WHAT ARE FILLER MATERIALS ?

Filler materials are suspensions or gels made in a laboratory for injection into fine lines, wrinkles, creases, scars, or into the lips. Their purpose is to fill out these lines or hollows or to augment (increase the definition or volume of the lips).

WHY ARE THERE SO MANY FILLERS ?

Many fillers exist because the perfect filler has not yet been found. In this practice we only use temporary fillers. It is difficulty to achieve absolute perfection with filler injections, and it is our philosophy that if perfection is not achieved with a given treatment, that the resulting slight irregularity will completely disappear. In 2004, the focus on fillers is to use materials which, although temporary, are longer and longer lasting.

WHAT ARE THE DIFFERENCES BETWEEN THE VARIOUS FILLERS LISTED ?

Zyderm™/Zyplast™ Bovine collagen products require two skin tests done at least one month prior to the injection into a patient. There is an incidence of allergic reaction to about 1% of patients who have two normal skin tests. These materials, Zyderm™ and Zyplast™ generally last 3-4 months. Lumpiness is occasionally seen after their use.

Cosmoderm™/Cosmoplast™ These products are derived from human baby skin. They are virtually non-allergenic and thus, no skin testing is required. They last slightly longer than Zyderm™/Zyplast™. Lumpiness is rarely a problem.

Restylane, Hylaform, Perlane These products are synthesized in a laboratory and chemically are known as hyaluronic acid. Unlike the milky white of collagens, hyaluronic acid is a clear gel. Its principal advantage it that it lasts nearly twice as long as any other collagen products listed above. FDA approval was given for Restylane and Hylaform within the last few months. Perlane, fills deeper lines and creases and lasts somewhat longer than Hylaform or Restylane.

WHAT DOES A FILLER INJECTION FEEL LIKE ?

All of the collagen products are diluted with an injectable anesthetic, Lidocaine. Thus, injecting these materials is well tolerated by most patients. When lip injections are done with any product, topical anesthetic or a dental nerve block may be required. The Hyaluronic acid products contain no anesthetic. With the exception of the lips, they are well tolerated by most patients simply with a topical anesthetic cream. For lip augmentation, injections are preceded either by a topical anesthetic or, in some cases, a local nerve block.

HOW LONG WILL THE INJECTION TAKE ?

This will depend on the area (s) to be treated but ordinarily will require 15-30 minutes.

WHEN CAN I RETURN TO MY NORMAL ACTIVITIES ?

Most individuals can return to their normal activities immediately. With the injection of the lips, especially with Hyaluronic acid products, some swelling may occur for a few days.

WHEN WILL I SEE RESULTS ?

Results are immediate.

HOW MANY TREATMENTS WILL I NEED ?

Usually, a single treatment suffices.

HOW LONG WILL THE EFFECTS LAST ?

The correction will last anywhere from two months to as long as 8-9 months depending on the area injected and the material used.

Today, many patients with saucer-like stretchable acne scars can be successfully treated non-invasively with either a neodynium YAG laser or with the elos approach of Polaris™ treatment. As of April 2004, we have added GentleYAG™ which we hope will enable us to do an even better job of treating these scars. Thus, three non-invasive laser devices are being use in the practice to treat acne scars as well as the Thermage procedure for certain individuals.

Studies have shown that some cases of nodulo-cystic acne will clear with 1-3 Thermage treatments while at the same time there has been improvement in acne scars. Our experience over the past 18 months, has validated these studies.

WHAT OTHER TREATMENTS ARE AVAILABLE FOR ACNE SCARS ?

1. Laser Resurfacing with the carbon dioxide and Erbium YAG laser has been very effective and can now be used safely in all skin types. We have treated East Indian and Africa American patients who have fully recovered normal pigment in their skin.

2. Acne surgery. Certain types of scars will not respond to invasive or non-invasive resurfacing procedures and must be treated by some form of surgery. Very deeply depressed scars may be either surgically excised and repaired in a plastic manner or treated by dermal grafting. Dermal grafting involves removing the epidermis with a carbon dioxide laser and then excising dermis for placement under a very deeply depressed scar. The donor site is closed with fine sutures. The scar is strategically placed to avoid being seen at a later time. The harvested dermis is then shaped in a manner to fill out the deeply depressed scar and it is placed under the scar through a very fine incision requiring one or two sutures. Certain other scars which are large and tightly bound down are best treated by surgical excision with plastic closure. When surgical scar revisions are done, the entire treated area is often resurfaced with a carbon dioxide laser to better blend all the scars into the surrounding skin.

Small ice pick scars are usually removed with a very small hair transplant punch and closed with a single dissolving suture.

This is the most precise surgical method with the highest cure rate of non-melanoma skin cancers, i.e. basal cell carcinoma and squamous cell carcinoma. This is a procedure which is done in our office in which our dermatologic surgeons remove a thin layer of skin at the site of the skin cancer. Microscopic slides are then made for the dermatologic surgeon, by a laboratory technician in our office laboratory. The surgeon then examines the tissue microscopically to ascertain that all cancer cells have been removed. If any abnormal cells remain in the first layer of tissue examined, then additional tissue layers are removed and reanalyzed until all tumor cells have been removed. This approach minimizes the overall size of the wound. Once we have determined that all of the skin cancer has been removed, the defect is reconstructed. This reconstruction is done by our physicians who have done more than 50,000 such procedures.

Often, the wound can be simply closed with sutures. Frequently, especially with lesion of the lips, nose and ears, a more complex reconstruction such as a skin flap or skin graft is done. This is done in our office the same day as the Mohs Surgery.