So you’ve been staring at the mirror a little longer than usual lately. Are those crow’s feet creeping up in the corner of your eyes? No they couldn’t be…… you’re too young for crow’s feet, smile lines, frown lines or any lines for that matter.
How did the hands of time swoop in so quickly leaving its dreaded mark? Just when you’ve started to master life and enjoy the benefits of maturity, you get socked in the face with the kiss of gravity.
Now if this was a decade ago you may have had some real concerns on your hands. However being that we’re in the 21st Century where technological advancements have taken over every sphere in our lives including the cosmetic & beauty industries, it’s a whole other story.
Amongst the slew of treatments available in beauty salons, med spas and doctor’s offices alike one of your most trusted tools in your beauty arsenal is that of modern day injectables.
Injectables & fillers as they’re often called are widely available and vary from brand and type. From Juvederm®, Radiesse®, Restylane®, Perlane®, Collagen®, Botox®, Sculptra®, to fat injections, etc, there is plenty available that has been FDA approved.
But the two injectables that came up in my research as winners, especially when they work in tandem, are Restylane® and Botox®.
I decided that if I was going to find confirmation on my research I would have to seek it from the best. So I set a date with one of the top medspas in Beverly Hills for some answers. The impressive med-spa that makes AVA MD is owned by Ava Shamban, M.D., Board Certified Dermatologist a featured dermatologist on ABC Television’s “Extreme Makeover”. Ava considers herself a skin scientist, a participant in dermatological research, technology and product development for skin rejuvenation and the treatment of acne. Dr. Shamban is also an Assistant Clinical Professor of Dermatology at UCLA and in addition owns the Laser Institute for Dermatology and European Skin Care in Santa Monica, California.
Not only was I privileged enough to get an interview at the AVA MD facility, but I was also lucky enough receive a demo of Restylane® and Botox®.
So there I was at the AVA MD Med Spa In Beverly Hills. I knew I was in good hands when I discovered that Dr. Shamban is an authority in the art of injectables, being a national trainer who teaches others the injection technique. I would be meeting with Ava’s protege Christine Erdman, a nurse practitioner at the facility. Having interned directly under Ava in her practise in Santa Monica for over a decade Christine herself has evolved into a highly skilled and sought after injector. Hailing from a small town in Wisconsin, Christine exudes a sweet,open and compassionate air about her that quickly puts one at ease.
The ambience of the Med Spa is immediately captivating with its clean, sleek lines and glowing white interior. Stylish, modern and crisp are the words that come to mind. Yet somehow it succeeds in feeling warm and inviting.
The spacious facility has numerous, zen-like treatment rooms to cater to all their services, from dermatology, medical and even advanced hair treatment. It helps to have gorgeous surroundings that put you at ease before venturing into an intimidating cosmetic medical procedure!
I sat down with Christine and she recalled how Ava’s involvement in the popular EXTREME MAKOVER tv show quadrupled their business. The public poured in to personally experience Ava’s unique skill and expertise in the area of dermatology. In fact things got so busy that in July 2007 they opened the AVA MD Med Spa in Beverly Hills to cater to the legion of new clients.
I discovered that what sets AVA MD apart from other med-spas is that they are a full fledged dermatology clinic not just a cosmetic clinic. You’ll find a combination of 50% medical services along with 50% cosmetic services. So the same person who comes in for Botox® can come in for a full body mole check. Thus their medical services can be billed to the patient’s insurance provider.
According to Christine, “A lot of patients who come here for acne treatment say, by the way these lines are bothering me can I fill them in with Restylane®? It’s a one-stop shop. Patients start feeling comfortable with me and whoever is treating them and they want to be able come to one place that does it all. We have an international hair stylist & a dermatologist so that relates to all issues with skin hair & nails. We’re a full-fledged medical practise. We write prescriptions and diagnose skin conditions, our medical services are what set us apart from other med spas.”
I noticed that Christine had a very impeccable presence about her, in her dressing & mannerisms, traits that I suspected transferred to her skill as an injector. True enough she revealed that, “Dermatology fascinates me. I’m passionate about helping people improve their skin in any way possible. I’m also very particular about my own skin to a fault. It’s the pursuit of perfection”
So what’s with all the attention on injectables & fillers? Is it true that the combination of injectables such as Restylane® and Botox® can deliver a rejuvenating effect that can transform one’s entire face?
Christine explains ‘ Botox® and Restylane® alone make huge differences giving a lifting effect to the face. Restylane® is a hyaluronic acid that is a stabilized, biodegradable version of a naturally occurring sugar in human joints and skin that provides support and cushioning. Depending on the person, results may last from 6 to 12 months, about twice as long as collagen based fillers. Its longevity also depends on the area injected.
Restylane® sometimes has a little downtime with it. You may get a little swelling and bruising from it. When augmenting lips, they look 30% more swollen for two days. Restylane® is a filler so in a sense it replenishes volume loss. As we age, we lose fat in our faces. Not only does gravity bring the fat pad from the eyes down, but by losing volume it creates a sunken look. When you use a filler like Restylane® it boosts the volume in those sunken areas so light hits your face better. So, it creates a fuller face making you look younger. Plus it gives a lifting effect. With age the loss of fat doesn’t plump the skin the way it used to. But with a filler we create that plumping effect by expanding the skin and filling in the wrinkle. Remember the effect lasts from 6 months to a year. God forbid if patients don’t like the result, they’re not stuck with it forever. But they usually end up loving and then they are bummed that it doesn’t last forever. The good thing about Restylane® is that it’s extremely cumulative (meaning it lasts longer and longer after you have had several touch up treatments)”
“As for Botox®,” she explains, “it’s injected into the muscles and is used for expression lines. You can use it in the lower face but traditionally its used in the upper third of the face. All of the lines in the forehead come from making expressions, so if you stop the movement of those muscles you not only relax the muscle and smooth out the wrinkle that is already there but you also prevent the wrinkle from getting worse. So it is both a treatment and a preventative. Girls are starting to use it a younger age, even in their twenties, to prevent lines from even forming. If you can't make the expression, you cant make the wrinkle deeper. Plus it has a nice side effect of treating headaches, so it’s used for the treatment of migraines. As long as you use the appropriate FDA approved product and administer the correct dosage, Botox® is very safe. Just know that you don’t see results instantly. It takes about 5 days for it to take effect. Restylane® however provides results that you see immediately.”
Christine also touches on the other fillers available in the market “ Juvederm® is a hyaluronic acid that manufactured by a different company. Technically it involves a different cross linking, making the product slightly different. Both are injected in a very similar manner and you get instant result for a reasonable price. We feel comfortable with them both as they are safe and have been on the market awhile. Restylane® feels firmer in the skin while Juvederm® is a little softer. Patients feel difference between the two although it really varies per patient how long each one lasts. There’s a place for both of them to be used on the face. Radiesse® is another filler that lasts longer than Restylane® and Juvederm®, however its newer. Also you can’t inject Radiesse® into the lips as you can with Restylane® and Juvederm®.”
”As for fat transfer, it’s a surgical procedure. Fat is harvested from a different part of the body. It’s surgical which means there’s a lot of swelling and only a certain percentage of fat stays permanently. Basically it involves a lot of expense, a higher level of risk and more downtime for not much more benefit. Dr. Shamban used to do fat transfers, but as soon as hyaluronic acid became available she stopped doing it. It’s becoming much less common.”
Where Restylane® & Botox® are used:
Christine explains “ Restylane® is used in the naso-labial folds, oral commissures, marionette outlines and for lip augmentation. With the proper injection technique it’s safe for use in the under-eye area. It’s also used in the cheeks and to enhance the cheekbones. A lot of these are off-label uses as Restylane® is only FDA approved for nasolabial lines. Further off-label uses include plumping the hands, scars, acne scar , plumping up heavy crevices such as frown lines.”
“ Botox® is mainly used where there are expression lines, between the brow, frown lines, horizontal lines, and crows' feet. It’s also used in the platysmal bands in the neck, relaxing the bands making them less apparent. It can also be used in the lower face for a bit of a lifting motion.”
“Injectables are so common now both women and men come in . The age range of patients is anywhere from the 20s to the 80s. More patients are coming in for injectables now than ever before. Women whom you would think would be more conservative are regular clients. We have patients from all walks of life including a fair share of celebrities but really it's so varied. Some women come in with their friends and make an outing of it. I just had a case where two girlfriends in their 30’s came in to do a filler for the first time.”
Christine glows as she relates the experiences of her patients “ For so many it's life changing it gives people higher self-esteem what I like about these treatments, about injectables in general is that you can really enhance the individual’s natural beauty. You work on their own traits without making them look like a different person. It’s all about enhancing their natural attributes and giving them a refreshed look. Other people can’t tell what they did, they just say you look so good or you look refreshed like you got a good night sleep. That’s what I hear all the time.”
TIPS FROM THE EXPERTS:
1) PREPARE YOURSELF ! – Injectables may be a minor procedure but it does induce swelling & bruises depending on the individual. Arnica Montana is a homeopathic medicine that has been used in Europe for centuries to treat swelling, soreness and bruising . Purchase arnica tablets and gel. Begin using the arnica tablets the day before your procedure and keep taking them til the swelling subsides. Bromelain is an anti-inflammatory formula containing the proteolytic enzyme from the stems of pineapples & Vitamin C - is essential for normal healing, so start drinking pineapple juice the day & taking Vit C tablets a few days before your procedure. Slather on the arnica gel after your treatment. If you do bruise (especially in the under eye area) try to sleep with enough neck support (extra pillows) to keep your head relatively upright. This allows excess fluids to drain the area and return to its normal state more efficiently.
Note: On the day of your procedure you will be asked to apply a numbing cream an hour before the process. You also have the option of local anaesthetic, which is probably a good idea if you are working on the sensitive lip region. If you’re really sensitive to pain you could opt to take a valium tablet 30 mins before your procedure as well.
2) BE PATIENT & DON’T REACT – Due to the fact that the human body is an organic vessel that is fundamentally unique, its reactions cannot always be predicted. Bearing this in mind, the use of fillers may possibly cause lumps & irregular swelling in the initial stages. Be patient and allow a week for the filler to settle down. If the lump or irregularity still exists just massage the area over the next few days/weeks until you achieve your desired contour.
3) DO YOUR RESEARCH – Injectables are considered safe when administered by a properly qualified and trained clinician in an appropriate medical setting . So ensure that your injector is licensed and properly trained to administer injectables. Look for before & after pictures. Make sure the product used is authentic. Ask your injector to show you the box packaging of the injectable administered. Don’t be swayed by cheap prices, make your decision based on the credentials & experience of your injector. It will be well worth the extra cost.
NOTE: AVA MD also offers a treatment called THE LIQUID FACE-LIFT using combinations of fillers and Botox®. A liquid face lift combines a variety of different injectables, such as Perlane®, Restylane®, Juvéderm® , and Botox® strategically placed to bring back cheek volume, minimize nasolabial folds, lift lip corners, improve under-eye circles, rejuvenate lips, and smooth frown creases. A liquid face lift may last for one year, nearly triple the average time for individual site injections.