Question 1: What do collagen injections do?

Collagen injections are typically used to fill small fine lines and wrinkles typically in the perioral area. Collagen was the first generation of injectable fillers.  For the most part, collagen is no longer used today as most plastic surgeons and dermatologists choose to use hyaluronic acid fillers which have taken the place of the collagen fillers.

Question 2: What do dermal fillers do?

Dermal fillers are used for two purposes; one to reduce prominent wrinkles such as the nasolabial folds or the marionette lines.  They may also be used to increase the volume of the soft tissue of the face such as in areas of the tear trough and the temples.  Products such as hyaluronic acid tend to work immediately replacing the extracellular matrix which is lost to the normal aging process.  Other products, such as Sculptra, tend to cause an inflammatory reaction and cause the re-growth of your own collagen.

Question 3: What is bovine and porcine collagen?

Bovine collagen originates from a cow and porcine collagen originates from a pig.  Whether the collagen is from bovine or porcine origins, they have been thoroughly tested and are treated so that they have decreased risk of infection.  Typically bovine collagen is more reactive and patients who are receiving bovine collagen require a skin test to make sure that they do not react negatively.  Porcine collagen is more like human collagen and these skin tests prior to a treatment are not necessary. 

Question 4: What are natural dermal fillers?

Hyaluronic acid is the most common natural filler.  Hyaluronic acid is also known as extracellular matrix.  It is a gel-like material which is found normally in the body and is the consistency of a thick gel.  In the past hyaluronic acids have been of animal origin.  However, today most hyaluronic acids on the market are genetically engineered.  The infection risk and the cross-reactivity is almost zero.

Question 5: What kind of materials can be injected to improve the appearance of my lips?

Today the most common injected fillers into the lips are hyaluronic acids.  The most common products containing hyaluronic acid are Restylene and Juvederm. Other fillers, such as ArteFill, may be injected around the lips to reduce the wrinkling of the smoker’s lines around the lips.

Question 6: What is subcutaneous tissue?

Subcutaneous tissue is the layer of tissue that is directly beneath the skin.  It may vary from very minimal, such as in areas of the eyelids, or as a thick layer as in the fat padding around the abdomen and waist.  It is the subcutaneous tissue, or fat plane around the waist and abdomen, that is treated with surgical procedures such as abdominoplasty and liposuction.  Most fillers are injected into the subcutaneous tissue and not directly within the dermis.

Question 7: Can Botox prevent wrinkles in the young people?

The action of Botox is to paralyze muscles.  There are two types of wrinkles; dynamic wrinkles and static wrinkles.  Dynamic wrinkles are wrinkles that are caused by the mechanical action of muscles pulling on the skin.  In young people dynamic wrinkles occur when smiling or raising the brow.  The action of Botox is to paralyze muscles and thereby, reducing the muscle action on the skin.  This reduces the appearance of dynamic wrinkles.  Over time dynamic wrinkles, as they become confluent, can become static wrinkles or permanent wrinkles.  Static wrinkles do not change in relation to the mechanical action of the muscles.  While Botox can prevent dynamic wrinkles from becoming static wrinkles, Botox will not prevent the more common causes of static wrinkles which are smoking and injury to the skin from repeated exposure to UV radiation from sunlight.  In order to prevent wrinkle formation over time, a lifestyle of sun avoidance is necessary, especially during the peak hours of sunlight, from 10a to 3p.  Additionally, topical medications such as Retin-A, have been shown over time to decrease static wrinkles.

Question 8: What is Restylene?

Restylene is a hyaluronic acid dermal filler.  The FDA approval for Restylene is for the improvement of moderate to deep wrinkles, especially the nasolabial folds and marionette lines.  Hyaluronic acid is the gel-like substance in between our native cells.  It is also known as extracellular matrix.  The hyaluronic acid in Restylene is a bioengineered product and does not come from human or animal sources.

Question 9: What are the advantages of Botox treatment over facial plastic

surgery?

In the past, the only way to decrease wrinkling of the forehead, for example, was to do a surgical procedure in combination with a brow lift to damage the muscles of the forehead area to reduce their wrinkling.  With the advent of Botox such surgical procedures are not necessary.  While Botox decreases the mechanical action of the muscles of the forehead and face, it does not do anything to treat excess skin for sagging jowls and facial tissue.  These still require facial plastic surgery.  In essence, both Botox and facial cosmetic surgery are components of global management of the aging face.