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As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling, chewing and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow's feet or facial creases over the areas where this muscle movement occurs.
1. Botox
Facial plastic surgeons have been innovative in their use of botulinum toxin in the management of hyperfunctional lines. These lines often caused patients to be misinterpreted as angry, anxious, fearful, or fatigued. In the past, facial plastic surgeons only had surgical options in their armamentarium, including excision or implantation of fat, collagen, or silicone. These procedures often provided minimal improvement and exposed patients to the risks associated with surgery. Injections of botulinum toxin A provide an opportunity to manage these hyperfunctional lines with minimal morbidity. The 3 most common sites for injection are the glabella, periorbital crow's feet, and forehead areas. Hyperfunctional lines result from the contraction of the underlying facial musculature. Soft tissue laxity of the forehead and periorbital area causes brow ptosis and reflex contraction of the frontalis muscle to restore brow position, exacerbating forehead rhytids. Treatment of these rhytids with Botox can increase brow ptosis. Injection of this area requires special cognizance of adjacent musculature to avoid upper lid ptosis. The toxin requires 24-72 hours to take effect, but some individuals may require as many as 5 days for the full effect to be observed. The effect of botulinum toxin lasts 8-12 weeks. However, the effect may last longer because of a learned behavioral response caused by chemical paralysis.
Contraindications to Botox injections include the following:
- Pregnancy
- Lactation
- History of reaction to toxin
- Preexisting motor neuron disease (eg, myasthenia gravis, Eaton-Lambert syndrome, neuropathies)
- Age younger than 12 years
- Participation in occupations that necessitate a wide range of facial expressions, such as television personality (Some clinicians fear unintended mimetic musculature paralysis.)
The ideal patients have thin skin, fine wrinkles, lines that are exacerbated by muscle contraction, and hyperfunctional lines that can be spread out with their fingers. Candidates that have received minimal improvement from botulinum injections include those that failed the spread test, those with previous surgery near treated areas, those with thick skin or deep dermal scarring, and those with actinic skin changes. Facial lines resulting from the loss of dermal elasticity associated with aging are unlikely to respond to botulinum toxin injections. These areas are more appropriately treated with injectable fillers (eg, injectable collagen), which efface the static rhytids. Some physicians recommend prophylactic treatment, ie, treating hyperfunctional muscles before permanent dermal changes create static rhytids.
Approximately 1-3% of patients may experience a temporary upper lid or brow ptosis; the most troublesome complication to the patient is upper lid ptosis. This results from migration of the botulinum toxin to the levator palpebrae superioris muscle. The ptosis usually lasts 2-6 weeks. The main advantage of Dysport is that it can be stored at room temperature.
2. Fillers
Soft-tissue fillers can help fill in lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be used alone or in conjunction with a resurfacing procedure, such as a laser treatment, or a recontouring procedure, such as a facelift. Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery, such as a facelift or browlift. Injectables are sometimes used in conjunction with facial surgery procedures; however, injectables alone cannot change facial contour the way surgery can.
The most important fact to remember about injectable fillers is that the results are not permanent. Injected material is eventually metabolized by the body. You should not expect the same long-lasting results that may be gained from cosmetic surgery. Researchers believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all play a role in the injected material's "staying power." However, the precise reason for the variation of results among patients has yet to be identified. Injectables are usually administered in a surgeon's office-based facility. If, however, you are being hospitalized for a facelift, necklift, browlift, or any other procedure, your injections may be administered in the hospital as well. You should stay out of the sun until the redness and bruising subsides - usually about 48 hours. In the meantime, you may use makeup with sunblock protection to help conceal your condition