Over the past several years, options for injectable fillers have become significantly refined. The majority of fillers used today are forms of hyaluronic acid (HA). Hyaluronic acid is a substance that occurs naturally in all mammals and has been successfully and safely cloned in the laboratory.
Because pure hyaluronic acid would be broken down by the body in about 24 hours, HA injectables have been modified to increase their stability over time by a process called cross-linking. The different HA products differ in molecule size as well as amount of cross-linking. These variations cause changes in characteristics such as “thickness” of the product and how long it remains in the body. The average treatment results last around six months, although the length the product remains can vary based on individual factors, the product chosen, and the area being treated.
There is a very small number of patients who are very nervous about any kind of procedure that involves needles or even minimal discomfort. For these individuals we offer a range of options to offer complete comfort, including sedation by our expert anesthesiologist. Read More >>
The most popular types of HA injectables are Restylane/Restylane Lyft and Juvederm/Voluma. These products are made by different companies who all, of course, claim that theirs are the best. At the time of an individual consultation, Dr. Rapaport will advise which type of filler is best for a given area.
Products such as Voluma and Restylane Lyft are more “robust,” and therefore they are commonly injected deeper, especially near the bones of the midface. This creates a very natural enhancement of the area and restoration of volume which is naturally lost as part of the aging process.
Restylane and Juvederm are “thinner” products, which are used more superficially, as appropriate. Restylane Silk is a newer formulation of Restylane, specifically designed for the lip area. Dr. Rapaport was one of the first physicians in the United States to use Restylane Silk.
Belotero is yet another HA product which is often favored in the lower eyelid, “tear trough” area. In addition, we were one of the first practices in NYC to offer Volbella, a new HA that is very low viscosity and offers excellent results for lip enhancement and the improvement of fine lines.
The newest fillers to reach the market are Restylane Refyne (a thinner product, designed for more superficial applications) and Restylane Defyne (a thicker product, designed for deeper applications). These products are more flexible, allowing for an increasingly organic appearance during movement of the face.
In recent years, injectables have become increasingly popular among both men and women. We have seen a dramatic rise in the use of injectable products for facial refinement and facial rejuvenation.
Unlike fillers such as Restylane and Juvederm, which restore lost volume, Botox, Dysport and Xeomin are neurotoxins, which cause muscles to relax for a period of several months.
Botox, Dysport, and Xeomin are each slightly different formulations of Botulinum toxin type A, a naturally occurring toxin which when injected next to muscle, causes the muscle to relax. This relaxation can be partial or complete, depending on the amount of product used and the strength of the muscle being treated. The 3 different brand names listed above are in reality much more similar than different. Over recent years, Dysport has become our preferred preparation in most cases, because its onset of action seems to be quicker, with noticeable improvement usually beginning after 2 to 3 days, versus 6 or 7 days with Botox or Xeomin.
The FDA has approved the use of Botox for treatment of glabellar lines, which are vertical wrinkles between the eyes These typically occur with frowning. Botox is also approved for treatment of crows feet, which are wrinkles occurring on the sides of the eyes and in the lower lids, typically with smiling or squinting.
There are many off-label uses of botulinum products which have become quite popular in recent years. These include the forehead for reduction of its horizontal lines, bunny lines on the sides of the nose, vertical lines of the lips, and vertical neck bands, also called platysmal bands, muscles which can cause a gummy smile, muscles which pull the corners of the mouth downward, and chewing muscles which when overgrown can cause excessive widening of the lower face and/or TMJ pain. Finally, Botulinum toxin can also be used to stop sweating, particularly in the underarms. For almost all uses, Botox typically lasts for 3to 5 months, depending on how much is used, while when used to reduce sweating it typically lasts from 6 to 9 months, and sometimes more.
Just like with fillers, the key to getting good results with botulinum toxin injections is to have the proper artistic approach to the face as a whole, and to truly understand the desires of each patient. To aid in achieving optimal results, we keep a photographic record of precisely how much neurotoxin is used and where it is injected. This allows for duplication is results are ideal, or fine adjustments if one is seeking a bit more or less muscle relaxation.
Even though no allergy testing is needed, before having any HA filler injections, patients should avoid using aspirin products, Vitamin E supplements and other medications that can thin the blood and may increase bruising.
In recent years, injectables have become extraordinarily popular among both men and women. We have seen a dramatic rise in the use of injectable products for facial refinement and facial rejuvenation. Unlike fillers such as Restylane and Juvederm, which restore volume, Botox and Dysport involve neurotoxins, which help to relax tense muscles.
People are clearly more conscious of their appearance in these days of social media and “selfies.” While people are increasingly interested in doing things to improve their appearance, many remain reluctant to have surgery. Injectable treatments performed by New York plastic surgeon Dr. David Rapaport uniformly involve little to no downtime, with patients commonly coming in before work, during a lunch break, or after work to get their Botox and/or fillers.