Davis

Did you enter the new year determined to make more of an investment in yourself? Rewarding as that will ultimately be, it can be difficult trying to figure out exactly where and how to begin. A positive return on those first few steps will likely give you all the momentum you’ll need to stick with it. But stumble just a bit and you may fall back to your old ways.

Worth your consideration is a small but effective act that’s come to be described as a “tweakment.” It’s a new category of quick, minimally-invasive cosmetic procedures that are meant to provide a dramatic refresher and stave off the early phases of the aging process. Think injectables, microneedling, and lasers. Here’s a closer look at a couple of the most popular tweakment procedures.

Concern: Double Chin

You may have heard about the growing wave of body-contouring technology that’s capable of removing unwanted fat without a single incision or any downtime. Lesser known is just how versatile many of those treatments are. CoolSculpting, the best-known brand among the fat-freezing devices, has a treatment head that can be used under the chin to tackle jowls, for example.

Through a process called cryolipolysis, the fatty tissue in the treated area is cooled and up to 25% of the affected fat cells are ultimately destroyed. And because the body only produces a certain number of them, those particular fat cells are never coming back. Basically, as long as you maintain a healthy lifestyle, you can expect to never again be plagued by that pocket of stubborn fat.

Concern: Dark Circles

Dark circles really have more to do with genetics than anything else, but they will become more prominent if you’re not staying sufficiently hydrated or getting enough sleep. They also worsen with age. The upside: A well-placed, subtle hyaluronic acid filler can have a pretty dramatic effect simply by creating a plumper under-eye.

Hyaluronic acid is a natural part of the skin’s dermis, but we store less of it as we age, which causes the undesired hollowing effect under the eyes. The hyaluronic acid in fillers helps pull water to the site of the injection, stimulating the appearance of thicker fat pads under the skin.

Another tweakment option is platelet-rich plasma injections, which have the same effect. A small amount of blood will be drawn from your arm (about two to four tablespoons). Then, it’ll be placed into a centrifuge, which separates the blood into layers. The layer with the highest concentration of platelets will then be injected into your under-eye areas.

Each of the procedures outlined here takes less than an hour and requires little to not downtime. In other words, it’s a fairly minimal investment, time-wise, but you’re likely to reap the sort of rewards that’ll inspire you to make this your best year yet.

Already the most widely performed minimally-invasive cosmetic procedure in the United States, botulinum toxin (Botox, Jeuveau, Dysport, Xeomin) is forecast by industry insiders to become even more popular in the year ahead as more twentysomethings turn to it as a preventative treatment.

“Preventative Botox,” as it’s come to be known on beauty sites and across social media, may sound like overkill at first. Someone in their twenties who regularly thinks about their whispers of wrinkles is obsessed, not concerned, right? We are the harshest critics of ourselves. In other words, we’ve all been there, whether we choose to remember it and relate or not.

How it works

Personal motivations aside, there’s plenty of merit to preventative Botox. Frown lines, crow’s feet, and expression wrinkles result from the repetitive folding of the skin. It doesn’t happen overnight, but it does happen a lot sooner than many of us think it will.

We’ve come to realize that by injecting these areas earlier, we can keep these wrinkles from developing in the first place, instead of trying to diminish and delete them after they’ve developed. It’s a cumulative effect. With each subsequent treatment, we’re training these muscles—and, in turn, preventing the lines from developing until much later than they normally would.

One of the clearest examples of this are the downturned lines on the sides of the mouth, often referred to marionette lines. Once they form, they can be very difficult to treat. But by injecting the muscles at the mouth angles with botulinum toxin, we’re able to keep them from appearing in the first place.

When to start

Since the goal is prevention, when should treatment start? There is such a thing, of course, as being too young for preventative treatments. Botox is FDA-approved for patients 18 and older. Most begin around age 30. Some start as early as 25. Any younger than that and you likely haven’t developed enough lines to worry about.

When you start to notice frown or forehead lines, it’s reasonable to consult with a board-certified plastic surgeon about starting preventative treatments. Ideally, we want to prevent those lines from turning into larger folds.

It’s worth mentioning that while preventative Botox has been shown to be quite effective at staving off wrinkles, it’s also one part of a healthy skin-care regimen. Applying sunscreen on a daily basis, getting plenty of sleep, and keeping stress to a minimum with activities like yoga and meditation will all contribute to maintaining a youthful radiance.

As cosmetic injections have penetrated the mainstream in recent years, there’s been an increasing tendency by media outlets, bloggers, social media influencers, even some board-certified* plastic surgeons to use certain cosmetic-injection terms as though they’ve been part of our vocabulary all along. By doing so, the best-case scenario is you’re left in the dark. Worst-case, you’re misled. Whether you’re preparing for your next treatment or your first, think about taking a moment to brush up on your cosmetic-injection terms.

*Board Certification

Indicates that the injector has not only graduated from medical school and is a licensed physician but they’ve also completed a three-year residency program in plastic surgery. When you’re considering any sort of cosmetic injection, you want a board-certified plastic surgeon because they have extensive knowledge of the musculature of the face.

Botulinum Toxin

A drug made from a purified protein derived from a strain of protein called Clostridium botulinum. With 7.4 million procedures performed last year, it’s the most popular type of injectable by far. It works by preventing nerves from releasing the neurotransmitter acetylcholine, which triggers muscles to contract. In doing so, overactive, wrinkle-causing muscles become relaxed and lines they’ve etched become less pronounced. In 2002, Botox became the first brand under which botulinum toxin was available for cosmetic injections. Jeuveau, Dysport, and Xeomin are newer versions of the drug.

Filler

Refers to any substance that can be injected into the skin or underneath it to create a physical change. There are currently 15 different kinds of fillers approved by the Food and Drug Administration (FDA) for cosmetic use. In recent years, plastic surgeons have gradually drifted away from permanent and semi-permanent fillers, which can last up to five years, in favor of hyaluronic acid fillers, whose results can last up to two years but are reversible.

Hyaluronidase

Used to reverse poorly done procedures (overly plumped lips) or the bumps that can occur as a side effect of bad injection technique or when an injection is too shallow. Hyaluronidase is comprised of a group of enzymes that break down hyaluronic acid fillers within hours without compromising the hyaluronic acid that’s found naturally in your skin. (It cannot be used on permanent or semi-permanent fillers.)

Poly-L-Lactic Acid

A sugar with medical and cosmetic applications—it’s in the filler Sculptra, which is approved by the FDA to plump nasolabial folds for up to two years. But unlike the sugar that makes up hyaluronic acid fillers, this one doesn’t occur naturally in the body, and it can’t be reversed.

Hyaluronic Acid

A naturally-occurring sugar that plumps the skin by holding 1,000 times its weight in water. With more than 2.1 million injections done in 2018, hyaluronic acid-based fillers are the most popular types of fillers today. Different brands and types offer the sugar in different concentrations and particle sizes. Small particles, such as those in Juvéderm Volbella and Restylane Silk, are often used to fill in shallow lines and delicate areas, like the lips, while larger ones, such as those in Juvéderm Voluma XC and Restylane Lyft, are most appropriate for adding volume to the cheeks and smoothing nasolabial folds.

Until recently, many plastic surgeons didn’t hesitate to prescribe the likes of Vicodin, Percocet, and oxycodone to address a patient’s discomfort that could follow a procedure. But an opioid epidemic that claimed tens of thousands of lives last year alone has prompted the field to take a closer look at pain management.

Narcotics are often necessary for controlling pain after major operations, like large-volume liposuction and tummy tucks. But more and more plastic surgeons are finding alternatives and using anti-inflammatories, local anesthetics, and numbing medications to attack different pain pathways.

And, increasingly, patients are asking their surgeons not to prescribe them any pain medication.

Redefining recovery with Experal & Celebrex

As reducing narcotics use becomes a greater priority, innovations like Experal are becoming commonplace and changing the recovery experience. Experal is a drug that contains bupivacaine, a longer-acting numbing agent. Injected at the site of the incision, it binds to fat molecules in a microscopic honeycomb. In some cases, an ultrasound is used to place it precisely where the nerves are.

Experal dissolves over the course of 72 hours, which enables plastic surgeons to significantly decrease the narcotic requirements for a number of procedures and get patients off of them a lot sooner.

Similarly, some doctors are incorporating Celebrex, an anti-inflammatory arthritis medication and pain reliever, and a nerve medication called Lyrica into their pre-surgery pain-management plan. The first is taken the day before surgery, the second, several hours before and four to five days afterward. The combination is able to cover a lot of a patient’s discomfort for certain cosmetic procedures.

And, believe it or not, Tylenol has garnered some renewed interest as an alternative. It’s been found to be particularly effective at blunting pain when it’s taken in frequent doses.

Voice your concern

Well before that point, doctors are also being more vigilant about screening patients for a history of substance use disorder. But medical records aren’t always a reliable reference for such a condition. Not to mention, there’s no way to take into account those who have a genetic predisposition for addiction.

Plenty of people are able to take opioids as they were prescribed and never use them again. But then there are others who aren’t able to stop taking them. Until you’re in that position, you can’t know for sure what you’ll be inclined to do.

If you have any concern about being prescribed a narcotic before or after your procedure, discuss it with your board-certified plastic surgeon. If an alternative isn’t readily available, your surgeon may be able to refer you to a pain management therapist, who can at least monitor your behavior when taking a small, controlled prescription.