?) While the actual injections may only take five or ten minutes to do, the preparation for it is much longer.
Time is not important, however, if the procedure does what it promises. I’ll bet most people would be willing to spend several hours if it would take away five or ten years in such a short period of time. Does plumping up the skin really achieve a facelift? Not by what most people would consider a facelift to be. While inflating a hot air balloon will lift it, such a phenomenon does not really occur in the aging face. While some areas of the facial skin can be made smoother and little volume added to the cheeks and lips, those falling eyebrows, heavy eyelids, or jowls and sagging neck will not be improved. A few wrinkles may be better but calling that a facelift is more than just a bit grandiose.
But for the sake of argument, let’s assume that the 5 Minute Facelift was really possible. Would it be a good idea? If you were going to an event or wanted any improved look for a few months, then it is clearly better than any surgical alternative. When viewed from the perspective of value, however, it is not a good investment. The volume of injectable fillers needed and their cost could easily be several thousand dollars. For a treatment that lasts six months or less (there are no permanent injectable fillers) that money would be better saved and eventually invested in a surgical facelift which is proven to last many years.
The 5 Minute Facelift, also called the Liquid Facelift, sounds too good to be true because it is. It undoubtably appears on magazine covers because it makes you instantly grab it off the rack and turn to the article. Injectable fillers have been a revolutionary facial treatment for adding small areas of temporary plumping. But to say they can lift a sagging face is like that hot air balloon…over plumped and soon to be lost in the horizon of hope.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facelift, five minute facelift, indianapolis, injectable fillers, plastic surgery
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Wednesday, July 7th, 2010
Q : I have heard that regular use of Botox and injectable fillers over years can reduce the need to do them so often. Is that true or just wishful thinking?
A: Recent research presented at plastic surgery meetings have indicated that such a ‘rumor’ may have some truth to it. A study out of Oregon looked at women between the ages of 30 and 50 who received Botox every four months for two years. After that time, the frequency of their injections could be adjusted down to every six months and still have sustained satisfying results.
The same observation has been seen with injectable fillers. If the treatments are done long enough, they seem to be needed less often. One possible explanation may be the filler’s ability to stimulate new collagen.
Is less Botox and fillers really needed if they are done long enough? One of the problems is assessing long-term effectiveness is that it is very subjective and not able to be quantified objectively. Can facial muscles be re-trained by long-term Botox? Can injectable fillers create new collagen? Or are these apparent effects more of a function of the patient being able to tolerate a few wrinkles longer or less full lips or deeper nasolabial folds between injection sessions? The economics of regular injection treatments can certainly make patients space out their injection treatment intervals and still be satisfied.
It is tempting to want to believe that Botox and filler’s effects have some long-term benefits after they wear off…but it is far from a proven fact.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: botox, dr barry eppley, indianapolis, injectable fillers, plastic surgery
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