Juvederm and Juvederm XC | Dr. Mark Foglietti - Botox, Juvederm, Breast Augmentation, Breast Enlargement, Facelift, Cleveland, Skin care, Beachwood, Ohio 216-292-6800

216-292-6800

Juvederm and Juvederm XC

If you're considering injectables...

As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling, chewing and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow's feet or facial creases over the areas where this muscle movement occurs.

Soft-tissue fillers, most commonly injectable HA (hyaluronic acids) or fat, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be used alone or in conjunction with a resurfacing procedure, such as a laser treatment, or a recontouring procedure, such as a facelift.

If you're considering a facial-rejuvenation treatment with HA (hyaluronic acids) or fat, this brochure will give you a basic understanding of the procedure - when injectables can help, how the procedure is performed, and what results you can expect. It may not answer all of your questions, since a lot depends on your individual circumstances. Please ask your doctor if there is anything about the procedure you don't understand.

KNOWING YOUR OPTIONS

Injected HA (hyaluronic acids) and fat are primarily used to improve the appearance of the skin's texture. They can help fill out deep facial wrinkles, creases and furrows, "sunken" cheeks, skin depressions and some types of scars. They can also be used to add a fuller, more sensuous look to the lips.

Injectables are usually not sufficient for severe surface wrinkles on the face, such as multiple vertical "lipstick lines" that sometimes form around the mouth. Instead, your plastic surgeon may suggest a resurfacing technique, such as chemical peel, dermabrasion or laser treatments. Rather than filling in facial lines, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance.

Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery, such as a facelift or browlift. Injectables are sometimes used in conjunction with facial surgery procedures; however, injectables alone cannot change facial contour the way surgery can.

Keep in mind that a plastic surgeon is a specialist that can offer you the full gamut of the most advanced treatments ranging from cosmetic surgery, refinishing techniques, laser therapy, injectables and the use of other fillers. You and your surgeon may determine that a single procedure or a combination of procedures is the best choice for you.

ASPS brochures are available on chemical peel, dermabrasion, laser treatments, facelift and browlift. If you and your doctor think that one of these other procedures might be more appropriate for you, ask your plastic surgeon to provide you with a copy.

A WORD ABOUT OTHER TYPES OF FILLERS

This brochure deals with the two most commonly used types of injectable fillers, HA (hyaluronic acids) and fat. However, to a lesser extent, a number of other filler materials are also being used for facial-rejuvenation purposes. They include: Fibril, a gelatin powder compound that's mixed with a patient's own blood and is injected to plump up the skin (similar to injectable HA (hyaluronic acids)); and Gortex, a thread-like material that is implanted beneath the skin to add soft-tissue support.

Each of these options has its own set of risks and benefits. If you're considering any of these alternative filler treatments, tell your doctor.

WHAT TO EXPECT FROM TREATMENT

The most important fact to remember about injectable fillers is that the results are not permanent. Injected material is eventually metabolized by the body. You should not expect the same long-lasting results that may be gained from cosmetic surgery.

In some individuals, the results may last only a few weeks; in others, the results may be maintained indefinitely. Researchers believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all play a role in the injected material's "staying power." However, the precise reason for the variation of results among patients has yet to be identified.

If you've had short-lived results from fat injections, you shouldn't necessarily assume that HA (hyaluronic acids) injections will work better for you. And, conversely, if you've had disappointing results from HA (hyaluronic acids), don't assume that injected fat is the answer. Although it's true that some individuals' bodies are more receptive to one substance than the other, others may find that neither substance produces long-lasting results. Sometimes one substance may work better than the other for a specific problem.

RISKS RELATED TO INJECTABLES

When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature. Still, individuals vary greatly in their anatomy, their physical reactions and their healing abilities. The outcome of treatment with injectables is never completely predictable.

HA (hyaluronic acids): Allergic reaction is the primary risk of HA (hyaluronic acids). To help determine if you are allergic to the substance, your surgeon will perform an allergy skin test about a month before the procedure. After the test is performed, the test site should be watched carefully for three or four weeks, or as long as your surgeon advises. Any sign of redness, itching, swelling or other occurrences at the test site should be reported to your surgeon.

Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare.

Fat: Allergic reaction is not a factor for fat because it's harvested from a patient's own body. However, there is still a small risk of infection and other infrequent complications.

PLANNING FOR TREATMENT

Facial rejuvenation is very individualized. That's why it's important to discuss your hopes and expectations with a board-certified plastic surgeon who has experience with many different types of surgical and non-surgical facial procedures.

In your initial consultation, your plastic surgeon will evaluate your face - the skin, the muscles and the underlying bone - and discuss your goals for the surgery. Your doctor will help you select a treatment option based on your goals and concerns, your anatomy and your lifestyle.

Your surgeon will ask you about your medical history, drug allergies, and check for conditions that could cause problems, such as active skin infections or non-healed sores from injuries. HA (hyaluronic acids) injections are generally off limits for pregnant women, individuals who are allergic to beef or bovine products, patients who suffer from autoimmune diseases, and those who are allergic to lidocaine (the anesthetic agent contained in the syringe with the HA (hyaluronic acids) material). For more specific information about the contraindications and risks of HA (hyaluronic acids) use, ask your doctor for the manufacturer's brochure for patients.

Insurance usually doesn't cover cosmetic procedures. However, if your injectable treatment is being performed to treat a scar or indentation from an accident or injury, you may be reimbursed for a portion of the cost. Check with your insurance carrier to be sure.

WHERE YOUR TREATMENT WILL BE PERFORMED

Injectables are usually administered in a surgeon's office-based facility. If, however, you are being hospitalized for a facelift, necklift, browlift, or any other procedure, your injections may be administered in the hospital as well.

TYPES OF ANESTHESIA

HA (hyaluronic acids): Because the anesthetic agent lidocaine is mixed in with HA (hyaluronic acids), additional anesthetic is usually not used. However, if you are especially sensitive to pain, your doctor may use a topical cream anesthetic or a freon spray to numb the injected area. Or, you may elect to have an injected local anesthetic or sedative drugs.

Fat: Both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you elect to use sedation, be sure to arrange for a ride home after your treatment.

THE TREATMENTS

HA (hyaluronic acids)
HA (hyaluronic acids) is a naturally occurring protein that provides support to various parts of the human body: the skin, the joints, the bones and the ligaments. Injectable HA (hyaluronic acids), patented by the HA (hyaluronic acids) Corporation under the trade names Zyderm and Zyplast, is derived from purified bovine HA (hyaluronic acids). The purification process creates a product similar to human HA (hyaluronic acids). Injectable HA (hyaluronic acids) received approval from the Food and Drug Administration in1981. It is produced in various thicknesses to meet individual patient needs.

HA (hyaluronic acids) is used primarily to fill wrinkles, lines and scars on the face and sometimes the neck, back and chest.

The procedure: Treatment with HA (hyaluronic acids) can begin after a skin test determines that you're not allergic to the subsstance. The HA (hyaluronic acids) is injected using a fine needle inserted at several points along the edge of the treatment site. If a local anesthesia has not been used, you may feel some minor stinging or burning as the injections are administered.

Since part of the substance is salt water that will be absorbed by the body within a few days, your doctor will slightly overfill the area. You may be asked to hold a hand mirror during the procedure to help your doctor decide when you've had enough.

After treatment: Immediately following treatment, you may notice some minor discomfort, stinging or throbbing in the injected area. Occasionally some bruising or swelling will occur, but it is usually minor. Any redness that appears in the injected site usually disappears within 24 hours. However, in some individuals, particularly fair-skinned patients, this redness may persist for a week or more. Tiny scabs may also form over the needle-stick areas; these generally heal quickly.

No bandaging is needed and you are free to eat, drink, and wear makeup with sunblock protection shortly thereafter. There may be some temporary swelling and redness in the treated area which should dissipate within a few days. If these symptoms persist, contact your surgeon.

Results: As stated earlier, the duration of results from HA (hyaluronic acids) injections is variable. HA (hyaluronic acids)'s longevity depends on the patient's lifestyle and physical characteristics as well as the part of the body treated. In general, the injected material is likely to disappear faster in areas that are more affected by muscle movement.

Your doctor can help you determine how long you can go between treatments to best maintain your results.

Fat
In the medical world, the fat-injection procedure is known as autologous fat transplantation or microlipoinjection. It involves extracting fat cells from the patient's abdomen, thighs, buttocks or elsewhere and reinjecting them beneath the facial skin. Fat is most often used to fill in "sunken" cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimize forehead wrinkles and to enhance the lips.

The procedure: After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat is withdrawn using a syringe with a large-bore needle or a cannula (the same instrument used in liposuction) attached to a suction device. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site.

As with HA (hyaluronic acids), "overfilling" is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this overcorrection of newly injected fat may temporarily make the face appear abnormally puffed out or swollen.

After treatment: If a larger area was treated, you may be advised to curtail your activity for a brief time. However, many patients are able to resume normal activity immediately. You can expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. You should stay out of the sun until the redness and bruising subsides - usually about 48 hours. In the meantime, you may use makeup with sunblock protection to help conceal your condition.

The swelling and puffiness in the recipient site may last several weeks, especially if a large area was filled.

Results: The duration of the fat injections varies significantly from patient to patient. Though some patients have reported results lasting a year or more, the majority of patients find that at least half of the injected fullness disappears within 3-6 months. Therefore, repeated injections may be necessary. Your doctor will advise you on how to maintain your results with repeat treatments.

YOUR NEW LOOK

If you're like most patients, you'll be very satisfied with the results of your injectable treatments. You may be surprised at the pleasing results that can be gained from this procedure.

Planning your Surgery

In your initial consultation, Dr. Foglietti will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your body and health.

Be sure to discuss your expectations frankly with Dr. Foglietti. He or his staff should be equally frank with you, describing your alternatives and the risks and limitations of each. You may want to ask Dr. Foglietti for a copy of the manufacturer's insert that comes with the implant he or she will use (if you are considering a procedure which requires implants) -- just so you are fully informed about it. And, be sure to tell Dr. Foglietti if you smoke, and if you're taking any medications, vitamins, or other drugs.

Your surgeon should also explain the type of anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved. Because most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.

PREPARING FOR YOUR SURGERY

Dr. Foglietti or his staff will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Where your surgery will be performed

Dr. Foglietti may prefer to perform the operation in an office facility, a freestanding surgery center, or a hospital outpatient facility. Occasionally, the surgery may be done as an inpatient in a hospital, in which case you can plan on staying for a day or two.

The Cosmetic Surgery Institute is able to perform your procedure at many of the local leading healthcare facilities.

About the Surgeon- Dr. Mark A. Foglietti

Dr. Mark A. Foglietti was born and raised in the Steubenville, Ohio area.
He attended Ohio State University in Columbus, Ohio where he received his Bachelors of Science Degree and completed one year of post-graduate work in microbiology and virology. He then went to Medical School at Ohio University, where he currently serves as a Clinical Professor in Plastic and Reconstructive Surgery. The Ohio University College of Osteopathic Medicine is nationally recognized as one of the top physician training programs in the country.

Dr. Foglietti returned to the Columbus area to fulfill a one-year rotating internship at Doctor's Hospital where he stayed to finish his training in general surgery. As a general surgery resident, he was accepted into the plastic surgery residency at The Plastic Surgery Institute of Des Moines Iowa, under the direction of the internationally acclaimed plastic surgeon Dr. James O. Stallings, M.D. During his time in Iowa, Dr. Foglietti served as a resident and as the Chief Resident of the program. To further enhance his plastic and reconstructive surgery knowledge, he completed an additional fellowship in cosmetic surgery and reconstructive surgery of the breast, in Cleveland Ohio under the direction of Dr. Melvyn I. Dinner and Dr. J. Sheldon Artz.

With 17 years of higher education, medical, and surgical training behind him, Dr. Foglietti started his career by joining Drs. Dinner and Artz at The Center for Plastic Surgery. He soon became board certified in both plastic and reconstructive surgery and in general surgery, later co-founding the Woodlands Center for Plastic Surgery, located in Sagamore Hills, Ohio.

During his time at the Woodlands Center, Dr. Foglietti has established himself as an educator and leader in his field both locally and nationally. He is a member of The American Osteopathic Association, The American Medical Association and their respective local organizations. He is a past president and board member of the Cleveland Academy of Osteopathic Medicine, and serves nationally on the Board of Governors for The American College of Osteopathic Surgeons. As a Fellow of the A.C.O.S., he is also a past President of the Plastic and Reconstructive Surgery Discipline, and serves nationally as a board examiner. Dr. Foglietti is currently Chief of staff, and Chief of plastic surgery at Mt. Sinai Medical Center East in Cleveland Ohio. He is also Director of the plastic and reconstructive surgery residency at the Cleveland Clinic Health System Hospital, Meridia Southpointe.

For over a decade, Dr. Foglietti has published numerous papers in a variety of internationally recognized medical and scientific journals. Keeping up to date on all of the latest surgical techniques, and newest technology, Dr. Foglietti has been given significant local and national television exposure, (ABC, CBS, NBC, FOX, CNN, and The Discovery Channel) for bringing new advancements to the Cleveland medical market. He has also been recognized for his advanced treatment of burn victims internationally and for his assistance in the treatment of the Afghanistan Freedom Fighters, for which he received an award from Washington D.C. in 1988.

Dr. Foglietti has been featured in Cleveland magazine, Northern Ohio Live, The Plain Dealer, The Canton Repository, as well as a number of other newspapers for his improvements in plastic and reconstructive surgery. As an inventor, Dr. Foglietti holds three U.S. Patents on improved breast implants for surgical use. He strives to remain on the cutting edge of medicine to serve his patients in the most up-to-date, personalized, and holistic manner possible. Dr. Foglietti has also recently received a registered trademark for the Foglietti Natural Vector Facelift Technique from the US Patent and Trademark Office in Washington DC in November 09.

Dr. Foglietti has been recognized for treatment of the Haiti earthquake victims for a medical mission in February 2010.

After your Surgery

You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by Dr. Foglietti. The Doctor and his staff will work with you to provide a program to accelerate your healing process, and maximize the effects of your surgery. Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.

YOUR NEW LOOK

Your decision to have this procedure is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you've met your goals, then your surgery is a success.