From the Corner Office
Another year, another fantastic Fall Beauty Event! Thank you to all who attended or joined us virtually on social media for the educational seminars. I was very pleased with the energy and excitement in the room which complemented the beautiful environment and hospitality that my staff created. Based on the feedback, the number of people who attended, and the 100-plus treatment deposits collected to lock in future savings, it was a resounding success. Unfortunately, I was sequestered in a consult room doing back-to-back mini-consults so I did not get a chance to chat with many of you. In the future, I will clone myself.
Shifting gears, I want to address two issues that I feel are gaining traction on social media platforms and in casual conversation. One is that injectable hyaluronic acid (HA) fillers such as Juvederm can cause a puffy and distorted face and two, that HA fillers may move over time. Many of us can think of Hollywood stars or everyday people who look distorted due to injectable HA fillers. This is not a condemnation of the fillers but a comment on the skill, artistry, knowledge, experience, and technique of the injector. It ain’t the paint, it’s the painter.
Purchasing filler is unfortunately too easy, which opens up the possibility of it being used by people who don’t have the proper training or skill. As you can imagine, this can lead to a variety of outcomes. The vast majority of well-done injectable fillers indeed enhance without telegraphing to others what has been done. However, to get consistently excellent, natural-appearing results requires an intimate knowledge of facial anatomy, the fillers themselves including their capabilities and limitations, an artistic appreciation for what makes faces beautiful and the important differences between the sexes and respect for ethnic and age-related variations. Technique also matters a great deal. Whenever possible, placing fillers deeply on the facial bone leads to a smooth, natural, and long-lasting result, though many injectors are simply not comfortable placing fillers deeply due to a lack of knowledge or comfort with deep injection technique.
To properly correct facial asymmetries, which magnify with age, the differences can be measured in millimeters, but the aesthetic impact of misjudging these small differences can be aesthetically catastrophic. Properly reshaping the face to create a more youthful and attractive appearance while maintaining a natural and age, sex, and ethnically-appropriate appearance is an art form. A common mistake I often see is when a patient has their nasolabial folds (smile lines) treated without appreciating that it is lost cheek volume and lack of lateral facial support that is the underlying aesthetic problem, leaving the face looking round and puffy, rather than youthful and beautiful. Overfilled and distorted lips are another frequently seen problem. Keeping the lower lip fuller than the upper lip, accentuating the philtrum, and enhancing the natural M-shape of the upper lip and W-shape of the lower lip is easier said than done. In my mind’s eye what I do with my Injecta-Lift technique, which is placing HA fillers deeply to create total facial rejuvenation with results that can last for years, reminds me of sculpting in clay, and is just as artistically challenging as sculpting a nose during rhinoplasty, yet with even greater potential to enhance appearance as I can work across the entire face. It is the foundation for much of my facial rejuvenation work regardless of whether I am employing complementary techniques such as lasers and/or surgery.
This brings me to the issue of injectors without aesthetic surgical training trying to fix everything they see with the only tool they have available to them, HA fillers. It’s a great tool, but sometimes you need a full tool kit, not just a single tool to get the job done. One area that I see mistakes made all the time is filling the upper cutaneous lip to improve vertical lines. This is not the right approach and often leads to a weird, overfilled, and distorted upper lip appearance that is detectable from across the room. CO2 laser is the proper treatment of choice, complemented with peri-oral Botox, in my professional opinion.
Lastly, as a general rule, when I place HA fillers deeply on bone or in the deep soft tissues for areas where there is no bone, such as the marionette folds, fillers do not move or migrate. Period! This is a falsehood that is promulgated and is simply not true, particularly in my practice.
I want to finish by saying that during the early portion of my career, HA fillers were not available and I injected harvested fat to create volumetric rejuvenation. However, after using HA fillers since they first arrived in the United States in 2003, I have no use for injectable fat. HA fillers do not require a harvesting procedure and are manufactured in different formulations allowing me to choose the most appropriate filler for the area I am treating. They are biocompatible (we all have HA in our skin, fascia, and joints), provide me with millimeter artistic control, don’t change with weight gain or loss and are reversible, safe, and long-lasting. Fat don’t got that.
Stay Healthy, Stay Beautiful!
Seth A. Yellin, MD, FACS
Founder & Director, Marietta Facial Plastic Surgery, Laser & Aesthetics Center
From the Aesthetic Team
This year, we expanded our medical-grade product collection to include my new favorite product, TNS Advanced+ Serum. This is a human growth factor serum that is both colorless and fragrance-free. It targets visible signs of aging skin and results are seen in just two weeks!
What are growth factors?
-Growth factors are naturally secreted proteins in the skin that decrease with age. They improve the efficiency of rejuvenating processes, facilitate cellular communication, and support repairing and remodeling skin.
How can TNS Advanced+ Serum support you?
- If you are in your 20s and early 30s:
- It supports growth factor levels before they decline to help maintain optimal levels of collagen and elastin.
- If you are in your late 30s and 40s:
- It supports skin rejuvenation to address visible signs of aging, including fine lines, wrinkles, tone, and texture.
- If you are in your 50s and 60s+:
- It supports skin rejuvenation to improve the appearance of accelerated signs of aging, like coarse wrinkles and sagging.
How do you use TNS Advanced+ Serum?
Apply in the morning and evening after cleansing BEFORE applying any other products. Be sure to press evenly on the two chambers and blend both serums together in your hands before applying. The first chamber contains the growth factors and a peptide complex. The second chamber supports the first chamber with a highly active blend of botanicals, marine extracts, and peptides. You can take the serum down to your neck and chest if desired.
Be sure to incorporate growth factors into your at-home routine if you haven’t already! TNS Advanced+ Serum is part of the Skin Medica portfolio, which means you can use your Alle points when purchasing!
Sarah McPherson, Medical Aesthetician & Licensed Laser Practitioner
From the West Cobb Office
As we head into fall, I want to take a moment to talk about the role of prevention in anti-aging treatments. We know that daily sunscreen use can help prevent sun damage and keep our skin looking youthful. As I tell patients in clinic and have mentioned in previous newsletters, taking great care of your skin is one of the best things that you can do to help keep you looking more youthful for longer. But did you know that we utilize injectables as prevention as well?
Neurotoxins (Botox and Dysport) help to relax the muscles that are creating lines on our faces. Yes, it helps to correct lines that are already there, but if we are not making the muscle movements, those lines will also be prevented in the future. We can use neurotoxins full face and neck to help with preventing certain lines. Even if you think that you have deep lines, neurotoxins will help soften these lines and prevent them from getting worse.
Biostimulators (such as Sculptra and Radiesse) help to stimulate new tissue growth and can help restore the structure of the skin. This in turn will make your skin look more radiant while also creating natural volume over time. We all lose collagen every year starting in our late 20s, so using biostimulators can help replace it over time and can help prevent signs of aging.
Traditional hyaluronic acid fillers are great for correction and prevention. They will replace volume and support the skin. This support will prevent lines from forming and becoming deeper over time. They are a great tool in slowing down the process of aging.
As a cosmetic injector, I have many tools in my toolkit to not only correct the signs of aging but also help you create a plan for prevention. While we of course cannot stop aging altogether, there are many things that we can do to keep you feeling like your best self!
Kelly A. Houmand, MMS, PA-C
