Last time I wrote about different techniques to refresh your look. You have done your research or may have asked around. You have opted for injectables as they fit into your schedule (no down time) and your budget. You have considered the safety and tolerability of the procedure and products and are re-assured. What can we expect?
Congratulations on your decision. Let me tell you how we proceed at Medestetica.
Firstly we do a consultation. This entails a brief evaluation of your general health, allergies and medications.
With the help of a mirror we evaluate ( with you) your face section by section (upper one third of the face/middle and bottom one third). We will discuss the areas of wrinkling and volume loss. This will dictate our approach. Do we need Botox and/or fillers? What quantity of product is needed and how much will it cost?
We need to discuss expected results. The goal is to improve and refresh the look. We are not looking for perfect results. It is impossible to look like that picture of you at age 20. Recall on a previous blog that I discussed the changes of aging which include changes in skin tone and elasticity as well as changes in bone structure. Obviously we cannot change the bones back to their younger status.
Furthermore the procedure may have to be done in steps. We will need to discuss these steps and together decide on the priorities for you.
If we do a Botox treatment, the product is sold by the unit. We pull out of the vial the number of units necessary and inject through very tiny needles in the appropriate areas. The effect will begin in about 2 days with maximal results at 2 weeks or so. The effect is expected to last 3 to 6 months. Complications are very rare and dissatisfaction can result from incomplete effect at which point we can simply add in a small amount more. This will establish the required doses good for you for future treatment. Rarely bruising may occur.
Should we need fillers, the main products are the hyaluronic fillers (HA). These give essentially no allergic reaction. They too are injected in the appropriate areas with a needle. Here too bruising may occur. As with any bruise, it will subside within 4 to 6 days and can be minimized with ice applications and covered up with make-up if need be.
HA is typically sold by the syringe. It will be estimated how many syringes are necessary for the given procedure, and what can be expected. Contrary to Botox, the results of fillers can be seen immediately and therefore the requirements (number of syringes required) will be adjusted as we go along. Even though the effect can be seen immediately results usually get better as the product integrates in the tissue and causes an internal hydration.
Photos are typically taken before and after the procedure. These are for internal use and kept in the patients’ files.
The whole appointment from consultation to photos to procedure typically lasts from 30 to 45 minutes. Future appointments for top-ups or repeat treatments will be quicker as the whole consultation and explanation part will not be necessary or, at least, greatly shortened.
At Medestetica we firmly believe that a satisfied patient is one who understands what we do and how we do it. The patient that has realistic expectations, as discussed with the doctor, will not be disappointed. We will not make false promises and will advise against any treatment that will not satisfy the patient or doctor.
Have a great day and speak to you soon
Dr. Bruno Bernucci
Hello one and all
Due to a too busy schedule and time restraints I have been a little late in writing this blog. Forgive my tardiness, but I still have plenty to share.
In my previous blogs we had discussed historical attempts a attaining beauty and how beauty has been perceived differently at different periods throughout history. We defined the physical features associated with beauty. In the last blog we have seen the changes to skin and bone that result in the undesired facial features associated with aging. We discussed briefly some ‘anti-aging’ methods. This time I wish to discuss what and how we do to negate the changes associated with aging.
I do not wish to belabor this topic as the details of the procedure, its results and post-operative consequences as well as durability will be discussed by the surgeon should you choose this method of treatment.
Facelift: Briefly, incisions are made in hidden areas (hairline/behind the ears) and the skin is pulled or ‘lifted’ to smooth out wrinkling.
Implants: Similarly, through tiny incisions implants can be added to augment volume (chin/breast/buttocks).
Given these are surgical procedures there is anaesthesia, rarely, an overnight stay, more pain and bruising resulting in ‘down time’ away from work and regular activities. There is a greater financial implication as you must pay for the procedure and equipment/materials used as well as the time of the anaesthesist. Although minor, the risk of infection, post-op medication side effects and anaesthesia may be frightening for some patients.
Threadlift: This technique involves passing beaded threads under the skin such that when we pull on the thread we snag the skin pulling/lifting it back.The thread is left there to hold the skin. This is less traumatizing than surgery but wide needles are used to pierce the skin to be able to pass the thread and there will be more pain and bruising. The durability as well, is questionable and the costs,although less than the surgery will bemore than injectables.
Fillers: you may have heard of names such as Juvederm/Restylane/Teosyal/Belotero and others. These are all made of a product known as ‘hyaluronic acid’ which I will refer to simply as HA. This HA is a substance found in ALL living things (people/animals/plants/microbes). Obviously the HA will differ between the species. HA is the skeleton of our cells and tissues. The HA is prepared in different concentrations and ‘thicknesses’ to have different applications. There is one such preparation (quite a ‘thick’ one) that we inject in painful arthritis joints. In aesthetic medicine they have been formulated for skin and tissue. There are a variety of preparations suited to go deep and add volume to those shrinking fat pads beneath the skin (see previous blog) as well as others to go very superficial for tiny wrinkles. We add them to lips as well to make them fuller. Given that HA is already a part of living things, allergic reactions are very rare. There is no down time and pain levels associated with the procedure appear minimal. Furthermore, we even have an antidote that can completely remove the product should we not be satisfied. Depending on the product and where on the face it is applied the durability can be from 6 to 15 months.
Botox: Botox is a product that ‘numbs’ muscle contraction. In certain areas of the face such as around the eyes (crow’s feet), between the eyes (glabella) or on the forehead we can see creases in the skin caused by muscle contractions as we make expressions. These creases may become quite deep and evident even when we do not make the expressions. The botox will reduce or eliminate the contraction such that the creases are less obvious or disappear. It is given in very small quantities and therefore do not add to volume. The quantities are very minimal as compared to the amounts given in medical applications such as the treatment of migraines or bladder problems. Typically the effect lasts 3 to 6 months at which point it should be repeated.
Others: There are other fillers that can be used in particular situations. These may have more tendency to give an allergic reaction and are less reversible. Without dwelling on these, we would suggest and discuss them if you are a good candidate for these alternatives.
As expected, the injectables are given through needles at various areas of the face and neck. They are usually minimally painful and, as with all piercings of skin, there is a little risk of bruising. Of course this heals and disappears quickly.
The secret to good results is to inject the right product at the right place and in the proper quantity. The horror stories of duck lips or a porcelain paralyzed look are because we have not respected these rules. At Medestetica we will not inject any area if not needed and will suggest the appropriate procedure tailored to your needs. Nearly 15 years of experience in doing procedures as well as ongoing exchange with colleagues and keeping up with upcoming methods and techniques have made Medestetica a reliable and sure choice for your injectable aesthetic needs.
Dr. Bruno Bernucci
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Dr. Bernucci runs a busy medical practice. He is frequently called upon to advise on elaborating educational programs for fellow physicians and as a conference lecturer to other medical doctors. He also speaks frequently to large groups of patients as well as the general public on numerous topics. He is one of the Co-Authors of Managing My Life: Managing My Health.