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One Treatment Does Not Fit All

By Sydney Gatta, RN


In the ever-evolving world of facial aesthetics, there are constantly new treatments on the market to help us tackle (and in some cases prevent) the inevitable – facial aging.

Botox, which is the most well-known neurotoxin, has been around for ages. Brand name Botox was the first neurotoxin approved by the United State’s Food and Drug Administration (FDA). However, since it first was first created, many other generic forms have been developed and manufactured. Some that are currently available are Xeomin, made by Merz; Jeuveau, made by Evolus; Dysport, made by Galderma; and Daxxify made by Revance. At the American Academy of Facial Esthetic’s Training Center in South Euclid, Ohio, we currently use Botox and Xeomin. At this point, neurotoxin is our most frequently sought-after and most popular treatment. Simply put, neurotoxin’s main purpose is to relax muscle movements and smooth wrinkles. It is often used preventatively in younger patients to prevent wrinkles from ever forming, by minimizing muscle movement early on. People of all ages can receive neurotoxin treatment, however once static creases form, depending on the severity, they become more and more difficult to tackle. Because of this, there are many other modalities that can help us treat these stubborn areas.

One of those most widely used modalities is dermal filler. There are all types and brands of dermal fillers on the market, but the most commonly used in our practice are Hyaluronic Acid-based and Calcium Hydroxylapatite fillers. We carry Belatero Balance, Radiesse, and Radiesse Plus, made by Merz; Juvederm Ultra, Juvederm Ultra Plus, and Juvederm Voluma, made by Allergan; and Revanesse Versa Plus and Revanesse Lips Plus, made by Prollenium. Overall, dermal fillers are used in volume-lacking areas to improve deficiencies and to hydrate tissue. Areas that can be filled include, but are not limited to: temples, tear troughs, cheeks, mid-face, nose, nasolabial folds, chin, jawline, lips, and philtrum columns. Additionally, filler can also be used to help fill and disguise fine lines. Depending on what area is being treated, we choose an appropriate weight filler to most effectively treat the deficiency. In my day-to-day practice, I fill mostly lips and cheeks. When filling lips, I like to use a medium weight filler and for cheeks I reach for a heavier filler with a higher G-prime. This is because cheek filler is often placed deep using direct needle injections, to help mimic the appearance of bone. Regardless of the area treated or the type of filler used, the products are typically moldable for a short period of time following treatment and can be manipulated when necessary.

Now that we’ve discussed the benefits of using neurotoxin to treat muscle movement and wrinkles, and filler to minimize volume deficiencies, let’s talk about the dreaded sagging tissue that is left behind. Until Polydioxanone (PDO) lifting threads hit the market for aesthetic purposes, there was very little to be done for sagging tissue, aside from surgical options. Nowadays, PDO threads are widely used in this industry to treat skin laxity in the face, neck, and certain other parts of the body. In our practice, we most commonly use them in the nasolabial folds, marionette lines, jowls, jawline, and neck. The threads are made of Polydioxanone suture material and contain barbs that are either laser cut or molded. Those barbs physically lift the tissue and the results can be seen and felt immediately. As the threads start dissolving and breaking down, collagen is produced. The timeframe for peak collagen stimulation is typically around the six month mark following treatment. In addition to PDO lifting threads, there are PDO smooth threads as well. PDO smooth threads can be used for treating scarring, loose or crepey skin, and fine lines. Both types of PDO threads are used frequently and are great options for stubborn skin laxity and scarring issues.

While we have discussed the three main treatment modalities that we use in our practice, there are a couple more that we use as well. One of them is mirconeedling and in our clinic, we use the SkinPen which is made by Crown Aesthetics. We often use microneedling to essentially resurface the skin. This treatment can help with skin scarring, tone and texture concerns, minimzing pore size, fine lines, and many more patient complaints. The treatment is relatively simple, but there is a good amount of downtime involved. Ideally, we complete three sessions, each at least four to six weeks apart. Once the three initial treatments are complete, they can be done annually or as agreed upon by the patient and provider. Microneedling is and has proven to be a game-changer for many patients with a multitude of skin issues and complaints.

Lastly, skin care. Arguably one of, if not the most important piece of this whole puzzle is skin care. Consistent, and ideally medical-grade skin care is absolutely essential when treating and/or preventing facial aging. At the American Academy of Facial Esthetic’s Training Center, we use and sell the ZO Skin Health line. This line of products was founded and developed by the world-renown Dr. Obagi, who is an expert in this industry. To this day, he is still the Medical Director for ZO Skin Health. The basis of their line is focused around three main steps: Getting Skin Ready, Prevent + Correct, and Protect. We belive that this is an absolutely essential part of treating and preventing facial aging.

As you can see, there are endless options to choose from when developing an appropriate plan of care for our patients. The different modalities discussed above are just a small snapshot of the many options on the market and the industry is only getting bigger and bigger. Luckily for us, we have so many of these treatment modalities at our fingertips and it is the combination of many of them is what enables us yield the most desirable and effective results for our patients.


Start your facial esthetics journey by registering for the Botulinum Toxins & Dermal Fillers Level I Course! Register here today:

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