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With the multitude of treatments available today that can assist with facial rejuvenation, injectables are among the most popular and are a favorite among patients. These procedures are minimally invasive with very little down time, provide long-lasting results, and easily complement many other procedures (eg: lasers, facials, and microneedling). Their anti-aging benefits have very high patient satisfaction, and have surged in popularity in recent years thanks to their safety profile and growing prevalence among celebrities. Injectables have a long history of effectiveness for both men and women. They can be used to reverse the effects of aging for patients in the middle-aged range and above. In addition, they are beneficial for younger patients in their 20’s and 30’s as well in order to prevent those aging effects from developing in the first place.
There are a variety of injectables available on the market, and it can be a bit overwhelming to determine which treatment to select out of the plethora of options. To help make things a bit easier to understand, injectables can usually be classified into one of two main categories – neuromodulators and dermal fillers. There are a couple of other injectable treatments available as well that don’t fit as well into one of those two main categories, but these are few when compared to the majority of products available on the market.
When certain muscles in the face are activated, they create deep wrinkles and lines that do not otherwise appear while those facial muscles are at rest. Examples of these kinds of wrinkles include lines between the eyebrows while frowning (the so-called “elevens”), and crow’s feet around the eyes while smiling. After years of repeated activation of these muscles, the wrinkles and lines eventually set in and stay in view even while the muscles aren’t activated. Neuromodulators, which are the first category of injectables, are intended to stop the movement of these specific muscles in order to prevent these wrinkles and lines from setting in.
Neuromodulators do not fill in or add volume to wrinkles that appear while the muscles are at rest. Instead, they are designed to stop the movement of targeted facial muscles. The injected muscles are relaxed and are unable to contract while under the effects of these neuromodulators, and the wrinkles that normally appear during expressive movements are not created. This process then reduces the deepness of facial wrinkles and folds that would otherwise set in these areas as time goes on. While neuromodulators are not reversible, they wear off within a few months naturally in the body, and follow up treatments will be needed to continue the effects.
Dr. Behroozan offers the following neuromodulators:
Additionally, neuromodulators such as Botox also have the benefit of being used to treat excessive sweating in the scalp, underarms, palms, and feet.
The second main category of injectables is classified as dermal fillers (also known as soft tissue fillers). This category of injectables is designed to “fill in” wrinkles and lines that are visible while the facial muscles are at rest. Dermal fillers target the mid dermis to restore lost volume to these wrinkles and lines, but can also be used to add additional contouring to other targeted areas, such as hollowness in the cheekbones or plumpness in the lips.
There are numerous dermal fillers available on the market. The most common fillers, such as Juvéderm and Restylane, are composed of hyaluronic acid, which is a substance naturally produced in the skin. This substance is known as “nature’s moisturizer,” and binds moisture 1,000 times its own weight in water in order to keep the skin plump and hydrated. These fillers are soft and gel-like in appearance, and allergy testing for these fillers is usually not needed. Results last between 6-12 months on average before the body naturally breaks them down, and they are often infused with lidocaine to reduce discomfort during and after the treatment. Higher levels of hyaluronic acid in the body lead to more skin hydration, joint lubrication, inflammation protection, and better immune regulation. These fillers are recommended for patients who are newer to fillers, and are completely reversible via the use of a special solution that can break down the filler instantly.
Some fillers, such as Radiesse, are based on calcium hydroxylapatite, which is a substance that is naturally found in the bones. These particles are almost microscopic and are contained in a smooth gel that is a bit thicker than fillers based on hyaluronic acid. As a result, they last a bit longer – usually around 12 months or longer on average. These types of fillers have the benefit of stimulating natural collagen production, which makes them a great option for lines and wrinkles that are very deep in the skin. Because calcium hydroxylapatite is found in the bones, these fillers are also a great option for improving volume loss in the hands as well.
Fillers such as Sculptra Aesthetic are based on poly-L-lactic acid, which is a biodegradable synthetic filler based on a natural substance produced by the body after exercise and other active movements. This substance has been used medically for many years, such as in dissolvable stitches. These kinds of fillers are collagen stimulators, and help your skin naturally rebuild collagen in order to smoothen fine lines and wrinkles that are embedded a bit deeper in the skin. While the gel dissipates a few days after treatments, the results can last 2 years or more on average.
Firmer fillers are suitable for areas such as the cheekbones and temples, whereas some of the more flexible fillers are used for areas that have movement during expression, such as the nasolabial folds.
Dr. Behroozan offers the following dermal fillers:
There are a couple of injectable treatments available that are not classified as a neuromodulator or dermal filler. These treatments have specific uses that don’t treat wrinkles directly, but assist with facial rejuvenation in other ways:
Kybella – This treatment contains deoxycholic acid, and is FDA approved to reduce the amount of submental fat under the chin (colloquially known as “double chin”). Kybella dissolves pockets of fat in the areas in which it is injected by breaking down and absorbing unwanted body fat.
PRP Injections (aka the Vampire Facial) – PRP Injections have grown rapidly in popularity the past few years thanks to its spread among celebrities. This procedure uses the platelets in your own blood that are then injected into the face. In addition to reducing the appearance of wrinkles over time, this treatment also has the benefit of tightening and brightening the skin in order to give you a more youthful appearance with an extra glow and vibrancy. Because this treatment involves your own blood, it is 100% natural and is safe for all patients.
Anyone who is looking to rejuvenate their facial features is a great candidate for injectable treatments. While the results are not permanent, almost all treatments take only a few minutes to perform, and they are a cost effective way to see results quickly that will last for many months.
Because these treatments are non-surgical, these are excellent for those who cannot afford to endure large periods of downtime that typically follow surgery. Because the results don’t take long to start appearing, they are a favorite for candidates who have upcoming events such as weddings and other ceremonies that patients wish to look their absolute best for.
Injectables have different roles depending on the type selected. Some of the most common concerns patients wish to address are:
It is important to note that there is no set time to “start” receiving injectable treatments. Instead, they should be viewed as a part of a skin care plan that is developed with you and your dermatologist to address your concerns during regular visits. Developing your treatment plan earlier allows you to start fighting off the effects of aging before they happen as opposed to beginning everything all at once after the aging effects have already started to kick in.
The product and treatment selected depends on what your goals are. As a general guideline:
Because injectable treatments are so versatile, patients who do not have very visible wrinkles and lines can still be great candidates as well. As the natural aging process develops, previously unnoticeable features such as acne scars can become more visible as the skin loses its elasticity and wrinkles form around them.
Neuromodulators such as Botox are also used to reduce excessive sweating in the underarms, scalp, palms, and feet.
PRP injections are also used to help reverse the effects of aging-related hair loss.
Certain conditions such as sun damage speed up the aging process up even more, and many anti-aging creams and products usually only address the uppermost layers of the skin instead of being able to penetrate the deeper layers below. Thus, the use of certain injectable treatments can be used to complement an existing skin care regimen or other skin care procedures such as laser treatments, microneedling, and microdermabrasion. Neuromodulators and dermal fillers are also frequently performed at the same time for many patients.
There is no downtime with injectable treatments. After your injectable treatment has been performed, it is possible to experience mild bleeding, swelling, and slight discomfort around the area where the injection took place. These are all normal, and are usually short in duration (wearing off within 24 hours most of the time). Many patients report that these aftereffects aren’t nearly as bad as they had initially anticipated, and go back to work or hit the gym the same day that they receive their treatments.
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As a general rule of thumb, the denser the product is and/or the more deeply it is injected, the longer it will last. Certain factors can affect this, such as the product, area of injection, and the patient’s natural healing process. Synthetic fillers tend to last longer as the body does not absorb these. Because these fillers last for a longer period of time, it is imperative to find someone who knows how to perform these injections correctly to ensure satisfactory results.
During your injectable treatment, the process normally goes as follows:
Injectable treatments are not permanent, and will wear off as time passes. How long each filler lasts varies, as this depends on many factors. The timeframes mentioned are a rough average based on controlled tests. The results wear off gradually as opposed to wearing off all at once, and are not a “here today, gone tomorrow” situation; therefore, when patients notice that the results are beginning to diminish, they can then begin to plan out when their next treatment session will be.
Receiving touchup treatments every couple of months is recommended. Doing so spreads out the cost, minimizes any trauma to the injection site, and creates a more natural progression in results. For instance, receiving Botox treatments every 3 months in the beginning allows the muscle memory that creates forehead wrinkles to fade. Over time, a patient may be able to go from treating every 3 months to then treating every 4 months, then to 5 months, then to 6, etc.
A common myth is that injectable treatments make you look as if you’ve had work done. This is incorrect. This only applies for treatments that have not been performed artistically and/or skillfully. Bad work is noticeable. You may have noticed that well done treatments aren’t talked about as much. This is because good work is not supposed to be noticeable. Injectable treatments are about rejuvenating your looks instead of trying to make you look different. Doing this properly requires a thorough understanding of facial anatomy, as well as the natural proportions of YOUR own face. Every person’s facial shape and features are customized, and skill is required in order to ensure that treatment is adjusted to address your unique composition.
Remember – injectables are only one component of a full skin care regimen, and should not be something that is intended to be performed all on its own. In addition to performing your injectable treatment, Dr. Behroozan will assist you in developing a full skin care regimen to be used in conjunction with your injectable treatment in order to ensure that your skin is healthy and looking its best.
Injectable treatments are quick to perform, and the effects are long lasting; however, dissatisfaction with results is possible, and is most prevalent when performed by an injector who has not had the adequate experience. It is unfortunately very common for these treatments to be performed incorrectly. The biggest cause of unsatisfactory injection results is not the filler being used, but rather the technique of the injector. The skill level of the person performing the injection is the biggest factor to consider for your treatment – arguably moreso than the kind of injectable received. It is crucial to select a provider that has ample experience in order to ensure safety, satisfaction, and longevity. Even though these treatments are non-surgical, it is recommended to give these the same level of thought and due diligence as you would a surgical procedure.
For instance, Botox that is improperly injected can cause drooping of the brows. Dermal fillers that have not been artfully injected can cause asymmetry and too much volume in areas that cause the face to look unnatural. Injections in the cheeks require particular skill, as there is a fine line between a lifted, artfully sculpted look vs. having huge unnatural and bumpy looking cheeks while smiling.
Dr. Behroozan is board certified by the American Board of Dermatology, and has extensive experience with all variations of injectable treatments. He has been performing these procedures for thousands of patients for over 15 years.
Every procedure has its share of risks, and injectables are no exception. While complications are rare, they are possible and they are something you should be aware of. Receiving your injectable treatment from a board certified physician, such as Dr. Behroozan, ensures that proper technique and medical protocol is used. This will minimize your chances of any possible complications occurring.
Possible complications include persistent bleeding, soft tissue loss, and unintended effects on non-targeted areas (especially with neuromodulators). Other possibilities include infection. Allergic reactions are rare, but are also possible. It is important to let your physician know which medications you are taking prior to receiving your injectable treatment. Even rarer complications with dermal fillers can include stroke or even blindness.
A big red flag to be wary of is when you see large discounts being offered on injectable products. Often, this can mean that you are receiving diluted product that wears off quickly and won’t have long-lasting results. Large discounts on injectables can also mean that the treatment will be performed by someone inexperienced, which carries a much higher risk of complications or unsatisfactory results.
Alternatively, there have been instances where providers are offering knockoff products in order to lower costs. It is NOT advised to use these alternative products. For safety reasons, be sure to only use certified, approved products. These certified products have been tested extensively for safety, and also have the best chance of providing you with the best results. NEVER put your safety at risk by receiving injectable treatments from products that you have not done research on, or that are not certified.
Dr. Behroozan only uses authentic products that are obtained directly from the official manufacturers, and will always prioritize patient safety as his #1 concern through proper medical technique and official products.
While signs of aging are inevitable, they can actually be reversed by visiting a board-certified dermatologist with training in dermal fillers. Cosmetic and injection specialist Dr. Behroozan features the best dermal injectables for your particular skin care concerns. Whether you have wrinkles, hollow cheeks, or a saggy chin, the expert can enhance your appearance. Explore the fillers below to discover more about the exciting treatments we offer at our Southern California facilities!
Morpheus 8Morpheus 8 Basics