Aging gracefully requires optimizing your health and changing bad habits. One challenge is maintaining your skin's youthful appearance, which begins to diminish over time due to environmental exposure and intrinsic aging. Changes can arise from the loss of subcutaneous fat and thinning of the dermis. Aesthetic medicine offers a way to help restore your skin's youthful elasticity via non-invasive to minimally invasive medical cosmetic procedures. Now you can begin to look as good as you feel.

Aesthetic procedures can be classified as surgical or non-surgical. Invasive, surgical aesthetic procedures, such as liposuction, breast augmentation, and rhinoplasty, should be performed by a board certified plastic surgeon. Non- and minimally invasive procedures may be completed by any medical practitioner, aesthetician or nurse who has received the proper training, which often consists of apprenticeships and/or courses offered by a private medical society such as The American Academy of Aesthetic Medicine.¹ Since conventional medicine has not yet recognized aesthetic medicine as a discipline, the specialty is largely self-regulated; therefore, extra care should be taken when choosing a practitioner.

Aesthetic Injectables: Which is preferable?

Botulinum toxin type A injections (Botox®, most commonly) and dermal fillers are two of the most popular non-surgical aesthetic procedures. Botox will smooth away fine lines by relaxing muscle movement. Dermal fillers will fill-in or lift features of the face, correcting deeper wrinkles and restoring youthful skin volume. Most practitioners who offer minimally invasive aesthetic services will often combine their treatment options to include both Botox and fillers. Experts in minimally invasive aesthetic procedures should be able to examine their patient's facial contours and determine exactly which areas would benefit from Botox as opposed to a dermal filler. Some may even use Botox to extend the efficacy of a dermal filler.

Botox® or Fillers: What is the difference?

A result of the normal aging process, wrinkles often occur on facial areas associated with increased movement — the mouth, eyes, and forehead. Botulinum toxin type A is a neuromodulator used to reduce frown lines on the forehead and between the eyebrows, as well as wrinkles around the eyes (crow's feet). Three types of botulinum toxin type A are currently approved and available in the United States for cosmetic procedures: Botox®, Dysport®, and Zeomin®. All three function by blocking the release of acetylcholine at the neuromuscular junction. Acetylcholine is the primary neurotransmitter that stimulates contraction of the superficial facial muscles. Through this mechanism, botulinum toxin type A induces relaxation. The three formulations of botulinum toxin type A may vary in preparation techniques, antibody formation, and potency. Effectiveness may last up to 4 months.^2,3

Dermal fillers have gained recent popularity because of their ability to render cosmetic improvements that were once only possible through surgery. Results are almost instantaneous and achievable with relatively little downtime and without breaking the bank! A few types of dermal fillers are available, each possessing specific ingredients, functions, and varying degrees of effectiveness. Absorbable fillers are composed of temporary materials that are biodegradable: they include hyaluronic acid (HA), collagen, calcium hydroxylapatite, and poly-L-lactic acid (PLLA). Polymethylmethacrylate beads (PMMA microspheres) is the only permanent dermal filler that is FDA-approved and currently available.^4,5

Hyaluronic acid (HA) fillers are by far the most common for correcting wrinkles, scars, and enhancing lips. To achieve this result, hyaluronic acid microspheres absorb water to form a gel, which then swells and lifts the tissue. HA fillers may last between 6 and 18 months. Hyaluronic acid fillers include Restylane®, Perlane®, and Juvederm®. Some aesthetic practitioners will offer the patient the option of using his or her own growth factors to accompany the HA dermal fillers. Known as the Vampire Facelift® or simply as PRP,⁶ this specialized procedure isolates platelet-rich plasma (PRP) from the patient's own blood. The PRP is then used to activate growth factors. The growth factors are injected into the patient's face and are said to activate their own stem cells to stimulate new collagen, blood vessels, and subcutaneous tissue.

Collagen is a naturally occurring protein found within the framework of our skin. In conjunction with elastin, collagen is responsible for dermal elasticity. There are collagen-stimulating fillers, such as Radiesse® and Sculptra®, produced from calcium hydroxylapatite and poly-L-lactic acid (PLLA), respectively, and collagen-based fillers like Cosmoderm or Zyderm which contain human or bovine sourced collagen. Either option may be favorable as it stimulates the body to produce its own collagen. Touch-ups are usually necessary every 3 to 12 months.⁷

Permanent fillers composed of polymethylmethacrylate beads (PMMA) provoke a physiological response by the body to deposit collagen at the site of the foreign bodies or, in this case, microspheres. PMMA microspheres are non-biodegradable. Their effect may last for at least one year, and in some cases they are permanent. Artecoll™ — a PMMA/collagen implant — may be most effective for deep glabellar (between eyebrows) and nasolabial folds (laugh lines).

Cautions and Contraindications

Although side effects are rare with nonsurgical aesthetic procedures, you should be aware of the associated risks and strategies to avoid such complications.

Common adverse reactions:

• Injection site reaction: swelling, bruising, redness, pain, itching, and infection of the skin.
• Inappropriate technique: palpable implant, visible implants, over- or under-correction.
• Allergy and hypersensitivity: a reaction may occur depending on the type of material used. To lessen these effects, practitioners may perform a pre-treatment skin test to determine if sensitivity exists. This is more common with collagen fillers than HA.

Contraindications:

• Active infection near injection site.
• Known allergy/hypersensitivity to filler material or lidocaine.

There has been no established relationship between the use of a filler and autoimmune diseases. Therefore, aesthetic injectables are not contraindicated for individuals suffering from an autoimmune illness. However, it is important to fully disclose your medical history, plus the medications and supplements you take, to your practitioner to ensure that any procedure may be completed safely and with as little risk of complication as possible.⁸

Get Started

In order to determine your specific needs, you should contact a qualified Forever Health practitioner. Details regarding aesthetic specialties are visible on practitioner profile pages, so you can find exactly what you are looking for. During the consultation with your provider, discuss problem areas, ask questions about treatment risks, expected outcomes, and associated costs. Aesthetic procedures are elective, so medical insurance will not cover them. At the conclusion of your visit, your practitioner will suggest an appropriate course of treatment: This may include one or several types of injectable applications.

References

1. Aesthetic Medicine — The Past, Present and Future. http://www.aaamed.org/past_present_future.php. Published 2015. Accessed May 19, 2015. 
2. Indian J Dermatol. 2010 Jan-Mar;55(1):8–14.
3. J Clin Aesthet Dermatol. 2009 Mar;2(3):38–43.
4. Clin Cosmet Investig Dermatol. 2013;6:295–316.
5. J Clin Aesthet Dermatol. 2014 Sep;7(9):14–19.
6. Vampire Facelift: Procedure Explained. http://vampirefacelift.com/. Published 2013. Accessed May 19, 2015.
7. Clin Interv Aging. 2008 Mar;3(1):161–174.
8. J Cutan Aesthet Surg. 2010 Jan-Apr;3(1):16–19.