So I just got back from one of our cosmetic society meetings in chicago and there are certainly alot of things to talk about. I did want to briefly address a topic that has been growing quit a bit. Non invasive nasal reconstruction is getting more and more popular. Using various fillers and botox/dysport we can alter the shape of the nose. Although it is certainly no replacement for nasal surgery, using these non invasive techniques certainly supplement the process. The simplest treatment is performing a slight lift in the nasal tip, which is a common complaint, with botox or dysport. By relaxing a muscle that pulls the nose down over time we can accomplish this. Unfortunately, it does take maintenance. Using fillers such as juvederm, restylane, and radiesse we can smooth out some bumps and reshape some asymetries that exist in the nasal structure. This is very common after nasal surgery where the result may not have been ideal. Nose job surgeries, like many cosmetic surgeries, are not perfect and 100 percent predictable. Instead of undertaking an additional surgical procedure, these non invasive alternatives can be very useful to acheive the desired result. For a permanent result, silicone microdroplets can be used once a temporary filler establishes a satisfactory result.
Although this is now commonly performed, it is essential to seek out a medical professional that has alot of experience with fillers. These are advanced techniques and they do have aesthetic and medical risks. So in summary, the advances in fillers and toxins really have enhanced rather than replaced the surgical means in changing nasal shape. Depending on the desired result there are instances that surgery can be avoided but this is not always the case. Consultation with both an expert in nasal surgery and a cosmetic dermatologist with expertise in fillers is necessary if considering these treatments.

So i want to address an article that came out in one of the beauty magazines last month. It discussed the use of various fillers for the body as opposed to merely the face. I often get asked this question in my practice as it seems logical that if we can now sculpt and volumize the face that we can also accomplish this with the body. The fact is that it is possible but there are some logistical issues that often make it unrealistic. 1st off – most temporary fillers such as Restylane, Juvederm, Radiesse and Sculptra would be too expensive to use in significant volumes that would be needed for areas such as buttocks, breasts, hips etc. There are attempts being made with products such as Macrolane which is a hyaluronic acid fillers used in Europe for supposed breast enhancement. Unfortunately, its use is not very popular because it just does’nt compare to implants. You need to inject an enormous amount of it to get significant results and it is temporary. Implants are more consistent and natural appearing. There are certain instances such as body scars/defects and occasional deep cellulite pockets that I would perform body filling but it is not the norm. The most logical filler for body enhancement is one’s own fat. We certainly perform this in my practice. BUT…it is not common to find a patient who desires body fat transplatation to have enough donor fat from another area of the body. In addition, fat is not necessarily permanent either and would require several rounds of transfer to get enough fat to “stick” (this is true in the face as well). Fat transfer is most commonly asked about in reference to buttock enhancement…aka the brazilian butt lift. I do not perform this procedure because i have found in my own hands and also the results of many other physicians to be extremely inconsistent and often unattractive. The recovery is uncomfortable, the results often unnatural looking and most importantly too temporary to be worth the surgical procedure. There are some doctors that would disagree but most, including myself, believe that an implant is a more suitable option for buttock enhancement. So, pessimistic as it seems, i do believe that, as with all cosmetic technologies, we will see advancements in this arena. Although there are exception to the rule, i still believe that there are significant limitations in performing body volumization. I look forward to investigating, practicing, and writing about new options of treatment in the future.

Ah yes, another filler battle ensues…… People want to know “which is better”. The short answer , to me, is Radiesse. Many well respected dermatologists and plastic surgeons would disagree. Which is fine….this is my blog …they can start their own. The long answer goes like this.  Radiesse and Sculptra are both FDA approved fillers that work best for overall volume enhancements….cheeks , chins, temples, hands, etc.  Both put “air back in the balloon”, so to speak. Both can be used to achieve excellent cosmetic results that depend more on the injector than the substance itself. So aren’t they just interchangeable?…..not so much.   I like Radiesse for several reasons. First, it is a natural substance already found in the body. To date I have seen zero reactions. Sculptra is made of a substance that is foreign and more reactive (many sutures are made of similar material).  I have seen many reactions or unsavory aesthetic results pass through my office, fortunately from other injectors. Sculptra does last longer than Radiesse but I have found it much less predictable – meaning in some patients it disappears too quickly  and doesn’t cause enough of an clinical effect or the filler develops too much and lasts way to long. Much of this lies in the fact that Sculptra must be performed in several treatment sessions with the effect “building’ over time. Radiesse, I inject whatever I need in one treatment session and the results are in general, immediate and predictable.  And finally, Radiesse, I have found, to be much more cost effective for the patients and the physician. In my practice, 1 1.5 cc syringe of Radiesse has been equivalent to one bottle of Sculptra in patient effect. The substance itself is cheaper than Sculptra and the ability to perform all  necessary filling in one treatment session allow the physician to discount the additional syringes used. So there you have it. Being the only juror in this discussion, I am certainly biased. My opinion may change but Radiesse works for me and my patients. Obviously they both exist because there are many that like Sculptra. Only time will tell if one is superior.

What is Selphyl and is it a new anti ageing breakthrough?. Selphyl is a name brand of a treatment protocol for harvesting and injecting “platelet rich plasma”. This is a biologic substance derived from one’s own blood. Used successfully in orthopedic procedures for years ,“PRP’ treatments has helped promote healing by utilizing growth factors from harvested blood.
For cosmetic use, The procedure takes about 20 minutes to draw and process the blood of a patient. The substance is then injected in to wrinkles and scars to achieve a filling effect. The question is – does it work and how will growth factors improve wrinkles and scars which aren’t really a type of wound. Pros- this is a natural substance from one’s own body and it will have some sort of a filling effect Cons- it will unlikely have the same filling or lasting effect of many of the fillers on the market currently and it is unlikely that growth factors are going to dramatically change wrinkles and sundamage.
This may be a good option for those who cannot tolerate other fillers or as a adjunct to other procedures. The goal is that injecting one’s own growth factors may help to rejuvenate the skin over time. We shall see!

So…a simple and common question i get daily is Restylane vs Juvederm. My answer…..Coke vs Pepsi. Both are colas or more specifically hyaluronic acid based fillers for wrinkles. Both are similar but slightly different in consistencies and concentration. Cost the same, lasts essentially the same (some swear one way vs the other). They are both excellent fillers used for moderate lines on the face particularly smile lines and under the eye hollows. My preference…for now, i generally use Juvederm. I find it bruises slightly less and has a softer consistency. Then again, i could never tell the difference in taste when taking a Pespi challenge. I’ll stick to cosmetic dermatologist.