Monthly Archives: July 2018

Radiesse and Sculptra are the last injectables that I’m covering in this series. While they may not have achieved the mainstream brand recognition as Botox and Juvederm, they are well known within the cosmetic industry for offering well established and proven volume restoring, wrinkle fighting results. They accomplish this through very different methods. Sometimes Sculptra and Radiesse are called the tortoise and the hare.

The Tortoise

In the Aesop’s fable The Tortoise and the Hare, the slow moving tortoise actually wins the race with a hare because of its steady effort. In a seemingly similar way, Sculptra offers visible results that are slower to appear, but achieve a big win because the results usually last a lot longer than any other fillers. It does this because it actually stimulates the skin to make it’s own collagen.

• Medical: Sculptra is made of a poly-L-lactic acid, which is a manmade polymer that is biodegradable and biocompatible. In the medical arena, it has also been used for over a decade with FDA approval to restore the hollowed facial features caused by HIV. This material is also used in absorbable stitches and bone screws.
• Cosmetic: The FDA approved Sculptra for cosmetic use in 2009. With 1 to 3 injections over the course of 6 to 12 weeks, Sculptra stimulates the skin’s collagen enough to effectively restore volume and smooth out wrinkles. If not under any event’s time constraints, some people prefer the gradual results because they come on less drastically and obviously. Generally, most onlookers notice the youthful results, but can’t pinpoint when or how they exactly occurred. It just looks like a mini facelift happened gradually over the course of 2 months. Also, unlike hyaluronic acid fillers, such as Juvederm or Restylane, Sculptra can last much longer, such as 2 years or more.

The Hare

Instead of hyaluronic acid, which is used by Juvederm and Restylane, Radiesse is composed of calcium hydroxylapatite microspheres suspended in a gel. Calcium hydroxylapatite is a kind of mineral that is normally found in human teeth and bones. In addition to instantly adding volume, the scaffolding created by the calcium hydroxylapatite in Radiesse promotes collagen production. This offers benefits to the skin’s foundation that lasts beyond when Radiesse dissolves.

• Medical: In 2007, the same year it was approved for cosmetic use, the FDA approved Radiesse for treating facial wasting experienced by HIV patients. The medical community has also used Radiesse in therapeutic treatment for vocal cord deficiencies.
• Cosmetic: Radiesse is an injectable filler that also restores volume in a thicker gel than Juvederm and Restylane. Its dense formula is great for moderate to severe facial wrinkles, nasolabial folds and volume loss. It also is a phenomenal way to take 10 years off your hands, which tattle on your age.

I hope that this blog series, All About Injectables, has informed and encouraged you about the safety and efficacy of the top injectables. Isn’t it interesting that there are such helpful medical uses for them, as well as cosmetic? I think that just adds to their credibility.

As you can tell, at DAVinci Plastic, you’re certainly not lacking for great options for your cosmetic needs. Fortunately, you don’t have to be the expert in which of these injectables would be the perfect fit for you. Our expert injectors can help you find the best fit for your beauty goals. Schedule a consultation at www.davinciplastic.com today.

Steven Davison M.D.

Board Certified Plastic Surgeon

In addition to an increased awareness of neuromodulators like Botox, there is another major category of injectables called “fillers” that have become mainstream. They address wrinkles and other cosmetic issues related to volume loss. Fillers, such as Juvederm and Restylane, use hyaluronic acid to restore volume, but even within these popular fillers, there are a lot of options for different uses. We will talk about these fillers and some others in this blog.

What is Hyaluronic Acid?

The hyaluronic acid in these injectables is made from a safe bacteria protein. It is a modified, safe form of the hyaluronic acid that naturally forms in the skin. It attracts and bonds to water, creating a plumping effect within the injected area. It has the highest safety profile of all the injectables and contains no DNA from animals or humans. It is unlikely to induce an inflammatory or allergic reaction because it is similar to the natural hyaluronic acid created by the body.

What is the difference between Juvederm and Restylane?

Both are FDA approved HA fillers for smoothing the nasolabial fold (from the outer crease of the nostril down to the outer corners of the mouth) and are used “off label” effectively to restore volume in other areas. They both have an excellent safety and efficacy track record.

The main difference is the consistency. Juvederm is smooth and Restylane is granulated. They both come in a variety of thicknesses to accomplish effective revolumizing of different facial areas. Depending on how your body metabolizes hyaluronic acid, Juvederm will probably last a little longer, but this is not the case for everyone. Clinical trials demonstrate different kinds of Juvederm lasting from 1 to 2 years and Restylane lasting from 6 to 18 months. Both are excellent products, but may be better for different applications.

I would spend more time concerned with choosing an expert injector who is very familiar with correct and effective application of these products (such as who we have on staff) and let them make the recommendations. However, just so you can be familiar with all your options, here is a list of the different kinds of Juvederm and Restylane, along with their best applications.

Juvederm

• Juvederm Ultra XC adds natural feeling and looking fullness to thin lips.
• Juvederm Volbella XC plumps the lips subtly and smoothes the appearance of fine lip lines.
• Juvederm Vollure XCtreats moderate to severe facial wrinkles around the mouth and nose, such as mouth corner lines, marionette, and parenthesis folds.
• Juvederm Voluma XC is the longest lasting option for restoring youthful volume to cheeks and midface.

 Restylane

• Restylane Defyne smoothes out the deeper facial creases and wrinkles, while still allowing for movement in areas that need it, such as the nasolabial folds and marionette lines.
• Restylane Refyne offers the flexibility needed to maintain natural movement while filling in mild to moderate nasolabial folds and marionette lines.
• Restylane Lyft is FDA approved for restoring volume to the cheeks and midface area. It contains a numbing agent to reduce treatment discomfort.
• Restylane Silk is administered using an ultrafine needle to enhance accuracy for adding volume to the lips.

These are excellent fillers that can accomplish beautiful, rejuvenating results. Next week we will cover the remaining to injectables that are safe, effective and available at our office. Schedule your consultation today at www.davinciplastic.com.

Steven Davison M.D.

Board Certified Plastic/Reconstructive Surgeon

Botox has been around since the 1970s and has quite a history. Its original name was Oculinum and its original use wasn’t intended for cosmetic purposes. Smoothing lines that was seen as a nice side benefit from patients who were being treated by the ophthalmologist who invented it to treat a medical condition causing strabismus (cross eyes). In 1991, two years after receiving FDA approval for treatment of strabismus and eyelid spasms, the company Allergan bought Oculinum and changed the name to Botox.

At first, Allergan didn’t even realize what they had their hands on, but as use grew and more discoveries were made by the doctors experimenting with it, a whole new world opened up in the cosmetic industry. Even today as Botox is most well know in the mainstream population for it’s wrinkle smoothing effect, Allergan holds more than 800 patents for its use, most of which are for helping with medical conditions. Here are some of those strange, exciting and surprising uses for Botox:

FDA Approved Medical Uses

• Strabismus – Approved in 1989, this original use for injecting tiny amounts of botulinum type A helped correct the muscle issue causing crossed eyes.
• Neck spasms – Approved in 2000 for the management of neck pain caused by an abnormal head position called cervical dystonia. This approval was before Botox was officially FDA approved for the cosmetic treatment of frown lines in 2002.
• Excessive underarm sweating – Approved in 2004, for this condition, which is officially called primary axillary hyperhidrosis, is also used as a non invasive treatment for overly sweaty hands and feet.
• Chronic headaches – Approved in 2010 for chronic migraines, use for headaches started with a plastic surgeon’s discovery that his patients who received Botox for wrinkles also reported less headaches.
• Overactive bladder – Approved in 2013, the constant contracting of the bladder causes the need to urinate frequently or have leakage. When injected directly into the bladder muscle, Botox has been demonstrated to safely and effectively relax those muscles causing the problem with results lasting up to one year for a third of the study’s trial population.

“Off label” Medical Uses

• Depression – After multiple successful small medical studies, Allergan is currently conducting clinical trials to confirm the results many doctors are finding for their patients who want an alternative to medications. The theory of how Botox affects mood is related to the “facial feedback hypothesis.” This hypothesis says that a person’s mood can be affected by their facial expressions, so therefore if their facial muscles are inhibited from frowning, mood improvement follows.
• Abnormal heartbeat – Allergan is siezing an opportunity to help with an unmet medical need to help reduce postoperative atrial fibrillation, which occurs in 27 to 40 percent of patients. A promising small study with Botox conducted at Duke Medical Center demonstrated a lesser occurrence of an abnormal heart rate after heart surgery.
• Sexual issues – Botox is being studied to treat erectile dysfunction, premature ejaculation and painful sex for women.
• Cold hands – When Botox is injected into the hand muscles that surround constricted blood vessels, the resulting circulation improvement has been shown to provide up to 3 months of relief.

Botox is providing amazing help for a variety of medical needs, as well as cosmetic ones. You can read more about Botox for Bell’s Palsy here. It truly is a very exciting treatment.

Steven Davison M.D.

Board Certified Plastic Surgeon

Most people have a general knowledge about injectables through friends, social media and celebrities. They can be a great complement to plastic surgery or even help you restore some youthful features without any recovery or downtime. Injectables can address skin smoothness, feature definition and even correct a wide range of facial imperfections.

You know Botox stops the muscles from moving so that they can’t keep making wrinkles. You know Juvederm fills in the wrinkles so the lines are less prominent. You also know that there are different kinds of injectables, but maybe not what they are and the full range of what they can do. In this blog series I’ll give you a little orientation to expand your knowledge about the injectables that are currently available and those possibilities to come. In this blog, we will compare “neuromodulators.” In the next blog, I’ll go into depth about the uses for Botox (some surprising), and later, I’ll cover the “fillers.”

NEUROMODULATORS

This is the official name for the kind of injectable that is Botox and its main competitor Dysport. This kind of injectable uses botulinum toxin A to block the nerve signal to the muscle, which prevents movement. In tiny amounts and with impeccable accuracy in the hands of my highly trained, certified expert injector, this toxin is used to relax the muscle. This results in a less prominently visible wrinkle because of minimal localized muscle movement.

The most well known neuromodulator is Botox because it has been available in the US the longest (about 30 years ago) and has many clinical studies for medical and cosmetic use. However, you may not realize that Dysport has quite a bit of safety and efficacy testing also, and it was available in Europe long before it came to the US. They both use the same kind of molecules, but Dysport’s are slightly smaller. This makes for some differences between the two.

DIFFERENCES BETWEEN BOTOX & DYSPORT

• Dysport’s results are slightly quicker, within 3 days, while Botox’s results show in 5 to 7, so if you’ve got to get ready for a last minute event and don’t have a week to wait, Dysport might be better.
• Dysport distributes botulinum toxin A via a smaller molecules so there isn’t “unit to unit” match up, and no universal clinically accepted conversion ratio. This often results in Dysport’s cost per unit being less than Botox, but probably more units will be needed.
• This smaller Dysport molecule makes for a thinner solution and so it spreads out, or diffuses, a little more from the injection site. This makes it more or less suitable for different parts of the face. For example, it could be good for a larger treatment area such as the forehead, requiring less injections. However, Botox is necessary for a small area requiring exact precision, especially around the eyes and lips, as you don’t want any diffusion resulting in sagging or drooping.
• Both will require another treatment in 3 to 6 months, but its still up for debate whether Dysport doesn’t last quite as long as the thicker, more concentrated Botox.

There are benefits to both kinds of neuromodulators, making it impossible to say definitively one is better than the other. It allows us a greater diversity of applications to benefit our patients. Also it takes an expert injector to be versatile in using both effectively. You can trust us with the skill and knowledge to recommend and inject both correctly for beautiful results. Schedule your appointment today at www.davinciplastic.com.

Steven Davison M.D.

Board Certified Plastic Surgeon

Capsular contracture is one of the most common complications of Breast Augmentation. It is the hardening of the breast area around the implant so that the tissue tightens. Depending on the degree of capsular contracture, the breast area becomes uncomfortable and distorts the look of the breast. The highest percentage of women who would experience this, do so within the first 4 years, but it can also occur many years after the initial Breast Augmentation. Certain kinds of incisions have lower rates of capsular contracture, as well as submuscular placement of the implant, rather than subglandular.

There are many studies that propose different ways to reduce the incidence of capsular contracture. One of them is a recent study that demonstrates using a Keller funnel for a statistically significant decrease in capsular contracture when employing a periareolar incision to place the impant. The rate of capsular contracture occurrence is highest within the first year when using a periareolar incision, so this istudy provides a welcome bit of information, and a confirmation to the Keller funnel enhancement to the “no touch” method that use.

When placing a breast implant using a periareolar incision, the cut is made along the circumference of the areola. This incision method is usually chosen because the incision scar blends right in with the demarcation line of the areola. The periareolar incision is the second most common incision site chosen by my patients, with the most common being along the inframammary fold (the bottom crease of the breast).

However, with the periareolar incision, the implant has higher chances of being exposed to bacteria from the milk ducts and skin. This creates a biofilm around the implant and inflammation, ultimately leading to a higher chance of capsular contracture. “No touch” techniques where there is no patient skin contact or surgeon glove contact on the breast implant has reduced the chances of implant exposure to unwanted bacteria. This lessens the possibility of complications.

The use of a Keller funnel for inserting the implant takes the “no touch” technique to another level. It is a mechanical insertion device developed in 2009 as an alternative to hand placement of the breast implant into the chest pocket. The Keller funnel is sized to fit the implant exactly. Once the funnel is lubricated, the implant is poured directly from the packaging through the funnel where it advances down into the pocket in the chest. The Keller funnel shields the implant from any bodily contact until it rests inside its final location in the breast.

Since there is a higher incidence of capsular contracture in patients who’ve chosen a periareolar incision for their Breast Augmentation, I’m pleased to offer the advanced “no touch” technique of employing the Keller funnel for placing the breast implants. As this new study demonstrates, this will result in less incidence of capsular contracture for my patients. Visit www.davinciplastic.com to schedule a consultation for your Breast Augmentation.

Steven Davison M.D.

Board Certified Plastic Surgeon

Are you enjoying your summer sun and fun? I hope so, but keep in mind that too much of both of these can take their toll on the skin. That golden glow from the sun doesn’t come without a price. Some mid summer skin rejuvenation may be in order.

Dehydration

Dehydrated skin is different than dry skin. Dry skin is due to lack of sebum, but dehydrated skin is due to lack of moisture. It appears dull because the lack of moisture prevents cellular turnover. It also can be sensitive and flaky because the topmost layer of skin is not functioning correctly, so irritants can penetrate and more moisture is lost. In addition to drinking lots of water, use skincare that focuses of restoring moisture and not oil. A good example that we sell in our office is SkinMedica Rejuvenative Moisturizer. Also, avoid soapy cleansers that can strip the skin even more, and use cream cleansers instead. Restorative serums, such as SkinMedica’s Vitamin C and E complex, which prevents and repairs UV damage are helpful.

Fine Lines and Wrinkles

Dehydration along with aging, lifestyle and sun damage contributes to wrinkles. Fortunately, along with making healthy changes, there are effective non invasive cosmetic procedures to help smooth things out.

Here are some areas that can really be aged by the sun and dehydration, along with some “quick summer beauty fix” suggestions for your face:

• Crow’s feet creep out from the outer corners of the eyes and extend outward towards the hairline. They are corrected with Botox or Dysport because limiting the muscle movement in the area will relax the wrinkles and prevent them from deepening due to activity.
• Forehead Lines are caused by excessive brow movement and forehead furrowing. Accentuated vertical lines between eyebrows can give an angry or scowling appearance. You can quickly lighten your look with Botox or Dysport.
• Tear Troughs or Hollows swoop below the eye from the bridge of the nose along the lower eyelid and sometimes extending downward toward the cheekbone. Their sunken appearance gives a tired appearance to the eyes, but Restylane and Juvederm are hyaluronic acid gels that safely restore volume to these areas.
• Cheeks and Temples lose fullness and hollow out due to volume loss. Facial fat loss naturally occurs with age, but is sped up by dehydration and sun damage. As fat diminishes, these areas commonly sag and appear shallow. Restylane or Juvederm help plump these shallow areas to restore youthFULness.
• Nasolabial Folds are formed due to volume loss and skin shifting downward. These lines are also called “marionette lines” and reach from the outer corner of the nostrils to the outer corners of the lips. Fillers Restylane and Juvederm help fix this issue.
• Lips lose volume over time, looking thinner and flatter. They also can become framed by smile lines, called “parenthesis lines.” We can help you restore the youthful shape and fullness with the effective lip plumper Juvederm.

 Along with avoiding sun damage, staying hydrated and using effective skincare, these injectables are great “quick summer beauty fixes” for your face. Schedule your summer beauty touch up today at www.davinciplastic.com.

Steven Davison M.D.

Board Certified Plastic Surgeon

One of those subtle but annoying body issues many women deal with are those pooches of fat that bulge between the breast and armpit when they wear a tank top, swim suit or bra. This troublesome pooch can be called “bra bulge,” “tank toppers,” “armpit rolls” or the official name, which is axillary roll. What most women don’t realize is that this is an issue often exacerbated by a Breast Augmentation. If you have them before getting breast implants or a Breast Lift, they will likely be even more prominent.

This fatty tissue is often present even when there is little breast tissue, making it applicable for women who even have small upper bodies. Fortunately, getting rid of this little pocket is very simple and can even be done at the same time as the Breast Augmentation is completed. It would simply require a little touch of Liposuction.

When this axillary roll is reduced at the time of the Breast Augmentation or Breast Lift, the Liposuction smoothes out the upper sides of the breast and armpit areas. With less bulk in this region, there is better breast definition and upper body contour for overall greater happiness with the Breast Augmentation results.

This add on axillary roll Liposuction will increase surgery time by an hour or 2, but it’s for such a small pocket that it only includes a little more bruising and swelling to the sides of the breast and armpit during the recovery time.

Doing multiple procedures at one time definitely has its benefits. You’re in surgery one time, under anesthesia once and going through recovery once. For example, with the Mommy Makeover, women are addressing multiple issues at one time to restore their post partum bodies. Depending on individual goals, this can include Breast Augmentation, Breast Lift, Liposuction, Tummy Tuck, and Vaginal Rejuvenation.

Tell your “tank toppers” goodbye. To eliminate your armpit bulge and have smoother breast definition, consider adding on axillary Liposuction to your Breast Augmentation or Breast Lift. Schedule your consultation at www.davinciplastic.com.

Steven Davison M.D.

Board Certified Plastic/Reconstructive Surgeon