Fine Lines & Wrinkles

The appearance of fine lines and wrinkles are a natural part of the aging process.   As we age, the production of collagen and elastin slows over time, thus, our skin's elasticity diminishes.  As a result, continuous facial expressions such as frowning, squinting, smiling, etc., and the use of the same facial muscles over and over cause lines and wrinkles to form.  

Unfortunately, creams and lotions only offer, at best, a temporary fix while non-surgical options such as Botox® Cosmetic, Dysport®, dermal fillers, laser treatments and chemical peels can offer natural, longer lasting results.  

Botox® Cosmetic
The FDA originally approved Botox almost 20 years ago for blepharospasm or severe eye twitching.  Its aesthetic usefulness was discovered accidentally when physicians treating patients for therapeutic purposes discovered that the patients' wrinkles disappeared. Thus, a useful non-surgical aesthetic treatment was born.

In 2002, the FDA approved Botox Cosmetic for glabellar lines (the 11's between the brows), and every year since, it has been the #1 aesthetic treatment in the United States.  Today, we have a plethora of data and experience with Botox in many areas of the face to relax different muscle groups and to provide a refreshed and youthful look.  The diagram below represents the areas of the face and neck where Botox has been used to successfully soften lines and wrinkles caused by repetitive muscle movements. 

The effects of Botox Cosmetic may begin to appear within 24 hours with full results within 7 days.  Side effects associated with Botox Cosmetic are usually mild to moderate and resolve within a few days.  The most common side effects associated with treatment are tenderness and bruising at the injection site, headache, flu-like symptoms, and eyebrow droop.  To date, there have been no reports of serious side effects associated with Botox Cosmetic.   Click to download the Botox Cosmetic Medication Guide. Read More

Dysport®
Now there is a choice in botulinum toxin therapy for fine lines and wrinkles thanks to the approval of Dysport by the FDA in April of 2009.  Dysport is approved to temporarily improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults less than 65 years of age.  While Dysport is relatively new to the U.S., it has been widely available around the world for many years and is currently available in 36 countries.  Dysport is similar to Botox in that it relaxes the muscles that cause dynamic wrinkles and offers a soft, natural result.  Dysport and Botox both last approximately 3-5 months and thus need to be repeated for continued results.  Also, the side effect profile of Dysport is similar to that of Botox.  Click here to download the Dysport Medication Guide.  
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Choosing an experienced physician to administer Botox or Dysport and discussing any aesthetic goals to be achieved will help ensure a high level of satisfaction with the results.  Dr. Elahi has many years of experience injecting botulinum toxins for both cosmetic and therapeutic purposes and is often called upon to teach other physicians how to inject.  His in-depth knowledge of the facial muscles and his conservative approach to treatment leads to a soft and natural, but refreshed look.

For more information on Botox Cosmetic or Dysport, call 212-570-0707 to schedule a consultation with Dr. Elahi. 


DERMAL FILLERS

While Botox and Dysport are effective choices to relax muscles and soften lines and wrinkles caused by muscle movements, dermal fillers offer complimentary effects in deeper lines and/or to help reshape and contour the face.  Depending upon the needs of the patient, there are several choices in dermal fillers.

Hyaluronic Acid Fillers
Hyaluronic acid (HA) is a naturally occurring and abundant substance in our skin that draws in water to help hydrate the skin.  Age, sun exposure and other factors cause the amount of HA in our skin to diminish over time, contributing to a loss of volume and the appearance of wrinkles and folds. HA fillers are composed mainly of hyaluronic acid; thus, they help restore lost volume in the face and minimize lines and wrinkles.  Juvéderm®  
Juvéderm is a smooth consistency, clear gel HA filler indicated for the treatment of moderate to severe wrinkles and folds such as nasolabial folds, marionette lines and vertical lip lines.  It can also be used to augment the effects of botulinum toxin in areas where wrinkles do not completely diminish post treatment.  The effects of Juvéderm are immediate and can last from 6-months to up to 1-year. 

Juvéderm  is generally well tolerated, and most side effects are mild to moderate and last less than 1 week.  The most common side effects include, but are not limited to, temporary injection site reactions such as redness, pain/tenderness, firmness, swelling, lumps/bumps, bruising, itching, and discoloration. Read More

Restylane®/Perlane® 
Restylane and Perlane are both clear gel formulations of HA fillers that restore volume and fullness to the skin to help correct moderate to severe wrinkles and folds such a nasolabial folds, marionette lines and vertical lip lines.  They can also be used to augment the effects of botulinum toxin in areas where deeper wrinkles exist and do not completely resolve with botulinum toxin treatment.  
The main difference between Restylane and Perlane is the size of the HA particles.  Perlane offers a larger particle size, which can be more appropriate for deeper lines and wrinkles.  The manufacturer of Restylane and Perlane also offers lidocaine infused versions of the products for a more comfortable injection process.  

The effects of Restylane and Perlane are immediate and last approximately 6-months.  The most common side effects are swelling, redness, pain, bruising, or tenderness, which normally resolve within one week. Read More 

VOLUMIZING FILLERS

Radiesse®
If the cause of lines and wrinkles is due to more significant volume loss in the face, then a robust filler like Radiesse may be an appropriate option.  Radiesse is different from HA fillers in that it contains calcium hydroxylapetite microspheres that, when implanted, help stimulate natural collagen growth. Pain upon injection is limited due to the addition of lidocaine to the syringe before injection and bruising and downtime are minimized through careful injection technique.  Radiesse® offers immediate results and may last between 6-months to over 1-year.  The most common side effects after treatment with Radiesse are injections site pain, redness, swelling, bruising and tenderness, which normally resolve within one week. Read More 

Sculptra®
AestheticCollagen is a key structural component of the skin.  As we age, our skin produces less collagen, thus contributing to the formation of lines and wrinkles. Sculptra Aesthetic is a different type of facial injectable in that it works to replace lost collagen, and thus lost facial volume, over a series of injection sessions.  

Sculptra Aesthetic is made from poly-L-lactic acid particles, a biocompatible, biodegradable synthetic material that has been used by physicians for decades.  When injected into the deep dermis, collagen fibroblasts form around the particles to gradually replace lost collagen in the skin.  Sculptra Aesthetic works to correct shallow to deep facial wrinkles and folds as well as volumize hollow areas of the face such as cheeks and temples.  Unlike other fillers, the results from Sculptra Aesthetic appear gradually and usually require multiple treatment sessions to achieve full results.  The advantage for some patients is that the results may last up to two years.  Side effects after treatment with Sculptra Aesthetic include redness, swelling and tenderness, and pain, bruising bleeding and itching at the injection sites, which usually resolve within one week of treatment. Read More 

For more information on Dermal Fillers, please call 212-570-0707 to schedule a consultation with Dr. Elahi,  



Laser Treatments
Skin resurfacing treatments using highly specialized laser technology is another effective adjunct to managing fine lines and wrinkles. Fraxel® is a laser technology that offers a range of treatment options with varying levels of aggressiveness, downtime and number of procedures needed for full results.  Determining the right treatment depends on the individual needs of each patient.

During a Fraxel procedure, microscopic columns of laser light penetrate deep into the skin to create tiny wounds.  In response, the skin acts to repair those wounds, which leads to the remodeling of collagen and elastin, resulting in tighter, more youthful appearing skin. Because the laser penetrates the skin in microscopic columns, it leaves much of the skin intact, leading to faster healing times than more traditional ablative treatments like CO2 laser treatments. Read More

Chemical Peels
Another non-surgical option for fine lines and wrinkles uses a chemical solution to remove the damaged outer layers of the skin, called a chemical peel.  At FACES, we use the Obagi® Blue Peel, which combines the active ingredient Trichloroacetic Acid (TCA) with a patented blue base.  The concentration of the peel used depends upon the degree of skin damage and the desired results.  

During the procedure, the chemical is applied to the face and neck and allowed to work for several minutes.  The chemical solution is then neutralized to stop the chemical peel process.  After the procedure, a blue tinge may remain for the next 12-24 hours and mild swelling may occur.  Over the next 7-10 days, the damaged skin layers will peel away leaving healthier and more youthful looking skin.

Depending upon the degree of skin damage and the desired results, a series of peels may be recommended.  For more information on chemical peels, please call 212-570-0707 to schedule a consultation with Dr. Elahi.