Non-Surgical Facial Fillers General Considerations Realistic expectations are the key to success Facial fillers and injections can be a complementary procedure to enhance results of other cosmetic procedures. What will usually be helped? Relative improvement in the appearance of horizontal forehead wrinkles Improvement in vertical frown lines Improvement in crows feet Improvement in nasolabial fold area Improvement near or below the corners of the mouth or marionette lines Reduction in appearance of shallow to moderate acne scars What will not be helped? Major asymmetries in the face Extremely deep wrinkles or acne scars Jowls and skin laxity of the neck and under the chin Limitations of procedure Cannot achieve perfection Cannot prevent continued aging Cannot solve personal problems Goals may be only partially met Natural asymmetries are difficult to completely correct Other options and alternatives No treatment, chemical peel, laser resurfacing, facelift or fat injections Facilities, anesthesia and surgery Outpatient procedure No anesthesia or topical anesthesia Local (dental) blocks are also available Recovery Average time off of work – none Resume normal activities 1 day Resume exercise 1 day Redness: majority gone in 1-2 days Bruising may occur, resolves in 3 days May consume alcohol same day Massage lumpy areas for 3 days Temporary trade-offs Discomfort, pain, sensitivity during injections Swelling, prolonged redness Psychological depression Lumpiness Bruising Permanent trade-offs The products usually either wear off or reabsorb, restoring native structures Minor changes in appearance may remain due to permanent alterations in facial skin muscle structure Minor potential problems Prolonged swelling and bruising Asymmetry Granuloma Prolonged redness Allergic reaction to medications Droopy eyelids Major potential problems Scarring of the skin Necrosis or sloughing of the skin Infection Vessel occlusion in very rare circumstances Any and all of the risks and complications can result in: Additional surgery, hospitalization, time off Important considerations prior to your procedure It is important to stop using any blood thinners to include aspirin, ibuprofen, NSAID containing medications, Vitamin E, herbal supplements such as ginko biloba 1 week prior to your procedure. Please start removing all makeup and cleanse your face 1-2 days prior to your procedure. All makeup has to be removed in the areas treated. Notify your doctor if you are prone to getting cold sores or fever blisters. Prophylactic antiviral medication will be prescribed. Smoking can have serious side effects on the healing process. Additional procedures may need to be performed in 4-12 months. Multiple procedures are usually needed if you have extensive damage from aging or injury. Skin consistency, type, ethnic background, and age are important factors that should be discussed before the procedure. The practice of medicine and surgery is not an exact science. Although good results are expected there cannot be any guarantee, nor warranty, expressed or implied, as to the results that may be obtained. List of common medications to avoid prior to your procedure: Aspirin Ibuprofen NSAIDs Vioxx Celebrex Vitamin E Fish oil Garlic Ginco Biloba Heparin Coumadin Lovenox Eyebrow & Forehead Nonsurgical options No treatment Laser skin resurfacing Eyelid surgery Eyebrow Lift with botulinum toxin Eyebrow lift with Fillers Aesthetic nonsurgical options include eyebrow lift with botulinum toxin injection around the brow area. This is also known as a chemical eyebrow lift. The concept is based on selective chemodenervation of select muscle groups around the eye to help elevate the lateral brow in a more favorable position while slightly depressing the medial portion or club head of the brow, thus restoring a youthful ark of the brow. Another option for restoration of a youthful eyebrow is injection of a filler around the brow or fat grafting. This technique restores lost volume and fullness in the lateral aspect of the brow which also gives a brow a lift. The forehead skin can also be tightened by laser resurfacing with a CO2 laser. How long will it last? Usually 5 to 10 years Laser Skin Rejuvenation Skin Laser Resurfacing General Realistic expectations are the key to success Laser resurfacing can be a complementary procedure to enhance results of other cosmetic procedures What will usually be helped? Relative improvement in the appearance of fine and moderate wrinkles Improved skin tightening of the face Reduction of age spots and other pigmentary problems Reduction in appearance of shallow to moderate acne scars Before – After What will not be helped? Thick, porous, sebaceous skin Extremely deep wrinkles or acne scars Jowls and skin laxity of the neck and under the chin Limitations of surgery Cannot achieve perfection Cannot prevent continued aging Cannot solve personal problems Goals may be only partially met Natural asymmetries are difficult to completely correct Other options and alternatives No treatment Chemical Peels Dermabrasion Resurfacing combined with other procedures Facilities, anesthesia and surgery Outpatient surgery under general anesthesia or IV sedation with local Go home the same day , occasional overnight stay Recovery Must have caregiver first 48 hours to ensure that you are safe Average time off of work 1-2 weeks Resume normal activities 1-2 weeks Resume light exercise 2 weeks Redness: majority gone in 4-6 weeks Remaining 10% may take up to 1 year Must wear SPF 50 sunscreen or higher Temporary trade-offs Discomfort, pain, sensitivity Swelling, prolonged redness Psychological depression Pigment irregularities Permanent trade-offs Possible permanent lightening of the skin tone Possible demarcations of the treated areas Possible change in the sheen of the skin Minor potential problems Prolonged swelling Blotchy skin Prolonged redness Reaction to medications Acne, clogged pores or milia Major potential problems Scarring of the skin Malposition of lower eyelid Infection; can lead to scarring Reaction to anesthetic or medications Major pigment irregularities Any and all of the risks and complications can result in: It is very important to stop using any skin treatments to include acne , bleaching or peeling agents 4-6 weeks prior to your procedure. If you have been taking isotretinoin, a drug used in the treatment of acne, by mouth you must stop the medication 12 months before your treatment. Notify your doctor if you are prone to getting cold sores or fever blisters. Prophylactic antiviral medication will be prescribed. Smoking can have serious side effects on the healing process that may lead to scarring. No smoking will be allowed 6 weeks prior and immediately after the procedure. Additional resurfacing procedures can be performed in 6-12 months. Multiple procedures are usually needed if you have extensive damage from aging or injury. Skin type and color, ethnic background, and age are important factors that should be discussed before the procedure. The practice of medicine and surgery is not an exact science. Although good results are expected there cannot be any guarantee, nor warranty, expressed or implied, as to the results that may be obtained. Skin Resurfacing Aftercare Instructions General Once you have experienced one of our expert skin rejuvenating procedures, it will be time to let your skin heal in the most optimal way. In order to help you get the best possible result we ask you to follow a few simple aftercare steps What will I expect to see in the next couple of days? Most people will not actually peel, but you may have light exfoliation. You may experience light flaking and redness for a few days. Your skin will feel tight and pulled. Itching can also occur. Everyone responds differently and most patients look quite normal just 1-2 days after treatment Before – After What can I do to enhance the recovery of my skin? You can start applying non-fragrant moisturizing cream of your choice for normal skin and Aquaphor ointment for dryer skin types as frequently as needed. Do not pick up or pull any loosening or flaking skin. This could cause prolonged redness and hyperpigmentation. Wash your face with non-abrasive face wash regimen of your choice starting the night of the procedure. Dilute vinegar soaks may help loosen up dried skin or crust. FOR THE NEXT TWO-DAY PERIOD Do not wear makeup for 2-3 days Do not apply ice or ice water to treated areas Do not put the face directly into a hot shower spray. Don’t use hot tubs, steam room or saunas Do not go swimming, especially in chlorinated pools Do not participate in the activities that would cause excessive perspiration Do not use loofas, apricot scrub, or any other means of mechanical exfoliation Do not direct hair dryer onto the treated areas Stay cool, drink plenty of water. Getting heated internally can cause hyperpigmentation Do not apply AHA containing products to your skin as they may be irritating Apply sunscreen of SPF 50 or above if going outdoors Wear a wide brim hat THE DO’S and DON’TS DO NOT go in the sun or expose yourself to excessive heat DO NOT pick or pull on scabs DO NOT go in to tanning booths for 4 weeks after treatment DO NOT have another treatment until your technician advises you to do so Discontinue vitamin A-based drugs (called retinoids) for 1 to 2 weeks post treatment Do not have electrolysis, Botulinum toxin, or any fillers injected or facial waxing/depilatories for 5-7 days Prolonged redness, milia, acne breakouts, allergic reactions and pigmentary changes can sometimes occur. Please bring this up to your technician at your next visit. Notify your doctor immediately if you are developing cold sores or fever blisters. Prophylactic antiviral medication may be prescribed. Smoking can have serious side effects on the healing process that may lead to scarring. No smoking will be allowed 6 weeks prior and immediately after the procedure. Additional resurfacing procedures can be performed in 4-6 weeks. Multiple procedures are usually needed if you have extensive damage from aging or scar injury. Skin type and color, ethnic background, and age are important factors that may influence the outcome of the procedure. The practice of medicine and surgery is not an exact science. Although good results are expected there cannot be any guarantee, nor warranty, expressed or implied, as to the results that may be obtained. Frequently Asked Questions: Q: What if I am prone to forming dark spots on my face from prior peels? A: Sometimes your skin may need to be preconditioned with a bleaching agent such as hydroquinone (HQ) and Vitamin-A based drugs (retinoids) for 6-8 weeks prior to your treatment to help you get the best possible result Q: I get fever blisters frequently. Should I be treated with antibiotics? A: If you are prone to frequent fever blister breakouts, you may need to be treated with an antiviral medication starting three days prior and continuing treatment for one week after the procedure. Usually this is reserved for deeper resurfacing procedures Q: How do I make vinegar soaks? A: Dilute one tablespoon of white vinegar in a quart of sterile or boiled water. Soak a sponge and place on your face for 10 min.
