INJECTABLES AND FILLERS

There is an ever-expanding population of men and women who are excellent candidates for minimally invasive facial rejuvenation through the precise selection and application of the appropriate facial filler or injectable. Patients with even the smallest area of concern can often get this condition treated and cured, there really is no complaint or concern that is too minor. Dr. Raghu provides injectables and fillers in San Francisco.

Patients that seek consultation come for a variety of different reasons, these include wrinkle lines, deep laugh lines, furrows and creases, angry look, and lack of definition. The cheeks and the corners of the mouth may droop and look sad. Rejuvenation occurs at the level of the skin or just below where the appropriate product is applied. There is no one product that should be promoted to “fit all.” It may be two or more different products in the same or different sessions or locations. This is known as combination therapy.

The treatment areas intimately overlap with your many different anatomical facial features, which must be analyzed and addressed prior to your injection. Dr. Raghu will coordinate the features of your anatomy with your expectations, formulate a plan with you, and guide you through this process.

BOTOX

This highly purified and very safe substance has the very specific and predictable mechanism of action of deactivating ANY muscle function at, or sometimes near, where it is injected. Therefore, it can cure or reduce any wrinkles that are due to muscle activity. The effects are not permanent, and last three to five months depending on the patient, muscle, and activity. It can be administered in the office in a matter of minutes, and you can return to work and full activity virtually immediately. Long-term use has a tendency to lessen the frequency and amount of Botox needed to obtain a given result due to several mechanisms of action. There are no bad long-term side effects.

Botox only deactivates muscles and treats the wrinkles related to the muscle activity. It does not fill in deep furrow lines and creases. In these cases it may be necessary to utilize a combination treatment of Botox to deactivate the muscle and then an injectable to fill in the furrow or crease.

Dr. Raghu likes to think of the indications for Botox falling into two broad categories as outlined below. Functional use refers to injecting Botox into a muscle with the sole endpoint of deactivating the muscle and the wrinkles due to the muscle. Cosmetic use refers to injecting certain muscles in certain amounts and in certain areas to provide a specific or more balanced aesthetic result. Most offices only provide the first. Dr. Raghu’s office provides both.

This cosmetic usage, and understanding the balance of muscle activity and its effect on the skin and surface, is where he employs Botox beyond its usual capacity—in a very artistic way.

  • Frown lines between the eyebrows. This works best if the lines are not deep.
  • Crow’s feet
  • Transverse lines of the forehead
  • Heavy vertical muscle bands in the neck
  • Complex irregularities of the chin
  • Smoker’s lines of the lips

Cosmetic Uses of Botox:

  • Create symmetry in uneven eyebrows
  • Raise the tail of the eyebrows
  • Raise the inner corner of the eyebrows
  • Elevate the corners of the mouth
  • Decrease the muscle bulk at the corners of the jawline (typical in Asians)
  • Even up sagging lower eyelids
  • Even up facial features from Bell’s palsy or other facial nerve problems

PERLANE, RESTYLANE AND JUVEDERM

There is a well-defined spectrum of specific techniques and products for facial rejuvenation. Dr. Raghu prefers the hyaluronic products for areas, such as the lips, where a very soft gel product is best. It is also best in areas of furrows and depressions, but NOT fine etched-in wrinkle lines or areas that need a firm, non-compressible product, such as in raising the corners of the mouth.

The hyaluronics—such as Perlane, Restylane, Juvéderm, and others—are basically a very pure and stabilized form of hyaluronic acid. It is a clear, transparent, viscous gel-like material that has been used as an implant for over 20 years. It is completely organic, and is not made from any animal products. Hyaluronic acid is a constituent of all connective tissues in humans and most vertebrates. It is a naturally occurring polysaccharide, which is an important structural element of all connective tissues in the body including the skin, joint fluid, and connective and subcutaneous tissues. Hyaluronic acid belongs to a group of substances that are similar in all living organisms. It is a relative of GAG (glucose amino glycan). Therefore, in its pure form, it is extremely biocompatible and safe. The stabilized form of hyaluronic acid is designed to last for a very long time and undergoes degradation only very slowly over the course of about a year.

The treatment is preceded by a local anesthetic, so you have no pain. Camouflage makeup is applied before you leave. You can return to work immediately. There should be no bruising, and you will see a natural and beautiful result right away.

Perlane, Restylane, and Juvéderm Products are Best For:

  • Furrow and crease lines—NOT for fine or etched-in wrinkle lines
  • Laugh lines (nasolabial furrows)
  • Tear-trough lines (under-eye furrows)
  • Lip or lip-border enhancement
  • Cheek enhancement
  • Chin or jaw line enhancement
  • Use with Botox in certain areas (combination therapy)
  • Raising mouth corners
  • Use when you WANT something that is temporary (“trying out the look”).

FOR EMERGENCY CASES
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