Juvederm® Dermal Fillers by Allergan™

When we were younger and our skin had abundant collagen, the only lines and wrinkles we had were dynamic. Our face was otherwise wrinkle-free when we weren't animated All dynamic wrinkles, with age, will eventually lead to static wrinkles as collagen is depleted and constant motion "cracks" the skin. Dynamic Wrinkles are caused by facial expressions and repetitive facial movements. Each time we use a facial muscle, a groove forms beneath the surface of the skin, which is why we see lines form with each facial expression. As skin ages and loses its elasticity, the skin stops springing back to its line-free state, and these grooves become permanently etched on the face as fine lines and wrinkles.

What types of Dermal fillers by Allergan™ are available?

There is a range of Dermal Fillers available, the type, cost and amount of fillers used will be determined by the area you wish to treat and your attending Doctor's discretion.

These fillers include:

• Surgiderm 24 / 30
  
• Juvederm Hydrate
  
• Juvenderm Volift
  
• Juvederm Voluma
  
• Juvederm Ultra 4
• Juvederm Ultra 3
  
• Juvederm Ultra 2

What are injectable dermal fillers?

Injectable fillers are substances designed to:

• enhance volume,
  
• erase wrinkles,
  
• augment lips,
  
• induce collagen production and
  
• overall restore the youthful 3-dimensional contour of the face.
  

There are many filler choices: hyaluronic acid, a naturally occurring human protein responsible for cushioning the skin (Juvederm™, Surgiderm, Restylane™, Perlane) and newer fillers or volumisers that are meant to fill larger volume loss like sunken cheeks, lost cheekbones, and very deep nasolabial folds and marionette lines such as Juvederm Voluma or Juvederm Volift. These New generation fillers are also are made from hyaluronic acid but have a newer technology called Vycross technology which extends the length of the filler up to 2 years and can be used for the same indications as the original hyaluronic acid fillers such as Surgiderm / Restylane but give improved results for replacing volume loss.

What are the dermal fillers made from?

Hyaluronic acid dermal fillers are produced by human genes inserted into a bacterium for reproduction (Juvederm™, Surgiderm, Restylane™, and Perlane™). It is a highly "conserved" protein, meaning that its genetic composition is almost exactly the same in 97% of animal species. This gives an extremely low incidence of allergic reactions, hence there is no need for pre-treatment skin testing.

If you think of the skin as a 3-dimensional lattice with the structure mostly composed of collagen (which are like large ropes intertwined on each other) and elastin (which gives it its bounce and keeps it from getting stiff), then hyaluronic acid is the gel that is found between these structural proteins in the skin to cushion them. Thus, it has a very natural feel and cannot be seen since it is clear. Hyaluronic acid is hygroscopic which means that it draws water very strongly to it, yielding a larger volume effect than the material would have by itself.

What are the typical areas that are treated?

The typical areas treated are

• the nasolabial folds (lines from the end of the nose to the end of the lips),
  
• perioral area (wrinkles around the lips),
  
• wrinkles of the cheeks, and
  
• marionette lines (lines from the corners of the mouth to the jawline, accentuating the downturn of the mouth) and
  
• Lip augmentation which provides definition without looking overdone to lips which have become thin and wrinkled.
  
• Other areas include filling in acne scars,
  
• "tear-trough deformity" (hollow under-eye circles), hollow cheeks, cheek-lift, brow-lift and
  
• Resculpting the jaw line by lessening the effect of jowls and sagging.
  

Artistically performed injectable fillers can improve your appearance within one week.

Dermal fillers such as Juvederm 24 and Juvéderm Hydrate can also be used to improve ageing hands, décolleté and skin. Multiple micro injections are placed in the dermis attracts water and instantly plump up the skin.

What kind of wrinkles do dermal fillers treat?

To understand the various treatments of wrinkles, one must understand that there are different kinds of wrinkles, dynamic wrinkles and static wrinkles. Dynamic wrinkles are those wrinkles and lines that appear when your face is animated. Static wrinkles are those facial lines that are evident even when our face is at rest and is better treated with dermal fillers. Unlike Botox, dermal fillers can be used to treat both dynamic and static wrinkles.

Static wrinkles are wrinkles that are evident even when our face is at rest. Sleeping positions are one of the main causes of static wrinkles. Resting your face on the pillow in the same way every night for years on end also leads to wrinkles. Called sleep lines, these wrinkles eventually become etched on the surface of the skin and no longer disappear when the head is not resting on the pillow. Women, who tend to sleep on their sides, are most likely to see these lines appear on their chin and cheeks. Men tend to notice these lines on the forehead since they usually sleep with the face pressed face down on the pillow. People who sleep on their backs do not develop these wrinkles since their skin does not lie crumpled against the pillow. Unlike Botox, dermal fillers can be used to treat both dynamic and static wrinkles.

When should one start using dermal fillers?

Wrinkle treatment should start as soon as one sees a wrinkle developing when the wrinkles are still "soft". If these wrinkles are neglected they become "ingrained" and "scar like" they are impossible to treat successfully. If we intervene early and fill in wrinkles with dermal fillers, then we can prevent the breaks in the skin, commonly known as wrinkles. In addition, if the wrinkles are filled up with fillers, this exerts pressure on the fibroblasts in the area and collagen is stimulated which then gets incorporated into the wrinkle area and causes prolonged filling effects and wrinkle improvement. Repeated filler injections (every 6 to 12 months) will ensure a superior long term result as collagen is continually stimulated. In addition to wrinkles, often an ageing face is less about a softening jawline and more about losing volume higher up in the face viz the temples, the eyebrow area, the anterior and lateral cheeks. When the lower parts of the face start dropping, gravity is defied by lifting and replacing the lost volume with injections of dermal fillers in the upper parts of the face. Soft tissue volumising techniques using dermal fillers reverse these atrophic changes, yielding outstanding results and all with minimal downtime.

How does dermal fillers by Allergan™ (hyaluronic acid) work ?

Most tissue in the human body contains hyaluronic acid especially the skin, the eye balls and the cartilages. The Hyaluronic acid acts as a natural sponge / shock absorber especially in one's joints. As one gets older, the body produces less hyaluronic acid. This is one of the reasons older patients suffer from OA (osteoarthritis) as they lose the sponginess provided by the hyaluronic acid. The skin also becomes dehydrated and thus by replacing the hyaluronic acid in ones skin and lips, the hydration and thickness of ones skin will improve. Hyaluronic acid also stimulates ones own natural collagen once it has been injected into the skin. When the wrinkles are filled up with fillers, this exerts pressure on the fibroblasts in the area and collagen is stimulated which then gets incorporated into the wrinkle area and causes prolonged filling effects and wrinkle improvement.

In addition, when the hyaluronic acid starts breaking down, this produces an intermediate fragment of hyaluronic acid which stimulates collagen resulting in prolonged beneficial effects of the filler...a win win situation!

How can advanced filler procedures give back a youthful appearance and help the ageing process?

Consumers are always interested in maintaining a youthful appearance, and as the global population's median age increases, this market is increasingly expanding. Numerous studies have shown that gravity is not the only determinant of ageing, which is a complex process involving tissue atrophy and bone resorption. These two factors create a hollowing and sagging appearance with a loss of facial volume and contours which have a profound effect on the appearance of the mid face. Most people can see that they are looking older but do not recognize that volume loss is the reason that their face is beginning to "sink" and "sag".

Traditionally surgical face lifts have been used to tighten skin and muscle and reduce the appearance of sagging but surgery cannot restore lost volume. For those who would rather steer clear of going under the knife to shave a few years off their appearance, a new aesthetic procedure that works without visible wounding the skin is quickly gaining popularity… The Liquid Facelift.

The Liquid Facelift is a facial contouring procedure that involves the use of strategically placed Botox and dermal fillers around the face. This "injectable facelift" can create a younger, plumper look and address concerns like lines, wrinkles, volume loss and sagging. This "injectable facelift" has been making a noticeable impact in aesthetic medicine during the past few years. It is typically more subtle than surgery and an increasing number of individuals are trying liquid facelift procedures before traditional face lift procedures.

Patients are not alone in having a difficult time seeing volume loss; many aesthetic clinicians do not fully recognize mid-face volume loss and the degree to which it contributes to facial aging.

At Clínica Privé we recognize volume loss and we have developed a new grading system that evaluates facial folds and creases and helps the clinician calculate the appropriate amount of a specific dermal filler program required to attain specific corrective facial goals. This new grading system can also be used to help patients understand their degree of volume loss and their treatment plan.

Can dermal fillers be combined with other treatments?

At Clínica Privé dermal fillers are commonly performed at the same visit as Botox®… the Liquid Facelift. Botox® helps with the upper one-third of the face whereas injectable fillers generally help with the lower two-thirds. The combination is one of the most widely used and most effective methods of achieving a significant aesthetic improvement within 1-2 weeks time.

Fillers can be combined with just about any other aesthetic treatment that exists and at Clínica Privé. Fillers have been safely combined with our signature treatment 3D Skin Rejuvenation on the majority of patients.

What To Expect After Using Dermal Fillers?

After the procedure you are provided an ice pack to take home which lessens the redness and swelling and you may be advises to periodically apply ice to the treated area for a couple of hours. There is virtually no swelling or bruising, so normal daily activities can be resumed immediately after the treatment. At Clínica Privé the option of a complimentary LED Light Therapy after the procedure is available. This is a healing, anti ageing light which further reduces bruising and swelling and prolongs the effect of the filler. You will also be provided with an ice pack to take home which lessens the redness and swelling.

You may put makeup on immediately and resume whatever activities you have planned, as long as you recognize that you will be a little red and swollen for a half a day to a few days.

At Clínica Privé you are asked to have a follow up consult at two weeks when everything is settled to evaluate your results and ensure that you are satisfied with the outcome and have had no problems. Try to avoid aspirin, myprodol, omega 3 or products containing a high-dosage vitamin E supplements for 10 days before the filler procedure (unless medically necessary) to avoid bruising.

After the filler procedure, it's recommended to avoid saunas and steam baths for 2 weeks.