Soft-tissue fillers, most commonly injectable collagen or fat, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be used alone or in conjunction with a resurfacing procedure, such as a laser treatment, or a recontouring procedure, such as a facelift.

KNOWING YOUR OPTIONS
Injected collagen and fat are primarily used to improve the appearance of the skin's texture. They can help fill out deep facial wrinkles, creases and furrows, "sunken" cheeks, skin depressions and some types of scars. They can also be used to add a fuller, more sensuous look to the lips.

Injectables are usually not sufficient for deep surface wrinkles on the face, such as multiple vertical "lipstick lines" that sometimes form around the mouth. Dr. Gutstein may also suggest a resurfacing technique, such as chemical peel, dermabrasion or laser treatments. Rather than filling in facial lines, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance.

Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery, such as a facelift or browlift. Injectables are sometimes used in conjunction with facial surgery procedures; however, injectables alone cannot change facial contour the way surgery can. Botox injections can relax overactive muscles.  These, like collagen last up to six months.  Radiance, a new filler, can be expected to last several years.

Keep in mind that a plastic surgeon is a specialist that can offer you the full gamut of the most advanced treatments ranging from cosmetic surgery, refinishing techniques, laser therapy, injectables and the use of other fillers. You and Dr. Gutstein may determine that a single procedure or a combination of procedures is the best choice for you.

ASPS brochures are available on chemical peel, dermabrasion, laser treatments, facelift and browlift. If you and the doctor think that one of these other procedures might be appropriate for you, ask Dr. Gutstein to provide you with a copy.

A WORD ABOUT OTHER TYPES OF FILLERS
Gortex, a thread-like material that is implanted beneath the skin to add soft-tissue support is permanent. Restylene and Artecoll  may soon be released for general use.

Each of these options has its own set of risks and benefits. If you are considering any of these alternative filler treatments, tell the doctor.

WHAT TO EXPECT FROM TREATMENT
The most important fact to remember about injectable fillers is that the results are not permanent. Injected material is eventually metabolized by the body. You should not expect the same long-lasting results that may be gained from cosmetic surgery.

In some individuals, the results may last only a few months; in others, the results may be maintained indefinitely. Researchers believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all play a role in the injected material's "staying power." However, the precise reason for the variation of results among patients has yet to be identified.

If you've had short-lived results from fat injections, you shouldn't necessarily assume that collagen injections will work better for you. And, conversely, if you've had disappointing results from collagen, don't assume that injected fat is the answer. Although it's true that some individuals' bodies are more receptive to one substance than the other, others may find that neither substance produces long-lasting results. Sometimes one substance may work better than the other for a specific problem.

RISKS RELATED TO INJECTABLES
When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature. Still, individuals vary greatly in their anatomy, their physical reactions and their healing abilities. The outcome of treatment with injectables is never completely predictable.

Collagen: Allergic reaction is the primary risk of collagen. To help determine if you are allergic to the substance, Dr. Gutstein will perform an allergy skin test about a month before the procedure. After the test is performed, the test site should be watched carefully for three or four weeks, or as long as Dr. Gutstein advises. Any sign of redness, itching, swelling or other occurrences at the test site should be reported to Dr. Gutstein.

Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare.

Fat: Allergic reaction is not a factor for fat because it's harvested from a patient's own body. However, there is still a small risk of infection and other infrequent complications.

PLANNING FOR TREATMENT
Facial rejuvenation is very individualized. That's why it's important to discuss your hopes and expectations with a board-certified plastic surgeon who has experience with many different types of surgical and non-surgical facial procedures.

In your initial consultation, Dr. Gutstein will evaluate your face - the skin, the muscles and the underlying bone - and discuss your goals for the surgery. The doctor will help you select a treatment option based on your goals and concerns, your anatomy and your lifestyle.

Dr. Gutstein will ask you about your medical history, drug allergies, and check for conditions that could cause problems, such as active skin infections or non-healed sores from injuries. Collagen injections are generally off limits for pregnant women, individuals who are allergic to beef or bovine products, patients who suffer from autoimmune diseases, and those who are allergic to lidocaine (the anesthetic agent contained in the syringe with the collagen material). For more specific information about the contraindications and risks of collagen use, ask the doctor for the manufacturer's brochure for patients.

Insurance usually doesn't cover cosmetic procedures. However, if your injectable treatment is being performed to treat a scar or indentation from an accident or injury, you may be reimbursed for a portion of the cost. Check with your insurance carrier to be sure.

WHERE YOUR TREATMENT WILL BE PERFORMED
Injectables are usually administered in a surgeon's office-based facility. If, however, you are being hospitalized for a facelift, necklift, browlift, or any other procedure, your injections may be administered in the hospital as well.

TYPES OF ANESTHESIA
Collagen: Because the anesthetic agent lidocaine is mixed in with collagen, additional anesthetic is usually not used. However, if you are especially sensitive to pain, the doctor may use a topical cream anesthetic or a freon spray to numb the injected area. Or, you may elect to have an injected local anesthetic or sedative drugs.

Fat: Both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you elect to use sedation, be sure to arrange for a ride home after your treatment.

THE TREATMENTS

Alloderm
Alloderm is a graft material made from human donor tissue. Fortaflex and Pelvicol are made from porcine tissue, but in each case the cells are removed and your cells colonize the collagen matrix.

Gortex
Gortex, a Teflon substance, may be threaded below the wrinkle line to produce a permanent improvement. Gortex is non-toxic and is the same material that has been used to construct replacement arteries for a great many years. This material does not need over-correction and may be easily removed when and if desired.

Botox
Botox is an injectable liquid derived from botulism toxin. It works to ease a wrinkled appearance by paralyzing the muscle underneath the wrinkle, thereby smoothing the surface. It is effective in relaxing frown lines and crow's feet for approximately five months.

Collagen
Collagen is a naturally occurring protein that provides support to various parts of the human body: the skin, the joints, the bones and the ligaments. Injectable collagen, patented by the Collagen Corporation under the trade names Zyderm and Zyplast, is derived from purified bovine collagen. The purification process creates a product similar to human collagen. Injectable collagen received approval from the Food and Drug Administration in1981. It is produced in various thicknesses to meet individual patient needs.

Collagen is used primarily to fill wrinkles, lines and scars on the face and sometimes the neck, back and chest.

The Collagen Corporation (now Inamid Inc.) has recently released a collagen derived from human sources under the name Cosmadex.

The procedure: Treatment with collagen can begin after a skin test determines that you are not allergic to the substance. (This is not necessary with Cosmadex.) The collagen is injected using a fine needle inserted at several points along the edge of the treatment site. If a local anesthesia has not been used, you may feel some minor stinging or burning as the injections are administered.

Since part of the substance is salt water that will be absorbed by the body within a few days, the doctor will slightly overfill the area. You may be asked to hold a hand mirror during the procedure to help the doctor decide when you've had enough.

After treatment: Immediately following treatment, you may notice some minor discomfort, stinging or throbbing in the injected area. Occasionally some bruising or swelling will occur, but it is usually minor. Any redness that appears in the injected site usually disappears within 24 hours. However, in some individuals, particularly fair-skinned patients, this redness may persist for a week or more. Tiny scabs may also form over the needle-stick areas; these generally heal quickly.

No bandaging is needed and you are free to eat, drink, and wear makeup with sunblock protection shortly thereafter. There may be some temporary swelling and redness in the treated area which should dissipate within a few days. If these symptoms persist, contact Dr. Gutstein.

Results: As stated earlier, the duration of results from collagen injections is variable. Collagen's longevity depends on the patient's lifestyle and physical characteristics as well as the part of the body treated. In general, the injected material is likely to disappear faster in areas that are more affected by muscle movement. In some areas Radiance, a hydro appetite in gel product will provide longer lasting corrections.

The doctor can help you determine how long you can go between treatments to best maintain your results.

Fat
In the medical world, the fat-injection procedure is known as autologous fat transplantation or microlipoinjection. It involves extracting fat cells from the patient's abdomen, thighs, buttocks or elsewhere and reinjecting them beneath the facial skin. Fat is most often used to fill in "sunken" cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimize forehead wrinkles and to enhance the lips.

The procedure: After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat is withdrawn using a syringe with a large-bore needle or a cannula (the same instrument used in liposuction) attached to a suction device. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site.

As with collagen, "overfilling" is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this overcorrection of newly injected fat may temporarily make the face appear abnormally puffed out or swollen.

After treatment: If a larger area was treated, you may be advised to curtail your activity for a brief time. However, many patients are able to resume normal activity immediately. You can expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. You should stay out of the sun until the redness and bruising subsides - usually about 48 hours. In the meantime, you may use makeup with sunblock protection to help conceal your condition.

The swelling and puffiness in the recipient site may last several weeks, especially if a large area was filled.

Results: The duration of the fat injections varies significantly from patient to patient. Though some patients have reported results lasting a year or more, the majority of patients find that at least half of the injected fullness disappears within 3-6 months. Therefore, repeated injections may be necessary. The doctor will advise you on how to maintain your results with repeat treatments.

YOUR NEW LOOK
If you are like most patients, you'll be very satisfied with the results of your injectable treatments. You may be surprised at the pleasing results that can be gained from this procedure.

Acne Scars

Q: Can acne scars be erased?
A: No scar can be completely erased.  However, vast improvements are possible.  Acne ravages are best treated by dermabrasion, a surgical "sanding" of the skin. With acne scars you have a situation that resembles hills and valleys, with the valleys being the depths of the scar pits. The scars go all the way down and a surgeon cannot abrade to the full depth of the scar, or the entire face would be a scar. However, the tops of the hills can be removed, thereby reducing the  surface discrepancy between the skin and the depth of the scar.  This discrepancy can be changed by at least 50% with a well done, fairly deep abrasion. In some people with very craggy skin, the procedure may need to be repeated.  For lesser scars, after improvement of deep scars with dermasbrasion, a laser or chemical peel can be effective. Tecniques for releasing "stuck down" scars with, or without, fat grafting are also available. Filling under the scar is also helpful.

For more information, contact our office for a personal consultation.

PAP Ion Magnetic Inductor

The PAP ion magnetic inductor is a unique and advanced modality. This type of non-invasive, painless treatment appears to accelerate healing, decrease swelling, soften scars and ease musculo-skeletal aches. Work in progress combining this type of energy with standard massage or the Silk Light (endermologie type) suction/massage may provide significant benefits regarding the cellulite problem.

For futher information, visit the following site:   www.papimi.gr