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Fullness and projection of the cheeks, lips and chin are hallmarks of youth and beauty. As we age, our faces begin to show the effects of gravity, sun and environmental exposure and years of facial muscle movement, such as smiling, chewing, squinting and smoking. The underlying tissues that keep our skin looking youthful and plumped up begin to break down. There is loss and redistribution of fat, atrophy and remodeling of bone, and the underlying collagen, hyaluronic acid, and elastin fibers begin to deteriorate. Sagging of the face occurs and deep lines appear over the areas where muscle movements occur. This most commonly occurs around the eyes, mouth, cheeks, jaw line, brow, and bridge of the nose, producing crow’s feet, laugh lines, folds and furrows on the forehead, and “hills and valleys” on the lower third of the face.

Soft tissue fillers have the unique ability to fill and contour these changes and to reestablish a smoother, more youthful-looking appearance of the face, enhance various body contours and restore soft tissue loss associated with normal aging, diseases, or trauma. They can also add fullness to the lips and cheeks.

What are soft tissue fillers?
Soft tissue fillers are flexible substances that can be injected into the skin to improve the appearance of fine lines and wrinkles, plump lips, fill hollow cheeks, repair various facial imperfections, improve scars, and elevate deep folds. The result is a smoother, more youthful appearance with minimal "downtime" and maximum safety.

At Vein & Laser Center we use a variety of soft tissue fillers, including hyaluronic acid, autologous fat (one's own fat), and donor tissue. The growing number of available fillers has greatly expanded the anti-aging and skin-saving treatments that we offer.

A variety of filler substances have been developed to address a wide range of cosmetic and other needs of the individual patient. Each filler has its distinctive benefits. Sometimes more than one filler may be used to achieve the best results. Some fillers provide longer-lasting results; others allow for more precision with fine lines, and still others can gradually bring the face into better balance, creating an overall rejuvenated appearance. Since filler substances do not involve major surgery and are generally cost-effective, men and women are using these youth-enhancing techniques more than ever.

Soft tissue fillers are frequently used in combinations or with other techniques for facial rejuvenation such as chemical peel, microdermabrasion, laser treatments, Curl facelift, and photodynamic therapy. The most commonly available soft tissue fillers are:

	Restylane
	Radiesse™
	Juvederm®
	Autologous Fat
	Collagen
	Botox®

Restylane®

What is Restylane®?
Restylane is composed of non-animal stabilized hyaluronic acid (NASHA). Hyaluronic acid is a substance found naturally in the human body. It provides volume and fullness to the skin. Unlike rooster-derived hyaluronic acids and bovine collagen products, Restylane is free from animal proteins. This limits any risk of animal-based disease transmissions or development of allergic reactions to animal proteins. Restylane contains trace amounts of gram-positive bacterial proteins and should not be used by patients with a history of allergies to such material.
Hyaluronic acid molecule is hydrophilic, or "water-loving," a feature that allows it to bind to water to provide long-lasting results. Restylane has the highest concentration of hyaluronic acid available in a dermal filler.

Is Restylane® safe?

Restylane has been used since 1996 worldwide. There is limited risk of animal based disease transmission or allergic reaction. Restylane is fully biocompatible and allergy testing is not required. Restylane contains trace amounts of gram-positive bacterial proteins and should not be used by patients with a history of allergies to such material.
After your treatment, you might have some redness or swelling. This will normally last less than seven days. Sunbathing and cold outdoor activities should be avoided until any redness or swelling disappears. If you are pregnant, breastfeeding, or under 18, you shouldn’t use Restylane.

Can Restylane be used anywhere on the face?
Restylane has been used in more than 1.5 million treatments in over 60 countries to correct a variety of wrinkles. In the U.S. the FDA has approved Restylane for wrinkles and folds like the ones from the nose to the corners of the mouth. Your doctor will consult with you prior to your injection regarding common treatment areas.

How long does Restylane last?
Restylane is proven to deliver long-lasting results. Studies have shown that Restylane effects generally last for about six months. Treatments are typically scheduled twice a year. Having a touch-up treatment before the product has fully dissipated may enhance the lasting effect.

What should patients do prior to treatment?
Restylane requires no pretesting, but you should take a few precautions before being treated. Avoid using aspirin, non-steroidal anti-inflammatory medications, or high doses of Vitamin E supplements prior to treatment, because these may increase bruising or bleeding at the injection site. Also, if you have previously suffered from facial cold sores, we may consider prescribing a medication to minimize recurrence.

How is Restylane different from Botox Cosmetic?
Restylane is a natural, cosmetic filler. In contrast, Botox Cosmetic is a drug that blocks nerve transmission and relaxes the underlying muscles. Many patients have been very pleased after receiving treatment with both products.

Do the injections hurt?
Restylane® is injected directly into the skin in tiny amounts by a very fine needle, resulting in minimal discomfort. The procedure is simple and convenient, and results are practically instantaneous. To minimize your
discomfort during the short procedure, local anesthetic to numb the treatment area may be used.

What are the side effects of Restylane injection?
After your treatment, you might have some redness, swelling or bruising. This will normally last less than seven days. Makeup can be applied immediately after the treatment. Sunbathing and cold outdoor activities should be avoided until any redness or swelling disappears.

If you are pregnant, breast feeding, or under 18, you shouldn’t use Restylane.

Radiesse™

What is Radiesse™?
Radiesse is a soft tissue implant consisting of tiny microspheres of calcium hydroxylapatite (CaHA) which is naturally found in the body. It is combined with an aqueous gel. This material is biocompatible (not harmful to the body) as well as biodegradable (broken down by the body).

What makes Radiesse™ different from other fillers?
The distinctive feature of Radiesse is that it provides both immediate correction along with longer lasting duration. The aqueous gel delivers the immediate correction while the CaHA creates a matrix for collagen production allowing for longer lasting results.

Is Radiesse™ Safe?
The material is identical in composition to the mineral portion of teeth and bone, thus it is inherently safe. The material has been used for other medical applications such as reconstructive surgery, ENT, maxillofacial surgery, dentistry and urology.
No allergy skin test is required.

How long will it last?
The effect of Radiesse can last up to a year or longer. Touch up treatments may be needed to maintain the desired effect.
What can I expect following my Radiesse Treatment?
You will experience an immediate correction. The most common side effects include temporary redness and swelling at the injection site. Slight bruising may occur and typically resolves in a few days.

What areas are treated with Radiesse?

Smile Lines (Nasolabial folds)
These prominent aging lines running from the corner of the nose to the outer area of the lips can be more prominent in some people. Up until now, filler treatment for this area of the face was short-lived. Now, the nasolabial folds can be successfully treated with Radiesse™ injected into the deep dermis, with much longer lasting results.
Marionette Lines
These lines at the corners of the mouth can make you look very serious, or sad, even when your face is at rest. Radiesse™ allows you to carefully augment these small lines with only local anesthesia - with immediate results.
Cheeks
Some people are born with naturally beautiful cheekbones – many of us aren’t. But Radiesse™ can give you the cheeks you always wanted. As we age, we start to lose fat in our faces and it is often most noticeable in the cheek area. Radiesse is an ideal filler for adding volume to cheeks because it can be used to treat large surface areas in one procedure. The result is a healthy looking, contoured appearance common in more youthful cheeks. Published independent studies show that a typical treatment for malar and submalar augmentation lasts approximately 18 months to two years, with an occasional touchup recommended.

Chin
Re-shaping and contouring to create a more defined chin is an easy in-office procedure. Radiesse™ has also been used very effectively to augment a weak chin and is a non-surgical option to a chin implant. The result is a smoother, firmer chin that complements your other facial features.
Mental Crease
For deep mental creases that form under the bottom lip, Radiesse can successfully augment this deep indentation without invasive surgery. And since studies have shown that the filler substance does not migrate from the site of injection, you can rest assured that surrounding tissue will not be affected.
Jaw Line
Since skin loses elasticity over time and gravity pulls facial muscles downward, the jaw line is one of the most common facial areas where aging becomes apparent. Radiesse™ is an excellent choice to re-shape and contour the jaw line and chin. The result is a smoother, firmer jaw line that mirrors the younger-looking appearance of other facial areas treated with Radiesse.

http://www.radiesse.com/worldwide

Juvéderm™

What Is Juvéderm™ ?
Juvederm is a newly FDA approved injectable gel dermal filler. It has been added to our armamentarium at the Vein & Laser Center to fill wrinkles, smooth lines especially around the nose and mouth and enlarge lips.

Juvéderm™ gel is transparent homogeneous dermal filler made of cross- linked hyaluronic acid gel. It is developed using a technologically advanced manufacturing process that results in a malleable smooth gel that flows easily into the skin, creating a smooth, natural look and feel. It is injected under the skin to provide a long lasting correction of facial wrinkles and folds. Juvéderm™ is proven to be safe and effective for persons of color.

Juvederm is a Hyaluronic acid obtained by bacterial fermentation and is part of the new generation of implants. It is obtained by biosynthesis and is of non-animal origin. Hyaluronic acid is a physiological constituent of dermal tissue which maintains local moisture content and is gradually reabsorbed with time.

What is hyaluronic acid?
Hyaluronic acid is a natural complex sugar found throughout all living organisms that retains water, absorbing more than 1,000 times its weight, and adds volume to the skin’s surface. In addition, hyaluronic acid binds with collagen and Elastin. The triple combination of collagen, elastin and hyaluronic acid provides structure, elasticity and volume to the skin and contributes to its overall appearance. In addition, it plays a key role in numerous areas of other parts of the body including the maintenance of eye volume and shape, and joint lubrication and cushioning.

As a result of natural aging and exposure to environmental pollutants and ultraviolet rays, the cells lose the ability to produce hyaluronic acid. As a result, the skin begins to lose volume, often resulting in the formation of facial wrinkles and folds. Dermal fillers compromised of crossed-linked hyaluronic acid are used to help temporarily replace lost hyaluronic acid and to restore skin volume and a smooth, natural appearance.

What is cross-linked hyaluronic acid?
In its natural form, unbound hyaluronic acid forms a liquid made of highly-hydrated individual polymers (chains) that are metabolized in the body in just 12 hours. Cross-linking refers to a process in which the individual chains of hyaluronic acid are chemically bound (or “cross-linked”) together, transforming the liquid hyaluronic acid into a soft solid, or “gel.” The firmness of the gel depends on the degree of cross-linking of the individual hyaluronic acid chains. The body metabolizes cross-linked hyaluronic acid more slowly, resulting in a longer duration of effect when hyaluronic acid is used therapeutically.

What does Juvederm do and what are its advantages?
The hyaluronic acid in Juvederm simply adds volume, supplements the body's age-depleted hyaluronic acid, and helps raise the skin to fill-in and smooth moderate to severe facial wrinkles and folds, and plump-up the lip. As a dermal filler, it has the following major benefits:

It is obtained by biosynthesis

It is of non-animal origin and the molecule is highly biocompatible.

It does not require any prior testing.

A special advantage of Juvederm wrinkle filler is the Three Levels (two are now available) of product formulation which provide a personalized approach and the flexibility to tailor each treatment to your unique needs:

	Juvederm Ultra, a highly cross-linked formulation for more versatility in contouring and volumizing of fine and moderate facial wrinkles and folds around the lips and eyes.
	Juvederm Ultra Plus: a more highly cross linked robust formulation for volumizing and correction of deeper folds and wrinkles
	Juvederm 30 (not yet available in the U.S.)

Juvederm is an excellent treatment option for:

	Lip enhancement
	Deep folds
	Facial lines
	Wrinkle correction
	Volume augmentation of the lips
	Shaping facial contours (such as cheeks and chin correcting)
	Smile lines (correcting thin, superficial lines around the eyes, mouth and forehead)

How long does JUVÉDERM™ last?
A single treatment of JUVÉDERM™ , in the majority of patients, can deliver sustained results for up to six months or longer.

Do the injections hurt?
Injections may cause some discomfort during and after the injection. JUVÉDERM™ Ultra injectable gel is injected directly into the skin using a fine needle to reduce injection discomfort. Topical or local anesthetic is sued to numb (anesthetize) the treatment area to minimize discomfort.

What are possible side effects?
Most side effects are mild or moderate in nature, and their duration is short lasting (7 days or less). The most common side effects include but are not limited to temporary injection site reactions such as:

	Redness
	Pain / tenderness
	Firmness
	Swelling
	Lumps / bumps
	Bruising
	Itching
	Discoloration
	As with all skin injection procedures there is a risk of infection.

In addition, the following are important treatment considerations in order to avoid unsatisfactory results and complications.

	Patients who are using substances that can prolong bleeding, such as aspirin or ibuprofen, as with any injection, may experience increased bruising or bleeding at injection site.
	If laser treatment, chemical peeling or any other procedure is considered after treatment with JUVÉDERM™ gel, there is a possible risk of an inflammatory reaction at the treatment site.
	JUVÉDERM should be used with caution in patients on immunosuppressive therapy, as there may be an increased risk of infection.
	The safety of JUVÉDERM for use during pregnancy, in breastfeeding females or in patients under 18 years has not been established.
	The safety of JUVÉDERM in patients with a history of excessive scarring (e.g. hypertrophic scarring and keloid formations) and pigmentation disorders has not been studied.

What to expect following the procedure?
Within the first 24 hours, you should avoid strenuous exercise, extensive sun or heat exposure and alcoholic beverages. Exposure to any of the above may cause temporary redness, swelling, and/or itching at the injection sites. If there is swelling, you may need to place an ice pack over the swollen area.

What other treatments are available to me?
Other treatments for dermal soft tissue augmentation include bovine-based collagen, other hyaluronic acid-based dermal fillers such as Restylane, calcium hydroxyl apatite (Radiesse), and Fat Transfer. Additional options for the correction of lines and wrinkles do exist, including facial creams, BOTOX® Cosmetic (botulinum toxin type A),
chemical peels, and laser skin surface treatments. You may discuss your option at the time of your consultation.

Fat Transfer / Lipofilling

For patients who desire a more permanent, natural appearing result, Autologous fat transfer is a superb treatment option.
Autologous fat transfer, also medically known as Liposculpture, Lipofilling, Microlipoinjection, Fat Transplantation, involves extracting surplus fat cells from one part of the body (abdomen, thighs, buttocks or elsewhere) and implanting this fat where needed. Fat is most often used to fill in "sunken" cheeks or laugh lines between the nose and mouth, correct skin depressions or indentations, minimize forehead wrinkles, enhance and enlarge the lips, rejuvenate the aging hands, increase the buttocks size, and correct irregularities after liposuctionز

BOTOX®

While BOTOX® technically not a filler, it plays an essential rule in the rejuvenation of the face and neck and commonly used in combination with fillers. Small amounts of botulinum toxin are injected into specific facial muscles to immobilize or relax the underlying cause of lines and wrinkles. It is commonly used to improve forehead lines, furrows between the eyebrows, and crow’s feet. Using botulinum toxin and fillers in the same area may achieve longer-lasting results.