Calcium hydroxyapatite (CaHa; Radiesse) is one of the most well studied dermal fillers worldwide and has been used to replenish lost facial volume and correct facial lines and folds. It's a must have product in every injectors practice due to its profound immediate and long-lasting effects in improving skin elasticity and laxity. Since its approval in 2006, Radiesse remains as the only FDA approved CaHA filler for facial augmentation and retains a well safety profile. Radiesse CaHA (+) is an opaque, semi solid, cohesive implant of 25-45μm CaHA microspheres suspended in a gel carrier of glycerin, sodium carboxymethylcellulose, 0.3% lidocaine hydrochloride, and sterile water. It is a semipermanent and biodegradable filler that is an effective stimulator of neocollagenesis in the face.
So what makes CaHA so unique?
Not only does CaHa filler restore volume loss almost immediately, but the injection stimulates a controlled inflammatory response that replaces the aqueous...
Nodules..., every injector's worst nightmare! A nodule is defined as growth of abnormal tissue developed underneath the skin. They often present as a large and hard lump that is very visible on the body in areas like the lips, cheek, jaw, etc. This can occur post injection as the nodules will appear soon after. There is nothing worse when you find them on a patient after you finish a dermal injection procedure.
There are many causes that can lead to nodule formation. However, there are 3 main causes which include the properties of the hyaluronic acid tissue filler used, possible coexistent infection/colonization of pathogens, and the patient’s immune response. The plausible causes can include any of the following:
In the past decade, minimally invasive aesthetic procedures have become more popular due to its low risk and fast recovery time. In 2020, providers performed more than 13 million minimally invasive cosmetic procedures in the U.S., which will only continue to grow in the future. Facial aesthetic procedures are highly requested among women to restore a youthful appearance and combat aging. Facial aging occurs in a three-dimensional manner and results in reduced collagen and elastin and reduced superficial and deep fat pads. Most of the changes observed during facial aging occur in the middle and lower face due to the effects of gravity, causing changes in volume and reduced overall facial support networks.
Standard aesthetic procedures like surgical facelifts and facial thread lifting have traditionally been used to combat an aged appearance and descended facial tissue. Surgical...
Botox has been used to treat neuromuscular diseases and been a prevalent filler in the realm of aesthetic medicine for a long time. There have been so many companies developing their own neotoxin formula for botox injections available in the market, but which is the correct one to choose?
Typically, an injector should use a neurotoxin that is less immunogenic with highly purified toxins to obtain successful results for long-term repeated treatments. If there is a significant level of immunogenic response, this can lead to the formation of antibodies that can decrease the interaction between botox and presynaptic membrane binding sites. We want the interaction between botox and its presynaptic membrane binding site to have as little hindrance as possible so we can have the ideal results of relaxing the facial muscles, reducing wrinkles or frown lines.
New toxin formulations have recently emerged in Asia that created hype around these...
Ischemic complications. Two simple words that can make even the most seasoned injector quake in their Crocs. Ischemic complications are defined as an unintended impediment to normal blood flow during placement of dermal fillers. These complications are widely regarded as the most serious and require immediate intervention. The effects of these complications can include ophthalmoplegia, cerebral infarction, vision loss, and necrosis. In the case of vision loss, it is possible that symptoms may be irreversible with little to no evidence of symptom improvement. Some studies have determined that the rate of ischemic complications is around 3 injections per 1,000 performed globally.
The temples are one of the most complicated treatment areas of the face. They possess a highly complex vascular arrangement as well as multiple distinct layers of tissue that require an injector’s treatment plan to be precise and thorough. The main vascular features to take into account...
Facial filler philosophy has been characterized by an overwhelming focus on skin and fat as opposed to muscle action. When it comes to facial aesthetics, injectors will often focus on static wrinkles and volume loss rather than muscle interaction. Hyperactive muscles are commonly addressed by neuromodulators like botulinum and other toxins; for example, masseter hyperplasia may be treated with botulinum. However, a Brazilian study by Mauricio de Maio identified a link between injectable fillers and muscle movement, or myomodulation. Let’s take a look at the findings:
Facial muscles, or mimetic muscles, are in charge of facial expression. Three key aspects dictate such muscle movement:
The length-tension relationship is dictated by two components: contractile and...
Natural looks are trending, and as more people open up about getting injectables, many are reversing the effects of their fillers. While injections may fade over time, hyaluronidases can help speed up the process.
Hyaluronidases are a family of enzymes that break down hyaluronic acid (HA). The body degrades HA via thermal pathways, free radicals, and naturally occurring hyaluronidases. While these natural processes will help dissolve the filler over time, patients finding complications with their treatment may look for alternative methods of dissolution.
Adverse effects and complications from hyaluronic acid fillers may include the following:
Each of these occurrences may prompt patients to seek correction via...
The epidermis (the outer portion of your skin) is composed of multiple layers of epidermal cells. These cells help maintain your skins internal temperature and prevent dehydration by providing a barrier against the external environment, the epidermis in turn protects your tissue.
Tonofilaments (microscopic fibers) run between individual cells and anchor them together. An extracellular surrounds each cell, and acts as glue, to keep the cells together. Over time these cells are shed through the body’s means of exfoliation. Acids within the chemical peel raise the acidity of the skin to a 3.8 pH level. Normally, skin has a pH of 5.5, but by changing the pH level the cells that form the “glue” between dead skin and healthy skin are chemically loosened. Therefore, exfoliation occurs as dead skin is removed to reveal healthy skin underneath. By speeding up this process, you restore a more youthful glow to the skin and help to eliminate signs of aging.
An On and Off Label Approach to Injectables
The most seasoned plastic surgeons and sought after injectors can attest to the importance of training and innovation.
As the aesthetics field continues to flourish, a good injector will be up-to-date with the latest on-label and off-label procedures, the newest fillers on the market, and proper protocols for handling an adverse reaction.
Luckily, there is a multitude of ways you can perfect your technique and learn from the best. In recent years, the idea of shadowing expert injectors has started to fade. Many physicians like myself offer in person, one on one shadowing to other injectors.
Is there an injector that you admire on Instagram or Youtube? Are you eager to learn a new off-label procedure that seems to be taking off? Reach out to the provider or visit their website to see if they offer any form of training! Even if they don't have it listed on their website, it doesn't hurt to ask.
Whether you're an advanced...
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Module 2 - Optimizing the Patient Experience
Module 3 - Anatomical Safety & Danger Zones
Module 22 - Neck Filler