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There are lots of different injectables in my practice! Some relax movement and yield wrinkle reduction, some dissolve fat cells, and others volumize. And amongst those that volumize there are 18 to 20 to choose from in my tool box! Most are hyaluronic acid based, but others have additional characteristics. How do I decide which is the right one for the job? Well, that depends on many factors including your anatomy and goals, and your patience.


I guess if I had to categorize, my younger patients tend to seek volume improvement in a specific area, like the lips or the cheeks. There, immediate gratification is also sought out, making hyaluronic acid a great choice. My more mature clients might however be looking for improvement of the bigger picture, global enhancement, reduced appearance of laxity (by way of mild volumization of tissue), and perhaps have a wee bit more need for attention to the periphery of the face (think peanut temples, hollowing just in front of the ears). And while I’m not saying that “NOW” isn’t nice, it might be okay to look forward to younger looking, healthier skin overall in 4-6 months and have it last, than the need for one area to simply be volumized. It could take lots of syringes of filler to fill up with hyaluronic acid alone, ignoring the looseness of the tissues structure as the real issue.


Sculptra is one such “filler”. It is made of poly-l-lactic acid and when injected it behaves as a bio-stimulant (you guessed it, stimulates your own biology). It starts as a powder which is then reconstituted with bacteriostatic water and a little lidocaine, then injected under the skin or along the bone. I personally like to use a cannula to deliver this delicious liquid—which reduces your overall risk of bruising (but does not eliminate it) and in some areas, a needle is still best. While you immediately look fuller—keep in mind it is simply all the liquid filling out the regions treated. The water is reabsorbed over the next few days, and the PLLA is left behind. This is the magic which teases your skin into developing your very own collagen matrix! Post treatment requirements on your end are to massage for 5 minutes, 5 x day, x 5 days after injection—that’s just to keep all those particles evenly distributed so that when the water disappears you have a sprinkling of pixie dust evenly throughout the region intended to be treated. Collagen fibers are formed over the next few weeks, then reorganize themselves over time to being even more amazing! Important to think of this as a tool for skin laxity, not just volume replacement. A solid treatment plan for the face includes is 2 vials x 2 treatments roughly 8 weeks apart, then put on your patient panties and wait to let the magic happen. It yields a subtle, but natural effect and the durability of it is based on your body’s ability to produce it and reduce it—so everyone is different. And of course it isn't limited to the face (off label). There are amazing photos and testimonials on Sculptra.com if you’re interested in checking it out, keep in mind it requires you to have a healthy immune system to work optimally.


When you snoop on the internet to learn more, you might hear about the “Sculptra Glow”! When injected more superficially patients have reported healthier and glowier skin overall. There isn’t one of us that wouldn’t be for that as a bonus!


Sculptra isn’t for those who need an “event” fix (i.e. immediate). But it is for anyone who wants to be sure the foundation for the house is solid before they start building the structure. My favorite places to use Sculptra includes the temples, along the cheekbone, the preauricular space (in front of the ear), along the jawline and the nasolabial fold. No-no areas? Yes, there are a few of those: around the eyes and immediately around the lips (because of the way those muscles contract, it can leave you with clusters of product and an effect you aren’t quite seeking). At the time of this writing, pricing for Sculptra is $850/vial, down time is a couple of days of swelling and maybe bruising; though if you’re like me, you go right back to it the next day. This procedure can be accomplished at any of our locations with Teri at the helm, and if you want more intel for you specifically--book a virtual consultation where we can speak freely!


Wish your toxin would last longer? Step number one: talk to your injector about your dose! All 4 current manufacturers of neurotoxin approved for use in the US agree that the duration of effect is directly related to dose delivered for the area of treatment. And while all products are measured in units, the “math” involved in the equivalency of a onabotulinumtoxinA (Botox) unit compared to an abobotulinumtoxinA (Dysport) unit can be tricky to explain. Add on top of the unit equivalency challenge the volume used to deliver the aid number of units may vary from injector to injector and even from area to area with the same injector. The math can be a mess! Bottom line, the number of units actually delivered per region is what is documented in the medical record, and what we use to measure our treatment on.


Certain muscle groups are stronger than others (think glabella and masseter)—the bulkier the muscle the more medicine that’s required to put it to sleep for a spell. Some muscles are thinner but cover large regions (think forehead or platysma)—they need enough product to spread throughout the region. And yet other muscle areas we do not ever want to overdo (think lip flip—overtreating that can keep you from enunciating your words, or controlling your spit—yikes!). Underdosing an area or treating with a small amount generally means it will not retain its relaxed effect as long as a larger dose would, but there may be good reason to do just that.


So, if you wish your toxin would last longer, the first thing is to evaluate whether or not you are receiving a dose sufficient for the muscle or the area. There are commonly accepted “usual” dosing for most areas, but every person is different, and dosing needs to be personalized. Consider too what product you are using, and what your expectations are. Movement is fine for most of us, we just don’t want to allow so much that the repetitive nature of the movement can contribute to etched in lines. And some wrinkles might be unloved but accepted because having the rainbow wrinkle above your brow is better than dropping your eyebrow and adding to upper eyelid hooding, eh?! Younger skin has healthy collagen and elastin stores, so wrinkles from movement may be better disguised than thinner, older, crepey skin.


Your injector has a complex job—they manage pharmacological, anatomical, technical skills all while using their artistic ability to finesse your treatment to match your goals, anatomy and dosing. Developing a good relationship with your injector is critical!

Updated: May 16, 2021

One question I am asked about frequently is “what can be done about the under-eye region?” Indeed, tear troughs are a thing! There are a few treatments we can do to enhance them, but they can also be a little fussy because the tissue is so thin and there are many things that contribute to the hollowing or enhance the shadowing of pigment, so let’s try to understand it first!


The tear trough is a region just under your lower eyelid, but above your cheek. The tissue in that area is approximately 1/9th the thickness as other parts of your face. And we all know by now that collagen stores start to decline somewhere between age 20 and 30, contributing to even more thinning. Yikes! But that’s not all, other changes are afoot as well. Our bones change with age. We think about this in things such as osteoporosis and fracture risk, but we don’t necessarily equate that to our facial bones, yet they resorb and remodel just the same. With maturity our jaw shrinks, our teeth recess and our eye sockets actually enlarge. This contributes to skin draping in places it didn’t when we were 16. Fat pads change and move as well, so our precious chubby cheeks flatten out and gravitational pull can even turn part of them into jowls. The cheek offers support for the ligaments of the tear trough, so you can imagine that as they deflate, under eye areas can become more of a focus as we pass by a mirror. And lastly, we should pay homage to the fat pads that reside under our eyes. When tissue is tight and the area is full, those precious fat pads provide a buffer between the skin and the structures below. But as we gain laxity and lose support, gravity can induce an unsightly bulge. For those with herniated fat pads, expectation of non-surgical maneuvers should be guarded at best.


So, in my lineup of recommendations first up is always a really yummy eye cream. Yes, I appreciate they can be a little pricy, but it’s a must-have, not a consider-this when it comes to treating the region. I personally prefer a rich cream over a gel, but I’m getting up there in maturity so need more hydration. I also like a brightening eye cream, but haven’t found one that’s quite rich enough, so I use a brightening cream in the day and a repair cream at night. Some ingredients you might find in an eye cream and like the sound of are hyaluronic acid (hydrator), caffeine (tightener), licorice root/tranexamic acid/vitamin c/niacinamide (brighteners) to name a few. Keep in mind this area requires more richness than your daily moisturizer likely gives—so if we want to fluff it up to keep the shadows away we need to treat it nicely.


Next recommendation for long term gain is collagen induction. Treatments such as medical microneedling can promote natural collagen growth can be a great idea to keep the bounce in our skin, including under the eye. Other more targeted treatments can include autologous injection. Most commonly a trained practitioner will take a sample of your own blood and spin it down drawing off the critical parts, but leaving most of the red cells. Since it is your own blood, there is low-to-no potential for allergic response. Re-introducing this nutrient rich fluid to the area of interest floods the tissue with as much growth factors, cytokines and other factors which can encourage your own body to thicken the tissue (but not thick like leather, just healthier). Think of it like fertilizing the lawn—the grass is already there, it just needs a little go-go juice to bring back the vibrancy! The advantage of this type of injection is that the growth factors are released slowly over several weeks rather than the dump-and-done approach of other options. Unfortunately the food and drug administration is pursuing this as a biologic treatment and so there may be more scrutiny in the near future on this--but stay posted. (There’s more that I could say, but this is a blog, not a novel!)


And of course, we have the option of placing filler in this zone as well. Looking at contour of the area I first look at the cheeks. When the cheeks start to flatten out, we lose the scaffolding that helps hold our tear trough ligaments and skin in place. So, treating the cheeks is absolutely a part of treating the under eye. Following mid-face, we can then look at volume loss in the tear trough. When placing filler in this space I prefer to do this very sparingly--because you wouldn't want to replace a cave for a pillow! I use hyaluronic acid filler in this area, and HA's job is to attract moisture, so picking the right product and placing the right amount is essential. And since we really can't tell how deep the cave is in the first place, it's better to place a small amount, let it settle, then repeat as necessary.


So, while there is plenty we can do for the region under the eye, matching the correct treatment to the patient’s deficit is trickier than offering only one-solution. My goal is always to enhance what you already have, bringing forward a fresher version of YOU!


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