Injectables: Botox and Soft Tissue Fillers

As we age, our skin deteriorates and is more prone to develop wrinkles due to muscle action, sun and wind damage, and age-related loss of collagen and elastin.

Also, facial bony structure changes it’s shape. Zygoma (cheek bone) becomes less prominent, and facial subcutaneous fat shrinks. In effect, face deflates with advancing age. With loss of bony support, the skin of mid-face, descends toward lips resulting in prominent naso-labial folds. This also causes exposure of infra-orbital fat pads (“bags under the eyes”). Further atrophy of subcutaneous fat and mandible (jaw bone), as well as increasing laxity of the skin, produce jowls (lax skin fold along the jaw line). Can youthful appearance be restored without a face lift? In many instances, the answer is “yes, with help of soft tissue fillers and Botox ®”.

    Soft tissue fillers are substances that can be safely injected under the skin and along the shrinking facial bones and under wrinkles. This restores the lost volume, effectively “re-inflating” the face, and smoothing-out folds  and wrinkles of the aging skin. Some of these fillers also stimulate your own collagen production in dermis (deep skin layer), thus helping to maintain skin’s youthful turgidity.

    Botox ® is often used in conjunction with fillers in order to selectively relax the wrinkle-causing muscles for a period of 3-4 months, thus helping maintain the smoothing effect.             

    The discomfort involved with injections of  Botox ® and fillers is minimal, as these procedures are accomplished with use of very fine needles, similar in caliber to those used in acupuncture. These procedures do not usually result in much downtime, and are often called “lunch time procedures” 

	Botox is injected to relax over-active muscles that cause dynamic wrinkles.   The effect of Botox becomes noticeable 2 days after injection, then reaches its' maximum effect at 2 weeks, and then remains at this level for approximately 3 months, after which the muscle action returns to baseline.   Even though the effect of Botox on hyperactive, wrinkle-causing muscle lasts for 3 months, its smoothing effect on wrinkles may last longer, possibly because of remodeling which may be occurring in skin while it is smooth. For some, the smoothing effect on wrinkles may last as long as 6-7 months.
Figure 1	Soft tissue fillers replace the lost volume, thus "re-inflating" the deflated and wrinkled tissue. The wrinkles are in effect "pushed out" as illustrated in Figure 1
Figure 2	In Figure 2, filler material was injected around cheekbones, naso-labial folds, and chin. A total volume of 4 syringes of Radiesse ® were used.
Figure 3	In Figure 3, 1 syringe of filler material Radiese ® was mixed with local anaesthetic for comfort, and injected into the hand subcutaneously. This volume-restoring treatment has a profound cosmetic rejuvenating effect.