By William A. Carter
It certainly is an exciting time to be involved in the aesthetics arena of medicine! Just this week, I have been exposed to and/or trained in four new services and products that I didn’t know about just a month ago. Our talented licensed medical aesthetician, Michelle Phillips, has been doing a new technique for permanent eyebrows called microblading that has been getting outstanding reviews from our patients. Microblading costs the same as doing permanent eyebrows the old fashioned way, but ends up looking much more like natural hair. Everyone has simply loved the results.
The first new thing that I was exposed to this week was a process for inserting biodegradable thick, collagen-inducing PDO threads created by Novathreads to help to reshape the face. The technique is professionally not difficult to learn and the safety margin is fortunately huge compared to the technique I learned years ago called Contour Threads. So, what can be achieved from the insertion of PDO Novathreads? Basically, selective lifting or tightening of regions of the face that have descended or are excessively loose. Furthermore, this can be accomplished with no down time! Each thick thread can be expected to last about 12 months, and they can be supplemented at any point, typically between 6-12 months after the initial treatment.
Next in the “new parade” for me this week was a fat-alternative generalized face filling product called Allofill. The first modern large-region facial plumper was fat. Then there was Sculptra. Now there is also Allofil. These fillers are all “volumizers.” The more traditional fillers (e.g. All of Allergan’s Juvederm family, and Galderma’s Restylane family) are used for smaller target areas (under the eyes, lips, marionettes, nasolabial folds, etc.) The volumizing fillers take up larger regions of the face, and are generally placed deeper. They also tend to last longer that the more traditional and more localized fillers. Fat lasts as long as the patient is alive once it is placed, but the amount that survives initially is uncertain. It could be that 80% of the fat that is placed sets up its own blood supply and lives, it could be as little as 20%, or it could be anything in between. Sculptra lasts a minimum of two years, and most often a great deal longer. Some of the Sculptra I had placed into my own face has lasted in excess of 10 years. One argument against Sculptra is that multiple treatments are needed before there is any visible benefit.
Allofill is the newest volumizing filler and is unique in that it utilizes human derived fat cell growth factors to stimulate the patient’s own fat stem cells to replace 50% of the Allofill volume that is put into place. Very predictable. After that 1% of the achieved volume is lost each year. So in 50 years, 50% of the original Allofill volume is lost. Happily, for me in 50 years the loss of facial volume will not be my greatest physical concern!
Galderma has just released two new more “traditional mode” fillers that promise at least a year of benefit before they are naturally broken down by the body. They are Restylane Refyne, and Restylane Defyne. They are the first cross-linked fillers in the Restylane family, and are best suited for areas of the face where there is a lot of facial expression movement. I am very excited to begin using both of these, as well as the volumizing Allofill.
Along with these new products, many of us in the field are now using a blunt needle canulla technique to place an assortment of fillers in most locations of the face. Advantages of this method over the older sharp needle method are greater patient comfort, less chance of bruising, and often quicker injection times.
So, you can certainly see why this is an exciting time to be doing the incredibly satisfying work of improving people’s appearance: options, options, and even more options! For me, it has become exponentially more enjoyable to be able to increasingly customize what can be done for each person. For the consumer, there could be increasing confusion about what to ask for and how to consider one’s choices. Try to approach your facial needs in a general way, and allow your practitioner to discuss the best approach within the individualized framework of your treatment parameters and needs.