Peels, Fillers and Grafts

Less invasive treatments may include peels, fillers, injections, grafting, and laser treatment.

Chemical peels may help treat acne, pock marks, scars, or wrinkles. A number of active agents may be used. A light or superficial peel uses Alpha Hydroxy Acids (AHAs) such as glycolic, lactic, or fruit acids to treat the outermost layers of the skin. The treatment is not as deep as with some peels, so the recovery time is minimal. A medium peel usually involves TCA (tri-chloroacetic acid) of various concentrations. It penetrates the dermis, or deep layer of the skin, to a greater depth than the light peels. The recovery and pain are more significant than the lighter peels. Redness and flaking may persist for several days or weeks. A deep peel, or phenol peel, penetrates the skin to the deepest extent. As a result, it has the greatest impact on resurfacing the skin, but it also has the longest recovery time, and it can causing scarring and skin lightening. Chemical peels have been shown to be safe and effective for both light and darker skin types.

Fillers can be used to iron out wrinkles and to make the lips look plumper.

Botulinum toxin, or botox, is the brand name of a toxin produced by the bacterium Clostridium botulinum (C. botulinum), first approved by the FDA in the 1980s for muscle spasm. It is used to treat wrinkles and facial creases. It acts by blocking the signal from nerves to the muscles that are injected. The injected muscle can no longer contract, or tighten, as forcefully as before, and this leads to a controlled relaxation of the muscles. It is approved for treatment of frown lines on the forehead, crow’s feet, or lines around the eye, and axillary hyperhidrosis, or increased sweating of the armpits.

Soft tissue fillers, or dermal fillers, are medical device implants approved by the FDA for use in helping to create a smoother, fuller appearance in the face. They can be used to treat nasolabial folds, cheeks, and lips, and to increase the volume of the back of the hand. They can also reduce wrinkles, lines and scars, and augment soft tissue contours. They are not permanent, but they are degraded by the body, so repeat treatments may be necessary to maintain the effect. These products normally come in a gel formulation that fine needles can inject into the deeper layers of the skin and underlying soft tissue of the face. Collagen injections are no longer performed because some patients experienced allergic reactions, some of them serious.

Complications can occur with facial fillers, and especially permanent fillers. Clinicians and patients are urged to check the contents of a filler and discuss all the implications of surgery before going ahead with a procedure.
Fat injections and fat grafting have broad applications in cosmetic surgery.

The patient’s own fat is collected from one part of the body using liposuction, and it is injected into areas requiring volume enhancement. It is usually applied to the face, including the lips, the hands, and depressions in skin contour. The results are generally safe and long lasting, and it can have the additional benefit of removing fat from a place where it is not wanted. The fat is removed, washed, and purified and then carefully re-injected with specially designed needles. Sometimes the procedure needs to be repeated several times for best results.

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