From tips for superficial injections to the truth about unhappy patients, experts shared their insights at this year's Cosmetic Surgery Forum meeting in Las Vegas. Here are some highlights from the meeting’s coverage.
The effects from an injectable neuromodulator-peptide combination lasts significantly longer than the neuromodulator alone, according to new studies. The long-lasting effect might be due to a novel delivery mechanism — peptide molecules. Peptides transport the active molecule through skin in topical neuromodulator products; they restrict toxin molecules to targeted areas in botulinum toxin type A injectables.
Revance has been testing its new injectable botulinum toxin-peptide complex RT002. Mouse studies found it took 15.8 weeks for the neuromodulator alone, to wear off, versus 31.6 weeks for the neuromodulator and peptide combination.
A phase 1/2 clinical trial of RT002 suggests the complex lasted almost 30 weeks. While investigators aren’t sure why the combination of active ingredient and delivery system lasts so long, they found that adding the peptide cut product diffusion in half, meaning the neurotoxin also stays put.
Filler experts shared their secrets and challenges using fillers. Among them:
Despite the focus on midface rejuvenation, it’s not always about replacing lost volume, said San Antonio-based dermatologist Vivian Bucay, M.D. Sometimes, it’s about filling the line because that’s what the patient wants. Superficial etched lines, require superficial filler placement as well, she said.
When it comes to treating wrinkles around the mouth, however, superficial filler placement can create more bruising than normal. New York City dermatologist Heidi Waldorf, M.D., said post-treatment bruising is virtually unavoidable with superficial lip injections. Physicians can try to limit the number of injection points to limit bruising, but that’s difficult because superficial injections tend to involve more injection points than deeper injections. Making bruising worse, hyaluronic acid is not hemostatic, so it opens vessels, she said.
Dr. Bucay also suggested that perhaps it may be possible to avoid bruising: "It's a matter of how adherent those lines are — do you have to do a lot of subcision?"
Just Say “No”
Dr. Waldorf said the formula for great filler results is having the right patient and injection plan. And having the right patient sometimes means saying no to patients who show signs early on that they won’t be happy no matter what you do. One way to tell if a patient is going to be unhappy with the results is if that person makes the doctor and staff uneasy. Some red flags include:
- Patients who have a list of complaints about their prior procedures and physicians, as well as others who have unrealistic expectations.
- Patients who aren’t sure about what they’ve had done. Patients might say they went to an event, where somebody injected them. "You don't want to be injecting over silicone or something you could re-stimulate, like one of the polymethylmethacrylate fillers from South America,” Dr. Waldorf said.
- Patients who have extreme behaviors, like excessive anger or devotion toward the physician.
Dr. Waldorf recommends physicians suggest follow-up discussions or appointments, if they’re concerned about whether patients are right for fillers, or refer those patients elsewhere.
Click here for more news from the Cosmetic Surgery Forum 2014.