Petit Plastic Surgery

Cosmetic surgery is a surgical specialty that tries to improve or remove bodily flaws. These can be genetic, acquired, or caused by trauma or physiological conditions such as getting older. Cosmetic surgery also refers to surgical operations that individuals want in order to improve their looks. In this respect, cosmetic surgery varies from reconstructive surgery, which relates to the treatment of shape features that can be linked to pathological processes; both cosmetic surgery and reconstructive surgery fall under the umbrella of plastic surgery due to the specific nature of their respective fields. The goal of this specialty must be to maintain the same aesthetic and scientific approach in the correction of body flaws as well as spontaneous changes in appearance. The cosmetic aspect of reconstructive surgery cannot be overlooked, but on the other side, reconstructive surgery is a must in any plastic procedure.

In recent years, we have seen a rise in the popularity of medical treatment and cosmetic surgery in conjunction with the ongoing advancement of modern society, where an individual's well-being is also dependent on the beauty of their physical appearance.

What is Petit Plastic Surgery?

Petit Plastic Surgery is a basic treatment that improves a patient's appearance by making a natural modification to their face. Although this Petit Plastic technique is relatively straightforward, it is vital to speak with a professional to obtain a good assessment of the procedure area of the face. If procedures are performed without an adequate assessment, there is a danger of face disproportion and asymmetry. There are varieties of procedures that belong to petit plastic surgery of which are botulinum toxin injections (BOTOX), dermal fillers, and less commonly rejuran healer (which is used more commonly in Korea).

Rejuran Healer

Rejuran Healer is a treatment that administers biocompatible substances directly to the dermis, the skin's lowermost layer. It's a shot made up mostly of polynucleotides derived from salmon Genetic material. This material is recognized to be harmless and has no adverse effects when it comes into contact with foreign substances in the body. It restores damaged skin caused by trauma, UV radiation, and aging, resulting in bright and healthy skin.

Rejuran Healer Indications

The following are the patients who are recommended to have this procedure:

• Those who are aging so rapidly and their face become wrinkled
• Those who have very slow skin regeneration and have a long time to heal from various skin conditions
• Those who are annoyed by face wrinkles and asymmetry
• Those who want to improve their face look even if they don’t have any skin problems
• Those who want to see improvement of their facial features with only one procedure
• Those who want to avoid unnatural substances and need to have good facial features with natural substances

Botulinum Toxin (Botox) Injections

Botulinum toxin (Botox) is a medicine derived from the toxin produced by the Clostridium botulinum bacteria. This toxin, when consumed in high doses, can induce botulism, a nerve-related sickness. Botox has been utilized in the field of ophthalmology since the 70s, and in the last 20 years, its use has grown to other areas of medicine, particularly dermatology.

Botox is made up of seven different neurotoxins, however, only toxins A and B are employed in clinical practice. Botox A is a cosmetic injectable that is used to treat a variety of medical conditions, primarily in dermatology. Botulinum toxin A was the first form of Botox to hit the market. The Food and Drug Administration approved it as an aesthetic therapy for glabellar forehead wrinkles in 2002. The European Union granted the second form of Ona-botulinum toxin A, made in France, permission to be used for cosmetic purposes in 2006, and the FDA approved it in 2009. Botox type A has become a catch-all phrase for all chemicals used in cosmetic procedures.

Mechanism of Action

Botox's mechanism of action is broken down into four key steps:

• The toxin binds to specific proteins on the membrane of presynaptic cells in the first stage, which is regulated by the heavy chains' C-terminal. This stage takes about 30 minutes to complete.
• Internalization is the second stage, which is an endocytosis process mediated by energy-dependent receptors. The cytoplasmic membrane of nerve fibers protrudes around the toxin-receptor complex in this stage, generating vesicles in the nerve terminal that contain a toxin.
• Translocation is the third step. The covalent link is severed during internalization, and the toxin's light chain is released into the cytoplasm of the nerve ending through the endosomal membrane of the endocytosis vesicles.
• Blocking is the final phase. The light chain of serotypes A and E inhibits acetylcholine production by cleaving the cytoplasmic enzyme required for acetylcholine vesicles to bind on the inner surface of the nerve terminals' nerve cell membrane.

Following injection, the toxin disperses into the tissue till it connects to the presynaptic cell of the neuromuscular junction, where it adheres specifically and reversibly, and then binds to the particular protein-membrane involved in acetylcholine excretion.

The toxin stops the release of neurotransmitters in the neuromuscular junction instantly, producing transitory relaxation of local musculature and a reduction of facial wrinkles, some of which are caused by continual facial muscular contractions.

Botox Indications

Botox is commonly administered into the muscles of facial expression in the practice of dermatology. The majority of these muscles are linked to soft tissues rather than skeletons, and when they contract, they stretch the skin throughout the face to produce facial emotions. Botox is used to smooth out neck and chest wrinkles, as well as forehead wrinkles, crow's feet at the sides of the eyes, horizontal forehead wrinkles, wrinkles around the lips, malar folds, and glabellar frown lines. It can also be used to heal hyperhidrosis, lichen simplex, dyshidrotic eczema, and acne vulgaris by elevating the eyebrows. Other indicators of aging, such as dry skin, pigmentation issues, and vascular irregularities, cannot be prevented using Botulinum toxin.

Botox Contraindications

Patients with myasthenia gravis, motor neuron disease, multiple sclerosis, Eaton Lambert syndrome, pregnant and lactating mothers, neonates and children, patients with focal and systemic infectious diseases, patients who are overly sensitive or allergic to Botulinum toxin, and patients who have previously completed lower blepharoplasty are all contraindications to Botox treatment.

Botox Adverse Effects

Bleeding, edema, redness, and soreness at the injection sites are all common Botox adverse effects. By using finer needles and dissolving Botox with saline, these side effects can be prevented. Botox injections might cause headaches, but they usually go away after 3–4 weeks. Systemic painkillers can be used to address these adverse reactions. Lethargy, nausea, influenza-like episodes, and ptosis are some of the other side effects that have been recorded. Ptosis is most commonly seen in patients who have had Botox injections in the glabellar region. It is produced by localized Botox dissemination, which can last for weeks but can be cured with alpha-adrenergic agonist ocular drops. Ectropion can also occur as a result of Botox local diffusion when administered into the lower eyelids.

In addition, patients who receive Botox injections to address crow's feet or bunny lines may develop strabismus as a result of unintended Botox administration and local Botox dispersion. Nonetheless, once the toxin's paralyzing effect wears off, all of the mentioned adverse effects will fade away.

Aesthetic Botox injections have a low risk of side effects. Ecchymosis and purpura are the most prevalent side effects, which can be avoided by compressing ice on the puncture site before and after Botox administration. Botox should be administered in small amounts, at the right dose, and at least 1-2 cm away from the orbital bones' superior, inferior, or lateral margins. Patients should not touch the injected locations for 3-4 hours after administration and should sit or stand in a vertical position for 3–5 hours.

What are Dermal Fillers?

Dermal fillers are a type of soft material that is administered beneath the skin. Trying to smooth of deep under-eye shadows, uplifting of cheekbones, volumization of the lips, smoothing of lip creases and nasolabial wrinkles, and hand resurfacing are just a few of the frequent problems they may treat.

Dermal fillers are made up of a number of chemicals, some of which are found naturally and others that are manufactured. Hyaluronic acid is one of the most popular ingredients in dermal fillers. Hyaluronic acid is a naturally produced component in the skin that aids in the hydration and volumization of our skin. Hyaluronic acid fillers can last anywhere from seven months to much longer before being progressively eliminated by the body, depending on their chemical composition.

Aside from their natural appearance when administered, one of the major benefits of hyaluronic acid fillers is that they may be eliminated with a particular agent in the case of an unpleasant reaction or if the user rejects the look. In addition, most hyaluronic acid fillers come premixed with an anesthetic, a numbing agent, to ensure that patients are as comfortable as possible throughout treatment.

Calcium hydroxylapatite, poly-lactic acid, and autologous fat are among the additional dermal fillers available. Human bones naturally contain calcium hydroxylapatite, a chemical substance. It has a lengthy history of usage in orthodontics and cosmetic plastic surgery, with a proven safety practice. Poly-lactic acid is an artificial filler that aids in the formation of collagen. This filler differs from others in that it has progressive results; volumization happens over several months as the body is stimulated to manufacture collagen. A semi-permanent glue is polymethyl methacrylate. While it is more lasting than other more easily degradable fillers, it can cause problems such as lumps and being evident beneath the skin.

Each of these materials has its own set of advantages and disadvantages, as well as its own volume, durability, and smoothness, which means that one material may be best placed to a particular area of skin or desired effect over another. Selecting the proper type of dermal filler necessitates consulting with a board-certified dermatologist or plastic surgeon who has a piece of firm knowledge of facial anatomy and is aware of the various fillers and injection procedures available. To guarantee the best aesthetic results, a medical practitioner will thoroughly analyze any concerns and problems, explain what you intend to get out of the therapy, and discuss what to anticipate before, during, and after the therapy.

Dermal Filler Uses

Dermal fillers have been approved by the FDA for use in individuals aged 21 and up for the following purposes:

• Easily absorbed (temporary) fillers, such as nasolabial folds (creases running from the margins of the nose to the margins of the mouth) and perioral markings, are recommended for moderate to severe frown lines and skin folds.
• Lips, cheeks, and back of hand increased volume.
• Only nasolabial folds and cheeks acne scars are allowed for non-absorbable (permanent) fillers.
• In persons with human immunodeficiency virus, the repair and treatment of evidence of facial fat loss.
• Repair of flaws in the shape of the face, such as wrinkles and acne scars.

Dermal Filler Unapproved Uses

The FDA advises against using dermal fillers or any other injected filler for body contouring and augmentation in the following areas:

• Enlarge the breasts (breast augmentation)
• Buttocks size increase.
• Foot fullness increase.
• Implants to be placed in bones, tendons, ligaments, or muscles.
• Administer the filler into the glabella, the nose, the periorbital area, the forehead, or the neck.

Injectable silicon is not permitted for any cosmetic treatment, including sculpting or augmentation of the face or body. Long-term discomfort, infections, and devastating injuries including scarring and irreversible deformity, embolism (blood vessel obstruction), stroke, and death can all result from silicone implants.

The FDA has not authorized needle-free systems for injecting dermal fillers. It is unknown whether needle-free systems for injecting dermal fillers are medically beneficial. No dermal fillers have been authorized for over-the-counter usage by the FDA. The FDA is informed of significant disadvantages associated with the use of needle-free systems for dermal filler administration and has published a Safety Communication about the risk of needle-free systems for dermal filler administration.

Dermal Filler Complications

The use of dermal fillers carries the same dangers as any other procedure. It's essential to be aware of their limitations and potential dangers.

Any dermal filler has the potential to produce temporary, long-term, or both adverse effects. The majority of dermal filler adverse effects appear quickly after injection and go away within several weeks. After hand therapy, swelling and pain can linger for a month or more. Adverse effects from dermal filler injections might develop weeks, months, or even years after the procedure.

Unintentional Blood Vessel Injection

Accidental administration into a blood vessel, which results in clogged blood vessels and insufficient blood flow to tissues, is the most significant danger linked to dermal filler administration. While the likelihood of this occurring is minimal, if it does, the consequences can be significant and even permanent. Necrosis (tissue death), vision problems, including blindness, and stroke have all been described as risks. Before utilizing fillers produced of specific materials, particularly animal-derived materials, patients should be checked for allergies.

The FDA-approved usage of dermal fillers comes with the following hazards. There are no known dangers related to the use of unlicensed dermal fillers or prohibited substances.

Common Dermal Filler Risks

• Bruising
• Erythema
• Swelling
• Pain
• Tenderness
• Pruritus
• Rash
• Difficulty performing daily activities

Less Common Dermal Filler Risks

• Nodules or granulomas are raised bumps in or under the skin that can be addressed with injections, oral antibiotics, or surgical removal.
• Infection 
• Wounds that are open or leaking
• Soreness where the shot was given
• Reaction to allergens
• "Necrosis" refers to the process of tissue death
• Anaphylactic shock is a severe allergy that necessitates prompt medical attention.
• Migration is a term used to describe the movement of filler material from the site of injection
• At the treated area or through the skin, the filler particles leak or rupture, which may result from tissue reaction or infection
• Persistent solid nodules are formed.
• Injury to the vascular system caused by an unintentional administration into a blood vessel, leading to necrosis (tissue death), vision problems, including vision loss, or cerebrovascular disease.

Botox VS Dermal Fillers

Dermal fillers produced from hyaluronic acid, which is a glycosaminoglycan component made up of duplicated glucuronic acid and N-acetyl-glucosamine subunits, are the most commonly utilized. Hyaluronic acid is a polysaccharide that normally occurs in human tissues like the skin and cartilage. Because hyaluronic acid is particularly hydrophilic (draws water), it produces pressure edema and can endure compressive stresses, making it an excellent ingredient for dermal fillers.

Oversensitivity to filler ingredients, bleeding problems, and a history of allergy are all contraindications to using hyaluronic acid treatments. Because hyaluronic acid ingredients are derived from microbial fermentation, a history of sensitivities to gram-positive bacteria is also a contraindication.

Bruising and hematoma are two consequences that are very likely to develop when fillers are used since they are done by injection. Because the use of filler is so reliant on operator skill, there are a number of negative adverse effects related to injection procedures, including unrealistic patient expectations, under-correction, overcorrection, and lumping.

Lumping is frequently induced by the use of non-homogeneous fillers and the absence of massage in the injected zone. The filler will be compressed and blended to produce a tighter and smoother consistency after being injected into a narrow space in the skin. After massage on the injection location, the filler will be compressed and merged to form a tighter and smoother consistency. Failure to complete this procedure can result in visible and palpable skin abnormalities.

Focal necrosis is a significant consequence that can develop when fillers are used, however, it occurs in just 1 of a million of cases. The most prevalent site for focal necrosis among filler users is the glabella. Within 1-2 days, early symptoms of localized tissue necrosis usually occur. This is due to the blockage created by the intravascular injections' direct action. If the physician is aware of the approaching necrosis signs, the initial antidote therapy is hyaluronidase injection.

Botox and fillers are both very operator-dependent and have similar adverse effects. Antidotes are available for each of these treatments in the event that negative effects develop.

Conclusion

Thousands of people are discovering that Botox cosmetic can improve their looks without the cost, hazards, or inconvenience associated with surgical treatments. Botulinum toxin is a neuromuscular inhibiting substance generated by the anaerobic Clostridium Botulinum. Botox was first identified as a cause of severe paralysis caused by ingesting poisoned food when it was first identified. Chemo-denervation, which occurs when the presynaptic production of acetylcholine at the neuromuscular junction is blocked, causes Botox-related paralysis. Botox injections are commonly used to treat the corrugator, crow's feet, forehead, neck-bands, and jowl. There are currently no standards for physical limits after Botox injections. In a small number of people, adverse effects associated with Botox infections appear to be either local, due to the paralysis of neighboring musculature, or cold or flu symptoms extending several days.

With a plethora of fillers on the marketplace and the aging of baby boomers who want to maintain their young appearance, proper patient decision, dermal filler choice, and procedure choosing can maximize patient satisfaction and lead to a good result.