Candidates
In-office injectables are ideal for individuals wishing to improve developing areas of aging with methods that are well tolerated and fit well into a busy lifestyle. These eliminate the down-time associated with surgery while still providing powerful results.
Botox® injections are most typically used to treat the upper face, particularly crow's feet lines that appear on the sides of the eyes and wrinkles of the forehead and between the eyebrows. On the other hand, fillers are most commonly used in the lower face around the mouth, such as the nasolabial folds and marionette lines. They are also performed for lip and cheek enhancement. Importantly, subtle but yet powerful results can be delivered with injectables, but typically results are not as significant as those obtained with surgery.
Consultation
Dr. Knott and Seth will discuss your aesthetic goals and provide recommendations of the injectables that may best achieve your desired outcome. This discussion would go over your medical problems and medications so that they may determine if you are a good candidate for the procedures. In addition, they will explain the details of the procedure and the associated recovery and post-treatment care.
Procedure
Office-based procedures can typically be performed in less than an hour of your time. You will need to wash your face with a gentle cleanser in the clinic to remove any makeup and skin oils. We can then apply local or topical numbing anesthesia if needed, although these may not be required. Injections are performed with you seated in a large, comfortable clinic chair.
To provide you with personalized care, all treatments are administered by the doctors themselves. This typically involves small needle-pokes with very thin needles into your skin. Injections are performed in different depths and techniques depending on the material being used and the desired results.
Immediately after the procedure, you will be provided with ice-packs to apply to the area to help diminish any swelling or bruising. These are infrequent but can occur. Most bruising can be easily covered with applied makeup.
Recovery
Recovery is typically quick with most patients returning to a normal routine that same day. You can apply ice-packs to treatment areas for ten to fifteen minutes every one to two hours for the first three days as needed. You should avoid activities that can cause facial flushing, such as heat application, exercise, and tanning for the first one to two days after injection.
Results of fillers are apparent immediately. Botox results can be seen as early as the next day but full results are typically achieved at one to two weeks after injection. The effect varies with each product, but typically most products provide lasting results for four to twelve months. Dr. Seth and Knott avoid using fillers that are permanent except for infrequent situations.
Products and Treatments
Botox® Cosmetic
Botox® injections are the most commonly performed cosmetic procedure. It is used to reduce or eliminate the appearance of facial wrinkles through minimally invasive injections. These injections are of botulinum toxin A, a therapeutic muscle-relaxing agent approved by the FDA for several different uses. When injected into the facial muscles, it can block the nerve responsible for the repetitive actions that cause fine lines and wrinkles, smoothing them away for a younger and more refreshed appearance. Dr. Knott and Seth inject Botox® strategically in different facial muscles to produce a natural and optimum result of a pleasing aesthetic effect to help give you a refreshed look.
After treatment, the appearance of your wrinkles begin to improve within 24 hours, with full results developing gradually over the next seven days. The results of 
Botox injections typically last up to four months, with some patients reporting results lasting up to a full year.
Juvéderm®
Juvéderm® Injectable Gel is a safe, effective gel that restores volume to the skin and smoothes away moderate to severe facial wrinkles and folds. Juvéderm® is the first FDA-approved dermal filler proven safe and effective for persons of color. The Juvéderm® gel is made of hyaluronic acid with a smooth consistency, allowing for easy injections and instant, natural-looking results. There is no pre-testing needed for this procedure.
The Juvéderm® family of injectables offered by UCSF Facial Plastic and Aesthetic Surgery include Juvéderm® Ultra, Juvéderm® Ultra Plus, Juvéderm® Ultra XC, Juvéderm® Ultra Plus XC and the new Juvéderm® Voluma™ XC.
Juvéderm® Voluma™ XC was approved by the US FDA in October 2013 as the first injectable filler for augmentation and injection into the cheeks and midface. It is injected into a deeper layer of the skin to provide a desirable and youthful fullness, volume and contour to the midface and cheeks. Juvéderm® Voluma™ XC has shown powerful results in recent clinical trials to rejuvenate the midface. In some patients, the filling effect was noticeable for up to two years after injection.
Topical or injectable anesthesia may be used during this procedure to numb the treatment area and minimize any potential discomfort. The results are noticeable right away and can usually last for up to a year, the longest results available of any hyaluronic acid product.
Restylane®
Restylane® is an FDA-approved dermal filler made of hyaluronic acid that restores volume to the skin, lifting and smoothing out wrinkles and other fine lines. This procedure is most commonly used to treat the glabellar lines of the forehead and the nasolabial folds. It can also be used to add volume and shape to the lips.
Since Restylane® is made from a natural substance found in the body without any animal derivatives, no pre-testing is required. Restylane® produces results that last for several months through its unique ability to bind with water and remain in the skin for volumizing effects. The results of this procedure are visible right away and can last for several months up to a year.
Belotero®
Belotero Balance® is a hyaluronic acid based filler used to restore areas of fine wrinkles around the lips, mouth, and nasolabial folds. No pre-testing is required and similar to the other hyaluronic acid products above, this gel does not contain any animal-based products.
Belotero Balance® can be injected with a very thin needle due to its low viscosity. This leads to less chances of bruising for the patient. Also the chances of lumps with injection are lower as the material is "smooth" and easily injects and fills.
Radiesse®
Radiesse® is a synthetic injectable filler that has been approved by the FDA to reduce moderate to severe wrinkles, folds, and creases around the nose and mouth by stimulating the natural production of collagen in the skin. This product is made of microspheres composed of calcium hydroxylapatite within a water-based gel and is made from minerals similar to what makes up our bones. Radiesse® can be injected directly into the skin with no need for pre-testing.
Radiesse® is most effective in reducing the appearance of smile lines, nasolabial folds, marionette lines and other wrinkles around the nose and mouth. The results of this procedure are visible immediately after the injection and can last for up to a year or even longer. With continued treatment, patients require fewer and fewer injections.
Sculptra®
Sculptra® is an injectable filler that restores facial fat lost by the effects of lipoatrophy, including sunken cheeks, hollow eyes and other indentations. This filler is injected below the surface of the skin in the areas of fat loss. The Sculptra injection consists of an alpha hydroxyl acid called poly-L-lactic acid, or PLLA. This product is safe, synthetic, biocompatible, biodegradable and long-lasting. No pre-testing is required for Sculptra treatments.
The results of Sculptra will appear gradually after the injection, with most patients able to achieve their desired results after just one treatment session. The length of the results can vary from patient to patient, but often last for up to two years.
To learn more about facial injectables, fillers, and volumizers, and whether or not these procedures are right for you, please call us today to schedule a consultation.