The Body Beautiful Surgeon

Boston Juvederm™ specialist, Richard A. Moss M.D., has found the spring of 2008 to be very busy with a large number of patients who want to erase and soften some of the unwanted lines on their face.

“Nobody likes to see the signs of aging on their face and with the high quality of injectable products available today, I can help to eliminate or soften some of those unwanted lines with a 10 to 30 minute appointment,” says an enthusiastic Dr. Moss, of his Juvederm and Botox® Boston treatments.

The facial injectable market has been steadily growing, and the statistics from the American Society of Plastic Surgeons provide proof that the American public wants to stay young looking, especially when there is little or no down time involved in the treatment.

Botox® still reins “King” in the facial injectable category. There was an estimated 4,625,192 Botox® injections performed by board certified plastic surgeons in 2007. This was a 13% increase over 2006. There are a number of reasons why Botox® is so popular.

Botox® produces results that are unique and often cannot be duplicated in any other way, including surgery. By injecting Botox® directly into a facial muscle, a physician can weaken the muscle and the contractions associated with this muscle. These facial contractions which can cause the unwanted wrinkles are therefore eliminated or softened for periods up to four months. The areas that have traditionally been treated are the frown lines between the eyes, the horizontal forehead creases, and crow’s feet around the eyes.

“Patients will often tell me that friends and co-workers will comment that they look like they are scowling or are angry when they are not,” comments Dr. Moss, Boston cosmetic surgeon. Frequently the offending muscle is the “corrugator” muscle causing the unconscious scowl.

“Patients love how a 5 minute injection with little discomfort eliminates or softens this unwanted facial expression,” Dr. Moss continues. “In addition, there usually is no bruising or swelling associated with this treatment and patients can return to work or go home with no one knowing they just had a Botox® injection.”

Patients should expect to see the effects of Botox® in about 4 days, although in some instances it can take up to 14 days for the full effect of Botox® to be seen. In addition, patients need to be aware that there can be bruising at the site of any Botox® injection.

Although bruising does not usually result from a Botox® injection, patients should be aware of its possibility, especially if they are having their treatment in preparation of a special occasion.

“My wife Carla has a tendency to bruise more than most patients, so she has purchased a concealer product from the Medical Aesthetician, Kathy Antonowicz R.E., R.I. (888-806-4844), who performs her laser skin treatments. “Carla is always happy to share any helpful hints with any of our patients, as she is aware that this can often make a patient’s treatment much easier and more pleasant,” relates Dr. Moss.

If Botox® reins “King” of the facial injectable market then Juvederm™ is the “Queen” of the facial injectables. It is important to understand that Botox® and Juvederm™ work by completely different methods. While Botox® paralyses muscles; Juvederm™ fills in valleys in the skin.

Juvederm™ is the newest of the hyaluronic acid formulations to reach the cosmetic marketplace. Restylane® and Perlane® are two other popular hyaluronic acid products that have been available for some time.

Boston cosmetic surgeon Dr. Moss has been injecting Restylane® and Perlane® since their availability and has extensive experience with the injection techniques for all of these facial fillers.

“Until the introduction of Juvederm™, I would choose a filler product that best addressed a patient’s individual needs,” states Dr. Moss. “However, with the availability of Juvederm™, I am now finding that this product has the benefits of all of the other products combined and I expect it to soon be the market leader in the facial filler category” he adds.

“What makes Juvederm™ so unique is the combination of longevity and versatility. Juvederm™ is the first hyaluronic acid that the FDA has allowed to be labeled “the effects may last up to one year.” The other available hyaluronic acids, Restylane® and Perlane® have labeling that states “the effects may last up until six months.” Radiesse® which is calcium-based microspheres suspended in a water based gel does have labeling that states “the effects may last up until one year,” however, Radiesse® cannot be injected into the lips or vermillion border.

“Having a product that lasts longer and can be injected into the lips is a big advantage for a number of reasons,” Dr. Moss continues. “Patients need to be aware that when a product is labeled “lasts on average one year” means that a patient should expect that 50% of the correction is gone at six months. This meant that any product we had for injections in the lips before the introduction of Juvederm™ would lose 50% of the correction at three months. Patients really appreciate a correction that lasts for a longer period of time.”

“Another factor concerning facial fillers that patients need to be aware of is that the more animated the area of injection, the quicker the filler is absorbed and the correction diminished. The area around the mouth has the most activity and therefore fillers are absorbed at a faster rate in this area. For example, it would not be unusual for the correction to be lost sooner in the lips than in the nasolabial folds (the lines that run from the nose to the mouth, also called the parentheses) because the lips are much more animated than the nasolabial folds. Therefore the availability of a product such as Juvederm™, which lasts longer and can be injected in the lips is big advantage,” Dr. Moss further elaborates.

Juvederm™ is available in two formulations. While both the formulations are interchangeable, the Juvederm™ Ultra Plus is more robust and used more frequently in areas such as the nasolabial folds, while the Juvederm™ Ultra, which is less viscous, is used primarily in areas such as the lips where a softer result might be more desirable.

Like Botox® injections, facial filler injections also continue to increase in popularity. The total combination of facial filler injections performed by plastic surgeons in 2007 was around 1,250,000, making facial fillers by far the second most popular procedure in the field of cosmetic surgery and procedures. Dr. Moss attributes this to both the efficacy of injections and the ease of having the treatments.

Another new trend that is appearing in the facial injectable arena is the concept of “full correction” or sometimes simply called the “Wow effect.” This is where the physician injects sufficient filler into the areas of the face needing correction in amounts that greatly diminish the wrinkles rather than softening the wrinkles.

In conjunction with fillers, Botox® is also injected in areas of concern to the patient to reduce or eliminate the dynamic wrinkles. While this is more costly to the patient the effect that can be produced will often justify the added expense. In addition, the subsequent maintenance injections are often far less than the initial injections. Achieving a “full correction” can be more difficult than simply injecting one syringe of filler or one site of Botox®. Therefore, patients considering having injections to achieve “full correction” should choose a competent physician for their treatment.

“Plastic surgeons are some of the best trained physicians for administering facial injections,” states Dr. Moss. “We fully understand the muscular and neurological anatomy of the face. It is part of the core training in a plastic surgical residency program. You cannot perform facelifts, brow lifts and eye lid surgery without fully understanding the anatomy and the perils that lie beneath the facial skin. There is no other specialty that is better trained for facial injections than the specialties of plastic surgery and facial plastic surgery. I sometimes wonder why any patient would want to choose a provider from a website that does not clearly state who the physician in charge is at the facility, his/her training, and what specific board this physician is certified by.”

In order to stay current on all of the popular facial injectable techniques, Dr. Moss frequently attends courses.

In February of 2008 Dr. Moss attended the “Baker Gordon” Cosmetic Symposium in Miami, Florida. In May Dr. Moss attended an advanced course on Botox®, Juvederm™, Restylane®, and Perlane®. He is also scheduled to attend another full day course in June devoted to the more advanced techniques on the injection of Botox® and many of the facial fillers including Juvederm Ultra™ and Juvederm™ Ultra Plus.

“Patients who come to me do so because they are looking for the expertise of a Board Certified Plastic Surgeon. Whether it’s breast augmentation, tummy tucks, or Botox®, I pride myself on staying abreast of all of the latest techniques as well as continually evaluating the results my patients receive. I always offer my patients the opportunity to return and have 2 week to 1 month post injection pictures taken and to compare them to their pre-injection pictures. We can discuss if any further treatments are necessary or if the patient is happy with his/her result. I find that most are happy but occasionally someone wants more of a correction or even another area treated. My goal is always to have a satisfied patient.”