Regenerative Aesthetics vs. Traditional Fillers

With increased successes in Regenerative Aesthetics, are traditional fillers like Botox or Dsyport still necessary?

One of our many specialties here at Regen Doctor is Regenerative Aesthetics. Regenerative Aesthetics employs your body’s collagen-induction response to restore, rejuvenate and replace lost volume. Some examples include “sugar” thread lifts, microneedling with PRP and growth factor (stem cell) facial fillers.

In this blog post we will delve into the pros and cons of all types of filler and neuromodulators, when to use them and when to combine them with more natural, “regenerative” options.

While cosmetic results with Regenerative Aesthetics often last longer and are more effective than traditional Botox and / or dermal fillers this doesn’t exclude one for the other.

But here at Regen Doctor we certainly are using less syringes of commercial filler and less units of Botox while upgrading your facial restoration with thread lifts, PRP, microneedling, and stem cell injections. Our belief is the more natural “biohacking” you can tap into the better. Most of us would prefer autologous (your body’s) solutions rather than injecting a foreign substance anywhere in your face! This is also why our fat removal and fat transfer procedures with Body Sculpt are so popular. Why get artificial implants when you can remove the adipose (fat) from your abdomen and sculpt it into your breasts or buttocks with 80-90% viability!

However, sometimes one syringe of hyaluronic acid (aka filler) can be combined with these aforementioned techniques for the best of both worlds. We call this, Combination Therapy.

DERMAL FILLERS: Volume Loss

Did you know that many visible signs of aging can be traced back to volume loss? As facial tissues thin, lines become etched around the nose and mouth and cheeks that often create a “hollow” look. Dermal fillers can easily replace this lost volume to help smooth wrinkles, plump lips, and restore a more youthful appearance around the cheeks and temples.

BACKGROUND:
Maybe we’re skipping ahead. Let’s discuss what are Juvederm, Volbella, Restylane and Versa anyways? Dermal fillers are gel-like substances that are injected beneath the skin to restore lost volume, smooth lines and soften creases, or enhance facial contours. More than 1 million men and women annually choose this popular facial rejuvenation treatment, which can be a cost-effective way to look younger without surgery or downtime. While dermal fillers are casually known as “wrinkle fillers,” they can do much more. Here are a few of the common issues dermal fillers can help address:

  • Smooth out lines around nose and mouth (a.k.a. marionette lines, smile lines, and nasolabial folds)
  • Enhance & restore volume to sunken cheeks or temples
  • Diminish vertical lip lines
  • Plump & enhance the lips
  • Smooth out a chin crease
  • Improve symmetry among facial features AND…
  • Non-surgical Rhinoplasty –with oftentimes amazing results.

What are Fillers Made With?

In general, fillers are categorized by the substance they are made from:

Hyaluronic acid is a naturally occurring substance that is already found in your skin. It helps keep skin plump and hydrated. HA fillers are typically soft and gel-like. The results are temporary, lasting 6 to 18 months before the body gradually and naturally absorbs the particles. *Note: More recent MRI studies of the face show that oftentimes fillers last a lot longer than most people think. They don’t always get “metabolized” rather they migrate deeper into the dermis where they are not as effective! Most HA fillers are infused with lidocaine to help minimize discomfort during and after treatment. FDA approved HA fillers include:

Juvéderm products: Juvéderm XC, VOLUMA, VOLBELLA, VOLLURE

Restylane products: Restylane, Restylane Silk, Restylane Lyft, Restylane Refyne, and Restylane Defyne. Belotero Balance. One reason a lot of folks prefer HA is because the substance can be dissolved with Hyaluronidase. We strive to make our art and technique so “perfect” that we don’t ever have to undo or reverse our work. However, we have had patients come in to dissolve prior filler injections from other establishments and really, that is not to blame anyone. Filler is an imperfect medium that can migrate, swell, or deteriorate at different rates and cause asymmetry. This is why at Regen Doctor, we tend to only use one to two syringes of filler at a time, and usually in combination with threads and Botox. Remember, “Slow is Pro.” If someone is trying to sell you 4 syringes of filler to be injected in one sitting be wary. In skilled hands, proper placement of HA means you can use much less. Additionally, every patient should be given a 2 week waiting period before adding more. Everyone responds differently to different to different types of filler. Therefore, your injector better be a knowledgeable expert on the matter.

Calcium hydroxylapatite is also a naturally occurring substance, found primarily in our bones. When used in a filler, the calcium particles are nearly microscopic and suspended in a smooth gel. The consistency of a CaHA filler is typically thicker than that of a hyaluronic acid filler and typically last longer as well, about 12 – 24 months for most patients. Calcium hydroxylapatite is also reported to help stimulate natural collagen production, and it is typically used for deeper lines and wrinkles. FDA approved CaHA fillers include Radiesse®. Radiesse® is a great option for the back of the hands, to replace lost volume and give those digits a more youthful appearance.

Poly-L-lactic acid is a biocompatible (meaning it is safe to use in the body), biodegradable synthetic substance. It has been used for many years in medical devices, such as dissolvable sutures. Poly-L-lactic acid products are technically classified as “collagen stimulators,” as their main mechanism to smooth fine lines by rebuilding natural collagen—the filler gel itself dissipates a few days after treatment. Poly-L-lactic acid is typically used to treat deeper facial wrinkles, and results can last more than 2 years. FDA approved Poly-L-lactic acid fillers include Sculptra® Aesthetic. *Note: Regen Doctor loves to use PLLA for our thread lifts. The precision of placement is just much better. Because PLLA is not reversible we don’t encourage it’s use for facial filler. Additionally, if you’re planning to get a surgical facelift down the line, it’s reported that Sculptra can make the task much more difficult. This is not the case with our preferred alternative: PDO threads.

This one is extra credit.

Polymethylmethacrylate (PMMA) is a synthetic, biocompatible substance that has been used in medicine for much of the last century. In dermal fillers, PMMA takes the form of a “microsphere” or tiny ball, that remains beneath the skin indefinitely to provide continued support. PMMA fillers will also contain collagen, a naturally occurring substance in the skin that provides structure and firmness. FDA approved PMMA fillers include Bellafill® (formerly known as Artefill).

Autologous fat injections (facial fat grafting: autologous means “from the same person”)

Autologous fat injections are the only injectable filler treatment that require lipoaspirate, but the results can last for many years. Your own fat is harvested from an area such as the abdomen. The fat is then purified and injected into the face to help restore volume to the cheeks, temples, lower eyelids, or other areas. Fat injections require specialized training to perform safely and achieve great results, and should only be performed by an experienced, medical provider.

A cryopreserved flowable cellular biologic with additional extra-cellular matrix for the dermal layer. This is our exciting new product that combines the amazing volume replacing properties of traditional fillers with the exciting new field of Regenerative Aesthetics. Clinical Director Scott Mortensen and founder, Dr. Dale Kiker flew out to Utah to meet with the company heads producing this exciting new product. While it’s not inexpensive, we feel it’s the future of facial fillers, providing both lost volume AND signaling your cells to create more collagen.

Which filler do I need?
With so many dermal filler products on the market, it can be difficult to know which option is best for you without medical guidance. Each product is uniquely formulated to have a certain texture, density, and injection depth, which means that certain fillers work better for certain areas of concern. While your provider at Regen Doctor will determine what product is best for you it’s always best to do your due diligence. We recommend our patients go to www.realself.com, have a look around, get a baseline feel for what you want and see how happy others are with the product.

What to Expect During Treatment
Dermal filler injections are non-surgical and typically completed during an hour or two. Your initial treatment will begin with a consultation, during which you will meet with your medical  professional to discuss your concerns and goals.

Pre-treatment consultation
During your consultation, we will evaluate your area of concern and review your medical history. While the risks associated with dermal fillers are minimal, you need to fully disclose your medical history prior to treatment, as certain allergies, skin and neurological conditions, or medications can jeopardize your safety or results. For instance, you need to tell your cosmetic surgeon if you have been taking NSAIDs (e.g., aspirin, ibuprofen, naproxen) or blood thinners, as these increase the likelihood of bruising. Also, please don’t drink alcohol before a filler treatment. It accelerates bruising. We have Arnica gel and tablets here at Regen Doctor for you to use. But if you have them at home, feel free to take them the day or morning before your visit.

Your injectable filler treatment
Just before the actual treatment, the area will be cleaned, and you will be offered a topical anesthetic to numb the area prior to injection. Many filler products also contain lidocaine, a mild anesthetic, which is intended to help minimize discomfort during and after your treatment. We will then inject a precise amount of filler strategically beneath the lips, cheeks, temples or nasolabial folds. Depending on the product and the areas treated, you should be able to notice results immediately after receiving filler injections. Some patients experience mild bruising and swelling, but these are temporary and should subside over the days following treatment. You will be able to go back to your normal activities right after treatment, but we may ask you to take the day off from exercise or other strenuous activity.

If you are having fat injections…
Facial fat grafting is a surgical procedure and follows a different treatment protocol. Typically, fat grafting is performed as an outpatient procedure, using local anesthesia with sedation. Up to 2 weeks of downtime may be required, depending on the extent of liposculpture performed. For our Body Sculpt procedure, we will go over what to expect and best practices for recovery during your consultation.

How Long Do the Results Last?
How long the effects of dermal fillers will last depends on the product, the area of treatment, and the patient. Generally speaking, the denser the product and the more deeply it is injected, the longer it will last, although this is not a hard and fast rule. To maintain your results, we will offer combination therapy such as PRP or stem cell injections and thread lifts.

Hyaluronic acid fillers tend to be the most temporary option, and therefore are often recommended for first-time filler patients. These will typically last from 6 to 18 months. Injections to the lips will wear out a little faster than those to the nasolabial folds. Certain HA fillers, such as VOLUMA, are formulated to last longer, but are usually limited to certain areas, such as the cheeks.

Synthetic fillers tend to last longer, as they are not readily absorbed by the body. They can be a great option for the right patient, but you’ll want to be ready to commit to results that will be there for several years—and as always, please choose an experienced, qualified provider whose aesthetic style you like. We tend to promote a more natural look here at Regen Doctor rather than trying go too big too fast.

Fat injections are meant to last indefinitely; however, some of the injected fat is expected not survive. Initially, we may overfill the treatment area, resulting in an initially fuller look that will gradually settle into a more natural appearance. Our fat viability is among the highest in the industry because of the advanced technology and equipment we use.

Now for a quick discussion on Botox (aka neuromodulator, Dysport, Jeaveau, Xeomin, etc.)

First of all, remember: OUTER WRINKLES ARE JUST A SIGN OF INNER STRENGTH!

Anti-aging is a bit of a misnomer as it is an impossibility. A better term is “defy aging.” Look as young as you feel – and let others know it.

This an instance where BOTOX can help! Squinting in bright light, smiling big, raising eyebrows in surprise and laughing with all your might are visible signs of your facial muscles in action. Over time, this inner strength shows on the outside as deepened facial lines and dynamic wrinkles from muscle movement. BOTOX is designed to target the cause of wrinkles and give your face a fresher look.

RELAX 🙂

Botox is not a dermal filler like Radiesse® or JUVÉDERM® Injectable Gel; instead, BOTOX Cosmetic temporarily relaxes muscles that contribute to wrinkles. Within 24-72 hours of treatment your target wrinkles fade leaving skin looking smoother and more youthful. These quick, simple and safe injections can improve your facial wrinkles while maintaining natural expressions. Please note, Botox takes up to two weeks to fully “set-in.”

Did you know? Botox can also treat:

  • Hyperhidrosis (excessive sweating – armpits, hands, feet)
    Facial “Lifts” (i.e. Botox into the base of the nose for the appearance of a “nose lift.”)
  • Slimming (i.e. reduce that square jaw for more of a V-line contour)
  • TMJ (temporomandibular joint disorder)
  • Acne
  • Migraines
  • Muscle spasticity

BOTOX Cosmetic treatments can also prevent wrinkles from forming!

BOTOX treatments consist of a quick office visit and require no downtime. We offer cold compress, topical lidocaine (numbing agent) and vibration distraction for pain management however even without it most patients describe the pinprick of the tiny needle as a harmless bug bite. Improvements last between 3 to 6 months, and can often be maintained with occasional touch up treatments.

BOTOX CONSULTATION
During your consultation, you can discover if BOTOX Cosmetic is right for you. Optimal results can often be attained by adding one of our modern dermal fillers. Other combination treatments include PRP / Stem Cells (your body’s own growth factors), nanofat, threads and microneedling among many others. 

Patients who have more advanced wrinkling or lack skin elasticity might be better suited for a facial sculpting procedure such as a thread lift or face lift to achieve greatest results. 

It is our pleasure to thoroughly explain all of your available options and help you choose the procedure that is best suited to you. To learn more about BOTOX Cosmetic injections, skin rejuvenation treatments, and facial sculpting procedures, request a private consultation and schedule your visit.

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