Various Treatments of Facial Wrinkles
The gradual development of facial wrinkles, whether
fine surface lines or deeper creases and folds, is the
classic early sign of accumulated skin damage and inevitable
aging. Premature aging and wrinkling of the skin may
be accelerated by excessive exposure to the sun and
other elements, overactive facial expression muscles,
the frequent use of tobacco products, poor nutrition,
or skin disorders. Fine surface wrinkles that progress
to deeper creases, deepening facial expression due to
repeated skin folding, and deep folds which develop
with one's maturity are obvious changes which may combine
to portray a less desirable appearance. Persistent facial
lines, especially those involved in negative emotional
expressions, may mistakenly portray to others, the look
of worry, anger, anxiety, disgust or sadness, despite
one's own positive internal feelings. Regardless of
the cause of facial creases or folds, safe and successful
treatments for reduction or elimination of these problems
are now available with the help of a Facial Plastic
Surgeon. Injecting or implanting substances which either
temporarily weaken the muscles or act as skin volume
fillers serve to soften or eliminate the appearance
of wrinkles and produce a more youthful, rejuvenated
Treatments for facial wrinkles are usually performed
in the office setting which is convenient, private,
and safe for persons who desire therapy. Your health,
in conjunction with the appropriate therapy to achieve
your goals, is given full consideration by your Facial
Plastic Surgeon prior to the any decision to undertake
specific treatment. However, very few individual health
problems would limit the use of these therapies due
to their minimally-invasive methods of application.
Your concerns and any medical requirements for each
facial wrinkle therapy will be part of the consultation
with your surgeon.
Types of Treatments For Facial Wrinkles
Prominent forehead creases, brow furrows or eye lines
(crow's feet) produced by specific facial expression
muscles repeatedly creasing the skin may be effectively
treated by reducing the function of specific facial
muscles. Botulinum toxin (Botox)
is a sterile, purified protein produced from the bacteria,
Clostridium botulinum, in the laboratory. Botox injected
in small amounts into facial muscles binds to the
nerve endings supplying the muscle and prevents nerve
impulses from traveling to the muscle. When injected
into muscle, it weakens or paralyzes the muscle around
the area injected for a typical period of several
months. The resultant weakening or paralyzing effect
on the facial muscle temporarily reduces or eliminates
previous skin creasing and new skin creasing is avoided.
Botox may take several days to have its effect, and
the effect typically lasts 3-6 months, in most individuals,
before full muscle movement returns. At that point
further treatment may be elected.
Injectable collagen is an animal protein filler material
formulated for safe use in nearly all areas of the
face, including the lips and crow's feet. Fine wrinkles
are filled in by the material to reduce their visibility.
Other prominent facial creases and folds around the
forehead, cheeks and chin can be treated as well with
this material. Initial collagen allergy testing must
be performed, and repeated treatments every 2-4 months
are typically needed to sustain the desired result.
The treatments are easily performed in the office
and usually have minimal side effects.
Human collagen matrix, is an implant used for the
reconstruction of soft tissue defects. It may be threaded
beneath the deep creases of the brow or cheek folds
or placed within the upper and lower lips, to flatten
and reduce wrinkle visibility. Typically, this material
maintains the majority of its volume correction similar
to injectable collagen.
Another type of implant is a nonresorbable synthetic
polymer material, ePTFE which may likewise be used
in the forehead, cheek folds, and lips to produce
volume enhancement and effacement of deep facial creases.
This material does not incorporate into surrounding
tissue, but it does not lose volume either. It provides
more lasting change and may be placed during an office
procedure using local anesthetic and small incisions
with a relatively short recovery period.
Fat grafting creates a natural augmentation for the
face, especially for the lips and mouth region. Fat
is usually harvested from the abdomen and about one
third of the volume remains after the treatment. Fat
grafting can be repeated for additional fullness.
the Decision For a Specific Therapy
Expectations of any facial wrinkle therapy must be
realistic. While an expectation for the complete and
permanent removal of facial wrinkles for those persons
considering treatment may be attractive, it is unrealistic,
due to the ongoing nature of wrinkle formation and
the currently available methods for treatment. The
patterns and severity of facial wrinkle formation
are highly individual. Therefore, after consultation
with your surgeon, the appropriate therapy for your
specific problems must be tailored to meet your needs.
Management of many facial wrinkles may require repeated
treatments or the use of combinations of treatments
to achieve optimal results. The goal is to improve
or reduce the appearance of the wrinkle or crease.
This can be accomplished by reducing skin folding
caused by underlying facial muscle action, as in botulinum
toxin therapy. Alternatively, the skin beneath the
wrinkle can be augmented to efface the wrinkle with
injected or inserted filler material. The choice of
a type of therapy depends on the location and extent
of the wrinkles, the desired duration of the effects,
and the tolerance for potential side effects. All
of these treatments provide additional and complimentary
aesthetic benefits when combined with another facial
rejuvenation procedure such as facelift, browlift,
blepharoplasty or skin resurfacing.
to Expect After Each Treatment
In comparison to typical cosmetic surgical procedures,
the office time for these procedures and the subsequent
recovery period until one returns to normal function
are minimal. Botulinum toxin therapy typically takes
a few minutes to perform, and most patients may return
immediately to home or work. Minor local irritation,
redness, bruising, or swelling at the injection sites
are the most commonly observed side effects, all of
which typically abate within a few hours. Likewise,
collagen or human dermal injection therapy can be
accomplished with a 5-15 minute procedure with similar
attendant side effects. Some mild irritation at the
injection sites is unavoidable but can easily be camouflaged
with standard make-up, if necessary.
Filler implant insertions typically take up to an
hour to perform in the office, depending upon the
number and extent of treatment locations. Several
sutures are used to close the insertion site. More
swelling redness, and discomfort may accompany these
procedures, which require the use of a local anesthetic.
Local application of cold compresses may feel comforting.
Most early swelling subsides within a day or two,
though minor swelling and irritation may last for
several weeks during the implant healing phase. Your
activity level and medication for pain after the procedure
are dependent upon your doctor's recommendations.
Insurance does not generally cover surgery that is
purely for cosmetic reasons. Surgery to correct or
improve facial scars or contour deformities resulting
from injury may be covered. It is the patient's responsibility
to check with the insurance carrier for information
on the degree of coverage.
Copyright 2000 American Academy of Facial and Reconstructive