Implant Procedures:

Implants, also called injectable fillers, are becoming a common means of erasing wrinkles and folds. Several materials are being used for deep wrinkles, depressions under the eyes, lip enhancements, and acne scars.

After being banned from the market in 1992, silicone is making a comeback in research settings as a potential permanent wrinkle eraser. Scientists are looking into a new microdroplet technique (the use of very small drops) combined with purified silicone as a way to eliminate any danger. The past problems with silicone occurred when it was mixed with a foreign substance, such as mineral oil, or when it was injected in large doses.

The U.S. Food and Drug Administration (FDA) approved the Juvederm product line in June 2006. Juvederm is an injectable treatment for moderate-to-severe facial wrinkles and folds. Juvederm products are gels made from hyaluronic acid. They are injected into the face. Doctors report good results after a single treatment with Juvederm, and the results last for at least 6 months.

Most implants to date are not completely satisfactory. Collagen implants and biologic fillers from animal, bacterial, or human sources do not provide long-lasting benefits. Synthetic fillers are permanent but may cause an allergic reaction, which can lead to chronic problems. Such reactions are rare, but they can be painful and unattractive. In 2008, the FDA recommended that women be informed of the health risks from cosmetic fillers such as Restylane, Juvederm, Artefill, and Perlane. These risks can include allergic reactions, swelling, pain, blisters, and cysts.

Botulinum (Botox)

The popularity of Botox injections has skyrocketed in the United States. Botulinum, the deadly toxin found in uncooked foods, is also a powerful muscle-relaxant. Tiny amounts of a purified form (Botox) are injected into wrinkles to relax the surrounding muscles. Botox may help with forehead and frown lines, crow's feet, lower eyelids, lines on the side of the nose, and the area between the upper lip and the nose. Botox is also useful for treating involuntary muscle movements that can occur after a face-lift.

The injections need to be repeated every few months, because the effects wear off. The treatment decreases the ability to frown or squint and may cause the corners of the mouth to turn down. When used for areas around the eyes, it produces a rounder appearance, which patients should be aware of before they undertake the procedure.

The drug does not cross the blood-brain barrier, and, to date, the only side effects reported have been temporary muscle weakness near the injection site. However, the FDA has warned that in rare cases, the toxin can spread beyond the injection site and cause potentially fatal side effects. Most of the adverse reactions involved patients taking Botox for therapeutic, rather than cosmetic reasons.

Although there have been some reports that Botox can reduce migraine and tension headaches, Botox also causes headaches in about 1% of cases. In some cases, the headaches can be very severe and long lasting (from 8 days to a month). Some researchers suggest that either a contaminated batch of Botox or a specific injection technique may be the cause, but additional investigation is needed.