ulthera Archives | The Aesthetic Clinique

Comparing Infini to Ulthera and Why Infini’s Technology is Superior for Laxity, Wrinkles, and Acne Scars

When it comes to skin tightening and wrinkles, there has been an increasing trend for the consumers to choose the less invasive approaches and opting out of surgery. Although results aren’t as dramatic, nonsurgical treatments offer less downtime, less risk, and less cost. These treatments are great for the people who are not quite surgical candidates because of very mild signs of aging as well as those that just want to delaying the sagging before it is even apparent. Then there are those who really are surgical candidates but can’t afford the downtime or are concerned about the looks of some of their peers who have had face/neck lifts.

The most recognized name for noninvasive skin tightening currently is Ulthera (Ultherapy). This technology uses highly focused ultrasound to cause a thermal coagulation zone beneath the skin without affecting the surface. This technology is akin to the one used to break up kidney stones or gall stones with ultrasonic energy (lithotripsy). The coagulation zones elicit an inflammatory response leading to collagen stimulation and contraction. This results in tissue tightening and wrinkle improvement. Ulthera was brought to market in 2009, with Dr. Weiner being one of the first 20 adopters in the US. Dr. Weiner has had significant experience with this device and with all the changes in protocols.

In 2013, the Infini was FDA approved and introduced in the US. This was a novel technology for the US, but it had been used in Asia for at least 1.5 years prior. Infini uses radiofrequency attached to microneedles to cause similar thermal coagulation zones as the Ulthera, below the surface of the skin. Dr. Weiner is the largest user on the Infini in the US and now lectures and precepts other physicians in it use.

The similarities of the 2 technologies:

Both are fractional treatments (only treat a portion of tissue) which is safer and leads to faster healing.
Both can treat at multiple different levels. While Ulthera is restricted to 3 levels, it is not uncommon for Dr. Weiner to treat at up to 5 levels with the Infini.
Both have very little downtime – Ulthera has potential for bruising but otherwise no downtime. Infini has about 24-36 hours of redness and swelling. There are no activity or sun restrictions for either treatment.
All skin types can be treated with both technologies.
Both can be performed in the office with just topical – Patients who have had both technologies report that Ulthera had more discomfort in Dr. Weiner’s office.
Both can improve skin laxity, particularly in the jawline. It is Dr. Weiner’s opinion that this is primarily due to fat destruction by both technologies. Both can reach into this layer (the Infini only if desired, Ulthera almost always by default with the deeper transducers).
Both mechanisms of tightening are similar – create a controlled injury that leads to tissue contraction, tightening, collagen stimulation BUT the way the injury is produced is different.
Both can be safely off the face – neck, chest, extremities, under arms (hyperhidrosis)
Both are extremely safe technologies with very little side effects and don’t use lasers (so safer for the eyes).
Both have better results with multiple treatments. Although Ulthera states one treatment is needed, the experience Dr. Weiner had with the technology was that better outcomes were seen with multiple treatments.

Comparing the differences of Infini versus Ulthera:

Infini treatment of the face/upper neck lays down over 50,000 thermal coagulation zones VS Ulthera’s 16,000. It only makes sense that the more zones, the more results.
Infini depths can be adjusted from 0.25 mm to 3.5 mm in increments of 0.25 mm. Ulthera has 3 depths: 1.5, 3.0, 4.5 mm. Using the ultrasound of the Ulthera, Dr. Weiner was able to measure skin depths over the face and neck. There were no areas of skin thickness greater than 2.5 mm in the entire face and neck (except in very thick skinned males in the upper cheeks). Therefore, MOST OF THE TREATMENT FOR ULTHERA IS BELOW THE LEVEL OF EVEN THE DEEP DERMIS. Only the 1.5mm transducer causes coagulation in the dermis. This is not included in most protocols, or if it is, is only a minor component. Studies have shown that the area of greatest collagen formation is in the deep dermis. Infini is able to lay the coagulation zones all throughout the dermis, including the deep dermis because of its ability to change it’s depths. The Infini can even treat different areas of the face at different depths, which is important because the face has significant variability of thicknesses between the forehead, eyes, cheeks, lips, jawline, submental, and chin area. Depths below the dermis injure the subcutaneous tissue, which is mostly fat. Fat is what we want to preserve, not destroy, except along the jawline and submental area.
The treatment cost (consumable) of Ulthera for the physician is more than 10 times greater than for the Infini. The purchase price to the physician is also about 50% more for the Ulthera. The treatment time is also longer, sometimes up to 50% more for Ulthera. This all gets passed on to the patient resulting in Ulthera being about double the price of the Infini in most offices.
Although Ulthera touts that deeper penetration causes contraction of the SMAS, to Dr. Weiner’s knowledge, this has yet to proven histologically. The deeper penetration does lead to more discomfort as well as potential for fat destruction. The Infini targets the dermis, particularly the deep dermis, the area for maximal collagen creation.
Results seem to be more consistent with the Infini versus Ulthera. This seems to follow the science. More coagulation points in the correct zone of the dermis should lead to more collagen, more tightening.
Superficial fine lines can be treated with the Infini but not Ulthera. In certain cases with skin type 1-3, shallow treatments of less than 1 mm can be used to treat these wrinkles and etched in lines. Ulthera doesn’t have this capability.
Although there are some reports of Ulthera treating acne scars, Infini seems to be the best technology to treat these. It is probably the combination of the microneedles, RF energy, and adjustable depths that make it a superior technology to treat this difficult problem.

From about 2005 – 2009, Thermage was the most advanced noninvasive skin tighten device. This was replaced with Ulthera in 2009, which offered better, safer, and more predictable results because of precisely placed coagulation zones (albeit, maybe too deep). In 2013, Infini was introduce and it has been slow to catch on. However it is finally being adopted by the key thought leaders in the Aesthetic Industry. It will soon be recognized as the most efficacious noninvasive skin tightening technology on the market.

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Slimming Ones Facial Appearance with Botox/Dysport

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The ideal shape for an aesthetically pleasing face has been referred to as “an upside down egg” or heart-shaped. It is desirous to have the upper face wider than the mid/lower face. It brings more attention to the eyes, the center of beauty. Widening of the lower face can give a female a more masculine appearance, and also is a sign of aging. The causes of enlargement of the mid/lower face are:

Enlarged masseter muscles. Often caused by bruxism (grinding one’s teeth)
Obesity
Genetics. Asian females tend to have this issue
Jowling associated with the aging face

By injecting the masseter muscles with Botox or Dysport, the muscles can diminish in size and atrophy over time. If the procedure is repeated and regularly administered, a long-term slimming of the mid and lower face can be achieved. Candidates for this procedure are people who fall into the #1 and #3 category. Risks are minimal, but this can affect your smile if not done by someone who has experience with the anatomy and performing this procedure.

Many people would also benefit from injecting the temples simultaneously with filler to help create the upside down egg-shape to the face (from a square-shaped face).

For the person that falls into the #2 and #4 category, there is some literature that suggests that Ulthera might be helpful. Although a much newer technology, Infini might work for this as well, time will tell. By going to depths that are much deeper than the skin, into the fat layer, it might be possible to decrease the amount of fat in these areas and thereby slim the face.

Coagulation is Necessary For Maximum Skin Tightening; Science and Experience Prove This – INFINI is the Best Solution

It is fundamental that my patients understand the science behind their treatments. There is too much “quasi science” in the aesthetic industry that is fooling the general public. As a result, many patients are dissatisfied with their outcomes and have buyer’s remorse. Perhaps the most controversial area of the industry is with “skin tightening” procedures. After reading this and my previous blog on the Infini, hopefully you will recognize the reasons why most of the devices/procedures for skin tightening don’t work well and why the Infini stands out from the crowd.

To achieve skin tightening, the deeper layer of the skin, the dermis, needs to create new collagen. It has been found that heating this layer of skin can stimulate neocollagenesis (new collagen production). The threshold is 42 degrees centigrade to impart a stimulus to the dermis, because at this temperature collagen denaturing occurs (the bonds holding collagen together break down). The body senses the injury, and during the repair of this area, new, youthful collagen is produced. The response is very mild at these temperatures. At higher temperatures, 55-70 degrees centigrade, coagulation of the collagen and surrounding tissue occurs, with more coagulation seen in the higher range of those temperatures.

WHEN COAGULATION OCCURS, THE BODY’S RESPONSE TO THE INJURY IS MUCH MORE INTENSE. TO ACHIEVE MAXIMUM SKIN TIGHTENING AND COLLAGEN FORMATION, COAGULATION IS NEEDED IN THE DERMIS.

Digression: The long standing “gold standard” for wrinkle control and skin tightening (without surgery) has been considered the fully ablative CO2 laser. It has been determined that its efficacy is based primarily on its significant coagulation effect. The risks associated with complete removal of the upper layer of the dermis – prolonged healing, redness, scarring, infection, and hypo and hyperpigmentation – have significantly curtailed its use. Recent technology improvements that have made the CO2 laser fractional (treating only a fraction of the skin) has greatly reduced the risks, but they are still present. Erbium laser resurfacing, which traditional has very little coagulation, has not been shown to have the same results as the CO2 laser. Changes in the Erbium to give it more of a coagulation effect on the skin have lead to better results.

The ideal skin tightening device would cause tissue coagulation in the dermis, but have very little of the risks and downtime associated with the CO2 laser. Radiofrequency devices have been trying for over 10 years to do this without success. They try to heat the dermis, but not the epidermis (upper layer of the skin) to the 42 degrees needed to get a mild neocollagenesis. THE PROBLEM IS THAT ALL THE NON PENETRATING RF DEVICES CAN DO, AT THEIR VERY BEST, IS HEAT, BUT NOT COAGULATE, TISSUE IN THE DERMIS.

So what devices can coagulate tissue is the dermis aside from the CO2 laser: Microneedling RF devices (like Infini) and Ulthera (High Frequency Ultrasound). In this category, Infini wins hands down. All of the other microneedling devices currently on the market have one or more of the following downfalls:

The needles are not insulated so the epidermis is at risk for injury (pigmentation or indentation risks)
The needle depth is fixed and not variable. The facial skin has a huge variation in depth, from 0.38mm to 3mm. Ideally, the coagulation is placed at the deep dermal layer. If it is too deep, there will be minimal collagen response.
The themal injury is not fractional. Treating fractionally is the way to treat in 2014. This allows for accelerated healing, minimal risks, without compromising results.
Their temperatures don’t reach the level high enough for coagulation. Without coagulation, results won’t be as good.

THE INFINI USES INSULATED NEEDLES, HAS VARIABLE NEEDLE DEPTH (0.5mm-3.5mm), AND CAUSES A FRACTIONAL COAGULATION INJURY IN THE DERMIS.
Infini Coagulates the Dermis

Ulthera has been a great tool in our office for the past 5 years. When comparing the Infini to the Ulthera, the following deficiencies in skin tightening have come up:

Ulthera currently only has 3 depths – 1.5mm, 3mm and 4.5mm. For most of the face, only the 1.5 is at the level of the dermis. Ulthera reportedly tightens at the deeper muscular layer, the SMAS, but this has yet to be a proven mechanism by histological samples (looking under the microscope at biopsies). Much of the coagulation from Ulthera is in the subcutaneous fat or fat layer, an area that produces very little or no collagen. It does explain the improvement in the jawline and upper neck though, the areas where there are fatty deposits.
Ulthera lays down about 15,000 thermal coagulation points (TPC’s) during a treatment. The Infini will create 50,000 or more of these TPC’s during a treatment. More TPC’s probably mean more results because Ulthera has proven that going from 7500 TPC’s to 15,000 TPC’s gave them better results.
Ulthera is more expensive for the physician to use, so the costs get passed on to the patients.

To summarize, skin tightening requires a coagulation injury in the deeper dermis. The discussion above has tried to show that besides the Infini, all other RF devices fail to deliver a predictable, safe, thermal injury to the point of coagulation in the dermis. Without the coagulation in the dermis, results will be unsatisfactory. In essence, the Infini has made Thermage, Venus Freeze, Exilis, Pelleve, Tripolar, Titan – all OBSOLETE.

To get a better grasp of the RF skin tightening Industry, please read the blog: “FINALLY…A Radiofrequency (RF) Skin Tightening Device that Makes Sense. Infini by Lutronic.” Includes an overview of the RF skin tightening industry.

Ulthera (Ultherapy) Questions Answered by Steven Weiner, MD, Facial Plastic Surgeon

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Q: Is it okay to use hand held tightening devices for the face after ultherapy?

A: Hand held tightening devices can be used after Ulthera, but waste of time and money

Hand held devices for skin tightening do very little. You are better off to save the money for skin care products, dermal fillers, or other treatments. The energy the FDA allows for the home devices is so low that they don’t work.

Q: If you currently have fillers like Sculptra can you have Ulthera?

A: Combining Ulthera with Sculptra is the bomb!

Absolutely, you can combine the 2 treatments, Sculptra and Ulthera. You obviously recognize that the 2 do different things, Sculptra fills volume loss and Ulthera tightens loose skin. When done together, they are synergistic, meaning 1+1=3! My blog goes into details about doing both of these, please read. Steve Weiner, MD, Destin, Florida.

Q: Ultherapy Vs. Refirme Vs. Accent XL for Thin Face

A: Don’t bother with Refirme or Accent XL for the face, Ulthera is much more reliable

All the RF devices which try to transmit their energy through the skin are unreliable with very inconsistent or no results. These include: Thermage, Refirme, Accent XL, Pelleve, Venus Freeze, Exilis. The only one worth using from the RF family, at the present time, is the Infini by Lutronic. Please see my blog which goes into more depth on the technology. (I also have another blog about the benefits of Ulthera plus Sculptra.) Ulthera is a very reliable device, placing the right amount of energy at a given level, at all times. No, it does not affect the natural fat of the face. Steve Weiner, MD, Facial Plastic Surgeon.

Q: Which is more effective thermage or ultherapy for tightening skin?

A: Ulthera is far superior to Thermage for skin tightening results

Ulthera reliably places energy in the dermis and SMAS layer. The energy is always above the critical temperature to cause tissue contraction and collagen formation. Thermage is very unreliable in it’s placement of energy through the skin and therefore it’s results are very unreliable (some have results, while most do not). There is a new device called Infini, which uses RF energy like Thermage, but it places the energy very reliably in the dermis and is therefore much more effective than Thermage as well. I consider the Ulthera for tightening the jawline, turkey neck, raising the cheeks and the brows. Infini would be better for the superficial fine lines, lip lines, necklace lines, cheek lines. I used to have Thermage but sold it the same month that I bought Thermage – 3 years ago. I have much happier patients. See my blog below. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.

Q: Are these results of Ultherapy really true?

A: Ulthera is not a surgical result, but some people don’t want surgery

There is no debate whether or not the energy is delivered by Ulthera to the precise location that the device is made for. Most people, 8-9 out of 10 get noticeable improvements from the procedure. Are they the results similar to which surgery can give? Most of the time the answer is no. But, if you want little or no downtime, want a result that doesn’t leave scars, and has minimal risks (no long term risks), it is the procedure for you. Surgery has it’s inherent risks: bleeding, infection, scarring, anesthesia, need for redo, poor cosmetic results, nerve injury, as well as downtime (up to a month for a facelift). I have written a blog about why I believe that Sculptra and Ulthera are better than a facelift. Steve Weiner, Facial Plastic Surgeon. Destin, Florida.

Q: How Often Can Ultherapy or Thermage Be Applied? Do Repetitive Applications Have Any Side Effects or the Opposite?

A: Ulthera can be repeated in 4-6 months; Don’t bother with Thermage

Repeat treatments with Ulthera will help you keep up with the aging process. There is no exact right answer as to when you should do this. Getting more treatments will only improve the results and won’t be harmful. I have given up on Thermage 3 years ago when I got the Ulthera because results are so much better and more consistent with Ulthera. Read my blog about RF devices and see why Thermage doesn’t work well. Infini is a good skin tightener too and it’s full ability has yet to be determined. Steve Weiner, MD, Facial Plastic Surgeon, Panama City Beach, Fl.

Q: If I Have a Plate in my Neck Can I Still Have Ultherapy?

A: Ulthera can be performed on someone with a plate in their neck

Because the penetration of the energy is only 4.5mm deep, the plates will not be a factor. You can safely have the procedure. Steve Weiner, Destin,FL

Q: 1. Can This Procedure Affect/injure/change the Thyroid? 2. Why is Thyroid Area Avoided During Ultherapy Precedure?

A: Ulthera will not affect thyroid nodules

The thyroid area is avoided because of the cartilage that is close by. It has nothing to do with the thyroid gland. In fact, I could see the Ulthera technology being used to treat thyroid nodules in the future. You have nothing to worry about. Steve Weiner, MD, Destin, Florida.

Q: Can I Get Ultherapy ?

A: Ultherapy for someone who gets cold sores and shingles is ok with prophylaxis

We have done many treatments on patients like you. It just requires taking a dose of Valtrex before and a few doses after to prevent the problem. If you sense that there is an outbreak coming on despite this, take a therapeutic dosing for the recommended time by your doctor.

Q: Can an Ultherapy Side Effect Be Burning and Tingling on Scalp?

A: After Ulthera there is some burning and tingling of scalp, this can be related and will go away quickly

There are nerves in the forehead which travel to the scalp. During Ultherapy, it is possible to bruise these nerves and the result can give you abnormal sensations of the scalp and forehead. To my knowledge, there have been no reported long term issues with Ulthera. This should go away within a few weeks I suspect.

Q: Can Ulthera Be Done on the Neck Only, or is the Lower Face with It Necessary?

A: Ulthera can be done on neck only but not what I would recommend.

Ulthera was recently FDA approved to be done on the entire neck. Best result for the jawline would include the lower face as well to get some lifting above the jawline.

Q: Can Ultherapy Reduce the Size/appearance of Large Submandibualr Glands?

A: Ulthera won’t improve appearance of large submandibular glands

Ulthera won’t get deep enough to hit the submandibular glands. One thing you might consider is having them injected with Botox. I have seen at meetings that Botox reduces the size of enlarged parotid glands so there is no reason why it shouldn’t work for the submandibular glands.

Q: Nurse Squeezing and Tapping Foot During Ulthera?

A: Distracting during Ulthera treatment can decrease pain

The Gate theory goes back to the 1950s which states that the brain has trouble processing two stimuli at once. So when there is a competing sensation, the brain will block out one partially. This leads to less discomfort. We add vibration and cold air so the brain gets really screwed up. Steve Weiner, MD, Destin, Florida, Facial Plastic Surgeon

Q: Thermigen Vs Ultherapy?

A: I have the Ulthera and have seen Thermigen. Please read my discussion to get a better idea.

My clients have been very happy with the results they have seen with the Ulthera. They can walk in and do anything they want to do afterwards. Thermigen is quite similar to the new Precision Tx laser. It requires tumescent anesthesia and requires a chin strap afterwards. It goes under the skin and heats up the fat and skin to dissolve the fat and tighten the skin. It has thermal controls so the skin doesn’t heat up to a dangerous level. I have seen it performed and the patient was comfortable during the procedure. It all boils down to results, and I haven’t seen the “wow” results that would convert me from Ulthera to Thermigen. Thermigen is not FDA approved for this procedure either. The cost of the device is a lot less to the physician than the Precision Tx laser so the procedure should be less to the patient. It depends how invasive you want to be as to which you do. I’m staying with Ulthera for now. If you want more aggressive results, also look at the Precision Tx, which is the same technology as the Cellulaze laser.

Q: Should I Stop Taking Supplements (Eg. Fish Oil, Ubiquinol) After Ultherapy?

A: There is theoretic concern with anti inflammatories after Ulthera

There are no studies to suggest that anti inflammatories decrease the effect of Ulthera but some docs suggest not taking them after the procedure. The risk they say is that the healing process is subdued and therefore you are not getting the full effect of the treatment. I think this idea started with Thermage as an excuse when they weren’t seeing results. I don’t tell my patients to stop these supplements.

Q: Can Have Ultherapy Done Under my Chin and Neck if I’ve Had Cystic Acne Before?

A: Ulthera in patients with prior cystic acne is no problem

Ulthera can safely be performed in patients which have had cystic acne. As Dr. P has said, we don’t do it in the case of an active infection. In the long run, it might actually help the acne by partially destroying the sebaceous glands which are the source of the acne problem. There is an active clinical trial to see if Ulthera can actually be used for acne treatment.

Q: Now That They Have Had the Benefits of Experience Behind Them, Does Ultherapy

A: There have been improvements since Ulthera first came out about 3 years ago.

The changes which have occurred are:

There are now 3 different depths for treatment, 1.5, 3, and 4.5 mm.
There are about twice as many treatment lines being laid down as to when it was first introduced.
Topical lidocaine is being used and having an effect in improved comfort.
Lowering the intensity of the treatment lines give better comfort but same results.

All the above results in more comfort and/or better results (more aggressive treatments). It only makes sense that over time, everyone learns more about the potential of the technology and becomes more comfortable at trying new protocols.

Q: Can You Get Ultratherapy with a Titanium Piece in Your Cheekbone?

A: Ulthera cannot be done in face with Titanium plates

The ultrasound waves will bounce off the metal and scatter unpredictably. This is one of the only reasons someone can’t have an Ulthera treatment.

Q: Had Ultherapy on Upper Face, Had Little Pain, Will It Be Less Results?

A: Very little pain with Ulthera for upper face is a good thing, not bad.

Several measures have been done recently to reduce the discomfort with the Ulthera. A new protocol uses less energy but more treatment lines and seems to have equal results. We also use topical numbing creams and cold air, both seem to help as well. Because protocols are fairly standardize, at least the minimums are, I wouldn’t worry about your treatment. We tend to stay at the upper end of the protocols and give more treatment lines than the norm, but that doesn’t mean it should hurt.

Q: Ulthera After Peel?

A: When Peeling is done after a Peel, it’s ok to have Ulthera

You could probably do the Ulthera immediately after the peel, but because there is liberal use of ultrasound gel, it’s better to wait til the skin is done peeling. It really does nothing to the outer skin, so don’t worry about affecting results of the peel.

Q: Could Ultherapy Be Performed on a Person’s Neck, if That Person Has Some Nodules on the the Thyroid?

A: Ulthera on the neck can be performed on patients with thyroid nodules

The Ulthera (Ultherapy) penetrates 4.5 mm into the skin. The thyroid is much deeper than that, with a layer of muscle between the skin and thyroid as well. There is no worry whatsoever. Dr. Steve Weiner, Panama City Beach, Florida.

Q: How Long After Ultherapy Do I Need to Wait Before Getting Lip Waxing?

A: Waxing after Ulthera (Ultherapy) can be done immediately after treatment

There is no reason to stop doing anything you normally do after Ulthera. There is no downtime. If you use Retin-A or similar, you should wait about 4 days after stopping to get waxed, but this has nothing to do with Ulthera.

Q: Can I Drink Wine the Same Day As Having Ultherapy?

A: Wine after Ulthera is perfect, there are NO RESTRICTIONS

The beauty of Ulthera is that it is a no downtime, fairly risk-free procedure. No long term complications have been reported to my knowledge. Having wine afterwards is quite alright and we encourage people to do their daily routine after Ulthera. There is no data to support this, but some doctors recommend not using anti-inflammatories for about 6 weeks, but we don’t. Steve Weiner, MD, Santa Rosa Beach, FL

Q: Does Ultherapy Work for a Brow Lift?

A: Ultherapy is a noninvasive FDA approved method for Brow lifting

If you desire no downtime and a very low risk procedure to raise your brows, Ultherapy (Ulthera) is a great option. It won’t give a surgical result, but will give a natural look. If you want more results, a second procedure can be done. It takes about 15 minutes to do with only mild bruising or temporary numbness as a side effect.

Q: Aftercare for Ulthera on Lower Face and Neck Yesterday?

A: Aftercare following Ulthera is NOTHING

After having Ulthera, there is no need to do anything special. It is recommended not to use steroids or other anti-inflammatories, but this has yet to be proved to be detrimental to your results (its theoretic). That’s the beauty of Ulthera, no downtime, no aftercare! Please see my video too.

Q: Can I Take a Steroid Medicine (Methyprednisolone) After Ulthera?

A: Taking steroids for a brief period after Ulthera has a theoretical risk of decreasing the effectiveness of Ulthera

Although there are no studies, and it would be very difficult to do a study, there is the feeling amongst some doctors that anti-inflamatories after Ulthera can decrease it’s effectiveness. This is based on the fact that you need the inflamatory factors to produce the collagen and tissue tightening. This would include steroids, motrin, advil, aspirin, but not tylenol. If they can be avoided, it’s advisable but not absolutely. This is a gray area, so don’t worry too much about it.

Q: Does Ultherapy Work for Upper Cheeks?

A: Ultherapy is great for lifting the cheek area

Yes, Ulthera is perfect for lifting the cheek area. Ulthera works by laying down very precise lesions in the skin at 4.5, 3, and 1mm, which over time, leads to collagen stimulation and tightening. Results take about 3 months to fully appreaciate, and some people will want a second treatment. You can see lifting of the brows, improvement in wrinkles around the eyes, lifting of the cheeks, firmer jawline, and tightening of the upper neck.

Q: Ultherapy for Excessive Sweating (Hyperhidrosis Treatment)?

A: Ulthera does work for hyperhidrosis in one study by Dr. Nester

There was a poster presentation at a conference I was at describing very significant improvement in the sweating scores after 2 treatments of Ulthera for axillary hyperhidrosis. The proposed way it works is by destroying the sweat glands with the ultrasound from the Ulthera. It requires lidocaine injections to numb the area treated, just as the Miradry device does. The study was done by Dr. Nester from South Florida.

Q: Can Ultherapy Be Done on the Eyelids? Or is It Not Safe? Or Just Not Tested?

A: Ulthera is not to be used on the eyelids

The company has been evaluating the Ulthera treatment on the eyelids, but as of today, they have not found a good way to shield the eyes from the energy of the treatment. Therefore, it is not recommended to treat the eyelids. Who knows what the future holds though.

Q: What Risks Are Involved with Ultherapy?

A: The risks from Ulthera are mainly some mild bruising and discomfort which is short lived.

Ulthera has been proven to be an extremely safe procedure. According to the company, and our 2 years of experience backs this up, there have been no long term side effects. Some people might experience some mild swelling and bruising right after the procedure, but this subsides rather quickly. Very rarely, some people experience some temporary numbness. With new treatment protocols which are more aggressive, there is slightly more discomfort during the procedure. With topical anesthesia, this has been reduced.

Q: Is It Safe To Do Ultherapy One year Later?

A: Repeat Ulthera treatment is safe and is going to give longer and improved results.

Ulthera is a very safe procedure and there is no risk of repeating treatment after 1 year. In fact, several of my clients have a planned second treatment at 3-6 months after their initial one. The results will be better than just having one, and longevity will be increased.

Q: Ulthera – Are Welts a Normal Side Effect?

A: Swelling / Welts after Ulthera can happen but go away quickly

Occasionally, a person which has Ulthera can have overall swelling which is very short lived. Sometimes bruising can occur and present with firmness under the skin. Visible dermal swelling/welts can occur if the ultrasonic skin injury occurs too superficial. It can occasional have a little fluid like a cyst or pimple, but will resolve within about 5 days.

Rejuvenation of the Eyes – Completely Nonsurgically. Details the Factors Affecting the Aging of The Eyes.

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Studies have shown that the eyes are the most important area of the face for gauging attractiveness. Unfortunately, the eyes are one of the first areas to show aging. Several aspects of aging affecting the eyes are:

Dropping of the eyebrows
Tear trough formation
Eyelashes that are shorter, fewer, and less pigmented
Thinning of the eyelid skin (crepey skin)
Prominent fat bulges or bags
Hollowing of the eyes
Wrinkles in the crows feet

To understand the treatment of these problems, we have to delve into the reasons that they occur. Unfortunately, as a face ages, fat, muscle, and bone is lost. Imagine if our facial skin was a dress and it was a size 6 and it fit well at age 25. At age 45-50, we still own the same dress, but the facial support (bone, muscle, fat) is now a size 2 or 4. It looks like your dress (skin) is sagging and doesn’t fit well. The eyes are affected by multiple areas of loss:

The temple fat pad loses fat so the eyebrows lose some support and fall.
Several fat pads underneath the eyes become smaller and fall leading to tear trough and malar groove formation and loss of medial and upper cheek.
The eye socket (orbit) loses bone and becomes bigger making the eye look hollow and the fat to look like it’s protruding when in reality it didn’t move (pseudoherniation). [There are other factors affecting the orbital fat too – thinning and stretching of the membrane supporting the fat as well as this fat sometimes gets larger which can be camouflaged but not entirely corrected with nonsurgical treatment.]

Aging which affects our entire body is magnified in the eye area:

Just as the hair on the head gets thinner and less plentiful, the same thing happens to the eyelashes and eyebrows.
The skin becomes thinner, less hydrated all over the body but very apparent in the eye area, particularly the lower eyelids.
The muscles around the eye becomes stronger, creating wrinkles in the crows feet and pulling the eyebrows down when it contracts.

Improving the volume around the eye will deliver the most significant change in appearance. Dermal fillers such as Sculptra, Restylane, Voluma, and Artefill are used to reflate the temples leading to a lifting of the brows as well as rounding of the upper face. By enlarging the upper face, the focus of attention of the face is brought back to the eyes, as it is in a youthful face. Volume is also needed to replace bone and fat loss all around the eye in the tear trough, upper cheek, and orbital rim (palpable bony ledge around the eye). Filler needs to be placed under the eye, lateral to the eye, as well as above the eye (in the forehead area). In certain instances, filler can be placed inside the upper orbital rim, mainly in the inner aspect, but this can lead to swelling in some people that is not tolerable.

Botox is a mainstay of orbital rejuvenation. Treating the crows feet, frown lines, and injecting for a brow lift is essential to improving the eye appearance. Some people have excessive muscle in their lower lid that could be relaxed with Botox, but this can only be done in people with not a lot of laxity in their lower lid. Some people also want a more rounded appearance of the eye and this can be obtained by injecting in the middle of the lower lid. Youthful eyes are “wide eyes”.

Crepiness of the skin around the eyes is improved with skin care products designed specifically for the eye like SkinMedica’s TNS Eye Repair and Lifeline’s Eye Firming Complex which both contain growth factors. More invasive treatments, with more appreciable results are obtained with laser resurfacing (non ablative or ablative) and radiofrequency (RF) devices such as Infini. The standard of care is currently the ablative lasers (CO2 or Erbium). Non ablative laser have been shown by Dr. Biesman to have minimal affect on the eyelid skin. Ablative lasers have downtime (1-2 weeks) and can take months to blend in with the color of the surrounding skin. The tide will soon be turning to the Infini (MicroNeedling Fractional RF) for the lower risk and ability to treat all skin colors with minimal downtime.

If further lifting of the brow is required, Ulthera is a great nonsurgical option. A 15 minute procedure, which can be repeated, has been shown to effectively raise the eyebrow in most patients. Ulthera uses focused ultrasound which causes tissue contraction and collagen stimulation. The Infini has been showing promise in this area as well, but for now, Ulthera is the work horse for brow elevation.

Latisse has proven itself as a very effective treatment of the eyelashes and brows. It’s mechanism of action is prolonging the growth phase of the hair follicle. After initial application of once a day, it can be throttled back to once every 3 days when the results are met at around week 16 (78% of study group had results). The only side effects which have been noted with any frequency are skin irritation and that has happened mostly in client overusing the medication.

The eyes are the center of one’s beauty. Don’t let aging affect your eyes. There are multiple ways to improve the appearance around the eyes which are nonsurgical in nature and have little to no downtime.

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

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

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

Website: http://www.theclinique.net

Press Release about Dr. Weiner’s Eye Rejuvenation

Here are Dr. Weiner’s top 5 things “Not to Do” to improve your skin and looks.

There are hundreds of articles on beauty and skin telling you what you should be doing to improve your looks and skin health. I’m going to take the opposite approach. There are numerous activities and habits I see in our office that is just plain counterproductive to what I’m trying to improve. If you just stopped these 5 things, your skin, looks, and sometimes overall health would be significantly better.

Don’t smoke! Without a doubt, this is the worst habit for your skin’s health. The nicotine causes the small vessels in the skin to contract. This “strangulates” the organs and deprives the skin of oxygen and it’s vital blood supply. Toxins from the tobacco enter the blood stream and are distributed throughout the body and skin as well. Worst of all, smoking gives you smokers lip lines – a very difficult problem to fix.
Don’t use tanning beds! I’m surprised that tanning beds are still legal. There is no doubt in the medical community that tanning bed use increases skin cancers: basal cell, squamous cell, and even melanoma. Looking beyond cancers, severe premature aging of the skin is a result. Just as sun exposure does, tanning beds cause breakdown of collagen and elastin fibers leading to loose, thin, nonelastic skin. Volume loss associated with aging is exaggerated.
Don’t pick! I see numerous scars related to acne, particularly deeper cystic acne, that the patient tries to “improve” by picking, poking, and needling. This can lead to a worse infection, sometimes MRSA, that requires antibiotics and creams to improve. The end result is often scarring and hyperpigmentation which can require skincare, peels and often lasers or RF treatment.
Don’t listen to your friend/neighbor who recently became a skincare expert! Isn’t it funny that your friend now knows all about what’s good for your skin and they have the perfect product that will do miracles that they want to sell you. For additional convenience, they will also ship it to you on a monthly basis. Keep your guard up with these folks. Most often, the products are nicely repackaged creams available OTC from multiple different companies. Only physicians can sell certain products which are prescription strength or certain product lines that have peer reviewed research behind them. Aestheticians spend months in the classroom and devote their livelihood to skincare and are truly experts in guiding your skin care regime. At The Aesthetic Clinique, we have 4 fulltime aestheticians, 1 nurse, and Dr. Weiner to give you a team approach to your skin. We offer multiple skin care lines which we have chosen for their particular strengths in certain age and disease related processes.
Don’t expect a face lift to fix everything! It happens daily in our office. “I’m trying to decide if I should do skincare, peels, filler, lasers, Botox, Ulthera, Infini or JUST GET A FACELIFT”. A facelift will help with laxity, improve the jowls, improve some wrinkles but there is so much more that won’t get treated. In most cases, some sort of neck lift must be done to improve the jawline and “to match the face”. Getting a facelift does not mean you can eliminate Botox. A facelift will do absolutely nothing for the skin damage that would benefit from lasers, skincare, and peels. Volume loss is not addressed by a facelift unless a secondary procedure with fat grafting is performed. It’s been my experience that patients who have had facelifts actually have more volume loss related to fat atrophy in the preauricular area as a result of the flap elevation (lifting the skin). Rejuvenation around the eyes is not part of a standard facelift and requires another procedure called a “blepharoplasty”. The point is that it takes a multifaceted approach to improve all the aspects of the aging face, and a facelift only addresses a small part the problem.
Bonus (Addendum) Don’t drink from straws. This habit leads to those ugly lip lines, even if you don’t smoke.

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

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

Website: http://www.theclinique.net

Don’t Forget The Hands and Decolletage When Thinking About Your Cosmetic Refinements!

Before and after hand volumization with Radiesse.

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Most of the procedures advertised and touted have to do with rejuvenating and beautifying the aging face and neck. This blog is to bring attention to the often ignored areas: The Decolletage (chest) and The Hands. There are some simple, quick, and little to no downtime procedures that can be performed to bring these areas up to speed with your face and neck cosmetic improvements.

Just as the other parts of the body, the hands and chest lose volume from fat loss, and thinning of the skin. In the hands, the vessels and tendons become more apparent, and in the decollete, wrinkles form the “cleavage” area. The easiest way to improve this problem is with filler. Using micro blunt cannulas, the procedure becomes nearly painless and without any downtime. Filler of choice for the hands would be Radiesse, and for the chest, Sculptra. For the Sculptra treatment, it will take 2-3 sessions, but this will give 2 or more years of improvement. It thickens the skin by stimulating the skin to produce collagen.

Most people these days protect their face from the sun, but the chest and hands are neglected. Sunscreen is important fo r these areas as well. Sun damage on these areas presents as:

Hyperpigmentation, “sun spots”, lentigos
Wrinkles
Thinning of the skin
Skin cancers and pre cancerous lesions

Hyperpigmentation is treated with skin care, peels, and lasers. Proper skin care can include: Sunscreen, Retin A or Retinol (for the chest), Growth factors like TNS Essential Serum (for the chest), and body skin care like Environ which exfoliates and hydrates. For more extensive damage chemical peels can be done, or laser procedures. If just wanting a few spots removed, the Spectra Q-Switched Laser is state of the art to remove individual spots. They will darken and then flake off over 2-3 weeks. If the skin is covered with pigmented lesions, the Fraxel Dual 1927 is required. This will require 2-3 treatments and is a nice laser peel that rejuvenates the underlying skin as well and thickens the dermis. Peeling from the 1927 takes about 2 weeks to resolve. Subsequent treatments can be done after 1 month. The Fraxel Dual is also a great tool to remove and prevent pre cancerous skin lesions called actinic keratosis. It is FDA approved for this purpose and is equal in efficacy to the topicals used for this like: Aldera, Efudex, and Carac.

There are 2 technologies which have yet to be used extensively in the chest and hands but offer promise. Ulthera (Ultherapy) and Infini. These devices create small injuries in the dermis which lead to the body tightening the overlying skin, laying down collagen, and thickening the skin. There are already FDA trials of the Ulthera on the chest. Infini is a very new technology and Dr. Weiner is one of the first in the country to have it. Soon hands will be done with the Infini at The Aesthetic Clinique and results will be posted.

Often people who look much younger than their stated age, the truth is seen in their hands. Don’t ignore this area, as well as the chest! There are several easy ways to get them to match your youthful facial appearance.

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

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

Website: http://www.theclinique.net

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

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

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

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

Infini treatment for neck and lower face wrinkles.

15 hours after having the Infini Treatment, ready for work

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

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

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

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

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

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

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

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

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

Infini vs Other RF Devices

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

$Precise fractional controlled thermal injury of the Infini$

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

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

Evolastin
Fractora
Infini

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

Evolastin has tangential needle placement and large caliber needles

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

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

Fractora electrodes are not insulated and treatment is not fractional.

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

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

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

The wide spectrum of indications of the Infini are:

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

When comparing to the Ulthera, the differences are:

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

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

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

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

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

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

The various treatments for Acne Scars (scarring) at The Aesthetic Clinique

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Dr. Weiner answers questions about acne scars

Acne scarring is a very prevalent problem in our society. It also a very common concern for clients in our office because it most often affects the face and becomes a cosmetic concern. Treatment options are based of the severity of the disease and the intensity/aggressiveness the client desires. One must accept the fact that scarred skin will never improve 100%. However, once a scar in improved, it should persist indefinitely, unless further acne causes more scarring.

UPDATE: We now offer Infini, a radiofrequency microneedling device. This appears to be a great alternative to laser for acne scars. Please read the link.

Topical treatments are needed for all cases acne scarring. The regime should include: Retin A or Retinoid, serum with growth factors (TNS Essential Serum or Lifeline), and sunscreen.

Early scarring, which is the result of recent acne can be treated best with the VBeam. The VBeam will help with the redness and hopefully slow or prevent the progression of the scar turning into a mature and firm scar. The VBeam also helps with future acne breakouts.

Ice pick scarring can be treated with punch excision which involves removing the scar in a sleeve like fashion and closing the skin with a stitch. The more preferred way at our office is to use high concentration TCA and to chemically burn each individual scar in a series of 4 or 5 treatments. This method is called TCA Cross technique.

For more severe global acne scarring, the Fraxel Dual 1550 nonablative laser is probably the gold standard. This laser has more studies and experience treating acne scarring than any other laser. There is some mild swelling for a few days but no open wounds to dress. Peeling occurs for a few days a well. The number of treatments varies according to severity of disease and desired effect, but could be up to 10 treatments. It is safe for all skin types. Ablative erbium or CO2 lasers are used for acne scarring as well but we don’t have these lasers in our office. It’s been our experience that patient’s prefer the less invasive lasers with less wound care. less risk, and downtime.

For minimally depressed scars, using dermal fillers like Restylane can be a quick and easy medium term (9-12 months) improvement. Artefill has just published a study and will probably get FDA approval for acne scars in the near future.

There is research being done for using Ulthera, LaViv, and stem cells for acne scars as this blog is being written.

In general, there are several different choices to treat acne scars. Lasers are required for the most severe cases. Treating acne aggressively to prevent scarring is obviously highly recommended because treating the scarring is much more difficult.

What are realistic expectations for noninvasive cosmetic procedures?

As the number of physicians providing noninvasive cosmetic services increases, there is a tendency for many to make unsubstantiated claims as to what outcomes can be expected. This ultimately can lead to unhappy patients and certain procedures can be tarnished in reviews or in the press for not living up to what was promised. Patients need to be careful if something sounds too good to be true. In addition, patient’s sometimes expect way too much from a procedure, often well beyond what the procedure is capable of, and need to discuss what they want, in detail, with the physician before agreeing to it.

Some of the most common misconceptions are:

Most people need several different procedures, not just one to become more youthful. Don’t expect one treatment (or series) with a laser or skin tightener to be all that is needed. The Fraxel (Dual, re:pair) will make your skin less wrinkled, tighter, and more clear. Will it make you look “10 years younger” as some physicians claim. Probably not. The majority will look better but not by 10 years and will need other modalities such as filler and Botox to complete the youthful correction.
Don’t expect to have significant results from any cellulite treatment except for Cellulaze. All other treatments (Velasmooth, Velashape, Endermologie) are very temporary and end up being costly and time consuming. From the presentations I’ve seen with Cellulaze, there are significant long term results which are impressive.
Laser hair removal will not allow you to “throw away your razor”. Complete hair removal is not possible with any of the lasers which remove hair. You can expect up to 75-80 improvement with a series of about 6 treatments in the bikini and underarm area in most cases. Back, chest, and legs require more treatments, maybe up to 10. Darker skin individuals can require more treatments too because the laser needs to be turned down on these patients. Extremely fine hair on the face probably shouldn’t be treated at all because of the risk of making the problem worse. For all areas, touch ups every 6-12 months are required.
Some physicians were claiming Zerona was a weight loss (“fat zapping laser”) and slimming technology. This claim was completely unsubstantiated. There were no studies which showed long-term improvements with the technology and none which showed weight loss. The company is now bankrupt. Enough said.
A syringe of Restylane or Juvederm can’t usually make a significant improvement in volume in the face. Keep in mind that a syringe of these fillers is 1cc. There are 5cc in a teaspoon. So a syringe of the filler is a fifth of a teaspoon. In severely volume depleted patients, it’s not uncommon to use 4-8 syringes in one sitting. Some dissatisfaction commonly expressed on RealSelf.com are from patient’s which feel that there was no result with a filler procedure or that the filler was metabolized in a week or two. In actuality, they were expecting way too much from that fifth of a teaspoon. (In the lips, one syringe can make a noticeable improvement. This discussion is directed towards the patient needing volumization of face.)
Botox or Dysport is great for improving wrinkles which appear with expression but the wrinkles which are there at rest are helped to a much lesser degree. If you spread out your frown line and there is still a groove, this will not improve with Botox at one session and either requires multiple treatments to improve or the use of dermal fillers. Also remember, everything returns back to baseline unless injections are repeated every 3-4 months.
For an extremely strong frown line, complete “freezing” of the muscles is not possible. Studies show Botox can improve the frown line 1 or 2 grades (there are 4 grades/degrees of strength). You can’t go from a 4 to a 1 in one session.
Ulthera won’t give you a result that is comparable to a facelift. It will however give noticeable improvements for a procedure which takes about an hour with no long-term risks or downtime. Repeated treatments will give even further improvements. We send patients to be evaluated for surgery if they want tightening beyond what we can deliver with the Ulthera. Most still come back and request treatment from us.
Acne scars cannot be eradicated with any laser. You can expect up to about 50-60% improvement with the Fraxel Dual. This can take up to 10 treatments for the severely scarred patient.
Results for treating a smoker’s face will be diminished when compared to a nonsmoker. Smoking decreases the circulation to the facial skin by up to 60%. With this decreased “nourishment” to the skin, healing, collagen stimulation, tightening are all going to be significantly less. Smoking accelerates the aging of the face.
If you are 60-65 and are considering cosmetic procedures for the very first time, it’s been my experience that expectations from noninvasive procedures are unrealistic. Multiple procedures are required including: dermal fillers, Ulthera, skin care, peels, and possibly laser to turn back the clock. Thinking that a Botox treatment or a syringe or 2 of filler will do the trick is very unrealistic. I suggest that these patients consider surgical intervention, but if that’s not what they desire, we can definitely make noticeable improvements, but it takes time and multiple procedures.

In conclusion, this is an era of the minimal invasive cosmetic procedures. The future looks even more promising as to new procedures with even greater results and with more indications. Just make sure that you go to a trusted physician that can give you realistic expectations.

Comparing Infini to Ulthera and Why Infini’s Technology is Superior for Laxity, Wrinkles, and Acne Scars

Slimming Ones Facial Appearance with Botox/Dysport

Coagulation is Necessary For Maximum Skin Tightening; Science and Experience Prove This – INFINI is the Best Solution

Ulthera (Ultherapy) Questions Answered by Steven Weiner, MD, Facial Plastic Surgeon

Rejuvenation of the Eyes – Completely Nonsurgically. Details the Factors Affecting the Aging of The Eyes.

Here are Dr. Weiner’s top 5 things “Not to Do” to improve your skin and looks.

Don’t Forget The Hands and Decolletage When Thinking About Your Cosmetic Refinements!

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

The various treatments for Acne Scars (scarring) at The Aesthetic Clinique

What are realistic expectations for noninvasive cosmetic procedures?

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