Body Renovations

The new fillers, lasers, and topical products that are coming online offer abundant possibilities to improve the face. In my practice, we are combining lasers, radiofrequency, topical products, fillers, fat melting injections, toxins, collagen stimulators, and peels to provide dramatic results. However, the really exciting part is what is being done off the face. From the hands to the chest; from the neck to the arms and thighs, no area is off limits for a dermatologist or plastic surgeon with the skill and creativity to see these new opportunities as a chance to do a total body renovation. In many respects, I am surprised that it has taken this long. One only has to look at Instagram or attend the Cosmetic Bootcamp to see how advanced many of our colleagues are when treating other parts of the body.

Hands and Body

We have long known that the dorsal hands are great areas for treatment. The use of dilute calcium hydroxylapatite and/or hyaluronic acid fillers are wonderful at providing some buffer between the skin and the stringy tendons and veins that are frequent signs of aging. Renovating the surface is an opportunity to polish (with fractionated 1550 lasers) or remove freckles (with a variety of lasers) that many patients will benefit from. Many of these patients will see results from dilute injections of poly-L-lactic acid (PLLA) in the upper arms to stimulate collagen growth. 

For those patients with fat bulges on the anterior or posterior aspects of the bra area, injections of deoxycholic acid can help to remove the fat and make this area more attractive. The surface of the skin of these areas should be treated with sun protection, retinol, tretinoin, growth factors, salmon extract, or vitamin C to ensure that the skin tone and texture is optimal.

The upper extremity is not the only region that can be treated. The lower extremity is amenable to many of these treatments. I have injected deoxycholic acid into areas around the knees and thighs with moderate success. My impression is that the treatments to these areas require multiple treatments with diffuse patterns of injection and tapering at the margins. I have also injected it into patients who have had radiofrequency or ultrasound treatments that left them with deep dents and been impressed with the results. Most likely this will be helpful to patients who have had suboptimal results with liposuction. Injections around the knees may be performed with reconstituted hyaluronic acid. This may be injected using a 1½-inch needle or cannula. The amount of saline or lidocaine used depends on the region and thickness of the skin but in general, it is reasonable to dilute 1:1. When injecting PLLA, dilutions of 12 to14 mL have been reported useful with treatments planned over multiple visits.

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Chest and Neck

The chest is another area that does well with treatments. The easiest treatments are with topical products such as tretinoin. Using them for several months will help to improve the tone and texture. Botulinum toxins are useful for the upper chest in women with dynamic platysma action. Spreading out the injections of diluted toxin will help to minimize the wrinkles of the upper chest. Fillers such as hyaluronic acid also perform well in this region. I dilute these products and inject them to fill lines and stimulate collagen. Diluted PLLA also works well here. I have yet to combine these techniques but think that there may be some merit to doing so. 

The neck may be treated with multiple modalities. Many of us have been injecting platysma bands for years. This works well for patients with dynamic bands. Treatments with deoxycholic acid are great for treating the submental area and small amounts may be used to treat the jowls. Given the proximity of the marginal mandibular nerve, great care should be taken when injecting this area. Smoothing the surface of this region involves the use of fractionated lasers (usually 1550 rather than carbon dioxide). Injections of hyaluronic acid in this area should be done with caution because of the plethora of vessels in the region. PLLA has been used here and in very dilute volumes (eg, 12-14 mL per bottle) are reasonable. 

When trying new areas, proceed with caution and have a thorough knowledge of the anatomy of the region. Treating the entire body is likely to be the future of cosmetic medicine and surgery and the options will only increase. 

Dr Beer is in private practice in West Palm Beach, FL. He is also a volunteer clinical instructor in dermatology at the University of Miami, a consulting associate in the department of medicine at Duke University, and shareholder and director of the Cosmetic Bootcamp meeting. For information on upcoming Cosmetic Bootcamp Meetings please visit, www.cosmeticbootcamp.com.

Disclosure: Dr Beer was an investigator and is a trainer for Kybella. He is an owner of Theraplex LLC, and consults, speaks, or performs clinical trials for Medicis, a division of Valeant, 3M, Sanofi Aventis, Bioform Medical, Allergan, and Stiefel, a GSK company. 

The new fillers, lasers, and topical products that are coming online offer abundant possibilities to improve the face. In my practice, we are combining lasers, radiofrequency, topical products, fillers, fat melting injections, toxins, collagen stimulators, and peels to provide dramatic results. However, the really exciting part is what is being done off the face. From the hands to the chest; from the neck to the arms and thighs, no area is off limits for a dermatologist or plastic surgeon with the skill and creativity to see these new opportunities as a chance to do a total body renovation. In many respects, I am surprised that it has taken this long. One only has to look at Instagram or attend the Cosmetic Bootcamp to see how advanced many of our colleagues are when treating other parts of the body.

Hands and Body

We have long known that the dorsal hands are great areas for treatment. The use of dilute calcium hydroxylapatite and/or hyaluronic acid fillers are wonderful at providing some buffer between the skin and the stringy tendons and veins that are frequent signs of aging. Renovating the surface is an opportunity to polish (with fractionated 1550 lasers) or remove freckles (with a variety of lasers) that many patients will benefit from. Many of these patients will see results from dilute injections of poly-L-lactic acid (PLLA) in the upper arms to stimulate collagen growth. 

For those patients with fat bulges on the anterior or posterior aspects of the bra area, injections of deoxycholic acid can help to remove the fat and make this area more attractive. The surface of the skin of these areas should be treated with sun protection, retinol, tretinoin, growth factors, salmon extract, or vitamin C to ensure that the skin tone and texture is optimal.

The upper extremity is not the only region that can be treated. The lower extremity is amenable to many of these treatments. I have injected deoxycholic acid into areas around the knees and thighs with moderate success. My impression is that the treatments to these areas require multiple treatments with diffuse patterns of injection and tapering at the margins. I have also injected it into patients who have had radiofrequency or ultrasound treatments that left them with deep dents and been impressed with the results. Most likely this will be helpful to patients who have had suboptimal results with liposuction. Injections around the knees may be performed with reconstituted hyaluronic acid. This may be injected using a 1½-inch needle or cannula. The amount of saline or lidocaine used depends on the region and thickness of the skin but in general, it is reasonable to dilute 1:1. When injecting PLLA, dilutions of 12 to14 mL have been reported useful with treatments planned over multiple visits.

Article continues on page 2

{{pagebreak}}

Chest and Neck

The chest is another area that does well with treatments. The easiest treatments are with topical products such as tretinoin. Using them for several months will help to improve the tone and texture. Botulinum toxins are useful for the upper chest in women with dynamic platysma action. Spreading out the injections of diluted toxin will help to minimize the wrinkles of the upper chest. Fillers such as hyaluronic acid also perform well in this region. I dilute these products and inject them to fill lines and stimulate collagen. Diluted PLLA also works well here. I have yet to combine these techniques but think that there may be some merit to doing so. 

The neck may be treated with multiple modalities. Many of us have been injecting platysma bands for years. This works well for patients with dynamic bands. Treatments with deoxycholic acid are great for treating the submental area and small amounts may be used to treat the jowls. Given the proximity of the marginal mandibular nerve, great care should be taken when injecting this area. Smoothing the surface of this region involves the use of fractionated lasers (usually 1550 rather than carbon dioxide). Injections of hyaluronic acid in this area should be done with caution because of the plethora of vessels in the region. PLLA has been used here and in very dilute volumes (eg, 12-14 mL per bottle) are reasonable. 

When trying new areas, proceed with caution and have a thorough knowledge of the anatomy of the region. Treating the entire body is likely to be the future of cosmetic medicine and surgery and the options will only increase. 

Dr Beer is in private practice in West Palm Beach, FL. He is also a volunteer clinical instructor in dermatology at the University of Miami, a consulting associate in the department of medicine at Duke University, and shareholder and director of the Cosmetic Bootcamp meeting. For information on upcoming Cosmetic Bootcamp Meetings please visit, www.cosmeticbootcamp.com.

Disclosure: Dr Beer was an investigator and is a trainer for Kybella. He is an owner of Theraplex LLC, and consults, speaks, or performs clinical trials for Medicis, a division of Valeant, 3M, Sanofi Aventis, Bioform Medical, Allergan, and Stiefel, a GSK company.