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Robert L. Cucin MD FACS |
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Plastic and Reconstructive Surgery |
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Botulinum Toxin, Hyaluronic Acid, Hydroxyl Apatite, Polylactic Acid, and Collagen Fillers |
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The injectable tissue fillers such as the Hyaluronic Acid Fillers (HLA) (Juvederm®, Restylane®, Perlane®), Collagen (Zyplast®) Injections, and Fat Autografts when used alone or in conjunction with neurotoxins such as Botox® and Dysport® allow us to delay the onset of deep wrinkles and postpone many of the changes of aging associated with facial expression, the loss of subcutaneous tissue and bony prominence. A patient must understand that the effects of these products are temporary and that a “maintenance” program of continuing touch-ups every three to six months is required for the most cost effective delay of more major interventions. A more natural effect results with maintenance at short intervals rather than dramatic rises and falls with more required product at longer intervals. The patient must also realize that there can be “too much of a good thing” in plumping lips or frown suppression. Polylactic acid (Sculptra®) and Hydroxyl Apatite (Radiesse®) have their places in attaining semi-permanent results in certain applications but that longer lasting effect may be a detriment in some cases. It is essential for the physician to have a good knowledge of the underlying muscular and skeletal anatomy to accomplish a pleasing result with the least amount of product. These products work as a complement to good surgery to preserve and prolong its effects and can delay the initial surgical intervention but they are not a replacement for it when the clock has ticked too long. Dr. Cucin has been using these products since the first injectable product (Zyderm®) was available and his clinical experience is even referenced in the product insert. In the last decade we have come to realize how much fat autografting has a place in replacing the loss of subcutaneous tissue, revolumizing the face rather than just tightening the skin envelope with a lift. It is the first defense and the effects are additive. .
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Muscle Relaxants and Tissue Fillers |
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Slowing Down the Clock |