Cosmetic Injections/Dermal Fillers
We understand the importance of feeling good inside and out.
David Gamburg, MD, ABPM, DAAPM, Montvale Health & Wellness expert, offers a variety of cosmetic injections.
Among the many products and services Dr. Gamburg administers, he is able to counsel patients on what is the most effective, and most appropriate, for them.
Dermal fillers, also known as “injectables” or “soft-tissue fillers”, are injected or placed to fill in the area under the skin. Fillers can reduce signs of aging on the face and hands caused by diminishing collagen, elastin, and hyaluronic acid — components of the skin that give it fullness. Some fillers are natural and some are synthetic, but they all work to improve the appearance of aging skin in the following ways:
- Filling in wrinkles, fine lines and deep creases
- Improving other imperfections like scars
- Filling out thin or wrinkled lips
- Plumping up cheeks
- Contouring the jaw line and other areas of the face*
Botox® is a protein injection used to moderate fine lines, wrinkles and facial creases around the eyes, mouth, nose and forehead to help adults look and feel younger. In addition, it can address uncontrolled blinking and lazy eye. This is done with the use of a small amount of diluted botulinum toxin (the ingredient in Botox®) that enables controlled weakening of muscles by blocking nerve impulses. When the muscles can no longer contract, the wrinkles relax and soften.
It usually takes two to four days following administration of the product to see improvement. Although people need further treatments when lines and wrinkles begin to reappear, subsequent injections results in less severe wrinkles as the muscles are trained to relax.
The administration of Botox® usually takes just a few minutes to perform and does not require anesthesia. It is injected into the muscle using a fine needle which results in minimal discomfort and insures accuracy. To minimize bruising, patients are advised to avoid aspirin and anti-inflammatory medications about two weeks before the procedure, and to avoid alcohol about a week prior to the procedure.
Dysport®, which was developed in the 1990s, is similar to Botox® in that the same type of protein is injected into the skin to smooth out fine lines and wrinkles. However, the protein compound used in Dysport® is smaller, and therefore works quicker than that in Botox®. Some patients also feel it works for a longer period of time than Botox® and feel Dysport® is more effective, depending on the part of the face where it is used.
There are no major side effects with cosmetic use of either Botox® or Dysport®. The most common side effects are mild bumps and soreness; however, these are temporary and last only a few hours following the procedure. Therefore, this procedure is an effective and safe process for those who desire a reduction in facial lines and wrinkles.
Another choice of fillers are Restylane® and Perlane®, Restylane-L and Perlane-L. These injectable gels, used in conjunction with lidocaine, are for those concerned with the potential discomfort of the other procedures. In clinical studies of products in the family of the Restylane® brand, a majority of recipients reported less pain both during and for up to an hour following treatment. Like other fillers, these gels are used to fill moderate to severe wrinkles and skin folds on the face, and provide fullness and definition to the lips. Both Restylane® and Perlane® are formulated to act like your body’s own hyaluronic acid. Perlane® differs in the size of the particles and the depth of injection. Generally, the gel particles in Perlane® are larger than those in Restylane®, so that Perlane® is often a choice for wrinkles that benefit from a deeper injection into the skin.**
All of these are simple outpatient, minimally invasive procedures performed right in our office. Both injections, which last approximately 3-4 months, work equally well in helping our patients achieve their desired results.
Other newer or alternative products are listed below. They have similar properties to those above, and similar, if any, side effects.
XEOMIN® (incobotulinumtoxinA) is a prescription medication that is injected into facial muscles for the temporary improvement in the appearance of moderate to severe wrinkles (frown lines). XEOMIN® , administered no more than every three months, employs the same principle as Botox®. That is, it blocks nerve activity in the muscles, causing a temporary reduction in muscle activity. It is used to treat the same facial lines treated by Botox® and Dysport®, including frown lines, crow’s feet and forehead wrinkles.
Xeomin® is also additive-free. This may mean that there is less risk of developing antibodies against Xeomin® than other available similar products. In theory, antibodies could prevent a product from having its desired effects. The effects of Xeomin® occur within one week, and the results last from three to six months, making it comparable to Botox® in terms of both onset and duration of results. Xeomin® is not to be used interchangeably with other botulinum products.
Xeomin® distinguishes itself due to its long shelf life. Since it does not require refrigeration, it is considered to be the most environment-friendly in the Botox®-type category of dermal fillers available in the market today.
RADIESSE® Volumizing Filler is a cosmetic dermal filler that acts somewhat differently and longer than hyaluronic acids, such as Restylane® and JUVEDERM®. Numerous medical studies as well as a safety record of over 25 years have shown that Radiesse® is a safe, longer lasting treatment to fill and correct smile lines, as well as folds and wrinkles around the nose and mouth.
RADIESSE® works immediately so the results are instant. Once injected, RADIESSE® adds the volume and lift needed to diminish the signs of aging. RADIESSE’s® claim is that it is truly unique due to the ability of the product to act as a scaffold under the skin, providing structure and stimulating one’s own natural collagen to grow. The production of natural collagen continues for several months, which extends beyond the initial effect of RADIESSE®. The natural results are clinically proven to last a year or more in many patients. The benefit of RADIESSE® is its long-lasting effect, as opposed to treatments that must be repeated frequently.
Belotero® is a gel containing hyaluronan, a natural component of the skin which helps to keep it moist and elastic. The hyaluronan content of the skin diminishes with age, which is a reason that lines then begin to appear. Belotero® is a filler that plumps up wrinkles by replacing the lost hyaluronan. It integrates seamlessly with the skin and adapts to facial contours, therefore plumping and adding volume to the face.
As a comparison, Belotero®, Juvederm® and Restylane® are all forms of hyaluronic acid that differ in how the molecules are cross-linked. This affects the properties of each product, and ultimately, how the dermal filler reacts within the skin.
Belotero® is known to be thinner and more lightweight compared to other fillers in its category. It’s technology results in a final injection solution that contains a very high degree of elasticity. Therefore, the benefit of Belotero® is a much more even and seamless distribution between treated and untreated areas.
Belotero® can be injected more superficially (i.e. closer to the surface of the skin) compared to other fillers in its category. This indicates it may be best used for fine lines around the eyes or mouth.
*American Academy of Dermatology