Cosmetic Injectables Encinitas Doctor Speaks Out

Dr. Melanie Palm is a rising star in dermatology and cosmetic surgery and resides in beautiful Cardiff-by-the-Sea. She is a nationally-recognized speaker on various topics in cosmetic dermatology including injectables, laser technology, and liposuction technology. She is an expert trainer for Sculptra  Aesthetic, training over 40 plastic surgeons and dermatologists on the safety and use of this facial volumizer. She serves as a Distinguished Speaker for Scripps Memorial Hospital Encinitas and is an associate volunteer professor at UCSD.

Today, she shares her thoughts on techniques for facial fillers from the perspective of both a national expert and a San Diego woman. Delving into the world of cosmetic injectables for facial rejuvenation can be very intimidating for any woman. There is a myriad of choices when it comes to filler agents, and the choice of one product over another can seem confusing. I felt this article would be an excellent opportunity to explain my approach to this expanding field of fillers.

I think of facial rejuvenation in terms of the 4 Rs: Resurface, Relax, Revolumize, and Redrape. "Resurfacing" refers to the skin’s appearance. This can be addressed by topical therapies or through light/laser technology such as photo facials (IPLs) or fractionated laser resurfacing. "Relax" refers to using botulinum toxin agents such as Botox®Cosmetic or Dysport®. They soften wrinkles caused by muscle movements, such as forehead wrinkles or crow’s feet. "Revolumize" addresses facial volume loss that begins around age 30. Various products, from fillers to one’s own fat, can be used to address this concern. Finally, "Redrape" refers to traditional surgical interventions (such as a facelift) that improve areas of redundant skin.

Today, in the field of aesthetics, revolumizing is much more appreciated in our approach to facial aging. Temporary fillers like hyaluronic acid (HA’s) (Juvederm®, Restylane®, Perlane®) are considered the gold standard. Other fabulous volumizers exist and truly great physician injectors know how to harness the unique qualities of each. I often combine fillers in different areas of the face to recreate youthful contours, sometimes referred to as a "liquid facelift." My go-to fillers for correcting hollows under the eyes are Restylane or fat. For cheekbones, I often turn to Radiesse or Sculptra Aesthetic. For lips, Juvederm or Restylane are great choices. Vertical lip lines are treated with a combination of HA’s and Botox or laser resurfacing.

Sculptra® Aesthetic is an amazing revolumizing treatment that I suggest for patients who desire longer-lasting results or for those who would like to be discrete about improving their appearance. Sculptra works by causing your own body to form collagen in the area of placement.

The results from Sculptra® Aesthetic are long-lasting. The volume replacement lasts at least 2 years, and clinical studies demonstrate continued improvement for even 3-4 years following treatment. It can be used to replace volume in most areas of the face including the temples (a much-neglected area until recently), cheeks, jawline, nasolabial folds, and marionette lines. Sculptra® can even be used on the chest to reduce the appearance of wrinkles in the décolletage area. I love this volumizer as it rarely causes bruises, gives reliable, natural-looking results, and even improves the texture of the skin.

If the need for volume replacement is great and traditional fillers would be an expensive choice, I often offer fat transfer as a treatment option. Fat transfer is an easy, economical, safe, and comfortable means of volume replacement for the face. Fat is harvested from an area of excess fat such as the hip, thigh, or abdomen. The fat is then processed and placed in small aliquots to resculpt the facial contours of the face. Fat transfer is done completely under local anesthetic without a need for general anesthesia.

Fat is also an excellent choice for rejuvenating the hands, as it camouflages the appearance of visible tendons and dilated veins. Radiesse®, a calcium-based filler, is another excellent option for adding volume back to the hands.

We are lucky to exist at a time when so many choices are available for skin and facial rejuvenation. I have a real passion for educating patients and physicians on creating natural, gradual, volume replacement. Women often consult with me after they have had a bad experience with an unskilled injector that took a "cookie-cutter" approach to fillers. The key to a successful outcome is having a trusted, skilled, and caring physician to act as an artistic steward through this new age of facial rejuvenation.

Dr. Palm offers a full spectrum of medical dermatology and cosmetic services in private practice at Surfside Dermatology of Encinitas, near the Scripps Hospital. A consultation may be scheduled by contacting Sarah Anne Dordel, Director of Patient Services at 760.208.1641, extension 6.