Sculptra

Hi this is Dr. Kenneth Beer in West Palm Beach Florida. Hope you guys are all riding out the quarantine safely and enjoying the time with your friends and family. We are going to talk today about some injectable fillers and things that we can do when the quarantine lifts. As part of this we are going to have questions and answers and if we don’t get to you question upfront, please don’t worry we will get to it this afternoon and make sure that we answer it. In addition to that we are having a virtual week of beauty, so it is an opportunity for you guys to call the office, you can purchase fillers and injectable and lasers and a variety of other things so that when the quarantine is lifted we can get you in here and start making sure that everybody looks as good as they feel once everything is back to normal. So that is at 561 655 905 5. So let’s just jump right in, today we are going to talk about fillers and things like Kybella and all kinds of products that we use in the skin to make you look and feel better. And the nice part is there are so many opportunities and so many products now that are available, whereas 10 or 15 years ago we only had a few things today we have probably about 20 somewhat products available that are approved in the US and there are a lot more approved outside so Canada and Europe have probably 40 or 50 and there is going to be more in the US so it is going to be an ever changing landscape. It is going to be a lots of fun for those of us in the industry because for instance with this newer round of products we were part of the clinical trials so we have been using them for months and months and months and we will have the opportunity to train other physicians which is always fun. So today we can start by answering some questions you guys have and feel free to go ahead and ask them.

So when we started with everything years ago we used to inject collagen and collagen was a product that was okay it was not great, it really didn’t last as long as it should have and it was lumpy and bumpy and there were 2 or 3 different types, and this is probably 25 years ago we were injecting that and then along came Restylane which was being used in Europe and Canada. Restylane was a nice product because unlike collagen it was clear and it was a gel so it was smoother and it was more long lasting. In addition it was made out of bio compatible hyaluronic acid, and hyaluronic acid is a sugar that is found in all of your joints, all of your skin. It is pretty much in equitas throughout nature and it is one of the products that really has done well over time. So we have more than 20 years’ experience with that product. Restylane has been evolving over the years so we started with just Restylane and then it evolved into a thicker product called Perlane. Perlane then got rebranded as Restylane lift but it is the same as Perlane, used to be and those are products that are gels that get pushed through a screen, so instead of being a solid block like Jell-O would be, if you take a block of Jell-O and put it through a screen you can get fine little particles, so if we have a big screen you get Perlane or Restylane lift. If you get a smaller screen you get Restylane and you can do just about anything with these products provided that you know what they are and where to place them, they are really nice, nice products and those are from Gel Derma there is a whole other family of Restylane products, including Refine and Define. They use a slightly different technology and there the sugars are cross linked and a little bit smoother so they are better for areas like the nasal labial crease that is subject to a lot of motion, so we use those all the time in areas that are moving a lot. There is also some newer products called Restylane kiss, which as the name suggests is designed for the lips and those products are all highly, highly bio compatible. Patients do really well with them as with any product you can get some lumps or bumps but typically these are minor and in addition as with any injection you can get a little bit of bruising. Then there is a whole other family of products called Juvéderm and started with Juvéderm Ultra and Ultra plus, and these products are all from Allergen. So there is a whole range of them we now have Juvéderm Volbella which is a really nice product for the lips, we have Juvéderm Vollure XC which is an intermediate product that we like a lot. We use this, a lot in the nasal labial crease, we use it in the marionette line, and then something that has become very, very popular is the Juvéderm Voluma which is designed for cheeks. We also use it in other parts of the body such as the temples and variety of other places and it has done remarkably well. So jumping back what we use a lot of in the office, in addition are things like Restylane lift that I mentioned before and there you can see the product has Lidocaine in it. What the Lidocaine does is makes for a much more comfortable injection. This thing Restylane lift it is a little bit thicker and we use it a lot for sculpting the face. It is the cheek bones, the temples, the marionette the jaw sometimes we place them deep to build, and again as we mentioned before this is regular Restylane which is still pretty very popular all throughout the world, it is a really nice product we use it for a variety of things. It is just what works in a lot of practices. Alright so next – we have some other products that are a little bit different.
So from the Merz family we have something called Belotero which is a really, really nice product. It is soft as we use it a lot and the area around the eyes we use it in the lips. There is also something called Radiesse and Radiesse is really nice, Radiesse is a calcium based product so it is a little bit white and it is a little bit more durable, but at the same time it is very thick so it is great for structure we dilute it out and we constitute it and inject it in the back of the hands and it does well. I like Radiesse for people with thick skin or men who have really deep folds. It is a wonderful product we typically inject it with a cannula and it does really, really well. So that is another option. Sometimes people just lose volume we like to use something called Sculptra and Sculptra is a series of injections that we like. Usually we do them 4 to 8 weeks a part and what this does is it stimulates your skin to gradually make some collagen. Each time we inject it we inject either one or 2 bottles depending on how much we need, recovering and it is sort of like planting grass, you just put it under the skin and watch it grow. So this is a really nice product, sometimes we use it in the mid face, sometimes we use it in the other parts and the nice part is you can reconstitute it based on where you are going to put it so you can make it more or less diluted, if you are using it on the legs, the butt, the face you can blend it as you want. So this is a great product but it is depending on your body’s ability to make collagen so that varies in different people.

So one other thing that we inject a lot of is Kybella, and sometimes we use this with our cool sculpt device or other machines this is a great product for getting rid of some excess fat. We use it primarily in the area under the chin, but there is all kinds of other places we put it to and it works really nicely like other injections though. It is not one and down we typically inject this 2 to 3 times deepening on the area and how many bottles we are injecting so there is a whole range of products that we use. Let’s take a look for some questions. So one of the questions is which product would you use in different areas and really it depends on the thickness of the person’s skin. For thin skinned patients that are looking for fine lines sometimes we will reconstitute or blend with some lidocaine to thin it out and sometimes we will use a very soft or smooth product, so the nice part about having all these products is that we can blend or customize or we can just use different products based on what we are trying to accomplish. So it is a very different scenario now than it was 5 years ago. Let me see – Kristen, hi Kristen thanks for joining us and Coleen thanks for being on and Carla. So really a nice group of people and we are happy to answer any question you guys have.
So the other thing is which product lasts the longest and it really varies. I think if you inject one product 2 or 3 times in the same region you will start to get duration and that is always nice. If you do it once a year you will tend to get hills and valleys where you face looks really good and the product dissolves and goes away so we try and have people come in more consistently and try and develop a programme that fits their goals and their budget and their risk tolerance, because sometimes you get some bruising from these injections and does not really matter who does it or how it is done, some people just tend to bruise and I find that in my practice if we have them on aspirin they bruise more. I try and get people to stop taking aspirin a week before but we have people on blood thinners that do perfectly well and we have people who don’t take anything that bruise so it is a whole range of people.
When we are filling the cheeks we like to use a thicker product something like Radiesse or Voluma or Restylane Lift, and when we are doing fine lines around the mouth, we like to use something like Restylane Kiss when it is available or Restylane Silk which does really, really nicely. We also use a lot of Volbella in that area and sometimes we will reconstitute some of the regular Juvéderm, or Juvéderm Ultra Plus and that works really nicely we use very small micro needles for that we get a lot of very pretty results. So in terms of that the durations are all different. Some of the newer products are more durable and will last longer so there is a benefit to using them if you want to go long distance. A lot of people like to get injected twice a year which is what we recommend, mostly because the body is always changing so we can always keep up with it if we have more opportunity to inject and sort of customize your face. Sometimes people come in and they want to do every 8 to 12 months and for those people we have to end up using a lot more material to try and cover all the ground, so that is when we use different things.
There is a question about Kybella and what we see is Kybella has been very popular and we are seeing a lot of people using it off the face where its approved for so we see it used sometimes in different parts of the body and it works pretty nicely again, it is just an experience type of thing if you used a lot of it, you will be fine getting it done.
So then there is a question about Radiesse. Radiesse tends to be good for very thick skinned people with deep folds and wrinkles. I would not use it around the mouth and I would not use it in the lips at all so you just have to be careful about that. It is also white so you want to be careful about that, that you don’t put it in places where you will see lumps or bumps it is designed to be placed deeply, let’s see what else do we have. Sculptra – like Sculptra a lot particularly in patients that are over 60 because what it does is it restores collagen and elastic fibers and that is really a nice way to help people and it is a durable correction that is if you do enough of it in the beginning what you can do is have the person come back every 8 months and do a bottle or 2 as a refresher just because we can reverse the clock, we can’t stop it so a lot of times it is really nice when we can see you a few times a year sort of do maintenance on that. So that works out really, really nicely.
Let’s see – we have Gabrielle there. Nice to see you Gabrielle, we know that you have always been a big fan and we appreciate that and any other questions or any other comments that I can mention. One question that we always see is, what is the difference between fillers and Botox or fillers and Dysport or fillers and Xeomin or fillers and Jeuveau and the difference is that the botulinum toxins that we use tend to relax muscles whereas the fillers and the other products tend to add volume or subtract volume depending on where we are putting and which product we are using. So there is a big difference and I want to make sure that you are being injected by someone that knows the difference and somebody that does a lot of this, you would not want someone that does not know the difference or interchanges the two. Because if you put them in the wrong places you can have a really bad outcome and we try and make people look like they are rested but still they recognize themselves. We don’t want dramatic transformations just people that look like themselves ten years ago. So we welcome you to attend our virtual week of beauty, we are having some promotional products and some interesting combinations of things for those of you that have not been able to come in for the past few weeks. We understand your frustration and when things use up or so we are going to try and get everybody in. So just be patient with us and we will be happy to work with you. Let’s see there is Lauren popping up, hey Lauren how are you? Thanks for being here. If there are any other questions we are happy to see you or chat, and again if you have questions later, feel free to call us at the office at 561 566 9055 then we will be happy to speak again. Visit us online and take a look at what we have, the virtual week of beauty will be phenomenal and we welcome you to attend it. Thanks again for your time we will do these every day and look forward to speaking to you. Thanks!