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What is Vascular Occlusion or Vascular Compromise from Dermal Fillers?

Dermal fillers of becoming the fastest growing area of aesthetic enhancements. In general, the procedure of injecting the filler is safe, with very little downtime, and with visible results. However, there is a rare, but extremely significant potential risk, that patient’s, medical staff, and providers need to always be aware of: Vascular Occlusion or Vascular Compromise.

What is Vascular Occlusion or Vascular Compromise? This is caused when the dermal filler is either injected into an artery or around an artery to the point that the blood flow is reduced or completely stopped. The area of skin or other tissues that are supplied by the affected vessel will start to die without the necessary blood supply. Almost always, if this complication occurs, there will be an immediate blanching (paleness, tissue turns white) when the blood flow is interrupted, often in areas far away from the actual injection. Recognition is key to a favorable outcome. If this occurs, the injector must stop immediately and take measures to resolve the problem. Pain is usually associate with vascular occlusion. There have been cases reported that occurred 12-24 hours after being injected but almost always it occurs immediately.

If no treatment is initiated to improve the vascular flow, the skin will start to appear dusky, a bluish tint, with fine reticulations (lace like) to areas WELL BEYOND THE SITE OF INJECTION. This occurs within 24 hours. If still no therapy is done, the skin will start to die, turning black, and sometimes there is an associated infection. At this point, scarring will likely occur and surgery is often needed to remove dead tissue and/or to close the wound.

If there is a recognized vascular event, several steps should be initiated.

Hyaluronidase, an enzyme that dissolves Hyaluronic Acid, should immediately be injected in the area, and into the vessel if possible. Some doctors advocate using hyaluronidase even if the filler is not an HA filler because it will dissolve the naturally occurring hyaluronic acid hopefully improving blood flow.
Massaging the area will help mostly if the filler is externally pushing on the vessel. This might move the filler away from the vessel to re-establish flow.
Blood thinners will allow the blood to flow thru a smaller vessel or to go around a blockage. Aspirin and possibly heparin are recommended by most physicians.
Vasodilators such as nitroglycerin are also recommended by most physicians. There is a question as to whether this might allow the blockage to travel further down the vessel.
For severely vasacular compromised tissue, hyperbaric oxygen treatments are beneficial.

Administering dermal fillers with blunt tip cannulas will minimize the chances of a vascular event. The fact that the ends of the cannulas are rounded, makes it very difficult to enter a vessel, particularly with the larger cannulas. To the author’s knowledge, there have been no reported events of vascular occlusion with cannulas larger than a 27g. There is still the possibility of causing external pressure on vessels, but this seems to be a low risk, and mainly associated with fillers that expand, like the HA fillers.

The areas prone to vascular events are areas of the face that are called “watershed areas”. These are areas where there is poor collateral blood supply. These areas are:

Glabella
Under the eye
Nose and around the nasal ala (nostrils)
Nasolabial folds
Upper lip

The catastrophic complication of blindness from dermal fillers is also a form of vascular occlusion. This is when a bolus of dermal filler is injected into an artery in such a way that it travels back to the vessels supplying the retina. Not only does the injector have to be within an artery, but he/she has to exert a force of injection that overcomes the blood pressure (retrograde flow) in the vessel. This is an extremely rare occurrence but unfortunately is almost universally irreversible.

Prevention is key to avoiding a vascular event with dermal fillers. The safest fillers are the HA fillers which can readily be dissolved with hyaluronidase. Cannulas should be used in all high risk areas in the author’s opinion. If using needles, aspiration to see if the tip is within a vessel should be done before all injections in these areas. Careful counseling of patients and staff is needed to recognize a potential event early to get the best possible outcome.

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

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

Website: http://www.theclinique.net

Fractional Coagulation is in, Bulk Heating is out for Radiofrequency (RF) Skin Tightening

Ever since Rox Anderson suggested that treating a portion (fraction) of skin while leaving untreated healthy tissue behind as the basis for the Fraxel Skin resurfacing laser over 10 years ago, patients have been having less downtime, less risk, and less discomfort with their laser procedures. Healing is dramatically improved because the adjacent nontreated dermis is able to provide the needed blood supply, nutrients, and local immune response much faster than the traditional treatments and results have been shown to be very similar in efficacy.

Until recently, all RF devices have applied heat to the skin/dermis in a nonfractionated approach, called “Bulk Heating”. Whether the RF device is Bipolar or Monopolar, if the heating element does not penetrate the skin, the energy is pushed into the deeper layers using this method. The implication of bulk heating is that all precision is lost. Exact placement of the heat is impossible, with large opportunities for errors in depth of penetration and/or temperature control. When treating skin, heat from the RF device using bulk heating can be placed too superficial, leading to burns or pigmentation changes, or too deep, leading to fat loss. The dermis needs to be heated to 42 degrees C for 3 minutes to affect collagen stimulation. Only if skin temperature is measured can the operator be sure that the 42 degrees is reached with bulk heating, which is not the case for most bulk heating devices. One last temperature issue is that bulk heating devices are unable to obtain coagulation of the tissue, which occurs at about 67 degrees C, which is needed for maximal tissue contraction and collagen stimulation.

The Infini uses microneedles to deliver the radiofrequency energy IN A FRACTIONAL manner. Its unique array of needles allows the energy to flow between the needles, creating 49 coagulation points AT A SPECIFIED DEPTH in the dermis. Surrounding tissue is sparred, which makes for very little downtime. The superficial layer of skin is spared (because the needles are insulated), leading to no wound care, and markedly reduced risk of burns and pigmentation issues affecting the epidermis. The temperature created in the areas between the needle is enough to create coagulation, for maximal tissue contraction and collagen stimulation.

(Not all microneedling RF devices are fractional. Fractora uses microneedles, but because the energy is directed from the needles to the skin surface, the heating is in a fashion similar to bulk heating devices. Also, because more tissue is affected using this heating method, discomfort is much higher and local anesthetic needs to be injected in most cases.)

It has taken a long time for RF devices to catch on to the fractional technology revolution. The Infini has created much more precision in the delivery of RF energy to the dermis, allowing for higher degrees of skin tightening, while affording the safety and quick recovery time that fractional technology has created.

All Botox Providers are NOT the same. Choose carefully!

Botox injections are the most popular cosmetic procedure performed worldwide. Millions of patients are injected each year with the wrinkle fighting drug. Its popularity is attributed to:

There is minimal downtime – 15 minutes of bumps from the 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

So why is the “Was it Worth It” review on Realself.com for Botox only 69%? This can be attributed to multiple reasons, which be further elaborated upon in this blog. (A large volume practice should have a satisfaction rate in the >95%.)

Although the Botox procedure looks very routine to the observer/client, don’t equate this to being a simple procedure that all injectors can master easily.

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. 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.) Dr. Weiner mixes all his Botox personally, and will draw up the appropriate amounts for each patient in the room, just prior to injection.

Discomfort related to the injection 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. Dr. Weiner also uses several distraction techniques, capitalizing on the Gate Theory (the brain has difficulty processing more than one sensory input at the same time).

Varying the concentration of Botox is a technique Dr. Weiner has used for years. 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” never is worth it.

Although Botox is extremely popular, as the Realself.com stats show, there are many people that are not pleased with their experience. This is not the norm for the high volume, experienced injector. 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.

The Most “Botched” Cosmetic Procedures Dr. Steven Weiner Is Asked on Realself.com

Realself.com is a public forum for asking questions about cosmetic procedures which patients have had or are thinking of undergoing to the website’s participating physicians. The website allows doctors of the following specialties to respond:

Plastic Surgeons
Facial Plastic Surgeons
Dermatologists
Oculoplastic Surgeons

Unfortunately, experience and credentials are not always fully evaluated by the public, and undesired outcomes, often with long term repercussions, can result. Sometimes with only a few weekend courses under their belt, Internists, Family Practitioners, Dentists, ER Physicians or OBGyns hang up a shingle Aesthetic Procedures. An article by Tom Seery, CEO of Realself.com, points out that consumer satisfaction rates are about 30-35% higher when a specialist is performing Botox or Dermal Fillers vs. “all providers”.

Now for the most Botched Cosmetic Procedures:

1. By far, the #1 most botched procedure is tear trough injection with fillers. Complaints range from lumps, prolonged swelling, worsening of appearance, pain, prolonged bruising, vascular injury, numbness, and firm nodules. The skin around the eye is very thin, and there is very little room for error in this procedure. Dr. Weiner is a firm believer that this injection should be performed using blunt cannulas with Restylane. There is less swelling, bruising, and significantly less vascular risk with cannulas. Lesson: Leave this injections to “the pros” for better outcomes and safety.

2. Botox being botched is a close 2nd. Common problems are eyebrow or eyelid droop, uneven smile, ineffectiveness, bruising or swelling, or “Dr. Spock” look. Sometimes a touch up can improve these results, but often one has to wait for the Botox to wear off. This can be 3-4 months. So that deal on Botox that is supposed to improve ones looks becomes a nightmare where one looks abnormal and/or worse. Lesson: Botox deals aren’t usually worth it.

3. Laser hair removal resulting in burns is fairly commonly asked about on Realself. If the laser operator is not using the appropriate laser or settings for one’s skin type, permanent pigmentation problems can result. Fortunately, most superficial burns will reverse over the course of several months. In several states, rules for operating a laser are very lax, allowing techs without significant training to use the laser. Florida is one of the strictest in the country. The operator can only be a nurse practitioner, physicians assistant, doctor, or specially trained electrologist. Lesson: Get the most qualified person to operate the laser, preferably a physician with years of laser experience. Dr. Weiner has over 25 years of laser experience.

4. Lip augmentation with dermal fillers is another highly botched procedure. The most common lip problem is uneveness and lumpiness. These are a direct result of poor technique by the injector. Hyaluronidase to dissolve the filler is usually required, and then you are back to where you started (so 2 procedures to get back to square one). Bruising, swelling, and prolonged downtime is seen when lips are injected using needles in combination with injector inexperience. Dr. Weiner is a huge fan of using blunt cannulas for the lips to minimize the recovery time and bruising. Overfilled, and unnatural lips are also a problem, mainly due to lack of knowledge of the natural anatomy of lips by the provider. Lips should have a ratio of about 40% upper to 60% lower. When the upper lip is larger, or the natural landmarks (tubercle, cupids bow, shape) are not preserved, the lips become obviously “done” and unattractive. The sausage lip is when the lips appear tube like (like a sausage link) which is another common error by the inexperienced injector. Lesson: Lips are another area with several intricacies that require an experienced injector. Cannulas limit bruising, swelling, and downtime so you can enjoy your lips without interrupting your social life.

The take home message is that all providers are not equal. Please do the homework, look at reviews, ask friends, and ask the facility “Who is actually doing my procedure?”. In general, specialty trained physicians will give better outcomes with higher satisfaction rates.

Hyaluronidase – The “Magic Eraser” for Hyaluronic Acid (Juvederm, Restylane, Voluma) Dermal Fillers

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Hyaluronic Acid dermal fillers are the most popular fillers used worldwide. In the United States, the commonly used HA fillers are:

Juvederm Ultra and Ultra Plus
Voluma
Restylane
Restylane Lyft (Perlane)
Restylane Silk
Belotero

The beauty of HA fillers is that they are very well tolerated because hyaluronic acid is a component of skin, so it is a naturally occurring substance. It’s a soft product, and will last anywhere from 4 months, to up to 2 years, depending on the brand used, and the location it is placed.

Another key attribute to the HA fillers popularity is that it can be completely dissolved with an enzyme called hyaluronidase. It is manufactured from either bovine (cow) or ovine (sheep), so there is a remote possibility of having an allergic reaction to the commercially available products (Vitrase, Hydase, and Amphadase). There seems to be a crossover with people that are allergic to bees for these animal derived products. Hylenex is a recombinant form of hyaluronidase that is the human form that is the preferred form of Dr. Weiner for there are no allergies, yet it is a bit more expensive.

Hyaluronidase is useful for dissolving HA filler in the following instances:

The filler was over done/”over filled” and it is not aesthetically pleasing
There is prolonged swelling, particularly around the eye and most often with Juvederm
An infection has occurred in the area of prior filler
The filler is lumpy or has nodules and doesn’t respond to massage and time (especially lips)
Rare possible allergic reaction to the HA filler
When there is vascular compromise secondary to the HA filler injection which can be caused by external compression on a vessel or intraluminal (within the vessel) injection

My experience with hyaluronidase has been mostly with patients that have had Juvederm injected in the tear trough area from another facility. I strongly recommend that Juvederm not be injected in this area because of the risk of prolonged edema. The reason this happens more with Juvederm is speculated to be due to its ability to attract more water, higher concentration of HA in the product, and because it spreads more diffusely than the other fillers.

When injecting emergently for vascular compromise, at least 200 units (more is better) should be injected in and around the original site of injection of the HA. It has been shown that extravascular hyaluronidase is able to traverse the vessel wall to make it intraluminal, useful knowledge for the cases where the HA is within the vessel. (Blindness needs emergent Ophthalmology evaluation and might require arteriogram for placement of hyaluronidase. Even with such extraordinary measures, blindness is almost always permanent.)

When injecting hyaluronidase, it is mixed with lidocaine by the physician, so it is a fairly comfortable procedure. There are a couple limiting factors with the injection. It is not as precise as the filler injection, so it can remove some of the filler that you wanted to stay along with the unwanted filler. Also, dosing/how much to use, is not an exact science. It may take more than one treatment to dissolve the HA filler. The results can occur within minutes, but usually take about a day to fully appreciate. Also, Juvederm and Voluma tend to be the hardest to dissolve, and it is thought that this is related to the way it is cross linked (manufacturing process).

The bottom line is that you don’t have to live with HA filler that you are not happy with. You can easily reverse lips that are lumpy or too big, swelling around the eye from filler, or dissolve an over correction or asymmetry with hyaluronidase. An injection with hyaluronidase can get you back to where you used to be in about 24 hours. Also, it’s nice to have a little piece of mind when getting injected with an HA filler that the process can be completely reversed with a small procedure.

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. His website is http://www.theclinique.net . Call for a consultation: 850.622.1214

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

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

Revance (RVNC) RT001 is Going to Improve Crows Feet and Sweating WITHOUT Needles

Revance Therapuetics, RVNC

Revance RT001 is a topical treatment that is a neurotoxin or “neuromodulator”. This means that it decreases the muscle activity, similar to Botox Cosmetic, Dysport, and Xeomin. However, unlike the current FDA neuromodulators, Revance RT001 can penetrate through intact skin, whereas all the others require needle injections. Although the Botox injections are fairly quick and cause minimal discomfort, it is the belief by the company, Revance (RVNC), that there are many people that are avoiding treatment because of the needles. It has been reported that only 10% of the candidates for getting their crows feet treated are currently getting treated and that when offered a topical, the number of people getting treated will go up significantly. Unfortunately, the only area that has shown promise on the face in their studies has been the crows feet. The frown lines (glabella) treatment was not significantly improved with Revance RT001, and that’s most likely related to differences in the position of the muscles in this area (deep) when compared to the crows feet (superficial).

Revance topical treatment, RT001

The treatment will be applied in the doctors office and will need to stay on the skin for approximately 20 minutes. This will NOT be a home remedy. Results might actually be better than the injections, for the crows feet, because the application will be more uniform to the area as opposed to the injections which are done in a sequential, interrupted manner.

Another use of Revance RT001 being researched is for excessive sweating, hyperhidrosis, in the underarm (axilla). Treating this area with the injectable neurotoxins (Botox, Dysport) requires about 30 punctures on each side. Clearly, Revance will be a huge step forward in comfort for patients being treated for this problem. A growing trend has been using Botox to treat genital/pubic area sweat. Needless to say, most people would prefer topicals in this area to several injections. It doesn’t seem to be effective in the hands or feet at this time because the thickness of the dermis prevents proper absorption of the drug through the skin. Research is also being done on its use for improving acne.

It looks like Revance RT001 will get FDA approval because of its great safety and efficacy in their current FDA trials. When will it get approved? Probably late 2014 or early 2015. This will be a welcome relief to all the needle-phobes with prominent crows feet.

Dr. Weiner is a Facial Plastic Surgeon who laid down his scalpel in 2005 and concentrates solely on noninvasive and minimally invasive Cosmetic Procedures. He is Johns Hopkins trained and Board Certified.

Website: http://www.theclinique.net

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

Facebook: https://www.facebook.com/TheAestheticClinique

Dermapen – Advanced Microneedling for Skin Tightening, Wrinkles, Acne Scars, Stretch Marks, and Improving Elasticity of Skin.

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The Dermapen is used in conjunction with PRP and PPP in the video above.

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The Dermapen 3 is a motorized microneedling device that can produce over 1300 dermal penetrations per second. The micro-injuries that are created cause an inflammatory response that ultimately causes collagen production. The injury to the dermis is fractional, only a small percentage is affected, which has been shown to lead to faster healing and an improved risk profile when compared to treating the entire dermis. There is no heat produced, as a laser would, so the risks of pigmentation issues is very low. For maximal benefits, a series of about 6 are recommended. The advantage of a Dermapen over a dermal roller is:

The penetrations are perpendicular to the skin so there is no tearing of the skin.
The perpendicular penetrations are linear and more precise than the roller that creates a wedge defect in the skin.
Depth of penetration can be changed for the different areas of the face.
The microneedles are much thinner than the dermal roller
Many more penetrations are performed in a Dermapen treatment
Able to treat areas where rolling is difficult or not possible – around the nose and eyes

What conditions can a Dermapen treat?

Superficial skin laxity and wrinkles, especially around the eyes
Enlarged pores.
Scarring, particularly acne scars
Stretch marks
Thin skin related to sun damage or age
Etched in superficial lines

What should I expect on the day of the Dermapen treatment?

After pictures are taken, a dermaplane is performed – using a scalpel, the superficial layer of skin is removed including fine superficial hairs.
A topical numbing cream will be placed on the skin for about 20 minutes
The cream is wiped off and the face is cleaned thoroughly with hospital grade soap
A hyaluronic acid lotion is placed on the skin which allows for easier movement of the Dermapen over the skin.
IF THIS IS A “VAMPIRE FACIAL”, PRP (Platelet Rich Plasma) IS NOW PLACE ON THE SKIN INSTEAD OF THE HYALURONIC ACID.
The Dermapen is then placed on the skin and each area is treated in at least 3 directions to get a thorough coverage. The product or PRP placed on the skin is pushed into the deeper layers of the dermis by the Dermapen
When finished with the Dermapen treatment (about 20-30 minutes), topical growth factors or collagen stimulators are placed on the treated skin. Studies have shown that these topicals can penetrate 50x better immediately after the treatment.
Your face will remain red or pink for 24-48 hours. There is a skin care regime that will be tailor made for your skin, recommended by the aesthetician.

What are some other uses of the Dermapen?

Prior to Levulan treatment for precancerous lesions, areas of concern can be treated with the Dermapen to allow for much better penetration of the Levulan.
There might be some benefit when used in combination with the laser for tattoo removal.
Chemical Peels will have better penetration and become more aggressive if Dermapen precedes placement of the peel.
Stretch marks can be improved, particularly when topicals are used immediately afterwards.
Although still experimental, there might be some benefit in treating areas of melasma followed by intensive topical therapy with hydroquinones and retin A.

Website: http://www.theclinique.net YouTube: http://www.youtube.com/user/StevenFWeinerFacial Facebook: https://www.facebook.com/TheAestheticClinique

PRP and it’s Uses in Cosmetic Procedures: Facial Rejuvenation and Hair Growth Restoration

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PRP is “Platelet Rich Plasma”, a portion of whole blood that is separated from the blood through centrifuging. It should contain concentrations of platelets that are at least 4 times that of what is found in ordinary blood to get the maximal benefits. Its use in medical conditions started in the 1990’s mainly by Orthopedic Surgeons and Oral Surgeons but has recently been expanded to the Cosmetic Surgery arena.

(Not all PRP is the same! Most PRP systems don’t get the concentration of the platelets above the 4x level needed to get the full benefits from PRP. The system that has proven to have consistent 4-7x concentration is the Magellan “TruPRP” system. It costs the most but the results will be superior to all other PRP systems available on the market. In a recent lecture Dr. Weiner attending in Paris at IMCAS, 13 different PRP machines were evaluated. Some systems didn’t even result in platelets which were higher concentrations than whole blood!)

When an injury occurs, platelets are the “first responders”. Platelets have been found to contain the following growth factors and cytokines:

The end result of the combination of these growth factors is increasing the vascularity to the injured area, decreasing the inflamation, laying down new collagen, healing the injured tissue and generation of new tissue.

Studies have shown the benefits of these growth factors in multiple different areas of medicine:

Improved healing in orthopedic injuries
Faster and better integration of bone grafts
Improvements in healing of chronic wounds such as diabetic foot ulcers
Improved outcomes with hair transplants

About 3 years ago, Dr. Charles Runels, devised a new PRP procedure which he called, “The Vampire Facelift”, for facial rejuvenation. The procedure involves injecting dermal fillers, Juvederm, and combining it with injections PRP into the face. The theory is that the PRP will release all the above mentioned growth factors and cytokines and turn on “the healing process” in the aging face. The benefits of the “Vampire Facelift” are:

Collagen stimulation
Neovascularization (new blood supply to the skin)
Collagen remodeling (for scars)
Dermal thickening
Stimulation of fat growth leading to volumization of areas where fat has been lost

PRP has been used in conjunction with hair transplants for at least the last 5-7 years. Studies have shown that there is improved “take” of the grafts, faster growth of the transplanted follicles, as well as more plentiful hair growth. The PRP is bathed over the follicles prior to their transplanting as well as injected into the recipient and donor site areas. In the past few years, PRP with ACell (a membrane from pig bladder) has been injected into areas of hair loss WITHOUT TRANSPLANTS and results have been very promising. In a study published in the peer reviewed journal “Prime”, hair growth was seen in ALL patients, and ranged from 12-63% improvement. Women seem to have greater improvements than men for this treatment. It is recommended that men get 2 treatments, about 2-4 months apart, but women only need one. Once a year touch ups are needed.

The use of PRP is entering a new frontier in the area of cosmetic enhancements. Its benefits continue to be discovered in different applications and areas. It has no side effects because you are using one’s own tissue to heal and enhance your own body. It also is in nearly limitless supply. It seems only a matter of time when PRP will be mainstream for anti-aging treatments.

Website: http://www.theclinique.net

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

Facebook: https://www.facebook.com/TheAestheticClinique

Radiesse Questions Answered by Dr. Steven F. Weiner, Facial Plastic Surgeon

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Dr. Weiner performing Liquid Facelift with Radiesse and Belotero

Q: Restylane Vs Radiesse for Cheek Enhancement?

A: For cheek enhancement, Radiesse will last a little longer than Restylane

Radiesse is the highest G prime filler on the market. This is a measure of lifting ability. It will last anywhere from 12-18 mos in most people. Restylane is a little softer with less swelling and slightly less G prime. Both are good choices. More important than the filler is the “filler” you choose. The results depend on the injector for the most part.

Q: Is It Possible to Combine Radiesse and Joliderm?

A: Juvederm and Radiesse can be used in same area

If you get one filler like Radiesse and want to get more filler, it’s ok to use any filler on top of that filler. There is no interaction between the 2. If you’ve done Radiesse first, it has swelling which can persist for 4-5 days so wait for that to calm down before adding more. I typically wait about 10 days before I will inject more filler in someone. In the video, you can see using Belotero and Radiesse in similar areas. Steve Weiner, MD , Facial Plastic Surgeon, Destin, Florida.

Q: 5years Ago I Had Radiesse Filler Injected into my Lips. 4 Years Later my Lips Have Hard Bumps?

A: Radiesse is not a lip filler because you get long term nodules

Radiesse has been a problem for people who got their lips injected. It creates the problem you describe, hard nodules in the lips. These need to be excised to improve. Radiesse is a great filler though, but not for the tear trough and lips. See my liquid facelift video with Radiesse. Steve Weiner, MD, Destin, Florida.

Q: I Have a Ridge After Radiesse!! What is It? and How Can I Make It Disappear? (photo)

A: Ridge after Radiesse in orbital rim area, try injecting saline with lidocaine to mechanically break up

I have some success with the very few episodes of Radiesse clumping by using a combination of Lidocaine and saline in the area. I vigorously move the needle in and out to try to break up the area. I has worked in all my cases. No other solutions other than cutting it out or camouflaging with another filler like Restylane. See my videos of using blunt cannulas with Radiesse in this area. Steve Weiner, MD, Destin and Panama City Beach, FL.

Q: Tear troughs to be injected with radiesse by occuloplastic surgeon?

A: Radiesse in tear troughs, not recommended.

Radiesse is a thick filler and will tend to show in the thin skin around the eye. It’s great for filling the cheek, but not the area which is close to the eye. It also has a tendency to clump. So for tear troughs, Restylane or Belotero are the fillers I use. Also, to minimize downtime and the chance of bruising, I suggest using blunt cannulas for this treatment. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Panama City, Florida.

Q: I got radiesse injections in my cheeks 6 days ago. Swelling progressively getting worse. What should I do? (photo)

A: The swelling you have after Radiesse is too much

You should see someone. Swelling does occur after Radiesse, but not to the extent you have and usually subsides in 3-4 days. Either it’s infected or you have an angioedema. Either way, see someone ASAP. My video shows a liquid facelift using Radiesse. Steve Weiner, MD, Facial Plastics.

Q: Is It Possible to Combine Radiesse and Joliderm?

A: Juvederm and Radiesse can be used in same area

Q: Getting Radiesse a Month Before Engagement Pary in May, Will I Recover In Time?

A: Recovery from Radiesse should be very quick, especially if you have it injected with blunt cannulas

Radiesse has a characteristic swelling for a few days after injection. There is nothing that can be done to combat that. However to get the fastest recovery, use blunt cannulas so there is minimal bruising and less swelling. You can see the video attached in which I injected about 8 syringes of Radiesse plus about 3 of Belotero (a liquid facelift) and then she left to go to work. The only bruising she had was from the Belotero which was injected with a needle for the very superficial fine lip lines. Steve Weiner, MD, Between Destin and Panama City Beach, Florida.

Q: Is 25 Years Old Too Young to Be Considering Radiesse Injections for Minor Nasolabial Folds? (photo)

A: Radiesse for a 25 year old nasolabial folds is quite alright

There really is no age limit as to when to get fillers. If you have a concern about your nasolabial folds then try some fillers. If you don’t like them, after about a year, you are back to where you started plus one year of aging.

Q: How to Get Rid of a Botelero (Fille) Ridge Lump?

A: Belotero is a hyaluronic acid so it can be dissolved with hyaluronidase

It would be unusual to have bumps from Belotero because its properties cause it to integrate with the skin and become rather smooth. However, it you do have ridges, the first thing would be massaging the area. If this weren’t to work, than hyaluronidase will work fine. Lasers don’t dissolve filler.

Q: Will Radiesse Help Achieve Sculpted Cheek and Eliminate Slight Jowl?

A: Radiesse is an excellent choice to help lift cheek and fill pre-jowl sulcus

I like Radiesse for those purposes. Radiesse has the highest G prime of all fillers which means it has the greatest lifting ability. You will need at least 2, maybe 3 syringes to get the improvement. See my video which goes over the liquid facelift which includes these areas with Radiesse.

Q: Is There a Way to Remove Lumpy Radiesse Be Removed from Tear Trough?

A: Radiesse in the tear trough – shouldn’t be done

The tear trough is very thin skin and you need a thin filler like Restylane or Belotero for that area. Hopefully after 2 weeks it will not be noticeable. It tends to swell for about 3 days so don’t be concerned at this point. If it’s still a problem at 2 weeks, try some saline to break it up. If that doesn’t work, it’s either time or surgical removal. Watch my video for injecting all over the face with Radiesse and Belotero…so called liquid facelift. Steve Weiner, MD, Destin, Florida.

Q: Do You Recommend Radiesse in One Cheek? (photo)

A: I’m 50:50 on this one. Right cheek looks too big, do you add to left to make symmetric?

I can see your problem from the pictures. Do you overfill both sides to get symmetric? If you wanted to see how it would look, I’d go with Perlane or Restylane, so it can be erased with hyaluronidase if you don’t like it. Video shows cheek injection with Restylane. Steve Weiner, MD Facial Plastic Surgeon, Destin, Florida

Q: Am I a Good Candidate for Chinn and Cheeekbone Enhancements with Radiesse? (photo)

A: Radiesse is great for chin and cheek enhancement

Radiesse is a very hardy filler, great for creating “pseudo implants” in the cheeks and chin area. If cannulas are used, bruising and swelling should be minimized. See my video which uses Radiesse all over the face. Steve Weiner, MD, Facial Plastic Surgeon, Panama City Beach, Florida.

Q: Radiesse 1st Treatment Scheduled, Concerns & Questions

A: Questions when rushing for a Cosmetic Procedure discount.

When you see a 50% off discount for a cosmetic procedure, please evaluate the situation before rushing to get it done. What are the qualifications of the Doctor? Is the Doctor doing the procedure? Have your friends seen this Doctor? What are the Doctor’s reviews? What’s the Doctors experience with fillers and Radiesse. Sometimes this is a perfectly legit way to try to expand one’s business but most of the time it’s a non Plastic or non Facial Plastic Surgeon or non Derm that is trying to undercut because he/she is trying to get into the business. Blunt cannulas are the way to go with the Radiesse for less bruising, less swelling, and less discomfort. There are no knock offs for Radiesse. There is a little more swelling with Radiesse than the other fillers like Restylane or Perlane and it’s not reversable like the HA fillers..something to keep in mind. See my video. Steve Weiner, MD

Q: No Improvement After Initial Radiesse Injections?

A: Flat cheeks not improved with Radiesse…you just need more

Radiesse is a filler that you don’t want to do too much in one treatment in the upper cheeks. Waiting a month for putting more in is appropriate. I don’t think that the other fillers are any better than Radiesse for the cheeks so I would go with the game plan your PS has laid out.

Q: Does Radiesse Cause Serious Diseases Such As Cancer?

A: Radiesse is made of Calcium Hydroxylapatite which is a naturally occurring substance

Radiesse is made of Calcium Hydroxylapatite which is found in bone and joints. It is great for volumizing, where there is large deficits, because it corrects about one and a half to one when compared to the HA fillers. I does not cause any types of cancers.

Q: Complications from Radiesse Rec’d 6 Wks Ago?

A: Painful nodules soon after Radiesse injections – sounds like infection

You are not describing a normal reaction to Radiesse. Your symptoms seem like there is an infection going on and should not be left untreated. Unfortunately, Radiesse can’t be dissolved like HA fillers so you have to aggressive antibiotics. It might need to be removed surgically if the infection can’t be cleared. This is a very rare problem. It is imperative that the physician use aseptic technique when adding lidocaine and during the injection as well as proper skin cleansing.

Q: Radiesse Injection Went Bad?

A: Problems after Radiesse injection – call you doctor ASAP

What you are describing is not normal after having Radiesse. My patients have almost no swelling at day 4. Having pus is very concerning. Very rarely is there an infection after injections but obviously you have one. Hopefully a fully trained physician performed you procedures and you can get help. Could it be viral?-yes, herpes can be stimulated from the injection, but for anyone at risk for this, I put on preventative doses of Valtrex. I have also seen agioedema after filler injections which this might be, but unlikely

Q: Lingering Numbness and Vision Problems After Radiesse?

A: Visual changes and numbness after Radiesse; you need an expert opinion

You sypmtoms are not normal. I’d see an Ophthalmologist ASAP. It sounds like the infraorbital nerve is bruised and possibly the vessels near it were injected. This is not something that can wait. All numbing from injection should be out of your system already. If an Ophthalmologist clears you, I’d feel much better.

Q: I Want my Face to Look Fatter and Rounder. It’s Long and Skinny, What Can I Do?

A: A rounded face is more youthful than a long and narrow face. Sculptra is your best choice

You hit the nail on the head. As we age your fat pads, bones, jaw, and muscles in the face all atrophy. This creates a longer and skinnier face which ages us. To recreate the more rounded appearance of a youthful face, fillers are the answer. Sculptra is great for this because it is a long last volumizer, which can be injected in multiple areas such as the temples, preauricular area, upper and lower cheek, jawline, and marionette area. I can’t be used too close to the eyes or mouth area because of nodule formation, and that is where an HA filler is good. Can this all be done with Radiesse or Restylane? Yes, but the expense would be much more than Sculptra, and the duration would be less.

Q: Radiesse on Actual Cheekbone? (photo)

A: Radiesse for volumizing face is a good choice

In answer to your question, it’s not uncommon to place radiesse deeply, even at the level of the cheek bone. However, i think that the majority of your problem with volume is in the lower cheek area. This area needs a little rounding out to give the face a more youthful appearance. I just think you might need some more, you have moderate volume loss in your picture. This area is just great to use the blunt cannulas for less bruising, downtime, and swelling. A great alternative to Radiesse would be Sculptra for volumizing the entire face, including temples, lower cheeks, marionette area, and pre-auricular (in front of ear) area. Dr. Weiner, Destin, Florida.

Q: Radiesse Injection Technique-internal (Through Mouth) Vs External?

A: Radiesse should not be injected through the mouth

When injecting through the mouth, you risk dragging oral bacteria along the needle and infecting the area where the filler is placed. There is no advantage to this technique. The absolute safest way to inject Radiesse in my opinion is using the blunt cannula technique. There risk of bruising, swelling, and vascular injury is minimized and results are optimized. Cleansing the skin with Hibiclens and alcohol will help prevent infection.

Q: Radiesse Was Injected into my Trough/cheek Area About Six Weeks Ago.

A: 2 reasons why correction of Radiesse has gone

Radiesse has typically more swelling than all the other fillers. So after about 3 days, the initial correction will look less corrected. Also, Radiesse is a combination of Calcium spheres and a liquid medium. The liquid will gradually absorb over a 3 week period. Collagen will take some time (maybe 4-6 weeks) to form. So there is typically a loss of correction which then comes back somewhat when collagen is formed.

Q: Percentage of Patients That Had No Radiesse Side Effects?

A: Very little side effects can be expected with Radiesse, especially with blunt cannulas

The stories on this site showing side effects from Radiesse are quite frankly not related to the product but to the person injecting. If not properly placed in a deep plane or too much is placed in a single area, you can have some issues. But, with an experienced injector, you will be able to resume normal activity the following day. I tell my filler patients to avoid exercise for the first day to minimize bruising. Using the blunt cannula technique, bruising is almost nil. You can expect slight firmness in the area injected for about 3 days, but usually this is not noticeable. Do not have Radiesse injected too close to the eye, and I wouldn’t do it in the nose.

Q: Is It Ok to Have Radiesse Nose Injection 5 Months After Restylane Nose Injection? Fly Immediately After Radiesse Nose Injection?

A: Injections of filler in the nose, not as safe as once thought

There are more and more reports of complications coming from nasal injections with fillers of vascular compromise. Prior nasal surgery puts you at particular risk. After knowing that, and you still want to get it done, I would only recommend using an HA filler (Restylane, Juvederm, Perlane) because there is a way to dissolve these products if a problem arises. Radiesse can not be dissolved and posses a problem if an issue happens. There is no problem with “mixing” fillers by injection the same area as a prior injection.

Q: Can Improved Radiesse (2010) Be Used Under the Eyes?

A: Radiesse good for upper cheek but not superficial

I have been using Radiesse for years in the upper cheek, particularly medially without issues. When you get into issues I believe is when you try to inject superficial near the eye. If you keep the volumes small, stay near the bone, and not too high, it works very well. By the way, the formulation for Radiesse is unchanged since it’s inception.

Q: Is There a Way to Speed Up Radiesse Absorption?

A: Radiesse has more swelling than other fillers for about 4 days

I warn my cllents about the swelling you get with Radiesse. It’s different than the other fillers. I have warned my clients about the “Joker” look (from Batman) after getting it around the mouth which always settles down. It really helps to turn up the corners of the mouth. It should get better. There is nothing to dissolve Radiesse however.

Q: Possible to Remove Radiesse Lumps in Lips?

A: Radiesse is not a lip filler

Radiesse should not be used to fill lips. It will clump most of the time. Usually these can be removed with small incisions overlying the bumps.

Q: Getting Radiesse from a Plastic Surgeon or a Gynecologist?

A: Radiesse is an unforgiving filler

Having longevity in a dermal filler is good and bad. Good, if the results are what you want; bad, if you have an issue. I would say that my patients are most satisfied with Radiesse when compared to the other fillers (a study done by Radiesse came out with similar results).

Having said that, if you are considering Radiesse, you need to have a very experienced injector. Unfortunately, there is no remover for Radiesse as there is for the HA fillers. You need surgery to remove Radiesse.

In conclusion, read Dr. Persky’s notes, and make an educated decision.

Q: Radiesse for Lip Wrinkles?

A: Best treatment is to resurface upper lip for lip wrinkles

For the optimal results for upper lip lines with a prolonged results, CO2 laser is what I recommend. The Fraxel re:pair is excellent for this. You can see an example in my pictures.

Just doing this area is very easy. No pain med, no sedation, topical and blocks will make you extremely comfortable. About 5 days of healing time are needed. Sometimes a second treatment will be needed.

Another option is fillers and Botox. I do inject Radiesse horizontally very lightly along the area above the lip which helps somewhat, but not in the lip or directly into the lip lines. HA’s can be injected into these lines, but sometimes can be seen. In the future, Evolence Breeze will be great for this.

Q: Best Method of Injection for Radiesse?

A: Very comfortable injections with Radiesse is easy

The physician numbs the face with topical anesthetic for about 20 minutes. He/She mixes the Radiesse with lidocaine. Apply ice to the face for about 15 seconds. You should have minimal discomfort. If that’s not the case. Dental blocks are not needed. In my opinion, the blocks have more discomfort than the injection, and people usually don’t like the numb feeling they get from it.

Q: Radiesse After Success with Juvederm?

A: I would stick with HA fillers for the tear trough

I think that HA’s are best for the tear trough area. Their longevity there should be about a year. Although Radiesse is shunned by many in this area, it can be done by a skilled injector without issues. By the way, my favorite for this area is Restylane. The key to this area is to inject conservatively.

Q: Feeling the Radiesse in Nasolabial Folds Normal?

A: Not normal after Radiesse, but not necessarily a bad thing

Radiesse typically will swell and feel firm for the first few days, and should not be able to be felt after about a week or 2. If you still feel it, it could be that there was too much placed in that area. Usually massaging the area can break this up. I would recommend that. Ultimately, it should get better on its own in about 9 – 12 months.

Q: Tips for Avoiding Radiesse Pain

A: Radiesse is not painful for my patients

I routinely add lidocaine to all my Radiesse injections. This significantly decreases my patient’s pain. Also, by applying Pliaglis, a new topical anesthetic, there is virtually no pain. Applying ice before also helps. The lidocaine added will give short term pain relief as well, while the patient is driving home. After it wears off, the painful time period has usually lapsed.

Q: Radiesse for Nasolabial Folds

A: Radiesse is great for nasolabial folds

I think that Radiesse is great for the nasolabial folds. It will give a long term correction of about 12-18 months. A couple things that are particular to Radiesse is that it:

Swells more than the other fillers, but this goes away after a couple days
Causes slightly more bruising because you have to use a large needle to inject it

I do add lidocaine to the syringe, so it is a fairly comfortable injection. I love Radiesse for the marionette lines. It seems to have more structural support than any other filler and is great to turn a downward corner of the mouth, upward. One syringe of Radiesse is 1.3cc’s.

Also, Radiesse corrects about 30% better than Restylane. So, you get about 50-60% more correction per syringe of Radiesse over Restylane. You also get more longevity. So overall, it is the most economical filler.

Radiesse is made of microscopic calcium particles and a gel. The gel will dissolve and leave the particles which cause collagen stimulation. The new collagen is what leads to it’s longevity. I sometimes will layer a thinner filler like Juvederm or Restylane on top of the Radiesse. I think of Radiesse as a foundation, and the other 2 as finishers

Questions answered about Sculptra by Dr. Steven Weiner, Facial Plastic Surgeon

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Q: Do you have experience with Sculptra injected in front of ears to improve slightly flaccid jowl?

A: Jowls are not affected much with Sculptra

Part of the routine areas of injection for Sculptra is the preauricular area. There is loss of volume in this area related to loss of fat that is contiguous with the temple fat pad. Injecting this area does pull up skin from below and defines the jaw line better and rounds out the face. Helping the jowls is probably not going to happen that much. Steve Weiner, MD, Panama City, FL.

Q: Sculptra – Can the Effects Be Reversed?

A: Sculptra in the temples – overfilled, is hard to fix

The reason to have about 3 sessions, at least 6 weeks apart, of Sculptra to get to full correction is so that the risk of overfilling is less. Once overfilling has set in, it is hard to correct. Surgically removing the product/collagen can be done but this is probably worse than living with the problem. Steroids will only work if there is excessive inflammation or granuloma formation. It will gradually improve, but it will be months. I am a trainer for Sculptra now and my techniques are to fill to correction, not overcorrection. Steve Weiner, MD, Facial Plastic Surgeon.

Q: I take warfarin 3mg daily & Have INR fortnight can I still Have Sculpture?

A: You can still get Sculptra while on coumadin but you will bruise

Placement of Sculptra requires multiple injections. A blood thinner will cause you more bruising than if you were not on one, but this won’t affect the long term results. Bruising after Sculptra can be improved with the VBeam which is offered complimentary to any Sculptra patient that bruises in my office. Steve Weiner, MD, Destin, Florida.

Q: Sculptra and Dexamethasone Question?

A: Taking one dose of steroids 2 months after Sculptra will not affect results

Steroids inhibit the inflammatory process which is exactly what Sculptra needs to work. So long term steroid use would counteract the results you would get from Sculptra. One dose should not matter at all. I do worry about dental procedures infecting fillers and Sculptra so I tell patients NOT to get dental procedures within 2 weeks after I inject them. Steve Weiner, MD, Panama City, Florida.

Q: About Sculptra and Swelling in Cheeks?

A: Wait for things to settle down before being worried about Sculptra done a few days ago

The results from Sculptra take about 6 weeks to appreciate. Being worried at this point is just going to be spending negative energy on something that might be fine. Its possible there is some bruising or asymmetric swelling going on that makes things uneven. Steve Weiner, Facial Plastic Surgeon, Sculptra Trainer, Destin, Florida.

Q: Aggressive Rings/ridge Under Eye? (photo)

A: Agree, there appears to be a ridge around the undereye area after Sculptra and Belotero

I can see what you are complaining about. I would try to dissolve the Belotero in this area with hyaluronidase. If you have no improvement, its probably due to poor placement of Sculptra and then you can’t do much, other than try to camouflage the area with filler around it. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.

Q: Why Are Those “Completely Safe and Natural” Facial Fillers Causing Me to Be Extremely Ill 3-4 Days After Receiving Them?

A: Around the eyes, Restylane is a better choice than Sculptra or Radiesse

I would switch the product to Restylane instead of Sculptra or Radiesse for the eye area. Your symptoms are unusual, but this would be a good test to see if it is those products. Sculptra and Radiesse can leave lumps when injected close to the eye and Restylane is a much better choice.

Q: Probability of Sculptra Lumps?

A: Lumps after Sculptra were mainly when using older dilution

It took me a long time to come on board with the Sculptra because of this very issue. After observing the very low frequency of issues with the newer dilution, I started using it (early 2012). Other measures which have helped are: not injecting around the eye or mouth, avoiding people with autoimmune disease, mixing the Sculptra days in advance, and massaging the areas injected. At this point, the most likely reason to get lumps would be technique (injecting too much Sculptra in a single location). I am now a Sculptra Instructor too. Please see my blog which addresses this very issue. Steve Weiner, MD, Destin, Florida.

Q: Should Extra Volume Still Be There 5 Days After Injections?

A: Swelling persistent 5 days after Sculptra is not a concern

Even though the injection of Sculptra is mostly sterile saline and lidocaine which is absorbed in about 24-36 hours, there can still be swelling related to the injection at day 5. This is just related to trauma from the injection (bruising and swelling) and by no means is an indication of what the final result will look like. Steve Weiner, MD

Q: Does Smoking Delay Results for Sculptra?

A: My gut instinct is that smoking negatively affects sculptra results

Smoking decreases blood supply to the face by up to 60 percent. So all the inflammatory response which creates the collagen is muted because it has trouble getting to the Sculptra via the bloodstream. This isn’t proven to my knowledge but most likely true.

Q: Ultherapy Plus Sculptra? (photo)

A: Sculptra and Ulthera in combination is the bomb for the aging face

These 2 treatments work together to help volumize the face from fat, bone, and muscle loss, and then tighten skin which has sagged due to gravity and aging. I frequently do both on the same client. There are reports which say they are synergistic (ie 1+1=3) when someone gets both. I have written a blog about doing both procedures which I note that I think that Sculptra and Ulthera are better than a facelift because of the very low risk and downtime….see the link.

Q: Dr Injected my Lips with Sculptra and Im Worried the Visable Lumps Are Permanent or Can Erupt into Something Worse Later On?

A: Sculptra is not a lip filler, Juvederm, Belotero or Restylane is better choice

Almost certainly after getting Sculptra placed in the lips, you will get nodules. They will last for months or years. It is recommended not to place Sculptra close to the lips or eyes because this is a known complication. The HA fillers are best for lip augmentation.

Q: Sculptra Decomposition?

A: Collagen that is made from Sculptra will last usually 7 years but aging continues

In general, most people quote the volumization effect from Sculptra lasts 2-3 years. However new collagen has a 1/2 life of about 7 years. What is happening is that the body is aging and countering the effects of the improvements from Sculptra. I recommend touch up treatments at 12-18 month intervals to keep the correction rather than go all the way back to baseline and then refill then.

Q: Is Sculptra Safe for People with SLE and APS?

A: Sculptra has been shown to have more granulomas in patients with autoimmune disease

With retrospective analysis, people who developed granulomas after Sculptra injections were disproportionately more likely to have an autoimmune disease than ones without granulomas. In reality, very few people actually develop granulomas. It has been recommended by the company not to inject a person with autoimmune disease like SLE but it is still safe. The theory is that the immune system is not normal and the reaction to the Sculptra is not predicatable with some over reacting and cause granuloma formation. It’s something you need to discuss with your physician and decide amongst yourselves.

Q: Average Amount of Lidocaine Per Sculptra Vial?

A: Amount of Lidocaine added per vial of Sculptra is 3cc in our office

The consensus for mixing Sculptra these days is adding about 9 cc of a combination of sterile saline and lidocaine. It used to be 3-4 cc total, but the greater dilution seems to lead to less nodule formation. How much is Lidocaine and how much is saline is really up to the doctor. In our office we use 3cc of 1% Lidocaine and 6 cc of saline. I’ve known offices which reverse that mixture, but in the long run, it doesn’t matter one bit. I feel that the 3 cc gives enough numbing to the injection without worry of giving too much lidocaine.

Q: Is One Month Post Sculptra Treatment Too Soon for Restylane Under Eye Treatment? (photo)

A: Tear troughs and undereye area need Restylane, not Sculptra to improve

When you have concerns which are close to the eye, you can’t use Sculptra to correct. You can get nodules if you do this. Restylane is great to improve this and can be done at this time. You can get the two treatments simultaneously as well. The results from Sculptra take 6 weeks to see. I also notice that the first session leads to only minor changes, and it’s the second and third sessions which result in the wow factor with Sculptra. A recent study showed that getting even more treatment sessions, 4 or 5, leads to even greater patient satisfaction.

Q: Scultpra for Thin Face with High Cheekbones?

A: Sculptra is a good choice for someone with a thin face and is starting to get jowls

Without seeing you, it is hard to say. But in general, Sculptra is great to replenish volume lost with an aging face and starting to see jowls. You might not need Sculptra in your cheeks, if you still have prominent cheek bones. However, the temples, jawline, lateral cheeks, chin, marionette, and chin area might need to be volumized.

Q: Is Sculptra the Best Filler to Help Produce Your Own Collagen?

A: Sculptra is the best filler to produce collagen and results last for a couple years or more

Sculptra is a collagen stimulant. It’s usually done in 3 sessions, about 6 weeks apart or more. Most people need between 4-6 vials total, but some might need more and some less. The longevity of collagen is about 7 years, but you continue to age, so touch ups are needed at about 1-2 years. Radiesse will produce collagen too, but not as robustly as Sculptra. It is great for temples, cheeks, jawline, marionette, chin, preauricular areas. It can’t be used close to the eyes or mouth area. It is a rather long lasting filler, so carefully choose your physician. It can’t be reversed like Juvederm and Restylane.

Q: What is the Difference Between Artefill and Sculptra?

A: Artefill is a permanent filler made from synthetic material, Sculptra is a natural substance, is long lasting but not permanent

Sculptra is a very popular filler which is used to volumize a face. It causes the body to produce collagen where it is injected and then is degredated by the body. The results will last about 2-3 years because of the collagen which is produced. Artefill, is never degredated, and will last a lifetime. I don’t recommend this filler because the body changes as we age and the filler might not look good down the road. Also, complications can occur with this fillers years after it’s placement. Although the attractiveness of having a long corrrection with the Artefill is appreciated, the long term potential issues keep me from using it.

Q: Considering Sculptura to Enhance my Cheekbones And Ultherapy?

A: Sculptra and Ulthera in combination are a great way to improve collagen, build up cheek bones, and tighten skin

Many of my patients are doing exactly what you asked. Sculptra and Ulthera. They work differently to build up collagen and increase lost volume from aging. The end result is a fuller face that is lifted and tighter. They can be done on the same day, and because the Sculptra has lidocaine added, the Ulthera is more comfortable. There is no destruction of fillers with laser, Ulthera, or any other device. A recent presentation and soon to be published study has shown when Sculptra is done with Ulthera, it’s like you are getting 2 1/2 times the benefit of the Sculptra than without doing the Ulthera

Q: Is Sculptra Likely to Cause Lumps if Injected in the Temples?

A: Sculptra is my filler of choice for filling the hallows in the temples

As we age, a fat pad in the temples shrinks and makes them depressed. To fill this area, Sculptra is injected deeply in the temples, along the bone in a series of about 3 sessions. By injecting at this level, the risk of nodules is very low, and the product spreads out evenly. It creates the collagen at the periosteal layer (lining of the bone). It’s a very quick and easy procedure. It cause some skin tightening around the eyes and eyelids too.

Q: Does Having Sculptra After Ultherapy During the Same Visit Increase Risks for Bruising?

A: Sculptra can be done at the same visit as Ulthera

You can have both procedures done at the same visit. I would say there is no additional risk of bruising with the Sculptra injections. Bruising is fairly common after Sculptra, but the VBeam can significantly decrease the time it takes for the bruise to resolve. I have a photo where the bruise was gone in 2 days after the VBeam on RealSelf. This is offered complimentary after any treatment and is painless. The VBeam can’t be used on skin types 5 or 6 or if the skin is recently tanned. I would do the Ulthera first, then the Sculptra injections, as your doctor has suggested because the water in the Sculptra could affect the Ulthera treatment.

Q: I Had Sculptra Injections Yesterday. I Am Severely Bruised, All Purple from my Nose to my Chin?

A: Bruising after Sculptra can be improved with the VBeam within the first couple days

I offer complimentary VBeam treatments (painless and quick) for any bruising after a dermal filler treatment. This can cut the bruising down to a couple days. I have a picture on Realself in the VBeam sectioin showing this. Arnica can help as well. Blunt cannulas can decrease the bruising with dermal fillers significantly, but I don’t’ use them with Sculptra because it needs to be placed more superficial than the layer which the cannulas place product. Obviously, limiting physical activity for the first 24 hours and avoiding blood thining supplements like aspirin, motrin, ibuprofen, fish oil, vit E, etc. will decrease bruising as well. It’s unusual to be as bruised as you describe although bruising is common with Sculptra.

Q: Time Between Sculptra Treatments?

A: Spacing of Sculptra treatments should be at least 6 weeks, but no problem with longer

The timing of the Sculptra treatments is based on the fact that it takes about 6 weeks to fully appreciate the collagen that one is going to produce from Sculptra. If you want to wait longer, that is no problem what so ever. There is no advantage to doing it at exactly 6 weeks other than getting the entire treatment completed sooner.

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