New Medical for Skin Rejuvenation without Surgery

Excerpted from
About Face : A Plastic Surgeon's 4-Step Nonsurgical Program for Younger, Beautiful Skin
By Dr. Gregory Bays Brown

As we await the bioengineered topical creams that will repair aging skin cells, there are other treatments currently available to improve your skin's appearance, and the results are remarkable. Some of these are injections, which do nothing more than add volume underneath the skin. Then there is a wide variety of facial peels that can turn back the clock dramatically. As an added benefit, you can have one of these treatments and still use the innovative topical treatments for long-term maintenance of your refreshed new look. Many of these procedures have become accessible and affordable, as witnessed by the growing number of consumers.

Injections

Contrary to what many people believe, removing or tightening parts of the skin structure does not always result in the appearance of youth. Aesthetic surgery does not re-create youth. Often it is better to add volume to the face, rather than take it away. Our skin does not bounce back like rubber-when we lose volume in our facial structure, the skin droops and sags. Adding tiny amounts of filler to the facial structure-in the bags under the eyes, perhaps, or to a drooping jowl-often takes years away from your appearance. Most injectables fall into two categories: those that smooth wrinkles, such as Botox, and those that add volume with soft tissue fillers, such as collagen.

Botox Injections

Botox is a trademark for botulinum toxin, and there are similar products known as Myobloc and Dysport. These products block nerve impulses, temporarily paralyzing facial muscles and smoothing wrinkles. More than 850,000 people had such injections in 2001, and that figure more than tripled, to 2.8 million, in 2003. Eighty-six percent of the patients were women, and most were between the ages of thirty-five and fifty.

Botox injections are sometimes offered by salons or aestheticians. As simple and safe as this procedure may be, you should only trust a board-certified medical doctor, such as a dermatologist or plastic surgeon, to perform this procedure. The results remain for only about five months or less, although frequent treatments can increase the length of effectiveness. It is primarily implemented for smoothing forehead lines, crow's feet, eyebrows, and neck creases.

Collagen Injections

Collagen makes up most of the epidermis-up to 70 percent, in fact. For many years, manufacturers marketed creams containing bovine collagen, claiming that this ingredient would rejuvenate aging skin in humans. Of course, since collagen's molecules are very large (particularly those from a cow), these creams did nothing more than moisturize. Aside from stimulation by human growth factors, nothing is known to restore human collagen, whose natural production virtually grinds to a halt at middle age. However, it was discovered that injections of bovine collagen (also known as Zyderm or Zvplast) served to "fill" lines of the face. There are also injections containing human collagen, such as Cosmoderm and Cosmoplast, which are equally effective and as long-lasting as bovine collagen.

Collagen injections are very safe, although they have more of a risk of allergic reaction than Botox does. Collagen, both bovine and human, also breaks down in less than six months, requiring repeated injections if you want to maintain its effects. These are best for deep lines from the sides of the nose to the mouth (nasolabial folds), or if the corners of your mouth point downward, forming two furrows on either side of the chin. Doctors sometimes call these "puppet mouth" or "marionette" lines. Filler injections also improve certain fatty undereye circles and the "lipstick-bleeding" lip wrinkles called perioral lines.

Hyaluronic acid is a natural sugar found in the human body that is important to the health of your skin. It is an intrinsic component of all living organisms' connective tissues. It has long been used in moisturizers, and is now being used in filler injections. Two new injections that bulk up soft tissues contain hyaluronic acid. Restylane and Perlane are synthetic versions of hyaluronic acid, adding volume to minimize wrinkles in the face. These are effective injections for the jaw line, lips, and nasolabial folds. They also last twice as long as collagen injections, so you need fewer treatments. They are now available in the United States.

In Europe and Canada, hyaluronic acid is derived from rooster combs and marketed under the names Hylaform and Juvederm (it is pending approval in the United States from the FDA). In 2003, many Americans traveled abroad to receive these injections, which last for about a year or two.

Two other soft tissue injections are in use outside of the United States, and are awaiting approval from the FDA here. Artecoll is a largely collagen-derived permanent "micro-implant" that fills facial lines. Radiance (also known as Bioform) is an injectable paste derived from calcium hydroxylapatite, a substance found in bones and teeth. The FDA has currently approved this substance only for those with paralyzed vocal cords and urinary incontinence, but in other countries it has been used to create implants in the chin and cheeks.

There are dozens of other filler-injection materials being used around the world. Some will receive FDA approval and debut in the United States with tremendous marketing campaigns-but don't be hoodwinked. Some of these are fine products, but their implementation and effects are not so different from options we already have.

Silicone Injections

Silikon 1000 is a man-made silicone injection that is far more effective than silicone injections of years gone by. Those received horrible publicity, two decades ago, after they were used for breast enhancements, because the injected silicone migrated to other parts of the body. But newer technology and better delivery systems have made silicone a more reliable choice, in certain cases, as a filler injection for the face. Silicone injections are permanent filler material, which distinguishes it from the other options. But silicone still contains the risk of foreign-body reaction.

And, once it is injected into soft tissue, it cannot easily be removed. For safer, permanent results with filler injections, there is another option that is far superior: the autologous fat injection.

The Top Five Nonsurgical Procedures: Number of Patients in the United States in 2003

Botox injection 2,891,390
Chemical peel 995,238
Microdermabrasion 935,984
Laser hair removal 623,297
Collagen injection 576,255

Fat Injection

Over the past two decades, doctors have practiced a procedure involving injections of a patient's own fat into parts of the face. There is nothing more natural than one's own tissues to enhance facial aesthetics. The miracle of fat injection is that the effects are often permanent. The newly injected fat (extracted with a needle from the abdomen or thigh) acquires a normal blood supply, and simply becomes an organic part of your face. This procedure is sometimes known as autologous fat transfer. Other injections, except for risky, artificial silicone, are not permanent-they recede in only a matter of months. If performed properly, fat injections last forever.

Fat is also a preferable injection material because it can be used in greater quantity than others, to fill deeper lines of the face. Until recently, however, there was one impediment to the reliability of fat injection. Traditional needles delivered fat in amounts no smaller than a pea, a size that often proved too large to successfully nurture a permanent blood supply.