Published: February 19, 2014
Category: BodyJet, Voluma, Blog, Juvederm, Botox

Get The Lift

The most exciting development in cosmetic medicine in the last couple of years is the improvement in our understanding of what causes the sagging face. This has come about largely as a result of the development of several new options for treatment. When the surgical “face lift” was the only treatment option the thought was that aging was the result of skin hypertrophy, i.e. extra skin, and gravity pulling down and stretching the skin of the face. Our interpretation of the process was driven by our treatment options. Now, we have a large tool box of fillers, and as a result we have come to appreciate how important volume loss in the face is to the aging process. Think of a raisin vs. a grape. As a grape turns into a raisin, theskin is not changing, but the water (volume) inside the grape is evaporating and the skin is now wrinkled around a smaller core. As we age, the fat pads in the face get smaller, the muscles in the face get smaller, and the bones of the skull also get smaller (osteoporosis); similarly leaving the skin to wrinkle around a smaller core. The only real effect of gravity is to determine the direction of the sagging.

The exciting part comes in the form of what we can do about this. There has been a proliferation of treatment options: Juvederm, Restylane, Radiesse, Natural Fat Augmentation, Sculptra, PRP (Platelet Rich Plasma) and now Voluma. All of these options work by restoring the volume under the skin and lifting the skin back into its original positions. These treatments use injection techniques, which means surgery is no longer needed to have a dramatic improvement and lifting of the face, but, most importantly, because we are addressing the actual cause of sagging, the results are very natural. By understanding where the fullest areas are in a younger face, we strategically replace the lost volume to restore the contours back to your natural look.

With so many choices it can seem confusing trying to decide which one to use. With some very specific exceptions, I think where the material is placed is more important than what material is placed. Like a golfer, the person holding the club is more important that which clubs they use. That being said, we still need to make the choice on what material to use. There are several factors than can influence that decision. What are the specific goals of the treatment? What is the estimated volume that is needed? What is your budget? Is longer lasting worth the additional expense? Is collagen stimulation a secondary goal? Are you thinking about liposuction and therefore fat transfer? Do we need quick results? etc.? The purpose of the pretreatment consultation is to discuss these questions, review the options and finalize a plan.

Here is a quick summary of how I think each of the options are best used:

Bellitero: The softest and least dense hyaluronic acid. Upside: Good for very superficial fine lines, such as the vertical lip lines. It is reversible. Downside: last only 6+ months, not good for the deepest lines.

Juvederm/Restylane: These are all moderately dense hyaluronic acid. Upside: These are both versatile and can be used for all indications on the face. It is reversible. Best choice for the lips. Downside: these last 9-12 months. Not the best when large area/volumes are needed.

Juvederm Plus/Perlane: (see Juvederm/Restylane above) These hyaluronic acids are slightly more dense than Juvederm and Restylane. This means they are slightly better when more filling is required.

Radiesse: This is a calcium based product that is the densest filler. Upside: This very good for deeper folds and areas with more volume. It also comes in a larger syringe size (1.5ml) and last 12-15months. Downside: Cannot be used in the lips. It is not reversible.

Voluma: This is most dense hyaluronic acid, similar to Radiesse. Upside: This very good for midface lifting and filling areas where more volume is needed. It lasts 18-24months. It is reversible. Downside: Can be more expensive if large volumes are needed.

Sculptra: Poly-L-lactic-acid is a product that induces the body to build collagen to create volume and lift. Upside: It lasts at least 2 yrs and possibly 5. Great when broad areas are going to be treated. Downside: It takes 3-6months to see the results. It is not reversible. It cannot be used in the lips.

Natural Fat Augmentation: Uses your own bodies fat to creat the volume in the face. Upside: It uses your own fat. You will get rid of an unwanted pocket of fat. It can be used on all areas of the face. It lasts 2-5 years. Downside: There are 1-2 weeks of downtime with the procedure. It is not reversible. There is some variability to the results.

PRP: This is best thought of as enhancer of other fillers. For example when it is combined with Juvederm it is called the “Vampire Face Lift”. We are currently using it with Fat Transfer. Upside: It uses your own body to make other fillers more effective.   Downside: It is not very effective  by itself.

Remember, restoring the lost volume in the face corrects the unwanted sagging and improves the effects of aging in a very natural way. If you are thinking this might be right for you, come in to the office for a complimentary consultation and together we will come up with a plan that is right for you.