Archive for the ‘Restylane’ Category

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Do Restylane injections hurt? Can you get anesthesia or some type of sedation if you have a fear of needles?

Saturday, June 4th, 2011

You can have restylane injections with some sedation but this is not a very common request.  Oral sedation is a consideration. The question of whether it hurts is “yes” there are variable amounts of discomfort and this is dependent on the approach, the type of local / regional anesthesia, how it is done, whether the filler has local anesthesia contained within it, whether the doctor uses topical anesthesia as well. On our webpage that can be found under procedures > facial fillers > fillers learn more. We cover the different types of anesthesia for fillers choices that you can choose from.

Thanks for reading, Dr Young

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

Posted in Fillers / Facial Fillers, Juvederm, Perlane, Restylane | No Comments »

Plastic Surgery Face lift Alternative, Older Philosophies, and Newer Alternatives

Friday, February 25th, 2011

Plastic Surgery in the past has concentrated on the philosophy of reductive surgery. In the past, Plastic Surgeons typically approached facial plastic and reconstructive surgery by reducing and excising away tissue. The results often lead to a tighter and unwanted look. These results have made people who have received plastic surgery in the past look like they had something done. The question is why that occurs.

As you age, the process is really dominated by a volume loss in your face (And your whole body for that matter). You lose volume all throughout the face. But what it appears to others though is that your face is dropping or sagging. How does this occur? Well, as you lose volume, the skin and tissues are no longer pushed forward away from the facial skeleton. Without this volume support the tissue, the only way for the tissues to move is down and inferiorly, therefore the sagging. So, in the past, plastic surgeons would see this drooping and would try to correct by lifting and cutting away tissue. This is also compounded by the fact that plastic surgeons were surgeons. What we mean is tht surgeons have been trained all of these years on the art of cutting and surgical procedures. Naturally over time, they had a predisposition to cutting things away. This is the genesis of the reduction philosophy in plastic surgery.

Why is this approach unatural? There is an easier way to answer this question and we have a great analogy. Your aging is analogous to a grape and it’s change to a raisin over time.  This process of change entails a lot of volume changes. The grape is the volumized version of the raisin. Plastic surgery has traditionally approached facial rejuvenation by making this raisin into a smaller more pulled raisin. They made incisions in the raisin’s wrinkles (from being dried up) and then excised the skin of the grape to make things tighter. As you can start to see, the raisin that has gone through this approach can never really look like the grape it once was without some type of addition to the volume of the raisin.

We are advancing in our understanding of facial rejuvenation and the above ideas are central to this change in thought. Volumizing is playing a major role in this improvement of our approaches.  It began with fillers in the 1990′s and possibly earlier.  The nasolabial folds were the first areas to be volumized in this spirit.  Collagen started the trend where restylane now dominates. This technique then began to be applied to other areas of the face such as the marionette lines (lines inferior to the corner of the mouth), lower eyelid hollows and bags, and the rest of the face. Because of the temporary results that were achieved from restylane (6 months to a year at best), other options began to surface and resurface.  Long acting injectable fillers include radiesse (a natural bone product made up of calcium hydroxyapatite), artefill (methylmethacrylate microspheres), sculptra (poly-L lactic acid).  Most of the results obtained by the longer acting fillers were like restylane but had the potential to last much longer.  What has been found through experience, though, is that the longer acting injectables eventually do lose volume over the course of a year but the actual materials can persist for longer.  How do we make sense of this? Part of the reason why is due to the carrier molecule that becomes absorbed (glycerin, carboxy methocellulose, etc).  With this absorption, the results also wane. Silicone has been used as injectable filler, but the results are variable from good to disastrous.

As I mentioned, other options began to resurface with this new interest in volumizing.  This new idea for more natural results, fat injections began to make a comeback.  The process includes harvesting fat from another part of your body (abodomen most commonly but also hips, waist, side of the legs) and then it is refined and injected into various parts of the face.  The results from fat grafting in the face can be amazing.  The main issue with fat grafting is finding the most optimal technique to achieve the most reliable fat survival results.  Consistency has been a major challenge for plastic surgeons. There are many steps that are taken with fat grafting that can play a role on the fat’s survival.  It has been difficult to study every aspect of this process.  But research is continuing. The plastic surgery community is doing all that it can to find the best alternatives including fat grafting and volumizing the face. In terms of fat grafting, there are many ways to approach this complicated endeavour.  Just as many different artists will draw a face in an infinite amount of varying ways, so too can a plastic surgeon volumize a face in a those infinitesimal ways . The Young Volumizer is an amazing approach to volumizing the face.

Other alternatives to volumizing the face is the use of facial implants.  Facial implants are most commonly placed in the chin, and cheeks.  Implants for the rest of the face have been used but with less frequency.  Implants, however, require a significant surgical procedure to place them in the face which many people are not excited about. This is one of the reasons that fat grafting has taken such a big part of the stage in natural facial rejuvenation through volumizing.

Thanks for reading, Dr Young

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

Posted in Facelift / Face Lift / S lift / Mini Lift / Weekend Face Lift / Quick Lift / Image Lift, Facial Implants, Fillers / Facial Fillers, Restylane, YoungVolumizer | No Comments »

Deep scar from a spider bite with no improvement with 6 laser treatments

Thursday, February 3rd, 2011

This was a question that I answered for someone that had a Deep scar from a spider bite with no improvement with 6 laser treatments . This is how I answered this question:

Deep scars are hard to reverse with fillers, excision and fat injections can work.  This is in my experience.  Sometimes you are able to get some improvement with fillers. But what I’ve experienced is that the filler tends to be injected in the surrounding areas and not where you want them which is under the scar.  You really have to break up the scar tissue that has accumulated under the depression and this needs to be released.   Once release you can fill it with fillers or fat.  What I like to do is undermine the depressed area with different instruments and then fill it with fat.  This however will not improve any surface details / qualities like incisions or lines there.  The only way to improve that is to actually excise this type of scar.  I would really need to see a picture of the scar or the scar in person to better figure out a way to improve it.  Sometimes with the scar revision, you need to go under the skin to really release the collagen bands of scar tissue to alllow the skin to relax.  Then more fat grafting or some filling may still be needed. You can always email me a picture if you would like more details.

If you ever want some questions answered you can always email me here.

Thanks for reading, Dr Young

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

Posted in Fat Transfer / Fat Injections, Fillers / Facial Fillers, Juvederm, Perlane, Radiesse, Restylane, Scar Removal / scar reduction / scar revision / scar treatment | No Comments »

Since you inject radiesse deeper do you have less bruising than compared to restylane?

Wednesday, December 15th, 2010

Bruising with radiesse and restylane really depends on the technique. Bruising with radiesse and restylane really depends on the technique. Yes if things are placed deeper, there is less visibility for the most part. Since radiesse is in general placed deeper it seems to have less bruising.  But it really depends on a lot of factors like genetics of the patient, whether they have been on blood thinners, whether local anesthesia was used which can increase the bruising.

Thanks!, Dr Young

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

Posted in Fillers / Facial Fillers, Juvederm, Perlane, Radiesse, Restylane, Sculptra | No Comments »

Botox is good for dynamic smile lines, filler and resurfacing can help static lines

Friday, September 17th, 2010

Restylane and Juvederm (or Perlane)  are both great options for filling and improving static lines and dynamic to a degree.  Ipl will, in my opinion, have little effect on the wrinkles. Glycolic peels can help to a minimal degree on fine lines and improving your general skin appearance. Resurfacing is another way to improve your wrinkles on your face by approaching from the outer skin side.  Whereas fillers approach the wrinkles from inside.

Botox is good for dynamic smile and facial  lines, in contrast filler and resurfacing can help static lines. Botox is a neuromuscular agent that blocks the action of muscles by acting on the nerves that innervate muscles.  The way you can tell if botox will work for you is to identify whether your smile lines or wrinkles are accentuated or increased by the act of smiling or the muscles that move your face when you smile.  Botox is good for the wrinkles that increase in appearance with muscle movement.  If it is the wrinkles that are present when you are not moving a part of the face, botox will have less of an effect.  But botox will have an effect on those wrinkles getting deeper when you move your face.  But when your face is at rest the wrinkles that are there will not noticeably improve with botox.  One thing to realize is that if you use botox for a long time, your static wrinkles can improve but this takes a while.  Your cells in your skin have to remodel your skin where the static wrinkles are in order to improve those wrinkles which could take months and years.  Part of what makes wrinkles deeper are the the loss of volume within your face.  This places the skin closer to your muscles and thus when you move your muscles to smile or talk, there actions begin to have more effect on your skin and the effects are wrinkles with the movement.  The volume loss can help this situation by increasing the distance of your skin to your facial muscles.  Fillers are a temporary solution (anywhere from 6 months to a year) and Fat injections are more of a long term solution.  The YoungVolumizer is a great way to volumize your face in a natural way with no incisions, and no general anesthesia.

Thanks for reading, Dr Young

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

Posted in Botox, Dysport, Botulinum, Fat Transfer / Fat Injections, Fillers / Facial Fillers, Juvederm, Restylane, YoungVolumizer | No Comments »

How do I prepare for a filler and what kind of post care should I think of after a filler?

Friday, July 23rd, 2010

Fillers (Dr Young from Aesthetic Facial Plastic Surgery, PLLC in Bellevue, WA) are products that are used to volumize your face.  As you age, you lose volume in your face and these fillers replace this volume.  The most common fillers include restylane, radiesse, juvederm, and perlane.  These are the top four products being used.  So what are some of the things you should be thinking about with filler.  Well to begin with you should not be allergic to any of the products including hyaluronic acid, calcium hydroxyapatite, carboxymethocellulose, gram positive bacteria especially streptococcus, lidocaine or amide type local anesthetics, or a history of multiple allergies or severe reactions to certain medications.  I usually tell people to refrain from high dose vitamin E, herbal medications, supplements, fish oils, omega 3′s, anti-inflammatories (naproxen, aleve, ibuprofen, advil, indomethacin, motrin, excedrin, piroxicam, sulindac, etc.), aspirin 2 weeks before and after the procedure included with this list are some obvious ones like warfarin, coumadin, heparin, lovenox, plavix. Here is a more formal list of medications to avoid from our website.  I do this because these elements / medications can cause bleeding and if you avoid these during this time frame you can avoid extra bruising and swelling.  Arnica and bromelein have shown some benefits but are still being studied and are not a standard in treatment for plastic surgeons so I don’t really recommend it.   This pre filler care will help with the post care.  You should discuss during your consultation the risks and benefits of the use of restylane. During the filler you will have some choices for the type of anesthesia you can get for the filler injections. Now most fillers have lidocaine in the preparation to make it more tolerable.  These are the options:

1. Use ice then inject. Can work but by numbing the area with the ice.  With the local in the filler, you may feel it go in initially with each stick in any new area. But subsequent injections will be more numb with the anesthesia in the filler itself

2. Use topical anesthesia first and then inject.  This is a good option.  The topical makes the skin numb, you may feel the injection go into the deeper layers. But like ice, it will feel like a stick in the new area and then get better with subsequent injections.

3. Local anesthesia and regional anesthesia, so called “dental blocks” to numb the nerves that innervate specific regions.  This is the best way to make it so that you don’t feel anything.  For some it is over doing the anesthesia.  Sometimes, people who get anxious can get reactions to the local anesthesia and you can get an anxiety situation where your heart rate goes up as well as your blood pressure.  This happens about 1 out of 25o times a filler gets done with local / regional anesthesia.

After the filler, you should ice the area especially for the first 48 hours.  I usually suggest 10 minutes for every hour.  I also stress that you should not have the ice directly on the skin but have a barrier to prevent damage to your skin.  This icing will keep the swelling down and also the bruising to a degree.

For the first two weeks, I usually suggest people to massage the area of the filler if there are certain areas that are more elevated and pronounced than the other areas.  Most of this uneveness if it is present will be improved with this.  When the filler is in the lower eyelid area, you need to pull down the swelling over the bone and then massage it from there to effect it.  After the first two weeks, I then suggest to consider more massage if the elevations are subtle and if large then you can consider enzyme injections or hyaluronidase injections which are very potent in reducing unwanted swelling from filler.  Now with radiesse there is no enzyme that will do the same and you have to just massage the area to make it go down to a point that you like.

If you have any questions you can always email me or ask me through this blog

Thanks for reading, Dr Young

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

Posted in Fillers / Facial Fillers, Juvederm, Perlane, Radiesse, Restylane, Uncategorized | No Comments »

Can fillers like restylane cause blindness if injected into the tear trough?

Wednesday, July 14th, 2010

Fillers (like restylane, perlane, radiesse, juvederm by Dr Young in Bellevue near Seattle, WA) in the tear trough can theoretically lead to blindness but there are precautions that you can take to prevent it.  The veins around your eyes and nose and center of the face are valveless and do not prevent particles from traveling back into the deeper tissues like your eyes and brain.  It is possible to cause the particles that are injected with fillers to go back into the eye to cause blindness.  But this is extremely rare.  You can take some precautions to prevent this though.  When you inject, you should not apply to much pressure with injecting.  Also when you inject it you should never be in one place and your needle should always be moving and distributing the filler evenly.  This prevents a load of filler being place in one spot and in the case that you are near a vessel the one spot is not being filler aggressively and possibly back into deeper structures like your eye. Also local anesthesia prevents the vessels from being injected by constricting the vessels so that it is less likely for the filler to get into the vessels. This is a video on fillers around the eyes.

Thanks for reading, Dr Young

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

Posted in Blepharoplasty / Eyelift / Eye Lift / Dark Circles / Eye Bags, Fillers / Facial Fillers, Juvederm, Perlane, Radiesse, Restylane | No Comments »

I have a line on my cheek and I was wondering what kind of cheek lift or filler I can use.

Thursday, May 6th, 2010

You can inject both Restylane or Juvederm (Dr Young is a filler expert in Bellevue Washington) in your cheeks.  They are both very safe when injected by someone with experience.  There are some differences in both of them.  Restylane has been approved for 6 month duration and juvederm for 9 months.  I think they are about the same in terms of length of duration in my experience ranging from 6 months to a year.  One thing to realize is the Restylane comes in 1.1 milliliters or cc’s and Juvederm comes in about 0.8-0.9 ml or cc’s.  You get a little more restylane than juvederm.  Some people think that Juvederm is smoother and results in less lumps but I think that hasn’t been the case for me.  The great thing about Juvederm, Restylane, Perlane is that you can mold these products a bit and if after 2 weeks you have some augmentation that you don’t like you can always inject some enzymes into the areas to decrease the amount of augmentation to get the very best results.

Thanks for reading, Dr Young

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

Posted in Fillers / Facial Fillers, Juvederm, Perlane, Radiesse, Restylane | No Comments »

Do non surgical cosmetic treatments really work?

Thursday, April 8th, 2010

Options for non surgical cosmetic treatments include: lasers, fillers, sun avoidance, topical skin treatments, etc.  All of these modalities have proven to show improvements in a person’s aesthetics.  Lasers can non surgically remove sun spots, tighten your skin, reduce vascularity and red spots, improve skin texture.  Fillers, can fill volume loss in your face which is actually the culprit of most of the aging that we experience as the years go by.  Sun avoidance decreases the aging of your skin that occurs when your skin is exposed to sun.  The UVA and UVB light can cause DNA mutations in your skin cells that cause aging and also can lead to skin cancer.  Skin treatments which can include microdermabrasion, topical creams, facials, chemical peels that can be done in office and at home can all lead to skin rejuvenation.  Skin treatments can tighten your skin to a degree, decrease unwanted pigmentation, speed skin turnover to rejuvenate your skin on a daily basis and prepare you for significant treatments.

Another in between option is the YoungVolumizer (Dr Young who is in Bellevue, Washington discovered the YoungVolumizer).  This is a procedure that I invented that entails volumizing your face with your own tissue. As we age we change from a grape to a raisin and using your own tissues to volumize your face can make your face look more like a grape instead of a raisin with the wrinkles and loss of the curves.  Most traditional procedures change the aged raisin to a smaller raisin.  You end up, often times, looking like someone else instead of the youthful grape you used to look like when you were younger.

Thanks for reading, Dr Young

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

Posted in Fat Transfer / Fat Injections, Fillers / Facial Fillers, Intense Pulse Light, Laser Resurfacing, Perlane, Radiesse, Restylane, YoungVolumizer | No Comments »

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

Posted in Botox, Dysport, Botulinum, Fillers / Facial Fillers, Juvederm, Perlane, Radiesse, Restylane, Wrinkle Treatment | No Comments »

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