Both products are offering goodies right now.
Juvederm is offering a free Vivite lip plumper ($45 value) when you use a syringe.
Restalyne and Perlane are offering $50 back for every syringe you use.
Woo hoo! Call the office for an appointment. These are great fillers for the tear trough, cheek, nasolabial fold (the parenthesis around your mouth) and your lips (yes,don’t worry, you don’t have to look overplumped and ducky when it is done well.)
Thanks to all of you for coming on Thursday for our informational session on Sculptra.
Here are some links to videos on the national news showing the injections: (No, I don’t look to these media outlets for my medical advice, but I do think these are good snippets to show you how the injections are done. There are needles, so don’t watch if you don’t want to see needles.)
The early show on CBS:
http://www.youtube.com/watch?v=dmBtJS-L6VU
Entertainment tonight:
Volumizing isn’t just for hair anymore.
There was a big shift in plastic surgeon thinking about a decade ago.
Look at the eyelid. We used to remove fat when doing lower eyelid surgery. The thought was remove the bulge, and the eye will look youthful. But the face doesn’t work that way. As you age, you lose facial fat. (Yes yes, you gain it elsewhere where you don’t want it.) As you lose fat in your cheek, you look hollow under the eye, your lower eyelid looks longer, your cheek pad drops, you get lines around your mouth which deepen (stop! stop!) and your face skin slackens. (oy! can you stop already?)
But this is what happens. So fast forward to now- the new generation- no scar, nonsurgical, fill fill fill generation. There is validity to it. I am a surgeon. I love to do surgery. But I saw a patient yesterday who has lost weight. She also exercises more, causing a lower body fat percentage (yes, for those of you with the wee ones, there is hope for us yet to see a gym again.).
She has loose skin.
She would benefit from a facelift. Her skin is loose from age and weight changes. But as I showed her in the mirror, even when I tighten the skin, she is flat. Hollow. The “deflated beach ball.” She needs volume. So instead of rushing to surgery, I recommended she try filler first. To get the result she wants, she must correct the hollowness. She should add volume first (nonsurgical, cheaper, no scar, minimal downtime), and then reevaluate. Adding volume will buy her time, even years, before she wants to do a surgery.
What filler to use?
For first timers, immediate gratification people, and small areas, I like restalyne/perlane or juvederm. For those with higher volume needs who want a longer lasting fill, I like sculptra. Volume doesn’t have to be a overly plump fake look. As with all plastic surgery, when done elegantly and well, it looks seamless. The goal is the “How do you look so good for your age?”, not the “Oh my. did you have a fight with a helium tank?”
So. Pump up the volume. It works.
The Medi Spa. Who doesn’t want to have medical procedures done in a spa? The soothing lights, smell of lavender, and cucumber ice water. Sounds much better than a doctor’s office. Oooh, and it is in the mall? Maybe I can go get a pair of shoes afterwards.
The issue is no one should inject who is not trained. That means the injection should be done by a doctor (plastic surgeon, dermatologist, or facial plastic surgeon), or a “nurse under the direct supervision of a doctor.” I do all the injections myself: botox, fillers like restalyne and juvederm, sculptra. I don’t use nurses. Be careful! Many offices do have nurses, but many of those nurses surely are not under “direct supervision” by the doctor.
We seem to forget injecting medications and substances into the body isn’t something to be done lightly. It is not as one article said “changing your hair color.” There are things which can happen: if botox is injected poorly, you can get eyelid droop. I have seen photos at our national meetings of people who lost skin on their face from a bad injection of soft tissue filler. Devestating to see or fix.
I am a surgeon. I know anatomy. I do eyelifts and facelifts and browlifts, so yes, I am better at injecting. I can visualize in my mind where I am, what is important nearby, and what is safe. I recently went to a CME (continuing medical education) workshop where we dissected cadaver heads (yes yes, I know it isn’t how you would like to spend an afternoon). It was fantastic. But I was amazed at the number of physicians with busy injectable practices who were not surgeons, and didn’t know their anatomy like we plastic surgeons do. They do not know exactly where they are when they stick the needle through the skin. I was surprised.
The bill AB252 is to stop the medispas from running amok. These are medical procedures with real risks. When done well, those risks are low. But we shouldn’t forget we are doctors. I like the California Medical Board’s Synopsis:
‘Medical Spas . The increasing popularity of cosmetic
procedures or treatments, and the lucrative business they
offer have given rise to a new model of providing cosmetic
services outside the traditional physician settings and
into malls and local spas. Medical spas or popularly known
as “medspas” are increasingly becoming the destination for
various cosmetic procedures or treatments.
has posted on its web site a fact sheet. The fact sheet
indicates that “medical spas are marketing vehicles for
medical procedures. If they are offering medical
procedures, they must be owned by physicians. The use of
‘medical spa’ is for advertising purposes to make the
procedures seem more appealing. In reality, however, it is
the practice of medicine. There is no harm in seeking
pampering or in wanting to look better. A visit to a spa
may provide a needed respite for our stressful lives, and
treatments that make us look better often make us feel
better. The Medical Board, however, is concerned when
medicine is being marketed like a pedicure, and consumers
are lead to believe that being injected, lasered, and
resurfaced requires no more thought than changing hair
color. According to the MBC’s fact sheet, cosmetologists,
while licensed professionals and highly qualified in
superficial treatments such as facials and
microdermabrasion, may never inject the skin, use lasers,
or perform medical-level dermabrasion or skin peels. Those
types of treatments must be performed by qualified medical
personnel. In California, that means a physician, or a
registered nurse or physician’s assistant under the
supervision of a physician. Patients must know the
qualifications of persons to whom they are entrusting their
health. Those seeking cosmetic procedures or treatments
should know that the person performing them is medically
qualified and experienced.
SO. Who is doing your injections? Clearly my bias is a plastic surgeon doctor. Board certified by the American Board of Plastic Surgery. Next would be other doctors trained specifically to do injections, dermatologists and facial plastic surgeons. Then it falls apart a little for me. I know of nurses who are excellent at what they do…but how are they trained? do they know the anatomy? and more importantly do they get complications? how do they treat them? The true test of someone is not what they do when all goes well. It is what they do when it doesn’t.
Sculptra is not a new soft tissue filler. It has been out for years and is good to add volume to the face. What started out as a basic treatment for those with “lipoatrophy” (when your cheeks are hollow and sunken from losing your facial fat), has now been approved for cosmetic applications by the FDA.
Sculptra is a collagen stimulator. In english that means it seeds the face and stimulates your body’s own collagen production. Essentially you are thickening your own skin, with a little kick start by the sculptra. The benefit of this is a slow change, a natural look, and a natural substance- your own collagen. It requires a series of two to three injections spaced by 4- 6 weeks. The results last an average of 25 months.
Sculptra is applied all over the face: the tear trough (lower eye), the cheek, the jawline, the eyebrown bone, and temporal region. When we age, we lose a little fat from all over. The goal of Sculptra is to replace soft tissue fullness. Youthful faces are not thin and gaunt. Look at your children to see what youth looks like. The other fillers in major use are hyaluronic acid fillers (Juvederm, Restalyne). They have a wonderful results, are immediate gratification, and can be used in the lip (Sculptra cannot). But if you need volume- two, three, four syringes of a HA filler, every 6 months, it adds up in time and cost. Scultpra has been approved for 25 months of longevity. I like it because there is good science behind it, showing histologic biopsies with the newly produced collagen. It is not a magic answer. But for many women who are in their 40s and 50s, particularly those who don’t want to do a facelift, it gives a longer lasting alternative to help rejuvenate the face.
Over the past decade plastic surgeons have shifted from taking fat out of the face to adding fat to the face, or “volumizing.” The analogy is your face is a beach ball, gradually deflating over time. When you want to fix the beach ball, you need to add air. The “air” is soft tissue volume. You will now see most of us plastic surgeons during our lower eyelid surgery won’t remove fat, doing what we call a “fat preservation” technique. We graft fat to the face: eyelid tear trough, cheek, and lips. Back when I was in residency, they advocated removing the cheek fat (buccal fat pad) to give that hollow cheek look. Now we would never imagine that.
Sculptra will be starting their new advertising campaign soon, this Fall of 2009. It was just approved by the FDA for cosmetic use. I think it is a good product. I have been using it for a while, and I am pleased by the results.
Lauren Greenberg M.D.
750 Welch Road, Suite 117
