Injectables and Fillers: What You Need To Know?

Join Dr. Roy Kim and Dr. Kristy Hamilton in Episode 8 of The Beauty Scientists as they dive into the world of injectables, specifically neuromodulators and fillers. Discover the purpose, application areas, and favorite brands of neuromodulators from these renowned experts. Learn how neuromodulators work, what affects their longevity, and the numerous benefits they offer.

Stay informed and make educated decisions about injectables by tuning in to this insightful episode of The Beauty Scientists.

#TheBeautyScientists #injectables  #Neuromodulators #fillers  #cosmeticprocedures  #hafiller #botox  #dermalfillers  #beautytips  #DrRoyKim #DrKristyHamilton #cosmetictreatments  #antiaging   #aestheticmedicine  #beautyscience

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Transcript

0:10

Hello this is Dr. Roy Kim with The Beauty Scientist with my co host Dr. Kristy Hamilton how are you? I'm great how are you doing Dr. Kim I am good so today we wanted to talk about injectables specifically neuromodulators and fillers we wanted to do it in a very consumer friendly style it will be fairly comprehensive like a light touch on all the major fillers and injectables in the United States so to all listeners out there thanks for watching and we'll get started with what exactly is a neuromodulator so in case you don't know neuromodulators are really given into muscles or areas of the face that have the muscle creating the wrinkle if we inject some chemical where we can weaken the muscle then it won't create the wrinkle classically it's in the forehead between the eyebrow what we call the gallbella area and the crows feet just to the side of the eyes and we can actually do cool little things with it including change your eyebrow position a little we can slim the width of your overall face in the masseters and actually help with TMJ or grinding of teeth and there are a couple of other fun things we can do so Dr. Hamilton what are your favorite neuromodulators? so I predominantly used Botox and just for it in my practice I feel like those are you know Botox is the original it's the one that most people come in asking for specifically and then Dysport I think is another really great option maybe kicks in slightly faster and has great data behind it as well so those are those are the two that I offer and overall the study show that there's be fair amount of equivalence between those two but I find that individually one patient may see more longevity with one or the other just like the look a little bit better so I'll often encourage patients to try try to switch at some point once we have their dose snailed down and so they can see if they have a preference what do you do? I mean my favorite is still Botox by Allergan I do also like Xeomin and Dysport which are similar in terms of injection application how long it lasts I have used Daxxify I haven't used it recently I do think it lasts a little longer but it probably doesn't last twice as long so it's not worth double the price since they recently dropped the price I may go back to that and Jeuveau does work but I don't think it lasts that long and so I'm not a huge fan of that specific neuromodulator that's been my experience too and so I feel like you see Jeuveau more in the med spa arena and perhaps less in physician offices just an observation I've noticed yeah and I do think you know honestly I don't think there's much of a difference between Botox and Xeomin in the built for products I feel like there's a lot of misinformation about that out there too hmm like does your Botox gotcha does it just does it just disappear a month 3 or month 4 what's happening yeah I think with Botox with all the neuromodulators they do dissipate they sort of fade away over time everybody is a little different the metabolism is different so you may actually as an individual have a better reaction to one neuromodulator versus another and I think that's highly individual so what have you found so the way I explain it to patients is so we we know that these neurotoxins neuromadulators they go and they block the connection between the nerve signal telling you to move the muscle in question and in the muscle that's actually making that contraction so you can see I'm pregnant right now so nothing is Botox I can move everything very freely so all those signals are going strongly to the muscle when we inject the neuromodulators we permanently block that muscle into a patient's house well why you know why doesn't my Botox last forever then I was like well wouldn't that be great but what happens is our bodies are really great at healing themselves and so we grow new nerve endings back into the muscle and so if you're a really great nerve grower nerve healer you may find that you're Botox wears off a little bit faster conversely if you're slower to grow those nerves back you may see more longevity with it and that's probably one of the reasons why people who are consistent and not microdosing their Botox seem to have better results over longer periods of time so I have conversations to be consistent yeah I totally agree with that if you're coming in routinely every 3 to 4 months then you're always making those muscles a little weaker you're always knocking them down before they get too strong yes and so at this point I started doing Botox when I and I I could flip between Botox and Dysport just depending on what's open at the end of the day but I started doing Botox specifically when I was about 27 here or there and so I credit that with why now having not been Botox for the last eight months and I'm very excited to redo it but I credit that with not having wrinkles at least at rest on my face right now because I have yes so obviously better skin quality helps but you know neuromodulators Botox or equivalent if you can yeah makes a huge difference absolutely now so I think one question I get asked often is you know really what's the difference between a neurotoxin and a filler? why why might I choose one versus the other fillers do what they say they fill and as you know if you have a static wrinkle one that the wrinkles always there muscles not creating the wrinkle muscle may deepen it but the wrinkles still there even with the blank expression filler is really the best thing for it the most common areas are the nasolabial fold around the jowl cheek enhancement jawline enhancement or definition typically Botox wouldn't work at all in fact may not even be recommended but fillers are really great for those areas so the most popular fillers are HA fillers or Hyaluronic Acid fillers and they do have a couple of chemicals out there Doctor Hamilton do you have a preference for any type of filler or any special situation? I do I really preferentially use Hyaluronic Acid fillers just because they are dissolvable in the face and I feel that's really important for a couple reasons one's just the safety factor which will talk about you know you're you're listening to two board certified plastic surgeons who know facial anatomy really well talking about this topic and even so we have a lot of respect for blood vessels because people have aberrant anatomy or unusual anatomy sometimes we know where where blood vessels are placed um in most people but there are exceptions and so I think it's really important that if you were to accidentally inject into a blood vessel that you have the ability to reverse it and then also just as time goes on we do see some filler migration if this is something that you do year after year after year and so sometimes it's nice to start over and I think patients also like knowing that Hyaluronic Acid this is a naturally occurring molecule we all I have it in my body Doctor Kim you have it in yours anyone who's listening you have it too and it's just a it's a natural plumper it draws in water - it's a sugar molecule and so that's that's the one I most commonly do in the face non surgically and my second favorite does require a small surgical procedure but if patients need diffuse revolumization I really love fat from your own body because that's the ultimate natural filler and fluffer what about you Doctor Kim? I totally agree with everything you said Hyaluronic Acid is natural it's found in human bodies it's in the joints and other areas it can be melted which is fantastic just in case you need to and since we're all surgeons fat is by far my technically favorite filler but it does require a procedure especially for newbies or for people who don't want a procedure I wouldn't necessarily recommend hey let's do some fat harvesting and filtration and processing and fat grafting in an operating room setting to give you the best results a lot of people don't want a procedure there are other fillers so they're different chemicals than HA So do you have any preferences there? so the other category of fillers that we often talk about are ones we put into the bio stimulator category so these are not ones that necessarily volumize themselves but the goal is for them to induce collagen production and so those can be really nice too for more like diffuse treatment especially for skin quality as well and so the most common ones are poly-L-lactic acid which is known as Sculptra and then another common one is Calcium Hydroxy Appetite which is known as Radiesse finally more into the autologous category but also a little bit of a bio simulator is BellaFill which I don't know if you've experienced with that one that's not one I use in my practice I've used BellaFill in the past it's a P M M A microsphere and don't ask me what P M M A stands for I just remember the initials and you have to allergy test for it once the patient passes the allergy test it lasts for about 5 years so it's a great great filler you just have to be very careful how you inject it because it does last 5 years and you can't get rid of it you cannot melt it yeah the PMMA Polymethyl Methacrylate I think and I agree I think that's more of a that's like your veteran patient coming in where you've been doing the same thing over and over again and they're like hey I like seeing you Doctor Kim but maybe is there a more durable a more durable option I already know that I like your work but that's not usually like a introductory filler for most patients so I I also like will choose based on properties of them like if I'm really trying to solved a cheekbone or a jawline or do a non surgical rhinoplasty I want a really thick structural filler like a denser a Juvederm and Restylane and if I'm wanting to do some pan facial like collagen induction for someone if you know who's maybe about to like hit 30 and just notes things don't look quite the same that's it I think a really great candidate for some diffuse Sculptra or Hyperdilute Radiesse I don't know yeah those two things you just mentioned Sculptra and Radiesse I think they have more support more structure more oomph if you will oh yeah well you know HA is slightly biostimulatory but it's not the same level and technically I think you do need a lot more of the robust HA fillers to get the same effect I agree with you I think the Biostimulators they're more subtle so patients are coming in with like really deep folds like really hollow cheeks I think I'm usually or I'm usually counseling them towards doing some some true volumization with filler and sculpting the face and then maybe we're doing this the biostimulatory is more for skin quality we're filling in like diffuse hollows underneath the cheekbones where we're trying to do something that's a little bit less structural yeah and so for our listeners and viewers out there even in the ha world there are a couple different brand names including Juvederm and Restylane Prolennium RHA Belotero made by Merz and they actually have different properties so this is why they have different brand names Juvederm for example that's the sort of overall family name but there's Juvederm - Volbella Juvederm - Volux Juvederm - Voluma Juvederm - L I'm sorry not L Juvederm - ultra plus Restylane has Defyne, Refyne, L bunch of other names and the thinking behind it is they have different types of cross linking different types of support so they're meant for different areas of the face however suddenly you have to maintain an inventory of like I don't know 15 different HA fillers if you want to really follow all of their suggestions so anyway Doctor Hamilton I don't know if you have an opinion do you like to have every single type do you have your favorites that are more versatile when you inject patients with HA filler? I have my I have my favorites I use Juvederm and Restylane Hyaluronic Acid fillers I don't use Belotero anymore cause I just feel like it doesn't last quite as long as the other 2 and then I I have my favorites for cheek bones jawline versus Nasolabial folds and it depends on like how deep they are what the patient's facial characteristics are so I stock quite a few of them I think a lot of them obviously a lot of them overlap and I like having just some different tools at my or different materials at my disposal so I can choose the right right one for the patient but to your point I mean originally there was Juvederm and Restylane and we were we were placing it all over the face so we're we're spoiled for choice now yes and then the other thing to remember is the FDA the labels all the information packets the fillers do have a suggested length of duration typically about six nine to 12 months and for the viewers and listeners out there for if you're a patient when you get an injected near an area or in an area of lots of movement and really it's the lips around the lips and the mouth even if the label says it lasts 12 months I found that it may not typically it may last 11 or even 10 months because the more movement you have where you inject the HA filler it will sort of be broken down and metabolized a little faster I don't know what your experience has been 100% I I tell patients I think like deeper static structures cheekbone augmentation jawline even tear troughs those fillers seem to last longer work like even relative to the expected duration and then around the mouth think about think about during the course of this podcast how much these areas are moving so I think that does cause them to break down faster um the other thing to keep in mind is that it's not like after 12 months or 9 months poof all the filler just suddenly dissipates they are breaking down slowly over time so it may be that at 6 months when yes theoretically half of these fillers or many of them are gone you might that might be the threshold where you really feel like you're due for a touch up especially if it's your first time doing it and you had deeper deeper wrinkles to begin with yeah and another thing you probably know if you're a viewer or listener out there is we keep on emphasizing that HA fillers can't be melted it's a chemical called hyaluronidase with a direct injection you can actually melt HA fillers Hyaluronic Acid and it dissipates immediately there may be a little swelling and more will dissipate over time interestingly fat that we can actually melt or slightly melt because we have Kybella chemical injection we can inject with steroid and you know we both know that Doctor Hamilton that with liposuction fat grafting pressure or direct pressure manipulation can actually cause the fat to be absorbed by the body I don't know if you've ever been in a situation where you felt like you had to have the fat broken down faster be absorbed in your patients I really haven't had that to a large extent it shows that the the fat breaking down faster right yeah it seems to be very durable and um I just tell patients you know that it's fat it's gonna act like the fat from once it came so if you got it from your inner thighs or your abdomens so it can it can grow or shrink with you so um that's another thing to consider are you someone who's fairly stable in their way because you wouldn't want um to do significant fat transfers anywhere and then have big fluctuations uh depending on your diet exercise regimen at the time um but overall for most people that are you know stay relatively within you know 5 or 10 pounds of their normal weight I think that's a a great option yeah so do you want to talk about any other filler or any other topic about this introduction to really pretty much all the fillers that are available in the United States I wanted to leave the viewers just with the consideration of when you're thinking about what to go in and ask for so I usually like to start by just asking patients like what do they see like what are you know is it these lines is it these lines like what what is it they're seeing or just like overall like I wake up and I just don't feel as refreshed as my usual self then for neuromodulators that's usually where we start just because I think those are the simplest and lowest commitment for patients who've never done anything for the first time and you can you can raise your brows with those soften lines in the upper third and then often times people point they're like oh what about a little bit of Botox here keep in mind how do I make that wrinkle by smiling so I have to be willing to get rid of the movement associated with it if I wanna use Botox in those areas so I'm not willing to Botox to my smile or someone else's smile so that's when we start moving to filler or even lasers for some of these other areas but we can really sculpt and optimize and um just enhance your own natural beauty by um by sculpting and it can be small amounts but if there's this is really the art um a plastic surgery and aesthetic medicine and so I encourage patients you know look at their look at their um look at their doctor look at their doctor's staff look at their their patients their work Doctor Kim you do beautiful work um you're going to be adopting as much as we're listening to you to get a sense of your aesthetic we also have a personal bias what you know you know what Doctor Kim finds beautiful what I find beautiful and so keep that in mind because you're likely to walk out with a with that aesthetic so if you see lips that are too big or cheekbones that are too full just consider that that might be the look that you will walk out with too so I think that's a good lip mist test for any office I totally agree this is sort of one thing that you alluded to and you have to have a holistic approach so in other words sometimes I have patients who say you know I really don't like my worry lines and say well I can knock those down I can make them look great if you have worry lines in your forehead if you have other lines that are complimentary just knocking out or making one area look good works but you have to look at the whole forehead and this is also true of fillers in other words um I think the companies sometimes emphasize a little too much maybe the lips or maybe the Nasolabial fold I do think that patients do better if they have a more holistic approach with someone like you who's gonna be looking at everything and saying you know you don't need like a ton of syringes just in one area let me give you an overall assessment and then let me give you a little here a little there so that overall your face is gonna look fantastic it's gonna bring out your own inner beauty okay so anyway Doctor Hamilton I think we sort of wrapped up this episode do you have any other questions for me at all or any other comments so I I completely agree with your philosophy as well I think we you need to respect the individuals facial anatomy respect their own natural beauty really use these this game of millimeters to enhance and really compliment your patient's face and that's a very individualized treatment plan and I think done correctly non surgical treatment with injectables is really really beautiful and can be maintained over years and decades with a lovely result and I think I think they're great products so anyway Doctor Hamilton thanks so much for joining me and thank you well I'm looking forward to talk to you soon and as always to you and to all of our listeners stay beautiful thank you stay beautiful