Injectables

Introduction

Cosmetic surgical procedures are widely performed for producing profound, long lasting changes in facial appearance. However, these procedures are invasive and have a significant associated recovery period. Many patients are just in beginning phase of signs of facial aging, but desire improvement. These patients are not justifiable candidates for the cost or time investment required for surgical intervention. For these patients, the rapidly expanding use of injectable treatments is perfect as it suits their needs. Injectables can be utilized during an office visit as an outpatient treatment and there is no need of a trip to the operating room. With some treatments, no anesthetic medication is necessary, as the needles utilized are so small that they cause minimal discomfort or pain. Some procedures require topical anesthetic agents or nerve blocks, depending on the patient’s preference and the sensitivity of the area being treated.

Two general classes of injectables are available, based on the principle of minimally invasive technique to treat facial wrinkles:

Soft tissue fillers

Many options are available in this type and it is still rapidly expanding. These injectables are usually more useful for treatment of firmly established old wrinkles or larger lines of facial aging such as the nasolabial folds. Fillers restore volume of the face and can add some structure as well. Depending on the type of filler and the depth at which it is injected, there are various uses of this technique. These are to smooth out fine lines on the surface of the skin, to fill out deep lines such as nasolabial folds, to augment soft tissues such as the lips, or to effectively augment facial bone structure. All of these injectable fillers are placed in the treatment area by an injection, so this group carries usual risks of bruising, lumpiness, redness, product specific adverse reactions, and sometimes local infections.

The technique of injection is appropriate for active facial lines or age associated wrinkles which are just starting to appear.

Many options are available in the filler class. The differences are predominantly influenced by how long the effects last, as well as how the filler feels to the patient. Very soft fillers are suitable for locations such as the lips and tend to have a shorter duration of effect. The fillers which last longer usually gives more structure and are better for regions where they are not easily palpable(such as the nasolabial folds). Previously, the most widely used fillers were based on collagen, with sources ranging from bovine to human. Skin testing may be necessary for some collagen injectable formulations, so as to confirm that there is no allergic response to the filler. The longevity of collagen based fillers is about 3 to 6 months, and they give a very natural feel when used for certain indications.

Neuromascular toxins

The technique of injection is appropriate for active facial lines or age associated wrinkles which are just starting to appear. This toxin temporarily weakens or paralyses the muscles that are causing the wrinkles. Botulinum Toxin type A is a group of neurotoxins that block the nerve signals which stimulate the muscles to contract. The toxin works directly at the site it is placed, and thus can be artistically used to improve the facial expressions. It is known as Botox widely, and it is the first neurotoxin to be used for cosmetic purpose. New manufacturers are also producing various toxins for use in the near future. These different varieties are differentiated by the time to onset, duration of effect, and the distance of effect from the injection site. There are some risks involved in injecting botulinum Toxin such as bruising at the injection site, sometimes chances of an infection, and the possibility of affecting unwanted muscle groups near the injection site. These risks should be discussed with the injector before considering treatment.

Suggestions:

Although there are many options available in injectables, there is no one best product for any particular use. It is prudent to discuss before the procedure with the doctor about the suitable injectable, areas of concern, and risks involved. Before considering soft tissue fillers, first a trial of a short acting agent is recommended to be certain about the effects of treatment before utilizing longer acting agents. The physician can recommend a filler or neuromuscular agent that gives good results in his hands, but the patient should choose a treatment regime that matches the desires.