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Facial Rejuvenation, Injectables, and Fillers

Your face can look younger, smoother and more radiant! There are many safe, non-invasive options for smoothing and beautifying your skin. You can get rid of wrinkles, lift and tighten bags, clear away scars and more.

Facial rejuvenation procedures include several different types of dermal fillers, Botox, Radiesse and Restylane are just a few that are available. Dermal fillers are gently injected into the face, eliminating wrinkles and lines. Recently, new dermal fillers have become available, specialized to create better results in specific areas. In addition to fillers, laser technology, such as the Profractional laser, can wipe away blemishes and acne scars. Years can be taken off of your appearance, and often in only an hour or less.

Botox Cosmetic

Botox®

Botox is a prescribed medicine that is injected into muscles and is used to improve moderate to severe facial frown lines. It works by blocking the nerve impulses to the muscle it is injected into. This reduces muscle activity that causes persistent lines. The most common areas treated are between the eyebrows (glabellar lines). The forehead and crow’s feet are the second most commonly treated areas.

The vertical lines between the eyebrows form as a result of constant contraction of the muscles from squinting, frowning or intense contraction. This causes the muscle between the eyes to contract, causing the skin to furrow and fold. This also happens to the forehead and the crow’s feet area.

Botox is injected in the office with minimal discomfort. Dr. Delgado has various techniques that lessen this discomfort. Often, multiple areas are performed at one appointment.

The onset of treatment is 48-72 hours and may continue to take a stronger effect up to one week. It lasts approximately four months. The muscle activity will return to normal once completely worn off.

Botox will not radically change your facial expression or make you look as if you had "work" done. Dr. Delgado will assist in a natural-blended appearance with your facial expression.

Botox is the single most popular nonsurgical cosmetic procedure performed in the United States today. Patient satisfaction is extremely high and repeat Botox treatments are just as common. Dr. Delgado is an expert Botox injector and has performed thousands of treatments. If you are curious, discuss your options with Dr. Delgado, he will explain it based on your specific facial animation.

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Dysport

Dysport™

Dysport™ is an injection used to temporarily inhibit the muscle contractions that create facial folds and wrinkles. It is injected into the muscle treatment site exactly like Botox™.

Dysport™ is gaining popularity in the United States since it was approved by the FDA for use in the United States in April 2009. It has been used successfully in Europe since 2001.

Frown lines are dynamic lines. They are caused by muscular activity that occurs with facial expression. By temporarily reducing the activity of the muscle, the fold or wrinkle will significantly soften and smooth out. The results are dramatic and obvious.

Static lines are lines that are still visible even when the face is relaxed and no muscles are being contracted. These lines will also erase in time, approximately 16 months, if an effective level of muscle relaxation is maintained over this duration. This is the time it takes for the permanently creased skin to naturally shed and be replaced with new smooth skin that has grown in from underneath, unimpacted by the assault of muscle activity. Since the effectiveness of a single treatment lasts about four months for most people, a series of up to five treatments may be needed before static lines disappear.

With continuous use, some people find that the treatments of his/her brow and forehead wrinkles are effective up to five months. On the other hand, treatment of the crowsfeet area around the eyes, where the muscles are more active, may never last more than three months.

Dr. Delgado does not see a significant difference between Botox™ and Dysport™. The cost is slightly less for Dysport™. Of concern only to the provider, the products are reconstituted with slightly different dilution volumes of normal saline and the units are calculated differently, with 300 units of Dysport™ being the equivalent of 100 units of Botox™. Dysport™ has a slightly shorter onset of action. With Dysport™, results are usually apparent in one to two days, where Botox™ takes three to five days. Therefore, the results may occur sooner, but Dysport™ works, in general, about the same length of time as Botox™.

Earlier concerns that Dysport™ may have a tendency to migrate more than Botox™ from the injection site, increasing the likelihood of a temporary eyelid droop, appear to be unsubstantiated in practice.

Most importantly, Dysport™ is providing competition for Botox™ and this will help the entire industry. Dr. Delgado suggests that patients who already use Botox™ try Dysport™ to determine which one is best for them.

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Restylane

Restylane™

Restylane™ restores volume and fullness in the skin and corrects moderate to severe facial wrinkling and folds.

Restylane™ is hyaluronic acid, a naturally occurring substance in your skin that contributes to its fullness and elasticity. Formulated to duplicate your own body’s hyaluronic acid, this filler is a clear gel. This product effectively reduces or erases small facial wrinkles by placing volume in the skin. Unlike the more deeply injected ArtefillTM or RadiesseTM, Restylane™ is injected into the skin layer.

This #1 selling wrinkle filler is used for laugh lines, marionette lines, lipstick crevice lines and the corner of the mouth. Restylane™’s safety has been well established in controlled clinical trials. As it lasts nine to twelve months, it is considered a temporary filler.

Before Treatment

1. Avoid using aspirin, nonsteroidal anti-inflammatory medications (e.g., AdvilTM, Aleve, ibuprofen, MotrinTM, naproxen), St. John’s wort, fish oil, or vitamin E supplements that exceed 100iu for two weeks before your filler treatment, as these agents increase the likelihood of bruising and bleeding at the injection site.

2. If you have a history of cold sores, advise Dr. Delgado of this fact. He will prescribe an anti-viral medication for you to start prior to your injection appointment to decrease the risk of the procedure provoking an outbreak.

After Treatment

1. Use cold compresses to reduce swelling.

2. Avoid touching the treatment area for six hours following treatment so you do not accidentally injure your skin while the area is numb. After six hours, the area may be gently washed with soap and water.

3. For one week following your injection procedure, continue to avoid agents that contribute to bruising, including non-steroid anti-inflammatories (e.g., AdvilTM, Aleve, ibuprofen, MotrinTM, naproxen), St. John’s Wort, fish oil and Vitamin E supplements greater than 100iu.

4. If you have a history of cold sores, continue to take anti-viral medication as directed by Dr. Delgado to minimize the risk of an outbreak caused by the injection procedure itself.

5. Make it a practice to protect the treated area from exposure to intense heat, tanning beds, or excessive sun exposure.

After treatment with Restylane, it is normal to experience swelling, redness, pain, bruising and tenderness. Generally, these side effects resolve within one week. Please contact Dr. Delgado if any of these symptoms persists longer than 14 days.

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Juvederm Ultra

JUVÉDERM®

Juvéderm is another hyaluronic acid injectable gel. It is used to instantly smooth out facial wrinkles and folds. It is an excellent temporary filler, which lasts nine months plus. Dr. Delgado likes it for fine lines as well as moderate ones or smaller corrections since it has a smoother consistency. Hyaluronic acid (HA) is a natural complex sugar found in the living cells, in one of the major components of the skin connective tissue matrix along with elastin and collagen. One of the greatest components of HA is that it retains water like a sponge. This aids in attracting and maintaining hydration and volume in the skin. You may ask: What is the difference between Juvéderm and Restylane; they are both hyaluronic acids (HA). Answer: Juvéderm has Hylacross technology, which creates a higher degree of cross-linking, which is stated to last longer in duration. Dr. Delgado was one of the physicians to test both Restylane and Juvéderm as a comparative study. Dr. Delgado feels that it does inject smoother, especially into fine lines, but lasting longer was inconsistent. Some patients, indeed, felt it lasted longer and others thought it lasted about the same. His conclusion was that it was patient-dependent. Dr. Delgado suggests patients to try both to determine which hyaluronic acid works best.

Before treatment

Avoid using aspirin, nonsteroidal antiinflammatory medications, such as Motrin, St. John’s wort, or high doses of vitamin E supplements. These agents may increase bruising and bleeding at the injection site.

After treatment

Use cold compresses to reduce swelling.

Avoid touching the treatment area for six hours following treatment, so you do not accidentally injure your skin while the area is numb. After six hours, the area can be gently washed with soap and water.

Avoid exposure to intense heat, sunlamp or sunbathing.

Reduce the risk of facial cold sore recurrence that could be caused by needle puncture. Talk with Dr. Delgado about medications that may minimize an outbreak.

Avoid taking aspirin and nonsteroidals for one week after treatment. These agents may increase bruising and bleeding at the injection site.

After your treatment, you might have some swelling, redness, pain, bruising and tenderness. This will normally last less than seven days. Contact Dr. Delgado if you experience side effects beyond fourteen days and ask about your follow-up appointment.

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Radiesse

Radiesse™

Radiesse&trade: is a highly effective, temporary filler that lasts about one year. It works well for treatment of the nasolabial folds or laugh lines, marionette lines and facial volume replacement. Radiesse&trade: is the product that generated the new term, "liquid facelift".

This face wrinkle filler also has the ability to stimulate the production of new collagen. It is injected underneath the muscle, reducing the depth of the wrinkle upward in a very natural fashion. This restores a smooth fullness to the face, creating a youthful and refreshed appearance.

Radiesse&trade: is composed of calcium-based microspheres suspended in water-based gel. Dr. Delgado uses the new technique that mixes the Radiesse&trade: with a local anesthetic (lidocaine) which makes the treatment more comfortable.

An extra benefit with Radiesse&trade: is the generous 1.5cc volume in the syringe. This represents at least 50% more product per syringe than other injectable fillers, such as Restylane™ and JuvédermTM, making it an excellent value.

Since this is a deep filler, it is not appropriate for the lips, upper lip lines, or crow’s feet. However, for nasolabial folds, marionette lines and any other area in the face where volume is required, Radiesse&trade: is an excellent choice.

Before Treatment

1. Avoid using aspirin, nonsteroidal antiinflammatory medications (e.g., AdvilTM, Aleve, ibuprofen, MotrinTM, naproxen), St. John’s wort, fish oil, or vitamin E supplements that exceed 100iu for two weeks before your filler treatment, as these agents increase the likelihood of bruising and bleeding at the injection site.

2. If you have a history of cold sores, advise Dr. Delgado of this fact. He will prescribe an anti-viral medication for you to start prior to your injection appointment to decrease the risk of the procedure provoking an outbreak.

After Treatment

1. Use cold compresses to reduce swelling.

2. Avoid touching the treatment area for six hours following treatment so you do not accidentally injure your skin while the area is numb. After six hours, the area may be gently washed with soap and water.

3. For one week following your injection procedure, continue to avoid agents that contribute to bruising, including non-steroid anti-inflammatories (e.g., AdvilTM, Aleve TM, ibuprofen, MotrinTM, naproxen), St. John’s Wort, fish oil and Vitamin E supplements greater than 100iu.

4. If you have a history of cold sores, continue to take anti-viral medication as directed by Dr. Delgado to minimize the risk of an outbreak caused by the injection procedure itself.

5. Make it a practice to protect the treated area from exposure to intense heat, tanning beds, or excessive sun exposure.

After treatment with ArtefillTM, it is normal to experience swelling, redness, pain, bruising and tenderness. Generally, these side effects resolve within one week. Please contact Dr. Delgado if any of these symptoms persists longer than 14 days.

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Sculptra

Sculptra™

Sculptra™ was FDA approved for correction of facial lipoatrophy (loss of facial fat) in the United States on August 18, 2004. It has been approved and used in Europe since 1999 and to date, has been used on more than 175,000 patients. Since poly-L-lactic acid, a derivative of fruit acid, comes from neither animal nor human sources, no skin testing is required before a treatment can be done.

Sculptra™ is another one of the products with which the term "liquid facelift" or "facelift in a bottle" has been associated. The product is used to create a fuller face and higher cheekbones, creating a lift that highlights the mid-face. It is used to correct volume loss, folds and sunken areas, including those around the eyes. Initially, it was used for people with HIV (anti-HIV drugs can cause lipoatrophy) but now has universal use as a dermal filler.

Sculptra™ is injected underneath the skin where fat has been lost. Clinical studies have shown it to last approximately two years. The great advantage is the amount of volume it provides. Each vial is 5 cc of filler.

Sculptra™ actually causes an increase in collagen production. Over two to six months following a treatment, patients notice that the skin becomes thicker. Although there are immediate results that are visible, the collagen building process occurs slowly.

Depending on the amount of correction desired, multiple treatments are usually necessary. Two or three treatments are common, but some patients may require up to six treatments. Treatments can be scheduled four to six weeks apart.

Some patients will want more immediate results. Dr. Delgado will discuss the various options available to achieve the goals for his/her appearance. Backed by his extensive experience with Sculptra™, he can competently advise patients as to whether or not Sculptra™ is a good choice for them.

The most common side effects following Sculptra™ injections are redness, swelling, tenderness and bruising. These resolve within four to 14 days. Ice should be applied intermittantly to the area for the first few hours after a treatment to minimize the swelling and redness. Occasionally small bumps will develop in the areas of a Sculptra™ treatment, but these are almost always invisible to the eye and only detectable upon palpation.

Following a Sculptra™ injection, patients are advised to massage the area two to three times per day for the first three days. Until all redness and swelling have resolved, the patient should avoid excessive sun exposure and tanning beds.

For two weeks before and one week after a Sculptra™ treatment, patients should avoid using aspirin, nonsteroidal antiinflammatory medications (e.g., ibuprofen, AdvilTM, MotrinTM, AleeveTM, naprosyn), St. John’s wort, fish oil, or vitamin E supplements that exceed 100iu as these agents increase the likelihood of bruising and bleeding at the injection site.

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artefill

Artefill®

Artefill™ is a permanent facial filler composed of unique microspheres enhanced with an outer shell of collagen. The Artefill™ microspheres are five times smaller than any of the other fillers. Due to the presence of collagen, this filler requires that a skin test be done prior to treatment. Approximately four weeks after injection, the collagen component is absorbed and the Artefill™ particles remain.

The proper correction usually takes two treatment sessions. Over-correction is not practiced with this product. A second session, if needed, can be done four weeks after the first injection, when the collagen coating from the first dose has been absorbed.

Although the cost of Artefill™ is about twice that of temporary fillers, the correction is permanent. Temporary fillers disappear after nine to twelve months, making Artefill™ a better value over the long term.

Artefill™ is FDA approved only for the nasolabial folds or smile lines. Therefore, when patients want other areas in the face treated at the same time, Artefill™ can be used in conjunction with temporary fillers, such as Restylane™ or JuvédermTM. The advantage is that the nasolabial fold treatment will be permanent and that the patient will need to have only the temporary filler areas retreated in time.

Artefill™ has been used successfully in Europe for many years. Dr. Delgado is confident in this product’s ability to produce a safe, effective and permanent correction.

Before Treatment

1. Avoid using aspirin, nonsteroidal antiinflammatory medications (e.g., Motrin, ibuprofen, Advil, Aleeve), St. John’s wort, fish oil, or vitamin E supplements that exceed 100iu for two weeks before your filler treatment, as these agents increase the likelihood of bruising and bleeding at the injection site.

2. If you have a history of cold sores, advise Dr. Delgado of this fact. He will prescribe an anti-viral medication for you to start prior to your injection appointment to decrease the risk of the procedure provoking an outbreak.

After Treatment

1. Use cold compresses to reduce swelling.

2. Avoid touching the treatment area for six hours following treatment so you do not accidentally injure your skin while the area is numb. After six hours, the area may be gently washed with soap and water.

3. For one week following your injection procedure, continue to avoid agents that contribute to bruising, including non-steroid anti-inflammatories (e.g., Motrin, Advil, Aleve, ibuprofen), St. John’s Wort, fish oil and Vitamin E supplements greater than 100iu.

4. If you have a history of cold sores, continue to take anti-viral medication as directed by Dr. Delgado to minimize the risk of an outbreak caused by the injection procedure itself.

5. Make it a practice to protect the treated area from exposure to intense heat, tanning beds, or excessive sun exposure.

After treatment with Artefill™, it is normal to experience swelling, redness, pain, bruising and tenderness. Generally, these side effects resolve within one week. Please contact Dr. Delgado if any of these symptoms persist longer than 14 days.

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