Not every cosmetic problem necessarily requires surgical intervention to correct. This is the case with the subject of our Atlantic Coast Aesthetics Question of the Week this week. The patient asks, “My excess skin around my mouth and below my cheek is really bothering me. I have 1 ml of Juvederm already in my upper cheek and corner of my mouth. Where would you suggest to inject to get rid of these folds?” Dr. Thomas A. Pane, our Chief Medical Officer and founder, chose this question because it addresses not only the uses of injectable medications such as Juvederm, but also their limitations.
Dr. Pane said that without a picture, it’s difficult to be certain what is really going on and therefore to suggest a good treatment plan for it. When speaking of folds, where the skin is creased or wrinkled, that’s one thing; excess skin, which can really only be definitively corrected with a facelift in extreme cases, is another matter entirely. Many patients are not interested in invasive surgical options such as facelift, which is fine. However, injectable fillers like Botox and Juvederm may be of limited utility where excess skin is present but work fine for correcting folds, fine lines and wrinkles.
When the folds in the skin around the mouth are very pronounced, they can often form what are referred to as “marionette lines” or deep commissures, the more technical term. Both of these terms refer to the same phenomenon and respond well to treatment with injectable fillers such as Juvederm or ABS. Every injectable filler has a somewhat different profile in terms of how long it lasts and what it is indicated for, so it is important to match the patient’s needs and desires to the right injectable for them.
Dr. Pane said what he likes about Juvederm is that it offers a great deal of versatility in where and to what skin types it can be applied. Unlike some fillers which have chemical characteristics that may be problematic, Juvederm can be used safely and with good results on fine lines and wrinkles around the lip area. However, like all fillers, Juvederm is a temporary measure that may last a few months to a year or so depending upon the patient and the overall condition of the skin. This is an important point to consider when choosing fillers over more invasive but longer-lasting surgical options.
Because the patient in this case has already had one cubic centimeter of filler injected into the face, using much more may not be desirable. A fat transfer and graft or facelift may be a better option because both of these will last longer and offer more predictable results. The other factor is cost. While injectables are less expensive on a per-treatment basis, if the patient is purchasing several ccs at a time or more than once a year, the cost versus benefit may make injectable fillers a less cost-effective solution than a surgical alternative that is more expensive up front but has more durable results overall. Naturally, the patient’s overall situation and needs control which solution or complex of solutions is the best choice for them. However, as a rule, Dr. Pane strongly prefers the treatment that is more likely to last over one that has a limited shelf life if there is an option.
Another factor to consider is downtime. While injectable fillers do not have the individual downtime of surgical measures, over time this can add up. While a facelift generally requires a downtime of 3-5 days for initial healing, a day’s downtime for each injectable treatment spaced out over the course of 3-5 years to get mediocre results may make the surgical option a more attractive one in the long term from both a time and money perspective. However, only an in-person consultation and examination of the area in question can really answer what the right choice is for a given patient’s needs.
If you have a question you’d like to ask Dr. Pane or the staff of ACA about anything related to cosmetic surgery, we encourage you to ask away! You can email us at https://acplasticsurg.com, call us at (561) 422-4116 or follow us on Facebook and Twitter. It’s possible that your question may be our next ACA Question of the Week, answered live by Dr. Pane himself in a Google Hangout to help you and other patients get the information you need to make a sound decision about your options. Remember, at ACA we believe the only bad question is the one you don’t ask!