Sculptra for the Buttocks? What you don’t know matters.

The latest and concerning trend in the use of Sculptra is the Sculptra butt lift. For those of you that don’t know what this is let’s start with Sculptra. It’s an injectable filler product that stimulates the body to make its own collagen. It is an excellent product for volume loss in the face and FDA approved for this treatment.

While Sculptra is most commonly used in the face, often medical practices use products “off label”, which means in a way that is not FDA approved. The Sculptra Butt Lift is an example of off-label usage. The question about off-label usage of this kind is when it becomes too far afield from what most practitioners are willing to offer? At Celibre, we pride ourselves in taking a practical approach to cosmetic medicine, and in the case of the Sculptra Butt Lift, we don’t think the procedure is a good option for consumers.

The average consumer would need a minimum of 10 vials per buttock to make even any appreciable difference in the curvature. On average, Sculptra is sold for a $700 vial, making this procedure a $14,000 investment. At that cost, a surgical procedure, the Brazilian butt lift, makes much more sense. It will be the same or could be even cheaper in price and the results will be better and more consistent.  Finally, the duration of Sculptra tops out at approximately 2 years, whereas surgery results will last many years beyond this.

So, we must ask…why would the Sculptra butt lift be a good option for consumers? In our minds, it’s not. And that’s why we don’t offer it.

los angeles perlane injections for temples before and after pictureslos angeles perlane injections for temples before and after picturesAs we’ve discussed in many previous articles, the aging face begins to lose volume beginning in the upper third of the face. As muscles and facial tissue descend as we age, the upper part of the face begins to appear more hollow and angular. This hollowness is often seen in the temple areas and the condition is often referred to as temporal hollows. The loss of volume in the temple area then affects the frame of the face – the eyes. By using dermal fillers such as Juvederm or Restylane, we are able to restore volume to the temple area. Filling the temporal hollows allows for a more balanced facial appearance and brings interest back to the frame of the face, the eyes.

You finally did it! You went and got Restylane or Juvederm injections for tiredness under your eyes that has been driving you crazy.  But after a few days, you notice something that doesn’t look quite right.  A bluish or greyish discoloration is visible at the point of injection.  Are you seeing things? Is this normal, and if it isn’t, how can you make it go away?

Getting dermal filler injections is a big decision. It takes time and research to understand what the procedure can and can’t do for you. You must find an injector who shares your vision that also has the skills and knowledge to make it a reality. Unfortunately, this can be the hardest part.  Not every injector has the same skills. And while some have the knowledge of the proper placement and techniques that are needed to perform filler injections, their technical skill may not always be up to that same level.

If you’ve noticed a bluish or greyish hue where you’ve had filler, you may be visualizing a  phenomenon known as the Tyndall effect. Without getting too heavy into the physics of light, what’s happening is that light is “reflecting” off your hyaluronic acid-based filler such as Juvederm or Restylane because it’s placed too close to the surface of your skin. Although your injector may have used the right product for your procedure and got the location of your injections right, he or she just didn’t put the filler at the right depth. You can see an example of what the Tyndall effect looks like in the photo here on this page.

The Tyndall effect is just one of the reasons that who you see for your injections is just as important as what you have injected. Your injector needs to understand the proper depth of placement for your dermal filler product to avoid the Tyndall effect.

Once it’s there, the only way to get rid of the Tyndall effect is to get rid of the filler itself.  The best way to reverse the filler is to dissolve the filler product with Hyaluronidase (Vitrase).   Hyaluronidase is an enzyme that breaks down common fillers like Restylane and Juvederm immediately.  The painful part is that you then must start over again at square one with your filler.

Over the last several decades, hydroquinone, (HQ) has become the gold standard treatment for many skin conditions that require lightening. As the use of hydroquinone has grown, there has been much debate as to whether it’s safe and effective.

melasma before and after pictureOne study commonly cited as evidence for the link between hydroquinone and cancer was based upon oral ingestion of hydroquinone in lab rats and mice. Although there is value in extrapolating information from research such as this, it was recognized that the studies were lacking and are now considered outdated.

Further, there are also reports of hydroquinone use and darkening of the skin – a condition referred to as ochronosis. Although possibly underreported, ochronosis cases are very rare and associated with sun exposure, and prolonged use at high concentrations. The FDA has called for more current and inclusive studies that focus on the dermal application (on the skin vs oral) of hydroquinone to determine its effect on humans.  The FDA’s position is that hydroquinone is generally safe and effective.

Currently, HQ is available without a prescription in numerous over-the-counter products at a 2% concentration. Typically, 4% is what most physicians prescribe and is also found in Obagi and other name-brand products. Anything above 2% is considered a prescriptive product and requires a prior exam by the physician, Nurse Practitioner, or Physician Assistant. This fact is important because consumers routinely purchase these products online or even at Medical Spas without going through the required prescription exam. Those practices dispensing or selling anything above 2% HQ without the required medical exam are breaking the law.

The potential adverse side effects of HQ are directly related to improper use of the product. Rather than the percentage of HQ, the more concerning factor is prolonged and uninterrupted usage of the product. For example, consumers often purchase numerous HQ products for use simultaneously. Without proper supervision and instruction, consumers expose themselves to risk by using low percentages of HQ for an extended period of time. Continuous use is where the risk lies.

At Celibre, our position is clear: hydroquinone is safe and effective when used appropriately.

Appropriate use of Hydroquinone:

  • Prescribed by physician or physician extender for the purpose of addressing brown pigmentation on intact skin.
  • Proper screening to eliminate questionable candidates (liver disease)
  • Education – the patient was discouraged from using multiple products of HQ and adhering to safe protocols
  • 4% and 8% concentration.
  • Limited Sun Exposure.
  • Limited consecutive usage, not beyond 90 days without a 30-day break.
  • Non-HQ program to sustain benefits when on break from hydroquinone.

Because hyperpigmentation (ex: brown discoloration) can be distressing for our patients, the topical HQ program is an excellent option.

At Celibre Medical, when it comes to using filler in the lips and mouth, we believe that less is definitely more. Technique and knowledge of optimal lip structure and anatomy trumps “plumping and filling” the lips. This is one area of the face that takes finesse and skill to inject well. When done right, the results are amazing!

First, we want to ensure that any lip filler treatment leaves you with a symmetrical and natural-appearing mouth and lips. To accomplish this, we pay special attention to the philtral columns, the raised, vertical ridges that connect the bottom of the nose to the lips. They are different for everyone—some people have more pronounced philtral columns and others less so. The key is adding just the right amount of structure to this important area with small amounts of filler to get the most natural, youthful appearance.

As we age, the area between the nose and upper lip elongates and flattens. This accentuates a natural flattening of the upper lip that happens over time (double whammy). By using a small touch of dermal filler such as Restylane or Juvederm, we carefully recreate youthful philtral columns that accentuate the border of the upper lip. Building these columns accentuates the natural “V” of the upper lip known as the cupid’s bow. This gives your lips more shape and helps to lift and evert the upper lip (turn outward and upward).

Note that these techniques don’t involve filler in the actual lip itself, but still change the shape and appearance of it.  When an injector doesn’t understand these principles and techniques and just “fills” the lips, the duck-bill or trout-pout results.

If you’re considering lip or mouth injections with dermal filler, we encourage you to discuss what techniques your injector will use. Understand how dermal filler injections can accentuate or enhance your natural beauty—not just give you big lips! Remember it’s quality, not quantity that makes all the difference between being “treated” with dermal filler injections for the lips and mouth and being “filled”.


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Aging is inevitable and happens to everyone. But, some manage to age more gracefully than others. Before you assume that it’s all genetic, we’re here to tell you that “looking good” for your age often involves a secret weapon: a good aesthetic practitioner.

If you asked around, you’d be surprised at just how many people are using Botox and dermal filler treatments to look younger and feel better about the way they look. A good cosmetic practitioner has a “playbook” of minimally invasive techniques that yield big results with little to no downtime. Dermal filler injections are one of them.

An example of an area that responds phenomenally to filler injection is the nasal alar area. This is the area of the inner cheek, just beside the outer edge of your nostril. It is the very top end of your nasolabial fold or “laugh line”.  As we age, this fold or crease becomes more noticeable due to structural changes and volume changes in the cheek itself. Combined with years and years of smiling and laughing (which is good!), this crease indents even further—which is bad! It can lead to a “heavy” look or like your cheek is folding in on itself.

Just a drop or two of a dermal filler product in the area next to the nose can make a big difference. Even if you aren’t bothered by too much “heaviness” in the nasolabial fold, treating this area with dermal filler can help improve your overall look by changing the topography. Without filler, it’s convex (like a bowl) which means that you’ll see a shadow in that area. Once filled, it becomes smooth which takes away the shadow effect and creates the visual effect of smoothness and fullness.

At Celibre, we like to use either Restylane or Juvederm for this area. It’s a small injection that can yield big-time results. And it’s just one of many little “tricks of the trade” that Celibre’s skilled injectors use to help you look your very best.

 

los angeles restylane for laugh lines before and after pictures los angeles restylane for laugh lines before and after pictures
Restylane before and after pictures

We all know and love the famous actress pictured below. Although many stars deny using any type of cosmetic injection treatments to keep them looking young and beautiful, at the end of the day, it is their job to look good. It’s a good bet that almost all of them do! So, back to our friend below. Yes, she is beautiful, but when you look at this picture, you probably think something is a bit off…and you’re right! Let us tell you more about what’s gone wrong with this actress’s look.

Botox: Yep, she’s done more than just “try” Botox. She’s a regular. How do we know? Because she’s developed a tell-tale sign of long-term Botox use known as “bunny lines”. Do you see those little lines on the side of her nose? Notice that the rest of her forehead, between her eyes and even her crow’s feet area looks almost perfectly smooth when she smiles. So, what’s happening exactly?

Remember first how Botox works: it blocks the muscle receptor that is stimulated by the nerve that tells it to contract. Treated muscles stay in a constant state of relaxation, which makes the skin look perfectly smooth instead of wrinkling with contraction (facial expression). Your brain is still telling your muscles to move and they can’t. If certain muscles can’t or won’t move to create facial expressions, others start to take over to get the job done! Bunny lines result from over-activity of the nasalis muscle on both sides of the nose. They usually only appear with a smile, so you won’t see them at rest. They happen when too much Botox has been used or when other facial muscles normally used in facial expression are constantly relaxed.

Filler: It’s no secret that we all lose facial volume as we age. One of the places where these changes can make us look dramatically older is around the mouth. There are many areas that can be injected with dermal fillers here. They include the “white” lip (area between the lip and nose), the vermillion border (the edge of the lip itself) and the lips (or “red” lip). Think of each of these as specific, different pieces of a puzzle that all need to be balanced with each other for it to look complete or right. If one area is out of proportion, the whole thing looks off. That is what’s happened here.

At rest, her lips may look great, but when she smiles, you can see that only the body of the red lip has been treated with filler. Her vermillion border is totally flat. Smiling causes the lip to “stretch” and essentially makes the upper lip look like it’s swollen and “rolled” upward over the teeth. This is not a very natural look.

This picture demonstrates the fact that cosmetic injections can be tricky. There is no one, cookie-cutter approach to any of them, Botox or filler. Your injector needs a trained, skilled and artistic eye that not only sees your natural shape and areas that need improvement, but one that can also judge and mitigate unintended consequences of treatment like the ones discussed here. Your evaluation should include an appraisal of your appearance both at rest and with expression and movement. This is the best way to judge appropriate treatments for you and tweak things that may not look quite right. This takes time, attention to detail and a personalized approach to cosmetic injections. Here at Celibre Medical, we pride ourselves on these things and believe our approach is what gives us an edge over the competition.

If you’re considering dermal filler injections for mouth or lip augmentation, there are several important things you should know before your procedure. First and foremost, you can’t (or shouldn’t) take a photograph of your injector and say, “I want lips like these!”  Unlike haircuts where a certain one may look good on many different people, your facial features are distinctly yours! It’s impossible and just not aesthetically pleasing to simply recreate someone else’s lips, nose, or otherwise on your face.

The goal of mouth and lip augmentation is to make you look like a better version of yourself. Whether that’s restoring lost volume in your lips or around your mouth, correcting/softening lines around your mouth, or restoring features that have changed or been lost over time in this area, the techniques used should help you look more youthful with soft and rounded features—not like a pouty, fish-lipped, obviously over-filled Hollywood celebrity!

At Celibre Medical, we use a combination of both dermal hyaluronic acid (HA) fillers like Restylane and Juvederm with Botox / Dysport to fill and shape the lips and mouth.

 

How Celibre Medical’s Approach is Different

We use HA fillers to add volume and definition to the lips. We can enhance and redefine the lip border with these products and reshape the mouth by carefully placing products just outside the corners, helping to turn them up and giving you just a hint of a smile. If your lips appear “deflated” with wrinkling, HA fillers can help restore soft, natural-looking volume and soften those wrinkles.

The ideal lip proportion is the bottom lip just slightly larger than the top. If your lips have always been disproportionate or if they’ve simply just thinned out over time, HA fillers can restore or establish a more aesthetically pleasing proportion to your lips.

Aging can also trigger changes in facial boney structure and soft tissue which elongates the space between the base of your nose and your upper lip. It can also make your upper lip appear as if it’s turning inward or rolling towards your teeth. HA fillers can help restore your lip volume and return the appearance of the area around your mouth to what it was in your younger days.

One of the most common complaints from patients like you is those little vertical lines that appear around the edges of the mouth. Not so affectionately known as “smoker’s lines”, they can appear on someone who’s never smoked a day in their life! We’ve seen many women mistakenly take to removing all straws and bottles from their daily lives to prevent smoker’s lines, but we’re here to tell you that’s not why they happen either!

It is actually a combination of factors that create a smoker’s lines. Number one, repeated contractions of the circular, purse-string-like muscle around the mouth is the underlying issue, but secondly, the loss of collagen and elastin in the skin just around the lips also contributes greatly.

Many injectors will simply try to place small amounts of filler in these lines, in an attempt to smooth them out. This may work for some, but for many, it just makes the lips look disproportionate and the top lip looks heavy.

Here at Celibre Medical, we address the underlying muscular issue with Botox or Dysport. Subtle relaxation of the muscle will improve the appearance of the lines. We couple this with dermal fillers to redefine the border of the upper lip.  This helps to soften the appearance of these lines, without injecting them directly. Using these combined techniques over the years has also shown us that many patients get a subtle lip eversion. This means the upper lip gently rolls outward and upward. This helps the upper lip look even fuller and shortens the distance between the lip and the base of the nose, a win-win!

As you can tell, there is a lot of artistry, skill, and knowledge that goes into lip and mouth augmentation. Before you book an appointment with an injector, make sure that you look for some before and after photos that demonstrate their skill. Also, make sure you understand the benefits and limitations of this procedure, so that you’re pleased with your results. If you’d like to learn more about Celibre Medical’s philosophy on using injectables and lasers for facial rejuvenation, please visit our laser and injectables for wrinkles page.


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It’s not unusual for patients, both men, to voice concern about their motivation for seeking out aesthetic treatments.

Some curious men will ask, “Do many men get these treatments?” Women, on the other hand, will say, “No one knows that I do these treatments. I’m treating myself today.” A more recent question that I’m asked by patients when receiving their injection treatments is, “do you think I’m being vain?

being vain with botoxI always pause before answering that sincere question. I recognize that the average patient works hard to invest in botox treatments, and I’m very aware that they are trusting me with this investment in themselves.
My answer remains the same. “No, I do not. Wanting to help your frown lines or freshen up your appearance is no different than getting your hair done or working out to maintain physical health.”

If we give attention to our physical health, maintaining our hair, nails, or wardrobe, then wanting to improve an important asset, our face, fits nicely into that routine.

I recognize that in this day of endless selfies, outrageous aesthetic treatments, and a society that is overwhelmingly promoting self-centeredness, it’s no wonder that a patient would pose that question.

I have often repeated a mantra over the years of, “crazy people do not wonder if they are crazy.” We can translate that to, “narcissists do not wonder if they are narcissistic” and finally….Vain people do not wonder if they are being vain.


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Botox $8.00 per unit? Dysport $3.00 per unit? Restylane for $350.00 per syringe? We all recognize that price is important. However, most will agree that cheaper doesn’t necessarily equate to better. In fact, we would even argue that cheaper, in most cases, doesn’t even equal adequate. We often hear stories of Groupon deals wherein the Botox “did not last.” In one serious case, a patient was injected with a dermal filler obtained overseas that resulted in a serious tissue infection.

No business or practice will operate in a manner to lose money. To support pricing that is significantly below the standard in our profession, many corners may be cut. Short- cuts and compromising standards in a medical professional do not bode well for patients and also call into question the ethics of the medical professional.

What consumers may not realize is that it is illegal for a medical practice to purchase, obtain, use, or distribute Botox, Dysport, or any injectable dermal filler from anyone other than the manufacturer in the United States. Because of this widespread problem, regulations and enforcement are finally equipped to catch up with those placing patients at risk and degrading the aesthetic medical profession. See the below link for a widespread operation that targeted numerous local and non-local medical professionals illegally purchasing their products.

You may be wondering right about now if it’s worth the risks vs. the potential benefit of saving money. If the only negative outcome is a short or substandard duration with your Botox, then you are still not saving money. However, please consider that illegally obtained products cannot offer a guarantee of sterility or proper handling, or that you are even receiving a safe product. If something goes wrong, the insurance carrier for the injector will not cover the adverse event. Finally, if we cannot trust our physicians and nurse to obey the law in one area, it calls into question everything as it pertains to ethics and integrity.

We recognize that we are not the cheapest, nor do we strive to be. Our goal is to offer competitive pricing with a safe, appreciable outcome, and most of all… remains a trusted name in aesthetic medicine.

 

https://www.fda.gov/Drugs/DrugSafety/ucm349503.htm

https://www.fda.gov/ICECI/CriminalInvestigations/ucm545872.htm


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