TEEN KUTZ

immediate volume and may stimulate collagen
synthesis over time—a more subtle result. In contrast,
Botox works by inhibiting small muscles
under the skin from contracting. These muscles
are close to the skin and cause wrinkling or dimples
when they contract. It takes a few days for the
full effect to become apparent, but when it does,
the skin over the muscle becomes smoother, leaving
you looking relaxed and less stressed.
Botox is essentially a toxin that is purified and
reconstituted as a clear, thin liquid. The approved
A COMMON APPROACH IS TO
USE BOTH FILLERS AND BOTOX IN
SOME AREAS, AS THEY CAN WORK
TOGETHER SYNERGISTICALLY
cosmetic formulation has a strong safety profile
when used appropriately. During your initial consultation,
your physician will map out the areas
that concern you. The next step is to identify the
muscles that need to be targeted and the number
of Botox units required to achieve the results you
would like. As mentioned, after the Botox is injected,
it takes several days to work, but then the
effects last for several months. Side effects are few
but can include small bruises from the injection
sites and occasional headaches. (Ironically it can
be used to treat migraines as well, in some instances.)
There are several different types of fillers on
the market. These include temporary fillers that
last three to six months, and then longer-lasting
ones whose effects endure for a year or more.
There are also permanent fillers. These are generally
used in the deeper layers to supplement the
soft issue because if they are placed too close to
the skin they may become visible. As you can see
from this, there are different products and different
strategies to address different problems in the
filler genre and, as with everything, there can be
an overlap of approaches.
The most popular injectable gels at present
are based on hyaluronic acid. Among these are
Restylane, Perlane, and the Juvederm family.
Hyaluronic acid is a naturally occurring substance
in the skin, which holds moisture and provides
some nutrients to the skin. The purported increase
in collagen production is a key in the anti-aging
process, as it reverses the natural one-way trend.
The gels are manufactured in different thicknesses,
so some last longer and are a bit more viscous
than others. Because the gels are more
viscous than Botox, they require larger needles to
insert into the skin. This means there may be more
redness around the injection sites, and also bruis-
ing can be an issue. If you are taking blood thinners
or aspirin products, bruising may be made
worse—something you would need to tell your
physician. The sites may also feel or appear to
have lumps. This means that it is better not to
have these procedures too close to an event or
outing. It is prudent to build in a week or two to be
able to deal with any of these occurrences, should
they arise.
The next level up in terms of duration is the
filler Radiesse, which is based on calcium microspheres
in a water gel. The microspheres are slowly
metabolized by your body, leading to a slow resorbtion.
The formulation is white (the color of calcium).
The gel provides volume and promotes
The improvement is visible...and the results look natural
collagen synthesis. The effect lasts longer than the
hyaluronic acid gels because the resorbtion
process is slower, but it requires deeper injections.
This works well with deeper folds and areas of volume
restoration. As calcium is a biocompatible
substance, there is a very low risk of allergic reactions.
Due to the deeper placement, care has to
be taken to minimize bruising. Again, allowing a
[Continued on page 61]
12 IMAGE Fall 2008