We have a large selection of different therapeutic options to choose from for the treatment of wrinkles.
The procedure or combination of procedures selected will depend on the nature of the wrinkles and the wishes of the patient.
Injections of botulinum toxin ("Botox") are used to soften the facial expression lines through temporary weakening of the facial expression muscles. The real art lies in administering the right dose of the medication. Mask-like expressionless faces are not what we're aiming for.
There are a large number of preparations which can be used for filling the deeper wrinkles.
In my practice, I use only biodegradable preparations, but these last for only a limited time.
I most frequently use hyaluronic acid, calcium hydroxylapatite and lactic acid, all produced by leading manufacturers.
The so-called permanent "fillers" can lead to the formation of inflammation-induced skin granulomas, which are cosmetically unattractive and are difficult to treat. I do not use these preparations, as I consider the risks to be too high.
The use of permanent fillers can also occasionally lead to rashes and swellings or to an allergic reaction, which would then require further treatment by me.
A well-tolerated filling material – and one which I have been using successfully for many years – is autologous fat.
The autologous fat is taken from a suitable donor region using a low negative pressure technique and after appropriate processing with special instruments is injected at the desired location.
This is, however, a surgical procedure which is performed under sterile conditions in the surgery under local anaesthetic and analgo-sedation. The advantage is that material is used from the person's own body and consequently even fairly large quantities can be transplanted. Autologous fat also contains undifferentiated cells, which can go on to develop into fat cells or into supporting tissue cells, thus building up both the skin and the subcutaneous layers.
After an autologous fat transplant, swellings and possibly bluish skin discolorations can be expected to last for several days. This will vary from person to person and depend on the extent of the area of injection and the coagulation status of the patient.
Fine wrinkles on the upper lip can also be removed by means of dermabrasion.
This procedure involves removing the upper skin with a fast-rotating burr coated with diamond dust. This produces a superficial abrasion wound, which heals fully in six to eight days with ointment treatment.
This procedure is performed on an outpatient basis under local anaesthetic. To prevent herpes infection or a general infection, antiviral medications and antibiotics are prescribed.
Post-operatively, the application of a sufficiently effective sunscreen is essential in order to prevent pigmentation disorders.
Radiowave treatment of facial skin
Radiowave treatment is a non-invasive method of improving the appearance of skin, primarily on the face.
The radio-frequency energy generates heat, which acts to stimulate the production of new skin cells and collagen. After three to four sessions of this treatment, the skin becomes tighter and smoother.
The treatment is performed as an outpatient procedure without anaesthesia. A smooth probe is moved over the parts of the face to be treated.
A series of three to four sessions is necessary in order to achieve visible success.
No side effects are known.
One more personal word on wrinkle treatment:
the media often gives the impression that you can magically remove all the wrinkles on the face with one "jab". This is simply not true. On the contrary, in most cases a combination of procedures is required for good results. This will depend on the nature of the wrinkles, the condition of the skin, the tautness of the facial muscles and last but not least the wishes and choices of the patient being treated. It is often recommended that skin ablation procedures (removal of the top layer of skin) be combined with injections. Where there is considerable sagging of skin and muscles in the face and on the neck, a tightening operation (cheek/neck lift) is and remains the procedure of choice.
A modern lift procedure includes additional optimization measures such as, for example, autologous fat injection or treatment with a radiowave device and, where applicable, treatment of upper lip wrinkles with hyaluronic acid.