Understanding Non-Surgical Procedures

Non-surgical procedures are minimally invasive techniques designed to make significant facial improvements, while limiting downtime compared to surgical procedures. Natural results and significant aesthetic improvement remain the overall goals, but realistic expectations for the degree of improvement must be established before treatment. Non-surgical procedures fall into several categories. Skin surface treatments can be divided into ablative techniques and non-ablative techniques. Non-ablative treatments include intense pulsed light (IPL) treatments. IPL treatments are designed to improve the color of skin, from prominent blood vessels called telangiectasias to brown pigmented spots. The treatment works directly on the targeted skin pigment without removing the overlying skin. In contrast, ablative skin treatments remove the top layer of skin, and rely on new skin growth for their results. These treatments include peels (chemical ablation), laser resurfacing (heat ablation), and dermabrasion (mechanical ablation).

Botox™ & Dysport™

Botox™ and Dysport™ are muscle relaxing agents that are injected into precise areas of muscles of the face (usually the upper face). They permit relaxation of certain muscles, creating an attractive aesthetic improvement that must be précisedly tailored to an individual’s anatomy.

Juvederm™ & Restylane™

Juvederm™ and Restylane™ are in a treatment category called filling agents or fillers. These work by filling in a crease from below, thus softening the depth of the shadow, or augmenting an area that requires some volume.

The Glabella

Often overlooked by people seeking facial rejuvenation, the glabella is one of the most important and central aesthetic areas requiring repair. The “V” shaped muscles of the glabella, called the corrugator muscles create the furrows, parallel vertical lines or “the 11’s between the eyebrows. The treatment goal of the muscle relaxing agents is to weaken the pull of these muscles, thus reducing the lines and heaviness created by brow furrowing. This is safely, although temporarily achieved with the use of injectable Botox™ or Dysport™. With injectable glabellar treatments, treatments should be repeated every 3-4 months to maximize results. Early treatment with Botox may actually prevent the progression of glabellar furrows and lines.

Additional off-label uses of the muscle relaxing agents include the softening of the fine horizontal lines lateral to the eye, commonly called the “crow’s feet” or softening of the horizontal expressive lines of the forehead. Additional FDA off-label uses have been identified, and can be discussed at the time of consultation.

Facial Fillers

In many cases, an alternative or complement to surgery is the use of facial fillers. The most commonly used soft tissue filler in our practice is the hyaluronic acid family (Restylane™ and Juvederm™ family of products). These can provide in many cases excellent improvements in facial contour. While these products are only FDA approved for the smile lines (naso-labial folds), they can be used to improve contour in nearly every part of the face. They work by filling the bottom of a line, wrinkle or fold in order to flatten it, and decrease its noticeability. We find that this can be particularly effective in FDA off label use at the “marionette lines”, jowl, glabella and in the creases below the eyes.

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