Facial Fillers and Otoplasty

Fillers

Facial fillers replace skin substances that, when lost, cause wrinkles. The skin thins by loss of collagen and fluid. In youth, the skin remains plump from a natural sugar called hyaluronic acid that attracts and binds to the body's water. Fillers are substances that are injected to fill in wrinkles and facial depressions that may come with age. With the advent of choices for facial fillers, we can choose the best for the specific problem and longevity.

There are now so many fillers available, we prefer to categorize them by their ideal usage. Fillers can be used to treat three conditions:

1. Superficial fine lines
2. Facial folds and crevasses
3. Facial volume loss

We all want fillers to last as long as possible, but don't want bumps from over-injecting. Gradual, precise and pointed is our method. The most superficial lines, those that appear "etched" into the skin require the thinnest fillers. As the need for more volume replacement increases, fillers are placed deeper and can be thicker. Medium thickness fillers are used for actual folds in the skin and deeper crevasses, such as the naso-labial folds. Naso-labial folds run from the corner of nose to the corner of the mouth. Medium depth fillers also may be very effective for melo-labial folds that run downward from the corners of the mouth to the jaw; otherwise referred to as "marionette" lines. These thicker fillers are also longer lasting than the thin, superficial fillers.

Since there are a number of available fillers for fine and deep wrinkles, both may be used in the same patient, and in conjunction with one another. We often layer fillers in the same areas in order to plump folds and fill the lines that may lie in the depths of those folds.

The thickest fillers are more for volume enhancement for the face that needs to be "plumped up." As the face ages, the cheeks get hollow in addition to droopy. Patients may need lifting as well as volume. In younger patients, however, facelifts can often be delayed by filling the cheeks. This can actually give a small lift as well and is called the "Liquid Facelift." Of course, nothing substitutes for a beautiful and professional facelift if it's a means to elevating jowls or excess skin under the neck. But we can go a long way in making you look more refreshed by starting with fillers.

There are a number of options for facial volume restoration. The most natural technique is using one's own fat. The fat is re-injected immediately after removing it from elsewhere in the body. This technique is called lipo-transfer. However, we now use it less than we did a few years ago because lipo-transfer is similar to a surgical procedure in preparation and healing time. Plus there are a number of facial fillers available that can restore facial volume that may last for up to a year or more. These are Sculptra, Radiesse, and the thinker Hyaluronic Acid products; Perlane and Juvederm Ultra Plus.

There are many types of filler available today. The most popular fillers are made from hyaluronic acid (Restylane, Juvederm). Hyaluronic acid is a clear gel that already exists in the human body. It attracts water, hydrating your skin. Hyaluronic acid fillers have been safely used in Canada and Europe since 1996. Unlike many other fillers, Hyaluronic Acid is non-animal-based and poses no risk of animal disease transmission or allergic reaction.

The hottest new application for Restylane is to fill dark circles under the eyes. Often, dark circles are the result of fat bulging in the lower eyelid that is exaggerated by a hollow area called the "tear trough." By placing Restylane into this tear-trough, there is less shadow and therefore improvement in dark circles, making you look more rested and smooth.

We also use Radiesse, a non-surgical facial contouring filler that delivers an immediate, longer lasting result. Radiesse may be thought of as a longer lasting filler for deep facial folds and may even be used for volume enhancement. Radiesse appears to last even longer than hyaluronic acid fillers for treatment of naso-labial folds and marionette lines. Radiesse provides immediate visual improvement common with other fillers, along with the benefit of long-lasting results. This is because Radiesse is made of very tiny, smooth calcium hydroxylapatite (CaHA) microspheres. These particles stimulate your own collagen to grow. microspheres (particles) form a scaffold through which your body's own collagen grows.

Below are the most commonly used fillers:

Superficial Fillers (for fine lines and wrinkles):

• Collagen: bovine-derived and requires an allergy test
• Cosmoderm: human-derived, no allergy testing required
• Juvederm

Medium Depth Fillers (Medium wrinkles):

• Collagen
• Cosmoplast
• Restylane, Juveder and Radiesse

Deep Fillers (Deep wrinkles):

• Perlane; thicker form of Restylane
• Juvederm Ultra Plus
• Radiesse; calcium hydroxyapetite granules. May last longer than hyaluronic acid.
• Artefill; PMMA (Teflon) beads in collagen, currently not available in the U.S. Long-term filler also still pending extended long-term testing.

Large Volume Fillers - (When patients require a larger quantity of facial volume enhancement):

• Fat lipotransfer; Spinning the patient's own fat in a centrifuge and then depositing very small amounts with each of multiple passes. A patient's fat is the most "natural" filler and the fat has a much better longevity. There is more swelling than with other fillers, but the results are smooth, natural, and often long lasting.
• Sculptra; poly-lactic acid. Patients retain long lasting facial volume enhancement after two to four injections spaced a month apart. Sculptra is a true volume filler for the face. It can restore youthful fullness to the cheeks, temples, and anywhere in the face there has been considerable loss of youthful fat. Collagen and hyaluronic acid products are best used for lines, folds and wrinkles. When you desire true restoration of fullness, Sculptra may be the ideal substance.
• Radiesse, Perlane or Juvederm Ultra Plus

Otoplasty

There are a number of procedures to make ears look more beautiful. Otoplasty is the surgical treatment for protruding ears. This is one of the few cosmetic procedures that can be performed on children. There are generally two problems with protruding ears: lack of formation of the "anti-helical fold." The other deformity is an excessively deep cup of the ear called the "conchal bowl". Otoplasty helps create or deepen the anti-helical fold. The conchal bowl can be made less shallow. Otoplasty is individualized for each patient is accomplished through a small incision that is hidden in the crease behind the ear.

Otoplasty can be performed on children as young as 6 years old. Their ears are 90% of the adult size by that age. They are also starting to socialize in school and may be subjected to teasing. So, surgery at this young age is advisable for a child who is uncomfortable with negative "ear attention." By 6 years old, children are aware of the reasons for surgery and able to participate in that decision. For children, otoplasty is performed under general anesthesia. In adults, local anesthesia with sedation is used. Otoplasty is well received by patients. It's heartwarming to see the look on a child's face when the bandages are removed 5 days following surgery and they no longer have "dumbo ears."

Unable to wear your expensive diamond stud earrings due to an enlarged hole, or a "Pac-Man" deformity? A very common condition that Dr. Pearlman often repairs is tears in the earlobe as a result of earrings that pull. These earring holes may also be elongated due to an accident. The most common culprits causing this condition are sweaters, hairbrushes and babies. Earlobes can be repaired under local anesthesia in the office. The procedure takes about 20 minutes per ear and patients often go right back to work after. Ears can be re-pierced in about 6 weeks. It's a quick and relatively painless solution to a rather unsightly and often overlooked condition.

Another reconstructive procedure that Dr. Pearlman performs is auricular reconstruction for microtia. This is a creation of a "new ear" in a child born without one or both ears. Cartilage from their own rib or a synthetic framework is used in a series of operations; The results are life-altering and very satisfying for parents and children alike.

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