Facial Plast Surg 2006; 22(2): 140-146
DOI: 10.1055/s-2006-947720
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Injectable Treatments for the Aging Face

Jeffrey B. Wise1 , Timothy Greco1 , 2
  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
  • 2Eastern Cosmetic Surgery Institute, Bala Cynwyd, Pennsylvania
Further Information

Publication History

Publication Date:
18 July 2006 (online)

ABSTRACT

The use of injectable agents, specifically soft tissue fillers and botulinum toxin type A, has risen dramatically over recent years, due to the increased demand for minimally invasive techniques. In fact, today they represent the most commonly performed cosmetic procedures in the United States, with botulinum type A injections topping the list. In the treatment of the aging face, these agents, when used individually or in combination, can effectively decrease rhytids and restore lost volume. The result is a fuller, smoother, more youthful appearance. This article provides an overview of botulinum type A (Botox Cosmetic; Allergan, Inc., Irvine, CA) and the two injectable fillers most commonly used in our practice, namely hyaluronic acid (Restalyne; Medicis Aesthetics, Inc., Scottsdale, AZ) and human-derived collagen (Cosmoderm and Cosmoplast; Inamed Aesthetics, Inc., Santa Barbara, CA). Although we commonly use autologous fat as an injectable filler for facial-volume augmentation, its discussion is beyond the scope of this article. Conceptually, the aging face can be divided into upper, middle, and lower thirds. Using this framework, we will discuss our treatment strategies for addressing each facial region. General principles, preinjection evaluation, and specific approaches and techniques for each anatomic region will be discussed, with particular emphasis on the benefit of using dermal fillers in conjunction with botulinum toxin type A to achieve optimal aesthetic results for facial rejuvenation.

REFERENCES

  • 1 Cosmetic Surgery National Data Bank Statistics 2005. New York; American Society for Aesthetic Plastic Surgery 2005
  • 2 Scott A B. Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery.  Ophthalmology. 1980;  87 1044-1049
  • 3 Blitzer A, Binder W J. Cosmetic uses of botulinum neurotoxin type A: an overview.  Arch Facial Plast Surg. 2002;  4 214-220
  • 4 Carruthers J, Fagien S, Matarasso S L. Botox Consensus Group . Consensus recommendations on the use of botulinum toxin type A in facial aesthetics.  Plast Reconstr Surg. 2004;  114(Suppl.) 1-22
  • 5 Blitzer A, Sulicia L. Botulinum toxin: basic and science and clinical uses in otolaryngology.  Laryngoscope. 2001;  111 218-226
  • 6 Meyer K F, Eddie B. Perspectives concerning botulism.  Z Hyg Infektionskr. 1951;  133 255-263
  • 7 Matarass S L. Complications of botulinum A exotoxin for hyperfunctional lines.  Dermatol Surg. 1998;  24 1249-1254
  • 8 Sengelmann R D. Dermal fillers.  E-Medicine February 7, 2006
  • 9 Cooperman L S, Mackinnon V, Bechler G et al.. Injectable collagen: a six-year clinical investigation.  Aesthetic Plast Surg. 1985;  9 145-151
  • 10 Tzikas T L. Evaluation of the Radiance FN soft tissue filler for facial soft tissue augmentation.  Arch Facial Plast Surg. 2004;  6 234-239
  • 11 Nakagawa M, Tanaka M, Miyata T. Evaluation of collagen gel and hyaluronic acid as vitreous substitutes.  Ophthalmic Res. 1997;  29 409-420
  • 12 Balazs E A, Denlinger J L. Clinical uses of hyaluronon.  Ciba Foundation Symposium. 1989;  143 265-275
  • 13 Hascall V C, Laurent T C. Hyaluronan: structure and function. http://www.glycoforum.gr.jp/science/hyaluronan/HA01/HA01E.html Accessed April 25, 2006
  • 14 Narins R S, Brandt F, Leyden J et al.. A randomized double-blind, multicenter comparison of the efficacy and tolerability of Restylane versus Zyplast for the correction of nasolabial folds.  Dermatol Surg. 2003;  29 588-595
  • 15 Inamed Aesthetics .Cosmoderm and Cosmoplast: human-based collagen explained. http://www.inamed.com Accessed April 26, 2006

Jeffrey B WiseM.D. 

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