Fine lines and wrinkles, crows feet, loss of volume, furrows, tension lines and jowels are all signs of aging that can now be remedied through the use of fillers and neurotoxins. Dr. Kriston J. Kent, a board certified facial plastic surgeon and facial rejuvenation expert discusses with Aesthetic Insider™ the best uses and application of fillers such as Restylane, Juvederm, Volbella, Radiesse and many more products that are available to help reverse or stabilize the aging process. He also discusses the best placement for neurotoxins such as Botox®. Dr. Kent shares new approaches to lip plumping, under eye shadowing caused by loss of volume, facial fullness and neck treatments. To learn more, visit www.sarasota-med.com.
What is the most popular treatment you offer for facial aging?
The most popular, and probably the most recognized, treatment we offer is Botox®. Unlike the rest of the Injectables, Botox® is not a filler but is a neuromodulator that weakens overactive the muscles that control expression and typically lasts about three to four months. Next up, are the newer hyaluronic acid gel fillers and volumizers which can last two years or more. We are now also offering collagen stimulating injectables that can stimulate your body to make new collagen. What is most exciting about this is that the new collagen will stay with a patient for the rest of their life, which obviously cannot be said for the temporary fillers.
Do you have any personal preferences when it comes to which facial filler to use?
I do have some preferences and I also have as many reasons. I’m a believer in the longer you work with something the more experience you have with it, and potentially the better you become with it. Practice makes perfect. Ultimately, however, it does come down to what the patient really needs. Every patient is different – genetically, environmentally, health wise and anatomically. Some patients might not have good cheek or jaw bones and require a filler that gives them an improved underlying facial structure. Whereas other patients have good bone structure, but lack volume and fullness and need a product that can give them that softness and plumpness they desire. Other patients may have jowls and double chins which some of the newer hyaluronic acid gel fillers and calcium hydroxyapatite fillers can be used deeply to mimic improved cheek bones structures, improve jaw line structures and are my favorite products.
Are there specific fillers for different parts of the face?
Yes. We evaluate each patient on a case by case basis. The most common ones we use are Juvederm and Restylane. The newest on the market is called Volbella and is made by Allergan, the developers of Botox. These products help with volume loss. Many patients have deep folds between the nose and the mouth, or folds at the corner of the mouth that lead towards the jaw line, so I may use a different type of hyaluronic acid gel filler for that. Restylane Silk is another brand name that I use. For patients with more severe volume loss, or a hollowed appearance in the temple and cheeks that makes them look gaunt, there are collagen stimulating products that provide overall fullness back to the face, Sculptra being the most beneficial.
What is the difference between a Filler and a Neuromodulator?
A neuromodulator is a product that uses a highly purified protein that is injected to weaken the muscles controlling over expression. The most common place to use a neuromodulator is for frown lines or a scowl between the eyebrows. Some patients often look prematurely (and falsely) angry. Or they look unhappy even when they are feeling great so a neuromodulator is a simple fix for this type of problem. They are also good for crows feet, or creases caused by laugh lines, or even squinting. With a neuromodulator, we inject a few drops into those muscles that are causing the frown or crease to weaken the muscles. A few days after injection the muscles are temporarily deactivated and can no longer create a frown or crease, therefore the patient no longer looks angry or tired. Botox, Dysport and Xeomin are the neuromodulators we use at our practice. Fillers on the other hand, replace a loss of fullness to several areas of the face including the cheeks, mid-face, lips and even the under-eye area and temples. Surgical procedures address sagging skin, but volume loss is equally important. A youthful face is plump and with no lines or creases. Using a combination of neuromodulators and fillers can help a patient capture a more youthful look because they address both the crease lines and the loss of fullness.
Are there permanent filler or facial implants available?
There is definitely a place for permanent implants, particularly in cases where someone has a dramatically small chin that needs a tremendous amount of improvement, and likewise in the cheek area. A permanent implant requires a surgical procedure, whereas fillers do not. Some of the newer injectable fillers that simulate bone allow the doctor to artistically sculpt the jaw, chin and cheeks in such a way that a permanent implant is not necessary. That way they do not have to have a surgical procedure, which many of our patients want to avoid.
How long do these procedures take to perform?
That depends on the how much or how little the patient needs. The products come in a pre-filled syringe or in a bottle that’s reconstituted and then drawn up into a syringe and placed into the face. Therefore, we have patients who will have one or two syringes of product at a setting. That would take about 15 – 20 minutes to perform the actual procedure. For patients that require multiple procedures utilizing a variety of products, takes more time. Generally up to 45 minutes. We always tell patients to anticipate one- to one-and-a-half hours of time from start to finish.
Should a patient expect any bruising or swelling?
We do a lot of things to decrease the chances of bruising and to decrease the discomfort. This is an in-office procedure and our staff is always very prepared to make the patient experience as comfortable as possible. As these techniques are as individual as the patient, the recovery is also unique. We are expert injectors which means that we have a lot of experience performing these procedures so understand how best to do the procedure to avoid unnecessary bruising. We also prepare the patient ahead of time, and use ice packs immediately afterwards to help offset swelling.
Are the results immediate?
Botox or the other neuromodulators mentioned take a few hours to a few days to take effect. The neuromodulator works slowly to weaken the muscles so generally the patient will notice the changes 24 – 48 hours after treatment. Most fillers provide immediate results and one of the reasons that the hyaluronic acid gel fillers and the calcium hydroxyapatite fillers are the most popular is because immediate gratification occurs. By that I mean that as soon as we put the filler in place, the results can be seen. In fact immediately after the filler is injected, within the first 30 minutes or so, the patient can see a very good preview of how they are going to look although sometimes there is a little swelling which might give the appearance of being slightly over-filled for a day or two. We tell our patients to expect a final result within 3 – 7 days following the procedure.
What are collagen stimulating products?
Sculptra is by far the most widely recognized and widely used collagen stimulating product. Sculptra has an interesting story as it is made from a chemical product that was first used almost 25 years ago as a dissolving suture. It was a buried suture that was put under the skin to hold a wound together during the healing process and make a fine line, but what was discovered was that tiny beads of white collagen appeared around the suture line. A very smart clinician realized that if you put larger amounts of this material in place and then spread it around, larger amounts of natural collagen would be stimulated. So what happens now is that the Sculptra is placed in areas that require more volume and over time new collagen beads develop, form and build fullness, as the Sculptra slowly dissolves. It’s really quite fascinating and does provide a return of some of the lost fullness that we all had when we were younger.
What is the typical age of a patient undergoing these procedures?
It’s funny because sometimes I will say that patients and doctors often grow up together, as I have performed so much aging face surgery on patients who were much younger when they first became patients. In today’s anti-aging climate, however, there really is no typical age. We see patients that are in their 20s and want to stop any premature aging, or circumvent future frown lines and crows feet so they have Botox. Then we have patients in their 70s and 80s that do not want to go under the knife, so they opt for injectable facial rejuvenation techniques.
Are men interested in injectable anti-aging treatments?
Most definitely. I’ve seen a gradual but definite increase in the male demographic over the last 20 years. Appearance has always been important in America and to everyone, but it seems as the population has shifted in terms of jobs, i.e. manual work, farming, construction, to more white collar work, a man’s appearance and youthful look is more important than ever. Especially in this job market where competition is fierce, and an aging man might become concerned about the ability to keep their job, or get a new job when a younger more vibrant looking person is being considered.
Do you use PRP (Platelet Rich Plasma) in conjunction with fillers and neuromodulators?
PRP (Platelet Rich Plasma) like some of the other treatments we discussed produces results over time. I use it often with fillers and other cosmetic treatments as it can help increase the vitality of the tissue.
To listen to Dr. Kent’s interview on Aesthetic Insider Radio CLICK HERE!
About Holcomb – Kreithen Plastic Surgery and MedSpa
With their main office located in beautiful downtown Sarasota, and services also available at locations in Lakewood Ranch and Tampa, Holcomb – Kreithen Plastic Surgery and H|K MedSpa offers a comprehensive range of aesthetic surgical and non-surgical treatments that enhance the lives of men and women. The AAAASF-accredited facility includes a private outpatient ambulatory surgical center. The founding physicians of the practice include J. David Holcomb, M.D. (Facial Plastic and Cosmetic Laser Surgeon) and Joshua Kreithen, M.D. (Breast and Body Contouring Specialist). Dr. Kriston J. Kent, MD (Facial Plastic Surgeon) recently joined the practice’s Tampa division.
Holcomb – Kreithen Plastic Surgery is renowned for its expertise in facial plastic surgery, plastic surgery of the breasts and body and cosmetic laser surgery. Additional core areas of focus within H|K MedSpa include non- and minimally-invasive body contouring, facial aesthetics, medical hair restoration, laser skin rejuvenation and medical skin care. With its comprehensive range of services and dedicated staff the practice has developed a reputation as one of the most advanced centers in Florida. Receipt of the Allergan “Black Diamond Award” is an objective benchmark for the practice’ success, ranking it among the top 1% of practices in the entire country providing Botox Cosmetic, Juvederm (including Voluma) injectable gel, Latisse, Natrelle breast implants and SkinMedica skin care.
The Holcomb – Kreithen Plastic Surgery and MedSpa staff is comprised of an extraordinary group of professionals whose primary goal is to safely empower individuals to reach their full potential. They are committed to always treating patients and each other with kindness, compassion and dignity. For more information, visit www.sarasota-med.com or www.tampa-med.com.