Which Product do You Choose?


One of the most challenging tasks for injectors is deciding which product to use and how much. When we assess the face, we should be using a global approach to optimize our aesthetic outcomes. Considering the frame of the face first is essential. It is like painting. You cannot paint a beautiful work of art unless the canvas is stretched on a frame. I start by assessing from the top and lateral and work my way down the face. As I evaluate, I also am deciding which product to use and how much. Knowing the rheologic properties of your products is critical. These are not one size fits all. Think about the platform, plane, purpose, and placement technique. Are you projecting the lateral malar apex or smoothing peri-oral rhytids? G' (G-prime) is often referred to as the lift capacity of the product. I look at this as the product's ability to project overlying tissue. High G' products most often are injected deep or supraperiosteal. A low G' product is suitable for intradermal or subcutaneous injection. I also think about G" (G-Double Prime) or the cohesivity of the product. Does the product maintain its shape, or is it more spreadable? X-strain refers to the flexibility of a product. High X-Strain products are soft and stretchable, where a low X-strain product will be stiffer. In areas of increased mobility, such as lips, a high X-strain product would be preferred. Hydrophilicity is the affinity the product has for absorbing water. Some products are more hydrophilic than others. In an older patient, high water absorption can create heaviness and an aged appearance. Choosing the correct product for the area being corrected is crucial.

Where Health and Beauty Meet!

Is beauty part of overall health, or is overall health required for beauty? My belief is they go hand in hand. You must be healthy on the inside and look healthy on the outside to have a complete sense of well-being. Beauty is more than just skin deep. It is our personality, spirituality, nutrition, sleep, attitude, and energy. As a medical aesthetic practitioner, it is my job to help you achieve a healthy balance of all of these to be your best you. 

Remaining happy and positive in today's world requires intention. We are bombarded with negativity, fear, and anger daily. Stress takes a significant toll on us, both inside and on the outside. Stress speeds up the signs of aging, causes us to gain weight and affects our hormones. Cortisol is our stress hormone, and elevated cortisol increases wrinkles, thinning hair, increased acne, hyperpigmentation, and more by degrading healthy collagen and elastin. Increased inflammation is another effect of increased cortisol, and we all know increased inflammation wreaks havoc on our skin, weight, cardiovascular system, endocrine system, and more. Many say inflammation is at the root of aging and disease. 

How do we decrease the visible signs of stress? Prevention is the number one way. Sleep is when our body heals. Make sure you get eight hours a night. Sugar and dairy create inflammation. Sugar is known to degrade our collagen and age us, so a diet rich in protein and plant-based foods is crucial. Engaging in relaxation and self-care is another means to decrease stress and all that it brings. Naps, walks, hobbies, reading, massages, and facials help reduce stress and slow down aging. While starting a prevention program, reversal is another essential factor. There are many ways to reverse the signs of aging. Laser resurfacing, neurotoxins such as Botox, dermal fillers like Volume, DiamondGlow treatments, PRP, Microneedling, and good at-home medical-grade skin care will help reduce the visible signs of stress and stress-related aging. We will all age, but we do not have to show it.

It's Complicated!

In rare cases, the formation of an inflammatory nodule may activate a foreign body response in the body, leading to formation of many nodules in all areas where filler was placed.  This may happen even if different fillers were placed in different regions.  The patient will present with many palpable nodules that are best described as "fish tank gravel" throughout the face where filler was placed.  This can and does happen with all fillers, but many falsely believe it only happens with Vycross fillers.

Nodules that appear during the first month generally are mild and self-limited. They can often be due to poor placement or filler migration.  Delayed Onset Nodules (DON) are nodules that appear at least a month after the injection.  Inflammatory DONs will be tender and often red. These often have an element of biofilm and I usually treat them all for biofilm first.

Many fear nodules but they should be viewed as a treated AE.  These are not catastrophic outcomes, but they can be a nuisance.  Recognition and proper treatment is key to a quick and satisfactory outcome.