Dermarolling or Microneedling has become a popular treatment in the aesthetic industry. It works by creating micro-wounds to the skin to promote skin rejuvenation. It triggers the body to create more collagen and elastin which are essential for tightening, lifting, and smoothing out the skin.
In recent years, the market has been flooded with advertisements of home or “DIY” dermarollers. These advertisements aim to target people who are looking for smoother skin without spending too much. Although everyone loves a good DIY, there are things that are better left to professionals. DIY dermarollers have needle sizes that average 0.1 mm – 0.3 mm in depth in comparison to professional clinical microneedling devices that have needle depths that range from 0.5 mm – 1.5 mm on average. Professional microneedling devices should only be used by trained medical professionals. DIY rollers are typically poorly manufactured and usually contain one needle head which is difficult to clean and sterilize with each use, increasing the risk of potential infections and skin damage. Not only that, microneedling may be fairly uncomfortable without numbing cream provided inside a medical office.
If used incorrectly, you may develop an infection, hyperpigmentation, scarring, or other serious damage. The risks far outweigh the possibility of an affordable at home project for nicer skin. It is important to discuss with a trained medical professional if you are considering microneedling or if microneedling is right for you.
Platelet Rich Plasma (PRP) is collected from a patient’s own blood sample that is centrifuged to create a high concentration of platelets in a small amount of plasma. Platelets are made in the bone marrow and play an important role in blood coagulation. In recent years, scientists have discovered that platelets contain different factors (growth factors, cytokines) that also assist in inflammation, neovascularization, stem cell migration, and cell proliferation.
PRP injections have frequently been used in musculoskeletal injuries. It has grown in popularity in this field as it increases the necessary blood and nutrients needed to regenerate damaged tissue. Besides orthopedics, PRP injections have also been used in fields such as ophthalmology, pediatrics, gynecology, urology, cardiac surgery, dermatology, and plastic surgery.
In aesthetic medicine, it has been shown that PRP is effective in increasing collagen and elastin production which can improve the overall quality of the skin. Topical application, skin injections, or a combination of both PRP applications have been used for patients with facial wrinkles, sun damaged skin, atrophic acne scars, and depressed skin. Studies have shown that patients who received PRP treatment for these concerns noted a general improvement within weeks of their initial treatment. PRP can also be injected into sites such as the nasolabial folds, supraorbital grooves, forehead, temple, and glabella. However, PRP alone is not as effective in addressing deeper wrinkles in comparison to filler.
It is important to discuss with an experienced medical provider if PRP injections or topical application is the right option for you.
Nasal septum perforation is a condition where there is a full thickness defect (or hole) of the nasal septum. The nasal septum divides the inside of the nose from the left and right cavities. Septum perforations can be caused by a variety of different factors such as trauma, autoimmune disorders, infection, neoplasm, nasal sprays, or drug use.
Today, we will talk about cocaine and how this can lead to nasal perforations! Cocaine was popularized in medicine in the 1880s. In 1905, there was increased usage of cocaine recreationally and snorting cocaine became extremely popular. Hospitals started reporting cases of nasal damage caused by using this drug.
Cocaine is a stimulant that causes blood vessels to constrict. When blood flow is compromised through continued use of cocaine, this causes lack of oxygen being delivered to the tissue. As a result, the tissue lining the cartilage as well as the cartilage will begin to die. Since cocaine also has a numbing effect, most people may not even notice that this is occurring. Once a nasal perforation is present, it cannot heal on its own.
Damage to the septum can cause changes in the appearance of the nose such as causing the nose to look collapsed (saddle nose deformity). In addition, perforations can increase complications during and after rhinoplasty. The size of the perforation and integrity of the septum are also factors which may affect the result of a rhinoplasty procedure. While this may sound discouraging, a safe rhinoplasty can still be performed for these patients by an experienced rhinoplasty surgeon. A consultation with an expert in advanced or complicated rhinoplasties would be best to discuss all possible options to achieve your aesthetic goals in a safe, predictable manner.
I’m afraid to get fillers because I have heard about possible vascular obstruction and necrosis!
Vascular obstruction/occlusion can occur when blood flow has been blocked by filler which does not allow the surrounding tissue to obtain the necessary oxygen and nutrients it needs. In turn, this can lead to necrosis of the tissue if left untreated long enough.
Although vascular obstruction and necrosis is a severe possible side effect of dermal fillers, the incidence rate is extremely low. In medical literature, frequencies of vascular adverse events range from 0.05–0.01%.
Studies have found that experience, in terms of how long a provider has been practicing and how many procedures performed, affects the rates of occlusion. A more experienced provider will have a lower rate of occlusion, but even still, the rate is significantly low.
Some ways to prevent this include getting a full history from patients, choosing a reversible filler (hyaluronic acid), and good technique.
It is important to remember that any cosmetic procedure has its risks, but with the right care and medical provider, this risk is significantly reduced.
Hyaluron pens are a needle free device that use pneumatic pressure to force hyaluronic acid into the skin. The FDA recently issued a warning on 10/8/21 advising against these devices, as they have been linked to serious injuries and irreversible damage. These pens are unpredictable because the levels of pressure distributed with each push are uncontrolled and uncalibrated pressure.
Some of the risks of using hyaluron pens for dermal fillers include:
Allergic reactions
Bleeding
Bruising
bacterial, fungal, or viral infections
the potential for disease transmission if shared with others
Blood-vessel blockage that can lead to necrosis
Blindness
Stroke
Scarring
Damage to the eyes from the device pressure
Skin lumps or discoloration.
Dermal filler is only FDA approved to be administered with a needle and syringe, and on occasions a cannula. It is important to consult with a trained medical provider to work towards an aesthetic goal that is not only beautiful but also safe.
After 2 Picofocus picosure treatments to improve her acne scars and hyperpigmentation
Microneedling vs. Picosure in regards to Melasma
Microneedling is effective in treating areas of hyperpigmentation; however, you would need further consultation to determine which treatment is best for you. In regards to laser treatment, it would benefit you to look into Picosure. PicoSure differs from all other lasers currently available as it causes minimal thermal damage to the targeted area. It is also the only laser treatment that is FDA approved to treat melasma.
Each surgeon will have his/her preference in terms of general anesthesia. For me personally, I find general anesthesia to be the most comfortable and safe form of anesthesia for my patients during rhinoplasty. The nose is a part of the airway, and for this reason during nasal surgery blood can potentially enter the airway. General anesthesia provides an excellent way to protect the airway and prevent issues from blood entering the airway.
Buccal fat removal (cheek fat removal) is a surgical procedure designed to create facial slimming by reducing the volume of the cheeks along the lower third of the face. The surgery is performed through small incisions hidden on the inside of the mouth, and therefore leaves no visible scarring. Through these incisions, the buccal fat (or Bichat’s fat pad) may be accessed, and removed in a calibrated fashion to achieve the desired slimming effect. Removing or reducing the buccal fat creates the appearance of a more contoured cheekbone, and a slimmer face shape.
Buccal fat removal may be performed under local or general anesthesia, and is generally a very well tolerated procedure with minimal post-operative discomfort. A certain degree of bruising and swelling is expected after surgery, though for most patients this will resolve within ~2 weeks after surgery.
I’m Jinli Wu, a plastic surgery physician assistant in Beverly Hills and I would like to talk about a popular topic that my patients regularly ask me about: what is the difference between Botox, Dysport, and Jeuveau, and how do you know if you’re picking the right one for you?
First, let’s take a look at the science behind these products. Dysport, Botox, and Jeuveau are neuromodulators made from Botulimum toxin type A, a toxin derived from a bacteria called Clostridium botulinum. This is the same bacteria that causes botulism(!), though in small, controlled doses is very safe and effective at reducing fine lines and wrinkles.
Neuromodulars work at the molecular level by blocking the signal from your nerves to your muscles. When injected, it stops the nerves from releasing acetylcholine at the neuromuscular junction. This prevents the muscle from contracting, ultimately relaxing it. For example, when injected into key spots in the forehead, the muscles that aid in facial expression become paralyzed and those pesky horizontal lines are minimized.
Dysport, Jeuveu, and Botox are all FDA approved to soften fine lines and dynamic wrinkles (wrinkles associated with facial movement) in the forehead and in between and around the eyes, like crow’s feet. They are also used to treat chin dimples, reduce neck lines, elevate eyebrows, and slim the jawline. The side effects for Dysport and Jeuveau are the same as Botox, which include injection site discomfort and bruising.
So what are the differences between Botox, Dysport, and Jeuveau?
Botox has been on the market for over 30 years and has a great safety and efficacy profile. It takes approximately 4-7 days to take effect and up to 2 weeks for full results. Dysport has also been used for many years in both Europe and the USA with great results. Clinical studies show that Dysport may last up to 4 months, similar to Botox; however, some patients find that Dysport may act quicker and last longer. Still, some people find there is no difference between the two. The effects of Dysport can be seen in 2-3 days with maximum results achieved in 2 weeks.
A key advantage of Dysport is that it can create a more natural appearance for those patients who prefer some muscle movement or want quicker results. For those who have stopped responding to Botox, it may also be a useful alternative. Dysport is also unique in that it requires more units to achieve the same results as Botox, however, because it costs less per unit, the cost per treatment is equivalent in our clinic.
Jeuveau is a newer generation of neuromodulators and is FDA-approved to treat frown-lines between the eyebrows, though it can be used in the same areas as Dysport and Botox. Studies comparing the efficacy of Jeuveau to Botox show that Jeuveau works just as well. Jeuveau’s characteristics are very similar to Botox, even down to the size of the molecule’s themselves. Compared to Dysport, which is smaller, Botox and Jeuveau do not diffuse as much, which means it is less likely to move to nearby muscles. Similar to Botox, Jeuveau takes about 4-7 days to take effect and up to 2 weeks for maximum results.
Most patients come in to the office asking for Botox because it is the most recognizable brand. When it comes to choosing a neuromodulator for you, there isn’t one right answer. Basically, it comes down to each drug’s individual profile, the needs of the patient, and the technique of the injector. These details, and your aesthetic goals will help guide the best treatment plan for you.
I hope this post clarifies some of the key differences between these neuromodulators, which are used frequently in our clinic. If you have any questions, or know of any other topic you would like me to discuss, please let me know!
Have a great day and I look forward to seeing you in clinic!
