ennis Archives | The Aesthetic Clinique

Are superficial chemical peels obsolete? The Spectra Laser Peel (“Hollywood Peel”) might make that happen.

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Chemical peels have been a staple for skin care for decades. There are dozens of different types treating various skin conditions. This blog will be directed at the superficial chemical peels used to treat: fines lines, pigmentation, sun damage, acne, large pores, and to rejuvenate the skin. These peels are usually placed by an aesthetician in a spa or physician’s office. After about 2-3 days, the peeling starts and lasts for a couple of days and sometimes up to 5 days. During the peeling phase, there’s various amounts of flaky skin, treated with moisturizer. The skin eventually looks great, 3-7 days after the initial placement of the peel.

Let’s turn to the Spectra Laser Peel. The Spectra Laser is a Q switched 1064 laser that has a tremendous affinity to pigment. It is designed for (and state of the art for) tattoo removal and treating various pigmented lesions (freckles, seborrheic keratosis, lentigos, cafe au lait, nevi, post inflammatory hyperpigmenation, and melasma). The laser peel begins by placing a carbon liquid on the skin for about 10-15 minutes. The carbon is absorb superficially in the skin. This liquid is essentially tricking the laser into thinking its attacking pigment when it is applied to the face. As the laser is first passed over the skin, the carbon absorbs some heat which is passed to the underlying skin. The next several passes cause vaporization of the carbon as well as a very superficial layer of the skin – 15-30 microns. What’s better is that there is no discomfort during the procedure!

The end result is a glowing and radiant skin tone with NO associated peeling or recovery time.

I believe the effectiveness for the various skin condition (acne, pores size, fine lines, pigmentation, melasma) is marked better with the Spectra Peel than with traditional chemical peels. Active acne outbreaks seem to resolve within days. Just like other laser procedures, the Spectra Peel can’t be performed on tan or recently sun exposed skin, or people on Accutane. It can not be done on darker skin types as well.

If you’re looking for a quick skin rejuvenation with essentially no downtime, do what they are doing in Hollywood just before they hit the red carpet, The Spectra Laser Peel.

Dr. Steven Weiner is a Board Certified Facial Plastic Surgeon practicing in Santa Rosa Beach, Florida, between Destin and Panama City Beach, Florida. After laying down his scalpel in 2005 he has devoted his practice to Lasers and Injectables.

Blog: http://stevenfweinermd.wordpress.com/

YouTube: http://www.youtube.com/user/StevenFWeinerFacial

Website: http://www.theclinique.net

Voluma is the latest filler to be FDA approved – What makes it different? Dr Steve Weiner explains

Front view before and after 12 syringes of Voluma: cheeks, temples, marionette lines, and preauricular area.

45 degree view after 12 syringes of Voluma injected.

45 degree view before and after 12 syringes of Voluma: cheeks, temples, marionette lines, and preauricular area.

Voluma, 12 syringes injected, 90 degree photo

After 12 syringes of Volume, 90 degree view. Injected cheeks, temples, marionette lines and preauricular area.

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Juvederm Voluma was approved by the FDA today for treatment of age related volume loss in the cheek area. This is the first filler to be approved for this purpose. Its main component is Hyaluronic acid which is also found in Juvederm Ultra, Restylane, Perlane, and Belotero, all FDA approved fillers. Juvederm Voluma is a thicker, more viscous version of Juvederm Ultra which gives it more “substance”. The technical term for this property is called “G prime”. The higher the G prime, the better ability for the filler to lift and support skin and surround structures. Compared with Juvederm Ultra, Juvederm Voluma has about 10 times (10X) the G prime. A comparison graph is shown below (from Going With the Flow: An Overview of Soft Tissue Filler Rheology and Its Potential Clinical Applications, Part II by Hema Sundaram, MD, FAAD):

As seen in the chart, Radiesse, Perlane, and Restylane have higher G primes than Juvederm Voluma. Although these others are not approved for volume loss of the cheek, they are all used commonly “off label” for this application.

Being very thick/viscous, Voluma will need to be injected with large bore needles or blunt cannulas. It is mixed with lidocaine (numbing medication) from the factory, so the procedure is very well tolerated. It’s longevity is longer than most fillers, lasting up to 2 years in their clinical trials. At 2 years, 76% of patients were still satisfied with their Voluma results. (It was 90% at 6 months). Also, at 2 years, the average patient’s perception was that they looked 3 years younger since the Voluma treatment. (It was perceived as 5 years after 6 months).

Obviously, the volume needed for correction varies from patient to patient, depending on their degree of volume loss. During the clinical trials, the average volume needed for correction was just over 6cc. Some patients needed up to 13 syringes.

An advantage of Voluma over Radiesse, Artefill, or Sculptra is that Voluma can be “erased” or dissolved with an easily obtained enzyme called hyaluronidase. Although it is seldom used, it can give patients the piece of mind that their results don’t have to last for a year if they aren’t happy with it.

Initially, Voluma is being released to a select number of physicians who are very experienced injectors. These physicians will then become trainers for the other physicians with less experience. Dr. Weiner has been chosen as one of these initial users of Voluma, and it should be available at his office in November.

Dr. Weiner is Facial Plastic Surgeon who laid down his scalpel in 2005 and now concentrates on minimally and noninvasive cosmetic procedures. His website is http://www.theclinique.net His YouTube is: http://www.youtube.com/user/StevenFWeinerFacial

Dr. Steve Weiner: “FINALLY…A Radiofrequency (RF) Skin Tightening Device that Makes Sense. Infini by Lutronic.” Includes an overview of the RF skin tightening industry.

Before and after one treatment with the Infini. After is 8 weeks after the treatment.

Infini treatment of forehead lines. After (right) is 8 weeks after one treatment.

Infini RF treatment of face and neck. After (right) is 6 weeks after 1 treatment. Show improvement in jowls, jawline, upper eyelids, and cheeks wrinkles.

Infini treatment for neck and lower face wrinkles.

15 hours after having the Infini Treatment, ready for work

3 hours after Infini Treatment, she had already gone to yoga

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Dr. Weiner’s White Paper on Infini (more medical terms and more detailed than blog)

Dr. Weiner explains why Coagulation is so important in tightening skin

Radiofrequency use in medical treatments has over a 70 year history. It has been used for multiple applications but the most exciting innovations recently have been in skin tightening. Thermage in 2002 was the first to market a device which was FDA approved to tighten skin and improve wrinkles. Since then, there have been a least a dozen devices come to market with similar technology including: Exilis, Venus Freeze, Pelleve, Viora Reaction, 3Deep RF, Accent XL, eMatrix, eTwo, TriPolar RF, ReFirme, Sublime, Fractora, Evolastin, and most recently Infini. The “knock” on most of these devices has been:

The results are variable – most patients get minimal or no results
Multiple treatments (6 or more) are often needed with touch ups with some of the devices

This blog will help the reader understand how RF devices tighten skin, the problem with most RF devices (why they mostly don’t work), and why the Infini by Lutronic is a game changer in this group. Research has shown that heating the dermis to a certain temperature will cause collagen stimulation and contraction. By heating to 40-45 degrees Celsius, enough heat is created to cause the body to try to repair the area by laying down new collagen. Higher temperatures, in the 65 degree range, will denature collagen and cause contraction. Obviously this requires more energy but this equates to more visible results. Here’s the problem with all cutaneous devices (Exilis, Venus Freeze, Pelleve, Viora Reaction, 3Deep RF, Accent XL, eMatrix, eTwo, TriPolar RF, ReFirme, Sublime): It is very difficult to heat the dermis to a temperature that is effective and still maintain safe temperatures for the skin surface. If the surface were to reach the 40-45 degree area, it would burn. So, these device’s solution has been to try to cool the surface while pumping in energy to the deeper layers. This becomes a very difficult and unpredictable task. The devices rely on the tissues to carry the energy to the right level. Differences in skin thickness, hydration and the composition of collagen and fat can lead to placement of the energy at unknown or variable depths. If the energy is placed too deep, you can get fat necrosis, as what was occurring with the early Thermage device, and if placed too superficial, the skin can burn or get hyperpigmentation. Also, if you don’t actually reach the critical temperatures, you will get no stimulation of collagen. Multiple treatments are the norm for several of these devices because getting collagen stimulation is very difficult with the one treatment. The bottom line is that

ALL CUTANEOUS RF DEVICES, NO MATTER WHAT THEY ARE CALLED, HAVE THE PROBLEM WITH UNPREDICTABLE HEATING OF THE DERMIS AND THEREFORE UNPREDICTABLE OR VERY LITTLE RESULTS.

Skin surface is cooled and RF energy is pumped through the skin surface to heat dermis is UNPREDICTABLE manner

During Thermage, the skin surface is cooled and then RF energy is pumped through the skin surface to heat the dermis in an UNPREDICTABLE manner

Infini vs Other RF Devices

Ever since Fraxel was approved in 2005, the concept of treating areas fractionally has been the desired treatment modality for most devices. By treating only a fraction of the tissue, you can have more safety, more comfort, yet still get fairly similar results than treating the entire area. This concept has been borne out mainly with lasers in the arena of fractional laser resurfacing. Now comes another “knock” for the majority of RF devices: Almost all of the devices use a bulk heating method and not a fractional heating, so the risk, downtime, and discomfort are high. By keeping surrounding tissues untreated (fractionally) as with the Infini, you get faster healing, less pain, and much less risk. So how can we get more predictability with RF? Penetrate the skin to the level you would like to heat with microneedles and bypass the superficial layer that must stay cool and untreated. You can heat the deeper tissues to a much higher level with this technique, leading to greater collagen remodeling, collagen contraction, and stimulation. As a secondary benefit, the actual penetration with microneedles has been shown to mechanically stimulate fibroblasts to produce collagen.

$Precise fractional controlled thermal injury of the Infini$

Precise fractional controlled thermal injury of the Infini, vs monopolar and bipolar RF, vs ablative laser

There currently are many popular treatments based solely on microneedling (Vampire Microneedling). By creating an opening in the skin with the needles, topical therapeutics can be applied at the conclusion of the treatment which will get to levels much deeper than when typically applied to the surface of the skin. These can include: growth factors (rejuvenation), Vitamin C (for collagen), hydroquinones (for pigment), Retin A (rejuvenation and acne). Going deeper into the skin allows for some treatment opportunities which haven’t been/or poorly been addressed in the past with RF devices: Acne treatment (attacking the sebaceous glands), acne or other scarring (particularly darker skin types), and sweating (attacking the sweat glands). There are 3 devices on the market which use this microneedling concept:

Evolastin
Fractora
Infini

Evolastin: Uses 32g needles in depths which are between 1-2mm. The needles enter the skin in a tangential manner, so the exact depth is hard to predict. The energy transmits between paired needles, so the heating in fractional and localized. The major problem is that the patient requires tumescent anesthesia (infiltrating lidocaine mixed with saline) into the area being treated. This adds additional time, discomfort, and risk. Another concern is that this solution actually changes the tissue characteristics, so the treatment becomes less predictable – maybe more or less effective in different areas or maybe safety concerns in certain areas.

Evolastin has tangential needle placement and large caliber needles

Fractora: Uses needles which have a fixed depth of 1mm. The energy is transmitted through the needles and circles back to the electrode sitting of the surface of the skin. The surface probe has a sensor to monitor the skin temperature so as to maintain it within safe parameters. This is truly NOT fractional because the energy is dispersed in the areas between the needle tips and the skin surface. Here we go again with unpredictable traveling of the energy through the tissues and bulk heating. Concerns for safety and discomfort come to mind.

$Fractora electrodes are not insulated and treatment is not fractional.$

Fractora electrodes are not insulated and treatment is not fractional.

Infini: Uses needles which are 200 microns (small). Has variable depth of penetration from 0.5mm to 3.5mm so in the same treatment, several different levels of the dermis can be treated PREDICTABLY. Also, some parts of the face have different thicknesses of dermis, so the variable depth allows for treatment of the entire face. A depth of 3.5mm is much deeper than the other 2 needle devices. The energy is transmitted between the needles which results in true fractional RF ablation in the dermal tissue. The energy only travels a very small distance so the discomfort is minimized. (The more distance the energy travels through tissue, the more pain is felt.) The surface tissue is safe because the needles are at a level that won’t transmit energy to the epidermis. The treatment time is fairly quick: full face treatments take about 30 minutes, as do the neck procedures. For optimal results, it can take 2-3 treatments and full results take the standard 4-6 months to fully achieve (when the collagen remodeling is complete.)

$Infini showing the microneedles causing a small precise fractional dermal injury at multiple levels$

Infini showing the microneedles causing a small precise fractional dermal injury at multiple levels

The wide spectrum of indications of the Infini are:

Improving superficial fine lines and wrinkles of the face, eyes, neck
Improving the elasticity of aged and solar damage “thin” skin
Treating scars of all types but particularly acne scars. It has a great advantage over laser for darker skin types. Infini might turn out to be the “go to” device for scars over the Fraxel Dual 1550 because of deeper treatment levels (3.5mm vs 1.8mm of the Fraxel) and without the pigmentation risks.
Tightening loose skin on all parts of the body including: arms, chest, knees, abdomen. There are no limitations as to where the skin can treated on the body.
Potentially a treatment for acne and hyperhidrosis
No exclusion of patients based on skin type with no risk of hyperpigmentation.
Downtime is limited to only about 2 days of sunburn like sensation and slight redness

When comparing to the Ulthera, the differences are:

Ulthera is more for lifting than for the superficial lines and wrinkles
Ulthera is only used on the face and neck at the present time
Ulthera is still being evaluated for acne scars
Ulthera can be used in conjunction with Infini for even greater tightening and lifting then just Infini or Ulthera alone
Ulthera results in 15,000 coagulation points with a treatment, Infini is over 50,000
Ulthera depths are below the dermis for the most part where tissue tightening is not very effective.

To summarize, RF skin tightening has over a 10 year history which has been fraught with several different technical hurdles: unpredictable results, discomfort, and safety concerns. Using microneedling RF, we can get the energy down to the level needed with more accuracy and more safety. Infini seems to have the right combination of the transmission of energy through their needle tips as well as having variable depths to be the ideal RF Skin Tightener at the present time. It also has a broad list of indications including acne scars, skin tightening on the body, and improving the fine lines and wrinkles of facial skin.

Dr. Steve Weiner is a Facial Plastic Surgeon who “laid down his scalpel” in 2005 and concentrates solely on non invasive and minimally invasive cosmetic procedures at The Aesthetic Clinique. He is one of the first 15 adopters of the Infini in the United States. His website is http://www.theclinique.net . Call for a consultation: 850.622.1214

This link is from a European round table discussion about Lutronic Infini and Spectra (both at The Aesthetic Clinique). Infini discussion starts on page 7. http://digital.miinews.com/publication/?i=174629

Blog: http://stevenfweinermd.wordpress.com/

YouTube: http://www.youtube.com/user/StevenFWeinerFacial

Everything you need to know about Laser Tattoo Removal

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As more and more people are getting tattoos, there is an increasing demand to get them removed. Whether the tattoo was a mistake from the get go, it didn’t turn out as you expected, or a relationship has changed and you want to remove your “ex” from your skin, the most common way to remove tattoos is with a laser. The only other option is to surgically excise the tattoo which can realistically be done only for smaller tattoos and it always leaves a scar.

A Q-switched laser is needed to removed tattoos. What’s unique about this type of laser is that its pulse duration (how long the time is which it fires it energy) is in the nanosecond range. By making the pulse this short, it makes the energy level of the pulse in the billions of watts. That huge energy hit to the tattoo causes a shock wave in the tattoo pigment which leads to the pigment breaking up into smaller pieces. Once the particles of the tattoo pigment get pulverized to a certain size, they are small enough for the body to “chew them up” and remove them from the body. Using traditional laser tattoo removal techniques, it takes multiple treatments, 10-15, to get complete tattoo removal. Often the waiting between treatments is up to 2 months, so it can take a year to 2 to removal a tattoo.

There is a newer technique called the R0 protocol for tattoo removal which will remove tattoos much faster than traditional techniques. The R0 protocol entails treating the tattoo 4 times in the same day. There is a liquid placed on the tattoo which removes the frosting which occurs (from heating nitrogen in the skin) so you can immediately proceed to another pass. Studies show much faster eradication, 1-4 sessions, with no more risks or side effects.

What type of Q-switched laser is the best? The safest wavelength for treating skin of all colors is the 1064 nm Nd:YAG laser. There is less pigmentation side effects and less textural changes with the 1064 Q switched laser than with the Alexandrite and Ruby laser. Sometimes, after treating with this wavelength, residual pigment remains, and that’s when other wavelengths are needed. You also want to look for a laser that has a “tophat” distribution of its pulse energy. What this means is that the energy is evenly distributed across the entire spot size to give a uniform treatment. If this is not the case, the tattoo can be under or over treated in some areas. The shorter duration of the pulse, the better safety profile, and the better results. The short pulse allows for less diffusion of the energy to nearby skin so as to leave this skin unaffected. It also allows for greater energy levels on the treated area.

Top Hat energy distribution of the Spectra laser. Left=others, Right=Spectra

Side effects from Laser Tattoo Removal are: scarring, hypopigmentation, hyperpigmentation, incomplete tattoo removal, and rare allergic reaction to the dyes of the tattoo. Darker skin individuals are at higher risks of complications than lighter skin individuals.

The Lutronic Spectra Q-Switched Laser seems to be an ideal laser for tattoo removal.

An extremely short pulse duration which leads to high peak energies
Based on 1064nm Nd:YAG platform
Has multiple other wavelengths for difficult pigment (4)
“Tophat” energy pulse profile
Dual energy generators to prevent loss of energy during prolonged laser firing

Energy output showing the high peak energy of the Spectra laser

Using the Kirby-Desai Scale, you can determine how many treatments it should take to improve the tattoo (within 80% accuracy) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923953/

For further information about Lutronic Spectra Q-Switched laser tattoo removal, please call our office at 850.622.1214.

Blog: http://stevenfweinermd.wordpress.com/

YouTube: http://www.youtube.com/user/StevenFWeinerFacial

Website: http://www.theclinique.net

The Combination of Sculptra and Ulthera is better than a Facelift and here’s why!

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Dr. Weiner answers questions about Ulthera

Dr. Weiner answers questions about Sculptra

Let me first explain that I’m a Facial Plastic Surgeon, trained at The Johns Hopkins Hospital. I “laid down my scalpel” in 2005 and since then, have devoted my practice solely to noninvasive and minimally invasive cosmetic procedures. The public has demanded cosmetic enhancement to have little to no downtime, appear natural, and be affordable. Surgical procedures such as facelifts, brow and forehead lifts, blepharoplasty have all had declines in their numbers while injectables, laser resurfacing, and noninvasive skin tightening are continuing to grow at a rapid pace.

Remarkably, it has been only over the last 10 years or so that the aging of the face has been recognized as primarily due to loss of volume. After landmark cadaver dissections, it was shown that there are several different fat pads in the face which all seem to atrophy over time. These are located in the temples, cheeks, under eyes, chin, preauricular (in front of ear) and above the lip. Using CT scan analysis, the boney structure of the face has been shown to change as well. The orbit (eye socket) enlarges leading to hallowing of the eye. The upper and lower jaw retract, and there is bone loss at the angle of the jaw. By losing fat and bone (as well as some muscle), the skin of the face loses support and droops. The strategy in the past by Plastic Surgeons was to cut the excess skin away. This lead to a face with tight skin and less wrinkles, but you looked like a skeleton. These days, it is all about filling the face to replace the lost volume from fat and bone loss.

After the science background above, we can now address why facelifts are a dying procedure. Facelifts have the following undesirable attributes:

Requires a surgical procedure which inevitably leaves some type of incisional scar. Sometimes this is fairly noticeable and requires further procedures (more surgery, laser) or topicals to correct.
There is the risk of anesthesia (cardiac, stroke, pulmonary) and the side effects of anesthesia (nausea, vomiting, etc.).
There is pain requiring pain medication
Recovery time can be lengthy, usually at least a couple weeks, sometimes up to a month for swelling and bruising to subside.
The cost is significant. Frequently a facelift is bundled with neck lift, and blepharoplasty. Adding in the cost of anesthesia and the cost of lost wages for 2-4 weeks, you could easily be looking at $15-20,000.
A facelift does not address volume loss, which would require fat grafting. Fat grafting adds in another cost, another procedure (liposuction), and additional anesthesia time. Fat grafting doesn’t always take, so further procedures are usually needed to get to full volume correction.
Often people which have had facelifts don’t end up looking like “themselves” and there is nothing they can do about it.
There are significant risks other than those mentioned which include permanent numbness, nerve damage, hemorrhage, need for corrective surgeries.

A little background about Sculptra and Ulthera is in order. Sculptra is a “collagen stimulant” which is used to replenish volume to a person’s face. It is injected in a series of treatments (usually 3) in the office in a 15-20 minute procedure. The results aren’t appreciated for about 6 weeks, the time it takes the body to create the collagen. It has been FDA approved since 2004. Initial concerns regarding nodules have been addressed with using different protocols and now that problem is less than 1%. Ulthera is a noninvasive skin tightening device. It has been FDA approved for over 3 years. It uses high frequency ultrasound to heat up the deeper levels of the skin to contract, lift, and produce collagen. It can improve the neck, brows, cheeks, and jawline. The procedure is done in the office with just topical anesthesia in 30-90 minutes, depending on how many areas treated. Further information on these procedures can be obtained by reading my blogs and watching my YouTube videos.

The reasons that Sculptra and Ulthera are better than a Facelift:

There is no significant downtime with either Sculptra of Ulthera besides the possibility of some minor bruising.
There are no scars, no anesthesia risk, and no post procedure pain significant enough to require pain medication
There is no time required to stay out of work, therefore no lost wages.
Ulthera can address skin laxity in the entire face – forehead, eyebrows, cheeks, jawline, upper and lower neck whereas these are all separate surgical procedures with their associated additional costs and risks.
Ulthera can be repeated for additional tightening without any additional risk (a redo facelift has significant increases in risk) and there are NO LONG TERM reported risks.
Sculptra is an “off the shelf” long lasting volumizer, not requiring liposuction (fat grafting does). Sculptra addresses the primary reason for facial aging by replenishing the volume in the areas where fat and bone have been lost.
By addressing loss of volume with Sculptra, there is a lifting effect on the cheeks, jawline, upper neck, and around the eyes and eyebrows.
The cost of the combination of Sculptra and Ulthera is much less than comparable surgical procedures particularly if you include loss of work compensation.
The results take several months to achieve and are a gradual and natural enhancement. No shocking your friends with a different looking “you”.

We are entering into a new age of cosmetic enhancements. Procedures are less invasive, less downtime, less risk, and more natural. The Gold Standard of having a facelift for correcting the aging face is having some serious competition from the facial volumizer Sculptra and the noninvasive skin tightening procedure Ulthera.

This link shows the limited benefit of facelifts. Only 3 years knocked off your looks and no improvements in attractiveness. http://www.dailymail.co.uk/news/article-2382922/How-facelifts-make-look-younger-just-3-years.html?ito=feeds-newsxml

Blog: stevenfweinermd.wordpress.com

YouTube Channel: StevenFWeinerFacial

Website: www.theclinique.net

After years of evaluating Sculptra, “I’m a believer”.

Patient had volume loss from weight loss and age. She was treated with 6 vials of Sculptra. Right side of picture is 1 year after treatment.

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Dr. Weiner answers questions about Sculptra

DR WEINER IS NOW A PHYSICIAN TRAINER FOR ADVANCED SCULPTRA INJECTION TECHNIQUES

Sculptra is a unique facial filler. It uses the body’s own collagen to create volume to the aging face. It is made up of Poly L Lactic acid, which is broken down to lactic acid, a natural occurring substance in the body. It comes as a powder to the physician, and is mixed with lidocaine and saline in the office days before the procedure. A series of 2-4 injection sessions is needed to get the full results, with at least a 6 week interval (because it takes 6 weeks to see the complete result of the prior treatment). After the treatment, your face will appear filled, but only for a day or two, and then the saline is absorbed. Gradually over the next 6 weeks, the Sculptra will stimulate the collagen, and create the volumization. Results are said to last 2-3 years. Touch ups are recommended at 12-18 month intervals.

Sculptra was initially FDA approved in 2004 for HIV associated facial atrophy, however it was used off label for cosmetic use soon after that. In 2009, it was formally FDA approved for cosmetic use. So what took me so long to get on board? There were problems with people developing nodules (bumps). Although, these were usually minor and not visible in most cases, they were a problem for some. I’m finally comfortable that this problem has been addressed and minimized. The steps take have been:

Make the Sculptra more dilute by adding more saline and lidocaine when mixing
Inject deeper in the areas where it is possible
Mix the Sculptra up days ahead of time instead of the night before
Have the patient massage the area
Do not inject too close to the mouth, lip, or eye area, the areas where most of the nodules were noted
Do not inject patients with autoimmune disease

Following these guidelines, the formation of nodules is now <1%, and comparable to the risk of developing these with Restylane and Juvederm.

Sculptra is unique in that it can volumize the entire face (except close to the eye, mouth, and lips) for a long duration. Considering its longevity, it is a cost effective solution when compared to Restylane and Juvederm. When comparing to fat grafting, its advantages are: