Aesthetic Procedures - Face

Botox versus Restylane
Both Botox and Restylane improve wrinkles and folds, but they work in different though complementary ways.   

Botox is injected into the muscles that control frowning and squinting and cause crow's feet, blocking the ability to contract. As these muscles relax, the brow lifts naturally, creating a refreshed look. There is no redness and, therefore, no down time following a Botox treatment. Results are apparent in approximately three days and last about four months. Botox prevents furrows from getting worse, and mild wrinkles may disappear altogether. Deep furrows — called static wrinkles — may not be totally eradicated with Botox. In such cases, a surface filler like Restylane, Sculptra, or silicone will be more effective.

Restylane is a complex sugar produced by the body. It is non-reactive and very safe. Injected just under the skin, Restylane plumps up folds and deep wrinkles. It is not a substitute for Botox, however, as it will not stop the muscles from contracting and forming new lines. Muscle activity should be calmed with Botox whenever possible. When Restylane is used together with Botox in the frown line area, the result can last seven months or longer.

Deep peels versus Carbon Dioxide (CO2)
laser resurfacing
Deep peels are not lunchtime procedures, as they cause the top layers of skin to "frost" (whiten) and congeal, leaving redness and peeling. Topical care, sometimes including dressings, is required, and recovery time is up to five days or more. Two types of peeling agents are used: Trichloracetic acid (TCA), or vinegar acid, is the safest and fastest healing; Phenol, a caustic chemical, penetrates even deeper.

Deep peels are dramatically more effective than lunch hour peels, which typically use alpha hydroxy acids (AHAs). They rejuvenate the skin at a deeper level, correcting deeper wrinkles and furrows and more serious sun spots. Deep peels are not appropriate for mild wrinkles or younger patients. Unlike lunch hour peels, which are generally administered in a series over several months throughout the year, a deep peel is done only once every five or six years.

Laser resurfacing, in which a carbon dioxide (CO2) laser beam is passed over the skin to vaporize the top layers, is increasingly used in place of phenol.

How do deep peels and lasers differ?
Like dermabrasion — sanding of the skin's surface — both deep peels and lasers remove deep lines and sun spots. However, lasers are more controllable than deep-peeling chemicals and cause less bleeding and bruising. Also, with laser resurfacing there is less risk of losing pigment than with a phenol peel.

The biggest difference between a CO2 laser treatment and a deep peel is the result. The laser can tighten lax skin, creating a facelift effect without surgery. Laser energy triggers the generation of new collagen, so that the face is not only free of lines and freckles but also tighter and younger-looking. Post-operative discomfort lasts only a day or so, although recovery requires topical care, including dressings, for three or four days. After about ten days, the redness from the C02 laser can be concealed with makeup. Approximately three months after treatment, the full effect is evident. A CO2 laser treatment produces a remarkable improvement that may last up to ten years.

How do I know when it's time to tighten my face?
Fillers like fat and Restylane, and muscle-relaxers like Botox can improve fine lines and furrows and even raise the brows. But when the mid-face becomes hollow and the jowls start to sag, it's an indication there is excess skin. Persisting with fillers at this stage would not be cost-effective. If there's a noticeable difference in the tautness of your face when you're lying flat compared to when you're standing up, it's time to seek advice about some type of facelift. Remember: The earlier the problem is addressed, the simpler the fix, and the longer time spent looking younger.

What is a volumetric facelift?
"Volumetric facelift" is a very broad term. It can mean repositioning the deep facial structure in a surgical procedure, with minimum skin removal. It can also mean filling out hollows in the face, without an incision, by injecting fat or another substance just below the skin's surface.

Read about the volumetric facelift here and learn about other facelift procedures here.