Injectables: Fillers and botulinum toxins
We offer a range of advanced cosmetic procedures which are individualized to treat your specific needs. These include injections of botulinum toxins (purified proteins known as Botox, Dysport, and Xeomin), as well as fillers. Botulinum toxins are used to relax muscles in various parts of the face. Botox is approved for the treatment of wrinkles around the eyes (crow’s feet) and frown lines (glabella). Dysport and Xeomin are approved for use in the frown lines. These are among the most researched molecules in the world. When used by an experienced injector in the proper dose, they can provide dramatic results, and are safe and effective. These products are all purified proteins that have subtle differences. So, although none is the “best,” they are like Coke and Pepsi, and different people choose different products. When getting injections of these products, the dose and integrity of the formulation are critical. In our practice, we purchase them directly from the manufacturer. In addition, we use doses that will provide superior results and duration.
Botox has been used for more than 20 years, and its indications include treatment of cosmetic wrinkles as well as more medical indications such as muscle spasms, headaches, and a range of other applications. In dermatology, it is most used to treat the wrinkles between the eyes (glabella or frown lines), as well as the lines around the eyes (crow’s feet). The dose required to treat each of these areas differs based on the muscle mass of the area being treated. In general, people with a lot of muscle mass will require more material than those with less mass. They also tend to require more frequent injections of material. When considering injections with Botox, price should not be your only consideration. Focus on the integrity of the practice and the skill of the injector. In our practice, we purchase products directly from the manufacturer.
Fillers may be used to “sculpt” the face and lift it, while also being able to fill in lines and wrinkles. Dr. Beer has been involved in the clinical development of many of these products, and he continues to teach advanced techniques in their use. In addition to these products, Sculptra is used to add volume by stimulating collagen production. This injection may be combined with other products, depending on the products that are used.
At Beer Dermatology, we use hyaluronic acid fillers, as well as those made from calcium hydroxylapatite. Among the fillers utilized in our practice are Juvéderm, Voluma, Restylane L, Restylane Lyft, Restylane Refyne, Juvéderm Ultra Plus, Juvéderm Vollure, Juvéderm Volbella, Restylane Defyne, Restylane Silk, and Radiesse. All of these come with local anesthetic (lidocaine) mixed in.
Dr. Beer and Dr. Davidson have been injecting these products, and Dr. Beer was an investigator and training physician for several of them. He is considered an “expert injector” because of his advanced skills.
While there is no one product that is the best, each has its own advantages and can be used to achieve a desired result in a particular area.
Each of the fillers has different physical properties that lend themselves to specific indications. For instance, Voluma, Restylane Lyft, and Radiesse are thicker products that may be used to restore lost volume and fill in areas that have lost volume. These thicker products are also used to lift the face, and can be used to help restore the face to a more youthful appearance. Smoother, thinner products such as Restylane, Refyne, and Juvéderm are best used for treating lines and wrinkles, and can also be helpful in restoring the corners of the mouth to a more youthful position. Restylane Silk, Belotero, and Juvéderm Volbella may be used to replace lost volume in the lips. They can also help to treat the fine lines around the lips. For some patients, combinations of these products are used to provide the personalized results that allow our patients to look refreshed but not artificial.
In general, injections are performed at intervals of between six to 12 months. Common adverse events associated with these injections include bruising and swelling in and around the injection sites, but these tend to be temporary in nature.
Sculptra is a molecule that is injected into the skin to stimulate collagen. When used correctly, it can restore the volume lost with time. Advantages of this product include the fact that it stimulates you to make your own collagen. However, it is a gradual process that can involve multiple injections over the span of a few months. This treatment has been around for about ten years, and during that time its use has evolved considerably. While only approved for injections into the face, it is being used to stimulate collagen growth in many areas of the body in an “off label” (non-approved by the FDA) manner. Sculptra is not appropriate for some areas of the face including the lips and tear troughs (eyelid region). In some patients, its use has been associated with the formation of small lumps and bumps under the skin.
Dr. Beer is an expert injector with Kybella, and was one of the few people in the US to participate in clinical trials that led to its FDA approval. When injected under the chin, it dissolves the fat that can accumulate there. Kybella treatments require a few visits to the office. After each treatment, it is common to have swelling that can last for about a week. The amount of swelling and degree of inflammation depend on the amount of fat that is present, as well as the amount of Kybella injected. In general, two to four treatments are used to help decrease the appearance of fat below the chin. While it is approved for use under the chin, its use in places such as the legs, arms, shoulders and other areas is considered “off label” by the FDA.
Lasers, intense pulsed light and radiofrequency
Beer Dermatology is one of the few centers to offer the entire range of lasers and energy devices. Whether you need to have a minimally invasive procedure or a more intense laser treatment, we have the experience and training to help you achieve your goals.
The Fraxel is one of our most popular lasers, and it is used to improve the appearance of fine lines and help the texture of the skin. After the procedure, it is common to be red for a few days. This procedure is typically performed as a series of treatments.
The intense pulsed light treatment is a broad spectrum light source that is absorbed by the pigment of the skin. This is used to treat red and brown discoloration typically seen with sun exposure. It may also be helpful in treating the redness associated with rosacea and acne. This treatment is performed as a series of procedures, and it is common to have some mild desquamation afterwards. The best results are obtained when this is done several times, and then twice a year.
The Isolaz is a laser that is used to treat acne. This is done weekly for several weeks, and may be combined with medications or performed by itself.
Pulsed Dye lasers are used to treat blood vessels, scars and other lesions that are pink or red. This treatment is typically performed several times, with each time helping to decrease the appearance of redness. Individuals getting this treatment may have rosacea, acne, birthmarks, or scars from trauma, burns, or surgery.
Cellulite is found in about 95 percent of women, and we are pleased to offer treatments. While there is no miracle treatment, Smoothshapes may help to improve the appearance of cellulite.
Skin tightening is performed using a variety of devices that utilize radiofrequency. These devices use energy to heat up the collagen and stimulate it to grow and to tighten. Multiple sessions are planned as part of any treatment with these devices.