Botulinum Toxin Type A treatments are one of the fastest growing cosmetic procedures today. American Society for Aesthetic Plastic Surgery statistics show that more than 3 million people in the U.S. were treated in 2005 alone. Botulinum Toxin Type A is a muscle relaxant. It is used to lift eyebrows, sagging cheeks and to make jowls disappear by injecting the muscles that pull the face down. Botulinum Toxin Type A eliminates frown lines, forehead lines, laughter lines around the eyes and lines around the mouth. In other fields of medicine Botulinum Toxin Type A has been used for over 30 years to treat muscle spasms and muscle hyperactivity.
Treatment with Belotero®, Juvederm Ultra® or other dermal fillers
While Botox® is used to lift eyebrows, saggy cheeks and to make frown lines disappear; dermal fillers are used to replace facial volume, smooth the lines and restore skin elasticity, the most visible effects of skin ageing. Dermal fillers can restore skin tone and texture and even prevent future ageing.
Belotero® or Juvederm Ultra® contain a synthetic form of hyaluronic acid, naturally found in the skin’s collagen layer. Hyaluronic acid in our skin gradually decreases over time. In fact, 50-year-olds are estimated to have less than half the amount of Hyaluronic acid they had in their youth. By the age of 40, signs start to show—skin starts to lose its elasticity and volume as lines and wrinkles appear.
Results with Belotero® or Juvederm Ultra®
If your treatment plan included lip enhancement, you’ll notice that your lips appear fuller and more defined. If your plan included adding volume to your cheeks, Hyaluronic acid is present throughout our bodies, with 50% of it located in the skin. It occurs naturally in the deeper layers of our skin (the dermis), where it helps to keep skin smooth and ‘plump’ through its amazing ability to hold up to 1,000 times its weight in water. A way to think of Hyaluronic acid is as our skin’s own natural and internal moisturizer.
Injectable Hyaluronic acid gel is a modified form of the Hyaluronic acid that occurs naturally in your body. Hyaluronic acid filler supports your skin, provides volume, can correct skin deficiencies and improves facial lines typically found between the eyes and around the mouth area. Skin elasticity in the treated areas improves significantly, especially after the treatment has been repeated.
Follow up treatments
Filler treatments work over a long period of time. The results are long lasting and can improve continuously over a period of several months. The effects of HA last 9 to 18 months, in some cases or after repeated treatments up to 36 months or longer. Keep in mind that everyone’s skin is different; the timing of any additional wrinkle treatment will vary from person to person. When repeat treatments occur over time, either the interval between appointments becomes longer, or fewer products is required to achieve the same results, or more areas can be treated with the same amount of product.
Q: What are the benefits of dermal fillers?
A: “Most of the signs of facial ageing are due to loss of volume. As proportion plays a major role in how we perceive beauty, replacing volume is a very effective way to improve facial proportions and to make a face look “naturally” younger. Loss of volume takes place as early as our mid twenties, depending on lifestyle. From thirty onward, hollowing of the cheeks can start to be visible, especially in people who diet or exercise a lot. Replacing the reduced collagen and increasing volume is both preventative and effective in maintaining youthful facial proportions. Treatment with hyaluronic acid-based dermal fillers such as Hydrafill Softline or Juvederm Ultra, minimises and smoothes out fine lines. Facial volume replacement is just as important in rejuvenating procedures as Botox, especially when you think of how we perceive “youth”. You only have to think of a baby’s face - rounded, plump cheeks. A full upper face and chiselled jaw line are both signs of attractiveness and youth. As we age, we lose volume in the upper face and gain it under the chin and neck. Heart-shaped faces are often used by cartoonists to portray “likeable” beauty think Pocahontas while a wide-jaw (Shrek) is usually a sign of age or unattractiveness.
Q: How do fillers work?
A: Most modern dermal filler contain Hyaluronic acid, a substance present throughout our bodies, with 50% of it located in the skin. It occurs naturally in the deeper layers of our skin (the dermis), where it helps to keep skin smooth and ‘plump’ through its amazing ability to hold up to 1,000 times its weight in water. Fillers such as Belotero® or Juvederm Ultra® replace facial volume, smooth lines and restore skin elasticity, the most visible effects of skin ageing. They can also restore skin tone and texture and even prevent future ageing. The new generation of fillers give even results, un-lumpy results and some, such as Belotero® or Juvederm Ultra®, contain local anaesthetic which reduces the discomfort during injection, making it possible to use small amounts to treat a wider area to get the best results. As it is a naturally based biological material, Hyaluronic acid (HA) is similar to your body’s natural HA, so you don’t need a skin test prior to treatment. The procedure involves small series of injections under the skin, either to fill lines or to increase facial volume, where the deeper layers of the skin are injected. Immediately after treatment, it’s perfectly normal to experience temporary minor stinging, sometimes moderate redness and swelling. Bruising can also occur. Recovery may take a few hours to a few days, depending on the area treated and the type of filler used. Most people find that they can return to work or go about their normal activities immediately after the procedure. Generally we would say the products last between 12 to 18 months, in some cases however 2 to 3 years is not at all unusual. The cost for one syringe starts from £360.”
Under Eye and Tear Troughs
One of the areas in the face where we first notice the loss of volume in the mid face is under the eye. This area is also called the tear trough area. For years I have avoided to treat this area, now I actually find it enjoyable because I can achieve very good results without downtime and discomfort.
Even very small amounts of volume injected in the right places can change a face dramatically. The under eye area is the most rewarding area to treat but also the most difficult. I stopped treating there for quite some time because I did not feel I had the right products at hand.
Since products have become much thinner and absorb completely I can now achieve very good results without having to fear lumps or visible bumps under the skin. When we look at a person we look at their eyes, this is where we gather most of our information. If you came to me and complained about your friends and family members telling you how tired you look, before anything else, I would look at your under eye area.
Volume replacement in the under eye area can reshape the face. It is the loss of volume in the mid face that produces all the effects of bagginess in the under eye area. There is no need to go too near the eye, just gently massage the product towards the area that needs reshaping. This works very easily. Downtime should be short. There is very little bruising to be expected. Results are visible immediately but like with any injection, will improve over the coming weeks and months.
Of course there is a chance for the usual side effects linked to dermal filler injections, such as bruising, unevenness, tenderness or swelling. These are transient. The filler product can be dissolved completely.
How to treat Facial Sagging and Loss of Facial Volume
The difference between a young face and an old face is the absence or the presence of jowls. Saggy cheeks are the most ageing feature in a person’s face. For this reason we need to look at how the face moves and where the face has lost volume. Most people who develop jowls at an early age have strong muscles around the chin and neck area. By relaxing those muscles, similar to what you would do with the frown lines, we can get a great lift and even more important prevent sagginess of the face in future. The next step is to replace the naturally reducing facial volume.Why should we think about replacing facial volume?
Our patients come to us for mainly one reason:They want to look younger, fresher and of course more attractive. Most people are very happy with their looks and they don’t want to change them. By replacing some of the missing facial volume, mainly around the mid face, cheeks and temple area you can get a great lifting effect even to the jaw line. This will also reduce the dreaded tired look around eyes and restores some of the youthful facial proportions, which are a fuller upper face and cheek region and narrower around the chin and jaw. Remember: The difference between a young face and an old face is the loss of volume.1. Can you give us a short overview on what fillers are and what they can do for you.
Most commonly used dermal fillers contain a synthetic form of Hyaluronic Acid (HA), naturally found in the skin’s collagen layer. HA in our skin gradually decreases over time. In fact, 50-year-olds are estimated to have less than half the amount of HA they had in their youth. By the age of 30, signs start to show—skin starts to lose its elasticity and volume as fine lines and wrinkles appear. Visible ageing of the skin is to 90% loss of collagen. By replacing the missing collagen the skin can appear plumper and more hydrated but also smooth and more elastic. Injected into the deeper layers of the skin, fillers can be used to contour and shape the face.2. So, the areas of the face that can benefit and why and what age does Dr Prager feel fillers should be used - from 30 onwards and why?
Most of the ageing of the face is due to the loss of facial volume. This starts in the mid face region below the eyes either side of the nose. As a result we tend to see the Naso Labial Folds deepening as a first sign of ageing. In the old days people had those lines injected regulrarly. The side effect was a slightly I hardly inject those now as first line treatment. It is the reduction in facial volume, fat actually that makes the lines appear as the cheeks sag. Therefore it is much more natural to replace this volume and lift the cheeks back up again. Facial proportions play a major role in how we perceive beauty. Replacing facial volume is therefore a very effective way to improve facial proportions and to make a face look naturally younger. Loss of volume takes place as early as our mid twenties. Look at an endurance athlete or a very lean person. The fat that gives the face its youthful shape is burned off and the athlete’s face can look much older prematurely. In a normal person hollowing and loss of volume in the cheeks can start to become visible at around 30. Especially in people who diet or exercise a lot. Replacing the missing volume in the face is preventative and maintains youthful facial proportions. At 20 dimples are cute and at 40 they can be deep lines. Dermal fillers prevent this from happening.3. Loss of volume in cheeks and lips and so on
After treatment with hyaluronic acid based dermal fillers the lines on your face should appear minimized and softer. Facial volume replacement has almost taken over from Botulinum Toxin Injections. For example, young people with thin lips are estimated to be older than their age peers, simply because thinning lips are something that happens with age. Our understanding of youth is linked to a fuller upper face and a chiselled jaw line. As people age they lose volume from the upper face and gain it under the chin and neck. Heart shaped faces are often used by cartoon artist to portray the likeable beauty such as Pocahontas. The Shrek character has the complete opposite facial volume distribution, narrow on top, heavy and square around the jaw. As we age we turn from Pocahontas to Shrek…4. Dr Prager, what kind of Dermal Fillers do you use in your practice, what do they consist of and why do you like to use them
In my office I use dermal fillers containing Hyaluronic Acid (HA). Modern HA fillers are much smoother and absorb completely compared to the first generation products. HA is present throughout our bodies, with 50% of it located in the skin. It occurs naturally in the deeper layers of our skin (the dermis), where it helps to keep skin smooth and ‘plump’ through its amazing ability to hold up to 1,000 times its weight in water. Dermal fillers based on HA are used to replace facial volume, smooth the lines and restore skin elasticity, the most visible effects of skin ageing. Dermal fillers can restore skin tone and texture and even prevent future ageing. HA dermal fillers can also contain local anaesthetic which reduces the discomfort during injection greatly. This way it possible to use small amounts and treat more often just like one would with Botulinum injections.5. How would you explain the procedure, any downtime and the cost and how long do the effects last?
As a naturally based biological material, hyaluronic acid (HA) is similar to your body’s natural HA. In fact, it’s so similar you won’t need a skin test prior to treatment.The procedure involves small series of injections under the skin, either to fill lines or to increase facial volume, where the deeper layers of the skin are injected.Immediately after treatment it’s perfectly normal to experience temporary minor stinging, sometimes moderate redness and swelling. Bruising can happen. Recovery may take a few hours to a few days, depending on the area treated and the type of filler used. Most people find that they can return to work or go about their normal activities immediately after the procedure. Generally we would say the products last between 12 to 18 months, in some cases however 2 to 3 years is not at all unusual. The cost for one syringe starts from £390.6. Next, what are the tell-tale signs of having too much filler? You see quite a few celebs with chipmunk cheeks!
Tell tale signs are patients in their 40ties and 50ties who’s cheeks and facial proportions are more Pocahontas now then they were in their twenties. Large amounts of even the safest dermal fillers can result in a strange look but is reversible. The more permanent products such as Silicone can cause permanent damage. Heather Locklear or Mickey Rourke for instance are examples for fillers gone wrong. Unfortunately any promising procedure that delivers amazing results is prone to be hijacked by the cosmetic junkies who will find a practitioner to supply them with even larger amounts of the stuff that makes them happy. In the end they are unable to see themselves, after all beauty is addictive. It is not the product or the procedure that makes people look funny, it is their need for more that eventually makes faces look pumped.
Hollow (Celebrity) Cheeks
have become a hot topic for discussion. There is hardly a week where we cannot see pictures of a famous actress or singer who is not noticeably enlarged in the cheek region. Why is that?
There are several reasons why cheeks are a favorite area where to inject volume. As we age, even from as early as our mid twenties the cheeks can lose volume. This can change our facial proportions and make us look older. Facial proportions change from the juvenile heart shaped face with the wider cheek region to the jowly aged look, haggard around the cheeks and square in the chin and jaw line.
There are several causes why people would look strangely enlarged and, or droopy in the cheek region. It would often be caused by a combination of too much Botulinum Toxin and dermal fillers.
Injected in large amounts around the crow’s feet area Botulinum Toxin helps to reduce the appearance of lines around the eyes, at a price though. The muscles that cause the smile lines are also part of the few muscles lifting the cheeks. Injecting Botulinum Toxin here is a mistake as it makes the cheeks droop. This is however still standard practice in most cosmetic practices because it makes the crow’s feet disappear due to the lack of movement around the eyes. The smile also becomes fake and expressionless as part of the famous frozen look.
Admittedly it is possible to give the jaw line and sagging cheeks a lift by injecting large amounts of dermal fillers around the upper cheek region. This helps to pull up the cheeks and lower face. However, you can imagine that it requires a lot of filler material and does rarely give a natural look.
In London this is called the Y lift, popular with French doctors. Very artificial and dubbed the pillow face in the press because the cheeks look so overly stuffed.
In Beverly Hills on the other hand a lot of the cheek enlargement is still done with fat transplant, this explains the initially huge cheeks and puffy faces which slowly return to almost normal after a couple of months. You might remember the pictures of Cameron Diaz in Grazia a couple of months ago…How to spot a bad cheek job?
The highest point of the cheeks should be near the cheek bone, lateral, in a feline kind of way. In most over-injected patients the highest point of the cheeks slips and is more on level with the tip of the nose or even below in a side profile shoot. Watch out for that, you will be surprised how many of those you can spot in any of the glossies.
"A Woman's Lips cannot really be big enough", Plastic Surgeon, Beverly Hills
Excessive Sweating – 'Hyperhidrosis'
You can tell a persons age by their hands… by Dr Michael Prager