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 Mary Lupo, MD, dermatologist and medical director, Lupo Center for Aesthetic and General Dermatology, New Orleans. ���Neck issues are usually sagging and sun damage. We like the Fraxel Dual (Solta Medical, fraxel.com) for the neck and chest, and combine it with Exilis. Te Fraxel Dual addresses mottled pigmentation (with the 1927nm thulium wavelength) and fne crepiness (with the 1550nm wavelength). Te RF Exilis improves skin texture and contours laxity. Te Fraxel Dual is my workhorse when it comes to the chest. I often add Botox Cosmetic (Allergan, botoxcosmetic.com) into the platysma and I sometimes add diluted Restylane (Medicis Aesthetics, restylaneusa.com), injected with a cannula. ���For the hands I combine Radiesse (Merz Aesthetics, radiesse.com) and the Fraxel Dual or IPL. ���Te most common problems with legs are veins and pockets of fat in the thighs. I use the Exilis on the fat and prefer sclerotherapy with Asclera (Merz Aesthetics, asclera.com) for prominent veins.��� Before After Vic Narurkar, MD, dermatologist and founder, Bay Area Laser Institute, San Francisco. ���As many as 30% of our treatments include of-the-face areas. We are seeing an increasing demand for treatments of the neck, chest and hands, perhaps because newer technologies are safer for use in these more delicate areas. ���One of our most popular of-face treatments is a combination of Termage and Botox for the neck. We include the neck when we use the Termage on the face for skin tightening; it is FDA approved for the neck as well as the face. Tis way, we avoid the common complaint of the neck not matching the face. We do decrease the settings by 10% to 20% in this area. After the Termage treatment we add Botox to the platysma to minimize platysmal bands, and the patient walks out with immediate results that improve over time as the Termage treatment builds collagen. Tere is a wonderful synergy, using the two treatments together. ���For even more signifcant results, we add a Fraxel treatment to address discoloration and maximize 32 JANUARY/FEBRUARY 2013 | MedEsthetics collagen building. You can do the Termage and Fraxel on the same day, but I often stage them. Finally, in some patients we inject very dilute (1:2 ratio with saline) Juvederm (Allergan, juvederm.com) just under the skin to plump up the neck skin. Tis combination of treatments keeps the neck looking its best for at least six months. Patients who don���t want surgery can get the best results possible in the neck area with this combination. ���I love combining skin resurfacing with volumizing fllers to treat aging hands. Te hands, like the face, lose volume over time and are even more likely to be afected by sun damage. Te veins on the hands also tend to become more prominent. We treat the discoloration and lentigines with the Fraxel Dual or the Clear + Brilliant (Solta, clearandbrilliant.com) and inject Radiesse or one of the hyaluronic acid fllers to add volume. Some physicians do sclerotherapy for prominent veins, but we fnd that adding volume often makes the veins look less prominent. We use sclerotherapy only if the patient is still unhappy with how the veins look after adding volume. Te Fraxel Dual is very safe for use on the hands, but we keep the energy much lower than we would use on the face��� somewhere between 10 and 20 joules.��� PHOTOS COURTESY OF VIC NARURKAR, MD This patient underwent Thermage CPT treatment on the neck and Botox Cosmetic injections to the platysma.