Dr. Garramone Plastic Surgery | Injectables | BOTOX® | LatisseT

BOTOX® Cosmetic (Botulinum Toxin Type A) is a purified and sterilized extract from bacteria. It has been FDA approved since 2002 to treat the area between the eyes in a specific muscle area. However, it may be used "off-label" in other areas. Doctors have used BOTOX® Cosmetic for over 17 years to treat various medical conditions, especially around the eyes. BOTOX® Cosmetic was the most popular cosmetic procedure performed in 2007 with nearly 2.8 million treatments.
Over time, active muscle contaction will result in visible lines on the face. Lines in these areas are called dynamic lines because they are caused by over active muscles. This type of line is the type of line that can be treated with Botox. Static lines, on the other hand, are lines that are visible even when the muscles are at rest. These lines are usually treated with an injectable filler such as Juvederm, Restylane or Evolence. For example, scowl lines, frown lines, and crow's feet are some of the most concerning dynamic lines for both men and women. These lines or furrows will continue to deepen and worsen with continued muscle activity and aging.
BOTOX® Cosmetic works by temporarily weakening the targeted facial muscles. Therefore, they are not able to cause the deep furrows. During treatment, very small doses of BOTOX® Cosmetic is administered through a series of tiny injections into the area of the muscles and takes about two to five days to take effect on the muscle area. Over the following days to weeks, the lines will fade away. The timing to see results varies with the severity of the lines and furrows. They can be quite dramatic and the effects usually last 3 to 4 months in some cases longer. The length of time that the injections last also depends on the patients genetics (muscle density), the amount of BOTOX® injected, how fresh the BOTOX® is, and the skill of the plastic surgeon doing the injections. Treatments done in proper conditions will usually last progressively longer up to a point that is determined again by the BOTOX® quantity and the patient's metabolism of the product.
The common misconception about Botox is that it will give the patient a "frozen" or expressionless appearance. In fact, when administered by an experienced plastic surgeon you will still be able to smile, frown and look surprised but with less or no lines in the areas treated. If you decide to discontinue using BOTOX® Cosmetic, you will usually have a return of some of your previous muscle activity.
Some of the side effects of a treatment, though rare, may include temporary bruising, tenderness at the injection site, and headache. Depending on the where the injections are placed you may experience brow asymmetry, forehead wrinkle asymmetry or other facial asymmetry secondary to how a muscle responds to the injections. These types of issues are also temporary and can usually be adjusted by additional BOTOX® Cosmetic into the areas. More concerning, is when the medication is injected or diffuses into other muscle groups that are not intended to be treated. When this occurs you may experience complications secondary to these other muscles not working correctly. This can occur with treatment of the scowl lines and you may experience a lowering of your eyelid. This is very rare, and when it occurs it will last a few weeks. This can be treated with eye drops however when the eye drop medication wears off, the eyelid will droop again. This complication is usually seen with aggressive injections near these eye muscles. Be sure to discuss this with Dr. Garramone is you have questions or concerns.
Botox has been used therapeutically for more than 17 years and is approved for use in more than 75 countries.

This text does not contain all the information known about these products. For more information, please consult www.botoxcosmetic.com.

Evolence is the newest injectable filler available in the United States. It was recently approved by the FDA. Evolence can immediately improve your appearance by smoothing out unwanted wrinkles and folds and restoring contour in areas that have been volume depleted. The natural-looking results are achieved immediately with minimal down time. The results are obvious immediately and last for at least 6 months.
Evolence is unique in that it represents collagen, which is the component of the skin structure which is lost with aging. The main drawback of the injectable collagen products that have essentially been replaced with the hyaluronic acid-containing products is that collagen did not last very long after its administration. Evolence, however will last for at least 6 months and in some cases as long as one year.
Collagen makes up approximately 70% of the thickest portion of the skin called the dermis. It provides structure, she drink and support. Collagen levels decrease naturally over time as the age. As collagen decreases wrinkles and lines and loss of facial contour and structure occurs. Sun exposure, genetics, hormonal changes and smoking can all accelerate the pace of collagen loss. By replacing loss collagen, Evolence can help enhance and maintain structure and volume and restore a naturally younger-looking appearance to your skin.
Evolence contains an advanced form of collagen. The collagen fibers have been joined together with bonds called "cross-links" so as to more closely resemble the 3-dimensional structure of your own skin's collagen. This patented technology is called Glymatrix and refers to the cross-linking of the collagen strands with sugar to provide strength. This not only allows it to integrate beautifully and to support your skin but also increases its longevity.
Evolence is able to achieve an immediate natural-looking result. It causes minimal swelling and bruising so you can get back to her daily activities quickly. It lasts for at least 6 months and it does not require a pretest prior to injection so you can get results in one visit.

This text does not contain all the information known about these products. For more information, please consult www.evolence.com .

Juvéderm is the latest dermal filler being introduced by Allergan, Inc. to help reduce the appearance of deep nasolabial folds, fine lines and wrinkles around the mouth and to create fuller lips. This innovative smooth gel is a non-animal derived hyaluronic acid dermal filler that offers patients a natural look and feel with long lasting results for up to six months and possibly longer. Juvéderm's longevity and smoothness can be attributed to the high concentration of hyaluronic acid and its special formulation process. Juvederm has the highest concentration of cross linked hyaluronic acid of any dermal filler currently available in the US market. Juvederm differs from other hyaluronic acid dermal fillers because of its smooth consistency. Juvéderm's smooth gel is positioned into the skin and creates a smooth natural appearance.
Juvederm was approved by the FDA in 2006 and is the first such hyaluronic acid general dermal filler that is FDA approved to last up to one year. Hyaluronic acid is a natural complex sugar found in all living organisms, including men and women, that retains water. It absorbs more than its weight and can add volume to the skin's surface. Hyaluronic acid plays an important role in numerous areas of the body such as the maintenance of skin volume and hydration, eye volume and shape and joint lubrication and cushioning. Hyaluronic acid will bind with elastin and collagen to transport essential nutrients. The combination of collagen, elastin and hyaluronic acid provides structure, elasticity and volume to the skin.
The skin cells age and are exposed to environmental pollutants and ultraviolet rays, this causes them to diminish their ability to make hyaluronic acid. This is what causes skin to lose volume causing facial wrinkles and folds. Dermal fillers crossed linked with hyaluronic acid are used to help temporarily replace lost hyaluronic acid and restore the skin's volume and smooth appearance.
Juvederm is administered as an in office procedure. The difference is noticeable immediately. Either a topical anesthetic for an injectable anesthetic is used prior to the procedure. The gel is then administered using a very fine needle.
The most commonly reported side effects are temporary injection site redness, swelling, pain or tenderness, firmness, swelling, lumps, and bruising. Laser treatments, chemical peels or any other active dermal procedure done after Juvéderm may cause inflammation around the injection site.
Patients should notify Dr. Garramone and his staff, if they are on any medication that may prolong bleeding, such as aspirin or ibuprofen or Vitamin E. This may cause increased bruising or bleeding at the injection site. As with all injection procedures, there is a risk of infection. The safety of Juvéderm injectable gel in patients with a history of excessive scarring and pigmentation disorders has not been studied.
Juvéderm injectable gel should not be used if a patient with a history of anaphylaxis or multiple severe allergies. Juvéderm should not be used with patients who have allergies to gram positive bacterial proteins. The effectiveness of Juvéderm, as with all other hyaluronic acid dermal fillers, for the treatment of areas other than facial wrinkles and folds has not been established in controlled clinical studies. This text does not contain all the information known about these products. For more information, please consult www.juvederm.com .

Restylane is a crystal-clear, non-animal derived, biodegradable gel based on a natural substance, called hyaluronic acid. Restylane is approved by the FDA for the treatment of facial wrinkles and folds like the nasolabial folds, which extend from the nose to the corners of your mouth. Restylane and Perlane belong to a family of products known as cosmetic dermal fillers. The replace lost volume and restore youthful contours to the skin by smoothing the way lines and wrinkles. Restylane and Perlane differ with regard to the size of the particles of hyaluronic acid. In Perlane, the particles size is larger and therefore Perlane is designed for deeper injection than Restylane. The Restylane or Perlane gel is injected into the skin in tiny amounts with a very fine needle. The result is instantaneous and produces a long-lasting, natural enhancement. Restylane gives natural volume in your skin to lift and produce new firmness, resulting in a healthy, vital appearance.
Restylane and Perlane are both safe products, made of hyaluronic acid which is naturally present in the body. Restylane was the first FDA approved, non-animal based, stabilized, injectable hyaluronic acid for aesthetic use. Since Restylane and Perlane are free from animal substances, the risk of transmitting diseases from other species is completely eliminated. To date, more than 10 million treatments have successfully been carried out with Restylane in more than 70 countries worldwide. It is the most studied cosmetic dermal fuller in the world.
The hyaluronic acid in Restylane and Perlane is naturally integrated into the tissue and allows for the passage of vital nutritive substances like oxygen and hormones. As cells are also able to pass between fragments of the gel your skin will look perfectly healthy and natural. The hyaluronic acid is biodegradable, which means that, when the injected gel breaks down, it turns into water and carbon dioxide and disappears unnoticed from your body.
Restylane and Perlane are totally non-animal products; there are no risks of an allergic reaction if you are sensitive to common foods, such as beef, chicken and eggs. Unlike some other injectable products for wrinkle treatment and lip enhancement (for example collagen is made from cow hide and other hyaluronic acid products made from rooster combs). No pretesting is required. Some precautions should be taken prior to treatment. Avoid using aspirin, ibuprofen or nonsteroidal anti-inflammatory medications or high doses of vitamin E supplements prior to treatment because these may increase her chance of bleeding or bruising at the site of the injection. Also, if you have previously suffered from a facial cold sore discuss this with your doctor who may prescribe a medication to minimize the chance of recurrence.
Restylane and Perlane may be used for treating facial wrinkles or folds, and enhancing facial features. Restylane is injected into the skin in tiny amounts with a very fine needle. Prior to the treatment, the area is anesthetized. The injected gel produces natural volume under the wrinkle, which is lifted up and smoothed out. The results can be seen immediately. Treating wrinkles with Restylane is fast and safe and leaves no scars or other traces on the face.
For many women, fuller and more sensuous lips are high on the wish list. With Restylane, you can enjoy more pronounced lips or a soft pouting look with the body's own material.
Perlane is specifically designed for shaping facial contours. Perlane works by volume augmentation. Injected into the skin, it corrects deep folds and lifts up the skin from cheeks and chin, giving a new shape to your facial contours.
Restylane and Perlane treatments are long-lasting but not permanent. The length of time a treatment will last is very individual and depends on many factors, such as your age, skin type, life-style and muscle activity, as well as the injection site and the technique used. This means that you always have the option to assess your aesthetic appearance. Experience shows that Restylane can be effective for up to six months for lip enhancements and for the treatment of wrinkles on the face. In many cases patients return after 9 months or even a year for an additional treatment. Perlane has been shown to last up to six months as well. It is recommended that you plan for regular future visits to maintain the result. Most patients choose to have a follow-up treatment six to twelve months after the initial treatment of wrinkles. This has been shown to increase the length of the result.
The reason Restylane and Perlane generally remains for 6-12 months after injected into the skin is due to its very effective stabilization method. This method allows the volume to remain intact for a long period of time. As the stabilized hyaluronic acid in Restylane does begin to break down, your body's water takes its place. The more fragmented the Restylane gel becomes, the more water it is able to bind. This is one of the main reasons Restylane lasts so long.
No previous skin test is needed, which means that you can have the treatment immediately. The injection session often takes less than thirty minutes. The time differs somewhat depending on the correction you want to have performed. The result is immediate.
Prior to your procedure, a topical anesthetic cream can be applied to the area to be treated. You can also choose to have a local anesthetic injection. For wrinkle treatments, pain relief is not required by all patients; however it can be easily arranged at your request and is recommended.
Immediately after the treatment, you can expect a slight redness, swelling, tenderness and an itching sensation in the treated area. This is a normal result of the injection. The discomfort is temporary and generally disappears in a few days. When it comes to lip augmentation, the swelling may last longer. Some patients experience swelling for about a week. During this time, the lips may look somewhat uneven. This means that the result directly after the treatment should not be regarded as the final result. If the discomfort continues or if other reactions occur, you should contact Dr. Garramone's office. A touch-up treatment within 2-4 weeks after the initial treatment may be necessary to achieve an optimal correction.
After treatment - please note the following:
Avoid touching the treated area excessively within the following six hours. After that the area can be gently washed with soap and water, and light make-up can be applied. Until the initial swelling and redness have disappeared, do not expose the treated area to intense heat (e.g. solarium and sunbathing) or extreme cold. If you have previously suffered from facial cold sores, there is a risk that the needle punctures could contribute to another eruption of cold sores. If you are taking aspirin or any similar medication, please note that the treatment may increase the bruising and bleeding at the injection site.
Other types of reactions are very rare, but about 1 in 2000 treated patients have experienced localized reactions thought to be of a hypersensitive nature. These have usually consisted of swelling at the injection site, sometimes affecting the surrounding tissues. Redness, tenderness and rarely acne-like formations have also been reported. These reactions have either started a few days after the injection or after a delay of two to four weeks, and have generally been described as mild to moderate and self-limiting with an average duration of two weeks.
As your face is constantly changing, beauty is best maintained by evaluating the need for further treatments from time to time. With Restylane and Perlane, you always have the option of continuing or changing the combination of treatments. The treatment can be repeated as often as you like.
One of the great advantages of Restylane and Perlane is that they are long-lasting, but not permanent. Unlike permanent treatments or implants, Restylane always leaves you with the option of re-evaluating your needs when the initial effect has worn off. A follow-up can be performed at any time you like after the previous treatment. This text does not contain all the information known about these products. For more information, please consult www.restylane.com .

As you age, collagen in your skin breakdown resulting in wrinkles and sagging loose skin. Thermage utilizes patented technology approved by the FDA to deliver heat deep into the skin to rejuvenate the existing collagen and stimulate new collagen growth. This results in the skin and that looks and feels noticeably smoother and tighter.
Thermage is the only noninvasive procedure that is available to tighten and renew the collagen in your skin. Radiofrequency technology safely heats the deeper layers of your skin causing both immediate tightening and improved tone and texture. The improvement continues and becomes even more noticeable after 4-6 months following the treatment due to new collagen growth. Unlike lasers, Thermage can be used on all skin types and colors. Only one treatment is necessary in order to obtain the full benefits. There is no downtime. You can quickly resume your daily routine after the procedure.
Thermage treatments are only performed in the doctor's office by certified personnel. Usually, a consultation with that physician is necessary to determine if Thermage is the right procedure for you. Generally, men and women age 35-60 have the best and most predictable results. If the skin is too lax or the collagen is not felt to be satisfactory and off to respond to Thermage the results will be less impressive.
Normally, the treatment is performed and in one session, which lasts about 1-2 hours depending on the areas of the body treated. Usually a light oral sedative or light pain medication is taken prior to the treatment. Immediately prior to the treatment the area is marked with a grade type pattern to assist in performing a uniform treatment application.
During the treatment you will feel a brief sensation of heat each time Thermage delivers the radiofrequency energy to your skin. After the treatment of your skin may be slightly red from several hours to one or two days. Most patients resume regular activities soon after the treatment. Immediately after your treatment you should feel and see that your skin is smoother and firmer and tighter. After the procedure, you should continue to see improvement in your skin as new collagen is produced and some additional contouring as continued tightening occurs with time. You should see long-lasting results.
Thermage can be utilized to improve the face. The forehead and eyelids can be treated as can the cheeks to improve the jaw line and the neck. In addition, Thermage can be utilized to improve loose skin on the upper arms, abdomen and knee areas. Recently, the FDA has approved Thermage to treat cellulite.
Thermage is a very safe procedure. Nearly 500,000 treatments have been performed worldwide and the reported incidence of complications is 0.2%. This text does not contain all the information known about these products. For more information, please consult www.thermage.com .

Latisse is the first and only FDA approved treatment which can be used to help eyelashes grow longer, thicker and darker. It works by both increasing the growth phase of the individual hair follicle and it also increases the number of hairs that are in the growth phase. The affect is gradual and the majority of Latisse users see results in two months.
Latisse is available by prescription or in your doctor's office.
The most common side effects after using Latisse include irritation and redness of the eye. Less common side effects include darkening of the skin of the eyelid along the base of the eyelashes, where Latisse is applied.
Latisse is applied nightly after removing all makeup and contact lenses of present. The product is applied to a small sterile applicator and the applicator is then drawn across the skin of the upper eyelid margin at the base of the eyelashes. Typically this is done from the inner part of the lash line to the outer part. Any excess solution should be blotted. The product is to be applied to the upper lash line only not the lower eyelid.
Patients who have been previously diagnosed with eye pressure problems should make their physician aware of this. In addition, if you are currently taking medications for eye pressure problems you should make your physician aware. Patients with risk factors for glaucoma, including a family history of glaucoma should discuss this issue with your doctor before proceeding with treatment.

The newest weapon against aging has recently been approved by the FDA. As we age we tend to lose volume in our face. This not only makes us look older but it may make us appear tired as well. The injectable line fillers are designed to address only certain lines and wrinkles but Sculptra is designed to restore facial volume over larger areas. The result is a gradual natural restoration of facial volume and a rejuvenated appearance. Sculptra is usually administered as a series of injections given about one month apart. Three injection sessions are typically necessary. As the product is absorbed by your body it is replaced by your own collagen, which is what ultimately gives the volumizing effect. The effect can last 2 years or longer in many patients.

Sculptra Aesthetic FAQs
What is Sculptra Aesthetic?
Sculptra Aesthetic is the first facial injectable that can give you noticeable results that emerge subtly. It replaces lost collagen to give you a more natural looking appearance without giving you away. A full treatment of Sculptra Aesthetic, on average, three injection sessions over a few months, can last up to two years.
How long has Sculptra Aesthetic been on the market?
Sculptra Aesthetic has been safely used worldwide since 1999, in over 150,000 patients, under the trade names New-FillT and Sculptra. In 2009, the FDA granted approval in the U.S. for the correction of shallow to deep nasolabial fold (smile lines) contour deficiencies and other facial wrinkles which are treated with the appropriate injection technique in healthy patients.
How does Sculptra Aesthetic work?
Sculptra Aesthetic works to target the underlying causes of the signs of aging such as collagen loss. Sculptra Aesthetic is a facial injectable that works gradually in a series of treatments - an average of 3 injection sessions over a period of a few months months - to produce a refined, more youthful-looking appearance. During the course of your Sculptra Aesthetic treatments, collagen is replaced. Over time, you'll notice changes to your face that can last up to 2 years.
What is Sculptra Aesthetic made of?
Sculptra Aesthetic is made of a synthetic material called poly-L-lactic acid, which works to replace lost collagen. Poly-L-lactic acid is safe - absorbed naturally by the body - and has been used for years in dissolvable stitches.
What parts of the face does Sculptra Aesthetic treat?
Sculptra Aesthetic corrects shallow to deep facial wrinkles and folds which are treated with appropriate injection techniques for a smoother overall appearance that can last up to 2 years.
How long does Sculptra Aesthetic last?
Sculptra Aesthetic is the first facial injectable with results that can last up to 2 years after your last treatment.
Are the results from Sculptra Aesthetic immediate?
No. Because Sculptra Aesthetic targets the underlying causes of the signs of facial aging, it can give you noticeable results that emerge subtly and can last for up to 2 years. Some visible improvements can be seen within the first few weeks of treatment, but the Sculptra Aesthetic regimen is designed to deliver its unique effects over the course of a few months. Typically, an average of 3 treatment sessions over a period of a few months - and because results happen gradually, you'll see subtle yet noticeable results in the appearance of facial wrinkles and folds.
What factors contribute to the cost of facial anti-aging treatments?
Cost varies greatly from treatment to treatment, and from person to person. The best way to determine cost is by talking to your doctor, but the factors that will have a bearing include, but are not limited to:
- How long the treatment is expected to last
- The amount of work to be done
- The complexity of the procedure
- Discounts and special offers
- Where you live
How do I know if Sculptra Aesthetic is right for me?
If you want subtle yet noticeable results, Sculptra Aesthetic may be right for you. Sculptra Aesthetic is injected beneath the skin and works to gradually replace lost collagen, targeting the underlying cause of the signs of facial aging, for results that can last up to 2 years.
Is Sculptra Aesthetic safe?
Yes. Sculptra Aesthetic is FDA approved in the Unites States, and has been used safely worldwide since 1999.
What are the possible side effects of treatment with Sculptra Aesthetic?
Side effects of Sculptra Aesthetic may include injection site pain, redness, bruising, bleeding, itching, or swelling. Other side effects may include small bumps under the skin that are sometimes noticeable when pressing on the treated area. Larger lumps, with or without inflammation, have also been reported. Other side effects may include the delayed development of non-visible, small bumps under the skin sometimes noticeable when pressing on the treated area.
Who should not use Sculptra Aesthetic?
You should not use Sculptra Aesthetic if you are allergic to any of its ingredients. You should not be treated when you have an active skin infection or inflammation in the treatment area or if you have a history or susceptibility to keloid formation or hypertrophic scarring. Sculptra Aesthetic and Sculptra are products that are intended for use in different populations and conditions of use.
How many treatments are required?
On average, a series of treatment sessions over the course of a few months may be needed. Your physician will decide the appropriate number of treatment sessions and the amount of Sculptra Aesthetic you need.
How many injections are there per treatment session?
The number of injections at each of the treatment sessions will vary depending on the degree of correction and the treatment plan determined by you and your physician.
Is treatment with Sculptra Aesthetic painful?
With any injection some pain is possible. Consult your physician for professional advice on what you might experience.
Is a skin test required before treatment with Sculptra Aesthetic?
No. Because Sculptra Aesthetic does not use any human or animal components, no allergy testing is needed prior to treatments.
How long may side effects last?
The type and duration of side effects may vary. If you are having side effects, talk to your doctor.
What should I do after each Sculptra Aesthetic treatment?
Proper aftercare is necessary in order to help get the best possible results. Your doctor will give you specific instructions at each injection session. The following general guidelines will help you get the most from your treatment: Within the first 24 hours of treatment, help reduce swelling by applying a cloth-wrapped ice pack to the area for a few minutes at a time. Avoid applying ice directly to the skin. Post-treatment, massage the treated area a few times a day for several days, as recommended by your physician. This will help evenly distribute Sculptra Aesthetic. Until any initial swelling and redness goes away, avoid excessive sunlight and UV lamp exposure.
When will I be able to apply makeup after treatment?
If there are no complications, makeup can be applied several hours after treatment. Consult your doctor after treatment.
When should I see my doctor for my next treatment?
On average, 3 treatment sessions are needed over the course of a few months, but treatment does vary, so talk to your doctor about the treatment option that's right for you.
What kind of training is provided to physicians who administer Sculptra Aesthetic?
Sanofi-aventis U.S. offers an award-winning training program to board-certified dermatologists, plastic surgeons, and facial plastic surgeons because we believe that proper injection technique and aftercare play an important role in helping to optimize patient outcomes. Be sure to ask your physician about the extent of his or her training and experience with Sculptra.