Instant Gratification

Fillers such as Restylane or Juvederme and muscle relaxers such as BOTOX are the most commonly performed procedures in plastic surgery these days. In fact they have been so for the past nearly 10 years! Lets say you have a few wrinkles on your forehead with the “number 11” lines between your eyebrows. BOTOX is the best way to relax your forehead and frown to minimize those inevitable wrinkles.

The best analogy I have devised to explain how BOTOX works is a white piece of paper. When we are born, our skin is like a white piece of paper: it has no wrinkles, no broken capillaries and no age spots. As you age, you fold your skin along specific patterns which are determined by your facial muscle distribution. These patterns are more or less constant among people but can vary slightly based on ethnicity and genetics. Some have deeper lines on their foreheads as they have strong forehead muscles while others have deep frown lines as they have learned to frown a lot throughout the day. As these facial muscles contract repeatedly, they fold your skin much like folding the piece of white paper. Now imagine folding the paper over and over again throughout your life. The paper will obviously develop a crease after folding it long the same line only a few times. This crease is a result of cellulose permanently breaking-down in the paper and is apparent even after you stop folding the paper. Your skin develops the same type of crease after folding it, this time because collagen breaks-down along a specific line. In fact, it is incredible that we do not develop our skin creases or wrinkles even earlier given that we fold our skin thousands and thousands of times per day! This is because our skin remodels constantly, a process which slows down as we age. We are so well designed that our body constantly repair damage throughout the body. Inevitable some of the damage including wrinkles in our skin persists and leads to aging. We also generally lose some of the elastic collagen in our skin, again contributing to the formation of wrinkles as time goes on.

BOTOX is able to significantly decrease the appearance of wrinkles by essentially stopping you from folding your skin along that same line. If done professionally with the expertise we have at IOSA, you can maintain some expression while reducing your lines. The areas we can currently address with BOTOX include crow’s feet at the eyes, the appearance of bands at the neck, frown lines, forehead lines, excess perspiration, small dimples a the chin, and an over-active smile leading to excess show of your upper teeth.

So what if you have the wrinkles already? Well Botox will relax your wrinkles thereby improving their appearance while slowing the deepening of the wrinkles. Fillers are the perfect solution for already existing wrinkles. Imagine you are driving down the street and you drive over a dip. The only way to fix the dip is to fill it with asphalt. The same holds for dips (wrinkles) on your face. The only way to “fix” them is to fill them in with one of a few different filler substances. The most popular fillers these days are Hyaluronic acid based. Don’t let the “acid” term scare you as it is a naturally occurring substance like collagen in our skin. Synthetic Hyaluronic acid comes in two brands: Restylane and Juvederme. Each one claims they are better than the other, but when we asked each company to substantiate their claim neither replied! In our experience, they are the same (much like Advil and Motrin are both comprised of Ibuprophen). If you like one, stick with it. Both Restylane and Juvederme have a more “concentrated” version of their filler. Restylane has “Perlane” and Juvederme has “Juvederme Ultra Plus.” The thicker and more concentrated versions are best for deeper line such as laugh lines which occur between your nose and lip, while the thinner standard concentration is best for thinner lines one might find around the lips, at the frown lines, or “lipstick” lines around the lips.

Other fillers aside from Restylane and Juvederme exist in the market. Radiesse has been approved for several years to treat deep laugh lines. Radiesse is comprised of hydroxyapatite or liquid bone. Our philosophy is that bone has no business being in your skin and should not be injected there. Regardless, Radiesse has gained popularity as it lasts 2 years versus 8 months for Restylane and Juvederme. But Radiesse injection, in our opinion, is fraught with the horrible complication of visibility (you can see the liquid bone in the skin) and “lumpy bumpiness” (you can feel small pea-sized bumps in the skin). When these problems occur, they are extremely difficult to treat and can last up to 2 years or the life of the product. That is why we have never performed Radiesse injections and never will. We have treated many Radiesse related problems though. If you have had Radiesse injected and are experiencing problems, we would be able to guide you through the treatment options including steroid and 5-FU injections. If you have visible lumps and bumps from Radiesse, a simple treatment is to inject a Hyaluronic acid filler around the bumps to “blend them in.” Another newer product is Collagen which has just been re-released in a new formulation. It has yet to gain popular use as the last version only lasted 3 months

So how about those brown age spots? How do we make your skin as clear as a white piece of paper? The brown spots we accumulate on our skin are purely a result of sun damage. The more sun exposure you have, the more brown sun spots. During childhood those brown spots are called freckles and are typically viewed as cute. In adulthood those same freckles from sun damage are called “sun spots.” As we continue to age, those brown marks on our skin are called “age spots.” Regardless of age, they are all the same spots are result from sun damage. The best treatment is prevention! Particularly in southern California, we are passively exposed to sun most days of the year as we drive around in our cars or walk from one place to the other. We highly recommend you apply a strong sunblock of SPF 30 and above to your face and any other exposed body part every day. If you already have a few sun spots, we can erase them off your face, chest, or even arms and legs with our modern lasers. The lasers can selectively treat brown spots and broken capillaries with no down-time.

At IOSA we are able to essentially rejuvenate your face and remove 5 to 10 years from your appearance by using a combination of fillers and BOTOX. Called a “liquid facelift,” the instant gratification of these treatments along with the laser facials is unsurpassed in simplicity. We like to say these procedures “postpone an inevitable facelift.” If you are into prevention and diligent about maintaining these treatments, you might even be able to indefinitely postpone your facelift as you continue to look your youthful best into your eighties. We look forward to seeing you in our office to customize your treatment plan with BOTOX and Restylane / Juvederme.

Other plastic surgery related pages: Glossary – Procedures – Surgical Guide – Procedure FAQ – Before & After Gallery