Category Archives: Injectables

What are Injectable Dermal Fillers?

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Dermal fillers are gel-like, volumizing substances that are injected beneath the skin to restore lost volume, smooth fine lines and deep creases, or enhance facial contours.

How Can Dermal Fillers Enhance My Appearance?
Many visible signs of aging are related to volume loss. As facial tissues thin out, lines become etched around the nose and mouth and cheeks look a little hollow. Dermal fillers can replace lost volume to help smooth wrinkles, plump the lips, and restore a more youthful appearance.  While dermal fillers are known simply as “wrinkle fillers,” they can do much more such as:
– Enhance & restore volume to sunken cheeks
– Plump & enhance the lips
– Smooth out nose / mouth / vertical lip lines or chin creases
Injectable wrinkle fillers can give you a more youthful look for a fraction of what a traditional facelift costs.

What are Dermal Fillers Made With?
There are a variety of FDA approved filler products that cosmetic surgeons use to achieve an individual patient’s goals. Each is uniquely formulated to have a certain texture, density, and injection depth, which means that certain fillers work better for certain areas of concern.

Hyaluronic Acid (HA)
Hyaluronic acid is most commonly used and is a naturally occurring substance that is already present in your skin. It helps keep skin plump and hydrated. HA fillers are typically soft and gel-like. The results are temporary, lasting 6 months to 24 months (or longer with thicker fillers in areas with less movement) before the body gradually and naturally absorbs the HA.  As the HA molecules are broken down, they collect more water and so they maintain their volume until they near the very end of their lifespan.  Certain HA fillers are infused with lidocaine to help minimize discomfort during and after treatment. FDA approved HA fillers include: Juvederm, Volift, Voluma, Revanesse, Belotero, Restylane and Perlane.

Calcium Hydroxylapatite (CaHA)
Calcium hydroxylapatite is less commonly used but is a naturally occurring substance, found in our bones. When used in a filler, the calcium particles are suspended in a gel.  Calcium hydroxylapatite may stimulate natural collagen production, and it is typically used for deeper lines and wrinkles. FDA approved calcium hydroxylapatite fillers include Radiesse.

Poly-L-lactic Acid
Poly-L-lactic acid is a biocompatible (meaning it is safe to use in the body), biodegradable synthetic substance. It has been used for many years in a number of medical devices, such as dissolving stitches. Poly-L-lactic acid fillers are considered “semi-permanent,” as the results typically last more than 2 years, and can help stimulate collagen production. As a thicker filler material, Poly-L-lactic acid is typically used to treat deeper facial wrinkles. FDA approved Poly-L-lactic acid fillers include Sculptra Aesthetic.

Polymethylmethacrylate (PMMA)
Polymethylmethacrylate (PMMA) is a synthetic, biocompatible substance that has been used in medicine for much of the last century. When used in dermal fillers, PMMA takes the form of a “microsphere” or tiny ball, that remains beneath the skin indefinitely to provide continued support. PMMA fillers will also contain collagen, a naturally occurring substance in the skin that provides structure and firmness. FDA approved PMMA fillers include Artefill.

Autologous Wrinkle Fillers
Fat is the most commonly used substance in this category and incredibly well studied. Your own fat is surgically removed from your thighs, buttocks, or stomach, treated, then injected into the desired area.  Fat “take” can be variable depending on the patient and the location but the fat that “takes” is then permanent.

There are other autologous treatments that are marketed, such as platelet-rich plasma injections (“vampire lift”) but the science is not conclusive and any results are temporary.

How Long Do the Results Last?
How long the effects of dermal filler treatments will last varies widely, depending on the product used, the area of treatment, and the patient.  Generally speaking, the denser the product is and the more deeply it is injected, the longer it will last, although this is not a hard and fast rule. To maintain your results, your cosmetic surgeon will simply repeat treatment, adjusting the amount and techniques as necessary to ensure optimal results.

Hyaluronic acid fillers tend to be the most temporary option, and therefore are often recommended for first-time filler patients. These will typically last from 6 to 24 months, depending on treatment. For example, injections to the lips will wear out a little faster than those to the nasolabial folds.  Certain HA fillers, such as VOLUMA, are formulated to last longer, but are usually limited to certain areas, such as the cheeks, jawline, and the top of the nasolabial fold.  Calcium Hydroxylapatite fillers will typically last about 12 months for most patients.

Synthetic fillers tend to be longer lasting, as they are not absorbed by the body. They can be a great option for the right patient, but you’ll want to be ready to commit to results that will be there for several years—and take care to choose an experienced, qualified provider whose aesthetic style you like.

Fat injection results are permanent, although you may need a series of injections done over time because not all of the fat “takes”.

Side effects:
Most side effects associated with soft tissue fillers happen shortly after injection and most go away in less than two weeks; however, any soft tissue filler can cause long-term side effects or permanent side effects.  Common short term side effects may include: bruising, redness, swelling, pain, tenderness, itching and rash.  Uncommon side effects may include: migration / movement of filler material from the site of injection.  Extremely uncommon side effects include: raised bumps in or under the skin (nodules or granulomas), infection, allergic reaction, vision disturbances (from injections around the eyes) and injury to the blood supply to the skin causing necrosis (tissue death).

Choosing a Provider for Filler Treatments:
When selecting a provider for injectable treatments, give your decision the same level of care and scrutiny that you would for a surgical procedure.  Even though it is non-surgical, filler treatment is still a medical procedure that requires specific training, knowledge and skill to ensure safe treatment and natural-looking results. You’ll want to choose a provider with an extensive knowledge of facial anatomy, a well-developed aesthetic eye, and a surgeon’s skill and precision. Injections should be provided by an experienced board certified physician who has been well-trained in facial anatomy and operates in sterile facilities. Typically a plastic surgeon or dermatologist has the requisite training and experience for the best outcomes.  Ask if they use blunt cannulas instead of needles for injections in sensitive areas (around the eyes, near facial blood vessels or for patients who have a tendency to bruise).

A reputable and experienced injector who has access to other skin treatments will know what fillers can do for your skin and what they can’t. For example, you may optimize your results by combining dermal fillers with Botulinum toxin or other skin treatments, such as a medical skin care regimes, topical treatments or skin rejuvenating lasers.  You may be better off tightening your skin through surgery, lasers or RF devices 1st and then adding fillers, if needed.  Don’t forget to treat your skin well.  If your skin is a beautiful canvas, it will allow other treatments, such as injectable fillers, to show to their best advantage.  Each person is unique; therefore, at your initial consultation, your physician should address your concerns in a comprehensive, integrative manner.



What is Botulinum toxin?

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Wrinkle Relaxing Injections
Botulinum toxin (BTX) is a protein produced by the bacterium Clostridium botulinum that acts on nerve endings to prevent their action on muscles or sweat glands. Botulinum toxin types A and B are commonly marketed under the brand names Botox, Dysport and Xeomin in North America.

Medical Uses:
Botulinum toxin was first used to treat spasmodic torticollis of the neck in the 1980`s. Since then it has been used to treat disorders characterized by overactive muscle movement and to relax clenching of muscles all over the body (neck, jaw, scalp, arms, legs, bladder). It is also often used to treat disorders of hyperactive nerves including hyperhidrosis (excessive sweating), neuropathic pain, and types of chronic pain.

Cosmetic uses:
Injection of botulinum toxin into the facial muscles causes relaxation of those muscles, resulting in the smoothing of the overlying skin.

Richard Clark, a plastic surgeon from Sacramento (CA), was the first to document a cosmetic use for botulinum toxin. He corrected facial asymmetry caused by one-sided facial paralysis by injecting toxin into the non-paralyzed muscles. Doctors Jean and Alistair Carruthers from Vancouver observedthat blepharospasm patients who received injections in the muscles around the eyes and upper face also enjoyed diminished facial wrinkles, thereby initiating the highly-popular cosmetic use of the toxin. In 2002, following rigorous clinical trials, the FDA approved Botox Cosmetic, botulinum A toxin as safe and effective for temporary improvement of the appearance of moderate-to-severe facial wrinkles.

Side Effects:
While botulinum toxin is generally considered safe in a clinical setting, there can be side effects from its use. Most commonly, botulinum toxin can be injected into the wrong muscle group or spread from the injection site, causing paralysis of unintended muscles. Bruising at the site of injection is not a side effect of the toxin but rather of the mode of administration. Both toxin spread and bruising are minimized or prevented when BTX is administered by a skilled and properly trained physician. There are other rare side effects reported, such as headache, allergic reaction or low grade fever.

Choosing a provider:
Where you get your botulinum toxin and who does the injecting matters a lot. Safety should be the primary concern of your physician. Injections should be provided by an experienced board certified phsyician who has been well-trained in facial anatomy and operates in sterile facilities. Typically a plastic surgeon or dermatologist has the requisite experience for the best outcomes. BTX should be administered in a medical setting, not at a party or at the mall. Proper storage, correct dilution, sterile hygiene, legal use, and honest practices are all factors that influence the quality of a BTX treatment. Results will be dependent on physician experience and detailed knowledge of facial anatomy. A skilled and experienced physician will typically inject lesser amounts with better results and a decreased risk of side effects. Furthermore, a reputable and experienced injector who has access to other skin treatments will know what BTX can do for your skin and what it can’t. For example, you may optimize your results by combining BTX with dermal fillers or other skin treatments, such as a medical skin care regime, topical treatments or lasers. Each person is unique; therefore, at your initial consultation, your physician should address your concerns in a comprehensive, integrative manner.




The 3 Ds of aging skin

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As we age and as environmental factors take their toll on our skin, we begin to notice the 3 Ds in our face: Degeneration, Deflation and Descent.

Aging, genetics, sun damage, smoking and other environmental factors result in a loss of collagen and elastin and an overall decrease in skin quality (degeneration). Often we notice pigmentation (colour) issues, uneven tone and texture, loss of elasticity, loose skin and creases, lines & wrinkles.

Deflation refers to the loss of volume that happens in the face, resulting in hollows under the eyes, flattening of the cheeks, and a more gaunt appearance, with thinner lips.

Gravity results in the descent of facial structures. We start to develop “jowls” or “turkey neck” for example.

Typical progression of the aging face:
Many will experience some hooding and tiredness around the eyes in the 40s.
In the 50s, the cheeks (Jowls) become troublesome.
Finally, in the 60s, the neck (waddle) is often a trouble area.


There are many solutions to correct and reverse the effects of aging and skin damage:

1) High quality sun screen and sun avoidance is the number one defence against aging skin!
2) Potent topical skin care products
3) Dermabrasion and advanced facial treatments
4) Lasers and Radio Frequenct energy devices
5) Injectable Hyaluronic Acid (HA) fillers (commonly branded as Juvederm or Restylane) or fat injections
6) Injectable Botulinum toxin (commonly branded as Botox)
7) Collagen and Elastin stimulators
8) Surgical procedures such as brow lift or face lift.