Posts Tagged ‘injectable fillers’
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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Thursday, July 1st, 2010
Q: Hi Dr Eppley, I was wondering if fillers can be used on a sagging elbow area instead of the surgical procedure?
A: Sagging of skin around the elbow area can be the result of age, body type, and weight loss. Most commonly I have seen it to be an issue in the extreme weight loss patient (greater than 75 to 100 lb weight loss) and it is one of the areas dealt with using bariatric plastic surgery techniques. While the usual approach to loose skin is to cut it out, the creation of a scar around a joint area can be problematic. The skin around joints, such as the elbows and knees, is not meant to be fixed. Rather it needs to have some flexibility and movement so the joint can go through its range of motion. Scarring around the joint may cause joint motion restriction in the long run and wound healing problems in the short run. (motion across a suture line) Known as elbow or knee lifts, the excision of loose skin must be carefully done to avoid these problems.
I suspect in this question that it is not a weight loss issue. Rather it likely is aging and the development of some loose skin around the elbow in an otherwise non-overweight person. (can particularly happen in an aging thin person) Therefore, excision and the scar that it creates is not an acceptable solution. This changes the approach to maybe an opposite solution…filling or reinflating the tissues. While injectable fillers can be placed anywhere, their temporary effects and the large volumes needed for a body area make them impractical. The only soft tissue filling option to be considered would be fat grafts. Harvested by liposuction, fat can be purified and then reinjected into soft tissue spaces. This is the only option I would consider when it comes to injecting any body area.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, elbow lifts, elbow sagging, fat injections, indianapolis, injectable fillers, plastic surgery
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Friday, June 18th, 2010
Q: I have a very asymmetrical jawline and am thinking about having a custom implant formed to the side of my jaw with the deficiency. For the rest of my face, I am hoping to achieve a balanced look, trying to get the best of both sides of my face, without exactly mirroring either side. One side is overly large, the other side is overly small. Both sides are appealing but different, except for the major sallowness to my face in my cheek area due to the smaller jawbone. I only want to have that filled in.
I was hoping to being treated with Radiesse or a facial filler to help even out the side with the deficiency without going through a drastic implant that might take away some of what I like about my face or compromising the way my muscle system has developed. Would it be a possibility to achieve some balance as a short term option?
A: One of the best benefits to injectable fillers is their immediate volume adding effects without having to undergo surgery to get it. For the soft tissue zone below the cheek bones but above the jaw line, only a filler material can add volume. This is not a facial area where a synthetic implant can be effective, there is no underlying bone to push off of.
The downside to facial fillers is that they do not last. And most will not last as long as the manufacturers claim in my experience. For this submalar facial area, good choices can be Juvaderm or Radiesse. One can expect about six to eight months of added volume before it dissipates.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, injectable fillers, juvaderm, plastic surgery, radiesse
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Wednesday, June 16th, 2010
Q: Have you ever used a patient’s own fat to fill in the nasolabial folds? I had it done in the past and it seems to last longer than other injectable fillers. Besides, I find it more appealling as it is completely natural.
A: The nasolabial folds have been injected with every conceivable form of injectable filler, including fat. To date, there does not appear to be an ideal filler for this, or any other, facial area. Off-the-shelf injectable fillers offer convenience but last less than one year at best. The use of fat injections is less convenient, as it must be done in the oeprating room in most cases, but does offer a natural material. Unfortunately, it has not proven to be permanent in most cases and has not been shown to last longer than commercial injectable fillers.
I do use fat as an injection material when one happens to be in the operating room anyway doing other procedures. This is a good time to take advantage of the natural or autogenous injection opportunity. This is particularly convenient when one is having some liposuction performed. In this case, some of the discard can be used for injection into the nasolabial folds.
Another fat option, not thought of very often, is that of the dermal-fat graft. Using a strip of skin with fat attached (and the top layer of epithelium removed), these grafts can be threaded into the nasolabial folds through small incisions above and below the folds. This type of fat graft provides very consistent survival. It does require a donor site, however, and that is a disadvantage if an excisional procedure (such as tummy tuck or breast reduction) is not being simultaneously performed.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, injectable fillers, nasolabial fold injections, plastic surgery
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Sunday, June 13th, 2010
Q: Hello Doctor, I just had juverderm ultra injected into my lips several weeks ago. But I am not happy with the amount of lip size that I got from it. I am interested in having more filler put in and want to change to Aquamid. Is it safe to use Aquamid a few weeks after having a Juvederm treatment ? What are the potential problems that could happen?
A: There are no studies that provide comfort that the mixing of different injectable fillers is safe. In fact, a recent report that looked at multiple different injectable fillers used in the same patient indicates that complications do arise from doing so. It may be one thing to mix and match different hyaluronic-acid based fillers (such as Juvaderm and Restylane, for example), but putting two completely different chemical compounds into the same facial site is unknown in terms of their compatibility and asks for problems. No facial area is more sensitive to inflammation and granulomatous reactions from injectable materials than the lips.
I would highly recommend that you want at least 6 months before considering injecting another filler into your lips because of these concerns.
I would also not recommend the use of any semi-permanent or particulated injectable filler be placed into the lips. Fillers, such as Radiesse, Artefill and Aquamid, are comprised of a mixture of polymer beads suspended in some form of a more liquid carrier vehicle. In the lips, these particles have been shown to have a higher incidence of foreign-body reactions, lumps, and even infection. The injectable fillers with the best track record of safety in the lips are of hyaluronic-acid derivation. Do not risk long-lasting results at the price of soft tissue problems. This is a particularly poor trade-off in the lips.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, injectable fillers, lip implants, lip injections, plastic surgery
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Monday, May 17th, 2010
Celebrities who undergo plastic surgery without question have a compelling influence on the general population, particularly those under the age of 40. One has to look no further than the checkout aisle in the grocery store to see how celebrity visibility is thrust upon us. From these consumer magazines to numerous television shows, anyone with a Hollywood connection is tracked and speculated upon about their cosmetic surgery, even if they have never had it. The media’s desire to push these cosmetic surgery tales of the stars fuels the public’s obsession with discovering the secrets to what keeps the beautiful and famous looking so.
While the star’s experiences may fascinate, they do little to actually educate. It is easy to confuse entertainment with reality because it is simply more interesting. Take the recent case of 23 year-old Heidi Mondag who had numerous cosmetic procedures done to satisfy her narcissistic and career agendas. While she may have had a lot of procedures, they were all quite small in scope. Most of her procedures were really ‘nip and tucks’ and not major overalls. After all, how many physical problems could a young person really have particularly given her appearance beforehand? But this is not how the media interpreted her surgery. Rather it was made to sound like it was a great undertaking and required supernormal surgical skills to complete.
These ‘tweakments’ are largely what is fueling the increasing visibility of plastic surgery. Botox, injectable fillers, lasers and minor skin lifts of the face have created a whole new set of treatment options that did not exist just a decade ago. While a 23 year-old partaking of this cosmetic menu does border on the overly self-indulgent, those in their late 30s and 40s have a more significant purpose. Fending back the early signs of aging is proving to be a more effective strategy than awaiting the day when major plastic surgery is needed. While my mother may have waited until retirement to wage the battle against the effects of time, today’s middle agers understandably what to look better and more rested now.
What is unique about these minimal procedures is that most of them are fueled and promoted by the cosmetic device and pharmaceutical industry. Plastic surgeons have taken a back seat to the promotions and marketing that billion-dollar-in-sales companies can do. The once retail approach to cosmetic and beauty products has expanded to include drugs and surgery. Targeting consumers through popular magazine and internet strategies, rebate coupons for Botox and eyelash stimulants are widely available as well as even franchise surgery for facelifts. Breast implant sizer kits are mailed to prospective patient’s homes with incentives for other procedures packed inside. Plastic surgeons collectively spend an insignificant fraction on marketing compared to that of the corporate world. This wave of industry’s promotion for profit and media attention for sales is why most people today know something about cosmetic enhancement and why it is now mainstream.
But like all entrepreneurial endeavors, making a profit and driving sales does produce some good byproducts that have wide benefit. Like the old commercial slogan from decades ago, there is ‘better living through modern chemistry’.
Dr. Barry Eppley
Tags: botox, cosmetic surgery, dr barry eppley, indianapolis, injectable fillers, plastic surgery
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Tuesday, May 11th, 2010
Q: I have read numerous blogs that talk about the value of facial exercises. With so many debates on this subject, I wonder if there is any benefit to doing facial exercises to tone up the face. Plastic surgery seems so drastic.
A: Much has been written over the past fifty years about using exercise to lift up a sagging aging face…or to prevent it from happening. This concept is not new. I have an original copy of a book entitled ‘Lifting Up Your Face’ from 1951. The more recent books that I have seen today in the book stores are beautifully done, and even have their own DVDs in the cover, but they are just modern re-inventions of this original concept.
It is certainly reasonable to do anything to avoid actual surgery, if it has some benefit. The problem that I have with facial exercising is three-fold. First, most of the signs of facial aging that are bothersome to people (appearance of jowls, loose skin in the neck, dropping brows, etc) are not muscular in origin. They did not occur because the muscles were loose and sagging. Anatomically, they are the result of the skin and the subcutaneous fat becoming loose and sliding off of the deeper tissues. That is not something that muscle tightening, even if it were possible with facial exercises, can really treat or prevent. Secondly, all facial wrinkles that develop are the result of muscle movement. That is why Botox is so popular, because it decreases this wrinkle-causing muscle movement. Moving those muscles a lot more through facial exercising will likely increase, not decrease the age signs of wrinkling. Lastly, I have yet to see adequate before and after photographs of believeable results from any facial exercising program. The photographs shown are never standardized. There are always some subtle changes in angle and lighting that can make a big difference in how the result looks. We know this very well in plastic surgery. It is very easy, intentional or not, to have an after result that appears to show a facial change that does not really exist.
For the sake of discussion, however, let’s us assume that there is some minor benefit to facial execising. In most patient cases, it is likely that the result would not be adequate…a lot of effort for a minor improvement. With todays’ minimally invasive and limited downtime facial procedures, they quickly surpass what exercising could do and require less effort. Plastic surgery does not have to be so drastic, one can get a few ‘tweakments’ that can make a real visible difference.
Dr. Barry Eppley
Tags: botox, dr barry eppley, facial exercises, indianapolis, injectable fillers, plastic surgery
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Wednesday, April 21st, 2010
Q : Which is better for my laugh lines, Botox or fillers?
A: It is very common that Botox and injectable fillers are confused as to what they do. Because both are administered by a needle and are used in the face, many assume that they do similar things. In fact, they are quite different both in chemical composition and the effects that they create and in how they are used.
Botox works its magic by being a muscle weakening or paralyzing agent. It is primarily used in the forehead and around the eyes to decrease unwanted expressions caused by overactive muscles. As a result, Botox (and now Dysport) is really a ‘northern facial’ procedure. It effectively reduces horizontal forehead lines, furrows between the eyebrows, and crow’s feet around the eyes.
Injectable fillers (there are now over a dozen commercially available brands) work by adding instant volume to deep wrinkles and folds as well as enhancing the size of the lips. By adding a material under the skin or into the lips, the outer skin and lips is pushed outward. Injectable fillers are primarily used around the mouth making it a ‘southern facial’ procedure.
While there are crossover areas in the face where Botox and fillers are otherwise used, they are largely separated in application to these northern and southern hemispheres.
Folds around the mouth are commonly referred to as laugh lines. When one smiles, indentations or wrinkles are created beyond the sides of the mouth. They are different than the nasolabial folds which run from the side of the nose to outside of the corners of the mouth which are situated above the laugh lines. Injectable fillers can be effective at softening one’s laugh lines.
Dr. Barry Eppley
Tags: botox, dr barry eppley, dysport, indianapolis, injectable fillers, laugh lines, plastic surgery
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Wednesday, April 7th, 2010
INSIGHTS FROM ‘BEHIND THE NEEDLE’
In the past, plastic surgery was all about having operations to reverse the effects of aging on the face. Time was, once you could no longer stand to see yourself in the mirror or in pictures…facelifts, eye tucks and the like became appealing with all of the associated swelling and bruising, recovery, and expense.
Over the past ten years, non-surgical injectable treatments have become popular for men and women of all ages…and have become part of mainstream society in ways that rival Starbucks, energy drinks, and iPhones. The concepts of muscle paralysis, plumping fillers, and fat dissolving agents have made it possible to have smooth foreheads, fuller lips and softer laugh lines, and maybe some subtle tightening of the jowls and neck in a few simple visits to the doctor’s office. Unlike surgery, injectable facial treatments are as much about the prevention of the effects of aging as they are about reversing what has already taken place.
Along with this explosion of available injectable treatments have come the inevitable, unbelievable marketing claims, and so-called ‘expert’ injectors. But, like much of what you may read on the internet, in popular magazines, and hear in commercials , what can you really believe? How do you separate reality from marketing hype? How can you decide where-or if-injectable treatments are for you? And if so, which ones??
Dr. Barry Eppley, board-certified plastic surgeon of Indianapolis, takes you on a broad tour of every injectable treatment option. Providing insight into Botox®, the many injectable fillers, and lipodissolve, Dr. Eppley provides the current science behind the treatments, and talks plainly about his experience and observations. These insights from ‘behind the needle’ about these incredibly popular injectable treatments are available nowhere else.
Whether you are just researching Botox® or fillers, or are a seasoned expert with an upcoming consultation about the next new option, Dr. Eppley gets you ready for Injecting Youth!
Tags: botox, dr barry eppley, facial injections, indianapolis, injectable beauty treatments, injectable fillers, plastic surgery
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