by Heidi L. Jarecki, M.D.
Facial rejuvenation describes a wide variety of treatments and procedures seeking to maintain or restore the texture, appearance and/or position of the face. As time passes the skin and other soft tissues of the face are subject to potentially damaging forces such as ultraviolet light, repeated muscle contraction, and gravity. Altered pigmentation, rhytids (wrinkles), loss of skin elasticity, and drooping or sagging of the skin may result. Treatment options for facial rejuvenation are numerous and include such options as non invasive therapies (light emission treatments, microdermabrasion, chemical peels), injectible therapies (botulinum or BOTOX®, collagen or other filler agents) and surgical treatments (blepharoplasty or eyelid lift, brow lifts and midface lifts).
Non-invasive treatments are numerous and include such options as light emission treatments, dermabrasion and microdermabrasion, and chemical peels. Light emission treatments use a variety of wavelengths of light to reduce wrinkles and pigmentation while improving skin tone and texture. Chemical peels utilize various types and concentrations of chemical substances to improve skin texture, decrease pigmentation and decrease wrinkles. Trichloroacetic acid and glycolic acid are two commonly used chemical peel agents. Microdermabrasion mechanically removes the most superficial layer of the skin, while dermabrasion also affects a deeper portion of the skin.
Botulinum toxin, or BOTOX® as the most popular form of the protein is known, is an agent that inhibits muscle contraction, thereby preventing unwanted wrinkles from appearing. It is commonly used cosmetically to treat frown lines in between the eyebrows, smile lines at the edges of the eyelids, horizontal wrinkles across the base of the nose and wrinkles in the forehead. BOTOX® is also used for a wide variety of other purposes. The effects of BOTOX® are temporary as the nerves affected regenerate their ability to communicate after a period of approximately three months. BOTOX® treatments are done in the office without the need for any anesthesia. A treatment involves several injections into specific muscles using a very small needle. Most patients say the injection feels like a small pinch and any discomfort is minimal. Results are visible in as little as two to seven days. Periodic treatments with BOTOX® are needed to prevent reappearance of the unwanted wrinkles.
Treatment of wrinkles present without muscle movement is often carried out with dermal fillers. Collagen or hyaluronic acid based products are among the most commonly used. Collagen is a component of the skin involved in elasticity. Hyaluronic acid is a compound that draws water into an area, thereby softening or eliminating the wrinkle. Typical locations of use for dermal fillers include the brow (for harsh frown lines), lower cheek crease, and lips (both to fill out thinner lips and to treat lines around the lips). Dermal fillers are also administered in the office setting with cold compresses or local anesthetic given prior to the treatment. Oftentimes, the area injected will need to be massaged afterward to achieve the best cosmetic result. Depending on the agent used, the effects may last several months or longer.
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