Tag Archives: hyaluronic acid

Hyaluronidase; Just In Case: injectables for beginners.

15 Jun

I’m so good at rhyme. I’m just saying.

One in 5 women has interest in doing Botox, but has a billion questions, and it’s overwhelming. The inability to find the answers leaves this grey area of fear that supports a misguided rumor-mill of what Botox actually is. You can’t believe everything you read, and you certainly can’t believe everything you hear (unless I wrote it or said it. Then it is pretty much a fact).

‘The oldest and strongest emotion of mankind is fear,

and the oldest and strongest kind of fear is fear of the unknown.

-H.P. Lovecraft ( ßI wonder if his parents are from Amherst… strange name… but good quote none-the-less).

New to the World of Injectables?

Usually, the first place we go to is the internet, but when it comes to health-related issues, this is not the best place to sift through to find information without training in How To Read A Medical Article (this is an ENTIRE class, and it is REALLY hard). And unless your best friend is me… there is a lot of misinformation going around via word of mouth.

To those readers who have never done a procedure, it is all the same. It’s ALL called Botox. (That’s NOT Botox..)

 

It’s Not All Botox!

There are a lot of injectable products on the market, and the world of Botox and Fillers is doing nothing but growing. Every person has a different face and different goals with aesthetics. So it needs to be the right product for the right problem, and really only an expert can decide what that is. Since I love making charts, I made a chart of the basic differences between Botox and Fillers. That’s important to know.

***Super Important Information Chart*** for lack of a better title.

Botox (or Onobotulinum Toxin A)

Fillers

Injected into the muscle.

Injected into folds.

Causes temporary “relaxing” of the muscles into which it is injected.

Causes temporary fill of folds into which it is injected.

Does not give any volume to the face.

Gives varying degrees of volume depending on the product used, the amount of product used, and the area being treated

Goes into lines that are a result of muscle movement.

Goes into folds that are a result of gravity and bone remodeling.

Botulinum Toxin family includes Dysport, Xeomin, Reloxolin, but they all basically do the same thing (but are not interchangeable in dosage) and are injected the same way into the same place.

No one uses collagen anymore. These products are way more advanced. We’re talking Hyaluronic acid (Juvéderm, Restalyne) and Calcium Hydroxylapatite (Radiesse). Sculptra (although technically a biostimulator) is in this family as well.

Lasts 3-6 months.

Lasts 4 months – 2 years depending on the product.

Is a thin liquid when injected.

Ranges from a thick gel (Radiesse) to a thick liquid (Sculptra).

Usually doesn’t bruise.

May bruise, depending on things like the technique used for injection, the amount of product injected, the size of the needle used.

Pinches, but requires no anesthetic.

Requires both topical and local anesthetic. And even then isn’t always completely painless (depends on the area you are injecting).

As we can conclude from my awesome chart, Botox and Fillers are very different products. The left side of the chart is pretty straight forward. If the line is a result of muscle movement you can inject Botox to improve it. The Botulinum Toxin family has the same properties and effects for the most part… and 99.9% of the time you’ll be receiving Botox. It’s a household name.

Fillers on the other hand… way more confusing to the novice patient. To anyone who has never undergone an injectable procedure, they are all called “doing Botox.” But, once the decision has been made to investigate what all the hype is about, there is a very VERY steep learning curve. So where should you start then?

The Hyaluronic Acid Family

There’s a few different kinds of HA’s. Restylane, Juvéderm, and Perlene are all examples of products in the Hyaluronic Acid family. They are all very different as well. They can last from 4 months to a year (Juvéderm lasts the longest… and is currently the #1 seller of HA’s).

Hyaluronic Acid is a sugar that your body naturally makes that attracts water molecules. Everything your body naturally makes, your body also naturally breaks down. One of the best things about trying Botox and Fillers is that they don’t last, so if you decide you don’t like the result of a treatment, the good news is, it isn’t forever. Unfortunately, that is also the bad news. But for a beginner, there literally is a product that can dissolve any HA injection that is not to your liking. This is a huge positive for people who are new to fillers.

Fortunately for me, I’ve never had to use Vitrase. My policy on filler removal has always been to wait two weeks post injection and to re-evaluate the area. Swelling can last about two weeks, and I like to take this into consideration as well as the initial “shock factor” some people can experience.

Hyaluronidase is an enzyme that acts at the site of injection (i.e. does not travel systemically) to break down and hydrolyze hyaluronic acid. Tissue permeability is increased. There is a temporary decrease in the viscosity of the HA, promoting diffusion of the injected product and facilitating the absorption of the fluid carrier.

It appears from the case studies I’ve read that this product can be injected anytime after misplacement of HA’s has occurred. From immediately, to up to five months post injection. It takes 24 hours for a majority of the HA to dissolve post hyaluronidase injection.

****Why not always use HA’s? …because they’re more expensive. But remember: Right product, Right place, Right person.

The world of Fillers is expanding. There’s a handful of products out there, and they’re all formulated just a teeny tiny bit different. It’s not all Botox, and it’s not all the same. If you need a starting off point, because you just don’t feel comfortable with the information overload, HA’s are definitely the safest bet. Because they can easily be dissolved if you don’t like the result… but I’ll put money on the opposite happening. J

XOXO

LK

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Under Eye Circles and Bags

16 May

Physiology: Broken blood vessels within the lower eyelid. A shadow forms underneath the bag causing the dark circles to appear. As you age, the “bags” (fat pads) can bulge due to gravity, creating an exaggerated space between the skin of the check, and the skin of the eye, over the orbital rim (bone of the eye socket). These dark circles can bring about a chronically fatigued look, or make you appear older than you actually are.

Cause: range from fatigue, vitamin deficiency, hyperpigmentation, allergies, age, and medical conditions. However, heredity is the most common cause for bags under the eye (also, from my patient’s personal experience… I hear children and husbands may also be contributors? It has not been clinically proven however.).

Treatment:

Getting the proper rest and eating the right foods can sometimes help treat and improve dark under eye circles, but if genetic, dark under eye circle will increase if untreated.

Fraxel®, Thermage®, Blue Light Therapy, IPL Photofacial, Dermal Fillers and Chemical Peels (like TCA). Patients with more severe cases of under eye circles, puffiness and loose upper or lower eyelids may want to seek out surgical alternatives including blepheroplasty.

My Best Advice

It is always a good idea to start with the least invasive methods and move on to the most invasive methods. That being said, genetics does play a HUGE role in this, and if your mom or dad has extremely sagging lids, or bulging fat pads, the earlier you do surgery the best result you will have.

Least Invasive to Most Invasive

  1. Hydration: The area of skin under the eye is the thinnest in the body. In a hospital setting, we monitor this area as a sign that a patient could be dehydrated. I can always tell when someone needs fluids just by looking at this clinical sign. Start with drinking water… water is good for your body all around. And… it’s FREE!
  2. Eye Cream: Supply your skin with the nutrients it needs. By depositing certain vitamins and peptides, you can decrease the appearance of dark circles. Before you tell me you’ve tried every cream under the sun… have you read my post on pharmaceutical products? Step 2: Spend wisely.
  3. Noninvasive treatments: Laser stuff. Not my area of expertise, however, I have had IPL on melasma, and it worked great. Laser treatments will help with the discoloration, and may subtly tighten the skin, but they will not fill volume loss. If you have volume loss, see step 5.
  4. Chemical Peels:  Best done in the winter time when you’re not in the sun.  And actually… this is more for fine lines and wrinkles around the eyes than bags and dark circles.  Although it will help the appearance.
  5. Dermal Fillers : (That’s NOT Botox..) A hyaluronic acid of low molecular cross linking like Juvéderm Ultra is most recommended for this area. Thicker fillers, like Radiesse, and biostimulators, like Sculptra, are not recommended for this area. Remember this skin is the thinnest in your body, and thicker products can leave bumps here. Be VERY careful about who you see for this treatment. It is a very advanced procedure that your Dentist or Primary Care probably shouldn’t be performing on you.
  6. Blepheroplasty: Check out my post on Blephs. Observing Surgery: Blepharoplasty.

Dermal Fillers

Dermal Fillers are my area of expertise (Remember photography is also not my thing!!!)

Here’s my Before and After Tear Troughs:


Before: I look tired. And old. Ew. Taken November 2011.


After: As you can see I look more awake and refreshed. Taken February 2011 after I had my tear troughs filled.

I am very happy I did this. Surprisingly, it didn’t hurt at all. The product used was Juvéderm Ultra. It will last about a year. Cost is about $600.

Creams

(The two I like best)

Image Max Eye Cream: This next-generation revolutionary day and night eye crème contains high concentrations of growth-factors derived from plant stem cells to protect skin cells and prevent aging effects caused by free radical damage. Reduces the appearance of fine lines and wrinkles; reduces puffiness and inflammation. Prevents cell aging. Contains grape, alpine edelweiss and apple stem cells for maximum age prevention. Corrective peptide blend for rejuvenation. Retails for about $45

Image Vital C: A scientifically- advanced hydrating, anti-aging eye gel. Contains a blend of nourishing anti-oxidants that reduce the appearance of fine lines and prevent the breakdown of collagen. Vitamin K  (Phytonadion) diminishes dark circles. Restores youthful looking eyes. Retails $31


That’s NOT Botox.

18 Nov
Another strong misunderstanding a lot of people have around the Boston Area is what products go where Botox does not.   If it’s caused by gravity:  THAT’S NOT BOTOX!

HYALURONIC ACID (HA) FILLERS (TEMPORARY)

Hyaluronic acid fillers are synthetic sugars that attract water molecules.  They are placed in actual wrinkles or other areas that need volume and offer instant results. They fill in marionette lines, lift up jowls or plump up volume along the jaw line where definition has been lost.

Restylane, Perlane and Juvéderm (www.juvederm.com) are the most commonly used hyaluronic acid fillers, with Juvéderm being the leading product (I refer to Restylane as ‘old school’).  There is no need for allergy testing, as these products are sugars your body naturally makes.  There is little pain with injection, as the new products come with lidocaine added as a powder to the product.   Expect a topical numbing agent (topical lidocaine) to be applied prior to injection.  This should be left on for AT LEAST 20 minutes.  The actual procedure only takes about 15 minutes.  Swelling and bruising are possible and you should probably not do a filler if you have an important event within a week from treatment.  ICE ICE ICE!  I also recommend arnica montana cream which can be purchased at GNC or Whole Foods.  You can expect results to last from six months to a year, depending on the brand and where it is placed (Juvéderm lasts the longest).

I have Juvéderm filler in my lips.  It feels and looks natural.  It was the first injectable I tried, and I’m very happy with it.  😉  I mostly just use HA’s in the lips and very deep frown lines between the brows.  Reason being, HA’s are injected into the superficial dermis and do not give as good of a fill for the cost for deep lines and folds.  I like other products more for those very deep lines.

Calcium Hydroxylapitate (SEMI-PERMANENT)

Radiesse (www.radiesse.com) is an example of a semi-permanent filler and it is made from calcium molecules suspended in a gel which stimulates your collagen. The microspheres in it create “scaffolding” that your own collagen will grow around, but is eventually broken down by the body. Radiesse can be used to fill the nasolabial folds and marionette lines, as well as define the contours of the face.  It goes deep in the dermal layer of skin, and should NEVER go in the lips!

Lidocaine topical should be applied 20 minutes prior to injection.  Lidocaine is added to the product immediately prior to injection.

I recently had a little lift put in my cheeks (as described in a prior blog).  I had zero pain or discomfort.  The lidocaine eventually traveled down my nerve from my cheek to my lips.  It felt a little funny!  It looks and feels completely natural. 

COLLAGEN STIMULATORS (aka collagen builders or stimulating fillers)

Collagen stimulators contain particles that signal the skin to produce more collagen. Instead of just filling in select lines and wrinkles, these are used on larger areas like the cheeks.  They can be used in areas where synthetic fillers look somewhat unnatural (like the lower face under the cheek area).  Results are not immediate; it takes about 6 weeks to see the result of the collagen stimulation; however, the product lasts two years.  Most women prefer the gradual change in their facial contour.

Sculptra (www.sculptraaesthetic.com) is an example of a collagen stimulator. It is approved by the FDA for restoration and/or correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus (as is Radiesse). Most patients require an average of two to three treatments six weeks apart for optimal results.

I had Sculptra injected into my temples.  Zero pain.  My patients are in LOVE with this product.  It costs about as much as other fillers when you take into consideration how long it lasts.  It also looks COMPLETELY natural due to the fact it’s ALL your own collagen produced.  I foresee this product being my number one injectable within the next year!  Move over Botox!!! 

COLLAGEN FILLERS

Although collagen fillers changed the face of beauty when they entered the marketplace in the 1980s, they quickly fell out of favor when longer-lasting hyaluronic acid was introduced. However, many doctors still use collagen, especially for plumping the lips and filling in “smoker’s lines” around the mouth.  Although overfilling is necessary to achieve the desired result, the excess fluid is absorbed over the first few hours after treatment, and minor redness and swelling subside in a few days.  Results last from two to three months… also known as a waste of money when there are so many better products!

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