Age is an inescapable fact of life. We get older. One of the first things that belie our age is the face. Wrinkles and folds form on the face with age. With age, the volume of subcutaneous tissue and fat below the skin diminishes, the supporting tissues weaken, and there is reduction of collagen and hyaluronic acid beneath the skin. Add to that the effect of exposure to the elements, primarily the sun and heat, the effects of alcohol and smoking, and last but not least, gravity. All these factors result in the production of what we call wrinkles, creases or folds. There is hope, however. Because one of the primary causes of wrinkles is the loss of subcutaneous tissue, we can introduce substances called facial fillers under the skin to replace the lost volume and thus make the wrinkles disappear. One of the major, safe and most popular of fillers is a hyaluronic acid gel called Juvaderm. Juvaderm, which is more correctly called Juvederm, is a cross-linked hyaluronic acid gel. Hyaluronic acid is a safe, non-allergy-causing naturally occurring substance in animals which forms a major part of the extracellular matrix or supporting tissue. However normal injected untreated hyaluronic acid lasts only a few days under the skin. Cross-linkage of this substance allows it to last longer, about 6 to 9 months after injection. In Juvaderm, this cross-linked gel also goes through a patented process called Hylacross that confers to it the property of smoothness and easy injection. Wrinkles and creases form typically on the forehead (forehead lines), glabellar area (frown lines), on the skin of the outer corner of the eyes (crows feet), along the nasolabial folds (which refers to the crease running from the sides of the nose to the corners of the mouth, and the marionette lines (creases running from the corners of the mouth to the sides of the chin. The first three, in the early stages, are often referred to as dynamic wrinkles, as they are formed by the contraction of facial muscles, and these dynamic wrinkles are better treated with a muscle relaxing agent called botox. Given time, however, these creases become permanent and do not disappear with the relaxation of facial muscles. This is the time when fillers such as Juvaderm are needed. Juvaderm is most popular for the filling and correction of nasolabial folds and marionette lines. As said before, the Juvaderm injected lasts between 6 and 9 months. It is a known fact that the filling of these creases on the face makes us look years younger. The space filling ability of Juvaderm is not confined to the elimination of wrinkles and creases alone. Juvaderm is also commonly injected into the lips in order to create sexier, bigger lips. Injection of Juvaderm is done by qualified esthetic doctors who will usually do this under local anesthesia, which is given either as a local application of an anesthetic gel, or by injection into a local sensory nerve to obtain a nerve block. The procedure of injection usually does not extend beyond an hour, and thus Juvaderm injection is commonly referred to as a lunchtime procedure. Follow-up after Juvaderm injection is usually about a week after the procedure. This is the time when the results of the injection are reassessed after the local post-operative swelling has subsided, and a topping up of the gel is given, if necessary.
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