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Wrinkle Treatment


Understanding Various Treatments of Facial Wrinkles

The gradual development of facial wrinkles, whether fine surface lines or deeper creases and folds, is the classic early sign of accumulated skin damage and inevitable aging. Premature aging and wrinkling of the skin may be accelerated by excessive exposure to the sun and other elements, overactive facial expression muscles, the frequent use of tobacco products, poor nutrition, or skin disorders. Fine surface wrinkles that progress to deeper creases, deepening facial expression due to repeated skin folding, and deep folds which develop with one’s maturity are obvious changes which may combine to portray a less desirable appearance.

Persistent facial lines, especially those involved in negative emotional expressions, may mistakenly portray to others, the look of worry, anger, anxiety, disgust or sadness, despite one’s own positive internal feelings. Regardless of the cause of facial creases or folds, safe and successful treatments for reduction or elimination of these problems are now available with the help of a Facial Plastic Surgeon.

Injecting or implanting substances which either temporarily weaken the muscles or act as skin volume fillers serve to soften or eliminate the appearance of wrinkles and produce a more youthful, rejuvenated appearance.

Treatments for facial wrinkles are usually performed in the office setting which is convenient, private, and safe for persons who desire therapy. Your health, in conjunction with the appropriate therapy to achieve your goals, is given full consideration by Dr. Swenson prior to the any decision to undertake specific treatment.

However, very few individual health problems would limit the use of these therapies due to their minimally-invasive methods of application. Your concerns and any medical requirements for each facial wrinkle therapy will be part of the consultation with Dr. Swenson.

Understanding Types of Treatment for Facial Wrinkles

Prominent forehead creases, brow furrows or eye lines (crow’s feet) produced by specific facial expression muscles repeatedly creasing the skin may be effectively treated by reducing the function of specific facial muscles. Botulinum toxin (Botox) is a sterile, purified protein produced from the bacteria, Clostridium botulinum, in the laboratory. Botox injected in small amounts into facial muscles binds to the nerve endings supplying the muscle and prevents nerve impulses from traveling to the muscle. When injected into muscle, it weakens or paralyzes the muscle around the area injected for a typical period of several months. The resultant weakening or paralyzing effect on the facial muscle temporarily reduces or eliminates previous skin creasing and new skin creasing is avoided. Botox may take several days to have its effect, and the effect typically lasts 3-6 months, in most individuals, before full muscle movement returns. At that point further treatment may be elected.

Injectable collagen is an animal protein filler material formulated for safe use in nearly all areas of the face, including the lips and crow’s feet. Fine wrinkles are filled in by the material to reduce their visibility. Other prominent facial creases and folds around the forehead, cheeks and chin can be treated as well with this material. Initial collagen allergy testing must be performed, and repeated treatments every 2-4 months are typically needed to sustain the desired result. The treatments are easily performed in the office and usually have minimal side effects.

Human collagen matrix, is an implant used for the reconstruction of soft tissue defects. It may be threaded beneath the deep creases of the brow or cheek folds or placed within the upper and lower lips, to flatten and reduce wrinkle visibility. Typically, this material maintains the majority of its volume correction similar to injectable collagen.

Another type of implant is a nonresorbable synthetic polymer material, ePTFE which may likewise be used in the forehead, cheek folds, and lips to produce volume enhancement and effacement of deep facial creases. This material does not incorporate into surrounding tissue, but it does not lose volume either. It provides more lasting change and may be placed during an office procedure using local anesthetic and small incisions with a relatively short recovery period.

Fat grafting creates a natural augmentation for the face, especially for the lips and mouth region. Fat is usually harvested from the abdomen and about one third of the volume remains after the treatment. Fat grafting can be repeated for additional fullness.

Making the Decision For a Specific Therapy

Expectations of any facial wrinkle therapy must be realistic. While an expectation for the complete and permanent removal of facial wrinkles for those persons considering treatment may be attractive, it is unrealistic, due to the ongoing nature of wrinkle formation and the currently available methods for treatment. The patterns and severity of facial wrinkle formation are highly individual. Therefore, after consultation with Dr. Swenson, the appropriate therapy for your specific problems must be tailored to meet your needs. Management of many facial wrinkles may require repeated treatments or the use of combinations of treatments to achieve optimal results.

The goal is to improve or reduce the appearance of the wrinkle or crease. This can be accomplished by reducing skin folding caused by underlying facial muscle action, as in botulinum toxin therapy.

Alternatively, the skin beneath the wrinkle can be augmented to efface the wrinkle with injected or inserted filler material. The choice of a type of therapy depends on the location and extent of the wrinkles, the desired duration of the effects, and the tolerance for potential side effects.

All of these treatments provide additional and complimentary anesthetic benefits when combined with another facial rejuvenation procedure such as facelift, brow lift, blepharoplasty or skin resurfacing.

What to Expect After Each Treatment

In comparison to typical cosmetic surgical procedures, the office time for these procedures and the subsequent recovery period until one returns to normal function are minimal. Botulinum toxin therapy typically takes a few minutes to perform, and most patients may return immediately to home or work. Minor local irritation, redness, bruising, or swelling at the injection sites are the most commonly observed side effects, all of which typically abate within a few hours. Likewise, collagen or human dermal injection therapy can be accomplished with a 5-15 minute procedure with similar attendant side effects. Some mild irritation at the injection sites is unavoidable but can easily be camouflaged with standard make-up, if necessary.

Filler implant insertions typically take up to an hour to perform in the office, depending upon the number and extent of treatment locations. Several sutures are used to close the insertion site. More swelling, redness, and discomfort may accompany these procedures, which require the use of a local anesthetic. Local application of cold compresses may feel comforting. Most early swelling subsides within a day or two, though minor swelling and irritation may last for several weeks during the implant healing phase. Your activity level and medication for pain after the procedure are dependent upon your doctor’s recommendations.

Fees for facial plastic surgery generally are expected in advance because this type of surgery is not covered by insurance. Surgery to correct or improve facial scars or contour deformities resulting from injury may be covered. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.

What Is a Facial Plastic Surgeon?

Appearance plays a big role in the lives of most people. We begin the day looking in the mirror-washing our face, brushing teeth, combing hair, shaving, putting on make-up. For some, the reflection can cause displeasure due to accidents, birth defects, or other signs such as premature aging. Many of these conditions can be improved surgically and many people choose to put their faces in the hands of a facial plastic surgeon. A facial plastic surgeon specializes in performing cosmetic and reconstructive surgery on the face, head, and neck region.

A facial plastic surgeon is typically board certified in otolaryngology, the specialty addressing surgery of the head and neck. These surgeons perform the majority of elective facial plastic surgery procedures in the United States. The facial plastic surgeon has spent five to six years in postgraduate surgical training. Training includes one year of postgraduate training in general surgery and at least four additional years of specialty training in head and neck surgery and facial plastic surgery. Concentrating on the complex anatomy, physiology, pathology, biochemistry, and bacteriology of all the organs and structures of the head and neck, provides the facial plastic surgeon a strong focus on the anatomical region being treated.

When Do You Need a Facial Plastic Surgeon?

The reasons for facial plastic surgery are varied. Some patients suffer from birth disfigurements such as birthmarks, cleft palates, and congenital facial deformities. Others are victims of accidents, burns, diseases, and the treatment required for such diseases. Many choose to change some of the signs of premature aging or the shape or size of a facial feature that has bothered them for years.

One aspect of facial plastic surgery that cannot be ignored is the patient’s mental and emotional attitudes. Facial surgery can help you increase self-confidence because, for most people, when they look better, then generally feel better.

Facial Plastic Surgeons may perform any or all of the following:


Surgery of the nose where cartilage and bone are reshaped and reconstructed; excess bone or cartilage may be removed.

Recovery time is approximately one week.

Results: Permanent.


Surgery of the eyelids where fat and excess skin, bags, pouches, wrinkles in the eye area are removed.

Recovery time is approximately one week.

Results: Lower lids, permanent; upper lids, ten years.


In facelift surgery, excess skin is removed and muscles are tightened.

Recovery time is approximately two weeks.

Results: From five to 10 years, depending on the patient.

Forehead Lift

Surgery to minimize forehead lines and wrinkles, and elevate brows to reduce lid drooping.

Recovery time is about 10 days.

Results: 10 years.

Submental Lipectomy
Surgery beneath the chin to eliminate “double” chin; excess fat is removed.

Results: Generally permanent.


Surgery of the chin where a receding chin is augmented with bone or an implant or a too prominent chin is reduced.

Recovery time is about one week.

Results: Permanent.


Surgery of the ear where ears can be “pinned back” by reshaping the cartilage.

Recovery time is about one week.

Results: Permanent.

Laser Skin Resurfacing

Removal of the upper layer skin using a laser, resulting in smoother and less wrinkled skin.

Recovery time is about 10 days.

Results: Generally permanent.

Chemical Peel
Controlled removal of the outer layer of skin with specific chemicals. Recovery time, depending on the nature of the chemical, is from one to three weeks.

Results: Generally, permanent.


Abrasion of the skin with either a wire brush or diamond fraise to remove the upper layer of the skin resulting in smoother, less wrinkled skin.

Recovery time is about 10 days.

Results: Generally permanent.

Facial Reconstruction

Surgery to repair or reconstruct facial features. This includes scar revision, fracture repair, laceration repair, vascular birth marks, cleft lip and palate, craniofacial deformities, orthognathic surgery, free flaps, and other cancer reconstruction.

How To Find a Facial Plastic Surgeon

The American Academy of Facial Plastic and Reconstructive Surgery instituted a toll-free number, 1-800-332-FACE in the United States and Canada, that provides inquirers the names, addresses, and telephone numbers of facial plastic and reconstructive surgeons in the inquirer’s area who specialize in the inquirer’s desired surgical procedure.

In addition, as with many things, word of mouth is often best. It is helpful to talk with friends, relatives, and coworkers who have had or may know someone who has had facial plastic surgery.

You may want to ask the following questions:

  • How did they locate the surgeon?
  • Were they happy with the results?
  • Would they return to the same surgeon for another procedure?

General practice physicians may also be able to recommend facial plastic surgeons with whom they may have worked. It is still important to validate the training, skills, and experience of the surgeon. The Directory of Medical Specialists, available in public libraries, can be used to check the credentials of any referral you may have been given. Facial plastic surgeons will be listed under the heading “Otolaryngology.”

Facial plastic surgeons are certified by The American Board of Otolaryngology, a board recognized by The American Board of Medical Specialties. Facial plastic surgery is included in the otolaryngology certification because it is an integral part of otolaryngology training, which is focused on the face, head, and neck. Other specialists are trained in surgery of the whole body.

Choosing a Facial Plastic Surgeon

One of the most important factors for successful facial plastic surgery is the relationship between the patient and surgeon. An initial consultation provides the patient and surgeon an opportunity to discuss all that is involved in the desired procedure. It is advisable for the patient to write questions down before the consultation.

You may want to ask the following questions:

  • Am I a good candidate for this procedure?
  • How long will the operation take?
  • What is the recovery time?
  • What are the risks involved?
  • Is post-operative medication necessary?
  • What is the charge for the procedure?

It is also a good idea to write down the answers the surgeon provides so that the patient can review these carefully. The consultation also provides the patient a chance to experience the personality style of the surgeon to see if it is compatible with the patient’s.

The patient should be prepared to be candid with the surgeon about their medical history, any medications, allergies, habits, and background which could affect the outcome of the surgery. The surgeon will also explain to the patient their experience in the area of facial plastic surgery the patient is considering. Some consultations may include computer imaging to show the patient what the surgery might accomplish. The surgeon can also describe what anesthesia the surgeon uses for each of the surgeries the patient is contemplating. The surgeon might also advise on supportive surgery to enhance the outcome of the specific surgery. It is crucial for the patient to find out about all aspects of the proposed surgery.

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