There are many potential improvements to be made to the aging face below the eyes. Some of the issues are at least partly hereditary and many just develop over time, as the face loses elastin and
collagen begins to break down. The youthful fat that makes a baby’s face so cherubic gradually disappears from some areas on the face, while at the same time
we may be struggling to keep it at bay in other areas of the body. Exposure to environmental hazards, such as UVA rays,
tobacco exposure, and other free radicals that assault our skin daily, also contributes to our problems.
At Rejuvena, we deploy a variety of minimally invasive techniques to correct or minimize these conditions. We target our treatment recommendations
to your specific needs and goals, as no two faces are the same. Moreover, as one person may desire full correction, another may just want to show a
minor improvement.
Cheek
Cheeks begin to lose their natural volume as we age, leading to a
tired, haggard or sad appearance. This also contributes to and is largely responsible for the dark circle appearance of the under-eye area. The smile
lines, also known as “crow’s feet” often extend out onto the cheek. The area between the nose and the corner of the mouth, or nasolabial fold, can be
deep, and may even extend under the corner of the mouth, leading to a “parentheses” look.
We treat the under-eye and cheek area in a variety of ways, depending on what is appropriate for you and your desired outcome. Advanced dermal fillers
such as Radiesse, Sculptra and Perlane will bring that fullness back to the cheek, eliminating the tired look that you see in the mirror, and largely
if not completely erasing dark circles under the eyes. Botox can be used to soften crows feet, alone or in conjunction with Fraxel II or one of our
other laser procedures. The resurfacing that is achieved with Fraxel provides tightening, as well as reduction of lines and créping. The number, mix
and depth of wrinkles, as well as your desired outcome, are all taken into consideration in treatment recommendations. In most cases, there is not
only an immediate improvement, but one that gets better over time.
Chin
Below the mouth, the chin may become prominent as the
area surrounding the chin shows volume depletion. This, combined with the gravitational movement of the cheek's fat pad (malar fat pad), creates
unattractive jowls.
For sagging jowls, we will use Thermage to lift and tighten, advanced dermal fillers precisely placed (depth and location), or minimally invasive
liposuction (Smartlipo) to remove fat pads and simultaneously tighten skin (or any combination of these therapies), depending upon the severity
and attributes of your particular condition.
Wrinkles and folds which can develop in the chin area are easily remedied. Beginning with the lines extending downward from the corners of the
mouth (puppet or Marionette lines) to the hollowing around the chin known as the pre-jowl sulcus, correction can be dramatic but subtle with properly
placed dermal fillers such as Radiesse. You may want to consider ArteFill to help you reduce your lifetime maintenance costs associated with these
corrections. We can also help the chin look less prominent (“witch chin”) and reduce lines and the orange peel (peau d’orange) look with a small
amount of Botox strategically placed. This problem is also helped with Fraxel, but like the forehead, may respond less to laser resurfacing than
other areas of the face, due to the muscular component. The area immediately under the chin (the submentum, can be best be treated with Thermage
(for tightening only), or laser liposuction (Smartlipo), for reducing and tightening.
Neck
On the neck, many patients complain of horizontal (“necklace”) lines and crêping, but the most frequently heard complaint is sagging, or the dreaded “gobbler” look.
Treatment options include Fraxel II, Thermage, laser lipolysis with Smartlipo, or combination therapy, including Botox.
Another problem that plagues many patients is the second or third chin--too much fat. We have had some remarkable results in treating excess fat with Smartlipo, which not only removes fat, but tightens the skin around the neck at the same time. See our Smartlipo/VASER section for more information.
All of our treatment regimens are minimally invasive and patients usually resume their normal routines almost immediately after treatment.
At Rejuvena, we do not charge for consultations. To schedule your free consultation, please email or call us at (405)842-1100.
Q: What is the difference between Botox and a dermal filler (such as Radiesse and Restylane)?
A: Botox relaxes the muscles that cause wrinkles. Dermal fillers are used to fill sunken areas and deep wrinkles (i.e., they occupy space)
and act as a bio-stimulant of new collagen and elastin production. Each filler works and acts a little differently than the others, and the
decision of which to use is dependent upon the patient’s desires, the type of wrinkles being treated and the actions of the specific dermal filler.
It is common to use a combination of Botox and one (or more) dermal fillers to achieve the desired result. In the initial consultation,
we will evaluate and recommend a treatment plan tailored to your specific needs.
Q: What are the differences between the various dermal fillers?
A: Restylane and Juvéderm are composed of hyaluronic acid (HA), which is a sugar molecule found naturally in the body.
They are used generally for more superficial issues, such as vertical lip lines (“smoker’s” lines) and in the lip itself. Denser versions
of the HA’s, Juvederm Plus and Perlane, as well as a calcium-based filler, Radiesse, are used deeper in the skin layers, and are ideal for correcting the
pre-jowl sulcus and deeper nasolabial folds, and are perfect for cheek augmentation. Radiesse is composed of calcium hydroxyapatite,
which is a component of bone and is also found naturally in the body It stays soft when injected into soft tissues. Sculptra is a
poly-l-lactic acid which is a biocompatible polymer. It is placed just beneath the skin and stimulates a collagen meshwork that
supports the skin, making it thicker and tighter. Sculptra is usually placed mid-face and on the jawline from the chin to the temples.
It very subtly and naturally fills in concavities, and eliminates some of the hollows associated with an aged face. ArteFill is
a combination of precision-filtered microspheres, suspended in purified bovine collagen, which also stimulates the body’s production
of a collagen support meshwork. It lasts for an extended period of time.
Q: How long do the dermal fillers last?
A: Some of the fillers last longer than others. For example, Restylane and Juvéderm show more immediate results that slowly
decline over four to nine months. Radiesse shows an instant result as well, but tends to show improvement to the smoothness of the
skin for up to three months (the bio-stimulant effect) and then lasts for another six to eighteen months, depending on the area placed
and the depth of placement. Sculptra does not show an immediate effect; its’ collagen layer takes several months for maximal result,
but lasts for about two years. Sculptra is usually administered in a series of treatments.
ArteFill lasts at least
five years, as it continually assists your body in building collagen in the area of placement. It is very important that the doctor
administering ArteFill has performed hundreds of previous dermal filler procedures, including procedures with one of the longer
lasting dermal fillers, such as Radiesse or Sculptra.
In the initial consultation, we will evaluate and recommend a treatment tailored to your specific needs.
Q: How do you decide which filler to use?
A: If you have a good deal of laxity and wrinkles, and very thin skin, you
might benefit from several different products, starting with Sculptra to build the framework (think in terms of building a house).
Then the more deeply placed fillers, Perlane and Radiesse may be used for cheek and jowl augmentation. This can be thought of as putting
up the walls of the house. ArteFill is the most cost effective and enduring treatment for deep lines and folds. Then the HA’s (Juvéderm and Restylane) can be used as the finishing trimwork, for fine line correction and lip enhancing just to
mention a few. This is another reason why extensive experience with different types of dermal fillers, not just one or two, is so important.
Q: Are these procedures safe?
A: The safety record of dermal fillers is excellent. They are all FDA approved for facial injections and have been used internationally for years. The complication rate is far lower than surgery. With an experienced injector, side effects are typically minimal and may include
bruising, redness and swelling. Serious complications are very rare. We utilize pre and post treatment medications to reduce any side effects. When you come in for your
consultation, we will discuss what side effects you may expect.
Q: Do the procedures hurt?
A: Most patients tolerate treatments well. Depending on the treatment, we may utilize topical, local or dental anesthetics. Comfort is of
utmost importance at Rejuvena Cosmetic Medical Center, and Dr. Hardt will discuss this with you prior to your treatment.
Q: How soon will I see results?
A: With some procedures, you will see nearly immediate results. With others, the results take longer, given the properties of the
different products utilized. Botox takes a few days to two weeks to show
it’s effects. Lasers and Thermage results are maximized at three to six months. When we evaluate your specific needs and treatment recommendations, we will discuss the results you may
expect.
Q: When can I resume my normal, daily routine?
A: You will be able to resume your daily activities immediately. However, depending upon the treatment, you may experience bruising,
light swelling, or redness that can last a few days. Some patients experience no bruising, but a mild temporary swelling is normal.
There are certain steps you can take before and after your procedure to minimize these side effects. If they are a concern to you,
then we recommend concealers, such as Jane Iredale mineral make-up. Dr. Hardt, or a member of her experienced staff, will go over
these steps in detail.
Q: How often will I need maintenance treatments for Botox and dermal fillers?
A: The frequency of maintenance treatments, largely, depends on the product used, your metabolism and the experience of your doctor in
placing the product at the proper depth and location. We will discuss the likely frequency of
your specific maintenance treatments at your consultation.
Q: How often will I need maintenance treatments for Thermage, Fraxel II and Smartlipo?
A: With Thermage, you will likely need only one to three treatments for results that will last for an extended period of time, usually
three to five years. The more treatments you have, the longer your results will last. With Fraxel, you will need three to six treatments performed
three weeks apart to treat most conditions. With Smart Lipo®, you will usually need only 1 treatment, and sometimes a touch up after three months. Proper skincare and other health practices in general after treatment will also optimize the endurance of your treatments.
Q: I am afraid I might have a Botox brow droop, or end up looking unnatural.
A: here is always a possibility of a short-lived problem like this, but it is very rare and can be largely prevented by choosing an
experienced injector. Knowledge of muscle anatomy, willingness to listen to and understand what the patient hopes to achieve, and using
the “less is more” approach will almost guarantee you don’t have problems.
Q: How do I know about my doctor’s experience?
A: To help ascertain your doctor's experience, you might ask some of the following questions.
How long has your doctor been performing these procedures?
Is this one of the primary focuses of the physician’s practice?
Has your physician been trained in a specific technique; does your doctor sometimes train others?
Does your doctor attend frequent educational
events to stay current on the latest products and techniques?
Q: Do some doctors get more training in these procedures than others?
A: Yes, and this is another good question to ask your doctor. It is a common misconception that surgeons and dermatologists get
this training in school. These products came out long after most doctors’ began their careers and training is something they must
seek out on their own. Dr. Hardt attends frequent educational events and has obtained one-on-one training with some of the pioneers
in the field. She feels that no matter how much you know, you can always learn more. She has also trained other doctors on occasion.
Q: What can I expect during my consultation?
A: Dr. Hardt will sit down with you and ask you to point out what your concerns are. She will offer advice on what you “need” if you ask,
but does not attempt to deflate your ego or pressure you into a procedure. You might be asked to make facial expressions for her, and she
may palpate your face. She will make certain all of your questions have been satisfactorily answered before treatment begins. You may be
asked to postpone a treatment in order to temporarily discontinue medications or begin others.
Q: Why do you recommend one filler for the lip enhancement, and another for the under-eye area?
A: For optimal outcome, and endurance, different products may be chosen. For example, it is important to use a soft,
pliable filler (Juvéderm or Restylane) in the lip, and a more dense product (like Radiesse) to enhance the cheeks. Sculptra,
which is acts like a scaffold to hold up drooping skin, is not used for line correction, per se, but for lifting and filling. ArteFill is the most cost effective alternative for deep lines and folds.
Wrinkle Correction
