Facial Augmentation

A beautiful face is a balanced faced with the eyes, nose, lips, cheek and chin in proportion to each other. Facial implants can be used to enhance structural integrity and create a more balanced and attractive face in patients with a disproportion between the different sections of the face.

Augmentation of the cheek and the chin are the most common facial implant procedures. A chin implant can improve the appearance of the chin whereas a cheek implant can give a more voluminous look to otherwise flat cheeks. These facial implants are made of biocompatible materials and are available in different shapes and sizes to achieve the desired results.

Good health is one of the prerequisites for the implantation procedure. Smoking hampers the wound healing ability of the body and causes increased scarring. If you are a smoker, the surgeon may ask you to quit smoking before the surgery and continue to abstain from it after the procedure as well.

Procedure

The implant surgery is performed under general anesthesia or intravenous sedation. For chin implant, an incision is made either below the chin or inside the mouth below the lower lip. For cheek implant, an incision is usually made inside the mouth through the upper lip. When coupled with other procedures for the face, the incision may be made inside the lower eyelid or within the hair line. Hence the surgical scar is either not visible or hardly noticeable. An appropriate implant is then inserted in the chin or cheek, through the incision. The implant is held in place either by making a well-fitting pocket or fixing it to the surrounding bone or soft tissue. The incision is finally closed with absorbable sutures or stitches that will be removed 1-2 weeks after the surgery.

After the Surgery

Pain killers and antibiotics are prescribed, after the surgery, to reduce pain and the risk of infection. Localized swelling, discoloration, numbness or discomfort, at the operated site, may develop after the procedure. Some facial movements may also be temporarily restricted, during the healing phase.

The final results of the surgery and the actual improvement in appearance can be appreciated only after 3-4 months of the surgery. This final improvement in appearance is permanent.

Contact your surgeon immediately if you experience any of the following symptoms after the surgery:

• Abnormal pain or swelling
• Abnormal discharge from the incision site
• Fever greater than 100 ̊F

Botox

Botox® injection or Botulinum toxin injection is most commonly known for its successful use in cosmetic therapies. Initially, Botox was approved to treat strabismus (crossed eyes), blepharospasm (spasm of the eyelids) and cervical dystonia (muscle contractions in the neck). Added to the list of indications is FDA approval for relaxing frown lines in the area between the eyes on the forehead (glabella). BOTOX® injections reduce facial lines and wrinkles formed from the aging process and by hyperfunctional muscles. It can also be used to treat excessive sweating.

BOTOX® is a purified protein toxin produced by the Clostridium botulinum bacteria. Although BOTOX® is a toxin, there have been no serious side effects reported. This is because it is used in extremely small amounts for medical treatments and does not spread throughout the body.

Procedure

The area to be injected is cleansed thoroughly. A topical anesthetic cream is applied and the BOTOX® material is injected into the area with a fine needle. When BOTOX® is injected into a muscle, it blocks the conduction of nerve impulses to that area and as a result, the muscle weakens. As the muscle weakens, the skin overlying the muscle relaxes and the wrinkles in the skin gradually soften and often disappear.

The conditions which are contraindicated for the use of BOTOX® injections include:

• Pregnancy and breastfeeding
• Previous history of reaction to the toxin

• Neurological diseases ( myasthenia gravis, Eaton-Lambert syndrome, neuropathies)
• Age -below 12 years
• Infection at the injection site
• Use of medications such as aminoglycoside antibiotics (may increase effect of botulinum toxin), chloroquine and hydroxychloroquine (may reduce effect), and blood thinning agents, warfarin or aspirin (may result in bruising)

Adverse Effects

Although Botox is well accepted, it is associated with certain adverse effects such as redness, bruising, infection, and pain at the injection site. Dizziness, difficulty in swallowing, headache and muscle weakness may also occur when this medication is injected into muscles. Double vision, drooping or swollen eyelid, dry eyes, reduced blinking, and increased sensitivity to light may also occur.

Fillers

Injectable Fillers

The injectable fillers, also known as soft tissue fillers, are products that are injected into specific areas of the face to correct any textural irregularities by plumping and smoothing out the skin depression. Injectable fillers work by restoring facial volume and filling out wrinkled or uneven areas of the face, thereby bringing an immediate vibrant and youthful appearance in one’s face without surgery.
With aging, the skin becomes more susceptible to wrinkles and sagging. The injectable fillers do not stop the aging process but restore the age related volume loss in the face providing a significant facial rejuvenation.

Uses

Injectable fillers are used to correct a variety of cosmetic concerns that include:

• Smoothing wrinkles, lines and folds
• Shaping facial curves such as the cheeks and jaw line
• Restoring volume and fullness to the skin
• Lip plumping and filling in lip lines
• Raising scar depressions

Types of Injectable fillers

There are several types of injectable fillers available to restore fullness to the face and lips and to treat wrinkles, folds and scars, based on the patient’s requirement. Injectable filters are either temporary or permanent.

Temporary – are made up of absorbable materials (those are absorbed by the body over time). These include:

• Collagen – Collagen is a natural protein that supports the skin; and forms the major component of cartilage, teeth and bones. Collagen filler is made from either purified cow skin or human skin. Collagen, the effects of which last for three months, is particularly used to fill the facial hollows.
• Hyaluronic acid – Hyaluronic acid is a natural substance found in the body, especially in the soft connective tissues. Hyaluronic Acid products are the most commonly used injectable fillers that are often used to plump thin lips and fill the nasolabial folds (indented skin between the nose and the mouth) and marionette lines (vertical wrinkle lines that begin at the corner of the mouth and extend down towards the chin). The effects of these injections last for six months or more.
• Hydroxylapatite – Hydroxylapatite is a natural substance that forms the major component of the human bones. It is the heaviest of the injectable fillers composed in a gel base and provides a long lasting effect (6-12 months). It is used to fill the nasolabial folds, marionette lines around the chin and frown lines. It is also used to enhance the cheeks and chin by improving the curves.
• Human fat – Fat injections involve extraction of fat from one part of your body using liposuction techniques and re-injecting them into the other parts such as the cheeks, lips, or chin. Fat injections augment facial fullness, fill the deep creases and improve the facial curves. The duration for which the effects last varies between patients and the location of injection.
• Polylactic acid – Polylactic acid is synthetic filler that stimulates the production of collagen within the body. It is mainly used to augment the facial lines and nasolabial folds, restore facial volume, plump thin lips, and fill the areas of fat loss in the face. The effects of polylactic acid fillers last up to two years.

Permanent (made up of non-absorbable materials)

• PMMA (polymethylmethacrylate) – PMMA is a permanent type filler that is used to fill the nasolabial folds. PMMA microspheres (microscopic granular substances) or beads are tiny, round, smooth particles that are composed in a collagen based gel to fill the wrinkles. PMMAs are found to provide a long-lasting correction.

The Procedure

The procedure is performed on an outpatient basis and involves the following steps:

• The areas to be injected on your face are marked and cleaned with an antibacterial agent.
• Topical anesthetic agents may be used to numb the areas to be treated or sometimes the filler itself may contain a local anaesthetic that makes the injection more comfortable. Local anesthetic may be required for deeper injections, for example –to fill deep nasolabial folds, marionette lines and the cheeks.
• Your surgeon then injects the filler through a fine needle beneath the surface of the skin
• The marks are then washed away and cold packs are applied immediately
• Make-up may be applied that allows you to resume your daily activities immediately

Multiple injections are required for areas with deep lines and scars. The amount of injection administered varies between patients and depends on the depth and size of the wrinkle. The best injectable filler for treatment is selected based on your age, condition of your skin, amount of sun damage and genetics.

Risks and complications

Though injectable fillers are very safe to use, they are associated with a few complications. Some of these include allergic reaction, bruising at the injection site, temporary numbness, redness, swelling, pain, skin death, itching and rashes on the treated area. Some of the potential risks of filler injections include the formation of lumps that are particularly associated with the use of microscopic granular substances such as the PMMAs.

Injectable Fillers that contain materials from non-human sources require a pre-treatment allergy test.

Recovery

• The procedure provides immediate results and requires very minimal downtime, allowing you to return to normal activities and work, directly following the treatment.
• You may be instructed to avoid strenuous activities and excessive exposure to sunlight and heat the rest of the day following treatment.
• You may experience swelling and bruising at the injection site that will fade away in a few days. If you have human fat filler injected, there might be an over filled appearance which would return to normal in a few hours or days, or sometimes may even take several weeks.

Treatment Outcome

The results from most injectable fillers are temporary lasting from a few months to one year depending on the type of filler injections used and the area of the face treated. For better results, repeated treatment sessions are encouraged.