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The Overview Collagen and elastin are the main proteins found in the dermis (deep portion) of the skin, and over time may be degraded. This can cause skin depressions or wrinkles. Many materials have in the past been used to fill these depressions, but until recently collagen treatment had been the most popular. Recently, a number of new materials have become available for treating fine wrinkles and skin folds. The Process Skin fillers can either be injected into the deeper layers of the skin or immediately below the skin through fine needles or implanted below the skin through tiny hidden incisions. Materials differ in their ability to correct different problems, as well as their longevity. The type of material used in a given patient depends upon the site, needed volume of augmentation and patient's goals. Dr. Sclafani can aid you in choosing the right material for you. The Procedure A derivative of hyaluronic acid (Restylane) has recently been approved by the F.D.A. for treatment of skin folds and wrinkles. Hyaluronic acid (HA) is a normal sugar component of the skin. The HA in Restylane is derived from bacteria, then purified and treated to last longer. It is also injected through a small needle into the skin, and appears to last 5-8 months. There is a potential for intermittent swelling and redness of the treated area during the first 1-2 days after treatment; however, most patients are extremely satisfied with their result. Treatments that are particularly amenable to Restylane are laugh lines, frown lines around the mouth as well as those between the eyebrows, fine lines in the lips and for lip augmentation. The results are exceptionally natural in appearance and feel. Some patients choose to have multiple areas treated at the same time, for a "VolumeLift". Typically, this includes treatment of the brows, under eye area, cheeks, laugh lines and jawline, and occasionally some other facial areas. While the VolumeLift does not take the place of a standard facelift, it can help give the entire face a more youthful appearance. Fat can be harvested from a patient's abdomen, thigh or buttock and reinjected under the skin in areas of tissue deficiency, such as the lips or skin folds. Through a small incision (often inside the belly-button), fat is harvested, then concentrated and reinjected under the skin through tiny access incisions. Fat can be used to augment cheekbones, lips, chins or fill depressions like laugh lines. There is usually a 1-2 week period of swelling after treatment, and the amount of fat that persists varies from patient to patient. Collagen treatments consist of collagen fibers isolated from cow skin or grown in the laboratory from human cells. These materials are processed into an injectable form, which are deposited in the area of concern through a tiny needle after application of a topical anesthetic. There is a limited amount of swelling; within 3-6 hours, results are seen, which typically last 2-4 months. Four weeks prior to treatment, bovine collagen requires a skin test to avoid an allergic reaction to treatment. Some materials are surgically implanted through slightly larger incisions. AlloDerm is a solid sheet of skin proteins harvested from human donors and can be used to augment the nasal bridge, in addition to adding bulk to the lips and laugh lines. E-PTFE (Gore-TEX) implants are solid synthetic materials that can safely add permanent bulk to skin folds or depressions. What to expect afterward Certain physical changes are expected following collagen implants. Some individuals experience all of the following and others only some. The degree to which each person is affected is variable and unpredictable. DIET- You can resume a normal diet immediately after treatment with Restylane or Collagen. After placement of fat, AlloDerm or Gore-TEX into the lips, it is best to avoid significant manipulation of the lips for 48 hours, so foods that require extensive chewing (for example steak, crusty breads) should be avoided. If the implants were placed under anesthesia, it is best to start with liquids (soup, juices, etc.) immediately after surgery. Once the anesthesia has worn off and your appetite returns, regular food is allowed. DRESSINGS/SUTURES- Collagen and Resytlane are injected through small needles into or under the skin. No incision, sutures or dressings are necessary. Fat is introduced through a small tube placed through a tiny (2-3 mm) incision, which is easily closed with a single suture. AlloDerm and Gore-TEX implants are inserted through tiny incisions easily closed with one or two sutures. All sutures are removed 7 days after surgery. ACTIVITY AFTER SURGERY- In order to allow your tissues to heal properly, we ask that you refrain from speaking, smiling or moving the lips for 2 hours after collagen or Restylane injections, and 4-6 hours after placement of fat, AlloDerm and Gore-TEX. SWELLING- Swelling of tissues is expected and generally resolves by 2-4 hours after collagen injection. This represents the fluid in the injection being absorbed by the body, while the protein injected remains behind. Some patients treated with Restylane may have mild fluctuating bruising and swelling for the first 24- 48 hours. Fat transfer and AlloDerm or Gore-TEX implant patients typically experience 7- 10 days of post-operative swelling. BRUISING- Make-up can be applied immediately after collagen injections to conceal any bruising. Application of an ice compress to the treated area for the first hour after collagen or Restylane injections (first 24- 36 hours for fat, AlloDerm or Gore-TEX) will help minimize bruising. NUMBNESS- A feeling of numbness in the treated area will occur and usually lasts for 1-3 hours after injection. This is due to the local anesthetic. Patients treated with fat, AlloDerm or Gore-TEX will have numbness of the area typically for 2-3 weeks afterwards. Learn about other procedures performed at the Center for Facial Plastic Surgery:
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In Westchester County, NY: Center for Facial Plastic Surgery . Chappaqua, NY . tel 914.238.5500
In New York City, NY: Division of Facial Plastic Surgery . New York Eye & Ear Infirmary . New York, NY . tel 212.979.4534
In New York City, NY: Division of Facial Plastic Surgery . New York Eye & Ear Infirmary . New York, NY . tel 212.979.4534