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Aesthetics Practice Today

An Exciting 20 Years

Published February 4, 2016 11:18 AM by Mina Grasso
It is exciting to reflect back over the past 20 years on the evolution of non-surgical aesthetics in our practice.   Non-surgical aesthetic procedures now address fine lines, wrinkles, volume loss, irregular pigment, loose skin, veins, tattoo and hair removal, scar reduction, body contouring for fat and cellulite. In our practice we have incorporated bio-identical hormones and sexual health now to include vaginal rejuvenation.   A majority of these concerns patients have presented with are related to aging and hormones and an ongoing endeavor of anti-aging secrets to optimize beauty and vitality.  The following are a few highlights in the aesthetic trends in our practice.

"Injecting poison in your face?" Although still feared and avoided by many, Botox, initially was referred to, as a "poison" is now a more common household word. It becomes beauty maintenance for those who have experience the benefits, just as getting their hair colored or their teeth cleaned. Botox, Dysport and Xeomin are neuromodulators available in the US used to relax dynamic muscles that create wrinkles and even prevent wrinkles by blocking active contracting muscles. From what one patient may have feared Botox as a "poison" she didn't want in her face to "going to her Disneyland" when she comes in for her Botox or Dysport.

Liquid Facelift with soft tissue fillers: In the late 1990s some patients took advantage of bovine-based collagen injections to fill fine lines and wrinkles.  Patients who desired this had to undergo skin testing one month prior to treatment to test for allergy to bovine collagen. A great percentage of patients loved their results, however dissatisfied with the 3-month longevity of the product. In an effort to provide products that would last longer, cadaver particles, silicone and various other ingredients have been used to fill soft tissue as an alternative to fat transfer and surgical facial implants. 

Liquid Facelifts became more of a concept when Restylane, a non-animal based hyaluronic acid was FDA approved in the early 2000. Other products in the Restylane family were developed then the Juvederm family of products was introduced soon after. Radiesse, calcium hydroxylaptettit, tissue filler as well as a bio-activator was introduced soon after these products. Results of these products would be experienced immediately.  For those who were not needing immediate results and were enamored by the idea that their own collagen could be stimulated, Sculptra, poly-l lactic acid gained popularity. As new products were introduced, we continued to learn more about volume loss and the aging process. Skin changes, fat shrinkage and redistribution as well as bone loss were better understood in the aging face. 

We have evolved from chasing fine lines and wrinkles to a more global approach, understanding that a youthful face is more a triangle of beauty vs. the squared, aged look. The phi theory of proportions is used as we restore and enhance beauty. 

Non-surgical "liquid facelifts" are popular worldwide. It was surprising to see the term now offered as a medical spa service on cruise ships. 

Non-ablative, no downtime laser and light technologies: 20 years ago, non-ablative laser and light technologies were just being developed and we familiar with what was out there. Intense pulsed light (IPL) was our first non-ablative device is still one of the most popular technologies. Since then various non-ablative lasers using various wavelengths treating specific issues of the skin such as redness, broken capillaries, large pores, irregular texture and pigmentation have come to market. We as well as our patients have observed age reversing appearance of the skin. There was a study that actually proved to show via skin biopsies more youthful gene patterns of skin treated with a broadband light device vs. non-treated skin. Patients can benefit from anti-aging treatments over time with non-ablative technologies.

Minimally ablative laser procedures: No one likes downtime, but those who were willing to sacrifice 5-7 days of social downtime have experienced more dramatic results with certain minimally ablative lasers such as our lasers that target small veins on the face and pigmentation. For skin texture and rejuvenation, fractional non-ablative Fraxel was very popular. Some patients had more downtime than expected.

A few years later, we started to offer a minimally ablative fractional CO2 laser resurfacing to treat acne scars, surgical and traumatic scars and for general skin rejuvenation. We found that patients that although patients looked more red and swollen the first couple days, we had fewer side effects such hypo or hyperpigmentation, minimal to no acne breakout post procedure. Patients tolerated the procedure better with less discomfort. All skin types can be treated. We experienced higher patient satisfaction, improved results with fewer side effects. Fractional CO2 laser resurfacing is our go-to laser for those seeking more dramatic results for skin rejuvenation.

Skin Tightening: Over the years several technologies to treat various concerns for the face and body have been developed. Cellulite was one of the most challenging to improve. Endermologie, a cellulite solution using mechanical massage based on lymphatic drainage improved the appearance of cellulite temporarily. We still have patients who have experienced the benefits of Endermologie till request the treatment. Over the years, laser and radiofrequency energy was found to enhance the effects of mechanical massage and Velasmooth, Tri-Active and Viora Reaction were introduced to the practice. These devices offered temporary relief of cellulite after a series of t1-2 times a week sessions. The most recent addition for cellulite is ThermiTight RF injectable radiofrequency offers a longer 1-2 year solution to cellulite after one session. 

We have addressed skin laxity in the face and body with Thermage and Viora radiofrequency without downtime. Now a minimally invasive temperature control system utilizes higher energy levels of radiofrequency and provides longer lasting results. Injectable RF - ThermiTight can address skin laxity in the jowls and neck, arms, abdomen, thighs and loose skin over the knees. Radiofrequency triggers neocollagenesis, which helps firm, tighten, lifts and tones the skin. Higher temperature range can produce more neocollagenesis.

Body Contouring and Fat Reduction: Laser lipolysis with small areas of liposuction were performed years ago. We abandoned this to meet our patient's demand for no downtime options. Coolsculpt technology utilizes cryolipolysis to freeze fat cells. Fat cells are destroyed controlled freezing of fat using a specific applicator for the area treated. Cryolipolysis results in apoptosis of fat cells. Initially we had an applicator only for the small areas of the abdomen. Over time specially curved shaped applicators to treat the love handles and back fat as well as larger applicators for larger areas of the abdomen were made available. Several years later an applicator for saddlebags became available as well as a smaller applicator that we can use for inner thighs, upper arms, anterior and posterior axillary fat.

Before the end of 2015 a long-awaited applicator, the Coolmini, was brought to market. It was developed to treat submental fat. The "double chin" is a concern for approximately 67% of all aesthetic patients.

This year, 2016, brings another promising solution to the "double chin" fat. Kybella (deoxycholic acid) is a chemical ingredient we used in our mesotherapy formulation to dissolve fat for various areas of the body years ago. We, like other practices, abandoned the practice of mesotherapy. Our reasons included lack of standardizations of recommended formulas, severe bruising and swelling. Skin necrosis had been one of the worst adverse events we encountered. Kybella is standardized and specific protocols have been developed for safety and efficacy. We have experienced great results and are proud to offer this minimal to no downtime solution for the "double chin."

Anti-Aging: For decades people have searched for various anti-aging remedies. Skin care, peels, laser have claimed to produce age-reversing results. Platelet rich plasma (PRP) has created quite a buzz during the past decade. PRP utilizes a patient's own plasma to regenerate and repair exposed tissue. We commonly apply the PRP immediately after procedures such as Dermapen (microneedling) and fractional CO2 laser resurfacing.

As part of an aesthetic practice we have incorporated bio-identical hormones (BHRT) and nutritional counseling. Nutrition and hormone balance plays a big role in overall skin health and vitality.

In providing hormone therapy, sexual health issues are frequently discussed. The most recent aesthetic procedure added to the practice is ThermiVA, a non-surgical, no-downtime vaginal rejuvenation that utilizes radiofrequency to tighten skin laxity of the vulva, and when used in the vaginal canal results in tightening of muscles and increases vaginal lubrication as a result of thermal neurogenesis. Patients report improved issues with incontinence and sexual health. 

The evolution of our aesthetic practice over the past 20 years truly has been patient driven. Patients seek and benefit from anti-aging, non-surgical, minimal to no downtime procedures that fit their busy lifestyle.


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About this Blog

    Occupation: Physician Assistant/Nurse Practitioner
    Setting: Miami & Upland, Calif.
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