Tag Archives: juvederm

Restylane Silk for Aging Lips

12 Apr

  

A New Addition to the Restylane Family

Restylane Silk is now FDA approved for submucosal implantation for lip augmentation and dermal implantation for correction of perioral rhytids (smoker’s lines) and it is currently available on the US market.   This product provides a subtle solution to aging signs around the lip and mouth area.  It’s greatest quality is subtle enhancement; your lips will not look “done” or “artificial.”  

  

Hyaluronic Acid for Lip Augmentation

Although Restylane Silk is the first product to be FDA approved for lips, we have been using other products for years.  Juvederm and Restylane are commonly used to augment the lips in an “off-label” treatment (FDA approval costs millions of dollars and takes many years.  These products are all very safe to inject in the lips by a trained professional).  

These products, along with Belotero, are all in the hyaluronic acid family.  Hyaluronic acid (HA) is a sugar your body naturally produces; these products are synthetic gels.  Because your body naturally makes this sugar, the chances of being allergic are almost zero.  This family of products IS reversible, if for any reason, you are unhappy with the results.

The molecular structure of Silk is smaller, and the product flows to where it is needed.  It doesn’t over bulk, and is a perfect finishing agent for fine lines.  

Which product is best is really dependent on who the client is, and what result they want.  If you are looking for subtle and natural lip augmentation, Restylane Silk is the product for you!  

My Experience 

At the beginning of March, I was told this product would be available and I was so excited to try it.  Lip augmentation has always been a specialty of mine, and I was told “I would love this product for the vermillion border” (where the color changes from pink to skin-toned).  

 

I was excited to try it, but my idea of an “ideal” client for this product was way off!  I first tried it on a 24 year-old patient.  She (and I for that matter) were not impressed, it looked like nothing was done.  Then I realized I was supposed to be using it for a whole different population of client.  The older patient who didn’t want to look like anything was done!   Oops… Probably should have read the email about the product FIRST. 

So then I tried it on an employee in her 50’s.  The results blew me away!  Like always, the pictures do the results no justice.   

The final result is very natural looking.  It is hard to see from the picture, but the before has a defined ridge above the lip, which is SO much improved with the Silk injections.  (The spray tan and make-up can throw you off in the after pictures.) 

The technique used to inject this product is VERY different than previous products used to treat lips.  If incorrectly injected, the product will not give you the best results, cause swelling, and has been reported as painful by patients.  This product requires the knowledge and expertise of a skilled injector.  

I had a few clients trial the product (including my awesome mom!).  They sent me their after pictures via text.  Again, not the greatest quality pictures, but every client was extremely happy with the results and gave great feedback.  (Thank you ladies!). 

    

Final Thoughts

Because the typical Silk client is older, make sure you consider timing in booking an appointment for this procedure.  Like any injectable product, swelling and bruising are always a possibility.  You want to avoid icing post-procedure to allow the product to smoothly integrate into the tissue.  If you have a big meeting at work the next day, you probably should reschedule (…the meeting OBVIOUSLY!  Who wants to wait for such amazing results!  Plus, then the meeting will go better with your new confidence!).   

How long will a bruise last?  Remember everyone is different.  Some people don’t bruise at all.  Check out my blog on bruising info.  

Other Uses

I read Silk was also a fabulous filler to use in the glabellar crease… Blog post coming soon!   

For questions or to book an appointment with me, call my office at 781-235-4957.  You can also book online at http://www.LauraKimberleyRN.com.  


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Video Blog: Tear Trough Augmentation

18 Nov

Check out my video blog on YouTube: 

One of my favorite procedures to do since the introduction of Belotero Balance in the United States last October.

The tear trough is a grooved demarcation where the cheek skin meets the much thinner and highly vascular eye skin.  Because of the anatomy of this area, a thinner hyaluronic acid like Belotero is the perfect product (Belotero: The Buzz.).  It does not last as long as the more viscous hyaluronic acids, but it also has fewer complications.

Treatments in the middle third of the face, which contains the eyes, nose, and cheeks, require an aesthetic eye and advanced knowledge of facial anatomy.  Filling the tear trough area often requires cheek augmentation as well in order to look natural.  The cheeks can require a large amount of product depending on the degree of volume depletion.  Make sure you discuss this with your injector prior to injections!

This is a very advanced procedure, make sure you check out before and after pictures before being injected!  Many practioners do not offer this procedure because of the advanced training and skill it requires.  When done correctly, it looks AMAZING.  I’m not even a very good iPhone photographer, and I have some great before and after’s on my Pinterest and in other blog posts:

More Belotero!.

I hope you enjoyed my video.  They are really hard to make!

Aesthetic Consultation: Botox and Fillers

25 May

What to ask for and expect during consultations for Botox and fillers. consultation video

Juvederm vs Restylane for Lip Augmentation

9 Feb

Trying to decide which product you want to go with for lip augmentation?  Check out this post!  

For more basic information:

Lip Augmentation: Basic Information for Patients.

Lip Augmentation: Basic Information for Patients

4 Feb

Interested in Lip Augmentation?  Check out this video and learn the basics!

Peanut Head: Volume Loss at the Temples

29 Jul

I’d argue the most over looked sign of aging is loss of volume in the temple. As we age, the temples lose fat and begin to narrow, shifting the balance of the face downward. Volume loss here contributes to the appearance of drooping and sagging of the cheeks and eyes (see Structural Changes in the Aging Face for other changes).  It begins as early as in your 20’s. It is most notable in athletes who have very little fat on their bodies, I’ve found especially runners.

As you can see, the area of total volume loss is pretty big when you actually look at it. In order to achieve the youthful contour of the temple, a patient will require a lot of product here. Adding filler to the temple is easy and almost painless, but deciding what filler to use can be difficult, they all have pro’s and con’s.

Juvéderm

This is usually my first choice with patients. For some reason… people tend to be nervous about filling this area! The great thing about Juvéderm is that it’s disolvable. The bad thing about Juvéderm is… you need a lot of it to fill this area, and that can be expensive. I’ve found great results by diluting the product before injection. The patient can see the result immediately. It may not last as long this way, but it is a good starting point. Most people love the result and usually step up to Sculptra when they notice they need a “refill.”


Radiesse

I personally don’t use Radiesse in the temples. It always reminds me of the scene from the Real Housewives of Beverly Hills when Adrienne Malouff’s husband injects Taylor and she has this big bump in her temple and Adrienne goes “is it supposed to look like that?” Although you get more volume with Radiesse, you also have more of a chance for lumps in this area. It’s not as smooth as Juvéderm (which is literally defined as a smooth consistency gel). It’s just not my preference, but for extreme volume lost I can see it being more cost effective.


Sculptra

I personally have had Sculptra injected into my temples. Sculptra is not a filler, but a biostimulator. Over several weeks post injection it promotes collagen production. It may take more than one treatment (usually 1-3 vials 1-3 treatments) to achieve the desired result. This is the longest lasting, and most cost effective product if you consider the longevity, but up front can be expensive. If you are the type of patient who is doing multiple fillers at a time, you should probably step up to Sculptra.


Fat Transfer

Fat injections can also be used in the temples but are only cost effective if a large amount of volume is needed for the entire face. I recommend only allowing a plastic surgeon perform this procedure (although a nurse can do it in Massachusetts). The fat is harvested from another area of the body (usually the lower back) via liposuction and transferred to areas of volume loss in the face (usually not just the temple). There is a lot of swelling and bruising with this treatment and not all the fat will graft (stay alive after transfer). It is also an expensive and invasive procedure. This being said, it can yield great results for patients who really need it.


The Procedure

Numbing cream is applied to the temple. The product selected is mixed with lidocaine and deposited on the bone until achieving desired volume. There is very little pain associated with all injectable products. Bruising isn’t typical; however, there are many vessels in this area, so it can happen. Expected cost depends on the product selected, but expect to use at least 1-2 syringes during time of treatment.

Good luck!

Trying New Products

27 May

Just like tissues come in the brand “Puffs” or “Kleenex,” there are different brands of products used in aesthetic medicine.

It is very difficult for patients to determine which product is right for them without consulting with a professional… and some professionals only use certain brands of products. I’m very lucky that the office I work with (and a lot of my patients!) let me experiment with different brands.

Right product, right place, right person!

Currently, I’ve been experimenting with different brands of Hyaluronic Acid Fillers (Juvéderm, Restylane, and Belotero). I use these products in tear troughs, temples, lips, vertical lip lines, marionette lines, nasolabial folds, and cheeks. They are not for large areas of hollowness (Radiesse and Sculptra are more cost effective choices). HA’s are great to experiment with because they can be dissolved if you don’t like the result. If you are a virgin to fillers, these are a good idea to start with.

Kiss, Kiss.

We all know I love Belotero under the eyes, and I almost always use this product for tear troughs (More Belotero!.)  The only time I use Juvéderm is for patients I think really should be getting a blepheroplasty…but aren’t ready to go under the knife (Observing Surgery: Blepharoplasty.)  But what about the Lips? ….Well it depends!

The Patient’s Concern

Bigger, Fuller Lips

Juvéderm remains my go to product for lip augmentation. It looks and feels the most natural (when injected right!), and is FDA approved to last up to a year.

I have found a place for Restylane in my heart recently, however. I had my vermillion border injected about 3 weeks ago, and I love it. This product really defines the border of the lip!

Vertical Lip Lines

For women trying to treat vertical lip lines, or “smokers lines,” I have mixed feelings on using HA’s vs. Botox. I usually tell people to try Botox first. Over treating the upper lip with a hyaluronic acid can create a “monkey lip.” It doesn’t look good! I’ve seen this happen a lot with Restylane and Juvéderm.

While Belotero is a good product to treat these lines, I’ve found the results don’t last long when I mix the product with lidocaine (local anesthetic). The lips are VERY sensitive, and require some sort of local and injected numbing agent (anyone who disagrees with this has never had their lips injected—it’s a lil pinchy).

My technique is to use both Juvéderm and Belotero. As you age, you loose collagen and the shape of the jaw and teeth changes. This causes an elongation of the upper lip. If you look really closely at an angle there is a horizontal ridge above the lip line. I fill this ridge with Belotero. The lips also begin to thin as you age. Juvéderm into the wet/dry border replaces this volume loss. I have found it can improve vertical lip lines when injected into the vermillion border and manipulated into the vertical lines. It may not completely get rid of them, but it will improve them, and it looks very natural (not like a monkey lip).

Downturned Corners

Changes in the shape of the jaw and gravity causes the corners of your lips to turn downwards as you age. By giving support to the lower lip in areas of volume loss, that from can be turned upside down before it turns into a full out marionette line (which Radiesse is the best for!).

To read more about lip augmentation check out Pucker-Up, Princess – Damn Sexy Lips.

Love Big Lips!  Lips, Lips, Lips!.

More Belotero!

27 Feb

Belotero: The Buzz.

Belotero has been my #1 selling injectable since it has been on the market (September). It gets into the small little lines that no other product really can with the natural result that Belotero offers.

The procedure I do the most? Under the eyes! It literally takes 10 years off your face! I might not be able to take away sleepless nights and stress, but at least I can make it look like I did by improving Under Eye Circles and Bags! I’m so thrilled with this product I did my own under eyes (called the tear trough). December was so busy and stressful, I was looking really tired. I did my under eyes about a year ago with Juvéderm, but Belotero is much better designed product for this area (read why below).

Do you see how tired I look? (I hate sharing before pictures of myself with no makeup!)



A little numbing cream is put under the eye for about 20 minutes. Then the numbing cream is removed and the face is marked for anatomical landmarks. This is just how I mark the face. Other injectors might do it differently. I am also aware I need an eyelash fill REAL bad.


Looks so much better after!!! It didn’t bruise or hurt at all!



Look at my dark circles. They are TOTALLY gone. I swear I have NO advanced computer knowledge what-so-ever. These are straight off my phone!

Belotero vs. Juvéderm vs. Restylane

Why do I like Belotero under the eyes more than other Hyaluronic Acid (HA) products? Belo doesn’t have any hydrophilic effects (hydrophilic = attracts water molecules). Plus or minus a little bit of swelling, the correction looks the same the next day, the next week, and the next month.

Juvéderm and Restylane are also in the HA family, but have a hydrophilic effect. This means the product will take on water molecules after it is injected, giving the area treated more correction over the next few days to weeks. Great for your lips and cheeks. Not great in the ultra thin skin under the eye. When this area is over treated you will see a bump or a bluish hue from the product. It’s not pretty. But it can be dissolved!  Hyaluronidase; Just In Case: injectables for beginners..

I also like Belotero because the product is thinner, which means it can be deposited in more superficial areas with a smaller needle and less pokes! Yay!

**Remember though: It’s the right product for the right place for the right person! Discuss which product is right for you and why during a consultation!  For more general information on which product is right for you What Goes Where?

More Before and After Pictures


The above patient had 0.2cc of Belotero to her tear trough area. It was two injections. The patient stated she did not even feel it (topical numbing cream was used prior to injection). The patient experienced no bruising associated with the procedure.

The above patient is a good candidate for filler in this area because the dark circles under her eyes are accentuated by a shadowing effect from volume loss. By replacing volume, the skin of the eye and cheek become more continuous as opposed to separate.


The above patient had 0.3cc of Belotero to her tear trough area. Topical numbing cream was used prior to injection, and there was no pain associated with the treatment. The patient experienced minor bruising the day after the injection which was easily covered with make-up.

The above patient would be a good candidate for a blepharoplasty. Although there is a clear demarcation of her tear trough, and filler drastically improved the area, the root cause of the delineation is not so much volume loss as it is a herniated fat pad. This fat pad is supposed to cushion the eye as it sits in the eye socket. Numerous causes contribute to the pad “bulging” out.

Interested in learning more about blephs?  Read Why I Chose To Have an Eyelid Lift.

The above patient had 1cc (1 syringe) of Belotero to her superficial marionette lines with great improvement to the texture of her skin. Topical numbing cream was used. The patient did experience some minimal bruising the day after the procedure. She is very happy with the outcome.


XOXO, LK

Above picture:

2 months after my Belotero treatment

3 days into the annual Cutera Conference in Las Vegas (so, I haven’t slept in 3 days)

1 week post break-up with my boyfriend

And still looking refreshed! Thanks Belo! Qué Bella!

(that’s Spanish I think…)

Will it hurt?

24 Nov

Pain is such an abstract and obscure concept. You can’t really define it. It has so many dimensions. In the hospital, we assess pain on a scale of either facial expression charts or numerically from 0-10. Zero being no pain, and 10 being the worst pain you’ve ever felt in your life. It is an individual experience; the numerical response to a stimulus can differ drastically from person to person. So, whether or not something will hurt is relative.

    Source: http://www.pamz.com

On a Scale of 0-10…

What’s the most painful thing I’ve ever experienced? First, a broken heart. That took a really long time to recover from… and I definitely still have scars! The second most painful thing I’ve ever endured is being in a car accident, which I also still have issues from. I’ve never gone through childbirth, never been divorced, still have both my parents, and never had a kidney stone. So my list has room to change. I’d like to point out that my list does not include Botox, Fillers, or my recent surgery. But that’s what this post is about. Do aesthetic procedures hurt as much as people think they will?

Beauty is Pain

We’ve all endured painful treatments in the name of beauty. Ever tweezed your eyebrows? Waxed your lip? Burned yourself with a curling iron? Stuck an eyelash wand in your eye? Walked more than a street block in stilettos? All painful, but relatable, every day examples of things women do in the name of beauty.

If you asked 100 women the same question, you’d get a 100 different answers. This is because women never have a “yes” or “no” answer. It’s always a story. So here’s a comparison story.

Q: How painful are stilettos?

A: Well, that depends.

  • How big are the stilettos
  • How long are you wearing them for
  • How far will you need to walk in them
  • Who makes them
  • How often do you wear stilettos
  • How often do you wear those particular stilettos (i.e. are they broken in)
  • What condition are your feet in (i.e. do you have any blisters)
  • What size are the stilettos vs. what size are your feet (i.e. does the shoe fit)
  • What are the road conditions for which you will be walking in them (i.e. changes in elevation)
  • What are the weather conditions for which you will be wearing them (i.e. rain or snow, inside or out)
  • Etc, ect, ect.

So, when you ask how badly something will hurt, there are many conditions which will change the outcome. It’s hard to explain the pain factor of beauty. The “Universal Pain Assessment Scale” does not really work when it comes to women and what they’re willing to endure. So… I decided to paint my own comparative scale. Because I love “Paint” (the computer program) and I love making stuff relatable.

The “LK Aesthetic Comparative Assessment Scale”

I’m not going to lie. This took me a long time to create, and it’s pretty scientific (although has no reliability or validity, it is merely my projections). This is how it works. Each treatment is rated in 3 dimensions on a scale of 1-5. Then those 3 numbers are added.

Chemical Peels

Laser Hair Removal


Laser on the Face



Eyeliner Tattoo


Botox


Fillers


Some fillers hurt more than others. The worst is the lips. I used that for the pain scale, but other areas hurt much less.

Tear Troughs    2

Cheeks        2

Marionette Lines    3

Naso-Labial Folds    3

Plastic Surgery

In all fairness… I think surgeries could be subcategorized. I heard liposuction isn’t really that bad. I guess it depends how well you are medicated too. Pain is relative.

I Hope this gave some perspective! Remember, this scale holds no scientific basis.

XOXO. LK.

What Goes Where?

4 Aug

Prior to 2002, there was one type of facial filler: collagen. Many products have been developed over the past ten years which have caused collagen to become obsolete. There are now multiple categories of fillers, all made of different materials. The products in these subcategories have properties which make them better in treating some signs of aging than other areas or other products. Remember, fillers are different than Botox (it’s not all just Botox!). So what goes where?

Hyaluronic Acid (HA’s)

Synthetic forms of hyaluronic acid (a sugar that your body naturally produces) include products like Juvéderm, Perlene and Restylane. HA’s increase fullness and enhance the viscosity of the naturally occurring hyaluronic acid in your body. Although it may cost a little more, Juvéderm is currently the longest lasting product (in some cases lasts twice as long, and therefore is worth the extra $100 or so per syringe). I have performed over 200 Juvéderm procedures, and have personally been injected with this product many times!

*note: My face is just a model, I haven’ had all this work done I swear! I just love “Paint.”

  • Best for superficial lines (not very deep, not folds).
  • They are used in areas where “plumpness” is desired (like your lips!)
  • They can be used in cheek augmentation, vertical lip lines, and nasolabial folds, but might not be the best product. Cheeks and Nasolabial folds typically require a lot of filler, and cost-effectiveness wise, this isn’t the product. But if you just need to fix a little sagging, it can be used in the cheeks. If you want to overpay for deep nasolabial folds, then this product also can be placed in this area.
  • Vertical Lip Lines are usually superficial, which would make Juvéderm a good product, HOWEVER, if it is not placed right, the result is a monkey face.

Tips on Hyaluronic Acid

  • When I’m filling lines in the glabella, I always administer a dose of Botox to the area 2 weeks before injecting Juvéderm. This allows me to inject directly into the line; it is easier to aim at a stationary target! How do you know if you will need Botox and Fillers? If you have a line in between your brows at rest (a “1”, “11”, or “111”) and you pull that line apart with your fingers, do you still see a crease in the skin? If yes, you need both, if no, Botox is enough.
  • I always apply numbing cream 20 minutes before injections.
  • I never inject too close to the outer rim of the eye (distal orbital rim), it usually irregularities in the contour of the face.
  • Injecting into the tear trough is a very advanced procedure. I can’t tell you how many times I’ve seen this area over filled (which looks TERRIBLE). My recommendation: it is better to under-fill and book a follow-up. This area requires a minimal amount of product, and my personal policy is to allow a client to come back at no charge if they require a small amount more (within reason).

Particulated Fillers

These products, like Radiesse and ArteFill, contain synthetic beads or particles in different liquid carriers. They last longer than HA’s, because the body doesn’t break them down as fast. They are also thicker than HA’s, which means they satisfy a larger area of volume loss. These products are injected deeper in the layers of skin (never superficially like HA’s are). Why? Because they’re made out of beads in liquid… and in superficial skin that would make bumps! This means they NEVER get injected into the tear troughs or into the lips. EVER. For very, very deep glabellar crease, Radiesse can be used (but usually an HA is a better choice).

  • These products are for moderate to severe volume loss. As you age, facial skeletal changes, general tissue volume loss, and the effects of gravity flatten out your cheeks. If you look at the contour of my face on right side of my face (your left), you will see how round my cheek is. I think you can see in this picture that the apples of my cheeks are round as well. A lot of women will look in the mirror at their nasolabial folds and want to go straight for filling only those, but that doesn’t give the youthful round shape back to the face. On some people I like to do cheek augmentation with Radiesse as well as nasolabial folds. I always do cheeks before folds, because the cheek bone is the scaffolding for the lower face skin. When you change that, the depth of the NL fold will also change. Always top to bottom, never bottom to top, when it comes to your face fillers! **When you have extra weight on your face, you keep the roundness. Skinny people have really flat cheeks when they age. HA. Take that skinny people.
  • The marionette lines, prejowel, and oral commissure are usually treated as one area that needs to be fixed. They’re kind of like vector components of each other (for all you Geometry dorks out there, *brushes shoulder off*).
  • Again, skeletal changes that occur as you age cause your chin to recess and along with volume loss, change the angles of your jaw and chin. This is another area a lot of people overlook when spending that quality time in the mirror pulling at their face in the “this is what I would look like if I had a face-lift” pose. Even if you do have a traditional facelift, you aren’t doing anything about the volume loss. This contributes to the unnatural look of a face-lift.
  • Radiesse and Juvéderm can be used in conjunction to fix contour irregularities in the nose.

I hope that cleared up the two main classes of fillers. It’s a lot of information!!! The next post will be about Sculptra, which gets grouped in with fillers… but this is already too long! Lol.

xoxo SPRAY TAN – O – REXIC LK

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