Holger G. Gassner, M.D., Board Certified Facial Plastic Surgeon (USA)

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Modern products for wrinkle treatment are based on hyaluronic acid (Restylane, Juvederm) or consist of hydroxylapatite (Radiesse).  Both products are widely used in order to treat facial wrinkles.  The filler is carefully injected into the skin in a way that lifts and fills the wrinkles.
Professor Gassner often prefers the hyaluronic acid preparations as these are well tolerated and since there is also a means for this group of treatments that can dissolve the substance.
Depending on the condition and location of the wrinkles, Professor Gassner applies preparations of different types and viscosities to treat, for example, the deeper tissues above the cheeks or the fine wrinkles of the upper lip with an optimally adapted product.  The selection of the right preparation and its correct application require the physician’s extensive experience in order to achieve an optimal result for you.

Juvederm® and Restylane® are common trade names for hyaluronic acid preparations for wrinkle injection.  Hyaluronic acid is often present in the body, e.g. in teh eyes and joints.  It is characterized by its ability to bind water.  Therefore, the excellent volumizing effect of this substance in the tissue results.  Hyaluronic acid is produced synthetically and not from animals.  The substance is distinguished by a high biocompatability.  Undesirable tissue reactions are rare.  Hyaluronic acid is slowly and completely degraded by the body over a period of months.  Juvederm® also contains an anesthetic, which significantly reduces any discomfort you might experience.

Radiesse® is also a very frequently used preparation.  It consists of the substance calcium hydroxylaptite, which is also very biocompatible and is slowly and completely degrade by the body over a period of time.  Compared to hyaluronic acid preparations, Radiesse® is characterized by its volume effect on depth.  It lasts a little longer and can be carefully modeled after injection by massaging.  For finer wrinkles, Radiesse® is generally less suitable.

If, for example, a tangible nodule formation occurs, the hyaluronic acid preparations can be used to dissolve the hyaluronic acid.  According to some experts, this proves to be a significant advantage of the hyaluronic acid preparations compared to other fillers.

Many factors need to be analyzed when selecting the correct product for wrinkle treatment.  Wrinkles may have various causes: the subcutaneous fatty tissue looses volume with time, the overlying skin looses elasticity and becomes redundant, some deeper tissues loose volume and become droopy as they follow gravity.  Moreover, some areas of the facial skin are distorted by the underlying musculature, which causes wrinkles as well.

In the area of the cheekbones and the cheeks, the loss volume may generate a tired or sad appearance.  In order to augment volume in these areas, fillers with higher viscosities are typically employed.  This can contribute to cheeks that appear full, rounder and more youthful.  Also the skin along the jaw line or in the region of the temples maybe gently augmented with deep injections of fillers with high viscosity.

The so-called nasolabial folds are wrinkles that run vertically next to the corners of the mouth.  These develop as the soft tissues of the cheek descend while insertions of soft tissue hold the fold in itself back.  In order to treat these folds, typically products of moderate viscosity are utilized.  The purpose is to render these nasolabial folds softer and less visible.  Especially deep creases may cause a break of light and shadow which may become conspicuous.  This effect can typically be well ameliorated with adequate volume augmentation of the nasolabial folds.  However, the nasolabial folds should not be completely eliminated as they represent an important landmark of the face.  The face would look unnatural without nasolabial folds.

The lips also lose volume with time.  The red color of the lip may become less visible and the lips lose the roundness of youth and become flatter.  In order to rejuvenate the lips, fillers of thinner viscosity are utilized in order to best preserve the natural softness and mobility of the lips.  Also finer wrinkles of the skin around the lips or on the sides of the eyelids maybe treated with relatively thin filler products.

During the first appointment with Dr. Gassner, all important aspects of filler treatment will be discussed.  Dr. Gassner will ask you about important aspects of your medical history, including allergies, medications you are taking or other illnesses.  This information is important in order to determine whether you are a good candidate for filler treatment and also which product maybe the best for you.  Dr. Gassner will subsequently analyze your face together with you.  He will invest great effort into understanding which areas are of most concern to you.  He will also try to communicate which changes in improvements are realistic and what the likely result will be with various treatment options.

The treatment itself takes a few minutes. First the skin is very diligently cleansed and disinfected. If you wish it, an anesthetic (numbing) cream can be applied to teh skin being treated that will last about 15 minutes which can reduce the very mild discomfort during the process. The injection is done with very fine needles. The injections are performed with the patient in a comfortable position in reclining examining chair.  The surgical assistant will apply some gentle pressure over the treated areas for a few minutes in order to minimize the risk of bruising.  Already about 1 hour later you may reapply make up.  Most patients can resume work or daily activity right after the treatment.

The hyaluronic acid products Juvederm® and Restylane® are slowly but completely absorbed.  Their effect lasts approximately 7 to 9 months.  The duration of action depends on various factors and differs from patient to patient.

The hydroxylapatite product Radiesse® is also completely dissolved by the body.  Its duration of action is slightly longer than that of hyaluronic acid products.

Modern fillers are all of excellent quality.  The differences in duration of action are marginal.  A very important criterion for the selection of a product is its viscosity: how thin or thick the product is.  Deeper tissues are typically injected with product of higher viscosity such as the cheeks.  Products with thinner viscosity are typically utilized more superficially.  Professor Gassner will take time to discuss which areas are of most concern to you and whether or not fillers are a good option for you.  He will also try to communicate which changes in improvements are realistic and what the likely result will be with various treatment options.

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Treatment of wrinkles with fillers is very widespread.  An accurate analysis and reasonable advice from an experienced physician is of treat importance to your outcome.  An important limitation of treatment with fillers is the nature of the overlying skin.  If the skin is too slack, the need for fillers becomes too great to smooth the wrinkles sufficiently.  The result of using fillers in these cases can create the appearance of  puffiness, or things such as “inflated” lips or cheeks. Therefore, it is of great importance to recognize when fillers are no longer suitable for treating wrinkles adequately.

Deep nasalabial folds often result from over relaxed cheek skin.  While fillers can still be suitable in this instance, up to about age 50, other methods are often necessary at later points in time.  If the skin is too slack, this aspect should be treated specifically e.g. via a face lift.