Fine lines and wrinkles. Volume loss. Blotchiness and age spots. You can’t escape the signs of aging.
Many of us want to freshen up our appearance but simply are not ready for plastic surgery.
Cosmetic injectables—which include neurotoxins such as Botox and fillers such as Juvederm™ and Restylane—are a simple alternative that can enhance your appearance and give you a more youthful look in a single office visit.
Mingyang Gray, MD, MPH
“These procedures camouflage some of the natural signs of aging,” says Mingyang Gray, MD, MPH, a facial plastic and reconstructive surgeon at Mount Sinai. “They bring your inner joy and positivity to the outside, make you look younger, and increase self-confidence in the way you look.”
No matter how well we take care of our skin, wrinkles catch up with all of us at some point. Wrinkles are perpendicular to the muscles underneath the skin, explains Dr. Gray. Every time we smile or squint the facial muscles contract and the skin on top of them folds. As we age, the skin also loses elasticity and collagen, causing ridges to form. Over time, these lines become more prominent.
“Some of us are luckier than others in terms of how much elasticity and collagen our skin holds onto with age,” explains Dr. Gray, who is also an Assistant Professor of Facial Plastic and Reconstructive Surgery at the Icahn School of Medicine at Mount Sinai. “But at some point, gravity and Father Time both win out.”
Still there are ways to prevent, or at least delay, the start of wrinkles. The most important thing you can do is limit the amount of time you spend in the sun. Wear sunscreen with an SPF of 30 or higher, cover your face with a wide-brimmed hat, and seek out shade especially in the heat of the day. Exposure to cigarette smoke, even if it is secondhand, can also take a toll on the skin. Staying hydrated and eating a well-balanced diet helps your skin maintain its elasticity.
Neurotoxins
Neurotoxins (Botox™, Dysport™, and Xeomin™) are botulinum toxin injections, which are approved by the Food and Drug Administration (FDA) and are the most common cosmetic procedure in the United States. For more than three decades they have been used to reduce lines and smooth wrinkles on the face. They are often used to treat:
- Forehead lines, such as vertical wrinkles or “11 lines,” which appear between the eyebrows after years of muscle movement.
- Creases around the corner of the eyes, often referred to as crow’s feet.
- Neck lines and bands.
- Wrinkles around the lips known as smile or frown lines.
- Gummy smiles that show a large portion of the teeth and gums.
- Sad or worried appearances, often a result of the corners of the mouth turning downward.
Fillers
(Juvederm™, Restylane™, Radiesse™, and Sculptra Aesthetic™)
Decades of smiling and squinting can cause deep creases to appear on your face. As we get older, our skin also becomes thinner, loses fat, and begins to sag. When these ridges are deep or when volume is lost (which leads to loose or sagging skin) freezing the facial muscles may not be effective in creating significant improvement.
Injectable fillers, also approved by the FDA, are most often made of hyaluronic acid and can be used to improve the appearance of deep lines and hollowed features of the face. These substances attract and hold water to restore volume and balance to the face.
They can be used to:
- Fill in deep creases, wrinkles, or scars including laugh lines.
- Enhance areas of the face that lose volume with age, such as the cheeks and temples.
- Improve the dark appearance of shadow lines and uneven pigmentation, especially around the eyes and cheeks.
- Plump up the lips.
- Improve the contour and shape of the nasal bridge and tip.
- Define the jawline and chin.
Cosmetic injectables are administered during in-office procedures that are relatively painless with adequate numbing medications. No downtime is needed afterwards, but you should avoid exercise for a few hours to be safe.
Five Things You Should Know About Injectables
1. Cosmetic injections are not permanent: Botox™ needs to be refreshed about every four months because the muscles come back to life. After about six months, the body begins to break down fillers. “I tell my patients it is like coloring your hair. You will have to get your roots touched up,” describes Dr. Gray.
2. Facial balance is essential: You may only be concerned about the 11 lines on your forehead, but it is important to keep the entire face in harmony when using fillers. “All the muscles of the face act in conjunction like a seesaw. You can’t hit one side of the seesaw without affecting the other. Even if you just have one area that is concerning to you, we may have to treat other areas of the face as well to keep everything in balance,” says Dr. Gray.
3. Side effects are rare but real: People who have thin skin or veins that are very close to the surface are more likely to bruise. If this happens, any discoloration will go away after just a few days. In very rare circumstances, one eyebrow may appear droopy. “This is why it is very important to see a board certified facial plastic surgeon or someone with similar advanced training who has a deep understanding of facial anatomy,” explains Dr. Gray.
4. Faces can be optimized according to the patient’s race and ethnicity: The golden ratio is a tool plastic surgeons use to determine what proportions are most pleasing to the eye. This varies across different backgrounds. “This geometry is not universally translatable,” she explains. “We have developed a better eye for optimizing our patient’s faces and balancing ratios to be more conscious of their ethnicity and race. For example, Asians and Blacks tend to have full lips while Caucasians have a slightly thinner upper lip.”
5. Pain is minimal and downtime is short. Injectables are procedures that can be done in the office on the same day as a consultation. Some patients are more sensitive to injectables and require either topical numbing medicine and/or pain medications after the procedure. Most people are able to go back to work with very little downtime.
Dr. Mingyang Gray is a Facial Plastic and Reconstructive Surgeon in the Department of Otolaryngology – Head and Neck Surgery, who treats patients at New York Eye and Ear Infirmary of Mount Sinai and Mount Sinai Doctors East 85th Street. For more information, call (212-979-4200) or email NYEEentreps@mountsinai.org.