Many patients are concerned with specific aesthetic areas such as lips, cheekbones, or chin. Products and techniques are available today to allow for augmentation (adding fullness) to these and other areas to enhance a certain feature in order to achieve facial balance. Reductions can also be accomplished as in rhinoplasty (nose); Genioplasty (chin), liposuction and in certain growth abnormalities and disease states that cause hyperplasia (overgrowth) reductions can be accomplished by osteotomies (bone cuts) or osteoplasty (bone recontouring). Here we will discuss augmentations.

Soft Tissue (Lips, Deep Rhytids (wrinkles); Restylane, Sculptra, Gortex

Non-Permanent Augmentations

For soft tissue augmentation, non-permanent fillers such as Restylane and Sculptra are available.

Permanent Augmentations

The patients’ own tissue such as fat and connective tissue can be transferred for permanent augmentation.

Reversible Permanent Augmentations

Reversible permanent augmentation is achieved with soft gore-tex fillers.

These are available for lips, nasolabial folds (between cheek and upper lip) and other areas.

What is Restylane®?

Restylane is a safe and natural cosmetic dermal filler that restores volume and fullness to the skin to correct moderate to severe facial wrinkles and folds, such as nasolabial folds.

What is Restylane® made of?

Restylane is made of non-animal-based hyaluronic acid. Hyaluronic acid is a natural substance that already exists in the human body and is used to provide volume and fullness to the skin. The hyaluronic acid in Restylane is a crystal-clear gel called NASHA,™ or Non-Animal Stabilized Hyaluronic Acid. NASHA is biodegradable and fully biocompatible with human hyaluronic acid.

How is Restylane® different than other hyaluronic acid-based products?

Unlike rooster-derived hyaluronic acid based products, Restylane is free from animal proteins. This quality limits any risk of animal-based disease transmission or allergic reaction. Restylane contains trace amounts of gram-positive bacterial proteins and should not be used by patients with a history of allergies to such material. Additionally, Restylane has the highest concentration of hyaluronic acid available in a dermal filler.

Is Restylane® safe?

Yes. Restylane has been used by dermatologists and plastic surgeons since 1996 worldwide. There is limited risk of animal based disease transmission or allergic reaction. Restylane is fully biocompatible and allergy testing is not required. Restylane contains trace amounts of gram-positive bacterial proteins and should not be used by patients with a history of allergies to such material. After your treatment, you might have some redness or swelling. This will normally last less than seven days. Sunbathing and cold outdoor activities should be avoided until any redness or swelling disappear. If you are pregnant, breastfeeding, or under 18, you shouldn’t use Restylane.

Can Restylane® be used anywhere on the face?

Restylane has been used in more than 1.5 million treatments in over 60 countries to correct a variety of wrinkles. In the U.S. the FDA has approved Restylane for wrinkles and folds like the ones from the nose to the corners of the mouth. Your doctor will consult with you prior to your injection regarding common treatment areas.

How long does Restylane® last?

Restylane is proven to deliver long-lasting results. Studies have shown that Restylane effects generally last for about six months. Restylane’s stabilization technology helps maintain the cosmetic effect until the injected material is nearly gone.

How often should I have Restylane® treatments done?

Treatments are typically scheduled twice a year. Having a touch-up treatment before the product has fully dissipated may enhance the lasting effect.

What should patients do prior to treatment?

Restylane requires no pre-testing, but you should take a few precautions before being treated. Avoid smoking or using aspirin, or steroidal anti-inflammatory medications, St. John’s Wort, or high doses of Vitamin E supplements prior to treatment, because these may increase bruising or bleeding at the injection site. Also, if you have previously suffered from facial cold sores, discuss this with your physician. He/She may consider prescribing a medication to minimize recurrence.

How is Restylane® different from BOTOX®® Cosmetic?

Restylane is a natural, cosmetic filler. In contrast, BOTOX® Cosmetic is a drug that blocks nerve transmission and relaxes the underlying muscles. Many patients have been very pleased after receiving treatment with both products.

How is Restylane® different from bovine collagen?

Bovine collagen is derived from animals (cows) and requires an allergy test. Restylane can be administered immediately—no waiting is required.

Do the injections hurt?

Dr. Reynolds uses nitrous oxide and local anesthesia so you are completely comfortable during the application of Restylane. Restylane is injected directly into the skin in tiny amounts by an ultrafine needle, resulting in minimal discomfort. The procedure is simple and convenient, and results are practically instantaneous. To optimize your comfort during the short procedure, local anesthesia may be administered at the treatment area.

What is Sculptra®?

Sculptra® is much different from Restylane. It is used for much larger areas.

Sculptra® is used cosmetically to restore loss of tissue thickness that occurs with time. The youthful face has fullness, as we age the tissues thin and begin to droop. In many patients this can be premature and give them an aged appearance beyond their years. In some cases the drooping tissues can make the person appear tired, sad or angry. This can have a negative affect on how others treat or perceive the person. Sculptra® can restore a more youthful appearance by putting volume back into the face. As the volume is replaced the tissues lift like a hot air balloon being filled with air.

Are the results from Sculptra® immediate?

No. At your first treatment visit, it may appear that Sculptra® worked immediately because of swelling from the injections and the water used to dilute Sculptra®. In a few days, when the swelling goes down and the water is absorbed by your body, you may look as you did before your treatment. Sculptra® takes time to gradually correct the depression in your skin. Dr. Reynolds will see you again in a few weeks to decide if you need more Sculptra® injections.

How many treatments are required?

Dr. Reynolds will decide the appropriate number of treatment sessions and the amount of Sculptra® you will need at each session. Patients with severe facial fat loss may require 3 to 6 treatment sessions. These will occur at 6 week intervals.

How long do treatment results last?

Treatment results will differ for each person. In a clinical study, the treatment results lasted for up to 2 years after the first treatment session, in most patients. Touch-up treatments may be needed to maintain the desired effect.

Do injections of Sculptra® hurt?

As with any injection, injections with Sculptra® may hurt. Sculptra® is injected in small amounts using a very fine needle. Dr. Reynolds will apply a local anesthetic.

What can I expect to happen at a treatment session?

Dr. Reynolds will answer all of your questions and prepare you for the treatment in a pre-treatment consultation.

Before the first treatment

What can I expect after treatment?

Immediately following a treatment session with Sculptra®, redness, swelling, pain, bruising or all of these signs can happen in the treatment area. These signs usually go away in a few hours to a few days. Some have been known to last up to 17 days. Dr. Reynolds will give you specific post-treatment care instructions. You should massage the treated area (a few times each day) for several days after the treatment session. Within the first 24 hours after treatment, an ice pack should be applied for a few minutes at a time to the treatment area to help reduce swelling. Wrap the ice in a cloth and avoid putting ice directly on your skin. Avoid excessive sun and UV lamp exposure until any initial swelling and redness has resolved.

How quickly can I get back to my daily activities?

Most patients feel comfortable going back to their normal activities the day following treatment.

When will I be able to apply make-up after treatment?

Make-up may be applied a few hours after treatment if no complications are present (for example, open wounds or bleeding).

What are the possible side effects of treatment with Sculptra®?

The most common side effects with the use of Sculptra® include injection-related side effects at the site of the injection such as bleeding, tenderness or pain, redness, bruising, or swelling. These side effects generally last, on average, 3 to 17 days.

One possible delayed side effect with Sculptra® can be small bumps under the skin in the treated area. These small bumps may not be visible, and you may notice them only when you press on the treated skin. These bumps tend to happen within the first 6 to 12 months after the first treatment. Occasionally, these bumps go away on their own. Visible bumps, sometimes with redness or color change to the treated area, have also been reported. As with all procedures that involve an injection through the skin, there is a risk of infection.

Who should not use Sculptra®?

You should not use Sculptra® if you are allergic to any ingredient of Sculptra®. Talk to Dr. Reynolds about your medical history when deciding on treatment options.

	Hard Tissue (Bone): MedPore, Implantech If you're considering facial surgery... Facial implants improve and enhance facial contours. Frequently, these implants will help provide a more harmonious balance to your face and features so that you feel better about the way you look. There are many implants available, manufactured from a variety of materials. They may help strengthen a jawline or bring the chin or cheekbones into balance with the rest of the face. What to expect from a facial implant Facial implants can enhance your appearance and bolster your self esteem. If you are looking for improvement, not perfection, in your appearance and are realistic in your expectations, you may find that a facial implant is the right choice for you. Facial implants can bring better balance to the features of a younger patient. For instance, a teenage girl may want her nose reshaped or her chin brought forward so that these traits are better proportioned. The more mature patient may choose to have an implant placed in conjunction with another cosmetic procedure. For example, during a facelift, a patient may wish to have implants placed over the cheekbones to help restore a more youthful appearance. Implants may also be selected to fill out a face that appears "sunken" or tired. Dr. Reynolds uses MedPore and Implantech products which are pre-contoured in multiple sizes for chin, cheekbone, orbital rim (around eyes), and nose. They also have custom implants made for reconstruction of virtually any area. Types of Anesthesia In some cases, facial implant surgery may require only local anesthesia combined with a sedative. However, more frequently, IV sedation or general anesthesia may be recommended. Chin Implants Insertion of a chin implant may take anywhere from 30 minutes to an hour. During the procedure, the proper implant size and shape will be selected to enhance your appearance and will be inserted into a pocket over the front of the jawbone. The small incision to create the pocket and insert the implant is placed inside the mouth (along the lower lip) or in the skin just under the chin area. Usually, the chin is taped after surgery to minimize swelling and discomfort. Sutures in the skin will be removed in five to seven days. If an intra-oral incision is used, the sutures will dissolve. Recovering from Chin Implant Surgery You will experience some discomfort and swelling in the affected area for several days. It's normal to experience some temporary difficulty with smiling and talking. Black and blue marks may be visible around the chin and neck. You will be instructed about dental hygiene, eating and any restrictions to your activities after surgery. Cheek Implants Cheek implant surgery usually takes about 30 to 45 minutes. When cheek implants are being placed in conjunction with another cosmetic procedure, such as eyelid surgery, the implants may be inserted through the incisions made for that procedure. Otherwise, an incision will be made inside your mouth under the upper. A pocket is then formed and an implant is inserted. After surgery, a dressing will be applied to minimize discomfort and swelling. The severity and duration of such side effects may vary, especially if another cosmetic procedure was performed at the same time. Recovering from Cheek Implant Surgery You will be provided with instructions about post-operative care. There will be dietary restrictions as well as limitations to your activities. Again, these instructions will vary, especially if another procedure was performed along with your implant surgery. However, you should be aware that your ability to move your mouth and lips may be diminished temporarily. Stitches used to close the incisions inside your mouth usually dissolve within about 10 days. Lower Jaw Implant Insertion of a jaw implant usually takes about one to two hours. Internal incisions are made on either side of the mouth to provide access for creating a pocket into which the lower-jaw implant can be inserted. Dissolving sutures are used to close the incisions. Recovering from Lower Jaw Implant Surgery Swelling is sometimes significant immediately following surgery, usually peaking 24 to 48 hours afterward. Although most of the significant swelling will subside over a period of several days, prolonged mild swelling may prevent your final facial contour from becoming apparent for several months. During the healing phase, your activities and diet will be restricted. Your ability to smile, talk or move your mouth in any way may be limited for several days to weeks following surgery. You will be instructed about dental and oral hygiene during your recovery. Getting Back to Normal Remember, with any facial surgery, you may feel and look better in a short period of time. However, it may not be advisable to participate in certain activities -- especially activity that may result in the face being jarred or bumped -- for several weeks. It's best to discuss any concerns with your surgeon about such matters. Your New Look You may not be able to accurately evaluate your appearance for weeks, or perhaps even months. Give yourself plenty of time to get used to your new look. You may be surprised to find that most people won't recognize that you've had facial implant surgery. To preview Pre-Operative Instructions, Consent and Post-Operative Instructions along with the scheduled visits, see “Doc’s Orders; Cosmetic Plastic Surgery; Augmentations and Reductions”.