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What do you think I need?

By Sydney Gatta, RN


I am a nurse injector and like many of you, day in and day out, I see patients hoping to maintain or improve their appearance in one way or another. I am employed at the American Academy of Facial Esthetics and treat patients at our Training Center in South Euclid, Ohio. I am one of five nurse injectors practicing in the office. Together, we have established quite a substantial client base, consisting of a very wide range of patients. We see people ages eighteen years old, all the way up to the mid-seventies. Their esthetic needs, wants, desires, and requests are always different. Additionally, the world of esthetics is constantly evolving and ever-changing. Our appointments range from simple neurotoxin treatments to much more advanced, full-face cases.


While many of our clients come in knowing exactly what their treatment plan is, or should be, many others rely on us, as their injector to assist them in the process. So often, our consultations start with the question, “what do you think I need?” Sometimes I find this question awfully difficult to answer. While I think it is extremely important to remain open and honest with clients, I don’t like to point out potential areas of concern that may have never bothered the client previously. Ideally, I will always lead by asking, “what bothers you most?” Either way, once we collectively establish what our esthetic goals are for a specific patient, that’s when we start discussing the seemingly endless options for treatment.


Like many fields in medicine, thorough patient education is of the utmost importance. Similarly to the discussion that should be had when obtaining informed consent, you want to ensure your patient fully understands what modalities there are and what can be used where and when. Due to the many options and constantly evolving nature of the industry, I lay out all of the options for my patients and talk about each one in great detail. Here, I will provide a short summary of what information is generally covered in these consultation discussions.


Starting with neurotoxin, which relaxes muscles. At the American Academy of Facial Esthetics Training Center, we offer two brands of botulinum toxin A; brand name Botox, made by Allergan and Xeomin, made by Merz. These are just two of the multiple brands of neurotoxin available on the market in the United States. Botulinum toxin A is a neuromodulator which functions by blocking brain signals that cause muscles to contract. By doing so, muscle contractions are prevented entirely, which causes temporary paralysis of the muscle. Sometimes, if less effect is desired, doses are titrated so that the muscle is just weakened greatly. This enables some movements to remain present, just not as strong. Neuromodulators act most effectively on the origin and insertion of muscles. There are many benefits to neurotoxin treatment. To name a few, it helps relax muscles, prevent wrinkles, soften static creases, and improve fine lines.


The next treatment I’ll touch on is dermal filler. Most dermal filler used regularly in the United States is Hyaluronic acid based. While there are others on the market, this type is what we use most often in our Training Center. All Hyaluronic acid fillers are a jelly substance that are used to fill or correct volume deficiency issues. Depending on the weight of the specific filler, the product is either more or less viscous. Typically, heavier products are used deeper and lighter products are used more superficially. They can all be injected using either needle or cannula depending on the treatment goals. Regardless of the method or depth at which we are injecting, safe injection technique is always our main priority. Some common areas that fillers are used are nasolabial folds, marionette lines, oral commissures, cheeks, chin, jawline, temples, tear trough, and nose. Of course, there are many more areas where filler can be placed, but these are the most frequently treated areas. In my personal practice, one area that many patients complain about are their “laugh lines” or “smile lines.” What people are usually referring to when explaining their concerns, are their nasolabial folds. Clients often report that their make-up gets stuck in these folds, causing a cakey and undesirable appearance. One of the main educational points that I always touch on is that most often, the problem is much greater than the lines patients are complaining about. In actuality, the lines that bother patients are caused from a much larger volume deficiency and that is the inevitable midface issues that arise as we age and support in this area begins lacking tremendously the older we get. While we are always able to fill nasolabial folds, I often recommend also considering dermal filler in the midface to more effectively combat these issues.


The other treatment modality that I will touch on briefly is the use of Polydioxanone suture for esthetic purposes. Polydioxanone is often referred to as PDO and is an absorbable, synthetic material that dissolves over time and stimulates collagen production. This product is used both in a smooth thread form, as well as in various lifting thread forms. The threads are loaded onto either a needle or cannula and placed into the tissue using AAFE’s safe injection techniques. Using PDO threads can help lift sagging tissue, correct various facial scarring issues, and in some cases even displace adipose tissue. This modality is the newest of the ones discussed, but a very important one when treating the whole face.


As you can see, the treatment options in the world of esthetics are pretty much endless. While I have just touched briefly on just a few of them, you can get an overall picture of some of the most common options. Whether it be a simple preventative neurotoxin treatment or a full-face filler and thread case, we do it all. Treatment planning is absolutely one of the most important parts and should be addressed as a team, involving both the provider and the patient. Happy injecting!


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

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