for non-surgical facial rejuvenation
Dysport™ or Botox® - Neuromodulators
Dr. Stampar’s safety insights on Botox and Dysport:
So many patients voice concern over the safety of Botox or Dysport because they are a toxin. Some medical, not cosmetic patients who receive relatively massive doses have had adverse reactions. BUT, at normal cosmetic doses, placed accurately by an expert it is safe and the results are beautiful. By not squinting in the Florida sun, your eyes look more open and happy. A smoother forehead is a happy forehead and smile lines next to your eye don’t have to be the center of attention in photos. It works, it’s nearly painless in my hands, and it’s safe. Try it, you’ll love it. Make patients need it too!
Dysport™ and BOTOX® Cosmetic are the brand names for a type of botulinum toxin. The microscopic dose per area blocks the contraction of muscles that generate wrinkles. Although the FDA has limited the approved areas and doses to be treated and used, “off label” use has allowed use in areas not FDA approved but proven safe in qualified hands such as the forehead, smile lines, around the eyes, and various unique facial locations.
Scientists found that small, diluted amounts of this toxin could cause muscle weakness when injected near the muscle. If the amount is small enough, it causes controlled weakening of the muscle, and not full-blown muscle paralysis. The right dose for the right patient should be determined by an expert trained to treat the patient given their desired result.
NEUROMODULATOR injections were the number one most popular cosmetic treatments every year with millions seeking treatment.
Where does it work? On label indications for Dysport™and Botox® are the glabella, between the eyebrows, and for Botox, “crow’s feet’ or smile lines around the eyes. Off label uses for Dysport™ and Botox® include the forehead, lips, chin, neck and other specialized areas.
How long does it last? You can expect the effect of your Dysport™ or Botox® treatment to last anywhere from 3-4 months. I refer to it as “use it and lose it." The more attempted movement, like smiling more tan scowling, smile lines come back faster than “11’s” in most people. Once you use up the “blockade” your muscles will once again begin to contract and the wrinkles will reappear. The good news is that your wrinkles may be less prominent after Dysport™ to Botox® treatment because your muscles may be somewhat “trained” to be in the more relaxed state. “11’s” that don’t go away with weakening can be filled to make them smooth at rest.
As the wrinkles reappear, you will have to have repeat Dysport™ or Botox® treatments to get them to disappear again. Properly done, you will enjoy a more open eye appearance but still be able to express yourself, without the wrinkles. AND, it shouldn’t be a painful procedure. A relaxed environment, a gentle touch, and the highest quality syringe leaves 95% or more of my patients to say “that’s it?” when I am finished with the treatment.
How much does it cost? Once Dr. Stampar has had the opportunity to meet with you and discuss your case he will supply a full estimate of fees so that you know all your facts and figures. Currently I am really favoring Dysport™ for it’s faster onset, equal duration, and price since the government doesn’t control the cost like it does with Botox®. That creates the best value for you. In general, each area, on or off label, smile lines, glabella, or forehead cost approximately $290, $260, and $190 respectively. Actual prices and doses vary patient to patient.
Hyaluronic Acid Fillers -
Restylane - Restylane Lyft - Restylane Silk - Belotero - Juvederm Ultra - Juvederm Ultra Plus - Voluma
Soft tissue fillers made by several companies with different degrees of structure are the most commonly used injectable products because of their versatility, but choosing the right filler for the desired effect in any given area is critical to a great outcome. The “thinest” products work on fine lines, lips, lip lines, and facial lines but don’t last as long as volume creating products and shouldn’t leave ridges or bumps if injected properly. Products that fill deeper lines or grooves, or are meant to restore volume range from Juvederm Ultra and Restylane-L with a moderate degree of lift and longer stability to Restylane Lyft and Voluma that provide maximal “oomph per ounce” and are longer lasting. In volume restoration and willing deeper Nasolabial folds, you get what you pay for. Only so much can be done with a 1 cc syringe of any product so the ultimate “wow” result depends on choosing the right product for the area and using enough of it to make the difference you are looking for. One advantage of all HA fillers over their competitors is that they are able to be dissolved with an enzyme called Hyaluronadase in case of a complication or undesired result.
Make sure anyone who is using injectables on your face has this in stock, because although complications are rare, using Hyaluronadase promptly can reverse or minimize the damage caused by an accidental injection into a blood vessel or over injection, a possible complication with any filler in anyone’s hands. The best injectors know all the products, their most appropriate uses, and will discuss the pros and cons of their choice with you before treating you. The cost varies by several hundred dollars depending on the expected duration of the product and the amount needed to achieve the best result.
How much does it cost? Price varies by patient, amount used, and areas treated. Dr. Stampar will provide a full consultation and cost estimate before any work is done. For example, lips would cost approximately $300-$550 depending on the variables mentioned above.
Love Your Lips
I have done lip enhancement on women and 2 men from age 21 to 81. Lips are a very personal preference when it comes to size and shape as well as relative size to face proportion. I’ve never had a patient who wasn’t anxious, but I don’t know of an unhappy lip filler patient of mine. There are a lot of terrible lips out there from over injection, disproportion, bad product, and obviously poor communication between the patient and injector. Lip enhancement is an art and should only be done by an artistic provider with a passion for perfection.
Other than off label micro-droplet medical grade Silikon-100 for “permanent” lip fullness, Hyaluronic Acid fillers are the only approved and appropriate products for lips. They are all reversible but obviously not enough providers know how and when to use Hyaluronadase properly. This should take most of the worry about a bad result away. But by using proper minimally traumatic techniques, asking the patient to approve what I’m doing a step at a time, and using the right product given the desired result, great lips can be the trust every time. In younger patients or those who inherited small lips, size, shape, and proportion are what matter most. In the older patient who sees their lips shrinking and wrinkling with age, smoothness and restoring the “cupid’s bow” shape to the upper lip is crucial.
In regards to pain, a powerful topical anesthetic used pre-treatment can minimize any discomfort and most of my patients are pleasantly surprised at how little discomfort is required. This keeps bruising and swelling to a minimum although some patients swell for a few days regardless of how gentle the procedure is done. Patients with a history of cold sores should be given a prescription for an antiviral preventively and any blood thinning medicines such as aspirin, ibuprofen, high dose vitamin E, and fish oil should not be taken for 2 weeks before the procedure. Stopping prescription blood thinners is a discussion to be had at the time of consultation to weigh the risks and benefits. Rather than provide typical before and after photos, I like to show candid pictures as well of patients loving their lips months after having them done. The cost varies with the product and amount used, and the duration depends on the product and individual factors but 6 to 18 months is possible. Touch-ups before all the product is gone are recommended to keep them looking the same all the time. Upper lip lines in the skin between the nose and lips are also commonly treated but require skill to avoid a bulging appearance or ridges in place of vertical grooves. More severe lines may never be completely smoothed.
In contrast to HA fillers, Rasiesse is a paste like texture, not a gel and is used to improve deeper lines and folds or to replace lost structureand volume with immediate results. RADIESSE is not reversible but, used properly, there should be no need. Once injected, RADIESSE adds the volume and lift needed to diminish the signs of aging providing structure and stimulating your own natural collagen to grow. The production of natural collagen continues for several months, which extends beyond the initial effect of RADIESSE and in general, Radiesse lasts longer rhan most HA fillers and comes in a syringe that provides 50% more product which is useful when trying to treat both nasolabial fols with one syringe.
Where does it work? Nasolabial Folds – also known as Smile Lines – are nothing to smile about. These lines and creases run from the side of the nose to the corner of the mouth, and are the result of the loss of facial volume and skin elasticity as we age. They can make you look older, tired, or unhappy – even though you feel youthful inside. Treatment with RADIESSE can replenish youthful volume and stimulate collagen production in this area, minimizing the appearance of those pesky facial lines, wrinkles, and folds that mask our smiles.
Marionette lines, lines that run straight downwards from the corners of the mouth can make you look unhappy. Marionette lines form as facial volume begins to deplete and deeper creases begin to form below the mouth.
The corners of the mouth, also known as the oral commissures, can turn downward as you age and lose volume below the mouth. This downturned appearance of the mouth can make you look like you are frowning or even mad. In addition, volume loss in this area often leads to the formation or the deepening of already-formed marionette lines
A little known area of the face that can make a big impact on the way we look is the pre-jowl area, or the pre-jowl sulcus, which is the area on either side of our chin. Facial volume loss associated with the aging process results in sagging of the skin in other facial areas, and leaves the pre-jowl area hollow. Volume replacement in the cheeks and hollows of aging faces benefit from Radiesse as do ACNE PATIENTS, where fuller support under problem areas looks smoother.
A unique application of Radiesse in aging hands. Placed judt under the most superficial layer of skin, it is massaged in to smooth prominent veins and tendons. I can last over a year and bleeding, infection, or pain complications are rare and have not occurred in my experience. Typically one syringe per side is used.
How much does it cost? Once Dr. Stampar has had the opportunity to meet with you and discuss your case he will supply a full estimate of fees so that you know all your facts and figures. Average price is $650 a syringe price is subject to change based on volume used. The hands are treated for $500/syringe.
Most facial aging occurs as a result of soft tissue volume loss and the descent of the remaining tissues. Sculptra has been my diffuse volume replacement preference over fat transplants for over 8 years including my own face. Sculptra injections are used to restore facial soft tissue volume and shape gradually as the body metabolizes the sculptra particles and lays collagen down in it’s place. Unlike solid fillers with immediate results, Sculptra can be thought of as “planting seeds deep in the skin to grow new collagen’ with gradual progressive fullness developing over months. The reward for multiple injection sessions and patience is the fact that 80% of the contour result is persisting at 2 years barring excessive weight loss of your own volume.. I explain it as a front loaded investment, 2-4 sessions to get to the desired volume and contour but then one session every 18 months to maintain the same appearance. In my hands the injection technique has been modified off label to use fewer injection sites and blunt cannulas to minimize pain, bruising, and swelling. A potent topical numbing agent is used before all injections.
The face is shaped to the desired youthful contour as the particles are converted to collagen. As the Sculptra particles are consumed in a controlled inflammatory response, collagen is laid down that thickens and firms the skin. Three to five sessions 4-8 weeks apart are needed for complete results, which may last 2-5 years in my extensive experience. The amount of product needed can only be estimated and details are provided in a comprehensive consultation. Marketed as “the liquid facelift” in Europe, downtime is the same as any injectable but results can be as dramatic as some surgical procedures.
The cost per treatment session ranges from $800-$2000.