New Treatment as VISAGE MedArt

Over the last  decade the aesthetic industry concentrated on many aspects of facial and body rejuvenation. None has received more attention than skin tightening and fat removal using the least invasive procedures with minimal downtime. Fat Reduction-Skin Tightening  became the  Holy Grail of Aesthetic Medicine but, until recently, most of those have not lived up to our expectations.

I have been  searching for the same  since 2009.  I have followed closely the evolution of many new devices in  Europe and here; I saw many prototypes and several interesting  devices  already in use; I have reviewed  many human and animal studies and considered  opinions of the  pioneers of new technologies. Not surprisingly, I’ve also witnessed remarkably aggressive marketing of many devices in lengthy “infomercials” and  TV shows promising, with doctor’s stamp of approval, quick, painless and nearly impossible results .

Almost always these magic devices  ended up, in the real world, very overpriced disappointments because of poor results or  intolerable  discomfort.

Many studies, quoted as support to promising claims, were found to have either design flaws, not reproducible results or were not confirmed by the  independent researchers. Although the consumers had spent/wasted billions on questionable treatments  their declining excitement was re-ignited when the “newest” and “revolutionary” technologies rolled in on  well-greased wheels of marketing vehicles.

On a more positive side, there have been few winners that deliver positive, satisfying and predictable results. Two distinctive technologies have proved to be highly effective for skin tightnening: Radio Frequency and Ultrasound. Although these two sources of energy are not new, the methods of their application have changed dramatically rendering very good results.

Thermage and Peleve use Radiofrequency; the first may provide measurably good results if one is able to tolerate a significant level of discomfort; the latter has a very limited field of treatment.

Liposonix and Ulthera use Ultrasound with very good results. Both are far from being comfortable to the average patient and frequently require remedies for pain control. However, the Ulthera can treat only selected areas while  Liposonix, although much more versatile ,  has not received, as yet, FDA approval.

Although, Exilis was designed to implement Radiofrequency and Ultrasound, the FDA has approved only Radiofrequency as the source of energy.

The treatment device delivers desired energy through one of  two hand-pieces with precise controls of depth and density of waves.  The deepest layers of the skin can be treated to reduce fat deposits. Improvements in  tightness,wrinkles, skin tone, and texture can be achieved by targeting more superficial  layers .

Real time monitoring of the skin temperature during treatment   allows for optimal treatments and full safety.

Exilis® treatments offer something that had not been possible until now. A non-invasive, downtime-free treatment ranging from the small area of the eyelid  to total body sculpting. It is a non-invasive alternative to those select patients who have considered liposuction but want to avoid an invasive procedure, downtime and sometimes prolonged recovery.

Before and After 4 Exilis Treatments

Before and After 4 Exilis Treatments

Before and After 1 Treatment

Before and After 1 Treatment

Before and After 1 Treatment

Before and After 1 Treatment

 

All our patients at VISAGE MedArt know that our only interest, from the very beginning, is to provide superior long term results rather than instant,  short-lived, gratification. The  long term results, whether it is Botox, fillers or laser procedures, motivates us while searching for new technologies. We are very proud to add EXILIS treatments to our list of services!

Areas of Exilis treatment :

−    peri-orbital (around the eyes)

−    peri-oral (around the mouth)

−    lips

−    chin

−    jaw line

−    neck

−    décolleté

−    breasts

−    arms

−    hands

−    abdomen

−    back

−    “bra roll”

−    “love handles”

−    tights

−    knees

−    “cankles.”

Treatments: For optimal and long-lasting results a minimum of  4 sessions are recommended spaced every 7-10 days. For fat removal and skin tightening the time it takes to treat depends on the treatment  area and varies from 15 to 45 minutes per session.

Aesthetic Medicine and Beauty

We all would like to be young and look young. We eagerly seek new options, miracles and fountains of youth believing that the newest and, how often, the most expensive is that elusive IT. Women, more than men, have a wonderful need to look beautiful, desirable and attractive with the least signs of  passing time. This healthy  desire is not new; it has been present for as long as human history records are kept , with notable exception of the Middle ages.

With development of mass communication and media, the internal drive for self-beauty is becoming less spontaneous and more “designed” and “ready to use” by duplicating prevailing  trends. Many has lost the perception of beauty in classical understanding and simply follow the trend-setters’ vision of marketable beauty.

So, is there a definition of beauty anymore?

There are many definitions of beauty because the perception of it seems to be so subjective. In general understanding, the beauty is that which brings about immediate and self-sustained admiration. This admiration  was for centuries a result of spontaneous and instant impression induced by particular set of lines, curves, surfaces and shapes. But more recently, a new and powerful factor begun to play a role in our perception of beauty:  the  conformity with our expectations and  desires coming from  our  acquired taste.

The issue of human beauty, however, is much deeper; it touches upon the qualities of our character and our soul. Even  before the  Greek Golden Age, beauty was always  associated with important qualities such as moderation, honesty and certain conventions, all complementing each other.  Greek philosophers defined this for us as :  “Harmony is the most beautiful thing”.

Since conformity implies the set of rules is there a prescribed standard of beauty?

Immanuel Kant defined  “beautiful” as ”…that which, apart from a concept, pleases universally.”  The extent of that vision was only fully realized  recently with the ability of contemporary media to beauty universal.  The explosion of mass media was the trigger for culture-dependent phenomenon of manufactured standard of beauty with its universality originating from the Western  model.

Human beauty in recent history

The last century technological revolution and advances in communication totally modified not only our perception of beauty but also the extent of its definition.

Take the example of nudity before the invention of photography and cinema. The nudity and looking at it was a strictly personal and intimate matter. For centuries, the only nudes seen in public were in the works of  painters and sculptors.

In the XXth century the visual representation of nudity became progressively more acceptable, easily accessible and eventually became a part of everyday life.  Not coincidentally,  it  came along  the process of emancipation of women beginning  with a new taste of Art Nouveau and culminating in the Second Wave of feminism and final women’s liberation in 1960’s.

Once the human body gained universal acceptance by exposure to contemplation and admiration, its representation was progressively applied to our daily habits and  practice in many forms of new lifestyles such as diets, outdoor sports, personal beautification and, near the end of the 20th century, new plastic surgery. These new forms became the most convincing tools in achieving our aesthetic objectives and desires.

Plastic Surgery

Plastic Surgery became a logical step in pursue of personal beautification and physical individuality. If one  lived in remote seclusion  there would never be a need  for plastic surgery. In reality, however, we pay great deal of attention to our reflection in a mirror as well as, or even more, in the scrutiny of others. The absence of these two key elements would eliminate a pursuit of any representation of self-image. Their presence in reality have determined rapid evolution of self-adjustments, in particular that of plastic surgery.

By far, the largest mirror in contemporary society is held by and directed by media which amplifies new standards and new criteria which are  defined  by  the avant-garde environment of entertainment and  fashion industry.

The modern plastic surgery owes its  explosion  to the dissemination by the media of these new standards of  representation of the body. Plastic Surgery has become a powerful promoter of individuality which our society  has embraced in the last few decades through new type of self–care and a strong will to improve oneself both spiritually and physically.

We are living in the era of “personal development” where the Aesthetic Medicine, and particularly Plastic Surgery,  keep high position  along with  personal coaching  and many other “well-being” strategies.

Is a harmonious, effective social life and sexuality possible outside of beauty?

How fortunate we are that the world does not revolve around beauty alone! How many of us know that the  long term personal happiness appears to be inversely proportional to the “attractiveness” of the subject?

The most dramatic and revealing sociological study compared many aspects of  personal happiness of people recognized by the society as “beautiful” such as models, beauty pageant winners or media celebrities to those whose appearance was considered average. The result were truly shocking, but not unexpected, and showed that the rates of depression, divorce, suicide, childlessness, and end-of-life loneliness are much higher for the “beautiful” than for the “average” looking people.

Excessive beauty, quite often, becomes a burden for the human being. Yes, the presence of beauty opens doors initially but  the price to be paid subsequently seems unusually high.

But there is another, universally negative factor that is too often attached to a “beautiful” person who has succeeded either professionally or personally. There will always be a sort of aura of non-credibility and non-recognition of their true worth and therefore, of their work and accomplishments. In fact, beauty effectively masks the objective reading of one’s worth.

Greek philosophers always  suggested moderation in all aspects of life  in order to achieve perfect harmony. In view of the study cited above  this idea has proven itself throughout the ages.

Are women increasingly becoming victims of physical complexes that they did not have 50 years ago?

The social pressure on women seems to reflect the power of media in creation of new standards.

Our society seems to glorify youthfulness as never before; this new standard forced itself upon us through media, contemporary music and cinematography. Over the last few years it even became a model for competitiveness on the job market.

Not to conclude the absolute we must admit some objectivity. Looking from a different angle on the  evolution of aesthetics , the new trends   are a reflection of the process we slowly begun to accept and incorporate  into our new concept of self-care. The process has its strong roots in natural and deep human need for “normality”, for harmony, for  moderation. But this universal  standard of “normality” has been extended in recent decades and  once it has been achieved there is a  desire to project the idea into individual originalityand, perhaps more often than not, into ambition of reaching a degree of uniqueness.

This trend is reflected clearly in patient approach to aesthetic changes. The initial requests frequently originate from  aspiration for “normality”: not to have  large breasts or too many wrinkles, to correct protruding ears, wide ankles or uneven bite.  And once this has been accomplished, any further requests  could bring aesthetic “alterations” from one level to another with more subtle and more refined changes aimed for perceived excellence such as brightening of teeth, modifying expressions, reshaping of buttocks or hips, improving contour of nose, or rejuvenation of ears or toes.

These two steps, from normality to originality, in order to be optimal and aesthetically pleasing, must be integrated with thorough understanding of the individuality  and objective technical possibilities of Aesthetic Medicine in 21st century.

How to assess which wrinkles or curve is beautiful or not, important or immaterial in aesthetic sense?

This is very important question, a question that many patients expect to be answered during the initial consultation. The  answer to this seemingly easy question depends not only on the technical possibilities but in essence on doctor’s artistic abilities and understanding of visual perception, light interplay anddynamics of the perceived abnormality.

It may come as a great surprise to many that the educational process in any medical specialty or post-graduate aesthetic  training  does not include  even the most basic  review of the aesthetic ideals, the concept of “Beauty”,  “Beauty” in the context of Art, the philosophy of “Beauty”, etc.

None of medical residencies, postgraduate fellowships, training courses or certifications  provide or require any knowledge of the art form. You learn a set of rules for each technique that is applied to every patient. For example, you learn to inject lips but not to assess the need for this injection. You learn how to lift  eyebrow but not  to predict at which level of elevation the effect will be opposite to intended. You learn many techniques of breast enhancement but not the aesthetic reasons to reject the idea.  It is as designing a vehicle with the breaks and accelerator pedals but no steering wheel. Simply, what is missing from the aesthetic training is….the Aesthetics, the concepts of art and beauty.

But come to think of it the descriptions of beauty do not come from aesthetic practitioners, but from philosophers, poets and artists.

All the medical and surgical disciplines use a stepwise approach  beginning  with initial inspection, palpation, auscultation etc., in order to collect all the signs necessary for  making  diagnosis. This science of signs, the semiology, is the essence of medical abilities to diagnose in order to treat.

But in Aesthetic Medicine there is no semiology. It is like giving antibiotic to everyone for all illnesses. Do you have falling breasts? We’ll bring them back up! Small breasts bother you? No problem, we’ll enlarge them! Sagging skin? We’ll tighten it! Wrinkles? No problem. We will erase them! There is no semiological research in the sense of asking questions: “what are the ideal breasts for a given woman?”, “what are ideal buttocks?”, “ideal legs”? what is ideal nose?”, “which lines and folds need not to be corrected?”, “what are ideal lips for a given face?”

The “ideal”, for clarification, is not the subjective concept of “the most beautiful”! It is the sum of many anatomical, cultural and artistic components that may gives rise to admiration.

If Aesthetic Medicine does not feel concerned about the definition of beauty, what is really the purpose of their vocation?

In any cosmetic procedure, artistry is paramount. There is a large degree of medicine, science and technology involved in the Aesthetic Medicine, and this is what we as doctors are taught and must learn. Knowledge, experience and continuous learning are extremely important, but we must not confuse these with the term “skill”. Without the artistic skill, without the passion and, above all, without understanding of  art form  the beauty is void and the end results are left to the gamble of chance.

In Art, the knowledge of art and experience with looking at it, without the artistic skill may produce, at the best, a very knowledgeable and experienced art critic rather than  artist. In Aesthetic Medicine, it is immaterial whether one has skills or not. There is no artistic scrutiny at any level or at any stage. Edgar Degas, a famous French painter explains this very simply: “ Painting is easy when you don’t know how, but very difficult when you do”.  Almost anyone with minimal training could remove tattoo using the newest and most sophisticated  lasers. But very few indeed, would have a skills to create one.

True art conceals its own creation is my favorite phrase and I feel this is so apt in today’s field of Aesthetic Medicine and Surgery. It’s all about the process of creating something that appears perfectly natural, and as such, simply appears as though it has always existed.

Since the early 1990’s the medical field of cosmetics has been rapidly expanding. It is an exciting and creative part of medicine encompassing an ever increasing number of techniques, procedures, products and technologies. The umbrella of cosmetics now covers a wide variety of options, from the minimally invasive to quite aggressive.

I have witnessed this expansion and rise in popularity since my beginnings in 2007. I have seen in this short time products and techniques come and I have seen products just as quickly disappear from the market. I have seen the “bandwagon” approach of many, jumping onto the latest fad, only to drop this for the next very “latest” ”amazing” thing.
I have quickly become more guarded over new products and technologies and their convincing claims. And I remain very cautious and often skeptical about the “latest” and “revolutionary” machines of beauty and miraculous methods .

The most important aspect of Aesthetic Medicine is a simple awareness that although lasers, Botox, Juvederm, implants and scalpel may bring about the most amazing and artistically pleasing results, these are just  raw, passive, and obedient  tools without built-in recipes for beauty or guarantees for aesthetic magic. These may come only through  skills and knowledge of those who use them  with artistic responsibility regardless of individual or prevailing tastes.

“Art has got nothing to do with taste” said Max Ernst.

(inspired by thoughts of one  giant of modern Plastic Surgery from Casablanca)

New Injectable and Merz

The Food and Drug Administration (FDA) has approved Xeomin for temporary improvement of moderate to severe glabellar lines. This alternative to Botox and Dysport has been used for many years in 14 European countries under the name Bocouture.

Xeomin is made by Merz, a company known for their filler Radiesse. Xeomin was already approved by FDA in 2010 for certain neurological conditions.

There have been many claims of superiority of many products used for wrinkle treatments. However, there is no significant difference in any of them from clinical and practical point of view.

The studies have shown that two major claims are of no  importance. First, if given in comparable doses and similar concentration, all products diffuse at the same rate and at the same distance from the point of injection. Second, the presence or absence of proteins in product is immaterial since these are immediately neutralized after injection.

Merz expects also an approval for new hyaluronic acid filler(s) that have been used in Europe for few years. Once approved, the company will become the main competitor on the aesthetic market in the US.

NUTRA SWEET™ Controversy

Aspartame in NutraSweet, Equal and AminoSweet is an artificial sweetener composed of 2 linked aminoacids: aspartic acid and phenylalanine. It is intensely sweet and although it may provide calories  the amounts used to sweeten foods result in negligible effect.

There are numerous controversies about aspartame although it has passed the FDA requirements. These controversies are easily found on the internet and are simple assumptions that are not verified by science.

The concern is that the by-products of breakdown of aspartame can be toxic. The metabolism of aspartame leads to formation of formaldehyde, formic acid and methanol. The methanol is a neurotoxin but it is rapidly converted to formaldehyde. The formaldehyde is a known carcinogen but is rapidly converted to formic acid which is excreted  in the urine.

The evidence suggests that the amounts of methanol and formaldehyde are too small to have a significant impact on health. What makes it controversial is the result of only one study conducted by the National Cancer Institute on rats. It showed that when female rats are fed high aspartame diet they have a higher incidence of Lymphomas and Leukemias. This association was never found in human studies.

New Sunscreen Rules from FDA

The FDA has finally set new rules for labeling of sunscreens. The major points of the ruling are:

Sunscreen labels must carry a “broad spectrum” label to show they offer some protection against UVA radiation as well as UVB.

The “SPF” designation still will show how well a product protects against UVB, although the highest SPF level a product can claim will be “50+.”

The  sunscreens claiming swim/sweat protection must say how many minutes such protection lasts.

UVB radiation is responsible for sunburn and plays a major role in causing skin cancer. It affects only the outer layer of the skin. UVA, while less intense than UVB, is 30 to 50 times more prevalent than UVB and penetrates to deeper layers of the skin. UVA is the dominant tanning ray, and is closely linked to skin aging. It’s also damages skin DNA and is believed to cause skin cancer.

The new rule also says that products cannot claim an SPF factor higher than 50. The highest permitted rating will be “50+,” because the FDA says there’s no convincing data that SPF levels higher than 50 are meaningful.

The FDA will allow product labels to carry the claim that they prevent skin cancer — but only if they protect against UVA and have an SPF of 15 or higher.

Products will have to specify whether they protect only against UVB (SPF rating alone) or whether they protect against UVA as well as UVB (SPF rating plus “broad spectrum” claim).

Sunscreen products that claim to be water resistant will have to undergo water-resistance testing. They will have to specify the number of minutes of “swimming/sweating” for which the product continues to protect.

Consumer groups have tried to convince  FDA to review and implement these changes  since 1978.

The new rules will take effect in one year for most manufacturers, although those with annual sales of less than $25,000 have two years to comply.

Did You Know?

According to The Skin Cancer Foundation:

•   Skin cancer is the most common form of cancer in the United States. More than 3.5

     million skin cancers in over two million people are diagnosed annually.

•   Up to 90% of the visible changes commonly attributed to aging are caused

     by the sun.

•   Indoor ultraviolet (UV) tanners are 74% more likely to develop melanoma

     than those who have never tanned indoors.

•   Frequent tanners using new high-pressure sunlamps may receive as much as 12

     times the annual UVA dose compared to the dose they receive from sun exposure.

The VISAGE Difference

VISAGE MedArt is a most unusual Aesthetic Medical Center.  It is a medical office. It is an art gallery. The waiting area, treatment rooms, even the restrooms contain original art from three continents. Many of the pieces are the creation of the owner, operator, physician, Marek Kacki, MD.

After nearly 3 years in operation, with minimal marketing, VISAGE is quickly becoming one of the leading aesthetic centers in Nashville and beyond. Their signature procedures revolve around artistic face sculpting, minimal down times and long lasting results.

From their own skincare line of prescription ingredients, state of the art face, neck and chest laser resurfacing to non-conventional uses of Botox and dermal fillers, VISAGE MedArt is known as a no-nonsense, no-fluff and no pressure aesthetic center. You will not find the usual multitude of hyped methods or many lines of overpriced “cosmoceuticals.” VISAGE operates purely on solid science, reproducible results and the world’s cutting-edge techniques.

Dr. Kacki is one of few physicians in the US using the newest revolutionary needle-less technique of dermal filler injections.  While perfecting this method he works closely with the German filler company Merz, as well as Allergan, the makers of Juvederm, and the French manufacturer of ingenious injection cannulas, Dermasculpt.

Dr. Kacki has developed a new laser technique for facial spider vein removal with results surpassing the standard laser approach. His technique was presented last October at the European Congress of Aesthetic and Anti-Aging Medicine in Paris, and he has now been invited to make a presentation at the upcoming World Congress in Monaco.

Dr. Kacki:

“I must admit that my contacts with the best contemporary pioneers of Aesthetic Medicine in the world have allowed me to take my reflections and skills farther than I could have imagined. It brought a realization that aesthetic medicine, plastic surgery included, is in its early stage of conquering true aesthetics.”

But there is another element, equally important to me, that fortified my aesthetic philosophy and propelled my enthusiasm: it is my ongoing irritation with certain “new faces”, those “done”, “operated” or “injected”, the look-alike faces that we see here and there: the swollen “sausage” mouth, distorted “fish” lips, “trumpet” noses with gaping nostrils, “suspended and surprised” eyebrows, massive breasts and “wind tunnel” look. These were acceptable in the early stages of modern plastic Surgery in 70’s and early 80’s. Some became a hallmark of Hollywood inspiring subcultures in the 90’s and at the turn of the new millennium. But from an aesthetic point of view, there is no excuse for such distortions in 2011! True art conceals its own creation.

The giants of plastic surgery have transformed the Aesthetics incorporating the key ingredient of

success, the Art Form. From Jack Sheen’s artistic rhinoplasties through Ellenbogen and Conell’s definition of a beautiful neck to Coleman’s facelift concept and, most recently, Benslimane’s frame concept, we have all the tools to enjoy universally the fruits of their leadership. We should…

Our prime goal is to inject a healthy understanding of the concept of aesthetics; what can be expected and what should not be considered in order to achieve the most beautiful and natural look. We always start with basic skin care, prevention of damaging factors and effective rejuvenation with topicals and, when indicated, with laser resurfacing. Only then can the optimal results be expected regardless of the next steps.

Botox or dermal fillers are wonderful tools to achieve optimal results. But, these are tools that must be used responsibly according to the rules of visual perception. Less than that will not work.

My approach to face sculpting is simple. Concentrate on the whole face and not allow one part to dominate your efforts. For example, the lips must fit the context and proportions of the eyes. The cheeks must have a natural projection and a harmonious angle with the midline. The jawline must be seen as a sum of the opposing forces. Light interaction may be more important in the perception of  the upper eyelid than the level of your eyebrow. And so on.

In the end you can reach an optimal stage when the only task is to maintain rather than enhance, to

enjoy continuity of your beauty rather than go through peaks and troughs without consistency. But

there is one condition. You must be patient. You must take small steps rather than periodic leaps. It

makes sense. In the long run, it is less expensive.”

VISAGE Skin skincare line was designed by Dr. Kacki and compounded by a local and respected compounding pharmacy. The core products contain only those ingredients that carry solid, scientific, long term data; therefore, most are by prescription only. Despite the simplicity of VISAGE Skin products, they provide 100% of what science offers for skin rejuvenation: stimulation of collagen production, removal of excessive pigment, reduction of wrinkles (not the appearance!) and hydration.

The improvement in the “appearance”, for example, of wrinkles is a marketing term for creating a temporary visual illusion of improvement. These are the essence of “cosmoceuticals”, which is a marketing category not recognized by FDA. Our goal is to achieve a real and long-term improvement of age-related skin changes.

Our recommendations relate to all exposed areas such as hands, neck and the upper chest, at the least. There is no other way to achieve what Greeks valued the most: harmony.

Botox and dermal fillers are injectable substances, the sculpting tools capable of improving or reshaping our 3-dimensional structure.

Botox, in addition to relaxing and eventually erasing many correctable lines (forehead, frown lines, lines around the eyes and lips, neck lines and folds and chest lines) can be successfully used to gently enhance lips, elevate different parts of the eyebrow, make eyes bigger, elevate the tip of your nose or corner of your mouth, may reduce a “gummy smile”, particular cheek lines, and reduce an uneven chin.

There are very few fillers available in the US when comparing to the rest of the world (over 90 products). Having experience with many key fillers not available here allows Dr. Kacki to maximize his expertise in facial sculpting.

Non-surgical rhinoplasty: Re-shaping the nose using a small amount of dermal filler can provide lasting results.

droppedImage droppedImage_1

Spider vein removal: Using our new technique, the majority of spider veins can be removed in a single treatment with truly minimal discomfort.

droppedImage droppedImage_1

The use of fillers has gone through many transitions until a few years ago when the new concepts were developed. We operate in volumes, not the lines, following in reverse the steps occurring in the physiological process of face aging. We operate, above all, in light and shadow interactions, which is an enigmatic key in visual perception.

Except in rare cases, there is no need to consider dermal fillers in the lines, wrinkles or folds. It is frequently a waste of your money. A typical example is naso-labial folds, the folds running from the corner of your nose to the corner of the mouth. That is where the majority of filler injections are done. Yet, in the vast majority of these you achieve no aesthetic improvement whatsoever. Why? Because in the majority of cases, the problem leading to the appearance of these folds is somewhere else. There are aesthetic priorities in face sculpting. The upper face is by far the key area. Nothing gives us better perception of someone’s youthfulness or aged appearance than the area surrounding the eyes. The second in importance is the lower face, the area we subconsciously scan with our peripheral vision.

Our mid-face, except in rare cases, contributes relatively little to our appearance.

At VISAGE MedArt, our expertise concentrates on long-term results and individualized care. Experience the VISAGE MedArt difference. Call today for an appointment, 615-646-9770.

What is IN? What is OUT?

The 6th European Masters in Aesthetics and Anti-Aging Medicine Congress ended in Paris on October 17, 2010. Each year, the most renowned aesthetic practitioners from Europe and beyond, present a multitude of avan-garde  studies, techniques and workshops. Receptive audiences have a rare opportunity to discuss many aspects of the newest developments and witness engaging live presentations. Major vendors display their most advanced products allowing for hands-on experience. VISAGE MedArt was represented by Dr. Marek Kacki with a lecture on his new laser technique for facial vein removal. Dr. Kacki presented results of a 10-month study on 56 patients who underwent the procedure at VISAGE MedArt. The presentation was met with great interest and was followed by discussion that extended beyond the scope of the subject.

What is IN?  What is OUT?

IN

In the field of facial aesthetics, the flexible cannulas for the injection of fillers are definitely here to stay replacing most of the needle injections. They are IN! Introduced less than 2 years ago, this technique has revolutionized dermal filler injections around the world. Key filler companies conduct many studies evaluating their products for all facial areas using flexible cannulas as a main mode of injections.

The flexible cannulas have replaced needle injections of cosmetic fillers with few notable exceptions such as chin augmentation, ear reshaping and Tri-Site method of lower eyelid and upper cheek enhancement. We are proud to be in the forefront of this revolution!

Several techniques of facial aesthetics have been validated. A revolutionary non-surgical upper eyelid approach has gained a universal acclaim since its initial presentation at the World Congress in Monaco in 2010. This ingenious concept was developed by Dr. Blenslimane by systematic observation of human faces and an artistic approach to aesthetics.

More sophisticated fat transfer techniques for volume restoration are IN. A lot of hope is placed on the stem cell revolution. Methods are being perfected and the newest generation of fat/stem cell transfers are around the corner.

The most important IN, to my delight, is a strong emphasis on the most natural results! This concerns the whole body in the areas that are subjected to aesthetic corrections or enhancements. The uniformity of the appearance is definitely IN!

OUT

OUT, and permanently expelled from the language of aesthetics are unnatural results! Again, I am delighted!

Tight faces and frozen expressions, fish lips, over-sized breasts and over-arched eyebrows belong to the archives of history of progressive aesthetics! Gone, but not forgotten. They are definitely OUT!

The discrepancies between face, neck, chest and hands are slowly leaving the scene, being replaced by fully natural and uniform appearances.

Overall, the most important aspect of Aesthetic Medicine, the natural look, is being reinforced by the Congress. Regardless of the cultural diversity and personal preferences, we all agree that each and every patient deserves the best appearance that emphasizes their own natural beauty.

A Revolution in Dermal Filler Injections

It has been 3 months since we began using blunt cannulas for filler injections. I wish I could forget the needles all together! There is no reason to subject my patients to the risk of bruising or bleeding if a better and safer alternative is available.

The needle-less filler injection is the single most monumental change that has occurred in the field of dermal fillers in several years; it has spread throughout Europe and South America very rapidly since it’s introduction less than 2 years ago. Aesthetic physicians around the world have embraced this chance to make filler injection strikingly less unpleasant and cut the risk of bleeding and bruising to almost negligible!

There seems to be another advantage of using cannulas. If placed properly and in a particular fashion the metabolism of the product could be delayed and the filler may last much longer!

The concept of a no-needle technique is not a new idea; it has been used for fat transfer for quite some time. Yet, the use of cannulas for dermal filler placement is hardly known in this country; even the representatives of filler companies are not familiar with this concept. It is somewhat puzzling since the reps from the same companies in South America or Europe are well versed in this technique and share all necessary information with their physicians. They are instrumental in helping their doctors to attain the necessary skills and equipment; both as a free addition to the purchased fillers.

The main problem is the availability of the cannulas, the blunt “needles” necessary for the injection of fillers.

Since the procedure is quite new, there are very few committed dermal filler cannula manufacturers around the world, however they work closely with the manufacturers of dermal fillers. Their products are available in several sizes and various lengths. These companies have grown exponentially within the last 12 months due to the enormous popularity of this technique and the continuously growing demand.

Overall, the no-needle injection technique is a major step forward in Aesthetic Medicine making filler injections a procedure that is much safer, less traumatic and with negligible downtime. There are reports of a longer duration of these dermal fillers when injected through a cannula.

There are only 4 centers in the US who use cannulas; two of them use this technique for lips only. We are very proud to be one of only two centers in the USA using this technique for total facial aesthetics.

What’s New with Dermal Fillers?

What’s New

Dermal fillers have been in use for several years. All non-permanent fillers have an impressive safety record allowing them to become a prime mode of rejuvenation.

With several dozens of fillers available around the world, we have only 6-7 products approved by FDA. Sadly, even the largest filler manufacturers have only handful of their products on our market while in Europe, South America and Asia several lines of dermal fillers are available.

The majority of fillers around the world are hyaluronic acid products. These are transparent gels of different thickness and different physical characteristics.

The thinnest products are used for very superficial injections in order to maximize skin hydration and provide fresh look. These products may need a touch-up every 2-3 months for the maintenance.

Thicker products provide much longer duration. The thickest hyaluronic acid fillers are used for the volumizing of face and other parts of the body. Their effect may last in certain areas for 2 yrs or more.

The concept of dermal filler has changed dramatically around the world almost 4 years ago; the injections concentrate on volume restoration and areas of enhancement  rather than simplistic filling of the visible lines.

Restoration of the volumes and understanding of light perception will provide an ultimate artistic/aesthetic results.

The most popular hyaluronic acid fillers around the world for the restoration of facial volumes areTeosyal Ultimate, Restylane SQ, and Juvederm Voluma. For non-facial volume restoration the Macrolane (made by the makers of Restylane) has been very successfull for over 2 years. None of the above are available in the US at this time. But, stay tuned. I predict that FDA will approve at least some of them soon since they clearance has nothing to do with their safety.

The hyaluronic acid fillers available on the US market are: Juvaderm Ultra, Juvaderm UltraPlus, Restylane, Perlane, Prevelle and Hydrelle. In practice, the last two are of minimal interest due to their suboptimal characteristics. Even with a minimal choice of available products one may expect excellent aesthetic results and fairly long lasting effect.

Personally, my favorite hyaluronic acid products are Teosyal Ultimate and Juvaderm UltraPlus. Teosyal Ultimate is the newest addition to the extensive line of hyaluronic acid products from a Swiss company Teoxan. Released just few weeks ago it provides almost perfect volume restoration when using in deep injections; its high thickness and great elasticity result in significant resistance to deformation and degradation. Consequently, this filler may last 18 months or more.

I was very impressed  with the ease of Teosyal injection, its smoothness and ability to restore the volume when injected using the no-needle technique. Unfortunately, Teosyal is not yet approved by FDA.

Juvaderm UltraPlus is overall great product for various applications. However, due to it’s small syringe volume and relatively high price, I find it difficult to use this product for larger volume restoration. It is unbeatable for lips and more superficial injections.

Aside of the hyaluronic acid fillers there are very few non-permanent products on the market:Radiesse, Sculptra and collagen fillers. The collagen fillers are of marginal use due to their short lifespan. Sculptra has markedly delayed visible response which may be difficult to monitor and plan ahead although those who use it report great results.

Radiesse remains an excellent filler for volume restoration and deep lines. In addition, at present pricing trends, it remains the most economical/cost effective agent with the largest syringe volume and relatively long lasting effect.

The permanent and semi-permanent synthetic fillers are still available. I do not use them and most likely never will. I would never recommend them to my patients under any circumstances. Once injected they are irretrievable.

Injections

The standard injections of dermal fillers can be quite unpleasant along with frequent bruising and bleeding. One can reduce the discomfort of injection by numbing the area with Lidocaine.

Although some use topical anaesthetic, these provide only superficial effect that is of minimal help with deep injections.

Alternatively, the anaesthesia can be achieved by injecting Lidocaine near the nerve supplying the injected area.

Up until recently, my preferred technique for needle injection involved mixing every product with the Lidocaine before every injection. This allows to numb the area during initial stages of injection making it much more comfortable.

But, to provide nearly painless injection, I begun to use a blunt technique that recently has revolutionized the majority of filler injections in many countries.

This technique gives the patient an amazing advantage over the traditional needle injections; it allows a nearly painless and precise injection, eliminates the need for multiple injection entry points and the risk of bleeding or bruising is dramatically reduced.

To summarize, the dermal fillers are here to stay. I expect much more fillers to be approved by FDA within next several months to provide our patients with the best choice of products.

But the most encouraging to our patients is the fact that the times of painful and bruising filler injections may well belong to past.

Meantime I will continue to take every opportunity to use the newest products in Europe before they reach our market.

One remains unchanged: LESS is MORE!