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Isn't it surprising how some people appear to age noticeably in a very short time while others look more youthful from year to year? What is their secret? Hollywood stars like Demi Moore and Madonna are just a couple of examples of people who keep you guessing. So-called liquid facelifts provide a non-surgical alternative to implants, incisions and recovery time.
As the face ages, it loses volume. This causes shifts in the youthful contours and prominent landmarks of the upper, mid and lower face. Loss of facial fat, muscle and bone, as well as loss of skin elasticity, lead to nasolabial folds, marionette lines, jowls and wrinkles around the lips. Redistribution of maxillary and infraorbital fat pads also occurs with aging, as does fat loss in the surrounding areas. The complex array of muscles supporting the facial dermis and adipose undergo a similar reduction in size. It is speculated that the thinning, sinewy facial muscles are more visible due to the aforementioned losses of overlying tissue and appear to cause increased (hyperdynamic) facial expression due to greater radiation of expression lines with movement (dynamic expression lines.) The more recently documented source of surprisingly substantial volume loss is bone loss around the eyes, teeth, maxilla and jaw. The pattern of bone recession is dictated by genetics. In addition to environmental factors, genetics predisposes us to the acceleration of these changes. Volume changes in soft tissue and skin contribute to the apparent changes that are visible with aging. The craniofacial bones change, and the overlying soft tissue repositions and loses volume. The face shrinks and the overlying skin becomes too big for the face, resulting in wrinkles, folds and sagging. The overall shape of the face changes from plump and heart-shaped to a triangle (upside down "V") with a widening at the bottom of the face and a hollowing of the upper and mid face.
Patients who are candidates for a liquid facelift usually present with a complaint of looking tired. They report that wrinkles, loose skin and dark circles under the eyes and around the nose are bothersome to them. Due to publicity about overdone facelifts in the media or in their own communities, some patients fear that treatment may change their appearance and that they will look artificial. Although the skin appears tighter after facelifts, balance and youthfulness can be lacking due to volume loss, resulting in less than desired results. The goal of volume replacement is to help patients appear more youthful and refreshed. Restoring youthful volume can help patients look more like they did 10 to 15 years ago, not make them look like someone else. The term liquid facelift refers to treatments that can be performed using injectable therapies that require little or no downtime. Some preparations work on underlying muscles by relaxing them, creating a softening of wrinkles or the appearance of a lift in certain areas of the face. Other therapies add volume to the face.
Botox relaxes dynamic muscles that create wrinkles as they contract. Areas that can be treated with Botox include crow's feet, frown lines, forehead lines, neck lines and chin dimpling. It can be injected on the chin to elongate the appearance of the chin in certain patients, creating a more continuous appearance of the jawline. Botox can be used to help elevate the corners of the lips, enhancing a patient's smile. A small amount injected into the lip border reduces the appearance of lip lines and can actually help the lips appear more plump. Botox is a brand name for botulinum toxin A. It has been used safely for more than 20 years to treat a variety of conditions and it received FDA approval for cosmetic use approximately 7 years ago. Botox injection is the most popular non-surgical cosmetic procedure today. Improvement of wrinkles may be evident within a few days and may last up to 4 months. Many patients experience benefits for an extended period of time. Until recently, Botox was the only botulinum toxin A preparation with a cosmetic indication. Dysport, the first competitor for Botox, was approved in April. The indications for Dysport are similar to those for Botox. Tissue fillers are another group of injectables used for liquid facelifts. The most commonly used are Restylane, Perlane, Juvederm, Cosmoderm and Radiesse. Not all products can be used anywhere on the face. Depending on the patient's appearance and the location, one or a combination of these products can be used to reduce the appearance of wrinkles and provide plumping of various facial structures. Hollowing under the eyes, mid face, temples and chin can dramatically improve with volume. Cheeks can be enhanced to return that heart-shaped youthful face and to lift and improve the nasolabial folds. Nasolabial folds and marionette lines can be treated with tissue fillers, as well as the jawline and hollowing of the cheeks. And treatment of the eyebrows can lift the eyelids and enhance eyebrow shape. Sculptra exists in a category called collagen stimulators. It can be used to volumize most areas of the face. Sculptra works by stimulating the body's natural collagen. Buildup of collagen helps smooth out lines and wrinkles. As collagen builds, it restores lost facial volume and results in a younger, more youthful face. Sculptra provides a long-lasting natural appearance.
Facial balance can be returned using a combination of the products discussed in this column - without surgery. These products require just a few minutes for treatment with little to no downtime. Patients do not appear to have had "work done." Rather, they look refreshed and rested. A liquid facelift may be the fountain-of-youth secret for women and men who want to keep everyone else guessing.
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