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Fat Injection Face
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Collagen is a natural protein that provides structural support to soft tissue. It can be used to minimize many of the visible signs of aging by hiding the superficial wrinkles of the face.

In addition, Collagen can be used to enlarge the lips. Collagen is injected into the skin beneath the affected area. It fills the fine wrinkles, which smoothes the overlying skin. This results in a more youthful appearance.

In the lips, the Collagen fills the soft tissue of the lips and can even turn the corners upward.

Collagen injections may be repeated every 6 months to touch up and enhance the effects.


If You Are Considering Injectables

As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling, chewing and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow's feet or facial creases over the areas where this muscle movement occurs.

Soft-tissue fillers, can help fill in these lines and creases, restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be used alone or in conjunction with a resurfacing procedure, such as a laser treatment, or a re-contouring procedure, such as a facelift.

If you're considering a facial-rejuvenation treatment with fillers, this brochure will give you a basic understanding of the procedure - when injectables can help, how the procedure is performed, and what results you can expect. It may not answer all of your questions, since a lot depends on your individual circumstances. Please ask Dr. Freedland if there is anything about the procedure you do not understand.

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The Best Candidate for Fillers and Fat Injection

Injected fillers come in many varieties. They are primarily used to improve the appearance of the skin's texture. They can help fill out deep facial wrinkles, creases and furrows, "sunken" cheeks, skin depressions and some types of scars. They can also be used to add a fuller, more sensuous look to the lips.

Injectables are usually not sufficient for severe surface wrinkles on the face, such as multiple vertical "lipstick lines" that sometimes form around the mouth. Instead, Dr. Freedland may suggest a resurfacing technique, such as chemical peel, dermabrasion or laser treatments. Rather than filling in facial lines, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance.

Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery, such as a facelift or browlift. Injectables are sometimes used in conjunction with facial surgery procedures; however, injectables alone cannot change facial contour the way surgery can.

Keep in mind that a plastic surgeon is a specialist that can offer you the full gamut of the most advanced treatments ranging from cosmetic surgery, refinishing techniques, laser therapy, injectables and the use of other fillers. You and Dr. Freedland may determine that a single procedure or a combination of procedures is the best choice for you.

ASPS brochures are available on chemical peel, dermabrasion, laser treatments, facelift and browlift. If you think that one of these other procedures might be more appropriate for you, ask Dr. Freedland to provide you with a copy.

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A Treatment Carries Some Uncertainty and Risk

When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature. Still, individuals vary greatly in their anatomy, their physical reactions and their healing abilities. The outcome of treatment with injectables is never completely predictable.

Fillers: Allergic reaction is the primary risk of collagen. To help determine if you are allergic to the substance, Dr. Freedland's staff will perform an allergy skin test about a month before the procedure. After the test is performed, the test site should be watched carefully for three or four weeks. Any sign of redness, itching, swelling or other occurrences at the test site should be reported to Dr. Freedland

Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare.

Fat: Allergic reaction is not a factor for fat because it's harvested from a patient's own body. However, there is still a small risk of infection and other infrequent complications.

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Planning for your Treatment

The most important fact to remember about injectable fillers is that the results are not permanent. The body eventually metabolizes injected material. Fat is different, as it often is retained long term. However, you should not expect the same long-lasting results that may be gained from cosmetic surgery.

In some individuals, the results may last only a few weeks; in others, the results may be maintained indefinitely. Researchers believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all play a role in the injected material's "staying power." However, the precise reason for the variation of results among patients has yet to be identified.

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Getting The Answers You Need

Individuals considering facial-rejuvenation treatment with fillers or fat often feel a bit overwhelmed by the number of options and techniques being promoted today. However, Dr. Freedland and his staff can help. In deciding which treatment approach is right for you, Dr. Freedland will consider effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience. Dr. Freedland also uses this judgment to prevent complications; to handle unexpected occurrences during surgery; and to treat complications when they occur.

Dr. Freedland's education and training, which he received at the University of Michigan, has helped to form his surgical judgment. Patients are encouraged to do their homework and consider a doctor certified by the American Board of Plastic Surgery ("ABPS"). By choosing a plastic surgeon who is certified by the ABPS, a patient can be assured that the doctor has graduated from an accredited medical school and completed at least five years of additional residency - usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the ABPS, a doctor must also practice surgery for two years and pass comprehensive written and oral exams.

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Specific Options

Collagen comes in many forms. Collagen is a naturally occurring protein that provides support to various parts of the human body: the skin, the joints, the bones and the ligaments. It is produced in various thicknesses to meet individual patient needs.

  • Zyderm 1, Zyderm 2 & Zyplast injectable collagen (technically bovine collagen) comes in three forms. These require an allergy test to determine if you are eligible for collagen treatments Dr. Freedland's staff will inject a small amount of collagen into the crook of your forearm. You are instructed to watch the injection site closely for several weeks for signs of inflammation (red, swelling, itchiness, etc.). The majority of test reactions occur within the first 3 days, but it can happen anytime within this time frame. Reportedly, about 3 in every 100 tested patients have a negative reaction and cannot be treated with injectable collagen.
  • CosmoDerm and CosmoPlast (technically: human collagen dermal filler) contain collagen purified from human fibroblast cell culture. The cell line used for collagen production is qualified by extensive testing. They are sterile injectable liquids made of highly purified human collagen, a natural protein that supports the skin. They're injected into the skin to correct soft tissue defects such as wrinkles and acne scars. These products also contain lidocaine, which numbs the skin at the site of injection. CosmoDerm is used for minor skin defects. CosmoPlast is used for more serious defects.

Hyaluronic Acid comes in many forms.

  • Hylaform (Hylaform Fine Line & Hylaform Plus): (technically: highly purified Hyaluronic viscoelastic gel made from avian hyaluronic acid) is derived from the combs of roosters (the red, fleshy crest on top of a rooster's head). Hyaluronan is necessary to provide moisture and elasticity in the skin. Reportedly, your body's hyaluronan gradually breaks down over time resulting in drier, wrinkled and aged skin. Hylaform is a sterile, nonpyrogenic, viscoelastic, clear, colorless, transparent gel implant composed of cross-linked molecules of hyaluronan. Hyaluronan is a naturally occurring polysaccharide of the intercellular matrix in human tissues, including skin. Hyaluronan is chemically, physically and biologically identical in the tissues of all species. Hylaform contains no pain reliever so you may ask for mini-injections of local anesthetic, or a regional block for pain relief.
  • Restylane & Perlane are made from non-animal stabilized hyaluronic acid (NASHA) gel. This means that Restylane & Perlane contain no animal products. Since hyaluronic acid is a natural substance found in the skin and other tissue, there is no need for a skin test. The hyaluronic acid in Restylane & Perlane supplements the body's natural supply, which becomes depleted with age. These are biodegradable so its effects are not permanent. The results of these filler treatments tend to last six to nine months. This is much longer than the typical results of collagen injections, which may only last three to six months. Restylane & Perlane can be used in conjunction with BOTOX® Cosmetic, which neutralizes the muscles that create wrinkles, but Restylane & Perlane simply reduces the visibility of wrinkles and folds.
  • Juvéderm (Juvéderm Ultra & Juvéderm Ultra Plus): As we age, our skin changes. Over time, the natural volume of youthful skin begins to diminish as wrinkles and folds form. But, with Juvéderm injectable gel, you don't have to just sit back and let it happen. Recently approved by the FDA, Juvéderm injectable gel is a “next-generation” dermal filler. The smooth consistency gel helps to instantly restore your skin's volume and smooth away facial wrinkles and folds, like your "smile lines" or “parentheses” (nasolabial folds—the creases that run from the bottom of your nose to the corners of your mouth). Juvéderm is a smooth consistency gel made of hyaluronic acid—a naturally occurring substance in your skin that helps to add volume and hydration. It lasts one year. Dr. Freedland's staff eases Juvéderm injectable gel under the skin to provide a smooth, natural look and feel—so everyone will notice (but no one will know)! In fact, studies show superior results of Juvéderm compared to all other temporary fillers. Juvéderm injectable gel is the first FDA-approved hyaluronic acid dermal filler that is proven to be safe and effective for persons of color.

Radiesse is a safe, next generation cosmetic dermal filler that lasts longer than the former leading filler. Radiesse is made of unique calcium-based microspheres that are suspended in a natural gel that is injected into the skin through a simple, safe and minimally invasive procedure. Its biocompatibility means no allergy testing prior to treatment. It is setting a new standard for the correction of facial lines and wrinkles, restoring a natural, youthful look in an easy, convenient treatment that last more than one year. It stimulates your skin to produce new collagen. Numerous medical studies have shown that Radiesse is a safe, longer lasting treatment to fill and correct smile lines, Nasolabial Folds and wrinkles around the nose and mouth. Since results may vary, be sure to discuss your expectations with Dr. Freedland's staff.

Sculptra is derived from fruit acids, which means that it is a biocompatible and biodegradable injectable material known as poly-L-lactic acid that naturally stimulates the body to produce its own collagen. The result is a fuller, smoother, more youthful and natural-looking face with less pronounced lines, creases, wrinkles and folds. Unlike traditional treatments Sculptra results can last up to 2 years. Its biocompatibility means no allergy testing prior to treatment.

Fat injection is another alternative. In the medical world, the fat-injection procedure is known as autologous fat transplantation or microlipoinjection. It involves extracting fat cells from the patient's body, such as the abdomen or thighs and then re-injecting them beneath the facial skin. The fat is separated and then injected into the areas of concern. Like the various fillers, fat will serve to fill out the facial lines and wrinkles, creating a more rejuvenated appearance. Fat is most often used to fill in "sunken" cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimize forehead wrinkles and to enhance the lips. Some of the fat will dissipate, but the fat that remains after 3 months is typically permanent. On occasion, the amount of fat that remains is insufficient and the process needs to be repeated. Dr. Freedland prefers to perform this procedure with sedation.

Realize that each of these options has its own set of risks and benefits. If you're considering any of these treatments, tell Dr. Freedland.

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Preparing for Treatment

Facial rejuvenation is very individualized. That's why it's important to discuss your hopes and expectations with Dr. Freedland, a board-certified plastic surgeon, who has experience with many different types of surgical and non-surgical facial procedures.

In your initial consultation, Dr. Freedland will evaluate your face - the skin, the muscles and the underlying bone - and discuss your goals for the surgery. He will help you select a treatment option based on your goals and concerns, your anatomy and your lifestyle. He invites you to view Before and After photos of his patients.

Dr. Freedland will ask you about your medical history, drug allergies, and check for conditions that could cause problems, such as active skin infections or non-healed sores from injuries. Collagen injections are generally off limits for pregnant women, individuals who are allergic to beef or bovine products, patients who suffer from autoimmune diseases, and those who are allergic to lidocaine (the anesthetic agent contained in the syringe with the collagen material). For more specific information about the contraindications and risks of collagen use, ask Dr. Freedland for the manufacturer's brochure for patients.

Insurance usually does not cover cosmetic procedures. However, if your injectable treatment is being performed to treat a scar or indentation from an accident or injury, you may be reimbursed for a portion of the cost. Check with your insurance carrier to be sure.

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Where Your Treatment Will Be Performed

Injectables of collagen are usually administered in Dr. Freedland's office-based facility. If, however, you are having fat injected or being hospitalized for a facelift, neck lift, brow lift, or any other procedure, your injections may be administered in the hospital as well.

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Types Of Anesthesia

Fillers: Because the anesthetic agent lidocaine is mixed in with collagen, additional anesthetic is usually not used. However, the other fillers may require topical cream anesthetic to numb the injected area. Or, you may elect to have an injected local anesthetic or sedative drugs. Discuss these with Dr. Freedland's staff.

Fat: Some surgeons may use a local anesthesia, combined with a sedative to make you drowsy, so you'll be relaxed but awake, and may feel some discomfort. Most patients prefer to have this procedure performed with a general anesthesia, so you'll sleep through the entire operation. Dr. Freedland feels a hospital provides the safest environment for your surgery and therefore performs almost all of his procedures at a JCAHO accredited hospital. The surgery is usually done on an outpatient basis; rarely does it require an inpatient stay.

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The Treatments

FILLERS
Treatment with Bovine collagen can begin after a skin test determines that you're not allergic to the substance. Other fillers require no skin test. All fillers are injected using a fine needle inserted at several points along the edge of the treatment site. If a local anesthesia has not been used, you may feel some minor stinging or burning as the injections are administered.

Since part of the substance is salt water that will be absorbed by the body within a few days, your doctor will slightly overfill the area. You may be asked to hold a hand mirror during the procedure to help your doctor decide when you've had enough.

No bandaging is needed and you are free to eat, drink, and wear makeup with sun block protection shortly thereafter. There may be some temporary swelling and redness in the treated area, which should dissipate within a few days. If these symptoms persist, contact Dr. Freedland.

Results: As stated earlier, the duration of results from filler injections is variable. The longevity depends on the patient's lifestyle and physical characteristics as well as the part of the body treated. In general, the injected material is likely to disappear faster in areas that are more affected by muscle movement like the lips. Dr. Freedland can help you determine how long you can go between treatments to best maintain your results.

FAT
The procedure: After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat is withdrawn using a syringe with a large-bore needle or a cannula (the same instrument used in liposuction) attached to a suction device. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site.

As with collagen, "overfilling" is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this over correction of newly injected fat may temporarily make the face appear abnormally puffed out or swollen.

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After Your Treatment

Immediately following treatment, you may notice some minor discomfort, stinging or throbbing in the injected area (severe or persistent pain or a sudden swelling should be reported to Dr. Freedland immediately. You will be given his pager number and his assistant's cell phone number). Occasionally some bruising or swelling will occur, but it is usually minor. Any redness that appears in the injected site usually disappears within 24 hours. However, in some individuals, particularly fair-skinned patients, this redness may persist for a week or more. Tiny scabs may also form over the needle-stick areas; these generally heal quickly.

No bandaging is needed and you are free to eat, drink, and wear makeup with sun block protection shortly thereafter. There may be some temporary swelling and redness in the treated area, which should dissipate within a few days. If these symptoms persist, contact Dr. Freedland.

If a larger area was treated, you may be advised to curtail your activity for a brief time. However, many patients are able to resume normal activity immediately. You can expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. You should stay out of the sun until the redness and bruising subsides - usually about 48 hours. In the meantime, you may use makeup with sun block protection to help conceal your condition. Dr. Freedland can instruct you on skin care products that can help.

The swelling and puffiness in the recipient site may last several weeks, especially if a large area was filled.

Results: The duration of the fat injections varies significantly from patient to patient. Though most patients report permanent results, the majority of patients find that one third of the injected fullness disappears within 3-6 months. Therefore, repeated injections may be necessary. Dr. Freedland will advise you on how to maintain your results with repeat treatments.

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Getting Back To Normal

Fillers are administered in the office and are associated with very little swelling. Most patients report very little down time and get back to their normal activities almost immediately. Fat injection on the other hand results in some swelling at the donor site. That is, typically there is some discomfort in the area where the fat was taken from. The area in the face is typically swollen and on occasion bruised for up to one week. Some patients have minimal swelling though.

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Your New Look

If you're like most patients, you'll be very satisfied with the results of your injectable treatments. You may be surprised at the pleasing results that can be gained from this procedure.

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