Address
George Commons, MD, FACS
1515 El Camino Real, Suite C
Palo Alto, CA 94306
Telephone
650-328-4570
Fax
650-322-8481
Fillers in cosmetic facial enhancement are called fillers, because that is what they do. They fill areas where tissue has been lost or are possibly congenitally deficient.
I like to consider aging as a three major event process:
Wrinkles and skin surface blemishes (brown spots, sunspots, pre- skin cancerous areas and melasma). These phenomena are caused by repetitive muscle action (frown), daily wear and tear our skin takes from the sun, wind and all the elements. Botox®, chemical peels, dermabrasion, laser, intense pulsed light, surgery and light fillers may help. Gravity and ptosis cause our tissues to sag toward our feet. If we stood on our heads and walked on our hands that might reverse some of this, but we will obviously not do that. Lifting is the answer. Surgical facelifts (mini, to extensive) all work. Then there are eyelid lifts, forehead lifts, cheek lifts, midface lifts, neck lifts, earlobe lifts and even nose lifts. All of these are surgical and fight gravity. Non surgical radiofrequency wave skin tightening machines may help a tiny bit, but I am unimpressed. Those procedures are expensive and not very productive or lasting. Then there is tissue loss. Fat is lost (atrophies), muscles thin and skin thins. Fat loss causes a sunken look around the eyes and a hollow gaunt cheek cavity. Lip lines are a result largely of fat loss, thinning skin and muscle thinning. Smoking doesn’t help, but it is rarely the prime cause.
The most common areas are:
In filling deficits, I like to choose the best substance for each patient. The hollow areas under the eyes are excellent for Juvederm® or Restylane®. The area about the mouth is well treated and beautifully enhanced by either. All can be done nearly pain free. Frown areas often are also improved and are the other deficient zones of the face. It is, in fact, possible to build up cheek bones and enhance a weak chin with Juvederm® or Restylane®. Fat transplants do work, but we must double the anticipated need, because only 50% of the harvested fat cells survive. Fat is fragile and some cells simply don’t survive, but the good news is that some do. Fat is your own tissue. It is your inexpensive gift to yourself. Fat obviously has not a purchase cost (it’s yours) however, there are costs associated with harvesting the fat. For this reason it is often ideally done during fat removal (liposuction) and placed where desired (face, hands, buttocks, calves, etc.). More than one procedure may be needed, but at least some does survive. In the case of other fillers, all dissipate within a year. Fat works and is a fine consideration for some areas. When large volumes are needed, fat is the only logical consideration. Fillers can cost from a low of $450 per 1 cc syringe to as high as $900 per 1 cc syringe or more. Fillers vary in cost depending on their longevity claims. Call my office and costs will be very openly discussed with you. M.D. injector fees may be different than R.N. injector fees. Every office basically charges what it pleases. There are no guidelines, except possibly common sense.
I have injected all the various fillers on the market at one time or another. I am not going to elaborate on the products I no longer use, but will rather discuss what I feel works best. This is simple…Juvederm® is outstanding, Resylane® is really fine for certain areas, Perlane® has definite quality and indications, and lastly, Artecol® has the double beauty of an excellent product and long longevity. There are many, many more. Others work, but the above four products are the best. Artecol® is more costly up front, but its longevity brings up the idea that it is quite likely competitive.
What is injection day and recovery like? I have discussed how easy Botox® is. The fillers are more complex, more painful possibly, slightly longer recovery and greater likelihood of bruising. First of all, avoid all things which hinder your blood clotting for 10 days prior to treatment. These include aspirin, Advil (all anti-inflammatories), vitamin E, fish oil and herbal medicinal preparations. Tylenol (acetaminophen) is fine to take. The placement of injectable fillers can be quite uncomfortable. Ice and topical lidocaine cream help, but most patients who know the option of a block will request a block. I agree. A block is a gentle injection to numb the appropriate nerves in the area to be treated, similar to what a dentist does. Remember the numb lips? The block takes 15 minutes and lasts approximately 2 hours. After the block, no pain is felt and the product can be more meticulously and precisely placed. We discharge the patient with a light ice pack. All attempts are made to avoid bruising, but the needle cannot be as tiny as the Botox® needle (fillers will not pass through). Occasionally tiny vessels that cannot be seen are bumped and a small bruise occurs. Both surgeons and patients dislike bruising, but we cannot guarantee they will not occur. If anyone guarantees that there will be no bruising, get it in writing. For 36 to 48 hrs. there is some swelling.
In many cases, surgery is more durable, but fillers offer a quick fix and an opportunity to see if you like the effect. From the early days of fillers, there has been fantastic progress. Plastic surgeons and patients are indeed fortunate to have such wonderful products as Juvederm®, Perlane®, Restylane®, and Artefil® and of course fat. I am certain even more and better products will continue to arrive.