Question: I have deep folds forming around my nasolabial region. Will the larger particle of Perlane injections fill in the folds more effectively than other available treatments?
Answer: Well, certainly Perlane and Juvéderm Ultra Plus are higher viscosity hyaluronic acid fillers and they do tend to fill deeper folds more effectively and last longer than their thinner counterparts. It is interesting that the longevity of these types of fillers really seems to be very individual as certain patients may get 6 to 9 months out these products and then other patients can get 2+ years out of their hyaluronic acid type injections. We are not really sure exactly why some patients get such a long lasting effect, but some feel that it is due to stem cell rejuvenation where the elastin fibers are stretched by the injection.  This then causes the fibroblasts to start creating collagen again and this tends to be a much longer lasting effect as we know that the actual hyaluronic acid filler more than likely resorbs within 1 year. Nonetheless, for those lucky patients, they get a very long lasting effect from this injection and I certainly feel the Perlane is an excellent product and you will more than likely be happy with the effect.
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Question: I am planning to have some injections to fix some wrinkling on my neck and face. I am afraid of medical procedures, so I would like to make sure that my injections are long-lasting, so I do not have to repeat the procedure. Will Radiesse provide permanent or temporary relief of my wrinkles?
Answer: Well, Radiesse is a temporary filler that can last anywhere from 6 to 24 months. I have certainly seen my fair share of patients where it has lasted for a good 2 years, but I have also seen many patients that will return in less than 6 months and the Radiesse is essentially gone. This tends to concern the patient due to the fact that this is supposed to be a much longer lasting injectable filler than the hyaluronic acids and yet in my personal experience, I have not had that to be a consistent effect. Furthermore, you mentioned having some wrinkling on your neck. I do not feel that injectable fillers are a very good way to try to improve neck wrinkling as they really will not be able to perform that function without adding a significant amount of filler and more than likely this will create some irregularities or at the very least give you too much fullness in the neck area that will more than likely be just as aesthetically displeasing as having the wrinkles themselves. I would recommend a consultation with a board certified facial plastic surgeon so that all of your options can be discussed as there are minor surgical options that can do a wonderful job of improving your neck wrinkling and these can be performed in the office setting under local anesthesia.
Question: My facial features need freshening up, but I am not a candidate for surgery due to an immunodeficiency disorder. If I have Radiesse injections to smooth out wrinkles, can they complicate my immune system problems?
Answer: I personally do not see any reason why you cannot have Radiesse injections as they really should not directly impact your immune system and as long as they are injected under sterile conditions, we should not have any issues with risk of infection. I personally believe that large boluses of the product should not be placed in any single location due to the increased risk of biofilm formation, but rather a threading technique would be more appropriate to prevent any risk of complications even though that risk is exceptionally low. I therefore recommend that you seek out a very experienced injector so that the appropriate treatment will be performed and your risks will be minimized.
Question: How do you decide which injectable filler to use on each patient? I am African American and wonder if all of these products will work on every skin type.
Answer: For the most part any injectable filler will work in any skin type and in fact, the patient’s skin type really should not dictate what type of injectable filler is used as it really is completely irrelevant to the situation. What is relevant is the depth of the area that is desired to be filled and the location of the desired effect for the filler treatment. The more superficial the depth of a depression or wrinkle is, the lighter the filler material should be. Also, if the filler material is placed very deep in the tissue, we can use a much thicker and longer lasting filler and that filler would most likely be inappropriate for placement in a more superficial area of the face. Also, very mobile areas like the lip command a much lighter thinner softer filler than more thicker areas like the cheek. So, in essence, it really does not matter what skin type you have, but it matters where we are going to place the filler and what kind of a problem we are trying to correct with the filler as to which filler we then choose. In the end, I am very partial to the hyaluronic acid fillers such as Juvéderm and Restylane, as these have an incredibly safe profile. They do a very nice job of providing the added volume that is necessary and the risk of complications with these fillers is almost zero.
Question: Is dermabrasion the right treatment for me? I have bad skin resulting from having teenage acne 20 years ago. I am worried that anything I do might make my skin even worse.
Answer: I personally am not a big fan of dermabrasion except in cases of scar revision where a revised scar may need a touch up of dermabrasion to make it less conspicuous. Even in that circumstance, I still feel that ProFractional laser treatments will most likely provide a better outcome than my own dermabrasion would and certainly for acne scarred skin, I feel that ProFractional laser will provide a better outcome than dermabrasion would and certainly have greatly reduced risk. The only downside that the ProFractional laser seems to have is that it tends to work best when performed in a series of treatments typically three, spaced out at least one month apart. I would highly recommend a consultation with our staff at the Quintessa Medical Spa so that a customized treatment plan can be made for your specific skin type and concerns and that your expectations can be met.
Question: My 16-year-old daughter has pretty bad acne and wants to have something done about it. I think she is too young for skin treatments, but she is being very insistent. Is there some sort of procedure that could help her at her age, something that is not too invasive?
Answer: First, I would recommend getting a consultation so that her acne can be properly evaluated. I would also recommend medical treatment for her acne and ultimately would even go so far as to refer you to a dermatologist for consideration of Accutane if standard medical treatments for her acne are unsuccessful. Certainly, minor spa procedures such as microdermabrasion with extractions can be very effective at improving the acne as can various light treatments that have no downtime. I certainly would not recommend any sort of treatment for any early acne scarring as she would need to have her active acne under control before we would consider evaluating and treating any actual scarring that remains.
Question: I have some stretch marks developing on the sides of my breasts and no matter how much cocoa butter and vitamin E I apply, they are staying around. Will microdermabrasion be effective in removing these stretch marks?
Answer: No, I really do not think that microdermabrasion would be a very good option for trying to remove stretch marks along the sides of the breasts, but there are various other options one being Ultherapy, which is the new ultrasound based technology that can heat some of the deeper tissue and this has been shown in our office to improve some visibility of stretch marks. The other option would be a fractionated laser such at ProFractional laser by Sciton, which can injure some of the deeper tissue, cause new collagen ingrowth, and improve upon the appearance of stretch marks. We are even starting a new protocol with both Ultherapy and ProFractional laser resurfacing for stretch marks and hope to have some nice improvements with this technique. Ultimately the Ultherapy is also going to be coming out with a transducer that injures the tissue on a more superficial plane, which is essentially into the deep dermis and we are very excited to try this on stretch marks as well, as hopefully this will provide a very nice improvement to this otherwise very difficult problem.
I personally always mix a small amount of lidocaine with the Radiesse before I inject it and, by doing this, the injections are almost painless. Certainly, nobody ever complains that there is a significant amount of discomfort involved with these injections and, overall, the injections are extremely tolerable. I recommend that you seek out someone who is a very experienced injector with Radiesse due to the fact that, if it is not performed correctly, small bumps and nodules in the surface of the skin can form, which can be rather difficult to completely eradicate. And, due to the fact that Radiesse
You really should be able to go back in the pool immediately after a Photofacial as it really has not injured the overlying epidermis and, thus, you should not be any more sensitive to the chlorinated water than you would have been prior to the Photofacial. You will have some slight redness and some darkening of the pigmentation after the Photofacial, so the skin can actually look worse in the first few weeks after the treatment. It will then rather quickly look better and then allow the provider to increase the amount of energy that can be used in your next Photofacial so that even more of the vascularity and pigmentation that you do not like can be treated successfully. But you should be able to continue your routine swimming exercise throughout this treatment regimen.
More than likely, it is safe but I would highly recommend that you not get expired Juvederm as there is really no good reason that, as a paying customer, you should be having an expired product injected into your face. These products have a shelf life somewhere around a year, so I question why an injector with any sort of experience would have a product sitting around on the shelves for that long, as it makes me want to assume that they do not perform injections very often and, secondly, in the majority of cases, they can exchange these products with their company representative so that they do not have expired products sitting on the shelf. I therefore would highly recommend that you request a non-expired Juvederm.
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