In the January 2015 issue of Plastic and Reconstructive Surgery, Manhattan plastic surgeon Michael A. Kane, MD, argues that when it comes to nonsurgical periorbital and brow rejuvenation, the best results come from using multiple modalities to treat the full range of concerns at once rather than singling out just one. We spoke with five prominent aesthetic practitioners who agree that today’s patients achieve the best results when treated with a combination of muscle-relaxing neurotoxins, versatile dermal fillers and energy-based devices. While the results may not last as long as surgery, the risks are minimal and patients express a high degree of satisfaction. Is it any wonder that surgical cosmetic procedures have decreased by 12% since 2000, while minimally invasive cosmetic procedures have soared by 144% (2013 Plastic Surgery Statistics Report, American Society of Plastic Surgeons)?
“I use a lot of different toxins and energy devices (we have more than 15) and customize each treatment regimen for the person sitting in front of me,” says Florida dermatologist Kenneth Beer, MD, associate clinical professor at the University of Miami and director of Cosmetic Bootcamp, an educational program for providers. He also co-authored an article, published in the January 2014 issue of the Journal of Drugs in Dermatology, on aesthetic treatments for the eyebrow and periorbital region.
Jill Waibel, MD, founder of Miami Dermatology and Laser Institute, finds that offering multi-modality procedures as treatment packages is a win-win. “What we’ve found is that someone will come in for an IPL treatment and, as the skin responds, she looks in the mirror and all she can see is forehead wrinkles. That’s why we now offer packages like the Fresh Start or the Fountain of Youth—a group of treatments designed to address not just one problem but a group of often related complaints. While the patient may come in for a specific treatment, what she really wants is to look her most beautiful, and these packages deliver that. The package approach has really worked for us,” she says.
“We’ve also found that cosmetic treatments can be synergistic. For example, fractional resurfacing opens up channels into the dermis that allow us to deliver products like vitamin C or a neurotoxin. By combining modalities we achieve results that are far better than the individual treatments,” Dr. Waibel adds.
Softening Dynamic Rhytides
Neurotoxins remain the No. 1 treatment option for dynamic wrinkles around the eyes. “Most people benefit from neurotoxin injections for crow’s feet and to help lift the brow,” says Thomas E. Rohrer, MD, of SkinCare Physicians in Boston. “The basic 150kD BoNT/A active molecule is the same for all of the neurotoxins used in aesthetic practices. If you understand the dosing and get that right, the results should be equivalent.”
“In the state of Nevada, toxin bottle size is a determining factor,” says H. L. Greenberg, MD, founder of Las Vegas Dermatology. “State law says we have to sell botulinum toxins by the bottle. As a result I end up using more Botox or Xeomin for periorbital areas because they come in 50-unit bottles; however, we will use a full bottle of 300 units of Dysport with distribution to the periorbital skin if the patient desires. I have no personal preference and offer all three toxins. We mix our Botox and Xeomin at 1mL/100 units and Dysport at 1mL/300 units.”
Dr. Waibel notes that many patients ask specifically for Botox, because it is the most established brand name. Yet, there are benefits to carrying multiple toxins. “A few will come in saying, ‘Botox didn’t work for me,’” she says. “We know that usually means the treatment wasn’t properly done in some way, but rather than going into that, we can now say, ‘Why don’t we try Dysport or Xeomin.’”
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