Wrinkle Fillers And Treatments

Anti-wrinkle products have become very popular recently and are currently in extensive use. Some of these products, such as collagen (ZYDERM) and hyaluronic acid (JUVIDERM VOLUMA, RESTYLANE, PERLANE), fill the wrinkles and in doing so blur or conceal them, while others, such as botulinum toxin (BOTOX, DYSPORT) block neural impulses to the muscles in the injected area meaning that the muscles no longer contract involuntarily and the wrinkles are concealed.

Each of these anti-wrinkle fillers comes with its own set of advantages and disadvantages based on its properties and type. We will briefly review each of them, citing both advantages and disadvantages.

Silicone

The injection of silicone droplets for filling wrinkles or adding volume to the lips is a disputed method among physicians and has raised many objections. Although silicone is a stable substance that remains as is permanently, which is one of its advantages, the body may develop serious and persistent inflammation around the silicone droplets injected directly into the tissue and herein lies its biggest disadvantage. This inflammation may cause tissue deformation and severe aesthetic damage that last for many years.

Artecoll

Artecoll is a synthetic material consisting of microspheres and collagen solution. The microspheres are injected into the connective tissue, stimulate the connective tissue cells, and cause them to increase their collagen production. This substance is suitable for treating depressed scars, deep expression wrinkles, adding volume to the lips and filling depressions on the side of the nose.
The disadvantage: A skin test must be performed before any injection is made in order to verify that the patient is not allergic to collagen. Occasionally, persistent lumps may appear. Artecoll is not intended for eliminating delicate wrinkles. Optimal outcomes are observed three months after treatment.

Collagen

Collagen is a natural protein that is found in great quantities throughout the body’s tissues, mainly in skin, cartilage and bone. Collagen is an ideal solution for eliminating slight wrinkles that appear in young women between the ages of 30 – 40. A skin test must be performed before any injection is made in order to verify that the patient is not allergic to collagen. Approximately 2 – 3% of women are allergic to collagen, and these women should not be treated with collagen. Similarly, collagen treatment should be avoided in women suffering from diseases known as collagen diseases, rheumatic disorders and some allergic disorders. Treatment begins with the injection of collagen directly into the facial wrinkle. The facial wrinkles that respond best to collagen treatment are those found on the skin folds that run from each side of the nose to the corners of the mouth (nasolabial folds), which become deep quite early on and give the face that tired and sagging appearance. Wrinkles between the eyebrows (glabellar wrinkles), which give the face an angry look, are also eliminated quite well when using collagen. Collagen is also effective for treating the horizontal wrinkles on the forehead and wrinkles on the cheeks and lips. On the other hand, it is not suitable for wrinkles that appear on the eyelids, on both sides of the eyes, the neck and the body. Collagen is made in various concentrations (ZYDERM I, ZYDERM II). There is also another preparation, ZYPLAST, which is more suitable for filling facial depressions and adding volume to the lips. Collagen’s biggest advantage is that it is a natural substance. However, its biggest advantage is also its disadvantage. Since it is a natural substance, it disintegrates just like any other biological substance in our body, which means that in order to maintain its results in the long-term the treatment must be repeated every 6 – 8 months on average. It should be noted that stopping collagen treatment will not cause wrinkles to worsen or deteriorate, but rather to be restored to their pre-treatment state.
Over the past few years, the use of collagen has ceased almost entirely due to the increased use in hyaluronic acid.

Bio-Alcamid

Bio-Alcamid is a chemical substance made of a polymer that absorbs fluids after being injected into the body. Bio-Alcamid is soft to the touch and matches the body’s original tissues. It remains in the body for a long time, but can be removed when necessary, although doing so is neither an easy nor perfect process. Bio-Alcamid is suitable for eliminating deep wrinkles and folds on the sides of the nose, for filling up the cheeks and for modifying the chin profile.

Autologous Fat Transfer

This method involves removing miniscule amounts of fat from regions in the body where it is found in surplus quantities (buttocks, stomach, hips) and transplanting them in the face. This treatment is performed in an operating room, under sterile condition, with the patient under local anesthesia of both the fat removal site and the injection site. Fat injections are suitable for filling very deep wrinkles. The advantage of this technique is the use of a natural substance, though its min disadvantage is that results only last for short periods of time.
Potential side effects include hemorrhaging and swelling that may last for several days. Asymmetric fat deposition is also possible around the injection site.

Hyaluronic Acid

JUVIDERM, RESTYLANE / PERLANE, and HYALOFORM are all preparations based on hyaluronic acid, a natural substance found abundantly in connective tissue, cartilage, and the skin.
Hyaluronic acid is effective and safe and does not cause hypersensitivity, meaning that there is no need for a preliminary allergy test before starting treatment. These preparations are particularly suitable for filling expression wrinkles on both sides of the nose and the mouth (nasolabial folds), filling the wrinkles between the eyebrows (glabellar wrinkles) and shaping or adding volume to the lips. They are very effective, and the outcome is visible immediately after the substance is injected. After the treatment, regular daily activity may be resumed without delay. The main disadvantage of these substances is the short and unforeseeable time (approximately 6 months on average) they remain in the body. Since they are natural substances that break down over time, the wrinkle returns to its pre-treatment state.

New Peel

New Peel is a polylactic acid hydrogel. This material is suitable for filling the wrinkles between the nose and mouth, between the mouth and chin, between the eyebrows and sunken cheeks. An allergy test is not required. The substance lasts for 18 – 24 months, but its main disadvantage is that lumps may form around the injection site.

Botox

Botox is the brand name of a toxin called botulinum, which is produced in a laboratory from the Clostridium botulinum bacteria. This substance paralyzes the muscles that cause wrinkles. The botulinum bacterium has been widely used in medicine for many years to treat various medical disorders. Botox is suitable for eliminating forehead wrinkles, the wrinkles surrounding the eyes, and wrinkles between the eyebrows. Botox treatment eliminates forehead wrinkles almost entirely. The treatment must be repeated every four to six months. In rare cases, Botox treatment may cause squinting or the eyebrows to droop; however, these cases are infrequent and subside spontaneously.

Dysport

Dysport is also made from the Clostridium botulinum bacteria, and its effect also resembles that of Botox. This substance is suitable for wrinkles on the sides of the eyes, the forehead, and the upper lip. The main disadvantage of Dysport, like Botox, is the need to repeat treatment every few months.

Beautiful, Natural and Happy

Every woman who comes to the clinic asks for the same thing, “I want a natural look only.”

Any woman who undergoes treatment to fill, stretch and tighten the facial skin expects the results to appear natural and make her look younger. Dr. Govrin’s clinic follows ten golden rules to ensure that each patient leaves with a natural, well-maintained and healthy appearance.

The 10 Golden Rules

1. Women who desire a natural appearance must understand and rest assured that their face is in reliable hands that have a deep understanding and appreciation for the face and its anatomical features.

2. A woman’s confidence is not vested only in the treating physician, but also in the quality of materials used for injections.

3. It is better to inject smaller amounts first and add later if necessary. The temptation of immediate improvement and perfect results on the first visit is hard to resist. Remember that the result achieved during treatment is not final and may change significantly after fluids are absorbed and additional biological processes take place within the tissue.

4. Do not inject what cannot then be removed. This rule pertains to the injection material used for facial filling. The facial regions are dynamic and in constant motion, and the muscularsystem of the face is unforgiving when it comes to fillers. Any filling that is anatomically imprecise and does not consider the body’s limitations in terms of volume may result in a distorted appearance. The advantage of hyaluronic acid is that the body breaks it down and it can then be reinjected in the desired areas.

5. Address all three elements of older-looking skin. The three elements of the facial skin that affect its appearance are: texture, expression wrinkles and loss of volume. Expression wrinkles are created by the muscle – such as the wrinkles on the outer corners of the eyes (laugh lines) or the wrinkles between the eyebrows and the wrinkles on the forehead. These are treated using botulinum toxin injections (Botox or Dysport). Loss of volume is the result of muscle or fatty tissue dwindling down, causing an empty and saggy appearance. These cases are treated with a filler such as hyaluronic acid, which brings back lost volume to the face. Skin texture is affected by the skin’s ability to product proteins, to maintain its moisture and from other elements that impact elasticity and vitality. Skin texture can be treated using peeling to renew the skin or by way of lasers that rejuvenate the biological activity of the skin and restore its original properties.

6. To understand why and how the face sags and droops as a result of the aging process. As with any restoration process, when restoring the face from a saggy state we must begin with the basics. The face sags downward, due to gravity. The anatomical structures of our bones, muscles and fat dwindle with the years, become hollower and cause sagging. To restore a youthful appearance, the cheeks are the first to be treated, then the area around the mouth, and eventually the jawline and neck, to ensure natural-looking results.

7. Each patient must love her appearance. Most women who come to the clinic say that they are dissatisfied with all their facial features. Speaking from experience, how a woman feels about her appearance and her actual appearance are, in most cases, out of sync. That is why you should be very critical with yourself before coming in and choose one or two features that you believe will yield great satisfaction if improved, and to treat only them. Such decisions usually result in treatment that is not over the top and which yields a more natural look.

8. Keep your skin well maintained. Preventive skin texture treatment is very important when seeking a natural appearance. A regular routine of maintenance, avoiding exposure to the sun and pollution, quitting smoking and a healthy diet – will all benefit the skin.

9. Be patient. Even if some treatments exhibit immediate change, such as filling injections, there are treatments that take time to produce results, such as botulinum toxin injections (Botox and Dysport), where initial results can be observed after 2 – 4 days and final results after 10 – 14 days. Treatments such as peeling only produce results about a month later, which continue to improve all the time during the 6 – 9 months after treatment. Therefore, trust your physician and do not urge him to act against his clinical experience.

10. One of the main causes of an unnatural appearance is frequent, repeated treatments without waiting. To be fully satisfied, you must allow the biological processes that take place after treatment to run their course and follow the clinical experience and recommendations of your physician.

Dr. Jacky Govrin

Expert plastic surgeon

A specialist plastic surgeon, one of the most senior and prominent plastic surgery specialists in Israel.
Dr. Govrin is a graduate of the Technion Medical School in Haifa, completed his residency at Rambam Hospital and trained at leading medical centers in Europe and the USA.

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Dr. Orel Govrin

Expert plastic surgeon

A specialist plastic surgeon and groundbreaking researcher, a second generation of excellence in plastic surgery.
Dr. Govrin, a summa cum laude graduate of the Faculty of Medicine at Bar-Ilan University, specialized in the Department of Aesthetic and Reconstructive Plastic Surgery at Ichilov Medical Center, Tel Aviv.

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