As the years go by, changes occur in the face as a result of old age, sun exposure, smoking, activity of the facial muscles, and other causes. The fresh and youthful appearance fades away. The texture of facial skin, as well as the presence of wrinkles, give the individual’s age away and contribute to overall aesthetic dissatisfaction. Through simple measures, much less invasive than surgery, it is possible to improve the visual appearance of the face. By injecting various materials into facial tissue one can address problematic features such as wrinkles, folds, and their underlying causes.
For skin texture and overall quality, certain creams and/or peeling is available.
Within the face there exist dynamic wrinkles that are caused by muscle contraction, as opposed to static wrinkles that appear as a result of aging, smoking, genetics, gravity, and gradual loss of tissue bulk beneath the skin. For the most part, it is possible to treat all wrinkles and improve the overall appearance of the face.
Botox injections are a simple and popular method by which one can treat dynamic wrinkles in the upper part of the face, namely the forehead. These wrinkles appear as a result of the activity of muscles that are responsible for facial expression. These muscles are, in turn, attached to the overlying skin. Injection of this material is done in small, yet highly effective, quantities. The injections are performed with exceptionally small needles. Recovery is almost instantaneous, and side effects are either non-existent or minimal and short-lived. The injections are performed in the clinic without any need for local anesthesia. Botox injections are suitable for treatment of wrinkles located on the forehead, between the eyebrows, and around the outer angle of the eyes (near the temple and right above the cheek-bone).
Note that injection of Botox into the skin around the outer angle of the eye may also help in elevating the outer ends of the eyebrow.
It is recommended that one cease taking any blood thinners at least one week before treatment in order to avoid any excessive bleeding or bruising. Furthermore, if one suffers from herpes in the upper region of the face, treatment with oral Zovirax is highly recommended in order to prevent any further outbreaks.
Any pre-existing weakness of the face may worsen with Botox injections, mainly due to the underlying mechanism of the treatment. Therefore, it is recommended that one refrain from Botox treatment if there is any medical history of facial muscle weakness.
Botox injections are suitable for those with wrinkles caused by usage of expression muscles. It is popular amongst those older than 30 years of age, when wrinkles start to appear. Consistent treatment with Botox injections prevents both the worsening of existing wrinkles and the formation of new ones. Furthermore, regular treatments with Botox injections prolong the effectiveness of the material.
The effectiveness of the first treatment normally lasts about 3-4 months. This period is prolonged with consistent treatments thereafter.
During the pre-treatment consultation, examination of the face, including symmetry assessment and location of wrinkles, is performed.
1) Wrinkles on the forehead caused by contraction of the forehead muscle (frontalis muscle)
2) Wrinkles between the eyebrows caused by contraction of muscles during periods of anger (procerus and corrugator muscles)
3) Wrinkles seen on the outer sides of the eye angles caused by contraction of the muscle surrounding the eye (orbicularis muscle)
Botox is named after the first commercial material marketed. Botox contains the material Botulinum Toxin A, a substance that is artificially synthesized from the existing toxin created by Clostridium Botulinum bacteria. There are other materials in the market that work by the same mechanism, such as Dysport. This material prevents musculature contraction by silencing the communication between nerve and muscle. The body normally breaks down this material slowly until the muscle regains full contracture ability. The process of this “break-down” can take between 3 to 6 months.
Treatment is completely reversible. The effectiveness and success of Botox has caused a significant decrease in the number of surgeries for face and eyebrow lifting.
At the end of treatment, one must refrain from direct pressure on the area and minimize physical activity for at least one day. Any pressure or activity can cause dispersal of the material to undesired locations and cause uncomfortable side-effects.
During the first few days after treatment there may be slight bleeding and bruising, redness, and local irritation and swelling. These signs go away after a few days.
The effects of Botox injection are visible only after several days to a whole week.
Botox can also be used to treat other conditions, such as excessive sweating. By injecting several doses of Botox into the armpit, the frequency and severity of sweating can be significantly reduced—thus minimizing embarrassing underarm sweat marks. This treatment too is performed in the clinic.
Possible complications of Botox injection are very rare, and may include:
1) Bleeding and bruising
2) Infection and Herpes outbreak
3) Temporary weakness of local muscles
Additional information about Botox injection will become available during the pre-surgical consultation.
Today, there is a large variety of filling materials for treating wrinkles and skin folds on the face, augmenting the size and shape of the lips, enhancing and emphasizing the cheeks, and filling areas on the face that lack bulk. Filling material is most commonly used for the lower half of the face. Wrinkles in this area are usually due to drooping of facial contours and folds that are caused, in turn, by general “wear and tear” of the skin and its underlying structures.
In general, the treatment itself is simple, and is performed by injecting the filler material via a thin syringe. Recovery is immediate, and any side-effects are short lived. The complication rate is nearly non-existent. The effect of the material on superficial wrinkles is enormous. This “filling out” of wrinkles is performed in the clinic setting. It can be done without any anesthesia but, if desired, superficial anesthetizing cream (such as EMLA) can be applied to the area before treatment.
This treatment is suitable for men and women alike.
It is recommended one refrain from taking any blood thinners for at least a week before the treatment. This is in order to avoid any unnecessary bleeding or bruising. In patients with a history of herpes outbreaks, prophylactic treatment with oral Zovirax is recommended.
“Filling” wrinkles is suitable for those who have facial wrinkles that are bothersome. Any weight increase of 5kg or more may change the shape and severity of the wrinkles that were filled.
During the pre-treatment consultation, examination of the face, including assessment of existing wrinkles and overall symmetry, is performed.
The common wrinkles observed are:
1) Wrinkles that start on the side of the nose and end towards the outer edge of the mouth (nasolabial lines).
2) Wrinkles that start at the outer edge of the mouth and end towards the side of the chin (marionette lines).
3) Wrinkles around the lips exacerbated by smoking, age, and genetics.
Furthermore, it is possible to fill any other line or wrinkle on the face, so long as it is superficial in nature.
The filling materials are divided into two: absorbable and non-absorbable.
With regards to all wrinkles, absorbable material has a structural advantage over the non-absorbable material. The duration of effectiveness of the non-absorbable material is approximately one year, depending on the area injected and the type of material introduced.
The most popular non-absorbable material is medical silicone. This material is in the liquid form, and has gone through an adaptation process that has rendered it suitable for injection into human tissue with minimal side effects. Injection should be done in small amounts and over several appointments in order to avoid formation of lumps.
The material is mainly used to thicken and/or enhance the shape of the lips (more of this later).
The absorbable material is based on natural ingredients that exist in the human body, albeit manufactured synthetically. The human body recognizes this material as “self” and slowly breaks it down by natural biological processes. The chance of infection with injection is nearly non-existent. The most popular absorbable material in this category is hyaluronic acid (the ingredients in products such as Restylane, Perlane, Theosyal, Juviderm). Other filler materials that are used include processed collagen found in all body tissues and hydroxy-apetite that is found in bones (Radiesse). Filling with natural adipose tissue (fat) is also possible (more of this later).
It is recommended that any physical activity be avoided for at least the remainder of the day after treatment. It is fine to return to normal daily activity the following day.
For the first few days after injection, one may notice bruising, redness, local irritation, and some swelling. These signs go away after a few days.
At times, it is necessary to repeat the injection and perform another “filling”.
The complications of this treatment are very rare, and may include: Bleeding or bruising, infection, and skin herpes outbreak. A very rare complication is the appearance of lumps.
Additional information about this treatment will be made available during the pre-surgical consultation.
Natural fat for the purpose of filling wrinkles, concavities, or other voluminous areas on the face such as the cheeks, is currently very popular. “Filling” other areas in the body, such as the buttocks, is also becoming quite common.
Fat tissue exists naturally in our bodies. The process of acquiring fat from one area of the body, filtering it, processing it, and, lastly, injecting it into another area (such as the face) is quite simple. The procedure is performed under local or general anesthesia.
Recovery is immediate, side effects are short lived, and the complication rate is minimal.
The procedure may be performed in the clinic setting, not necessarily in the operating room. However, it is necessary to anesthetize the both the doner and recpient sites.
It is recommended that one refrain from taking any blood thinners at least a week before the procedure is done. Furthermore, for those who suffer from Herpes, it is recommended that prophylactic oral antiviral (Zovirax) be taken several days before the treatment.
Fat-filling is suitable for filling wrinkles or concavities in the skin of the face or body. It is also appropriate for filling out the lips. It is possible to incorporate fat filling with other facial surgeries, such as eyebrow or face-lift procedures. Any change of weight exceeding 5 kg may change the appearance of the area filled. Fat filling can be performed in other areas of the body, such as contouring the buttock region.
During the pre-surgical consultation, the areas desired to fill or enhance are examined, and overall symmetry is assessed. Areas that are commonly used for “doner site” are the hips, lower abdomen, and thighs.
It is known today that within fat tissue exist stem cells—cells that capable of developing into other kinds of cells, not just fat cells. It is believed that these cells are responsible for preserving the fat tissue during filling. Other findings show that fat filling does not only add desired volume. Fat and stem cells within the tissue possess anti-inflammatory and anti-aging properties. The fat tissue injected tends to get absorbed in areas that are in constant motion and without any underlying bone mass. Therefore, it is sometimes necessary to go through several treatments in order to achieve the final and desired results (the fat tissue that is not absorbed will remain for an extended amount of time).
Needless to say, fat filling can be performed in the clinic or in the operating room. In the clinic’s treatment room, fat tissue aspiration is performed under local anesthesia. This tissue is filtered and processed before being injected into another region. Any physical activity is highly discouraged for the duration of the day. The following day, one may return to full and normal daily activity.
Throughout the first few days after treatment, one may notice slight bruising or bleeding, redness, local irritation, and swelling. Theses symptoms will go away within a few days.
Complications of fat injection treatments are very rare, and may include:
1) Bleeding or bruising
2) Infection and/or herpes outbreak
3) Worsening of any existing asymmetry
4) Changes in sensation in the areas treated
5) Formation of lumps
It must be noted that under general anesthesia fat tissue can be injected into other areas of the body as desired.
Further details and information regarding this treatment will be made available during the pre-surgical consultation.
Peeling (detachment of skin layers) is a method used to improve skin quality and appearance, and can provide a fresh and youthful look. The quality of skin is damaged throughout the years, mainly due overall age, sunshine exposure, smoking, climate, nutrition, medications, and genetics. Within aesthetic plastic surgery, peeling treatments are given much attention. These treatments may accompany other facial procedures, such as facial surgery, eyebrow surgery, and various injection treatments.
Peeling treatments are suitable for men and women alike. The treatment can help improve unsightly pigment changes seen in the skin due to accumulative sun exposure and increasing age. Furthermore, it may improve the visual appearance of the skin due to damage caused by untreated acne. Those who are prone to various sun-induced skin lesions may find facial peeling treatment especially beneficial.
During your consultation in the clinic, the face is thoroughly examined and skin type, hue, and quality is assessed. Finally, an appropriate treatment remedy is suggested.
Today, two main types of peeling treatments are available:
1) Chemical peeling—removal of skin layers via active agents that dissolve various skin components. Examples are TCA, citrus acids, and others.
2) Mechanical peeling—removal of superficial dead skin via friction. This is achieved with the help of a specialized tool that is used while the patient is under general anesthesia in the OR. Otherwise, this can be achieved via laser that actively cauterizes and dissipates dead skin layers. This method must also be performed while the patient is under general anesthesia.
Skin peeling can be performed at three levels of skin depth:
Superficial peeling—removes superficial and dead skin layers, as well as superficial spots. This can be performed at home via usage of various medical creams. This kind of treatment also leads to increased strength of collagen and elastic fibers found in the skin. In turn, the skin becomes more “tight”, youthful, and vibrant. This kind of peeling may cause temporary itching, stinging, skin shedding, and local redness. Each and every patient is suited to a cream that is appropriate for his or her specific skin type and hue.
Medium peeling—this treatment reaches superficial and delicate wrinkles, as well as deeper spots underneath. This kind of peeling should be performed via a specialist in the clinic setting. Treatment may be mildly painful, similar to the sensations felt during superficial peeling. One may experience accompanying skin shedding and redness that may last up to 6 days post treatment.
Deep peeling—reaches the deeper layers of the skin, suitable for those interested in thorough treatment of facial wrinkles, as well as some degree of skin “tightening”.
This is performed in the OR and necessitates general anesthesia and subsequent monitoring (due to the possibility of side-effects from strong analgesia administration after the treatment).
In those with dark complexion, deep peeling may cause either further darkening or even lightening of the area treated. Unfortunately, this possible side effect has no effective remedy. As such, those with dark complexion are advised to undergo either superficial or medium peeling only.
In patients with a history of facial herpes infection, prophylactic oral Zovirax treatment is advised before undergoing medium or deep facial peeling.
Because changes in skin texture and appearance occur most commonly only after age 30, it is ill advised to perform peeling treatments before this age.
Medium and deep peeling treatments are more popular during the winter months due to the more comfortable cool temperatures.
During and after peeling treatments, it is advised to use moisturizing cream on the areas treated. Additionally, one should avoid direct exposure to sunlight without protection lotion or sunscreen.
One must remember that the final texture of the skin after treatment will be apparent only after approximately one month (mainly due to the healing properties of the skin). One may progress from superficial peeling to medium peeling as necessary, but only after the accepted healing period.
The complications of peeling treatment are extremely rare, and may include:
1) Skin spots that appear either darker or lighter than the surrounding skin
2) Local infection and Herpes outbreak
3) Local redness due to inflammatory processes
4) Skin burns or small cysts (milia). The appearance of skin burns is very rare, and occurs only after deep peeling (if at all).
5) Irritation and scaling of facial skin
Further information regarding this treatment will be made available during the pre-treatment consultation.
Lip filling/thickening, sculpture of the lips
The length of our lips is approximately one third the width of our face. The upper lip is slightly more accentuated than the lower lip when viewed from the side. The appearance of the lips is meant to be harmonious and proportional to the rest of the face.
Thickening and sculpturing the lips is divided into 2 groups.
The first group includes those who wish to have their lips thickened with filler materials, with the ultimate desire of achieving lips that are more full and sensual. In a simple manner and within the clinic setting, it is possible to perform injections of filler material via a small syringe. Recovery is nearly instantaneous, side effects are minimal, and the complication rate is extremely low. This treatment is performed with a topical cream anesthetic (EMLA). Before starting treatment, the doctor will carefully examine the overall shape of the lips and face, including the jaw and teeth.
Any asymmetry is noted. One must remember that it may not be possible to achieve the desired thickness or appearance seen on someone else. Thickening of the lips can be performed via usage of absorbable filler material, such as hyaluronic acid. This filler material is temporary only, and its effect may last only between 3 to 6 months. Filling can be performed with non-absorbable material as well, such as medical silicone. This kind of treatment is performed more gradually, over a longer period of time and over several treatment sessions – during which each time a small amount of filler material is injected so as to minimize any possible complications.
It is recommended to stop any anticoagulation medication at least one week before each treatment. Furthermore, those with a history of Herpes virus outbreaks are advised to take prophylactic oral Zovirax before treatment.
Thickening of the lips is suitable for anyone with narrow and thin appearing lips. Given the fact that the lips, like the rest of the face, achieve its final maturity appearance only after puberty, it is recommended that lip thickening treatments be performed only after the age of 17-18.
Filling material made from natural adipose tissue (fat) for lip thickening is becoming increasingly popular.
During the first few days after treatment, one may suffer from local bruising, redness, irritation, and swelling. These signs disappear within 2 weeks time, sometimes even earlier.
Complications from lip thickening and filling are very rare, and may include:
1) Local bruising
2) Local infection and Herpes virus outbreak
3) Formation of lumps under the skin (extremely rare)
The other group of lip thickening and sculpting consists of those who are not expected to achieve the desired result with injected material alone. These patients frequently present with exceptionally thin lips, with an exaggerated distance between the nose and upper lip. The surgery involved can be performed under local anesthesia. In this surgery, excess skin is removed and the upper lip is drawn in the upward direction. The incision line is incorporated within the natural lines of the face – near the level of the nose bottom and nostrils. The recovery period is short-lived, and return to normal daily activity is quick. After surgery, one may experience local swelling, redness, and bruising. These signs disappear within one to two weeks. Stitches are removed one week after the surgery.
Lip sculpting surgery is also suitable for those with cleft lip, either before or after corrective surgery, who are interested in improving the appearance of their face and lips. Furthermore, those who have undergone excessive injections with non-absorbable material can have surgery done to reduce the size of their lips (or have any filler material removed). These kinds of procedures are performed via an incision within the mouth, and therefore any scarring is significantly concealed.
The complications of these surgeries are very rare, and may include:
1) Local bleeding and bruising
2) Local infection and Herpes virus outbreak
3) Scarring (mostly hidden)
4) Non satisfactory aesthetic results
5) Temporary loss of sensation in the area operated on
6) Necessity for an additional surgery
Further details regarding this treatment will be made available during the pre-surgical consultation with the physician.