MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
Issue link: https://medesthetics.epubxp.com/i/101607
BEYOND THE FACE Mitchel P. Goldman, MD, medical director, Goldman, Butterwick, Fitzpatrick, Grof & Fabi Cosmetic Laser Dermatology, San Diego. ���Te most common procedure of the face, and the one that gives the most dramatic and consistent results, is intense pulsed light (IPL), which we use on the chest, neck, arms and legs to treat photodamage, especially solar lentigines. Once a woman has facial rejuvenation, which often includes the neck, the next problem is usually the chest, especially for women who are proud of their cleavage and want to show it of. As they age, sun damage and loss of collagen leads to wrinkles and crepey skin that give away their age even if the face does not. Combining IPL with Sculptra (Valeant Aesthetics, sculptraaesthetic.com) and Ultherapy resolves all of these issues for up to two years. ���We suggest one to three IPL and Sculptra treatments at one-month intervals. We use the M22 Universal IPL (Lumenis, lumenis.com) at the same settings we use on the face to take care of sun damage. To treat wrinkles, we inject a 16cc Sculptra dilution (14cc of bacteriostatic water and 2cc of lidocaine) in all rhytides and indentations. Immediately after the injections we apply liquid soap and perform a vigorous massage to evenly distribute the product. With this technique we���ve never had any problem with nodules in the chest area. We fnish with one Ultherapy treatment, which works even better to tighten the skin in combination with the 30 JANUARY/FEBRUARY 2013 | MedEsthetics because the skin on the chest is much more sensitive and prone to scarring than the skin on the face. We tend to do less depth of penetration and recommend two to four treatment sessions. We do the BBL treatment frst, followed by the fractional laser. Tese two therapies address discoloration and crepiness in the skin, which is all many patients need, but some can also beneft from the addition of fllers. ���Because of the large treatment area, we prefer autologous fat injections to synthetic fllers for the chest. Tis allows us to inject 20, 30 or even 40ccs costefectively. Adding volume, especially to the upper pole of the breast, creates a more youthful look. Although autologous fat injections can be somewhat unpredictable, the natural fat injections still last as long as most synthetic fllers, and you have the added advantage of introducing some stem cells that can produce longerlasting results.��� Before After This patient received three Sculptura treatments to reduce wrinkles and crepiness in the d��collet�� area. Sculptra. We use the same settings as for the face. Four or fve months later, we will perform a second Ultherapy treatment on some patients if needed. We���ve just begun a phase 3 clinical trial using Ultherapy on the chest, as part of a multi-center study. I���m impressed with Ulthera���s commitment to continuing research. ���We use the same combination regimen���IPL, Sculptra and Ultherapy���for arms as well. If we���re doing arms or legs, we increase the IPL energy 10% to 20%. ���Aesthetic procedures can be a bit like redecorating your home. Once you rejuvenate the face, it makes other areas look bad in comparison. Te limiting factor for most women is usually cost. IPL treatments start at $400, Sculptra treatments begin at $750 and Ulthera treatments are $3,500 for each area. Some women can aford the $30,000 it might take to rejuvenate chest, arms and legs, but others have to choose only one or two areas.��� PHOTOS COURTESY OF MITCHEL P GOLDMAN, MD . Barry L. Eppley, MD, DMD, plastic surgeon and co-founder of Ology Spa|Aesthetics|Medicine at Clarian West Medical Center, Avon, Indiana. ���About 50% of our noninvasive therapies are of the face, including laser hair removal, body contouring and laser vein removal. We use a variety of energy technologies, from the 1064 Nd:YAG laser to Exilis (BTL Aesthetics, btlaesthetics.com), Termage (Solta Medical, thermage.com) and Ultherapy (Ulthera, ultherapy.com). Te two therapies most likely to be efective for the d��collet�� are broadband light (BBL, Sciton, sciton.com) and the fractional laser. We use ProFractional Terapy (Sciton, sciton.com). ���You do have to be careful with lasers in this area,