neck-lift Archives | The Aesthetic Clinique

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

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: stevenfweinermd.wordpress.com

YouTube Channel: StevenFWeinerFacial

Website: www.theclinique.net

Top 5 Procedures to Improve Your Jawline in 2019

It appears that 2019 is the “Year of the Jawline”. A strong jawline is interpreted as a characteristic of strength, beauty, virility, and power. In a study of S&P 500 CEO’s, 95% were considered to have a well defined jawline. With advances in aesthetic technology and techniques, achieving that perfect profile is becoming easier, with less downtime, costs, and risks. Here are the top 5 procedures to improve your jawline:

5) Neck Lift/Lower Face Lift: With incisions placed behind the ears, this surgery can be performed with just local anesthetic. Downtime is about a week or 2. For severe jowling and platysma bands, this will give the best results.

4) Ablative Laser (Erbium/CO2) or Renuvion(J Plasma): These procedures have significant wound care for a week or more. The skin is stimulated by the heat of the laser/plasma to contract and create collagen. Healing time can take weeks and redness can persist for months. Risks include infection, scarring, hyper and hypopigmentation. Procedure is limited to the face, and can’t achieve fat reduction.

3) FaceTite: A minimally invasive procedure whereby radiofrequency is placed below and on the skin surface. Requires tumescent anesthesia only for most patients. Procedure takes about an hour, more if liposuction is added. There is minimal bruising and swelling afterwards but requires a compression chin strap for a few weeks (constant for the first 48-72 hours). The RF energy causes deep collagen stimulation and contraction as well as dermal collagen remodeling. Jowls and submental fat can be attended to with RF and liposuction.

2) Genius/Infini: Radiofrequency is placed into the dermis (and subdermis for jowls/submental) using insulated microneedles. The downtime is 2-3 days but it requires 3 treatments. The procedure takes about 30-45 minutes. Most patients require just topical anesthetic with about 5-10% opting for Pronox (Nitrous Oxide – laughing gas). Results take 3 weeks to start to become apparent and 3 months for their full effect. It is the least downtime, least invasive of the top 5 procedures, outside of #1.

1) “reJAWvenation(TM)”: Using microcannulas, filler is placed along and below the jawline to enhance and restore the profile. Typical procedure time is 10 minutes or less and there is no downtime. The amount of syringes required varies, but can be anywhere from 1-6. Multiple sessions are required for the patients with severe jowling. While there is no actual removal of fat from the jowls or submental area, these areas appear improved due to the lifting by the filler as well as camouflaging the trouble areas.

It is left up to the individual as to what procedure is right for them. Lifestyle, degree of correction desired/needed, and finances all factor into one’s decision making. Dr. Weiner is world renown for his “reJAWvenation(TM)” procedure and is known as the reJAWvenator.

(Threads are notably absent because the author believes the expense, duration, and results, don’t warrant them to be a consideration for jawline improvement.)

The Genius is Truly a Huge Step Forward for RF Microneedling

The initial studies of radiofrequency microneedling (RFM) were performed by Hantash et al. in 2009. What Hantash was able to demonstrate was that RFM produced a fractionated radiofrequency thermal zone (RTZ) with coagulated tissue surrounded by normal tissue. Overtime, multiple growth factors and inflammatory components led to complete replacement of the RTZ with neocollagenesis and neoelastogenesis over the following 10 weeks.

Delivery of the RFM energy varies according to the device used. Unfortunately, there has been a paucity of solid research behind the majority of the devices. There is confusion in the marketplace for both consumers and providers as to what constitutes the best delivery system for outcomes, safety, and comfort. Lutronic decided to breakdown all the components of RFM energy delivery and optimize them in their development of the Genius.

One of the selling points of many of the devices has been that they are comfortable and have minimal downtime. What this actually means is that there is minimal energy delivered to the dermis. Discomfort is directly related to the amount of energy delivered. Lutronic’s research has shown that needle depths and energy settings don’t necessarily correlate to the what really occurs in the tissues.

Needle Depths

Skin intrinsically resists puncture by outside forces. If is especially difficult for 49 needles to penetrate the skin in a small area (1x1cm2). The natural tendency is for the skin to buckle with the needles “bouncing off the surface” and several of the RFM devices tested have been documented to exhibit this phenomenon. Furthermore, needles have a harder time penetrating deeper into tissue than superficially, so deeper depths are even more challenging to accurately place than more shallow treatments. Unfortunately, setting needle depth on the device doesn’t always correlate to actual tissue depth. Requirements for accurate depths include:

Sharp needles – but not too thin as to bend or dull during hundreds of pulses
Powerful motor – underpowered motors prevent accurate penetration
Quick motor – slower motors will lead to pushing the skin rather than penetrate it

Energy Delivery

One of the fallacies of RFM devices is that higher treatment levels correspond to higher energy delivery. Best results will be related to turning the energy settings “all the way up” is ABSOLUTELY FALSE. Too much energy in too short a period will lead to rapid rises in tissue impedance (resistance) and cut off energy flow immediately. Performance by the operator can affect the energy delivered if handpiece pressure is light or not flush with the skin as well.

Tissue Impedance

Impedance in the dermis is highly variable between patients and even within different areas of the face and body. Variables affecting impedance are: hydration, solar damage, collagen and hyaluronic acid content, and scarring. Using settings based on clinical findings and desired outcomes is not enough precision for optimal energy delivery.

Coated vs Uncoated Needles

Coated (insulated) needles allow the microneedles to penetrate the skin and deliver energy to the dermis while bypassing the heating of the epidermis. Some devices will use uncoated needles which will increase the risk of post inflammatory hyperpigmentation (PIH), particularly in darker skin types. To minimize this risk, uncoated needles use low energies and therefore sacrifice results. There will also be more downtime/wound care with uncoated needles because the skin surface will be more affected than with the coated needles.

The Genius Advantage

Proprietary needle design – sharp and coated for minimal resistance to insertion
Improved motor insertion – high torque and quick needle insertion
Improved protocols – changes to energy and pulse durations to avoid sharp rises in impedance based on Lutronic proprietary research
Impedance Feedback – the needles monitor tissue impedance every 2 msec and give feedback to the device to optimize energy delivery and adjust flow as resistance changes. This is the “brains” of the Genius.
Energy delivered feedback – each pulse is monitored and amount of energy delivered is noted. If energy is not exactly as desired/set, both a visual and audible signal is sent to operator. Adjustments in settings or technique can be made to improve energy output.
Total Treatment Energy – a running total of energy given is kept. This allows the provider to base treatments on energy delivered. Cumulative energies delivered from multiple treatments will become the standard of care to achieve clinical outcomes for a given diagnosis.

With the advancements made with the Genius, suddenly, all other RFM devices are now obsolete. Genius delivers a precise, safe, and efficacious treatment for laxity, wrinkles, neck lines, acne scarring, and hyperhidrosis in all skin types.

The Jawline – Beauty, Differences Between the Sexes, Aging, and Correction (reJAWvenation)

Nefertiti was recognized for her crisp jawline and smooth neck. Her bust is one of the most famous of the ancient Egyptian sculptures. A razor sharp jawline and well defined ascending ramus (or gonial angle) are hallmarks of beauty, both male and female. Jowling, submental fullness, blunting of the gonial angle, and an irregular jawline are all signs of aging.

While there are many commonalities between the sexes of what constitutes an attractive jawline, there are fundamental differences as well.

Males:

Broad/wide rami of mandible leading to a near vertical appearance on frontal projection
Approximately a 110-115 degree gonial angle (more acute than female)
Significant height of the body of the mandible
Wide defined, projected chin

Females:

V-shaped rami of mandible on frontal projection. A more masculine (vertical) ramus is also considered beautiful in some women (Such as Alessandra Ambrosio)
A more obtuse gonial angle of approximately 135 degrees
Shorter height along the body of the mandible
Pointed, less projected chin

There are considerable age related changes of the mandible.

Loss of bone along the body of mandible leading to loss of vertical height. This change is accelerated in an edentulous patient
Blunting of the gonial angle eventually leading to a curvilinear jawline
Narrowing of the male chin and widening of the female chin
Deepening of the gonial notch

The age related mandibular changes lead to loss of support of the soft tissue in the lower face – falling forward and downward. Jowling and submental fat is exaggerated. The upper neck skin shows more laxity as facial skin drops into the neck.

Correction of age related jawline changes with fillers- reJAWvenation

Dr. Weiner has perfected a correction using dermal fillers which he has coined “reJAWvenation”. It is based on restoring the age related loss of bone and leads to support of the lower face soft tissues. Filler is placed along the inferior border of the mandible as well as filling the gonial notch. The gonial angle is recreated. The lower aspect of the jowl is considered the new baseline and filling is made on either side to “camouflage” the jowl. Filler is also placed along the posterior aspect of the ascending ramus. The prejowl sulcus is filled, with emphasis to include the space beneath the inferior mandibular border. The chin must also be corrected to the male/female appropriate projection and shape.

reJAWvenation offers a quick (10-15 minute) correction of the age related changes to the jawline. Improvements in jowls, upper neck, jawline, and chin can be expected. There is minimal or no downtime. Even with facelifts, jawline volume is not typically addressed and needs to be corrected either during the procedure with fat grafting, or in the office, after healing, with fillers.

Treating the Double Chin and Jawline Fat Has Become Easy

Until recently, the dreaded double chin has been fairly difficult to treat. Liposuction was the mainstay of treatment. This can be performed under local anesthetic, but there is downtime, bruising, need to wear a chin strap, and some risks. Now, there are 3 non surgical options to treat this area and along the jawline (with 2 of them) which have no or minimal downtime.

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Kybella is a bile salt (deoxycholic acid) that is found in the gallbladder. It is natural secreted to assist the body in digesting consumed fat. It is now available in an injection form and can be used in the submental area to permanently reduce fat. It typically requires 1-2 vials per session, and about 2-4 session. This is all dependent on the amount of fat in this area. 1 month to 6 weeks in the recommended period between treatments. The procedure takes about 15 minutes. There is very minimal pain at first. It then starts burning and this lasts for up t0 30 minutes. Swelling occurs for the first 3 days that is significant. Most of the swelling is gone by a week. All swelling is gone by about 3-4 weeks and results are seen at this time. Areas other than the submental area are being investigated

Pros: short procedure, effective for submental area, long lasting results

Cons: swelling, can’t be used along lateral neck – only central portion, multiple treatments

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CoolMini from Coolsculpting is a new handpiece that is designed to treat the upper neck area. At this point, most people have heard of Coolsculpting. This technology cools fat down to a certain temperature to where it will partial die, but leave the other structures intact. The CoolMini is a newer technology from Coolsculpting that uses more uniform cooling, and doesn’t require the full one hour to get treated. It’s suction grabs onto the fatty area and stays attached for the 45 minute cycle. It can be used to the central and lateral portions of the neck. If there are large areas needing treatment, more than one session is needed and more than one attachment is needed per session.

Pros: minimal or no downtime, can treat lateral as well as submental fat, proven technology that is permanent

Cons: treatment times are 45 min per application, might need more than one application and more than one session

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Infini uses high intensity radiofrequency to treat excessive fat in the neck. It gets to the fat by use of the microneedling delivery system. It can go up to 3.5 mm which is into the superficial layer of fat. By adjusting the power and pulse duration, fat along the jawline, jowls, and submental areat can be treated. It is usually a series of 3 treatments, spaced about 4-6 weeks apart.

Pros: can treat all areas of fat in the neck and jowls, tightens skin as well and improves wrinkles

Cons: requires topical anesthetic (more painful than others), requires 3 treatments usually, mild redness and swelling afterwards for a couple days

There are now a few ways to treat the neck and double chin area. Which one is best for you is based on your desires, lifestyle, and anatomy. All are effective with minimal or non invasive techniques.

3 Year Experience with Infini – High Intensity Focused Radiofrequency

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It’s been a little over 3 years since the Infini was introduced in the United States in August, 2013 by Lutronic. It was developed in Korea, and had been used in the prior 2 years in Asia and Europe. Infini brought a significant evolutionary change to treating the skin with radiofrequency (RF). Although RF has an over 50 year history of medical uses, Lutronic’s Infini innovations has elevated the precision in which the RF energy is delivered to an entirely new level.

It been long established that heating skin causes an inflammatory response that results in collagen stimulation, tissue contraction, and skin rejuvenation. While 42-45 C (denaturing) has shown to be enough to create this cascade, 65-70 C (coagulation) has been shown to lead to maximum collagen deposition. Radiofrequency devices which push their energy through the skin without penetration are limited to temperatures of 45 C because of the risk of harming the skin surface (blisters/scarring). Bypassing the surface with microneedles, as Infini does, temperatures can go up to the coagulation point with very little risk. In addition, Infini can place this energy at the “sweet spot” of the skin, the mid to deep dermis. The depth of most of the predecessor RF devices was always in question, and was often too deep (fat necrosis risk).

Over the last several months, there have been significant treatment innovations with Infini. With diligent research and histological evaluations, optimal settings were further enhanced. These settings lead to larger zones of coagulation during each pulse. This translates into fewer pulses needed (shorter treatment times), and better results. In addition, the treatment tip was modified to allow for a more even distribution of energy, which also leads to better outcomes. The “price to pay” for these innovations is slightly more prolonged redness, possibly up to a week. Also, “microdots”, the grid-like white marks from the needle tips, might last for more than a couple weeks. These have always resolved without scarring or complications.

Dr. Weiner has performed approximately 1000 cases in the past 3 years with Infini. (Cases = areas treated, i.e face, neck, chest). A summary of his findings:

There have been no long term complications in his patients. There have been no incidences of scarring, unwanted fat loss, or pigmentation issues.
Infini is safe to use on all skin types.
Infini is the most effective device available for acne scarring when compared to ablative, non ablative lasers, and other RF devices.
Significant improvements can be established in the neck wrinkles, necklace lines, and creepy skin of the neck.
Superficial fine lines on the face are well treated.
Jawline and submental definition are improved in most cases. Purposeful fat loss is possible in these areas with deeper, more aggressive settings.
Infini is an option for axillary hyperhidrosis with proven long term results.
Infini can be safely used all over the body but the small footplate limits treatments on large surface areas.
Treatment of stretchmarks is only mildly effective. Further refinements in settings and combination therapies are still being researched.
Treatment of malar festoons (fat pads) is moderately effective with Infini (and will soon be even better with new protocols).
Over 95% of patients can be treated with only topical anesthesia. With the addition of the Superficial Skin Block, treatments are extremely well tolerated by the remaining patients.
For optimal results, some patients need volumization and Sculptra can be done simultaneously with Infini treatments.

Infini has already established itself as a low risk, low downtime, skin tightening procedure. Expect better results, less number of treatments needed, and new indications in the future. Significant resources at Lutronic will build upon the Infini platform to maintain its market dominance in the Aesthetic RF market.

Smoking and Aesthetic Procedures Don’t Mix Well

Smoking is well known for its detrimental effects to one’s lungs and health. Lung cancer, heart disease, chronic lung disease, strokes are all sited to have much higher rates in those that smoke. It certainly is no leap of faith to imagine the harm smoking causes to the largest organ of the body, the skin.

There is one study which shows that moderate smokers (30 cigs/day) will show 14 more years of aging when they hit 70 then nonsmokers. They are more likely to have deeper crows feet and “smoker’s lines” above the lips. Telangiectasias, often called broken capillaries, are more common in smokers. The color and glow of the skin is changed. The circulation is decreased because the blood vessels are constricted (vasoconstriction), mainly due to nicotine, so the skin becomes dull, ashen, and loses it redness. Carbon monoxide levels become elevated in the blood stream, reducing the oxygen capacity of the blood. Hydration of the skin is reduced in smokers. Also, the vasoconstriction affects the hair by thinning it and causing premature graying.

Another study shows that smoker had about a 20% collagen reduction in response to a wound. Extracellular matrix turnover was also decrease. Smoking also depletes vital nutrients in the skin such as Vitamin B and Vitamin C (needed for collagen formation), and magnesium. Each cigarette generates million of free radicals, which causes an inflammatory response throughout the body.

Many of our aesthetic procedures rely on the body’s response to get optimal or for that matter, any outcome. A collagen response is needed in our collagen stimulating fillers such as Sculptra, Bellafill, and Radiesse. The longevity and volume afforded by these fillers is solely collagen related. These fillers should be reconsidered if they are planned to be used in a smoker.

A flap during surgery is when an area of skin is elevated from its normal position. This compromises the blood flow because part of the normal vasculature is cut. This is what occurs when performing a face lift, neck lift, rhinoplasty (nose job), blepharoplasty (eyelid surgery), tummy tuck (abdominoplasty), and breast surgery. A smokers outcome with these procedures is at significantly higher risk because of the vasoconstriction that nicotine causes. The flaps are at risk of necrosis (dying), prolonged edema, prolonged healing, scarring, need for reoperation and infection.

Laser resurfacing or RF (radiofrequency) procedures depend on the heat injury to cause an inflammatory response which ultimately leads to collagen stimulation and skin tightening. In a smoker, the blood supply in compromised to the skin so WOUND HEALING AND COLLAGEN FORMATION IS SIGNIFICANTLY IMPAIRED. Complications such as infection, prolonged healing, scarring, poor results are much higher with smokers. Most physicians will not perform ablative laser procedures on smokers because of these additional risks.

Many smokers say they will quit and use nicotine gum/patches or e-cigarettes. These solutions are just as detrimental as cigarettes to wound healing and collagen formation. There is still vascular constriction with these substitutes. Most surgeons require a window of at least 3 weeks prior to surgery and 4 weeks after to be smoke free. Some require urine testing for nicotine and its by products to document compliance.

Smoking and aesthetic procedures aren’t a good combination. It is counterproductive to smoke while striving to look younger. If one is really concerned about their looks, smoking cessation is absolutely necessary. It will save your appearance and save your life too!

Off Label Uses of the Infini – A Plethora of Potential Treatment Options – Scars, Sweat, Cellulite, Acne, Fat, Breast Lift, Knees, Tattoos

Dr. Weiner Infini Hyperhidrosis treatment

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The Infini is quickly being recognized by the aesthetic physicians as a very powerful tool to tighten facial and neck skin with very little downtime (less than 36 hours). It has also proven to have an extremely low risk profile, with very few long term side effects noted, even in tan or dark skinned individuals. For those unfamiliar with the Infini, please read this blog. In a nutshell, the Infini is a microneedling fraction radiofrequency (MFR) device that coagulates the dermis at various depths (o.25mm – 3.5mm) leading to tissue contraction, new collagen and elastin formation, and overall skin tightening and wrinkle improvement. Dr. Weiner has been using the Infini soon after it was FDA approved and has become the largest user of the device in the US. There have been several off label (non FDA approved) uses of the Infini that Dr. Weiner has been studying that will be discussed below.

Scar Improvement – The Infini causes disruption of the abnormal/pathologic collagen deposition and stimulates new and more organized collagen that more closely resembles the body’s normal collagen. Acne scars have been treated, even in darker skin individuals, with improvements noted. A physician in Korea has a large series of acne scarring patients who have been treated with the Infini showing dramatic improvements. Other scars being studied are stria (stretch marks) and surgical scars (such as tummy tuck and skin cancers).
Hyperhidrosis (Excessive sweating) – The sweat glands lay in the lower part of the dermis and just below it. By heating these areas up to a certain temperature, they can be destroyed permanently. This has been proven by the Miradry device, which uses microwaves to heat up the tissue. There is a very high long term satisfaction rate using this device after undergoing 2 treatments. It’s drawback has been discomfort (requiring blocks with injections) and cost ($3000 for 2 treatments). The Infini can be set to a depth that targets the area of the sweat glands and heat this area up to a point of coagulation (gland destruction). In preliminary studies in axillary (underarm) sweating, Dr. Weiner’s patients have seen improvements with the Infini with less discomfort, no downtime, and at a fraction of the cost. Dr. Weiner’s Press Release about using Infini for Hyperhidrosis.
Acne – Dr. Weiner had been noting that patients whom were undergoing Infini for skin tightening/wrinkles were also noting improvement with their acne. It was postulated that the sebaceous glands, the glands responsible for sebum production (the root cause of acne) were being injured with the Infini treatment. An acne flair is not uncommon after an Infini treatment, and this is caused by inflammation of the sebaceous gland temporarily. Over time, the glands will involute (becomes smaller with less secretions) and lead to the acne improvements noted. Eventually sebaceous glands can enlarge again (unlike sweat glands with don’t have the ability to regrow), so the treatment with Infini turns out to be a potential long term but not permanent solution for acne.
Body Skin Tightening – Areas such as knees and arms are a concern for many patients. Other than surgical correction, which leaves large undesirous scars, there hasn’t been a good solution. Perhaps the Infini can create similar skin contraction and thickening in these areas as it does on the face. Dr. Weiner is studying this on a few select patients.
Fat Reduction – The depth of 3.5 mm is below the dermis in most areas of the body. Using this depth with the Infini, it is possible to target fat, particularly in the submental (below the chin) area and along the jaw line. Many patients have seen improvements in these areas with their Infini treatments for wrinkles on the face and neck. Dr. Weiner purposely will go deep in these areas to coagulate and destroy fat and then go more superficial to tighten the dermis. Slimming the mid and lower face for patients with excessive fat tissue can be manage with the deep depth Infini treatment.
Cellulite Improvement – Using the same rationale as targeting fat, it seems logical that destroying the fat that is herniating would improve the appearance of cellulite. This is still an area of treatment that is more speculation and research is being conducted by Dr. Weiner on a few select patients.
Tattoo Removal – There is evidence that combining fractional ablative lasers with the Q-Switched laser has benefit in removing tattoos. If this is merely causing more of an inflammatory response to enhance the ink removal, then Infini can cause a similar tissue coagulation, but with less risk and downtime than the lasers do.
Breast Lifting – If the Infini can cause tissue contraction in the area of the breast, is it enough to see a noticeable improvement in the position of the breast? A no scar breast lift sounds extremely appealing. Studies will need to be done to see if the Infini can work for this and if so, how many treatments are needed, are touch ups required, and is it’s price justified.

Dr. Weiner is carefully studying the Infini for these off label uses and trying to develop standardized protocols for the medical community. It seems like the Infini’s potential is just starting to be recognized and its future is very promising.

THE COMBINATION OF SCULPTRA AND ULTHERA IS BETTER THAN A FACELIFT AND HERE’S WHY!