Injectables: The Real Real. Part 2 of 3 Neuromodulators (commonly “Botox” “Dysport")

Ok, first, a neuro what what? Neuromodulators = Injectable wrinkle-relaxers to smooth fine lines on the face.

If someone’s ever told you to “beware of that Botox look” then they’ve never had it done well, or they've never seen great work applied with an expert hand. Drs. Cynthia and Julie take their time so that you are given the right injections and amount to fit your personal needs and goals. Here’s the real-real.

Neuromodulators for Aging Skin via The American Society for Dermatologic Society

Neuromodulators – wrinkle-relaxing injections of botulinum toxin commercially known as Botox, Dysport or Xeomin – are used to treat wrinkles, frown lines, and crow’s feet. A minute amount of the neuromodulator is injected directly into the underlying muscle, causing it to relax and gradually smooth out the appearance of the overlying skin. Botox can also be used to treat chronic headaches and hyperhidrosis (excessive sweating) in addition to relaxing the facial muscles.

Why choose neuromodulators for aging skin

• Non-invasive — does not require surgery
• Can be quickly performed in your doctor’s or medi-spa office by a certified physician
• Virtually no recovery time
• Very preventative

How to prepare for the procedure

Before the procedure, a consultation is scheduled. This is the time for the doctor and patient to discuss expectations, potential risks and outcomes of the procedure, as well as review a full health history. Wrinkle relaxing injections can last 3 to 6 months. Although there is very little risk of bruising with Botox or Dysport injections, we recommend the following steps the before your treatment:

• A week before treatment, discontinue aspirin or ibuprofen and take Tylenol for pain relief instead.
• A week before treatment discontinue Fish oils, Omega complexes, vitamin E, and St. Johns Wort.
• 48 hours before treatment, reduce or discontinue garlic and alcohol consumption.
• Take a dose of Arnica Montana, the homeopathic remedy, 24 hours before treatment.
• Be sure to tell your doctor about any medications you take. Medically necessary blood thinners should NOT be stopped. 
  
  

What to expect after the procedure

• Virtually no recovery time is required after neuromodulator injections.
• Patients should take care not to rub treated areas, which could cause it to migrate to another area.
• We like to advise no vigorous workouts for 48 hours, no facials, brow waxing or massages for 7 days post-treatment.
• Remember, it can take 3-5 days for Botox or Dysport to settle in and take full effect. 
• We always recommend a follow up with your doctor to evaluate the results and provide a complimentary touch up if needed.

Source: https://www.asds.net/Neuromodulators-for-Aging-Skin/

Injectables: The Real Real. Part 1 of 3: Dermal Fillers

Because there is a lot of folklore out there about Botox, Juvederm, Kybella, and others, let’s break down injectables by separating them into their respective categories and three sections since we get a lot of great questions about these!

1. Dermal Fillers
2. Neuromodulators
3. Kybella--a category of its own!

1. Dermal Fillers (commonly Restylane or Juvederm)

First, let’s talk about dermal fillers.

To demystify most of the folklore about fillers specifically, the Wikipedia entry of facts:

Dermal filler From Wikipedia
Injectable filler (injectable cosmetic filler, injectable facial filler) is a soft tissue filler injected into the skin to help fill in facial wrinkles, restoring a smoother appearance. Most of these wrinkle fillers are temporary because they are eventually absorbed by the body. Some people may need more than one injection to achieve the wrinkle-smoothing effect. The effect lasts for about six months or longer. Successful results depend on the health of the skin, skill of the health care provider, type of filler used.

In the US, fillers are approved as medical devices by the Food and Drug Administration (FDA) and the injection is prescribed and performed by a healthcare provider. In Europe and the UK, fillers are non-prescription medical devices that can be injected by anyone licensed to do so by the respective medical authorities. They require a CE mark, which regulates adherence to production standards, but does not require any demonstration of medical efficacy. As a result, there are over 140 injectable fillers in the UK/European market and only six approved for use in the US.

What it is

There are several types of dermal filler that can be injected into the skin, providing a rejuvenating effect. At Advanced Aesthetics, Drs. Cynthia and Julie prefer hyaluronic acid (HA) based fillers because they are the safest to inject, have the fewest side effects, and can be easily reversed. There are many types of HA fillers and each has unique qualities. Some fillers are best used to lift the cheeks, while others are better for subtle and natural enhancement of the lips and correction of under eye hollowness. Fillers can stimulate your own collagen and improve skin texture. Most fillers will last 6-12 months, but some may last as long as 2 years.

Done with an expert hand, your face still moves and shows the courage, laughter, and spontaneity that makes you, you. When we see over-done work, it’s really a shame because it often has the reverse effect.

How it works

Dermal fillers, also known as "injectables" or "soft-tissue fillers," do just what their name suggests: they fill in the area under the skin.

• filling in wrinkles, fine lines, and deep creases
• increasing facial volume in the temples
• improving other imperfections like scars
• plimping earlobes so earrings hang better
• filling out thin or wrinkled lips
• plumping up cheeks
• contouring the jawline and other areas of the face
• changing the contour of the nose

How to Prepare for your procedure

Drs. Cynthia and Julie offer a 30-minute complimentary consultation, during which you can discuss treatment expectations, costs, risks, outline a treatment plan, as well as go over your health history. Although every precaution is taken, there is always a chance of bruising at the injection site. To reduce the risk of bruising, we recommend the following:

• A week before treatment, discontinue aspirin or ibuprofen and take Tylenol for pain relief instead.
• A week before treatment discontinue Fish oils and Omega complexes, vitamin E and St. Johns Wort-they are blood thinners.
• 48 hours before treatment, reduce or discontinue garlic and alcohol consumption.
• Take a dose of Arnica Montana, the homeopathic remedy, 24 hours before treatment.
• Be sure to tell your doctor about any medications you take. Medically necessary blood thinners should NOT be stopped. 

Bottom line? They’re safe and highly effective. It’s been proven that injectables have an anti-aging and preventative effect. That’s not to say you should start at age 19 getting treatments. Instead, it’s something to consider when there’s a feature that starts bothering you every day. And you don’t have to look like you’ve “had work done.” It’s the expert hand that matters most, not the juice. Lastly, yes, they’re on the expensive side but provide long-lasting results. There have been plenty of articles written about why bargain-shopping for injectables is a bad idea -- namely, they are often diluted or you are being used as a practice-client while the person builds up their skillset. Be cautious.

The reason LNAA invited Dr Cynthia Ruggero, Medical Director for Medical Aesthetics and Dr Julie Seaman, Medical Aesthetics, to join our Studio is because of their years of successful cosmetic and medical work in addition to their approach. Injectables offer our clients a long-lasting way to complement their focus on smooth, vibrant skin and offset some of the effects of aging in a way that supports their outlook and lifestyle.

If you’ve ever been curious about them or have questions you were afraid to ask, reach out to us.

Injectables: The Real Real. Part 3 of 3, Kybella (commonly “double-chin-melter”)

Kybella is the first non-surgical way to reduce submental fat, or the dreaded double chin, without surgery, providing results similar to liposuction.

In the last five years, the number of body contouring procedures has grown two and a half times. This growth is reflective of consumer concerns. New procedures offer even more minimally invasive treatment options, such as Kybella, popular for fat below the chin, and micro-focused ultrasound used for skin tightening. (https://www.asds.net/_Media.aspx?id=10114&terms=kybella)

“The drug designed to treat my “submental fat” (the fat pocket under the chin) is the new cosmetic injectable Kybella, which promises to dissolve fat cells through a series of injections. There’s very little downtime, it’s noninvasive and nonsurgical, and there’s little risk. The drug is the first (and only) injectable designed to contour away the dreaded double chin...The process can be relatively slow, with results taking weeks or more often, months. This can be discouraging, especially to people who are self-conscious about their chins to begin with. The good news is that once your months-long process is completed, those fat cells are not coming back. There is no upkeep to consider or future costs.”

(source: The Atlantic June 2017 https://www.theatlantic.com/health/archive/2017/06/kybella-the-injection-that-melts-a-double-chin/529893/)

Why people choose Kybella:

• Non-invasive — does not require surgery.
• 90% of patients experience long-term effects.  
• A contoured jawline can make you feel more confident and appear younger.

How to prepare for the procedure

Before the procedure, a consultation is scheduled. This is the time to ask any questions you have and to discuss the desired outcome with your doctor.

• To reduce the risk of bruising and swelling, avoid taking aspirin, non-steroidal anti-inflammatory medications, St. John’s Wort, or high doses of Vitamin E supplements for one week prior to treatment, consult your primary physician before discontinuing any normally prescribed medications. We recommend taking Arnica Montana for a day or two prior to your treatment to reduce the risk of bruising. If you have a medical condition that affects clotting or are on a medication which affects blood clotting, you must get your primary care doctor’s approval before taking arnica.
• For men, the treatment area, the neck and under the chin, should be clean-shaven the morning of the treatment.
• You may take Tylenol after your treatment to minimize discomfort.

What to expect after the procedure

Since everyone’s chin profile is different, the number of treatments varies from patient to patient. We will help determine how many treatment sessions you need based on the amount and distribution of your submental fat and your personal treatment goals. Each Kybella treatment session is given at least 1 month apart, and you should not receive more than 6 treatments. Most patients experience full results with 2-4 treatments. 

Unlike fillers and neurotoxins, which offer semi-permanent results, Kybella is meant to permanently kill the fat cells, dissolve them, and help your skin tighten up a bit and improve contour. The results are not instant, but they are permanent.

After the treatment(s), you will likely have some swelling, bruising, or numbness under your chin which can last for one to four weeks. When we tried the treatments here, we wore a lot of scarves and turtlenecks for the first week!

 If there was one procedure more and more clients are asking about, it’s this one.