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Spacecoast Living

Youth in a syringe

By Anne Straub

If the thought of going under the knife keeps you away from the plastic surgeon’s office, consider the needle.

That’s the approach of millions of people who are getting a more youthful look without surgery. They’re turning to injectables as a way to minimize facial lines.

Some are the Hollywood starlets with Mick Jagger lips and frozen foreheads that populate the monologues of late-night comedians. But more common are the regular folk who see injectables as a cheap and easy way to reduce the appearance of aging.

“There are people that are coming in that would not come in otherwise,” said Dr. David Packer, an Indian Harbour Beach plastic surgeon.

Injectables fall into two broad categories:

• Botox blocks nerve impulses, temporarily paralyzing muscles and smoothing wrinkles. It would seem to be the current miracle in a syringe: More than 2.8 million people had the substance injected last year, making it the most popular cosmetic minimally invasive procedure, according to the American Society of Plastic Surgeons.

• Soft-tissue fillers fill lines and wrinkles and augment lips. The most widespread is collagen, which ranks fifth in the top procedures and is on the rise. More than half a million people had the filler injected last year, up 30 percent from the year before.

Collagen has been used cosmetically for decades. “It’s kind of the gold standard. But Botox has really changed the game,” said Dr. Leroy Young, a St. Louis plastic surgeon who chairs an ASPS committee on emerging trends.

“People are even injecting their armpits before their wedding,” Young said, to reduce sweating. Politicians and movie stars do the same on their right hand for those firm, cool handshakes.

But more common is the person who wants to reduce frown lines on the forehead. (By the way, for political junkies, Young comes down firmly on the “yes” side of the question of whether Democratic presidential nominee John Kerry started using Botox. “He’d, I’m sure, deny that but there’s a big difference and it’s not just because he’s smiling differently,” Young said.)

In general, experts recommend Botox for wrinkles on the upper third of the face, such as frown lines between the eyebrows and worry lines on the forehead. Soft-tissue fillers work better on the lower two-thirds of the face and tend to produce good results reducing the lines that stretch from the nose alongside the mouth when people smile.

“In my mind, the question is not which is better. In my mind, the question is what is the problem and what are you seeking to correct,” said Dr. Ross Clevens, a plastic surgeon with offices in Melbourne and on Merritt Island.

Fillers aren’t ideal for the upper part of the face because of the strength of the underlying muscle. Inject a filler between the eyebrows, and facial contortions might cause the filler to migrate and form lumps in other parts of the face. If a filler is needed in the upper third of the face, Clevens recommends injecting Botox first. That way, the muscles won’t be able to move the filler around.

People interested in a soft-tissue filler have choices. A few options:

Collagen. The naturally occurring protein supports various parts of the body, including skin, tendons and ligaments. Zyderm and Zyplast are derived from purified cow skin and require a skin test to eliminate the possibility of allergic reaction. Human-derived collagen, such as CosmoDerm and CosmoPlast, is harvested from donors or grown in a laboratory and poses no allergy risk. Some patients with acne scars are getting good results from CosmoDerm, a more superficial filler. The test: If the scars disappear when you put tension on the skin, they’ll likely respond well to treatment, Packer said.

Hyaluronic acid. The substance is part of connective tissues, including the skin, and has been used to treat joint pain. Some products, including Hylaform, are made from rooster combs. An exception is Restylane, a clear gel non-animal-based hyaluronic acid. Packer is performing a lot of Restylane injections on the border of patients’ lips. “Just by defining them, it adds a little shape without increasing them,” he said.

Semi-permanent fillers. Most common in the United States is Radiance, made from a substance found in bone and teeth. The body forms collagen around the Radiance, adding bulk and making the product a good choice for deep creases. “If I want more filler, more power, I would generally go with Radiance,” Clevens said. Radiance lasts longer than other fillers, up to several years.

Fat. Fat injections involve taking fat from the patient’s body – usually the thigh or lower belly – and reinjecting it below the facial skin. Results can be permanent if the body grows new blood vessels and the fat lives, but that’s unpredicatable. Uses of the technique are different than for manufactured fillers, Packer said. “You’re really changing the shape of the face rather than correcting an aging face,” he said.

Botox and soft-tissue fillers share a blessing and a curse, plastic surgeons say: Their temporary nature. Botox and collagen last about three months – an advantage for first-timers unsure about getting the treatment. “Sometimes, at worst, they describe it as a bad haircut,” Clevens said. But that’s the exception. “The overwhelming majority of patients are extremely pleased.”

His practice treats 600 to 1,000 patients a year with Botox. Those concerned about needles can use topical numbing medicine before the injections, which only take a few minutes. After a few minutes with the ice pack at the injection site, the patient is ready to. Many have the procedure done on their lunch hour.

All patients return 10 to 14 days after treatment for a follow-up visit, where Clevens can make any needed adjustments. Clevens, who serves on a national training council for Botox, likes to be precise about documenting location and doses so he can develop a template for each patient. “Each individual is seeking a unique outcome,” he said. Most patients return for treatment every three months.

“Botox is truly an art. You need to be very specific,” Clevens said.

Men appreciate the quick and easy nature of the treatment. Salesmen like the result because it makes them look friendlier, Packer said, and worriers can lose their anxious appearance.

A provider would have to overdo it to get the motionless face ridiculed in the media, Packer said. But even a good treatment can produce what he describes as a heavy feeling about the brows.

He finds most people do well without the numbing, and many even forgo the ice pack. He does, however, recommend a local anesthetic before Restylane, which some patients say burns as it’s injected.

Manufacturers sell fillers and Botox in prepackaged syringes at about $400 each, and each area generally will take a syringe. If a provider advertises a lower price, be leery: “This stuff’s expensive,” Young said. A lower cost could mean the substance is diluted.

Fillers that last longer tend to come with higher price tags. Restylane and Hylaform might cost $500 to $1,000 and last up to a year. Radiance generally ranges from $1,500 to $2,000, and Clevens estimates treatment would last 18 months to three years. The ASPS is more optimistic, giving a range of two to five years.

Using a patient’s own fat would cost less because the doctor can inject more and doesn’t have to purchase it.

Expect to purchase two syringes of filler for lip augmentation. Patients lose some of the softness in their lips after treatment. But in most cases, vanity wins.

“You’ve got to be willing to trade a look for a feel,” Packer said. “Having said that, people come back and they get more put in their lips.”