THE VISIBLE SIGNS OF FACIAL AGING OCCUR OVER TIME AS A RESULT OF MANY FACTORS INCLUDING SUN EXPOSURE, HEREDITY AND LIFE STYLE. One of the earliest signs of aging is a loss of facial fullness and the development of expression lines – wrinkles that appear as a result of the repeated movement of facial muscles. Softening of these facial lines and creases, and the restoration of volume and fullness in the face can often be achieved non-surgically through treatment with injectable fillers. If you wish to enhance or restore facial contours, or reduce the appearance of lines and creases, injection therapy with soft tissue fillers may be right for you. Injectable fillers can plump thin lips, enhance shallow contours, soften facial creases and wrinkles, and, in some cases, improve the appearance of recessed scars. The result is a smoother, fuller and more youthful facial appearance.

What are injectable fillers?
Injectable fillers are substances that enhance the fullness of soft tissues, primarily in your face. Some fillers are based on natural substances derived from the human body, others are synthetic forms of these substances, and some may contain synthetic, biocompatible compounds. Injection therapy may also be performed using one’s own fat cells. The differences among facial fillers are not only in their composition, but also in their preferred application and the duration of their results.

Collagen is a natural protein that supports your skin. Injectable collagen formulas derived from human dermis include Cosmoderm® or Cosmoplast®. Zyderm© and Zyplast® are forms of bovine collagen that, unlike humanderived collagen, require prior allergy testing. The results of treatment with injectable collagen may last 2 to 4 months. Restylane® is a form of hyaluronic acid, a natural substance found in your body. It is well suited to plump thin lips and fill facial creases such as nasolabial folds. It may also be appropriate for some surface wrinkles and concave scars. The fullness achieved from Restylane treatment may last 6 months or longer. Radiance® is a form of hydroxylapatite, a mineral-like compound found naturally in human bones, suspended in a gellike formulation. It is the heaviest of facial fillers and is recommended to fill deeper creases such as nasolabial folds, marionette lines and frown lines, as well as to enhance fullness of the cheeks and other facial contours. Radiance lasts 2 years or longer and is presently “off-label” in its use as a facial filler.

Human fat, harvested from your own body can be reinjected to enhance your facial fullness, fill deep creases and to build up shallow contours. Fat injection requires a more extensive procedure than other injectable fillers because it uses liposuction techniques to extract the fat prior to injection. Treatment results last up to a year or more in some cases and are highly variable. Fat can be stored for your own future treatment. The duration of results from preserved fat is not as favorable as fat used at the same time it is harvested.

The U.S. Food and Drug Administration reviews and approves pharmaceutical fillers in the same manner as medical devices. However, some fillers may be used on an off-label basis, meaning they are approved medical treatments but not directly reviewed for a specific application. The options discussed in this brochure are among the current fillers preferred by plastic surgeons. Some are available for general use, others are not; regulatory status may be subject to change. Dr. Massiha will have the latest information and will be able to advise you on the options currently available.

Where do I begin?
Your consultation with Dr. Massiha is the first step to learn how treatment with injectable fillers can enhance your facial fullness, and improve the appearance of your facial creases, wrinkles and scars. This consultation is designed to fully educate you in a non-pressured environment, and will include:

• A discussion of your goals and an evaluation of your individual case
• The options available for facial augmentation with injectable fillers
• The likely outcomes, duration of results and potential risks associated with the use of specific fillers
• The course of treatment recommended by Dr. Massiha

Dr. Massiha will also answer all of your questions.

Evaluation
Dr. Massiha will review your medical history and your goals for improvement in consultation prior to any treatment with facial fillers. The success of your procedure, safety and overall satisfaction require that you:

• Honestly share your expectations
• Discuss any past treatment with injectable fillers, facial shaping or Botox® therapy or other facial rejuvenation procedures
• Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs
• Commit to precisely following all of Dr. Massiha’s instructions

Safety
By making the decision to consult with Dr. Massiha and following all the instructions given, you are taking an important step in helping to assure your safety.

Dr. Massiha is certified by The American Board of Plastic Surgery®, which designates him of having expertise in plastic surgery of the face and entire body.

My soft tissue augmentation
Dr. Massiha will carefully evaluate your facial appearance and skin tone, and examine the areas of your face to be augmented with injectable fillers. Strategic points on your face may be marked as guides to the appropriate injection sites for the filler recommended in your individual case. The injection sites are cleansed with an antibacterial agent and icing or a topical numbing agent may be offered to make more sensitive patients comfortable. In some cases, the filler itself will contain an anesthetic agent. In other cases local anesthetic may be administered to the treatment site. Injection takes only a few moments per site and a few minutes for a course of treatment. Following injection, any markings will be cleansed and icing may be offered to alleviate any temporary, minor discomfort. Make-up may be carefully re-applied so long as care is taken not to apply pressure to the treatment area.

An improved appearance is visible almost immediately, although minor swelling or bruising may appear at the injection sites. With some fillers, a slightly “over-filled” appearance may be initially present. Any of these conditions will dissipate within a few hours, or at most a few days; however the duration may be as long as a few weeks with injection of one’s own harvested fat. The use of facial fillers may further enhance the outcomes of other rejuvenation procedures such as facial rejuvenation and shaping, and wrinkle reduction by injection (Botox® therapy), or surgical rejuvenation such as a brow lift or facelift. In addition, one’s own fat may be extracted in conjunction with liposuction (to remove localized excess fat) and prepared for injection, or preserved for later injection.

Preparing for soft tissue augmentation
Dr. Massiha will carefully explain:

• Your course of treatment
• The type and brand of filler recommended in your case and why
• The results you can expect
• How long you might expect results to last

In addition, you will be asked to sign consent forms to assure Dr. Massiha that you fully understand the procedure and effects of soft tissue augmentation and any risks or potential complications. Reported risks associated with the use of injectable fillers in soft tissue augmentation vary depending on the specific filler used and the relative permanence of the filler substance. Fillers derived from non-human sources may require a pre-treatment allergy test. Infection at the injection site is also possible. Complications from fillers generally are reported to be uncommon and temporary.

Those fillers that are not completely fluid and contain microscopic granular substances, carry a risk of “clumping” as a result of facial movement and the natural aging process. Over time, these can result in lumps or nodules that may require surgery to treat. Risks will be fully discussed prior to your consent.
It is important that you address any questions about soft tissue augmentation with injectable fillers directly with Dr. Massiha.

What to expect
Injection therapy with soft tissue fillers is performed in Dr. Massiha’s office. Your initial treatment will include a complete consultation. Subsequent follow-up procedures may take only a few minutes, as the full process of consultation is not necessary to repeat, although consent is required at each visit.

Following treatment
Once your procedure is completed, you will be instructed on how to care for the treated areas of your face. You will also be reminded about:

• The expected duration of your results
• Specific concerns to look for at the injection site or in overall health
• When to follow-up with Dr. Massiha

Progress and healing
You may experience temporary numbness, redness, swelling and minor bruising at the injection sites. These can be alleviated with topical icing and should resolve within a few days. The results of your treatment are visible immediately; however, they will lessen over time as fillers are absorbed. The post-treatment side-effects of fat injections last longer than other filler substances, from several weeks to several months, in some cases. The results of soft tissue augmentation with injectable fillers are not permanent, even though a filler substance may be considered permanent. The continued aging of your face and variables in the absorption of fillers will affect just how long your results last. The results of non-permanent fillers will diminish over time. Should you choose not to repeat treatment, your appearance will return to its original condition. Plumped lips will lose volume and improved wrinkles, creases and scars will visibly recess and fully reappear in time. The results of permanent fillers can change over time; as you age naturally, these fillers may shift or clump. Surgical removal may be necessary to correct these conditions and could result in visible changes in appearance and noticeable changes in the texture of soft tissue.

Results and outlook
You may find yourself surprised at how such a relatively quick in-office procedure can produce a marked improvement in restoring facial fullness and a more youthful appearance. However, injection therapy to augment soft tissue is by no means simple.

Effective and safe use requires a physician with specialized training and a thorough understanding of facial anatomy to recommend and inject an appropriate filler. Choosing Dr. Massiha to treat your face with injectable fillers means that your treatment will be performed by someone who not only has training in injection therapy, but in all types of non-surgical and surgical facial rejuvenation.

Dr. Massiha, Your Choice
Choosing to have plastic surgery is an important decision; so is selecting a plastic surgeon. Dr. Massiha has the following credentials:

BOARD CERTIFICATION – Not all physicians who perform plastic surgery or who use the title plastic surgeon are board certified in plastic surgery.
Dr. Massiha is certified by The American Board of Plastic Surgery (ABPS) which certifies physicians in plastic surgery of the face and entire body. To be certified by the board, Dr. Massiha:

• Graduated from an accredited medical school
• Completed a minimum of five years of surgical training
• Followed medical school, including an accredited plastic surgery residency program
• Passed comprehensive oral and written exams

PRIVILEGES -Your surgeon should have operating privileges at an accredited, local hospital for the same procedure you plan to have performed – even if that surgeon suggests your procedure be performed in an accredited office-based surgical facility or at an ambulatory surgery center.  Dr. Massiha has these credentials—A Doctor You Can Trust.

E-mail or call us today at (504) 455-9441 to schedule your consultation.