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more articles by Monacelli, David , MD  |  author's bio

Advances in Facial Rejuvenation

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 cosmetic surgery.


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 injectable fillers?


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 procedures.


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, board-certified physician.


Dr. 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 or he can be reached at (607) 266-0483. Dr. Monacelli is a member of the American Society of Plastic Surgeons.


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