Advances in Facial Rejuvenation
By David Monacelli, MD
One of the fastest growing areas in
the field of plastic surgery is facial rejuvenation. For many years, plastic
surgeons could only offer our patients facelifts and eyelid surgery to combat the visible signs of facial aging. As a result, we typically
encouraged our patients to wait until the age of fifty or older to explore
In the past decade, however, we
have seen very innovative changes as new, less invasive approaches have been developed,
tested, and approved. Non-surgical approaches, such as Botox and injectable
fillers, have made facial rejuvenation more easily accessible and attractive to
women and men of all ages. Younger people in their thirties and forties who
have begun to notice changes in their appearance are routinely taking advantage
of these newer techniques.
What is injectable filler?
Soft tissue filler is injected into
or beneath the skin to augment normal facial structures and to reduce signs of
aging in the face due to sun exposure, smoking, and the natural loss of skin
collagen and elasticity that results from aging. The
most common injectable fillers are collagen (a natural protein derived from
skin) and Restylane or Juvederm, which are made from hyaluronic acid (a natural
carbohydrate found in our bodies).
Injectables are used to treat
wrinkles around the lips, to augment the lips, to diminish the nasolabial folds
that run from the outer edge of the nostrils to the corners of the mouth, and
to fill in wrinkles in the lower forehead. They are also used to fill in
depressions and defects due to disease, trauma, and acne.
How long do the effects last?
Collagen injections typically last
only three to four months, but the results from the newer fillers like Restylane
and Juvederm can last up to six to twelve months.
How do Botox injections differ from
Wrinkles can be dynamic (which
means they are caused by muscle movement from smiling and frowning) or static
(which means they are present without muscle movement). Botox injections affect
nerve endings and interfere with the release of acetylcholine (a
neurotransmitter) at the neuromuscular junction. This, in turn, prevents the
nerve from stimulating the muscle to contract, essentially weakening the
affected muscle and diminishing dynamic wrinkles. The effect takes several days
to occur and lasts from three to six months.
Botox injections are by far the
most commonly performed and fastest growing cosmetic procedure. They are
typically used to diminish frown lines between the eyebrows, forehead wrinkles,
and crow’s feet at the outer aspect of the eyes. Many wrinkles respond best to
combination therapies of Botox and filler injectables or other surgical
Is facial plastic surgery more
lasting than injectable procedures?
Yes, the effects of facial
rejuvenation surgery are more lasting than non-invasive techniques. Many people
choose surgery when injectable fillers no longer produce the desired results.
The techniques for cosmetic eyelid surgery, brow lifts, and facelifts have
become more refined over the years, with excellent results. When performed by
an experienced plastic surgeon, facial rejuvenation surgery can restore a more
rested, youthful appearance to your face without fundamentally changing your
looks. If you protect your skin from the sun, avoid cigarettes, and live a
healthy lifestyle, the benefits of your surgery can last for a number of years.
How can I decide what will work
best for me?
The best way to approach facial rejuvenation
is to do some research and then discuss the various options with a doctor who
is board certified in plastic surgery. Non-invasive rejuvenation techniques and
facial plastic surgery both have associated risks. You reduce the likelihood of
complications by seeking treatment from a qualified, experienced,
Monacelli is a member of the medical staff of Cayuga Medical Center and is
board certified by the American Board of Plastic Surgery. More information is
available at www.plasticsurgery.org/md/monacelli.htm
or he can be reached at (607) 266-0483. Dr. Monacelli is a member of the
American Society of Plastic Surgeons.