Injectables

Dr Kontis is a national trainer for Sculptra, Botox and Restylane.

Neurotoxins:

Botox/Dysport

Botox and Dysport are different formulations of botulinum toxin. Injection of this product directly into muscles causes their action to weaken. Because wrinkles are produced by the movement of certain facial muscles, weakening these specific muscles will reduce the production of wrinkles. Although some patients are averse to the idea of having a neurotoxin injected, there have been no serious complications reported when it is used cosmetically and injected by well-trained individuals.

The most common use of these products is for wrinkles between the eyes, across the forehead and for crow's feet. However, by combining our knowledge of facial anatomy and experience with the products, we are able to do "fancy" corrections such as lifting the corners of the mouth, reducing chin dimpling (known as 'orange peel chin"), and lifting the brow.

The injection procedure takes just a few minutes, and is virtually painless. The results last, on average, about 3-4 months.

Filling Agents

Restylane/Juvederm Ultra, Perlane/Juvederm Ultra Plus

These products are all different formulations of a naturally occurring skin polysaccharide, Hyaluronic Acid (HA).  These products are used to improve deep folds and lines on the face by 'filling in" the depressions or augmenting certain facial features. They can be used to fill in the cheek folds and the grooves under the eyes as well as augment the lips and cheekbones. 

The beauty of these products is that there is an "eraser" available should the results not be acceptable. A very small amount of enzyme is injected to the area and literally overnight the HA is completely dissolved. For anyone contemplating trying a filler product, or someone who is contemplating a permanent filler, I always suggest a trial of HA.

Injection of HA is rather uncomfortable, so often topical anesthetic agents, or even regional blocks can be sued.  New formulations of HA products now have anesthetic medicine (lidocaine) mixed with them. HA generally lasts about 6-8 months. Perlane and Juvederm Ultra plus are more concentrated and may last up to a year.

Top Restylane Doctor 2011

Top Juvederm Doctor 2011

Radiesse

Radiesse is a filling agent that is thicker than the HA products, and is made from a type of synthetic bone, called calcium hydroxylapatite. Because of its very thick quality, it is not used in the lips, but gives excellent augmentation in other areas of the face like the cheek folds and cheekbones.

Injection of Radiesse is slightly uncomfortable, so topical or regional anesthetic agents are often used.  I have found that this product lasts about a year in most patients.

Artefill

Artefill is the only filler that is "permanent."  This product consists of small spheres of a plastic-like material suspended in a bovine collagen base. Because of the bovine collagen, patients must undergo a skin test to ensure they are not allergic to collagen. This skin test is a small amount of product injected under the skin of the arm and watched by the patient for one month. If there is no evidence of allergic reaction (redness, swelling, pain, etc), then Artefill can be injected into the face.

Because of its permanent nature, I will only inject this product into the cheek folds, and only on patients who have tried a HA product in the past. Once injected, the collagen gradually breaks down and the microspheres become surrounded by the patient's own collagen, which increases over time. The results gradually improve, so that in 1 year, the results are better than those seen at 6 months.

Sculptra

Sculptra is not like any of the other filler agents.  This is a product that gives very gradual results, but those results last about 2-3 years. I use this for improving the hollowing of the face due to loss of subcutaneous fat, a normal aging process in the face.

This product is small crystals of the same synthetic material we use as absorbable sutures in surgery.  The crystals are rehydrated in water and injected under the skin. The injected water initially gives the face volume, but this is all reabsorbed in about 5-7 days, leaving behind the crystals. The body then builds collagen around the particles and this produces an increase in volume in the depressed areas, just like blowing up a partially deflated beach ball.

This product works gradually, and requires several treatments separated by 6 week intervals. Once the ideal correction is reached, the results are maintained for approximately 2 years.