Smoothing Away Wrinkles
By Jeffrey S. Lewis, MD, DMD
While there are
truly enjoyable aspects of aging, such as watching our children grow up, most
of us do not appreciate the lines and wrinkles we acquire through the aging
process. Fortunately, facial cosmetic surgeons now have an arsenal of tools to
help smooth the lines and wrinkles that can make us look tired or older than we
In my experience
most patients seeking facial cosmetic work fall into one of two groups:
patients who know they want cosmetic surgery to achieve significant change, and
those who know they want to improve aspects of their appearance but they
absolutely do not want to have surgery.
What are the
nonsurgical options for smoothing facial lines and wrinkles?
essentially two general categories of injectable treatments to smooth facial creases,
lines, and wrinkles. The first category is injectable botox. This is used to
treat muscle-induced lines and creases, such as crow’s feet at the outside corners
of the eyes, forehead furrows, and lines around the lips. These creases and
lines appear when a person is engaged in activities such as laughing, talking,
or squinting. The second treatment category includes injectable fillers, which
are used to enhance volume in indented areas, such as scars and certain types
of skin folds. Fillers are designed to smooth lines and creases that are
present when the person is at rest and the face is still.
What’s the major
difference between botox and fillers?
Botox is a
paralyzing agent that is injected into the muscle fibers, weakening their
ability to contract. Botox injections are very successfully used for crow’s
feet, for example, where the skin is thin and wrinkles like an accordion when
the muscles contract t0 smile. This is quite an effective treatment in the
hands of an experienced practitioner. The amount of botox injected for facial
aesthetics is completely safe: people can still be very expressive facially,
but without their crow’s feet.
Two widely used
fillers today are Restylane® and Juvederm®. Unlike the injectable collagen that
was used in the past, these new gels are made primarily of hyaluronic acid,
which is a carbohydrate polymer that is naturally occurring in all humans and
is a major component of connective tissue in skin. As a result, these
injectable fillers are quite safe and there have been no reports of allergies,
as there were with collagen fillers.
What are some of
the pros and cons of injectable treatments?
facial surgery, which requires several days of recovery, injectable treatments
have very minimal impact on lifestyle. Injections, which typically take about
fifteen minutes, are performed in the office of a cosmetic surgeon. Patients
can resume regular activities right away: you can come from work, have the
injection, and go out to dinner afterwards. For the overwhelming majority of
patients, the resulting look from injectable treatments exceeds their
The downside of
injectables is that the results are not permanent. If you love the results, as
most patients do, it will be a recurring expense. We expect the effects of
botox to last for about six months and the injectable gels to last for twelve months.
Naturally results vary somewhat from patient to patient. However, with no
recovery time and no surgical risk, many people prefer this option.
It is very
satisfying to offer such a low-risk treatment that provides such a high level
of satisfaction and meets patients’ goals. Over 90 percent of patients who
visit my practice for botox or injectable gels decide to return for repeat
treatment in the future.
Dr. Lewis is
board certified in facial cosmetic surgery by the American Board of Cosmetic
Surgery. He serves on the medical staff of Cayuga Medical Center, where he is
director of the Cayuga Medical Center Cleft Palate and Facial Deformities Team
and Clinic. He can be reached at Cayuga Facial Surgery at (607) 277-7007.