I am different than many Injectors in that I do book longer appointments so that I may take my time in doing the fillers and the neuromodulators (Botox and Xeomin). This affords a more interactive experience for you as I will check in with you during the procedure and ask for your feedback. Most importantly, I commit to be mindful of everything that you are asking me to do.
What Benefits can you Expect From Injectables?
As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling, chewing and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow’s feet or facial creases over the areas where this muscle movement occurs. These “dynamic” lines respond best to neuromodulators such as Botox® or Xeomin®.
Soft-tissue Dermal Fillers can help fill in “static” or “at rest” lines and creases, temporarily restoring a smoother, more youthful-looking appearance. These Dermal Fillers can also be used to help stabilize and support natural aging processes such as loss of skin elasticity, increased bone resorption and loss of fat pads that all give us a more youthful appearance.
When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips, cheeks, hands and even fix those stretched out earlobes. Injectable fillers may be used alone or in conjunction with resurfacing procedures, such as laser or chemical peel treatments, and even recontouring procedures, such as a facelift.
Dr. Wilkinson will work with you, in person and via Telehealth consults, to decide what products are appropriate for you: Fillers, Neuromodulators or Kybella — so that we can obtain your desired results for the face, hands, neck or that “double chin.” Dr. Wilkinson does recommend, if possible, that we do schedule a brief video consult before the day of your appointment so that she may have a better idea for the correct products for you. This pre-consultation telemedicine consult is optional as we will always discuss in depth, what your concerns are and what your desired outcome is at our in person visit.
The Different Injectables You Can Choose From
Neuromodulators- Botox® & Xeomin®
Botox and Xeomin injections are used to improve the appearance of dynamic lines, wrinkles and unwanted creases on your face. Dynamic wrinkles are caused by contractions of the underlying facial muscles as you smile, laugh or frown. We move our facial muscles in a repetitive way which cause>s wrinkles and fine lines. . Neuromodulators have rapidly evolved into a popular treatment for reversing the visible signs of aging.
Botox and Xeomin can be used to improve:
Worry lines in your forehead
Lines between the eyebrows (11’s or Bunny Lines)
LIPS: Lip Flip and Gummy Smile
Frown Lines such as turned mouth corners or Marionette Lines (can make us look angry)
Migraine or Trigger point injections
Neck bands or necklace wrinkles
Neuromodulators block impulses from the nerve to the tiny facial muscles that cause these lines so the muscles do not contract. Untreated facial muscles contract in a normal fashion, allowing normal facial expression to be unaffected.
Is it safe?
Cosmetic denervation with Neuromodulators is a simple and safe procedure. Using a tiny needle, a very small amount of the neuromodulator is injected, very precisely, into several locations on the face. Because the needle is so fine and only a small amount of liquid is used, the pain associated with the injections is minimal. No anesthetic is required, and you can resume normal activities immediately. Some patients experience a slight temporary bruising at the injection site. This can easily be covered with make-up.
If dynamic wrinkles make you look or feel older than you are, cosmetic denervation can smooth these out and give you a more youthful and rested appearance. Lines around the eyes and on the forehead, and upper lip, respond as well as horizontal neck lines. Neuromodulators can also be used in the neck region to improve the appearance of platysmal banding. These neuromodulators do not improve wrinkles due to aging and sun-damaged skin, as they are unrelated to facial muscle contractions. These injections will not improve sagging skin or replace the need for a facelift or brow lift.
What are the possible side effects?
While infrequent, mild temporary bruising is the most common side effect. In some cases, the medicine can migrate and cause a temporary weakness of nearby muscles. In rare cases, there can be a drooping of an eyelid or asymmetry of facial expression. The risk of any side effect depends on the muscles injected. Your doctor will discuss this with you in length before your treatment. Because the effects of neuromodulators are completely reversible, any side effects are temporary, lasting only a few weeks.
The effects of the Botox®/Xeomin® injections last from three to six months with most people returning every 3-4 months. The clinical studies indicate that the duration of treatment benefits is increased over time so that you may require fewer units and less frequent injections in the future with consistent injections.
The duration of effect varies from patient to patient and may be less effective for those over 65 years of age, people with higher metabolism rates and so forth.
If you would like to learn more about your options, or to find out if Botox®/Xeomin® treatments might work well for you, please call Dr. Heather and schedule a consultation.
Hyaluronic Acid Fillers
Hyaluronic Acid Fillers (or HA fillers) are made from different amounts of hyaluronic acid and varying amounts of cross linking fibers that gives each product different characteristics of strength, support and stretch. There are many different HA Filler products available and Dr. Wilkinson has done the scientific and practical research and has chosen certain products which she prefers.
There are 3 major intricate steps to achieving an optimal result:
1. Listening to you and your concerns
2. Crucial physical examination (we may ask you to pull funny faces and move your head up and down or side to side)
3. Product selection based upon steps 1 & 2 and which technology is best for you individually.
There are 3 major families of hyaluronic acid fillers: both families are made from hyaluronic acid is which is a hydophyllic (water loving) polysaccharide component of collagen that is found in all living cells.
The original family of HA fillers include Belotero®, Juvederm Ultra® and Juvederm Ultra Plus®. Each one has different amounts of HA and cross linking which determines how much water that product will attract which then in turn dictates where/when/why and how we decide to use the product based upon much water the product attracts and how long the product will likely last.
The newer Juvederm® Vycross HA technology (developed in 2008) class is different because they are made via tightly crossed HA chains so that they do not rely on attracting water like the original Juvederm® products — this results in more predictable and longer lasting results because we are not depending upon how much water the product is attracting. The newer Juvederm® family of product names are Voluma® XC, Vollure® XC, and Volbella® XC.
Finally, there’s the”new kid on the block” which are the Revance® products: RHA®2, RHA®3, and RHA®4.
This newest innovation in hyaluronic acid dermal filler is from Switzerland and was developed in 2015 by Madame Valerie Taupin, one of the co-creators of Juvederm. The Revance® RHA is known to be more resilient than other hyaluronic acid dermal fillers for certain areas since it was specifically developed to work dynamically with the facial muscles. This family of fillers is also less processed resulting in fewer crossed HA chains so that they most closely mimic our naturally occurring hyaluronic acid.
Each of these fillers is specially formulated to treat different areas of the face and duration of effects are longer, on average, in more dynamic regions of the face than seen in the Juvederm® Collection.
RHA® is available for the first time in the United States in select practices like ours.
INDICATIONS for Dermal Fillers (FDA Approved):
Below are listed the products that we offer, FDA indicated areas of usage and average or expected duration of product.
Please recall that we, in our doctor patient relationship can discuss and figure out the best places and ways to use the products available to us including locations not listed.
Duration of treatment results depend upon which product used and location of treatment area. These lengths can be variable and is why you want to choose an experienced injector like Dr. Wilkinson who can pick the correct product for the most desired and sustainable result.
VOLUMA® XC is indicated for deep (subcutaneous and/or supraperiosteal) injection for cheek augmentation to correct age-related volume deficit in the mid-face and for augmentation of the chin region to improve the chin profile. Can last up to 2 years.
VOLLURE® XC injectable gel is indicated for injection into the mid-to-deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds). Can last up to 18-24 months.
VOLBELLA® XC injectable gel is indicated for injection into the lips for lip augmentation and for correction of perioral rhytids in adults. Can last 12 months.
JUVÉDERM® Ultra XC injectable gel is indicated for injection into the lips and perioral area for lip augmentation in adults. Can last 6-12 months
JUVÉDERM® Ultra Plus XC and JUVÉDERM® Ultra XC injectable gels are indicated for injection into the mid-to-deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds). Can last 6-12 months.
RHA®2: is designed to treat surface lines and wrinkles including vertical lip lines, radial cheek lines (those that fan out from the mouth when you smile), glabellar lines (a.k.a. the “elevens”), and crow’s feet. Can last about 15+ months.
RHA®3: works best for treating deep wrinkles and creases, such as nasolabial folds (the deep lines that run vertically between the nose and mouth) and the corners of the mouth. It can also be used to volumize the lips and midface, and smooth the cheeks. Can last about 15+ months.
RHA®4: is designed to treat the deepest lines and folds, namely those along the lower face and jawline. It is also effective at contouring the cheeks to create the appearance of high cheekbones. Can last about 15+ months.
Radiesse® is calcium hydroxylapatite microspheres in a gel carrier. And NOT an HA Dermal Filler It is biocompatible, non-toxic and non-allergenic filler. Radiesse® is commonly used to reduce the appearance of facial wrinkles and folds occurring around the mouth and nose, such as the nasolabial folds and marionette lines. It may also be used to fill in some types of scars as well as to contour facial features like the chin, cheeks and jaw line. It has also been approved for the improvement of aging hands.
Radiesse® produces an initial plumping of the skin during the first three months after injection which is then followed by extended correction as new tissue regenerates. Radiesse cannot be called permanent, although it can last for up to 2 years.
What are the possible common side effects with Dermal Fillers?
Any injectable treatment there are potential side effects. Minor swelling, discomfort or bruising may occur which generally clears up within a day or two. The formation of nodules or an allergic reaction are rarer but possible risks.
FINALLY, a different option available at New Level Healing: KYBELLA® (deoxycholic acid)
INDICATION: “melts fat”
KYBELLA® (deoxycholic acid) injection is primarily indicated for improvement in the appearance of moderate to severe fullness associated with submental fat in adults aka the dreaded double chin. The KYBELLA injection is a cytolytic drug, which means that it destroys the cell membrane causing cell death — and in this case: fat cell death (and who doesn’t love that, right?).
Deoxcycholic acid is a natural component that we secrete in our GI tract to break down fat cells. The deoxycholic acid from KYBELLA is rapidly absorbed following injection and then is safely excreted from the body. After treatment, there is swelling in the region that most people describe as a “bullfrog” swelling that resolves in a week or so. For optimal results, most people will require 2-6 sessions every 4 weeks. It may take some time to get there but the results are permanent.