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What products are available?

There are numerous implant substances that add bulk to tissue. Manufacturers of these products will claim theirs to have certain advantages over others. The decision as to which you should use will depend on what you are trying to achieve and on the expert advice of your dermatologist. Each has their place and specific uses in facial augmentation. See individual implant types for specific details regarding use.

Implant Type	Product Names
Fat grafting
Collagen	Zyderm, Zyplast, Alloderm, CosmoDerm, CosmoPlast
Hyaluronic acid	Hylaform, Restylane, Perlane
Hydroxyapatite	Hydroxyapatite (HA), Coralline Hydroxyapatite (CH)
Silicone	Popular manufacturers include Implantech, Allied Biomedical, Advanced Bio-Technologies, Inamed Aesthetics
Expanded polytetrafluoroethylene (ePTFE)	Gore-Tex, SoftForm
Polyethylene	Medpor
Polymethyl-methacrylate (PMMA)	Artecoll, MetaCrill
Hydrophilic polyacrylamide	Hydrogel, HPG, Argiform, Bioformacryl, DermaLive, Aquamid

Of the implant types described above, the following are injectable augmentation products:

• Collagen (excluding Alloderm®)
• Hyaluronic acid
• Polymethyl-methacrylate (PMMA)
• Hydrophilic polyacrylamide gel

These products provide facial augmentation with less downtime. Collagen and hyaluronic acid provide only a temporary solution as they are reabsorbed into the body over time; top-up treatments are necessary to maintain the desired correction. PMMA and hydrophilic polyacrylamide gel are recent additions of injectable augmentation products and claim to give more permanent results.

Are there any side effects from using facial implants?

All facial implants currently used have some side effects that preclude them from being the "ideal" agent. Some of the side effects and complications that may occur include:

• allergic reactions
• bleeding
• infections
• movement or extrusion of implant

More examples and relevant information booklets are available during your consultation where we will discuss your needs and recommend the product that is best suited for you.

Facial Peels

Chemical peels

A facial peel refers to the application of one or more chemicals to the face which 'burn' off damaged cells.

Chemical peels are sometimes applied to other sites such as the hands. They may be used to treat damage caused by exposure to the sun (photoageing), to remove pigmentation such as freckles and melasma and fine lines and wrinkles.

A peel removes several layers of sun damaged skin cells, leaving fresh skin which has a more even surface and colour. It may stimulate new collagen to be formed improving skin texture. Peels may result in superficial, moderate depth or deep skin injury.

A nurse or aesthetician (beauty therapist) may perform superficial peels. A dermatologist or plastic surgeon usually performs deeper peels.

Peels can be repeated as necessary; some people have superficial peels every few weeks. It is wise to wait 3 to 6 months before repeating a moderate depth peel.

Glycolic acid, salicylic acid and Jessner peels result in superficial skin injury and are well tolerated - the 'lunchtime' peel. They remove thin lesions on the skin surface, reducing pigment and surface dryness. The result of the first peel may be disappointing, but after repeated peels, significant improvement is usually evident.

Trichloracetic acid (TCA) is the most common chemical used for a medium depth peel. The results depend on its concentration, usually 20 to 35%. The treatment is painful and treated areas are swollen, red and crusted for the next week or so. It can lead to an impressive improvement in skin texture with a reduction in blotchy pigmentation, freckling and solar keratoses (dry sunspots). Although fine wrinkles and some acne scars are less obvious, the TCA peel has no effect on deep furrows.

Phenol results in deep skin injury. It is rarely used for facial peels nowadays because of the risk of scarring and because of its toxicity. Absorption of phenol through the skin results in potentially fatal heart rhythm disturbances and nerve damage. However, it is very effective at improving both surface wrinkles and deep furrows. After a phenol peel, the treated skin is pale and smooth but it may be waxy and "mask-like".

Before the peel

Pre-treatment creams are applied to the face at night for several weeks prior to the peel. By exfoliating the skin and reducing pigmentation themselves, they improve the results seen from chemical peeling. They may also reduce the time needed for healing. The creams usually include one or more of the following:

• Tretinoin
• Alpha hydroxy acid e.g. glycolic or lactic acid
• Hydroquinone for tanned or dark skinned patients or those with melasma

Broad spectrum SPF 30+ sunscreen should be used during the day.

The peel

Superficial chemical peels are a minor procedure and no special arrangements are needed. But you may need painkillers, sedation, local anaesthetic or even a general anaesthetic for deeper peels.

First the face is thoroughly washed to remove surface oil. The peeling agent is then applied for several minutes. It stings - how badly and for how long depends on the chemical, its concentration, whether you've had pre-treatment with aspirin, and individual factors. A fan can help. The peel is then neutralised, and the burning sensation lessens.

Individual treatments may include peels with several agents on the same occasion, with the aim of improving results and reducing risks.

Antibiotics and oral antiviral agents may be recommended after deeper peels.

Afterwards

Superficial peels result in mild facial redness and occasional swelling which usually resolve within 48 hours. The peeling is similar to sunburn. Most people can continue their normal activities. Make-up can be applied a few hours after the procedure.

Moderate depth peels result in intense inflammation and swelling, which resolve within a week. The peeling is more marked. Mild redness can persist for several weeks. Most people take a week off from work after a moderate depth peel.

Looking after the skin after the peel:

• Keep treated areas cool (use a water spray).
• Do not pick! Picking delays healing and causes scarring
• Moisturise - use light preparations after a superficial peel, thicker moisturisers after a deeper peel
• Protect from the sun - especially for the first 6 months
• If advised to do so, continue to use tretinoin, glycolic acid and/or hydroquinone at night long term

We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, NYC, New York, NY 10017.