Archive for the ‘Fillers / Facial Fillers’ Category

What is the best treatment for laugh lines? Fillers or Botox?

Monday, February 22nd, 2010

Juvederm is commonly used for laughl lines as well as botox.  It is important to know what you mean by laugh lines.  Many refer to these as the lines around the eyes, or crows feet.  Others mean when the say “laugh lines”, the lines around their mouths or nasolabial folds.  I have a blog that defines those areas if you are interested to know the terms.  But the nasolabial folds are the folds that run from the nose along the sides of the mouth. Whereas the lines below the mouth on the sides are commonly refered to as the marionette lines or puppet lines.  The crows feet can be improved by botox and they can also improve the nasolabial folds to some extent.    Fillers like juvederm can also fill in the nasolabial folds, marionette lines and also help with the crows feet.  In order to really understand how they work a visit to a facial plastic surgeon would be helpful.  Now the difference between fillers and botox is that fillers replace volume that is lossed during aging.  When you lose volume there is an excess amount of skin compared to the underlying tissues.  More skin for a set amount of volume leads to more folding of the skin and hence more wrinkles.  Fillers replace that volume and hence fill in the skin and thereby decrease the ability for the face to make wrinkles.  Botox, which is a neuromuscular agent can make the muscles less likely to contract.  Hence they are most beneficial for dynamic wrinkles, or the wrinkles that are caused by muscular activity.

I hope that helps.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Rejuvenating the Mouth Area through Fat grafting by Dr. Philip Young of Bellevue | Seattle

Saturday, February 13th, 2010

Rejuvenating the Mouth Area through Fat grafting by Dr. Philip Young of Bellevue | Seattle:

YoungVitalizer Before After Pictures

YoungVitalizer Before After Pictures

The mouth area undergoes a lot of changes that can contribute to nasolabial folds, marionette lines, smoker lip lines and a downturned mouth.  Volume loss plays a major role in these changes.  Replacing this volume can have a profound impact in rejuvenating the aging mouth and the YoungVitalizer is our approach to improving this area.  Fat injections are a great way to do this and other fillers can help as well.  Sculptra can help if fat is not available.  Fat and Sculptra are good options for permanent or semi-permanent effects.  By this, I mean results that last more than 1 year. The picture below shows the locations of the nasolabial folds, marionette lines, and prejowl volume loss.  All of these issues can find their origination from volume loss to a large degree.  For the nasolabial folds, there are studies that show specific fat pockets that when re volumized can play a major role in eliminating nasolabial folds.  Specifically the area lateral to the nose and immediately deep to the most medial and superior area of the nasolabial folds is the area where re volumizing can play a big role in reversing nasolabial folds.  Furthermore volumizing in the whole area inside the nasolabial folds and marionette lines can rejuvenate the peri oral and mouth area.  Volumizing in the area immediately medial to the marionette lines can diminish these lines.  Volume in the prejowl area will blend this area in a more pleasing way with the jowls and in turn make them seem less apparent.  This is in line with the whole idea of doing prejowl implants with facelifts to improve the jawline.  Also volumizing the chin can restore this whole area as well and give support for the other areas that are volumizing.  One important thing that I have learned is that volumizing other adjacent areas can help support other areas by aiding in the volume expansion.   An example is if you place on stake in the ground and place a very heavy tarp over this stake.  It is more likely that you will form a nice area under that tarp the more stakes you put under the tarp.  It is also more helpful the more stakes you spread out in the area to give the original stake support.  Volumizing the chin is analogous to this idea.  When you volumize the chin it supports the volume you put in the prejowl area as well.  More likely than not your chin has lost volume as well and volumizing deep to the chin will rejuvenate your lower third or lower mouth area.  Also people are likely to develop deep wrinkles in the labio mental sulcus which is the crease that is under the lower lip.  Volumizing deep in the chin just inferior to this crease will help to eliminate this crease.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Perioral Diagram

Rhinoplasty requires careful analysis during the preoperative stages that the perlane could interfere with

Monday, February 1st, 2010

Rhinoplasty (Seattle) requires careful analysis during the preoperative stages.  You need to know exactly what you want to correct and hence having the unaltered preoperative state is essential with rhinoplasty.  If the perlane that you have in the nose and bridge makes a big difference it would be prudent to dissolve the perlane with hyaluronidase. This will allow you the ability to see the native anatomy better and hence your surgeon can come up with an accurate plan.  If it does not make a big difference the preoperative analysis may not be that affected.  If the perlane with in other larger areas of the face where the impact would be less, the need to remove the perlane would be less necessary.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Can hyaluronidase leave scars, holes? Does the enzyme break down a persons own acids and what affects are there?

Monday, January 25th, 2010

Facial Fillers is an enzyme that breaks down hyaluronic acid such as fillers used for cosmetic purposes like restylane, juvederm, perlane, etc.  It doesn’t seem to affect natural hyaluronic acid and has a predominate affect on filler injected.  The reason for this is due to the fact that natural hyaluronic acid is found around a substructure within the skin.  When natural hyaluronic acid is degraded it is reformed almost just as quickly.  In fact, natural hyaluronic acid is turned over on a daily basis so your body naturally degrades its own hyaluronic acid and replaces.  With your natural foundation, the hyaluronic acid is formed all the time so the enzyme injected and its effects will be reversed quickly.  It does not leave scars or holes,  except in the area of previous filler injections.  You have to be conservative in the amount that you use otherwise you can get depressed areas in the previous area that you augmented.  That is the only temporary risk.  Some suggest a skin test for the enzyme in case of an allergic reaction.  But I know of hundreds to thousands of patients who ht tave received this in surgery centers with no issues at all.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Nasolabial Fold Grafts are another option to improve the Nasolabial folds by Dr. Philip Young of Bellevue | Seattle

Monday, January 18th, 2010

Nasolabial Fold Grafts are another option to improve the Nasolabial folds by Dr. Philip Young of Bellevue | Seattle: Nasolabial folds are a very common structure that develops as one ages and it is one of the most common structures that people want to get rid of.  I’ve learned a lot of things about improving this structure.  Facelifts have been experimented with over the years and most people believe that the deep plane facelift when the SMAS is lifted over the smiling muscles is the best way to improve the nasolabial folds from a facelift prospective.  Others find that a midface lift does this better.  Others find that volumizing the cheek in certain ways improves the fold as well.  Fillers have been used in the nasolabial folds to improve them and this is a very common option that people have chosen. Here is a video explaining the  differences between deep place facelifts and mini facelifts:

My opinion is dependent on the person’s anatomy.  If the person has a lot of tissue and has some extra weight that they have gained.  Volumizing might make the face a little too big.  In this case a facelift can help improve the nasolabial folds.  One thing that can help the folds is too fill the volume up with a nasolabial fold graft.  This graft can be taken from the SMAS (superficial muscular aponeurosis system) which is the layer of tissue that is connected to all of the facial muscles. The SMAS is convenient because this the layer that the facelift uses to pull the face and can be easily taken to use for the nasolabial fold graft.  This graft can be placed in the nasolabial folds through the nose and can help improve their appearance along with the deep plane facelift.

If a person is against such a surgical procedure than I think volumizing might be the best choice for them.  This can be done with essentially no incisions.  The YoungVolumizer is great for this.  If undergoing a procedure like this is too involved for the particular person, then volumizing with fillers such as restylane, radiesse, juvederm, and perlane are options.  Sculptra is another long term permanent filler option that can also be used to improve and volumize the face to improve the nasolabial folds.  In terms of fillers and volumizing, there is a special location, an area that contains a deep fat pocket that really helps to decrease the nasolabial folds when it is volumized.  It takes a lot of experience to learn how to fill up this fat pocket with fillers and other volumizers, like the “The YoungVitalizer” procedure.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

What is a good option for something in place of Sculptra? What are the alternatives?

Wednesday, January 6th, 2010

Fat injections are the best option as an alternative to Sculptra injections. I even consider fat injections first before Facial Fillers. Nothing is better than using your own tissues for plastic surgery purposes.  You have essentially no risk for reactions, no risk for cancer, no toxicity from your own tissues. Sculptra is made up of suture material. It is a foreign substance that is essentially broken down into carbon dioxide and glucose and ultimately carbon dioxide and water.  Other ways of filling is through silicone implants. The problem areas for implants and Sculptra is the periorbital area.  Implants are also hard to use for the buccal area where there is no bone for the implant to rest on.  It is here that Sculptra can be used and Fat injections.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Is Sculptra in the lips a good idea?

Wednesday, January 6th, 2010

Facial Fillers has the potential for nodules and this can be more of an issue in the soft tissue of the lips. The makers of Sculptra, due to prior treatments to the lips, have concluded that Sculptra in the lips is not advised.  Other options for lip augmentation include restylane, juvederm which are temporary fillers for the lips. Some permanent options include fat injections, lip lifts, vy advancements, corner of the lip lifts, tissue grafts for the lips, etc.

Hope that helps!

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

What are the long term side effects of Sculptra? Is it a smart choice? Who are the best candidates?

Wednesday, December 30th, 2009

Facial Fillers is actually the powder form of a suture, Vicryl, that has been used in surgery for many years without significant problems. The body absorbs the powder and eventually turns it into carbon dioxide and water. The benefit of Sculptra is that during this inflammation to degrade the Sculptra collagen formation is being carried out by the body in a scar like reaction. It is this collagen that creates the new volume.  With this inflammation there is the risk of infection.  However the benefit of having the inflammation to create the collagen in a scar form is paradoxically what can lead to the infection.  If you didn’t have this inflammation you wouldn’t have as much collagen formation.

In my opinion, Sculptra is most beneficial for the person who does not have a lot of fat in the rest of the body to undergo fat injections and would like some more volume in the face.  It is also useful in the person who has only a little fat to offer for fat injections.  In this particular situation I would use sculptra in the areas that can tolerate it more such as the cheeks, mouth area, temples, forehead and jawline areas and reserve fat injections for the areas closer to the lips and around the eyes.  It is also good to use Sculptra for people who don’t want the invasiveness of fat injections where you have the need to harvest the fat from somewhere else. Sculptra, in general, is less of a process than fat injections.  But with the negatives that come with Sculptra, there is a lot of positives for people in these situations above.

From a long term standpoint, once the Sculptra is dissolved there should not be long terms issues. If a person somehow does not degrade the Sculptra effectively there could be infections but there are ways to treat these issues without a lot of problems.  Silicone injections and Artecoll injections present more long term issues in my opinion.

Hope that helps!

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

lumps and bumps 3-4 days after lip augmentation with Restylane

Monday, December 7th, 2009

The swelling in the lips usually takes a while to go down after Lip Augmentation (lip filler, lip enhancement, lip plumper, younger lips, lip injectibles) with Facial Fillers. Your lips are very vascular and with that comes easier bruising and swelling. 3-4 days is on the early side. I usually wait for the first 2 weeks for the swelling to go down.  During these first 2 weeks is when massage can really help dissipate the swelling.  Enzyme injections are also another way of removing restylane, juvederm, perlane but they are more of a permanent removal of the restylane.  If enzymes are injected during the first 2 weeks, this may be a mistake.  The swelling that would normally go down the first 2 weeks will further go down more if enzymes are injected the first 2 weeks.  Sometimes waiting at least 3 weeks is even better.  One thing to remember is that restylane and other hyaluronic acid fillers can be shaped though and you shouldn’t have to go through 6-9 months of a less than desirable result.  Enzyme’s can help shape your results after 2-3 weeks.  Notice how in the example that the lower lip in the after maintains the size that is 2 times greater than the upper lip.  From the viewer standpoint, it doesn’t look wierd to them.

Thanks for reading!

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Before Restylane Injections / Lip augmentation

Before Restylane Injections / Lip augmentation

After Restylane Injections / Lip augmentation

After Restylane Injections / Lip augmentation

Is overfilling possible with new fillers like restylane that were more likely with Collagen fillers

Friday, December 4th, 2009

Hyaluronic acid fillers (dermal fillers, dermal injectibles, restylane, juverderm, perlane) present a great option forLip Augmentation (lip enhancement, lip filler, lip injectible, lip plumper, lip rejuvenation, lip wrinkle filler/treatment). Hyaluronic acid fillers like restylane, juvederm, perlane, etc are a great way to augment the lips.  They allow accurate filling and you always have the options of using enzymes to dissolve the fillers for accurate touch ups.  I have an approach that allows me to manipulate the fillers based on how long the fillers were injected.  So poor results should be a thing of the past.  Also a knowledge of facial aesthetics is indispensable. I discovered a new theory of facial beauty, called the Circles of Prominence, which can be read on my website. Essentially, the lower lip should be at least 2 times the size of the upper lips. The puckering of the lower lips should emulate the eyes. Here is the link for my theory on facial beauty: http://www.drphilipyoung.com/pdf/circles_of_prominence.pdf.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington