Are you considering getting fillers or Botox? What are cannulas and why are they better than needles? Are fillers and Botox safe?
In this podcast episode, Melissa Vogel talks to Dr. Alex Denes and April Turner about the ins and outs of botox and fillers.
Meet Dr. Alex Denes and April Turner
Canyon Lake Med Spa is conveniently located between the 15 and 215 freeways on Railroad Canyon Road in the Canyon Lake Town Center. The office is owned and operated by Alex Denes M.D. and April Turner R.N.
The Medical Aesthetic treatments and preliminary surgical consults are performed by April Turner, R.N. April is a highly trained, medical aesthetic specialist. April has worked in the Medical Aesthetic field for over five years and has performed over 15,000 documented injections and is enthusiastic about sharing her knowledge and experience when training other health care providers in her field.
April entered the Medical Aesthetics field when she started working for Dr. Denes at his Cosmetic surgical office in Hemet. April manages operations and provides all treatments for the Medical Aesthetic portion of Dr. Denes Surgical office.
In This Podcast
- What makes fillers last longer and what makes them go away faster
- Fillers under the eyes
- Botox for dummies
- Areas to get Botox
- How safe is Botox?
- How long does Botox last?
- Too much Botox
- Botox tolerance
- Increasing your collagen
Needles are non-discerning and once they are injected, they slice and dice at the blood vessels. Cannulas are blunt, rounded tips that have the ability to go around, over, or even move blood vessels out of the way instead of going through them. As bruising is caused by blood leaking into the skin from a damaged blood vessel, with Cannulas you don’t get bruising 99% of the time. It is an advanced technique with a learning curve which is why a lot of providers go with the old school needles but most advanced practitioners that do medical esthetics do use cannulas.
Dr. Denes and April only use Allergan products (they make Botox) and only use hyaluronic fillers as they are much safer to use. If you have an occlusion of a blood vessel, you would be able to use what’s called hyaluronidase (also known as Vitrace) to break down the hyaluronic filler.
- Radiesse, for example, is basically calcium hydroxyapatite and it doesn’t break down with hyaluronidase.
- Sculptra – very unpredictable as it is based on your own body’s ability to stimulate and produce collagen around the liquid that’s been injected.
When Dr. Denes and April train other providers, they encourage a slow injection technique and make sure that they know their facial anatomy and are aware that individual patients’ facial anatomy does vary slightly.
What makes fillers last longer and what makes them go away faster
Our bodies are all different and metabolize differently. A case that April often refers back to is that of twins that she treats. Their lip fillers break down and are completely gone within two months but when she does their cheeks or their nasal labial folds, they hold onto it for a good six months to a year. The mechanisms as to why fillers break down can be due to manipulation:
- The lips – we do a lot of talking, eating, kissing, etc.
- Cheeks – less dynamic movement area
- Placement of the fillers is very important as well as there are fewer enzymes that break down the filler near the bone than in the mid-dermis.
Fillers under the eyes
It’s important to have the right filler for the right treatment in the right location. Don’t use heavier fillers under your eyes, you’ll end up with “the worm” or with severe swelling. Some fillers, like Juvederm Ultra XC, have a hydrophilic effect meaning that it draws water into the filler – you never want to use that under the eyes. April uses Volbella under the eyes as it is the least hydrophilic and is the softest filler.
Botox for dummies
Botox is a neural modulator that decreases muscle movement. It paralyzes the muscles so that your own collagen is able to flow through, without getting manipulated, to fill in those lines. It can also be used as a muscle modulator which allows the lift of muscles that can then open the eyes a little bit.
Areas to get Botox
Botox Cosmetic – meant for the face and down to the platysma bands in the neck.
- Around your eyes
- Upper lip
- Corners of the mouth
- Chin – masseter muscle (large jawline muscle)
Botox – Used for medical necessities like bladder spasms and cervical dystonia.
How safe is Botox?
Botox is actually very safe with only 16 deaths in about 20 years, all of which were attributed to mass amounts of injections. You can have side effects from Botox, like flu-like symptoms and headaches but they are temporary. The most common side effect, which is easily reversible, is drooping. For every muscle action, we have a counteraction – if the lifting muscle gets too much of an effect, then the depressor muscle can get Botox so there is a nice balance.
It all comes down to skill and experience, knowing exactly where to put the Botox, how much to use, and how each person is going to react to that. One of the advantages of seeing the same provider over and over again is that they know your anatomy and how you’re going to respond to the treatment.
How long does Botox last?
It varies for everyone but on average, patients get Botox every three months. For most patients, after two months it starts working less and less because our nerve endings take over and cause contraction of the muscle again and the Botox slowly dissipates. It’s very patient dependent as to how their body metabolizes.
Too much Botox
It’s patient dependent and is really about what type of look you are going for. April, and most of her patients, like a little bit of movement in the forehead. One of the reasons for this is because, over time, if you keep your muscles paralyzed, they can become atrophied, they can’t move and become much weaker. If the forehead muscles become atrophied, they relax down and can relax down almost in a permanent fashion if you don’t continue Botox in the frown lines which lift those muscles.
April highly recommends getting both the forehead and the glabella done although you can just get the glabella done. It is never recommended to just do the forehead because without those raised glabella muscles to allow the forehead muscles to slightly rest on, you can get some hooding of your eyebrows.
You can build up a tolerance to Botox. A study done about 15 years ago proved that 1 in 70,000 may become immune to the neurotoxin treatments. All FDA approved neurotoxins for the face right now are botulism toxin type A. There is a newer neurotoxin called Myobloc, botulism toxin type B, but it is not approved for cosmetic use yet. For those who have an increased tolerance and have built the antibodies that neutralize the Botox faster (and for some completely), April believes that you will eventually be able to use type B but it takes a long time for FDA approval. The chances are very good that you won’t become immune but there are also other factors that come into play:
- Aging lines
- Decreasing collagen
- Elastin fibers
- Sun exposure
- Increasing creeping of the epidermis
Increasing your collagen
A lot of providers have been talking recently about increasing the collagen in your skin. There are two major treatments for this:
- Using Retin-A – The only FDA approved topical agent that increases collagen production over a 12-month period. After 12 months, you maintain the collagen that you produce.
- Get Co2 laser – Markedly increases your collagen production very quickly.
If you visit their offices and mention that you heard about them on this podcast, April will give you a free microdermabrasion and chemical peel!
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Meet Melissa Vogel
Melissa Vogel is an energetic keynote speaker, business owner, certified personal trainer, certified group fitness instructor, 1st degree Black Belt in Tae Kwon Do, a mother of three, and a podcaster.
Melissa has been voted as the Best Personal Trainer for 2020 by Inland Empire Magazine, and Built the Busy to Bomb Fit Mom exercise system.
She is quickly becoming recognized for her expertise and influence in her field!
Melissa has contributed to numerous publications and has been featured in the Trail Blazer Magazine, and published in the April 2020 edition of Health Magazine. Her approach incorporates personal experience, energy, humor, and charisma.
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