Noninvasive procedures

One of the trends in Plastic Surgery is more the availability to maintain a youthful appearance, including the development of noninvasive procedures. The most common of these are Botox and fillers.

Botox is an injection of purified protein in very small doses that work to weaken the muscles that create dynamic wrinkles, especially the frown lines between the eyes, the horizontal lines of the forehead, and crow's feet. It will take effect in about a week, and usually lasts about four months. Most people come in thre to four times a year. Fillers are used, as suggested by the name, to fill in depressions and grooves. The most common uses are to fill in the nasolabial grooves that run between the nose and the corners of the mouth. They are also used to plump lips, for lip lines, for the marionette lines that run between the corners of the mouth downwards, for acne scars, and for other irregularities or wrinkles. There are several manufacturers, and the most commonly used are the hyaluronic acid fillers. There are two main brands - Restylane (Perlane being the thicker form) and Juvederm (Juvederm Ultra being the thicker form).

Your doctor will asses the area of concern and choose the one that is most appropriate for th best affect. Effect is immediate, although there may be a little swelling for up to two weeks. Fillers generally last six months to a year. Sometimes a surgical fat transfer is chosen as a filler (see lip enlargement below).

Lip enlargement is requested at any adult age. In younger patients this is done to create a more pouty look, to change the shape, to create more balance between the upper and lower lips, to increase the cupid's bow in the middle of the upper lip, or simply to make the lips more plump and full.

In aging patients all of these may be done, and in addition the corner's of the mouth can be turned up again to some extent. In the aging process, the area between the nose and the upper lip can lenghthen and the soft tissue thin out. This has a tendancy to turn the lip in, lessening the amount of red that is visible. Plumping the lips can create a very youthful appearance.

Most often this is done through the injection of fillers. There are numerous fillers on the market, but in general it is good to look for a filler which has withstood the test of time and has a low allergic potential. The longer the filler stays before it absorbs, or the more inflammation, the higher the chance for problems such as granulomas.

The most commonly used fillers, hyaluronic acid based ones, do not require an allergy test. They last between six months and one year in most people and include Restylane and Perlane (thicker), Juvederm and JuvedermUltra (thicker).

Also still used by patients who are not allergic is collagen, a bovine product, made from beef byproducts, which lasts approximately three months.

Another option is fat transfer, removing a small amount of fat from an area such as the abdomen under local anesthesia and injecting it into the lips or other areas such as the cheeks, nasolabial folds or even buttocks. This is a minor procedure, but there is a recovery time as there is more swelling than with injections. The benefit is that it is your own tissue that is being used for filling. The unkown is how much if any, will be permanent, and how many times it will need to be repeated.

Other surgical mouth procedures include a lip lift and a corner lift, leaving small scars under the nose and at the corners respectively.