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It is critical to make total facial restoration a focus of any surgical or nonsurgical aesthetic practice. There are six modalities that I commonly employ on the face for natural results, which can also be used above or below the waist.
While these modalities possess some level of regulatory clearance, it is important to note that off-label use of these products involves risk, thus they should only be utilized, or appropriately delegated, by well-trained licensed professionals.
1. Neurotoxins. Neurotoxins are the foundation of medical aesthetics. Patient satisfaction is high, and indications have grown from relaxing lines to facial reshaping and minimizing underarm sweat.
2. Dermal fillers. The realization that facial aging was a phenomenon of volume loss / misdistribution was a game-changer. Using a single modality to surgically pull skin hurt the reputation of aesthetics. In addition, responding to panfacial loss with segmental restoration using dermal fillers was a mistake. We have now learned it is better to split two syringes of filler between the cheeks and lips with attention to transition areas rather than placing all the volume into the cheeks only. And, for most patients, it is better to treat the entire face starting with six to eight units of dermal filler to cover all areas of loss.
3. Fat grafting. In our practice fat grafting to the face has introduced the mindset of comprehensive restoration. As practices embrace full restoration, patient satisfaction will increase, and new patients will enter the market. As a result, the use of dermal fillers will continue to expand.
4. Platelet-rich plasma (PRP). PRP is another autologous procedure that should be a part of all aesthetic practices. PRP bridges aesthetic and therapeutic indications. It is used for hair restoration, sexual health, skin brightening, and to extend the life of dermal fillers.
5. Thread lifts. This modality is on my list because it enjoys niche indications, is delegable and has desirable margins. PDO filaments come in a variety of sizes and contours, and we’ve been using them for three years to rejuvenate skin and to lift tissue. A moderate amount of skill is required, but the risk profile for patients is favorable.
6.Versatile energy-based platform. Every practice in aesthetic medicine needs a multi-use energy-based device platform that delivers state-of-the-art results.
Since hair removal became a commodity, my workhorse choice is the CO2 family of MiXto V-Lase lasers, which are available in a single platform. This system may be the most effective and versatile device on the market. Offering several modes, it delivers extreme value. The surgical handpiece allows us to destroy superficial lesions. We can perform pressureless cutting, including blepharoplasty. And it is more reliable for capillary destruction than my three other vascular lasers.
The fractional CO2 ablative scanner hand-piece delivers a heat signature that allows us to achieve consistent results for superficial and deep skin resurfacing. The non-ablative mode (unique throughout all CO2 lasers) consists of a defocused CO2 laser beam that can rapidly heat tissue beyond the typical radiofrequency target of 42° C. We have observed impressive tightening and therapeutic tissue responses with excellent patient experience.
Winning the Best Nonsurgical Facial Rejuvenation Enhancement award at The Aesthetic Show 2012 served as a pivotal point for our practice, providing validation of our dedication to the field of cosmetic surgery. Further validation has come in the form of vendors offering luminary relation- ships and being named Best Aesthetic Practice in 2015.
Having become patient- and peer-evaluated as a top-tier practice, I am often asked to share my insights on the tools needed for success in aesthetic medicine.
So, my advice to any aesthetic practitioner entering aesthetics – if you are going to join the party bring these six friends!