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    Creative filler treatments

    Dr. HarperThere are dozens of creative, off-label ways to use fillers, now that filler safety and efficacy are established, according to Justin Harper, M.D., who presented “Creative Filler Treatments to Please Nonsurgical Patients,” at AmSpa’s Medical Spa Show in Las Vegas, February 9 - 11, 2018.

    The Aesthetic Channel asked Dr. Harper, who practices cosmetic medicine and is the medical director of Juvly Aesthetics, to share out-of-the-box options to impress nonsurgical patients. A national trainer for Allergan and Galderma, Dr. Harper tells The Aesthetic Channel that his practice is ranked in the top 25 in the U.S. by Allergan and Galderma, based on volume of injectables.

    The Aesthetic Channel: What do you mean by creatively using fillers to please nonsurgical patients?

    Dr. Harper: Clients that would have required invasive cosmetic surgery a decade ago are surprised to learn that most of the asymmetry in their faces that bother them can be addressed with fillers. Usually in a single office visit.

    We see dramatic results with treatments, like liquid nose jobs, because we’re able to balance proportions with hyaluronic acid fillers and give them the illusion of a smaller nose with great symmetry. Another classic problem area is the chin. A disproportionately small (or weak) chin used to require sedation and foreign implants. Today we can change the contour of a chin, so that it flows perfectly with our clients’ faces. The beauty of these treatments is that there is little to no downtime involved [and] it’s a drastic change that can be done without most of the risks you face with traditional surgery.

    Hyaluronic acid treatments that address the sculpting of a person’s face also give clients the opportunity to change their minds about any aspect of their treatment. The fluid nature of fillers gives people the freedom to make nuanced changes without committing to an invasive ordeal.

    The Aesthetic Channel: Describe some of today’s more creative filler treatments.

    Dr. Harper: One of my favorite antiaging treatments involves sculpting the cheeks and filling the temporal hollows with Juvéderm Voluma XC [Allergan]. It’s a relatively new filler that uses varying molecular sizes to create a ‘crosshatch,’ or mesh-like, structure when injected into the deep layers of the skin.

    One philosophy that I abide by is the avoidance of filling nasolabial folds. We’ve found that the added structure and lift created with a good HA [hyaluronic acid] treatment in the upper and mid-face, including the temples, will soften or eliminate these lines that don't have naturally underlying fat pads to begin with.

    The Aesthetic Channel: Please offer nuances or words of wisdom for achieving optimal results with fillers.

    Dr. Harper: There is no substitute for good training and hands-on experience. I’ve trained many doctors in filler and neuromodulator use. Where you receive your training and the people that you practice with will inevitably influence your effectiveness as a provider. Research your trainers' work, ask questions and investigate their reputation among their own peers. It robs you of precious time to ‘unlearn’ bad habits.

    As for neuromodulators, we are regularly finding new cosmetic and traditional medical uses for them. One aesthetic treatment that has become quite popular is jaw slimming. We accomplish this by injecting a neuromodulator into the masseter muscles. [Neuromodulators] are also quite popular for treating excessive sweating and migraine pain.

    The Aesthetic Channel: What do you think is possible nowadays with fillers, and could you compare potential results with those from surgical procedures, such as a facelift?

    Dr. Harper: Excessive sagging skin is one of the few things that is difficult to treat with cosmetic injections. While fillers like Voluma [Allergan] or collagen stimulators, like Sculptra [Galderma], can renew the look of healthy volume and firmness, there is only so much tightening that can be accomplished. Fat travels downwards as we age, often landing in the submental area of the chin, or what one of my providers calls, ‘The collection canister.’ This area can be treated with Kybella [Allergan] or CoolSculpting [Zeltiq Aesthetics] and, in many cases, we’ll see enough tightening by simply ridding the area of fat.

    The Aesthetic Channel: Finally, what’s coming down the pike in filler use?

    Dr. Harper: In my opinion, hyaluronic acid-based fillers and Sculptra are the best injectable options when it comes to rebuilding or mimicking a beautiful skin structure. In the coming years, we may begin to see science producing safe fat-based alternatives to HAs, but, currently, there is nothing on the horizon that can rival these treatments. I think that fat-based treatments were the past in cosmetic treatments, and they are quite possibly the future, but they are definitely not the present.

    See Dr. Harper’s work @juvly_aesthetics on Instagram. 

    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...


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