Wrinkles of time, now gone in no time. Used to be, if you had facial wrinkles, you either had to invest in expensive topical crèmes and concoctions that didn't deliver lasting results, or you just had to grin and bear those smile lines and crow's feet.

Dr. Nicolette Picerno, ( www.nicolettepicernomd.com), is a double-board certified facial plastic and reconstructive surgeon at Faces First, ( www.facesfirst.com) in Denver at 303-744-2300 and in Lone Tree at 303-708-8787.

According to Dr. Picerno, "The newest aesthetic technology and advances now offer a dazzling array of options for those with undesirable facial wrinkles. Dermal fillers are now being developed for every purpose imaginable and in every concentration. Some fillers are more dramatic and long-lasting than others, and as with all cosmetic procedures and treatments, pros and cons exist for each. Research is key, so the more homework you do to consider your options, the more informed you'll be throughout the process."

Dr. Picerno loves less-invasive procedures such as "Botox Cosmetic" and fillers. This is why she specializes in cosmetic procedures of the face and neck only. She recommends asking the following questions at your initial appointment:

>What are the potential side effects?
>Does the FDA approve the filler for this use?
>How long has the physician used this filler?
>How many patients has the physician treated?
>Are before and after photos available?

Wrinkles result from loss of three crucial skin components - collagen, elastin and hyaluronic acid. With the newest technologies, two of the three components can be replenished: collagen and hyaluronic acid.

Hyaluronic Acid

As you age, the level of your body's natural hyaluronic acid tends to diminish, lending that saggy, loose, dry effect to your skin. To get a good mental image of what hyaluronic acid does for your skin, you might imagine a grape and a raisin. The grape is very robust, and the skin is tight, yet elastic. The raisin is dehydrated, a shriveled shadow of what the grape once was.

>Hyaluronic acid is a "water loving" molecule in the skin that attracts and binds with water.
>Hydrates and makes the skin look plump, fuller and healthier.
>Injections of hyaluronic acid help to replenish what time, lifestyle and age have taken - the natural elasticity and youthful appearance of your skin.

There are several different forms of injectable hyaluronic acid:

>Made from Non-Animal Stabilized Hyaluronic Acid, "Restylane" comes in two forms: "Restylane" and "Perlane."
>"Restylane" is used for all types of facial lines and wrinkles.
>"Perlane" is a thicker, stronger and more durable substance that is more commonly used in deeper folds and wrinkles and in facial contouring (also known as the "liquid facelift").
>The effects of these two products last anywhere from 6-12 months.

>"Juvederm" is another type of hyaluronic acid that also comes in two forms: "Juvederm Ultra" and "Juvederm Ultra Plus."
>"Juvederm" is a smoother, more concentrated product as compared to "Restylane," which has a longer lasting effect as well as less swelling and redness. These products last 12 months or longer.

>A calcium hydroxyapatite material also used to fill in deeper folds and crevices.
>Particularly useful for facial contouring and the nasolabial folds. (Facial contouring includes areas like the cheeks, chin, brow and nose.)
>Does not require any special skin testing prior to first use and lasts longer than the hyaluronic acids; typically 12-18 months.

>"Botox" is also an injectable facial wrinkle remedy, but it is not a filler like the above mentioned products.
>"Botox" injections reversibly paralyze specific hyperactive facial muscles to smooth the deep, persistent furrows and creases that often result in the brow, forehead, eye area, and neck.
>"Botox" is often combined with filler treatments at the same time for an overall facelifting effect.
>Once injected, "Botox" affects the wrinkles by blocking transmission of nerve impulses in the area. The effects are confined to the injection site and are not absorbed throughout the body.
>"Botox" has also helped patients with severe tension headaches and migraines, and excessive sweating of the armpits, palms and soles of the feet.

A final note from Dr. Nicolette Picerno: As with any type of cosmetic procedure, a patient must be completely evaluated for associated benefits and risks. Patients need to understand the limitations of cosmetic surgery as well as the remarkable innovations and possibilities. Consulting with a cosmetic surgeon (or several) to get a realistic picture of the outcome of a treatment before undergoing a procedure is vital.

Contact Dr. Nicolette Picerno ( www.nicolettepicernomd.com) at Faces First in Denver, 303-744-2300 or at the Lone Tree location, 303-708-8787 to learn about a collection of fabulous packages and monthly promotions.