The 21st Century has introduced new aesthetic procedures to help combat the signs of aging. Although these new minor procedures are just that, minor, they cannot replace the traditional surgical procedures that produce permanent, longer lasting results. Most new cosmetic consumers are often confused which is right for them: Botox® or Juvederm®? First, it is important to classify these two common cosmetic procedures as temporary. Neither Botox® nor Juvederm® should be considered if one is desiring a permanent cosmetic result.
When Botox® isn’t enough or the patient seeks a temporary improvement of wrinkles around the mouth and frown lines, artificial fillers such as Juvederm® are available. Artificial cosmetic injectables come in variations of thickness and are injected into fine lines and wrinkles to help reduce their appearance. Contrary to many false claims, artificial fillers are temporary and should not be expected to last longer than 6 months.Juvederm, like most artificial fillers, is hyaluronic acid which does not require prior sensitivity testing. It is important to note that hyaluronic acid fillers do not replace the more natural and permanent autologous fat grafting.
Some patients may require cold compresses for the first few hours after receiving Botox® cosmetic injections. You may experience some mild tingly sensations to the area treatment. A few patients experience a mild headache.
The average cost for Botox® begins at $175 depending on how much is needed. A complete/full forehead of Botox® injections can cost up to $500.
Botox® doesn't actually lift or tighten skin, nor is it a facial filler. Botox® temporarily paralyzes facial muscles so that those treated muscles cannot animate the skin to create wrinkles. Botox® is not used for facial wrinkles such as nasolabial folds.
Botox® lasts up to 6 months, but over time patients may need to re-treat sooner than 6 months. The Billiant Distinctions® awards program will allow rewards to be gained and used at three months post treatment.
Some patients may prefer temporary cosmetic injectables for facial lines and lip enhancement. Juvederm® by Allergan comes in a variety of formulas depending on the area to be injected and according to how long you wish the facial filler to last.
The cost of Juvederm® depends on which Juvederm® product and how much you will need to achieve the desired result. Most patients start off with Juvederm Ultra XC® in the beginning to see if they like the result. If the patient desires for the product to last longer in the cheek area, then Juvederm Voluma is preferred but costs more.
Juvederm costs per syringe are as follows:
The cost for lip injections begins at $400 for a 1/2cc syringe of Juvederm Volbella®. Most patients prefer a full 1cc syringe to achieve upper and lower lip fullness ($700 regular price). For a more permanent and natural appearing solution using your own fat, please visit Dr. Howard's lip augmentation page.
There are dozens of cosmetic injectable facial fillers in development at this time. The sheer number of fillers indicates that the perfect material, composition, thickness, and longevity are under evolution and each practitioner must use his or her judgment regarding which is best for an individual patient. The longevity of the material has increased from several weeks to 3 or more months but in all circumstances the foreign material fillers (Restylane, Juvederm, Radiesse) are temporary. There will always be a place for the temporary injectable filler as a touch-up procedure with minimal or no down-time. The multiple injections of foreign material in the lips or for deep wrinkles will eventually cause subcutaneous scars which manifest themselves as thickness. The overall take of the material changes over time so that the result is less predictable. One of the best uses of Juvederm, or its equivalent, is to obtain a temporary lip enhancement that allows the patient and surgeon to determine how much fullness is desired.
In the instance that the lips are too full or too pouty the material will resorb over a period of time so that over-estimating volume is not permanent and some idea of the desired enhancement is visually determined. Photos of the lips at the desired fullness can then be used as a template for the more elegant and permanent autologous fat injections. Temporary fillers are always a good choice for the patients who are undecided about lip enhancement and need visual clues, if only temporary, to make an informed decision regarding a permanent procedure. The treatment of deep wrinkles usually involves either temporary or permanent filler injection in conjunction with for facial muscle relaxation. The overuse of as a temporary wrinkle treatment has created what is called a mask face, paralyzing or weakening the facial muscles causing an unnaturally smooth visage with little or no facial expression. The expressionless, or static, face photographs well but facial expressions are necessary to show emotion, a nice trait to have when communicating with other humans.
What are the characteristics of the “perfect” facial filler? Permanency, reproducibility, naturalness, affordability, and minimal down-time are a few of the most desirable traits for a facial filler. In principle, which filler addresses the cause of volume loss in the aging face? The applicable plastic surgery principle tells us to replace lost tissue with tissue in kind: bone for bone, cartilage for cartilage, skin for skin, and fat for fat. These are plastic surgery principles which apply equally to reconstructive and cosmetic surgery and should be headed if at all possible, moreover a lack of surgical skill is no excuse for lack of principle. Fillers that are not the best choice for the patient but are simply the most expedient for the surgeon are a poor choice and indefensible.
Stem Cell, or permanent fat injections (fat grafting), has been around for over two decades and is my prefered method for addressing the loss of volume in the aging face as well as other corrective deformities such as acne scars. The "take" of stem cell fat transfer is above 85%. It is natural appearing, natural feeling, and is permanent.
This procedure is performed in the privacy at Dr. Howard’s office under oral sedation. Dr. Howard will gently remove a small portion of fat from a predetermined area on your body such as the abdomen. This fat is then processed to purify the fat and remove unwanted by-products that surround the fat cells. The fat is then gently injected through tiny incisions. These tiny incisions equal the size of a 16 gauge needle and rarely require stitches.
Tape will be placed for a few days to allow the fat grafts to heal into place. Some swelling will be present by cool compresses are usually not necessary. Patient can shower but not get the tape wet until it has been removed in a few days. The stitches will be removed about 2 or 3 days after the procedure. Some patients may bruise from facial fat injections. Patients should not take any aspirin, Aleve, or Advil prodcuts for 2 weeks prior to this procedure to reduce bruising. Also, Dr. Howard highly recommends patients take two different herbal supplements before and after this procedure: Bromelein to prevent bruising and Arnica to help eliminate bruising.
The cost for this procedure begins at $1500.
Insurance does not cover this procedure. It is strictly cosmetic in nature.
Forever! Most people experience complete "take" of the fat transfer, but others sometimes desire additional fat grafting to achieve the desired result.
Fat grafting works by removing fat from one area of the body and transfering it to the desired area to enhance such as facial wrinkles, acne scars, and for lip augmentation. The grafted fat works exactly as artificial fillers to fill-in wrinkles and acne scars to reduce their appearance. Likewise, fat injections to the lips work to enhance the shape and volume of lips. In some cases, fat grafting alone will not achieve the desired cosmetic result to improve deep facial wrinkles and excess skin in the jowl areas. Dr. Howard may recommend a mini or full facelift to achieve the desired results.
Yes! Since no cosmetic procedure stops the aging process, facial fat grafting can be repeated as you age, or if you desire more fullness in a particular area such as the cheeks and/or lips.
For those patients not certain about fat grafting at first, Dr. Howard also offers Juvederm as a temporary alternative. In addition, Dr. Howard is a participating member of the Brilliant Distinctions progam that allows patients to earn points towards every Botox and Juvederm treatment for rewards and coupons towards future treatments.
Fat Grafting Myth: Fat grafting doesn't work. Dr. Howard has been one of the leader's in fat grafting for decades. Some doctors simply haven't figured out how to properly handle, process, and/or inject fat to get results. Dr. Howard has also noticed that fat grafting is less effective in patients who use nicotine products and consume alcoholic beverages on a regular basis. The quality of the fat cells are dependent on healthy stem cells for a good grafting result.