Archive for the ‘Radiesse’ Category

Fillers, Botox or Lasers for the Under Lower Eyelid Area?

Thursday, October 15th, 2009

This was a question I answered for someone recently:

Restylane is a filler and can be used to fill in the lost volume that is really the cause of the majority of the reason why your lower eyelid looks the way it does. Fat injections, the YoungLift, Juvederm, Perlane, Radiesse are other fillers that can be filled into the lower eyelid area.  The temporary fillers last from 6 months (restylane) to a year or more (radiesse) with perlane and juvederm in between.  Fat injections can last much longer but this isn’t guaranteed but is the best shot for a long term correction.

Botox prevents the muscle around the eyes from squinting which can make the wrinkles less noticeable. Dysport (or botox / bo tox / botulinum / neurotoxin / disport) is a great option.  But these do nothing for the surface quality of the skin and neither does the filler. But the fillers can decrease the amount of wrinkles by filling up the volume.

This is where the co2 laser or other resurfacing procedure (erbium yag, active fx, ultrapulse, deep fx, max fx, total fx, traditional co2 laser resurfacing, laser peel) can help with by decreasing the wrinkles and actually tightening the skin.  A small amount of volumizing also occurs with lasers with their creating of a thin collagen layer deep to the skin.

I hope that helps some!

Thanks for reading, Dr Young

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

Can radiesse / radiance be used in the Jawline and lateral portion of the Jaw area?

Sunday, September 27th, 2009

Radiesse can work but you may need a bit more in this area. Radiesse is made of calcium hydroxyapatite, the same constituent as your own bone.  This makes it really compatible with our bodies. For Mandibular augmentation, you will likely need a siginificant more amount of augmentation here than you would along the mouth lines.  Mandibular silicone implants are made up of approximately 10-15cc each side. So you will need quite alot of radiesse to show the same amount of change.  This is important to know before doing radiesse injections in this area.  If you just want to get a little taste of what this will look like then radiesse would be a good trial.  Silicone implants are one of the better ways of really augmenting the lateral jaw bone.

Thanks for reading!

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

What are the options for sunken cheeks besides temporary dermal fillers?

Wednesday, August 5th, 2009

This is a questions I answered for someone that was wondering what option there were for sunken cheeks besides temporary Facial FillersFat Transfer or Facial Implants can give you the long term volume you desire in the cheek.

Sunken cheeks is a natural aging process.  When you age you lose fat in your cheeks and this can lead to your tissues descending, wrinkles developing, folds developing, lower eyelid fat protruding, eyelid bags, etc.  Dermal fillers like restylane, juvederm, radiesse, perlane, are temporary and last from 6 months to a year or more.  Of these fillers radiesse is a bone product made up of calcium hydroxyapatite while the others are made up of hyuloronic acid.  There are more permanent fillers like silicone injections, and artefill.  The problem with permanent fillers is that they have the potential to cause infections, scarring and granulomas (balls of chronic infection) that can present years later after you think everything is okay.

Other more permanent options for sunken cheeks include fat injections and silicone implants.  Silicone is very compatible to place in the cheeks.  The silicone atom is one step below carbon on the atomic chart and hence makes it really compatible.  The infection rate with silicone is very low and its use has a long history of safety.  Silicone implants can be placed within the cheek to give a person a more permanent volumizing and lift up sunken cheeks.

Fat injections are another way of volumizing the cheek. Perrmanency depends on whether the fat survives.  This depends on many factors: technique, health of the patient, care of the patient after the procedure, etc.  If fat lasts for more than 6 months to a year, it will likely survive for many years sometimes 10-15 years or longer.

I refined an amazing volumizing procedure called “the YoungLift”. This is an innovative technique that volumizes your face to bring out the younger and natural you without looking like you had something done. This is not a facelift and requires no incisions. Only pinpoint puncture sites are used and these heal imperceptibly. The YoungLift can be done without general anesthesia and without drains, and large bandages. You also have a lot less downtime and discomfort compared with traditional facelift procedures. I employ the very best techniques from around the world into one volumizing procedure and I use my internationally acclaimed understanding of facial beauty to create the youthful volume you once had.

Dr Young is located in Bellevue near Seattle, Washington

Can a forehead augmentation be done after a brow lift?

Wednesday, August 5th, 2009

Forehead augmentation can be done but can affect the results of previous browlifts. You can augment the forehead with silicone after a browlift.  One of the issues is that the augmentation will affect what was done with the previous browlift and you will sometimes need to refix the brows and allow them to fixate in the newer position.  Browlifts depend on the fixation of the bone to the bone covering and the soft tissue that covers the forehead.  When you dissect to implant something into the forehead it will break that bond.  Also with the implant fixating the brows to a new position will present some challenges as well depending on where the implant is placed.  Implants placed in the forehead can establish needed volume that is lossed with aging.  Most of the time, however, forehead augmentation is used to fill in defects from trauma and for reconstructive purposes. Also depending on what implant is used and the size you may need longer incisions such as a variation of the coronal incision that goes from ear to ear.  Not all of this incision is needed most of the time.  In terms of augmentation, you can use silicone sheets / blocks, Facial Fillers or fat augmentation.  Silicone and fat are the options that offer more of a longer lasting results with silicone being more permanent than fat.  Fat injections, however, can be done with no incisions most of the time with less downtime associated with long incisions. Augmenting the forehead can potentially help with wrinkles in the forehead, eyebrow drooping, extra eyelid skin and temple hollowing depending on how and where the augmentation is done.

I refined an amazing volumizing procedure called “the YoungLift”.  This is an innovative technique that volumizes your face to bring out the younger and natural you without looking like you had something done.  This is not a facelift and requires no incisions.  Only pinpoint puncture sites are used and these heal imperceptibly.  The YoungLift can be done without general anesthesia and without drains, and large bandages.  You also have a lot less downtime and discomfort compared with traditional facelift procedures.  Dr Young employs the very best techniques from around the world into one volumizing procedure and he uses his internationally acclaimed understanding of facial beauty to create the youthful volume you once had.

Dr Young is located in Bellevue near Seattle, Washington

Radiesse injections to the nasal bridge and how long to wait before rhinoplasty

Thursday, July 16th, 2009

If the augmentation is lost, I think it would be okay to consider Rhinoplasty. Facial Fillersis made up of 30% hydroxyapatite and 70% of the carrier. Much of the carrier dissipates over the course of the year.  It might be prudent to wait. But if you think the results are essentially back to normal you could consider rhinoplasty and an implant to raise your nasal bridge. What is left in your nose is likely the hydroxyapatite and this could stay in your nose for years. Biopsies of the bladder have shown it to be there for 5 years.  Hence if most of the augmentation is gone you could do the rhinoplasty earlier than the full year that it is expected to give you results.  If you really wanted to be safe you could wait for the full year to pass.

Thanks!

Dr Young is located in Bellevue near Seattle, Washington

What is the best method of injecting radiesse, nerve blocks, ice, etc?

Sunday, July 12th, 2009

There are many methods of injecting radiesse so that it is not as painful.  Nerve blocks are the best way to make parts of the face numb. You can numb almost the whole face by injecting a few small areas that affect large nerves that control the sensation to large areas.  Local anesthesia can then augment the numbness.  You can also add lidocaine into the Radiesse.  2% lidocaine is the best to use with the radiesse.  Topicals can also help out to insure that the area will not have any pain during the injection.  This can help when the regional blocks do not make the complete area numb.  Ice is another way to help make the injections less painful.  They are also helpful when you do the initial regional blocks to lessen the needle pain when these regional blocks are done.  Radiesse injections can be painful without anesthesia so all of these techniques can augment this experience. A dental block may not be the only thing you need.  There are other blocks you can do to the face to make almost the whole face numb.

Hematoma and asymmetry after Radiesse Injections?

Sunday, July 5th, 2009

This is a question that I answered for a patient who had Facial Fillersto the under eye area by another doctor who developed a large hematoma under the eye and what options she had to help the situation:

Bruising is a natural consequence that can happen after any procedure that enters the skin. This can be a procedure that involves injections or any surgical type procedure. Any doctor that tells you that he doesn’t get bruising is not telling the total truth. I think only God can assure no bruising.

The swelling and the difference will eventually get better. Your body does a lot to heal and make things better. Your doctor will help you through this and be there for you.

Some of the ways to avoid bruising and bleeding are to avoid blood thinners 2 weeks before and 2 weeks after your procedure, which include, but are not limited to:

  • High dose vit E
  • Aspirin
  • Anti inflammatories
  • Herbal medications or supplements

Local anesthesia with epinephrine can shrink the vessels in the area of injection and make less likely to manipulate blood vessels that can lead to bleeding. Genetics play a factor in how someone is likely to bleed, and this can be something that cannot be changed in a person many times.

There are some medications that can help certain bleeding disorders. But there are a lot of factors that can affect bleeding in ones genes that still need to be discovered and not likely can be changed through medicine.

In terms of the swelling that is asymmetric, this will eventually go down things that could help it include oral steroids for general swelling, pressure in that particular area (which could be done by a full facial compression garment with more gauze in the area of swelling the other side, or localized injections of steroids. You can also improve the swelling from the bruising through limited exercise that will bring blood flow to the area and help remove some of the residual inflammation and swelling.

Dr Young is located in Bellevue near Seattle, Washington

Bulky radiesse results and what should be done? Steroids?

Sunday, July 5th, 2009

This was a patient that had a procedure done by another physician and wondered what could be done about some bulky results  after Facial Fillersinjections only 7 days after the procedure:

Seven days is too early to make a decision about steroids or other intervention. You should wait at least 2 weeks to a month before considering some type of treatment for the radiesse. During the first 2 weeks to a month, you are going to have a considerable amount of swelling from the inflammation that is undergoing around the radiesse. Your body is fighting and adjusting to the new tissue that has been injected. Doing something this early would be a mistake.

There are several risks with steroids that should be considered before using them. You have the risks of high blood pressure, high blood sugars, muscle and bone loss, poor wound healing, immunosuppression (you could be more susceptible to infections), hip damage, adrenal suppression, hormonal changes, acne, weight gain, mood changes, psychosis, changes in your appearance and more.

These are systemic effects that can happen if you are on a lot of injections over a long period of time, which is unlikely to happen with 1 or 2 injections but these risks need to be considered by anyone getting steroids. Locally at the site of injection, the effects could be thinning of the skin, you can develop vessels and increase vascularity that can change the appearance at the area, fat can be metabolized and cause depressions, your chances of infection and rejection of your radiesse could also be increased.

Dr Young is located in Bellevue near Seattle, Washington

Radiesse good for lip augmentation?

Sunday, July 5th, 2009

Facial Fillers is generally avoided in the lips due to the bumps and nodules that it can create. Restylane is the best in the lips. Juvederm can also be used in the lips as well. Both of these products have a limited longevity and can last from 6 months to a year.  Fat injections are an option in the lips but take a lot of experience and knowledge of lip anatomy and dynamics to create the best result.

Lip Augmentation, when done well, can last years. But you want to go to a surgeon that has experience doing these in the lips. The length of time fat lasts is tightly related to the technique that is being used. You have to traumatize the fat as little as possible and when you place the fat it has to be layered in small amounts so that the fat can survive and find its own blood supply and environment.

I refined an amazing volumizing procedure called “the YoungLift”.  This is an innovative technique that volumizes your face to bring out the younger and natural you without looking like you had something done.  This is not a facelift and requires no incisions.  Only pinpoint puncture sites are used and these heal imperceptibly.  The YoungLift can be done without general anesthesia and without drains, and large bandages.  You also have a lot less downtime and discomfort compared with traditional facelift procedures.  Dr Young employs the very best techniques from around the world into one volumizing procedure and he uses his internationally acclaimed understanding of facial beauty to create the youthful volume you once had. The YoungLift techniques can help with filling up the lips as well.  You can great results with fat injections in the lips.

Dr Young is located in Bellevue near Seattle, Washington

How Long does Radiesse Last?

Sunday, July 5th, 2009

It slowly goes down with time but can last for longer than a year. In fact biopsies of areas that have hadFacial Fillersinjections have shown that it can last up to 3 years or more.  But the volume that remains later on is no more than 30% of the original volume that was injected. The area that is injected also determines how long it lasts.  In more mobile areas, the effect is less and goes away faster.

Dr Young is located in Bellevue near Seattle, Washington