Answers to Common Questions Asked at Our Medical Spa
Get answers to the most common questions asked at our Medical Spa in Lancaster, PA. If you have additional questions, don’t hesitate to contact us today.
A: Botox is Allergan’s brand named botulinum toxin A (BTA) product. Like all BTA products, it inhibits the release of acetylcholine from nerve endings. From an aesthetic perspective, it is used to lessen the activity of facial expression muscles. Examples would be the muscles involved in frowning or raising the eyebrows. In this manner, it relaxes the memory etch creases in between the brows, on our foreheads, or at the sides of our eyes.
Dermal fillers take up space beneath or within the skin to soften or eliminate fixed or static depressions or wrinkles. BTA takes 10-14 days to reach maximum relaxation of the injected muscles, and fillers work immediately. Generally, the beneficial effects from BTA do not last as long as the effects of fillers. Basically, they work in completely different ways and are used for different purposes. Although they are frequently used to complement each other they are not by any means interchangeable.
A: For use in treating facial wrinkles it lasts 3-4 months in about 85% of patients. The rest of the population will experience the benefit for as little as 2 months or as long as 6 months. Interestingly, if it is used to treat regional areas of excessive sweating (e.g. hands, feet, foreheads, or under arms) it will last an average of 8-9 months.
A: In our country, and our Medical Spa, the answer to this question is “No.” We do have now available to us four branded FDA approved BTA products. In order of length of time each has been available to us for use (longest to shortest) they are Botox (Allergan), Dysport (Galderma), Xeomin (Merz Aesthetic), and most recently Jeuveau (Evolus). They all contain exactly the same active protein molecule of botulinum toxin A.
A: It is because of quality control and precision of measurement issues. Each 100 unit vial of Botox (enough to treat 2-5 patients) contains less than 1 billionth of a gram of BTA. It is not visible in the vial until saline is inserted. At that point the injected liquid is visible, and the assumption is that the Botox is then dissolved within the liquid saline. Because Botox is so powerful in such extremely small amounts EXACT measurement of the precise amount within each vial is critical. Achieving this precision is expensive and can only be done in a professional medical spa.
A: First off there are different facial fillers with different characteristics. They can be made from different substances and each person’s body metabolizes them at different rates. Also, how long a given filler lasts also has to do with the exact area of the face at which it is placed. Most of the fillers used in the US are made out of hyaluronic acid (HA). This is a carbohydrate substance that is already present in our skin and acts as one of the components that helps to hold our skin together.
There is one filler available that contains calcium hydroxylapetite. The other distinct filler that we use in our Medical Spa is made from poly-L lactic acid (PLLA) and the creates brand new collagen within and under the skin over months to re-volumize the face. The HA fillers last from 3-18 months, the calcium hydroxyapatite filler 3-24 months, and the PLLA filler (after a series of treatments) 2-10 years. There is one filler that has FDA clearance for use in the US that we will never use at our Medical Spa in Lancaster, PA. That particular filler contains polymethyl methacrylate (PMMA). This is the same substance that makes up Super Glue. The body can never break it down, and this scares us.
A: There are several reasons for this. First of all, a laser by definition has just one pure wavelength of the electromagnetic spectrum. This corresponds with a limited number of substances or colors which will be able to absorb that particular wavelength. Some lasers will blend two different wavelengths into the same delivery device in order to target two substances simultaneously. The Fraxel Dual (1550 + 1927 nm light) comes to mind, but there are several others. If two or more wavelengths are delivered at the same time, then the energy for each must be limited or else the skin itself will be heated beyond a tolerable level and irreversible injury to the skin may occur.
Interestingly, an IPL (intense pulsed light) or BBL (broad band light) device utilizes a gated range of contiguous wavelengths that are delivered simultaneously to the target skin. In such a way both red and brown targets can be treated at the same time. If, however, just one target is the goal, in many cases a specific laser could accomplish the goal with less total heat buildup in the skin.
Learn more about the laser treatments offered at our Medical Spa in Lancaster, PA.
A: Although Botox is given by a great many injectors, experience and training vary widely. Number of units given per site, and site placement to accomplish a given aesthetic (or medical) goal are very important and have everything to do with both outcome and cost.
A: Yes, and no. They all contain the exact same 150 kilodalton heavy and light polypeptide chains of active BTA. Most of these BTA varieties have associated with their active BTA some biologically inactive aggregating proteins. It is not felt by the experts that the inactive aggregating proteins have anything to do with how each product’s active BTA performs. However, in every aesthetic practice there are a low percentage of patients who will strongly prefer one company’s BTA product over other company’s BTA. We don’t know why there would be a difference, but we believe these patients personal observations.
A: There are just three ways that we can help you accomplish this. The most obvious is to put on extra weight. Of course, there is a downside to this, and most of us would like to avoid all of the associated problems that come with weight gain. The most elegant and time honored way to achieve increased volume in the face or elsewhere on the body is to see a plastic surgeon or someone who routinely performs liposuction. These folks can harvest fat from one location and move it to another place! The beauty of using one’s own fat for this purpose is that the fat cells that are able to establish their own blood supply in the new location will then live for as long as the person does. The problem with fat is that the amount of it that does live in the new location is variable. It can range from a low of about 20% to a high of about 80%. Also, very thin individuals may not have adequate fat located in other areas to have enough to harvest in order to transplant it to the new desired location. So, for facial, buttock, and sometimes extremity use, there is the other option of Sculptra (poly-L-lactic acid, or PLLA). Here at our Medical Spa, we love this stuff. It has been around for about 15 years and it works by growing collagen in and under the skin. Sometimes one treatment is enough but more often 2-4 treatments will be required over several months. The results are very natural looking and occur gradually. The benefit lasts 5-10 years in many cases.
A: If we think of facial skin as the envelope of a balloon, and everything underneath the skin as the air of the balloon, then there are two possible ways to approach this situation. One could either tighten the envelope of the balloon or increase the volume inside the balloon (put more “air” into it).
Sometimes a little bit of each approach is the best option. See the previous question about how to increase the volume. Tightening of the skin almost always involves heating it up. We have seen some mild tightening from series of micro needling treatments, but this is inconsistent. A variety of modalities can be used to heat up the skin. Various lasers, ultrasound, and radio frequency energy are the most commonly employed techniques to achieve the most reliable skin tightening. These methods can be used either on the face or just about anywhere else on the body.