Medesthetics

SEP 2017

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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Hydrating fi llers—low-viscosity hyaluronic acid-based ma- terials injected superfi cially throughout the face to improve skin tone—have become popular offerings outside of the U.S. and are fi nding their way onto aesthetic message boards and review sites, generating signifi cant interest among U.S.-based consumers. Outside the states, physicians have access to specifi cally formulated products, such as Juvéderm Hydrate, Restylane Vital and Restylane Vital Light, as well as robust marketing campaigns to educate consumers on these new hydrating treatments. Miguel Aristizabal, MD, an aesthetic specialist physician, in Bogotá, Colombia, has been using hydrating fi llers for more than three years to improve fi ne lines and wrinkles, reduce pore size and improve skin hydration and now rec- ommends them for the majority of his aesthetic patients. "Patient satisfaction is high, and the results are fantastic," he says. "In my experience, outcomes of other collagen stimulation therapies are enhanced when I fi rst treat my patients with hydrating fi llers." He performs up to three sessions spaced three to four weeks apart, using 1ml to 2ml of product, and fi nds that results last up to one year. "I like to start injecting directly below fi ne wrinkles or lines—on the superfi cial mid- dermis injection plane—to address lines on the forehead, crow's feet or lateral canthal lines, and wrinkles on the cheeks," he says. "After that, I treat the skin that is less elastic, commonly over the cheeks." For younger patients, Dr. Aristizabal injects several small aliquots of the product in the same plane all over the face from the forehead to the chin, avoiding high-risk areas like the nose and under eye. "After treatment I massage the treated area with cotton swabs to evenly distribute the product," he says. If the patient needs additional laser or radiofrequency treatment, he waits three to four weeks after injection to perform the energy-based procedure. Dermatologist Jason Emer, MD, learned about these procedures while training in Korea and brought them back to his patients in Beverly Hills, California. Because Hydrate and Vital are not yet FDA approved, he uses Belotero Balance. "It has the lowest viscosity and inte- grates completely into the dermis," he says. "For patients with fi ne lines or those who want an overall improvement in their complexions, we either microneedle the Belotero into the skin after laser treatment or we do microdrop- let injections." He thins the fi ller with a small amount of lidocaine with epinephrine and performs "very fi ne, intradermal injections throughout the face using 50 to 100 or more injection points all across the cheek, the forehead and even small injections in the lip for the lip lines. It plumps the skin, improves fi ne lines and globally makes the face look more youthful. This will not give you volume or lift, because the fi ller doesn't have that capacity," says Dr. Emer. He performs one session every three to six months. The procedure has become so popular that he is now us- ing it on the neck, chest and hands as well. "On the hands I use Radiesse to replace volume and then do microdro- plet injections of Belotero to improve the crepey skin that develops there. On the chest area, women who have cleavage lines get really nice improvement. "The only downside with these low-viscosity fi llers is they just don't last as long—it's really a three to six month improvement," he says. Like other soft tissue fi ller procedures, the cost is dependent on the type and volume of fi ller injected. Dr. Emer uses two to four syringes of Belotero for global treatment for the face. "This is a new arena in soft tissue fi llers," he says. "We've been doing it for about three years, and my pa- tients love it." Inga Hansen is the executive editor of MedEsthetics. NEWSMAKERS | 72 SEPTEMBER 2017 | Med Esthetics By Inga Hansen Microdroplet injections of low-viscosity hyaluronic acid-based fi llers are gaining fans around the globe. Hydrating Fillers Miguel Aristizabal, MD Jason Emer, MD

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