Nonsurgical innovations address full face

"There are finally enough tools available that one can discuss nonsurgical facial rejuvenation comprehensively," says Dr. Werschler, assistant clinical professor of medicine and dermatology, University of Washington School of Medicine. "It used to be that we essentially broke the face up into parts. We said, 'we can treat forehead lines and frown lines with botulinum toxin A (Botox Cosmetic, Allergan). Or we can inject collagen into the lips to make the lips fuller and smooth out the lines around the mouth."

However, he says, "We really didn't have a recipe that was nonsurgical all the way around. In the last few years, though, we've had Sculptra (poly-L-lactic acid, Dermik), Restylane (hyaluronic acid, Q-Med Laboratories) and ThermaCool^™ (Thermage Inc.) approved. Combining those with other treatments we have, we now possess a package that allows one to approach total facial restoration nonsurgically."

Assessing patient needs

Assessing and consulting with patients, he adds, begins with looking at what's gone wrong over time.

"In the upper face," he says, "with botulinum toxin, one is mainly treating muscle movement and associated pleating of the skin with muscle folding. But around the mouth, lines can form because the skin is attached directly to the muscle. It's one of the few areas on the body where that's the case. So one tends to see unique spokes in a wheel formation around the mouth. And with age, we tend to lose volume in our lips. And as the upper lip loses volume, it tends to elongate somewhat and roll inward. Therefore, we lose the sharp Cupid's bow and red hue of the lip."