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Cosmetic Injections Details Beverly Hills

Life is about change and one of the most obvious examples of this are the changes that occur in our skin. Our skin is at the mercy of many forces including harsh weather, lifestyle, personal habits, diet, genetics, injuries, trauma, obesity, stress, normal aging, gravity, sun damage, repetitive facial movement, and the loss of subcutaneous support (fatty tissue between your skin and muscle). All of these can have a negative impact on our appearance making us look exhausted and older than we really feel. Fortunately, at Neo Surgery Center, Dr. Brent Moelleken M.D., F.A.C.S., offers cosmetic injectables that can safely and effectively leave you looking youthful, rejuvenated, and refreshed. Cosmetic injectables can minimize your fine lines and wrinkles, the deep folds around your nose and mouth, and correct your crow’s feet while providing volume to enhance the contour of your jawline, cheekbones, and lips.

Dr. Moelleken is a Plastic and Reconstructive surgeon with offices in Beverly Hills and Santa Barbara, California. He is double board certified by the American Board of Surgery and American Board of Plastic Surgery and specializes in cosmetic surgery. He received his premedical, medical, and surgical training at Harvard University, Yale University, UCSF, and UCLA. He is one of three specialty-trained surgeons in the world to complete the yearlong Aesthetic Surgery Fellowship at UCLA. He has the prestigious FACS degree and is a member of the American Society of Plastic Surgeons (ASPS), The American Society for Aesthetic Plastic Surgery (ASAPS), Who’s Who in the World and numerous medical and scientific organizations.
Cosmetic surgical procedures can produce profound, long lasting results but they are invasive and they have an associated recovery period. Many people who are just beginning to show signs of facial aging want improvements but they are not ready to commit to surgical intervention. For these patients, the rapidly expanding inventory of injectable treatments is a perfect option. Injectables can be performed during an office visit on an outpatient basis and with some treatments, no anesthetic is necessary. The needles used are so small, pain and discomfort is very minimal.

If you would like to restore fullness to your face, enjoy plump lips, enhance shallow contours, or soften those facial creases and wrinkles that you see when you look in the mirror, cosmetic injectables may be the answer for you. Although they cannot help with excess sagging skin, these soft tissue fillers can add more volume and provide immediate results at a lower cost than surgery. It is important to note that these treatments are not permanent, however and they must be repeated and maintained. Some cosmetic injectables are used in conjunction with other skin rejuvenation treatments and during your consultation Dr. Moelleken will assess your needs and recommend one or a combination of treatments to achieve your desired results.

Aging Skin
Wrinkles can make you feel and act older than your actual years. Cosmetic procedures can restore a healthier, more youthful look to your face and in doing so, they can boost your confidence and self-esteem. Skin type, texture, color, elasticity, bone structure, and individual healing patterns should all be considered before deciding to undergo a cosmetic procedure. A youthful appearance is not only about the surface of your skin nor is a well-rounded approach to rejuvenation simply skin deep. To meet your expectations, rejuvenation must take into account all of your skin from the outermost to the inmost.

With the passing years, changes occur simultaneously in four, vastly different “aging zones.”

The four zones of aging include:

  • The Epidermis: Dullness, dryness, irregular pigmentation, and fine lines are the definitive aging concerns occurring in this outermost layer. By the time you reach the age of 30, your skin becomes drier because less sebum is produced. The pigment-producing cells called melanocytes live in the bottom layer of your epidermis and it is there that your skin color is produced. Over the years, the cumulative effects of the sun cause melanocytes to become more active. The resulting overproduction of melanin leads to blotchy discoloration and the large freckles (lentigos/lentigines) that frequently appear as you age. Closer to the surface, the corneocytes (superficial epidermal cells) accumulate and the epidermis thickens resulting in a dull, lifeless complexion.
  • The Dermis: Below the epidermis, the dermis is an active place as tiny veins called capillaries bring blood flow to your skin. There are also sweat glands, hair bulbs, nerve endings, and collagen and elastin fibers, which give strength and support to your skin. Like the epidermis, the dermis undergoes major changes related to the aging process because collagen and elastin fibers break down, leading to sagging of your skin.

Compounding this, collagen and elastin producing cells called fibroblasts become less active so your skin cannot make the amount of collagen fibers necessary to maintain your skin and repair damage. Sunlight also takes its toll on the dermis by damaging cellular DNA. This leads to an increased formation of blood vessels and the skin becomes more fragile and easily bruised. GAGs (glycosaminoglycans), a cellular component that helps give your skin overall structure, thin as well as the extracellular cement, which holds the cells together. Some age-related lentigos are caused by melanin deposited into the dermis and that is why the bleaching process can be so difficult, or even impossible, for some women.

  • The Fat Layer: Below the dermal layer is a layer of fat. As we age, the fatty layer on the backs of your hands, neck, and face becomes noticeably thinner. This results in more noticeable blood vessels on the backs of the hands and dark circles exacerbated by fat pad atrophy beneath your eyes. There is overall thinning of your skin, allowing for increased fragility. Fat will accumulate, however, along the jowls, creating the double chin and sagging lower cheeks appearance.
  • The Muscle Layer: Below the fat layer lies muscle. Deeply grooved wrinkle lines on your face are caused by the buildup of facial muscles through the overuse of repetitive muscle movements such as smiling or frowning. Chronic puckering from smoking can also cause deep lines to form around your mouth but even non-smokers can eventually develop deep, crevice-like lines, particularly if there has been a lot of additional sun damage.

 

Over time, the sun’s ultraviolet (UV) light damages certain elastin fibers in your skin. The breakdown of elastin fibers causes your skin to sag, stretch, and lose its ability to snap back after stretching. Your skin also bruises, tears more easily, and takes longer to heal so while sun damage may not show up when you are young, it will later in life. Nothing can completely undo sun damage, although the skin can sometimes repair itself. It is never too late however to begin protecting yourself from sun exposure and skin cancer. You can delay the changes associated with aging by staying out of the sun and wearing a sunscreen with an SPF of 30 or more every day.

The changes below your skin can cause loss of fat below the skin in your cheeks, temples, chin, nose, and eyes result in loosening skin, sunken eyes, and a “skeletal” appearance. Bone loss, mostly around the mouth and chin, may become evident in your 50’s and 60’s, which causes the puckering of the skin around the mouth. Cartilage loss in the nose causes drooping of the nasal tip and accentuates the bony structures in your nose. Gravity, facial movement, and even sleep positions are the secondary factors that contribute to changes in your skin. When your skin loses its elasticity, gravity causes drooping of your eyebrows and eyelids, looseness and fullness under your cheeks and jaw (jowls and “double chin”), and you will have longer ear lobes.

Types of Wrinkles
Injection fillers can reduce the appearance of fine lines and wrinkles by adding volume to your skin. Cosmetic fillers are used to restore fullness that is naturally lost as fat diminishes from the face or they can be used to create stronger features. The first wrinkles you usually notice are the tiny lines around your eyelids and cheeks. With each passing year, these become more pronounced and new wrinkles appear as well. Before deciding which cosmetic filler treatment is best for you, it is important to understand that there are differences in facial wrinkles.

The three types of wrinkles are:

  • Dynamic Wrinkles are caused when we use our muscles to form facial expressions. Smiling or frowning causes your skin to contract, forming lines between the muscles. The most common location for dynamic wrinkles is between your eyebrows or the outer corners of your eyes (crow’s feet). When you are young, your skin easily returns to its original position but as you age, dynamic wrinkles remain and form static wrinkles. Injectable fillers weaken your muscles, which cause a reduction in the severity of wrinkles, and sometimes it can prevent them from forming altogether.
  • Static Wrinkles are the wrinkles and folds that are noticeable when you are not forming facial expressions. They occur as you age because collagen, elastin, and hyaluronic acid decrease. This loss means your skin is less able to spring back to its original position.
  • Wrinkle Folds are caused by the sagging of your underlying facial structure, which causes deep grooves between your nose and mouth known as the naso-labial groove. This type of wrinkle can be temporarily corrected by plumping up the groove from beneath the skin with substances like collagen or hyaluronic acid derivatives. Another alternative to correcting the wrinkle fold is fat transfer where your own fat is removed from one area and injected into the area where fullness is desired.

Most people have a combination of all three types of facial wrinkles but regardless of your wrinkle type and your desired degree of correction, there is a solution available for you. The face is a unique anatomic region of the human body. It is the only part of the body where muscle activity directly causes your skin to move, because facial muscles are attached to your facial skin. In all other areas of the body, muscles only attach to the bones. Dr. Moelleken knows facial anatomy best. Lines on the face are of two distinct types; Static Lines or Dynamic Lines and each type of line requires treatment with a different product. If the wrong product is chosen, the result will be less than optimal.

Static Lines are lines that are always present, regardless of whether your face is at rest or in motion. They are present when you are awake or asleep. Dynamic Lines only appear when your face is put into motion. When you smile, “crow’s feet” lines appear next to your eyes and when your eyebrows are raised, transverse lines across your forehead appear. When you squint, vertical lines between your eyebrows appear.

Types of Cosmetic Injectables
Injectables are also known as facial and dermal fillers and they are temporary to long-lasting solutions administered through a few tiny injections on specific areas of the face. Various types of facial fillers are available in the United States; each is designed with one or several purposes.

From the standpoint of using minimally invasive techniques to treat facial wrinkles, there are two general classes of injectables:

Neuromuscular Toxins
This option, which is most appropriate for active lines or age associated wrinkles that are just starting to appear, is to temporarily weaken or paralyze the muscle that is causing your wrinkle. Botulinum Toxin type A is a family of neurotoxins that block nerve signals that cause muscles to contract. The toxin works directly where it is placed, and thus can be artistically used to alter facial expressions. Botox Cosmetic® is widely recognized, and was the first neurotoxin to be approved for cosmetic use in the United States. The clinical effects of Botox Cosmetic® typically last three to four months and risks include bruising at the injection site, rare chance of an infection, and the possibility of unintentionally affecting nearby muscle groups. Specific risks will be discussed with during your consultation when you consider this treatment.

Soft Tissue Fillers
The second class of injectable treatments is the soft tissue fillers. This group is rapidly expanding, and many options are available. These injectables are more useful for treatment of firmly established wrinkles or larger lines of facial aging (such as the nasolabial folds). Fillers restore volume to your face and can add structure as well. Depending on the type of filler and the depth at which it is injected, you can smooth out fine lines on the surface of your skin, fill out deep lines such as your nasolabial folds, augment soft tissues such as your lips, or even effectively augment facial bone structure. All of these injectable fillers are placed by an injection so they carry the usual risks of bruising, lumpiness, redness, product specific adverse reactions, and in rare cases, local infections.

Many options are available in the filler class, with clinical differences being predominantly governed by how long the effects last, as well as how the filler feels. Very soft fillers tend to have a shorter duration of effect, while fillers that last longer tend to have more structure and are better suited in regions where they will not be palpable. In the past, the most widely used fillers were based on collagen with sources ranging from bovine to human.

A more recent class of fillers is based on hyaluronic acid (HA), which is a sugar, found naturally in human skin. When first introduced, a major benefit of this filler class is that allergic reactions are extremely rare, and no pre-treatment skin testing is necessary. These compounds bind water similar to the way a sponge absorbs water and because of this, they hydrate your skin in the treated region. Several manufacturers have versions of HA fillers, and the formulations vary with the size of molecules and other components of the injectate, such as local anesthetic to help decrease the discomfort associated with injections. The various formulations expand your choice of options available as certain products are better suited for different anatomical regions. Formulations with smaller particle sizes tend to be softer and smoother and work well in regions such as the lips. Larger particles have more structure and are best suited for deep folds such as your nasolabial creases.

A newer class of fillers has been introduced that is based on microsphere technology. Microspheres are tiny round particles of solid material that are relatively uniform in size. These products are used for volume replacement and for deep facial wrinkles but are not approved for use in the lips.

Filler Categories
The Food and Drug Administration (FDA) approve injectable cosmetic wrinkle fillers as medical devices. These devices are injected into your skin and most of these wrinkle fillers are temporary because your body eventually absorbs them. The FDA has approved absorbable injectable cosmetic wrinkle fillers for correcting soft tissue contour defects, such as moderate and severe wrinkles and folds. Wrinkle fillers are made of various types of materials, and some include a combination of products. Some products also contain lidocaine, which will numb your skin at the injection site during your procedure.

Cosmetic fillers can be divided into three categories:

  • Temporary, which last a few weeks or months
  • Semi-permanent. which last six to twelve months
  • Permanent.

Fillers are derived from animal sources, donated human sources, or they can be completely synthetic.

The materials used in injectable cosmetic wrinkle fillers include:

Temporary (absorbable) Fillers

  • Collagen injections are made of highly purified cow or human collagen. Collagen is a natural protein that is a major component of skin and other tissues in the body.
  • Calcium Hydroxylapatite is a mineral that is a major component of bone. Calcium hydroxylapatite is a well-matched (biocompatible) material that dissolves in your body (biodegradable) and is implanted in the form of a gel.
  • Poly-L-lactic Acid (PLLA) is a biodegradable, biocompatible, synthetic material from the alpha-hydroxy-acid family that has been widely used for many years in dissolvable stitches and bone screws.
  • Hyaluronic Acid Gel is a protective lubricating gel, produced naturally by your body that binds with water to plump your skin. Hyaluronic acid is the most prominent glycosaminoglycan in the skin. A natural complex sugar found in all living cells, Hyaluronic acid binds to water and when injected into your skin, it softens, hydrates, and volumizes, and plays a role in cell growth by stabilizing intercellular structures. Hyaluronic acid adds volume to the spaces between the collagen and elastin fibers in your skin that you lose during the aging process. These benefits make hyaluronic acid an excellent dermal filling agent and because it is identical in all species, the risk of an allergic reaction is remote. Hyaluronic acid’s natural form is a liquid state but through the process of cross-linking; it has been formulated into a variety of clear and concentrated gel products. Hyaluronic acid fillers have emerged as the leader of dermal filling agents for soft tissue augmentation because of their superior cosmetic results.

It is important to realize that dermal fillers are not permanent. Even the semi-permanent procedures eventually require re-treatments and the way your face ages and your body absorbs fillers will determine how often you need maintenance. If you choose not to continue treatments, your appearance will return to its original condition allowing your wrinkles and scars to return. Dermal fillers are wonderful because of how they rejuvenate your appearance but they cannot stop the aging process. If you want a permanent solution, you should talk to Dr. Moelleken but until you are ready for a surgical procedure, choosing a cosmetic injection treatment will allow you to see impressive changes in your appearance.

Permanent (non-absorbable) Fillers

Polymethylmethacrylate Beads (PMMA microspheres) are tiny round, smooth plastic particles that have been tested to be biocompatible however, your body does not absorb them.

Fat Transfer is another permanent solution that comes directly from your own body so there is no chance of allergy or rejection. Fat transfer is also known as fat grafting, fat transplantation, or fat injection.

Dr. Moelleken has innovated LiveFill™, disarticulated fascial fat grafts, a method of permanently augmenting areas of hollowness in the face, and of increasing lip fullness. The LiveFill™ method has many advantages over conventional fat injection, including higher survival rates and much less swelling postoperatively. The results of his studies have been published in the journal Plastic and Reconstructive Surgery, have been presented at several international meetings, and have appeared on numerous local and national television segments. Dr. Moelleken is an Attending Surgeon in the Division of Plastic and Reconstructive Surgery at UCLA, where he often performs surgeries and teaches residents. Dr. Moelleken believes that art and perspective comprise 30% of the surgical equation, while the other 70% come from unhurried, compassionate surgical judgment, knowledge, and technique.

Risks
As with any medical treatment, getting injected with cosmetic wrinkle fillers is an elective procedure and it poses risks.

Complications are rare but possible side effects include:

  • Infection
  • Headache
  • Skin Tightness
  • Bruising
  • Redness
  • Pain
  • Tenderness
  • Itching and Rash
  • Sore at the Injection Site

Most side effects occur shortly after injection and disappear within seven days.

Cosmetic Injectables Procedure
Everyday you are busy fulfilling your many roles in life so when you look in the mirror and the person staring back seems worn-out and exhausted, at first you may ignore it. You do not feel older so you are sure your appearance is just a result of your grueling routine then other people start commenting on how tired you look too. After hearing the remark over-and-over, you realize that you do look older and being tired has nothing to do with it because age is finally catching up and it is showing on your face.

In today’s society, looking good and feeling good go hand-in-hand so with excitement and apprehension, so you start weighing your options. Invasive procedures, non-invasive procedures, recovery time, expense, general anesthesia, possible risks, and wondering what people will say or think fill your thoughts. You know you have arrived at a point where you have to do something but the choices are confusing and intimidating.
Once you decide you might want a cosmetic injectable, the first step is to schedule a consultation with Dr. Moelleken and he will listen to all of your concerns and desired goals. After a thorough examination of your face, he will evaluate your skin before deciding what options would work best for you. The day of the treatment, Dr. Moelleken will mark strategic points on your face and use them as guides to treat the appropriate injection sites. Your injection sites will then be cleaned with an antibacterial agent before a topical anesthetic agent will be applied to numb the area. (In some cases, injections already include an anesthetic in their mixture.) The actual injections will take a few seconds per site with the entire procedure taking a few minutes. The marks will then be washed away and you will be offered an ice pack to reduce temporary swelling or discomfort. Scars and deep lines will often require multiple or deeper injections and in this case, to be more comfortable you will be offered a local anesthetic. It is important that you have realistic expectations about the benefits you want to achieve with cosmetic fillers and this is something Dr. Tabas will discuss with you during your first consultation. The way your face continues to age will determine the timing of repeat treatments and if you decide not to re-treat, your appearance will eventually return to its original condition.

Cosmetic Injectables Benefits
With so many options available in the world of cosmetic fillers, when it comes to selecting an anti-aging treatment it is hard not to consider the use of cosmetic injectables. After injected into the area of concern, cosmetic injectables will instantly fill and plump your skin making it smooth and wrinkle free. The simplest and least expensive method of facial contouring is with the use of injectable fillers. Although the results are not permanent, cosmetic fillers help you restore your skin’s natural beauty in a procedure lasting from five to fifteen minutes. Skin Injectables can be used for people who are just beginning to show signs of facial aging, but do not want to use cosmetic surgery to enhance their appearance.

The benefits of Injectables include:

  • Being able to have the treatment in one or two visits because many treatments are now marketed as ‘lunchtime appointments’ suggesting that treatment is quick and simple.
  • The Injectable is normally administered through a small gauge needle so discomfort is minimal and no anesthetic may be needed. With some treatments, a topical anesthetic may be necessary depending on the sensitivity of the area being treated and what you prefer.
  • Results tend to be fairly instant with minimal bruising, redness, or swelling.

The disadvantages of Injectables include:

  • Having repeat treatments every several months in order to maintain the visual benefits.
  • The cost implications of repeated treatments.

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