Beneath the Lines

Dr. Kirn and Dr. Al Bayati are Plastic Surgeons devoted to advanced techniques in Cosmetic Surgery of the Face, Breast, and Body.

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Injectable dermal filler technology continues to improve with a commensurate expansion of applications. With time, the dermal filler manufacturers have worked to develop products especially suited for particular applications, largely based upon the depth at which the filler is injected. Some fillers are placed deeply at the bottom of the skin or just below it for a plumping effect to restore facial volume. On the opposite end of the spectrum, less viscous and more elastic fillers are placed very superficially to smooth out fine lines.

The artful injector carefully considers the patient’s needs and goals and develops a treatment plan to achieve maximum correction. Like building a house, it is best to work from the foundation upward. The deep layer should be addressed first to restore volume. Often, restoration of volume also leads to an improvement in more superficial wrinkles without directly treating them. Much of our perception of aging is related to volume loss in specific facial areas including the upper cheek, known as the malar eminence; the temples; and sometimes the central cheek. Studies on twins published in the plastic surgery literature have shown that after age 40, the twin with higher weight looked younger thereby demonstrating the importance of adequate facial volume.

Happy and beautiful woman smiling to camera

Sculptra®, Juvederm® Voluma, Restylane® Lyft and fat grafting are useful for deep layer volume restoration. Sculptra® is unique among injectable fillers and our practice has utilized it since it first appeared on the market roughly a decade ago. Sculptra® works subtly and gradually over time for a more youthful-looking appearance. Sculptra® helps stimulate the skin’s natural collagen production to increase facial volume. Following injection, the volume gradually builds up by stimulating collagen production in the skin. An advantage of this timeline is that the changes are gradual and therefore less likely to be noticed by friends and family. Depending on the degree of volume restoration needed, multiple injection sessions may be required. For most people, Sculptra® lasts about 2 years. Periodic treatments can help maintain the effect consistently over time.

Hyaluronic acid (HA) fillers dominate the market for treatment of superficial wrinkles and fine lines. HA is a naturally occurring component of human skin. The HA in dermal fillers is synthetically created in the lab, so it lacks undesired human or animal proteins which can trigger allergy or reactions. The HA fillers have been on the market, and used by our practice, since the FDA approved Restylane® in 2003. They are extremely versatile and have an unparalleled safety record. Both the Restylane® line of products and the Juvederm® line have expanded over time with variants designed to target specific areas such as lip enhancement, fine lines, nasolabial folds, and more.

Regardless of the product selected, the most important ingredient is the person doing the injection. The best filler injected into the wrong area or at the wrong depth can miss the desired affect or potentially create problems. Each treatment plan must be custom tailored to the patient, and it is always good to have an anticipating eye toward future aging. Most all of our filler patients simultaneously utilize neurotoxins such as Botox® or Dysport® for a comprehensive injectable treatment plan. Additionally, a quality skin care program is an essential. And lastly, there is only so much that can be accomplished with injections. For these needs, surgery frequently provides the answer.

Our team of two nurse injectors, myself, and the Aesthetic Skin Care Center LLC work to coordinate the options to maximize the results for each very individual patient. Experience, a sense of the aesthetic goal, and knowing how to achieve it are essentials for a skillful injector. But, they must also possess the necessary training to inject safely. An injector with a global understanding of all the options from skin care to surgery is able to recommend the most direct route to achieve your goals.