Juvederm injection, Nashville TN practice offering Botox injections, Collagen, cosmetic laser treatments, laser hair removal, acne treatments


What is JUVÉDERM® made of?

JUVÉDERM® is made of hyaluronic acid, which is a natural complex sugar that contributes to the volume and elasticity of the skin and is found naturally in all living organisms. Hyaluronic acid is instrumental in the delivery and retention of moisture and nutrients to the skin, and levels of this compound in the skin naturally decrease with the progression of age. The hyaluronic acid in JUVÉDERM® is created during an advanced manufacturing process and is specially formulated as a smooth and malleable gel to ensure the most natural looking results possible.

How Does JUVÉDERM® Work?

Your skin naturally produces hyaluronic acid, a sugar-based compound responsible for delivering and maintaining moisture and nutrient levels in skin cells, and which creates the appearance of volume and smoothness in young, supple skin. Unfortunately, with the progression of time, your skin’s ability to manufacture its own hyaluronic acid diminishes. JUVÉDERM® is a smooth gel that is made of cross-linked hyaluronic acid particles. When injected into fine lines, wrinkles, furrows, or sunken areas of the face, JUVÉDERM® replenishes the hyaluronic acid that has been absorbed into your body over time, helping you achieve a more youthful appearance.

JUVÉDERM® comes in a number of formulas of varying strengths, so treatments can be tailored to the specific needs of each patient. JUVÉDERM® is effective in the treatment of fine lines and wrinkles as well as in plumping up the lips, filling in the cheek area, and even restoring a youthful, rounded shape to the face. While JUVÉDERM® provides very visible and long-lasting results, patients who have extensive facial wrinkling or sagging may be more appropriate candidates for facial plastic surgery, such as a facelift or a browlift.

Is pre-treatment testing required?

No pre-treatment allergy testing is required for JUVÉDERM® treatments. Hyaluronic acid already occurs naturally in human skin, and the hyaluronic acid that is used in JUVÉDERM® is created through biosynthesis and is not of animal origin, so it is highly biocompatible.

Are JUVÉDERM® results immediate?

Yes. While the appearance of treated areas will continue to improve for a few days following JUVÉDERM® treatment, patients enjoy immediate reduction in the appearance of fine lines and wrinkles in areas treated with JUVÉDERM®.

Is there downtime following JUVÉDERM® treatment?

There is no downtime required after JUVÉDERM® treatment. Patients who undergo JUVÉDERM® treatment can expect to be able to return to work or other normal activities immediately, with only mild redness or soreness at the site of the injections.

The hyaluronic acid found in Juvederm promotes hydration in the skin, naturally restoring volume to sagging areas.  The procedure only takes about 15 to 20 minutes to administer. Since it’s a non-invasive cosmetic surgery process that is accomplished by injecting the gel directly into the troubled layers of the dermis, results are instantaneous and there is virtually no recovery time needed. Juvederm is FDA approved and because of its chemical compounds, it can be used on almost any skin type or color. There are also different options for unique types of skin and skin problems, enabling you to customize your treatment to your needs.

Contact Sieveking Plastic Surgery in Nashville, Tennessee

If you are curious about wrinkle treatment and facial volumizing with Juvederm™, please contact Sieveking Plastic Surgery in Nashville, Tennessee to schedule a consultation with our Nurse Injector today.



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woman holding her face, Nashville TN practice offering Botox injections, Collagen, Juvederm, cosmetic laser treatments, laser hair removal

04 Aug What is collagen? What does collagen do?

Collagen is the most abundant protein in the human body and is the substance that holds the whole body together. It is found in the bones, muscles, skin and tendons, where it forms a scaffold to provide strength and structure.

Endogenously produced collagen (i.e. collagen synthesised by the body) plays numerous important roles in health, with the breakdown and depletion of the body’s natural collagen associated with a number of health problems. As such, exogenous (supplemental) collagen is increasingly used for medical and cosmetic purposes, including to help with healing and repair of the body’s tissues.

What is collagen?

Collagen is a hard, insoluble and fibrous protein that makes up one-third of the protein in the human body.  In the majority of collagens, the molecules are packed together to form very similar long thin fibrils.

According to MediLexicon, collagen comprises a family of genetically distinct molecules, all of which have a unique triple helix configuration of three polypeptide subunits known as alpha-chains.

Each chain contains around 1,000 amino acids, and usually features an amino acid sequence consisting of glycine, proline and hydroxyproline.

There are numerous different types of collagen, at least 16 types, but 80-90% of collagens in the body belong to types I, II and III. The collagens in the human body are strong and flexible. Type I collagen fibrils are particularly tensile, and are stronger than steel, gram for gram.

Collagen and the body

Collagen is most commonly found in the skin, bones and connective tissue within the body, providing structural support, strength and a degree of elasticity (in combination with elastin). In particular, collagens can be found in the extracellular matrix – an intricate network of macromolecules that determine the physical properties of body tissues.

In the middle layer of the skin – the dermis – collagen helps form a fibrous network, upon which new cells can grow. Collagen is also required in the replacement and restoration of dead skin cells. Some collagens also function as protective coverings for delicate organs in the body such as the kidneys.

Collagen production naturally declines with age, reducing the structural integrity of the skin and leading to sagging skin, the formation of lines and wrinkles and the weakening of cartilage in joints.

Collagen is secreted by a variety of different cells, but primarily by connective tissue cells. While young, the body consistently produces collagen, but collagen synthesis begins to decline around the age of 40, with a dramatic reduction in synthesis in women after menopause. By the age of 60 there is typically a considerable decline in collagen production.

Medical uses of collagen

Collagen is resorbable (can be broken down and assimilated by the body), is functionally diverse and is naturally occurring. This means that collagen has several different medical applications and can be used with a variety of medical devices. In addition, it can be formed into compacted solids or lattice-like gels when being prepared for use, making it clinically versatile.

Collagen that is used medically can originate from human, bovine, porcine and ovine sources.

Skin fillers

Injections of collagen can improve the contours of the skin and fill out depressions. Collagen can be used cosmetically to remove various lines and wrinkles from the face, as well as scarring (including acne), so long as the scars do not have a sharp edge.

Collagen fillers can originate from human and bovine sources. Use of injected collagen can be restricted in people with severe allergies, and skin tests are typically required before bovine collagen is used.

Collagen is used to fill relatively superficial defects. More extensive defects are usually filled with substances such as fat, silicone or implants.

Wound dressing

Within wound healing, collagen attracts new skin cells to the wound site, promotes healing and provides a platform for the growth of new tissue. Collagen dressings are therefore used in order to aid the healing of certain types of wound, including:

  • Chronic non-healing wounds
  • Exuding wounds
  • Granulating or necrotic wounds
  • Partial and full-thickness wounds
  • Second-degree burns
  • Sites of skin donation and skin grafts.

It is advised that collagen dressings are not used for third-degree burns, wounds covered in dry eschar or with patients who may be sensitive to bovine products.

Guided tissue regeneration

Collagen-based membranes have been used in periodontal and implant therapy to promote the growth of specific types of cell. In oral surgery, barriers can be used to prevent fast-growing cells of the gingival epithelium migrating to a wound in a tooth, preserving space there for tooth cells to potentially regenerate.

The benefit of using collagen-based membranes for this purpose, in addition to collagen’s healing qualities, is that they can be made to be resorbable (the body breaks down the collagen and assimilates the protein over time). This means that patients do not require a second surgical procedure to have the barrier removed.

Vascular prosthetics

Collagen tissue grafts from donors have been used in peripheral nerve regeneration and vascular prostheses, used in arterial reconstruction. Certain prostheses have been found to be thrombogenic – causing coagulation of the blood – but at the same time, compatible with the body of the host.

Treatment of osteoarthritis

Collagen supplements or formulations may be beneficial in the treatment of osteoarthritis. In a number of trials, they have been found to provide some degree of pain reduction. However, in other trials, use of collagen supplements and formulations has not been found to result in any additional benefit.

A 2006 review found that collagen hydrolysate helped to significantly decrease painful symptoms of osteoarthritis while improving joint function. The supplement was well absorbed, led to collagen accumulation in cartilage, and helped to stimulate specialized cells in the joints called chondrocytes to create extracellular matrix.

Skin revitalization

Many products containing collagen, including creams and powders, claim to revitalize the skin. However, despite the marketing of these products as ways to increase the levels of collagen within the body, collagen molecules themselves are too big to be absorbed through the skin.

The benefits of these products, where they exist, are most likely attributable to their moisturizing effects, but they do not strengthen the skin or directly increase collagen concentration in the skin. Such over-the-counter treatments are also not classified as drugs, meaning that there is no requirement for scientific validation of the claims made regarding their efficacy.

Increasing collagen production

The growth of collagen, elastin, and melanin can all be stimulated through laser therapy, involving intense wavelengths of light. This method can be used in the treatment of stretch marks.

Collagen, like all proteins, is made up of amino acids. Of these amino acids, nine are considered essential, i.e. they cannot be synthesized by the body and must be acquired through the diet.

Other nutrients that may support collagen formation include:

  • Proline: found in egg whites, meat, cheese, soy and cabbage
  • Anthocyanidins: found in blackberries, blueberries, cherries and raspberries
  • Vitamin C: found in oranges, strawberries, peppers and broccoli
  • Copper: can be found in shellfish, nuts, red meat and some drinking water
  • Vitamin A: found in animal-derived foods and in plant foods as beta-carotene

What damages collagen?

There are a number of factors that can deplete the levels of collagen found within the body. Avoiding the following could keep the skin healthy for longer:

  • High sugar consumption: a diet high in sugar increases the rate of glycation, a process whereby sugar in the blood attaches to proteins to form new molecules called advanced glycation end products (AGEs). AGEs damage adjacent proteins and can make collagen dry, brittle, and weak.
  • Smoking: many of the chemicals present in tobacco smoke damage both collagen and elastin in the skin. Nicotine also narrows the blood vessels in the outer layers of the skin, which reduces the delivery of nutrients and oxygen to the skin, compromising skin health.
  • Sunlight: Ultraviolet rays in sunlight cause collagen to break down at an increased rate, damaging collagen fibers and inducing the accumulation of abnormal elastin. Abnormal elastin leads to the production of an enzyme that can also break down collagen. This process can lead to the formation of solar scars.
  • Autoimmune disorders: Some autoimmune disorders cause antibodies to target collagen. Mutations to the genes responsible for the coding of collagen alpha-chains can affect the extracellular matrix, leading to a decrease in the amount of collagen secreted, or to the secretion of dysfunctional mutant collagen.

Collagen levels deplete naturally over time and there is no way to prevent this intrinsic aging. However, by taking precautionary measures, it is possible to reduce extrinsic aging and protect collagen, keeping the skin, bones, muscles and joints healthy for longer.

If you are curious about collagen, please contact Sieveking Plastic Surgery in Nashville, Tennessee to schedule a consultation.




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15 Jul Are you a good candidate for Botox Treatment

Botox® Cosmetic (Botulinum toxin) candidates in Nashville, TN?

Smiling, frowning, squinting, and even chewing – basically any facial movement – can eventually lead to one of the most common signs of aging: wrinkles. They can make you appear tired or even angry when you are not. One of the quickest and safest remedies to remove wrinkles is an injection of botulinum toxin type A – Botox.

Botox® Cosmetic (Botulinum toxin) can be combined with other cosmetic skin procedures – such as chemical peels, dermal fillers, or microdermabrasion – to further improve your results. This combination of therapies can even help to prevent the formation of new lines and wrinkles.

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01 Jul Botox – a Minimally Invasive Procedure

What is botulinum toxin type A?

Botulinum toxin (BOTOX) is a purified substance that’s derived from bacteria.  Commonly known types of botulinum toxin type A injections include Botox and Dysport.

Injections of botulinum toxin blocks muscular nerve signals, which then weakens the muscle so it can’t contract. The end result is diminished unwanted facial wrinkles.

Botox injections can be used to help smooth:

  • Crow’s feet
  • Forehead furrows
  • Frown lines
  • Skin bands on the neck

Photos of Botox injection results.

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Contact Dr. Nicholas Sieveking

If you would like more information on BOTOX Cosmetic treatment, or if you would like to schedule a consultation to talk more about your options, please contact Dr. Nicholas Sieveking in Nashville, Tennessee today.

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26 Jun Botox Treatment Questions

Questions to ask my Nashville, TN plastic surgeon about Botox Treatment

Use this checklist as a guide during your botulinum toxin (Botox) consultation:

  • Are you certified by the American Board of Plastic Surgery?
  • Were you specifically trained in the field of plastic surgery?
  • Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
  • Am I a good candidate for botulinum toxin?
  • What will be expected of me to get the best results?
  • Who will perform the botulinum toxin injections?
  • Have they been specifically trained in this procedure?
  • Where and how will you perform my procedure or treatment?
  • How long of a recovery period can I expect?
  • What are the risks and possible complications associated with my procedure?
  • How can I expect to look over time?
  • Do you have before-and-after photos I can look at for this procedure
  • What results are reasonable for me?

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10 Jun All Botox solutions are not the same – Nashville’s best can help

Botox injections are the most popular cosmetic procedure performed worldwide.

Millions of patients are injected each year with the wrinkle fighting drug – Botox.

Its popularity is attributed to:

  • There is minimal downtime – 15 minutes of bumps from the Botox injection
  • The procedure is highly effective in improving wrinkles
  • Discomfort is usually minimal
  • Side effects are few and rare
  • Cost is fairly reasonably, but depends on how many areas are done
  • The time it takes to get a treatment is less than 10 minutes

All patients will age differently, so what areas need treating for optimal cosmetic results needs to be tailored specifically to each patient.  A cookie cutter approach to every patient will not work.  There are several areas of the face which can be considered advanced:  lips, corners of mouth, neck, gummy smile, under eye, bunny lines, inner eyebrows which require a highly trained and experienced injector, or you will live with a disfiguring facial appearance for 3 months.

The trend is moving away from the frozen, no movement, very obviously treated face to a more natural appearance.  Rather than blasting and overwhelming the forehead with Botox, a technique using very small, precisionly placed aliquots that allows for movement but with diminished wrinkles.  This is a more difficult technique to master.

Shortcuts are often routine in regards to Botox injections.  A majority of practices will draw up syringes of Botox in the morning, or the day before, by a nurse, medical assistant, or office staff.  That means the patient will need to get injected in multiples of what is contained in a syringe, leading to limited customization.  Also, errors in dilution and sterile technique are possible when filling the syringes is not done by the same person that is injecting the Botox.  (Botox comes in a powder form and needs to have saline added to reconstitute it to become an injectable solution.)

Discomfort related to Botox injections can be minimized using various techniques.  Using preserved saline has been shown to result in less pain than using regular saline.  Needle size, speed of injection, and using proper needle placement is also a key factor affecting comfort.  Certain areas require different dilutions to lead to maximal cosmetic benefits.

Touch ups to correct minor imperfections require an advanced injectors experience.  They also need a responsive provider, easily available for a drop in or work in patient.

Getting injected by an unknown provider at someone’s Botox party, is never a good idea, and almost always leads to problems that one has to live with for 3 months.  The “savings” are never worth it.

Although Botox injections are extremely popular, there are many people that are not pleased with their experience.  This is not the norm for the high volume, experienced injector in Nashville, Tennessee.  As explained above, there are many intricacies which can contribute to better results. Hopefully the public will understand that Botox should not be considered a routine cosmetic procedure, and they need to select their providers carefully.

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03 Jun Nashville TN – Sieveking Plastic Surgery can help treat Chronic Migraines with Botox

Treat Chronic Migraines with Botox Injections in Nashville, TN

Botox injections can relieve migraine headache symptoms for up to 3 months.

Did you know that Botox — famous for smoothing out wrinkles on the face — has been approved by the FDA to treat chronic migraine headaches in adults.

The FDA says Botox injections have been shown to be effective in the prevention of migraines, which are debilitating headaches that cause intense pulsing or throbbing pain and affect about 12% of Americans.

“Chronic migraine is one of the most disabling forms of headache,” Russell Katz, MD, of the FDA, says in a news release. “Patients with chronic migraines experience a headache more than 14 days of the month. This condition can greatly affect family, work, and social life, so it is important to have a variety of effective treatment options available.”

Migraine headaches are sometimes called “sick headaches” because they often are accompanied by nausea and sensitivity to light and sound.

Botox to treat chronic migraines is typically given at intervals of about 12 weeks as multiple Botox injections around the head and neck to try to dull future headache symptoms, the FDA says in a statement.

The FDA says it’s important that patients who suffer chronic migraines discuss with their doctors whether Botox is appropriate for them.

Allergan Inc., the maker of Botox, says in a statement that the FDA’s approval applies to people with chronic migraine, which it defines as a “distinct and severe neurological disorder characterized by patients who have a history of migraine and suffer from headaches on 15 or more days per month with headaches lasting four hours a day or longer.”

The company says that when treating chronic migraine, qualified medical specialists administer 31 Botox injections into seven specific head and neck sites.

It says that Botox, when injected at labeled doses in recommended areas, is expected to produce results lasting up to three months depending on the individual patient.

If you would like more information on BOTOX Cosmetic treatment, or if you would like to schedule a consultation to talk more about your options, please contact Dr. Nicholas Sieveking today – Nashville, Tennessee’s number-one Plastic Surgeon.

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14 May Cosmetic Procedures to Cure Smile Lines

We all love to smile, but so-called ‘smile lines’, or nasolabial folds, can make us look sad and tired.

What are the best ways to treat smile lines – nasolabial folds?

Nose to mouth lines (also known as the nasolabial fold) run from the outside of the nostril to the corners of the mouth. They appear as we get older, as our cheek fat descends and we lose volume in our faces. These lines naturally look deeper when we smile, but if they stick around when our expression is serious, they can appear to drag our features down. That’s why many people look for a solution to restore a smoother, happier look.

One of the simplest options is to plump out fine lines by injecting them with a temporary hyaluronic dermal filler. If done carefully this fills in the crack and gives a fantastic effect. Less is more here, so look for a doctor who offers you a complimentary follow up appointment as part of your treatment.

Deeper folds are caused when the fat in the cheeks sags down to the nasolabial lines and the skin becomes less elastic with age. The result is that the skin and fat appear to droop around the mouth.

If the folds are more pronounced an alternative approach to injecting directly into the lines, is to use a thicker filler to restore volume to the cheeks. This pulls up the skin over the cheeks, so smile lines soften or disappear. Again, this needs a subtle approach. Do not be tempted by permanent fillers as they are much more likely to cause complications. Results from fillers can last from six months to a year.

For folds with overhanging sagging that fillers can’t fix, or if you want a more permanent solution, a facelift or mid-facelift is a good approach.  This replaces the cheek tissue into its youthful position and tightens loose skin. It will leave scars in the crease where the ear meets the face, behind the ear and into the hairline. But in the hands of a skilled and experienced surgeon can create a beautiful result.


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