Quintessa Medical Spa's Blog

Would you recommend Juvéderm Ultra Plus or Perlane for deep wrinkles?

Dr. Andrew Campbell, M.D. — Fri, 07 May 2010 14:30:07 +0000

I personally feel that Juvéderm Ultra Plus and Perlane are both excellent products that can do a wonderful job of filling in deeper facial wrinkles or folds. Both products are exceptionally safe and I have extensive experience using both of them. Regarding a preference, I really do not have much of one as I have had excellent results with both. They both are very similar in their injection techniques. Juvéderm Ultra Plus may be slightly softer than Perlane and some feel that it may last slightly longer though, at Quintessa Medical Spa, we actually did a head-to-head comparison between Juvéderm Ultra Plus and Perlane, and though we had a very limited number of patients, we did not see any significant difference between the two products.

How would you recommend finding a good Botox or Juvéderm injector?

Dr. Andrew Campbell, M.D. — Wed, 05 May 2010 14:30:29 +0000

I would look for an injector that is either a board certified facial plastic or plastic surgeon or an injector that is associated with a board certified facial plastic or plastic surgeon. I think some of the best injectors are individuals that are either surgeons themselves and therefore fully understand the facial anatomy or they are associated with surgeons and have been taught the intricate details of facial anatomy so that they can customize their injection approach and provide patients with excellent results and at the same time minimize any sort of minor complications that can occur. Kristin, my nurse injector, has been performing Botox and filler injections for approximately seven years. Prior to working at Quintessa Medical Spa, she was employed by a general plastic surgeon and she had also taken part in several master injection courses to improve her results. Once she started working at Quintessa Medical Spa, I had the opportunity to hone her skills even further by discussing various aspects of Botox and filler injections that she had not really thought of or discussed in the past. This essentially allowed me to take Kristin, who was an excellent nurse injector prior to starting at Quintessa Medical Spa, and turn her into truly a master injector that would be on par with some of the best injectors in the country. I am very happy to have Kristin on our staff and I am very comfortable allowing her to inject Botox and fillers as I know that she consistently gets excellent results while at the same time assuring the patients maintain their comfort and overall have a pleasant experience. I would invite anyone to have a complimentary consultation with Kristin regarding their interest in Botox or filler injections.

I have had a few microdermabrasions performed in the past and like the temporary improvement in my skin. It has been recommended that I consider a TCA and Jessner peel. Is this something that you would recommend?

Dr. Andrew Campbell, M.D. — Tue, 04 May 2010 14:30:35 +0000

No, I personally do not recommend Jessner TCA peels any longer as technology has improved to the point where these sorts of historical chemical peels really are completely unnecessary. If the Jessner TCA peel is intended to improve the pigmentation of the skin, then I would personally recommend BBL or broadband light as we can rid the patient of their pigmentary issues without the downtime of a Jessner TCA peel. If the Jessner TCA peel is recommended for textural improvement or wrinkle reduction, then I would recommend a micro laser peel and/or ProFractional laser resurfacing as we will get a much greater improvement in the texture and wrinkling of the skin than a Jessner TCA peel will accomplish. I personally discontinued telling patients to expect wrinkle reduction from a Jessner TCA peel many years ago due to the rather underwhelming results that we would get regarding wrinkle reduction. Micro laser peels and ProFractional laser peels; however, can injure the deeper layers of the skin creating significant new collagen growth that will indeed create improvement of the overall texture of the skin and significantly reduce visible lines and wrinkles. All of this can be accomplished with less downtime than a single Jessner TCA peel would cause. I would recommend that you schedule a consultation at Quintessa Medical Spa where we can discuss the various skin care options with you and due to the fact that we do have these very high technology devices, we typically can provide patients a better result with less downtime than our competitors that do not embrace this technology.

Would you recommend SoftForm or Ultrasoft implants for permanent lip augmentation?

Dr. Andrew Campbell, M.D. — Mon, 03 May 2010 14:30:12 +0000

At this point in time I would not recommend any sort of lip implant for lip augmentation mainly due to the fact that, over time, these do tend to migrate slightly and create some asymmetries, a doublelip crease, or other unintended consequences and ultimately these will commonly require removal. I have personally placed multiple Gore-Tex style lip implants over the years and have a very high frequency of requiring removal due to mild migration of the implant. The lips are such a mobile facial structure that virtually everyone uses for the most part continuously throughout every day of their lives. Due to this significant daily motion and the fact that there really is no bony attachment anywhere, any implant that is placed in the soft tissue of the lips does have a propensity to slowly migrate into a different position. With that said, I really feel that the hyaluronic acid fillers like Juvéderm and Restylane are absolutely ideal for lip augmentation and when a small amount of local anesthetic is added to the filler itself, the injection experience can be virtually pain free without the need for a dental block type of anesthetic. What is wonderful about the Juvéderm and Restylane fillers is that these can be extraordinarily customized regarding their injection technique so that the patient can achieve luscious lips without the telltale signs of typical augmentation where the patient’s lips look like two sausages or duck lips. This is an unfortunate consequence of either placement of an overly large implant or injection by an inexperienced filler injector that places too much of the product toward the corner of the mouth thus creating a very unusual and unnatural lip shape. By customizing our injection techniques, we can create very natural plump and youthful lips that no one would question were not completely natural. The only downside of these filler injections is that they are unfortunately temporary, but most patients will get somewhere between six and twelve months from their injections and these are easily repeated and overall quite affordable as well. I would caution any person interested in lip augmentation to seek out an extremely experienced injector so that the result will be natural appearing and the patient will get the result that they expect.

Can ArteFill fill the empty pocket once a chin implant is removed?

Dr. Andrew Campbell, M.D. — Fri, 30 Apr 2010 14:30:57 +0000

No, I would highly recommend that you not let anyone place ArteFill in an empty pocket where a chin implant was removed. ArteFill is a methylmethacrylate permanent injectable filler that is designed to be placed in the dermis of the skin and placing large quantities of this substance in a pocket in the chin I think would have a very high risk of some sort of complication. Mainly, I would be concerned that the filler material would not provide adequate support for the chin and you could end up with asymmetries, bumps, nodules, and even infection. Depending on the reason that you required a chin implant removal, I would personally recommend replacement of the chin implant with another more appropriately sized implant. This could be performed at the same setting as the removal of the implant if the only reason for removal was due to malposition, malplacement, or an overly large or small size. If the reason for removal was infection, then you may have to wait until the infection completely subsides before another chin implant can be placed. I would again caution you against placement of any sort of filler in the chin area as I personally feel that you would have a much higher likelihood of a successful result if you opt for revision chin implant surgery.

Would you recommend intense pulsed light versus other different photorejuvenation laser systems?

Dr. Andrew Campbell, M.D. — Thu, 29 Apr 2010 14:30:04 +0000

As far as I know, virtually all photorejuvenation laser systems use some form of intense pulsed light. Intense pulsed light has been around for many years, but they have made some significant improvements in the technology, specifically the BBL System by Sciton, which stands for broadband light, seems to be distinctly superior over our previous technology of intense pulsed light in that it has a significant amount of “punch.” In essence, the broadband light seems to be much more efficient at treating vascular and pigmented lesions and we therefore tend to turn down the power setting quite a bit compared to our prior intense pulsed light technology. This allows us to treat in a much safer and more comfortable manner and yet we end up getting superior results when compared to intense pulsed light. We have had several employees that have extensive experience with intense pulsed light in the past and now have been trained on our new broadband light or BBL technology. These employees have been extremely impressed with the BBL therapy as it seems to provide a more efficacious treatment with less discomfort and less risk of any complications. At Quintessa Medical Spa we will frequently combine BBL technology with other laser systems such as the ProFractional laser and/or micro laser peels to not only rid our patients of unwanted pigment and vascularity, but also to improve their overall skin texture and provide for wrinkle reduction.

Can you use Juvéderm to fill minor smile lines or do you have to have deep folds for Juvéderm to be effective.

Dr. Andrew Campbell, M.D. — Wed, 28 Apr 2010 14:30:44 +0000

Juvéderm can be placed in virtually any fold or line on the face that is deep enough to fit the filler material in. In essence, any fold that can create a shadow can be filled with Juvéderm or Restylane and the fold and shadow then will temporarily be gone. These hyaluronic acid fillers are wonderful treatment options for patients that have some early signs of aging as with one to two syringes, we can virtually rid the patient of any unsightly lines and folds that they have and give them an extremely rejuvenated appearance in as little as 20 minutes. The results are instantaneous. The downtime is absolutely minimal with only a small amount of redness or swelling in the area for a day or two. The results can then last up to 12 months and then the product slowly is resorbed. For certain issues like the smile lines, there really is no adequate substitute for the hyaluronic acid fillers as they work so incredibly well, are so well tolerated, are relatively inexpensive, and last a relatively long period of time. I would recommend anyone interested in considering Juvéderm or Restylane for their smile lines to make a complimentary consultation at Quintessa Medical Spa so that your concerns can be discussed and a customized treatment plan developed.

Do fat injections change skin quality more than Sculptra?

Dr. Andrew Campbell, M.D. — Tue, 27 Apr 2010 14:30:14 +0000

I would personally have to say that fat injections would indeed improve the skin quality more than the Sculptra injections would simply because fat injections do have this subtle rejuvenating quality to the overlying skin, which is thought to be due to a stem cell type rejuvenation of the skin cells. Sculptra obviously would not have the stem cells that fat injections have and the only improvement in skin quality the Sculptra would perform would be due to the overall volume improvement of the face due to the inflammatory changes that occur with the injection of Sculptra. The improved volume would thus essentially stretch out the skin or fill the face with more volume, so that the overall skin looks better, but the actual quality of the skin really should not have any significant improvement. I have; however, seen significant overall rejuvenation of the skin secondary to fat grafting and this is an interesting and positive side effect of the volumetric enhancement that fat grafting has.

How do I improve a wide nose and deep smile lines?

Dr. Andrew Campbell, M.D. — Mon, 26 Apr 2010 14:30:09 +0000

A wide nose for the most part can really only be improved by surgical treatment via a rhinoplasty. I would recommend that if you are interested in treating a wide nose, that you seek out a very experienced rhinoplasty surgeon, especially one that can perform computer generated imaging as I feel this really aids not only the patient in understanding the expected outcome, but also really aids the surgeon in creating an appropriate plan for the patient’s anatomic features. The deep smile lines can be treated in multiple different ways, the easiest of which is through the use of injectable fillers such as Restylane and Juvéderm. These filler materials can be placed in the fold of the smile line and used to fill in the depression and virtually rid the patient of this concerning area. The only downside of these types of fillers is that they are temporary, but they will typically last nine to twelve months and overall are a very good value. A more sophisticated approach toward treatment of the smile lines would be placement of the patient’s natural tissue whether that be by fat grafting or if the patient has significant features of aging, we can harvest portions of the fibrofatty tissue beneath the skin during a facelift and place this under the smile lines for a more permanent improvement of this area. A more sophisticated approach to treatment would be an extended SMAS deep place facelift, which is really the only surgical technique of a facelift that can improve the smile lines long term. I have had many patients with extremely significant improvement in their smile lines after an extended SMAS deep place facelift, but overall I discuss with my patients the fact that they can expect a one out of four improvement in this area in that if they have severe smile lines, they can expect moderate smile lines after the procedure and if they have moderate smile lines, they can expect mild smile lines after the deep plane facelift. I have however seen many patients get a more significant improvement. The only other option that will create significant improvement would be direct excision of these folds where the soft tissue is literally removed and then sutured resulting in a relatively inconspicuous, yet visible scar in this area. For the most part, I tend to condemn this treatment as most patients do not find the scar to be an acceptable alternative to the smile line fold.

Do you have any alternative options for facelift for patients that have a heart condition?

Dr. Andrew Campbell, M.D. — Fri, 23 Apr 2010 14:30:51 +0000

Yes, there are certainly options for patients that are not healthy enough to undergo general anesthesia specifically regarding their lower face. Standard facelifts or certainly extended SMAS deep place facelifts are typically performed in the operating room setting under either deep sedation or general anesthesia. Options for patients that are not healthy enough to undergo these types of anesthetic care would be mini facelifts, which can be performed under local anesthesia in the office and I have certainly performed these on patients that are not qualified for procedures performed in an operating room setting. Though this treatment is compromised compared to the more sophisticated and technically demanding extended SMAS deep plane facelift, they nonetheless get a very significant improvement in the lower third of their face and these patients are quite satisfied with the results of this type of surgery. A more advanced and newer technology that is available now for patient that are showing the early signs of aging would be Ultherapy, which is an ultrasound device that can target the deeper layers of the skin and this ultrasound energy is then focused on the deeper layers thus heating up the collagen and causing new collagen deposition, which in turn results in tightening of the deeper tissue and lifting of the facial structures. This can be performed in the area around the eyes to cause a nonsurgical brow lift. This can also be used to treat the midface, jowl, and the area under the chin to create the lift of a miniature facelift. There is no need for any anesthetic and there is absolutely no downtime as this is performed in a medical spa setting and the patient’s own healing creates the lift over a three-month period. This would be an excellent alternative for any patient with early aging that is not a good candidate for a standard facelift.