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Spa, MD: The Results-oriented Revolution

Jeffery S. Dover, MD, and Amy Kamin June 2008 issue of Skin Inc. magazine

cosmetic treatment with botox injection

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Until recently, the only effective procedure available to the individual wanting appearance enhancement was a face lift. Throughout the past few years, treatments featuring Botox and fillers, as well as laser and light procedures—in conjunction with good skin care—have revolutionized the ability to rejuvenate an aging face.

Statistics

According to a consumer survey by the American Society for Aesthetic Plastic Surgery (ASAPS) of 1,000 American households in 2007, 83% of women and 78% of men would not be embarrassed to undergo cosmetic surgery. This has been a major shift in society’s views toward cosmetic procedures. It has become trendy to openly contemplate procedures with peers, discuss a physician’s techniques and compare results. This trend, however, is occurring in regard to noninvasive, nonsurgical procedures. Recent statistics from the ASAPS reveal that, of 11.4 million procedures performed, 17%—or 1.9 million—were surgical, such as face lifts, eyelid lifts and liposuction, while 83%—or 9.5 million—were nonsurgical, such as the injection of Botox and fillers, and laser and light-based treatments.

Fillers and injectables

While face lifts are surgical procedures associated with anxiety, high cost,and significant recovery periods, filler and Botox treatments are relatively simple, safe, quick, relatively inexpensive and, in many instances, without downtime. Many individuals who would never consider a cosmetic surgical procedure are happy to have a noninvasive procedure. Because of this, the potential pool of candidates has increased dramatically.

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Neuromodulator Options

 

Botox*

Reloxin**

Product source

Purified form of botulinum exotoxin A

Purified form of botulinum exotoxin A

Indications

Frown lines between eyes, forehead wrinkles, crow’s-feet, upper lip, lower face and neck

Frown lines between eyes, forehead, crow’s-feet, upper lip, lower neck

Onset

Three days—the peak effect takes place 7–10 days after treatment

2–3 days—the peak effect takes place 7–10 days after treatment

Duration

3–4 months

3–4 months

Treatment protocol

A series of injections every 3–4 months

A series of injections every 3–4 months

Cost

$400–1,500, depending on the number of injections and the amount of material used

$400–1,500, depending on the number of injections and the amount of material used

Benefits

Temporarily paralyzes the muscles that cause lines through negative facial expressions

Temporarily paralyzes the muscles that cause lines through negative facial expressions

Risks

If performed properly, almost none, although bruising, an incomplete effect, brow droop, eyelid droop, lip droop and asymmetry of the effect can occur.

If performed properly, almost none, although bruising, an incomplete effect, brow droop, eyelid droop, lip droop and asymmetry of the effect can occur.

Collagen Options

 

Bovine collagen

Human collagen

Porcine collagen

Product source

Naturally occurring protein from purified cow skin

Naturally occurring protein from lab-grown human foreskin tissue

Porcine (pig) tendons

Indications

Fine and moderately deep lines and creases around eyes and lips; lip and lip edge augmentation; scars

Cosmoderm* for superficial lines, glabellar lines, lip edge; Cosmoplast* for superficial and moderately deep lines and wrinkles, lip edge, lip body and acne scars

Evolence Breeze** for superficial lines, glabellar lines, lip edge, lip body; Evolence** for lip edge, lip body, and superficial and moderately deep lines and acne scars

Duration

2–6 months

2–6 months

Long-lasting temporary—at least 12 months

Treatment protocols

A series of injections every 2–6 months

A series of injections every 3–4 months

One time per year

Cost

$400–800 per syringe

$400–800

$600–1,000 per syringe

Benefits

Versatile, short-acting filler

Versatile, short-acting filler

Versatile, short to mid duration-acting filler

Risks

Allergic reaction, required skin test, bruising, swelling, incomplete correction, asymmetric results

Rare allergic reaction, bruising, swelling, incomplete correction, asymmetric

Rare allergic reaction, bruising, swelling, incomplete correction, asymmetric

Hyaluronic Acid Options

 

Restylane and Perlane*

Juvéderm Ultra and Ultra Plus**

Product source

Genetically engineered streptococci

Hyaluronic acid

Indications

Lips, nasolabial folds, marionette lines, tear trough, adding volume to cheeks

Lips, nasolabial folds, marionette lines, tear trough, adding volume to cheeks

Duration

6+ months

6+ months

Treatment protocols

A series of injections every 4–8 months

A series of injections every 4–8 months

Cost

$600–1,000

$600–1,000

Benefits

Natural looking results; lasts for at least 6 months; Restylane good for finesse areas; Perlane good as an underlay and for volume enhancement

Natural looking results; lasts for at least 6 months; Ultra good for finesse areas; Ultra Plus good as an underlay and for volume enhancement

Risks

1–2 days of redness, swelling, bruising, tenderness

Less redness and swelling than with Restylane and Perlane

Semi-permanent Filler Options

 

Radiesse*

Sculptra**

Autologous fat

Product source

Calcium hydroxyl apatite

Poly-L-lactic acid

Fat harvested from other parts of the body.

Indications

A volume filler for deep nasolabial folds, marionette lines, and hollow cheeks.

A volume filler for deep nasolabial folds, marionette lines, and hollow cheeks.

A volume filler for deep nasolabial folds, marionette lines and fat loss related to aging

Duration

12–18 months after a single treatment; if a touch-up treatment is provided, results are even better and duration is longer

1–2 years after a series of between 3–6 treatments

Six months to life-long; results are best and effect is longer if one or two touch-ups take place

Treatment protocols

Every 12–18 months

May need touch-ups

May need touch-ups; varied by individual

Cost

$800–2,000 per treatment

$800–2,000 per treatment

$1,000–4,500

Benefits

Allergic reactions are rare, and results are long-lasting.

Allergic reactions are rare, and results are long-lasting.

No possibility of allergic reaction, ubiquitous material, natural appearance

Risks

Swelling, redness, bruising and lumping

Redness, swelling, bruising and lumping; requires a series of treatments to obtain the desired effect

Redness, swelling and bruising

Permanent Fillers Options

 

Artefill*

Silicone

Product source

Synthetic beads of methyl methacrylate in a base of bovine collagen

Liquid form of the chemical polymer silicone

Indications

Superficial, moderate and deep lines and folds, acne scars, volume loss

Lips, acne scars, sunken cheeks, nasolabial folds and marionette lines

Duration

Permanent

Permanent

Treatment protocols

One treatment with one or two touch-ups provides the best result

Depends on number of sites and amount of correction desired

Cost

$2,500

$500–1,000 per injection

Benefits

Long-lasting benefit; once the desired result is achieved, touch-ups are needed only as the client ages and lines deepen with time

Long-lasting benefit after a series of treatments; once the desired result is achieved, touch-ups are needed only as the client ages and lines deepen with time

Risks

Swelling, redness, bruising and permanent lumps; should not be used in the lips

Swelling, redness, bruising permanent lumps, and the rare possibility of a late foreign body reaction or migration of the material

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