I got juvederm "voluma" yesterday!! I have cheeks!
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free skin care · Thu Jan 28, 2010 6:54 pm

Dr Rose - I checked out your pic on your blog spot. You are beautiful and your cheeks are perfect, that's how I'd like mine.

I also loved the story on the transformation of your sister, very inspiring.

http://drroseca.blogspot.com/

free skin care · Thu Jan 28, 2010 8:47 pm

I've had fat transfers done several times over the years. It's not something that is only done once. It has to be "built up" over time. Then I'd just go for touch ups as needed for lips, nasolabial folds, cheekbones, jaw. I wish I could afford to go in again because my face is looking too narrow and pointy and I want fat added along the back rear part of my jaw to widen my face.

As mentioned, it depends on the skill of the practitioner and my doc has loads of experience. He said most doctors prefer fillers because they are easier to use.

One bonus of doing fat transfer is you get two procedures at once -- injections and lipo. My doctor, whom I've seen many times for many procedures over the years, sucked out my lower abdomenal fat, even though he didn't need that much fat. It was just a favor, which I appreciated!

I've also had fat taken from the inner side of the knee and from the upper, inner thighs. He said inner thigh fat is the best because it's very dense so will last longer. I also diet for a few weeks beforehand to make the fat cells smaller so when he injects them, I get more of them instead of a few big blobby ones.

But when I'm going on vacation and don't need a lot done, I opt for one vial of filler.

free skin care · Thu Jan 28, 2010 9:05 pm

Thanks for the input Softskin - it's good to hear from someone who's had it done. So is the procedure very expensive?

free skin care · Thu Jan 28, 2010 11:55 pm

I don't really remember. Maybe less than $2000.

Fri Jan 29, 2010 8:06 am

Keliu wrote:

Dr Rose - I checked out your pic on your blog spot. You are beautiful and your cheeks are perfect, that's how I'd like mine.

I also loved the story on the transformation of your sister, very inspiring.

http://drroseca.blogspot.com/

Thank you!

I have a school picture from when I was 15 and my graduation from medical school 20 years ago and my cheeks look about the same. This is from Teosyal injections done in August '07. I'm mentally composing a blog post with those pics and a current one (had head shots done yesterday so when I get those back, I guess) to talk about cheeks.

Some of my clients are afraid that I will give them cheeks just like mine when I suggest cheek restoration to them so I always have to explain that this is natural to me and I wouldn't do the same cheek for them. Very Happy

My sister keeps looking better and better. She has gone from looking 10 years older to 10 years younger than her true age.

Thanks again.

free skin care · Fri Jan 29, 2010 8:27 am

which is better radiesse juvederm for cheeks??

Fri Jan 29, 2010 9:29 am

tasha92337 wrote:

which is better radiesse juvederm for cheeks??

Tasha, I think this partly depends on what you are trying to achieve and partly on what your injector is comfortable with.

If you just need a cheek lift, then I think a filler is best, e.g. Juvederm.

If you need overall volume in your face, Radiesse and Sculptra are volumizers. I personally use Sculptra and don't have much experience with Radiesse (I just like the idea of lactic acid of Sculptra better than calcium hydroxyl apatite of Radiesse -- the latter is a component of bone).

It is not unusual for me to use a little Juvederm in the cheeks on someone who is having Sculptra. It gives an instantaneous cheek lift (instant gratification) while we wait for the full effects of the Sculptra.

Hope this helps.

Dr. Rose

free skin care · Fri Jan 29, 2010 9:49 am

thanks dr Rose!

I'm young and have a baby face as it is..LOL but i want more of a nice cheek lift appearance

like Kim's (girl on right side) in this pic below:

http://inyourface.freedomblogging.com/files/2009/05/kris-and-kim-450pxw1.jpg

Fri Jan 29, 2010 10:04 am

Tasha, I would use a filler like Juvederm to give you those cheeks rather than a volumizer like Radiesse.

Very Happy

free skin care · Fri Jan 29, 2010 10:14 am

Great!

Whats the difference between Juvederm and Juvederm ultra Plus?

Which one is best to give me that look??

Fri Jan 29, 2010 10:42 am

Within the Juvederm product line, which are all hyaluronic acid, there are different densities for different applications.

For cheek augmentation, I usually use the Ultra Plus but could also use Juvederm 30 or Voluma (which is not available to me yet).

I usually use Ultra with Lidocaine for lips but sometimes use Ultra Plus for an experienced client who wants longer-lasting results and doesn't mind the initial stiffness of the product.

Hope this helps.

Dr. Rose

free skin care · Fri Jan 29, 2010 11:42 am

Rose, as an aside I want to compliment you on your blog -- one of the few such sites I've seen where the models look authentic and the lighting and camera aperture aren't distinctly favoring the "after" photos. I love the story of your sister and the ten-years-younger makeovers. Everyone should go check those out!

free skin care · Fri Jan 29, 2010 12:00 pm

The transformation on your sister is amazing Dr Rose!! WOW! It's great to see such an improvement all without surgery..makes me believe there is hope for me yet! ha ha...

And may I say I nearly fell out of my seat when I scrolled down below your sisters story and saw that severely over-baked woman on the beach

My lord, I cannot fathom how someone could think that looks even remotely attractive! Or maybe they just don't care?? And here I am worried about sagging... Rolling Eyes

I really hope that's her great great great grandchild in the photo and not her son.... Laughing

free skin care · Wed Feb 03, 2010 11:38 pm

I have these fine lines right under the lower eyelids (sort of crepey lines). Do these fillers work for those?

Thu Feb 04, 2010 7:50 am

essq2w3e4r wrote:

I have these fine lines right under the lower eyelids (sort of crepey lines). Do these fillers work for those?

Hi essq2w3e4r,

The brief answer is I can't tell without seeing you. Smile

There are 2 possibilities:

If the lines are caused by loss of collagen in the skin leading to crepiness, you would be better off with skin tightening. I would use a good firming eye cream (my favorite is SkinMedica's TNS Line Refine -- on my blog, look under TNS Line Refine in the right hand column).

Also, I have been doing fractionated laser around my eyes to tighten skin and raise my brows. We have the Pixel laser here but Fraxel, ProFractional and others work on same principle.

Second possibility: The lower lid can become loose and pouched as you lose volume in your cheeks. Putting the volume back in the cheek will smooth out the lower lid. You can see pictures on my blog if you look under Tri Site Bolus in the right hand column.

I hope this helps.

Dr. Rose

free skin care · Fri Feb 05, 2010 10:25 am

I finally have my appointment to get my cheeks done on the 16th...I am so excited and can't wait!! Hopefully all goes well...

free skin care · Fri Feb 05, 2010 6:57 pm

bren21 wrote:

I finally have my appointment to get my cheeks done on the 16th...I am so excited and can't wait!! Hopefully all goes well...

Good luck Bren, though I'm sure you won't need it. Very Happy

Please let us know how it goes.

free skin care · Sat Feb 06, 2010 7:54 am

wow what a brilliant thread. I am a newbie here but have experience with most of what this topic discusses.
Most recently I have had Sculptra (4 vials over 3 years) for minor correction. I haven't had any major concerns and love the concept of it but I think it's possible due to me asking for a lot to be placed in the areas between chin and jowl to fill indentation this has caused a more pronounced jowl effect (jutting out) in turn widening my lower face further especially on one side. I am thinking this is due to my body making an excessive collagen mass in response slightly above the treatment area. I may be wrong since aging is also occurring but am quite upset and can feel the thicker skin mass within my lower cheek.I wish there was a way to dissipate it-hoping the Tripollar STOP device might help.I did have some Bio-alcamid near the area(spit troughs)5 years ago but am told this cannot migrate once in place and it's much deeper.
That being said my most current doctor in the UK (not the one I was going to for the Sculptra-he's also very good)is rather well known so reputation at stake etc..he's strongly against Sculptra and has heard/seen too many complications that can occur even 1-2 yrs after injection-he doesn't feel it's worth the risk. I fortunately have had no granulomas or the like! He is a big fan of Radiesse but says now that I have had Sculptra I can no longer have Radiesse Sad

Apparently a contra-indication?

I am wondering if this would be the same case with Juvederm Voluma or are they compatible?

On a side note I had fat transfer for under the eyes(hollows) about 5 yrs ago in Canada (where I'm from -now living in UK) and it was amazing. With me fat tends to last but the thing with fat transfer is it's more invasive being you need the lipo in conjunction. This means you are kind of having 2 surgeries. It is a nice advantage to get the fat taken away elsewhere but my experience is lipo always ends up somewhat lumpy over time (even ultrasonic) especially with any further weight gain.Perhaps newer techniques like Lipodissolve prevent this? -dunno. I do like the concept of using your own fat better but the ease of fillers seems more ideal especially now they are improving.
I was wondering if Dr Rose you might know if the Juverderm Voluma or even the Teosyal is compatible after having had Sculptra over time?
I know you mentioned you top off cheeks with juvederm while giving a Sculptra treamtnet (which is bloody brilliant by the way for those of us who want the instant gratification! Wink

)
Also wondering if this stem cell treatment you discuss is the same as S3 therapy where a cocktail of amino acids is mixed with your own blood and then reinjected back into your face. Is this what Kylie has had done?
I just want to say how kind it is of you Dr. Rose to share your knowledge on this forum. You really know your stuff. I mean that in that I have worked with/for several cosmetic surgeons/doctors in different capacities and I feel your information is spot on Smile

feel so lucky to have found this forum Very Happy

Sat Feb 06, 2010 8:41 am

Pollyanna,

Yes, Juvederm Voluma and Teosyal can be used in conjunction with Sculptra.

I'm sorry to hear about the heaviness/thickening in your jowl area. If you were my patient, I would try Accent radiofrequency to your lower face to remodel the heaviness and tighten the jawline.

If you don't have a good cheek lift, I would definitely get that done as well to help lift the jowls.

I wanted to tell everyone here that I just tried a new product and am very excited about it. It has been in Europe for a few years (called Outline) but is relatively new to Canada.

The product is called Beautical and it is a semi-permanent relative of Bioalcamid, in the polyacrylamide family.

I have never touched the polyacrylamides before because it seemed to me that when problems occur with them, they can be horrendous. I've had experience cutting Artecoll out of someone's face when they developed granulomas.

With Beautical, the half life of the product is 2 - 5 years, depending on which one you use so you don't get permanent problems.

What I really like about Beautical though is the injection technique. It is very forgiving. I did my sister's cheeks 2 days ago and she looked beautiful instantly, with minimal bruising or swelling.

Beautical can be used as both a volumizer like Sculptra and a filler, for instance for lips. Unlike Sculptra, the results are instantaneous and you may be able to have the full treatment in one session.

I'm going to be trying Beautical on more people in the next while so I will let you know how it is going.

free skin care · Sat Feb 06, 2010 9:17 am

thanks so much for your answer Dr. Rose.
My doctor was going to do the Tripollar RF(this is what Accent is- am I correct?) to try to tone it down thinking it would be more successful via tightening after other attempts at fat melting in the jowl area with ultrasound and bi-polar RF were unsuccessful Sad

For this the reason I purchased the home version of Tripollar in the STOP device. I know it wil be less powerful but I am hoping over time it may be as effective and definitely more cost effective since it is based on the same principles..not sure what your thoughts are on home devices.. Neutral

I have only done one session so far so cannot comment on my results just yet!
I wouldn't add more volume to my cheeks as they are fine due to the sculptra and more would give me the dreaded 'pillow face' Laughing

and wow that Beautical sounds phenomenal-especially since it correct undereye!! Is it approved in the UK?If not- at some point in the future I may need to see you on one of my visits back to Canada! Wink

DO you know what the price will be per vial/area with this?

Please keep us posted..how long has testing been going with it? Are there any known side effects? I suppose like scupltra if injection was poor then you'd then have to wait 2-4 years for correction/dissolution?
also Would Beautical be compatible with Scupltra and how long after Sculptra would you need to wait to do this?
sorry for so many questions- it just sounds so exciting!2-4 yrs is unheard of!

Sat Feb 06, 2010 10:15 am

Pollyanna wrote:

thanks so much for your answer Dr. Rose.
My doctor was going to do the Tripollar RF(this is what Accent is- am I correct?) to try to tone it down thinking it would be more successful via tightening after other attempts at fat melting in the jowl area with ultrasound and bi-polar RF were unsuccessful Sad

For this the reason I purchased the home version of Tripollar in the STOP device. I know it wil be less powerful but I am hoping over time it may be as effective and definitely more cost effective since it is based on the same principles..not sure what your thoughts are on home devices.. Neutral

I have only done one session so far so cannot comment on my results just yet!
I wouldn't add more volume to my cheeks as they are fine due to the sculptra and more would give me the dreaded 'pillow face' Laughing

I'm not sure about your RF device. There are big differences between devices, based on what frequency of RF they use. I know that Accent and Thermage use the upper end of the range of RF and VelaSmooth/VelaShape are at the bottom end. Not sure where your machine fits in.

I haven't looked at a lot of home use equipment so I can't comment about what works and what doesn't. Lots of knowledgable and experienced people here though. Very Happy

My personal concern was always that I would use the equipment enthusiastically for 2 weeks and then never have time -- kind of defeats the purpose, right?

Pollyanna wrote:

and wow that Beautical sounds phenomenal-especially since it correct undereye!! Is it approved in the UK?If not- at some point in the future I may need to see you on one of my visits back to Canada! Wink

DO you know what the price will be per vial/area with this?

Please keep us posted..how long has testing been going with it? Are there any known side effects? I suppose like scupltra if injection was poor then you'd then have to wait 2-4 years for correction/dissolution?
also Would Beautical be compatible with Scupltra and how long after Sculptra would you need to wait to do this?
sorry for so many questions- it just sounds so exciting!2-4 yrs is unheard of!

I'm not sure about Beautical in the UK. I know it was developed in France and is approved in Europe for 8 or 9 years.

You can reduce the volume after Beautical with hyaluronidase and you can move it with massage so you can make corrections for overfilling.

The only thing it is not compatible with is Dermalive/Dermadeep.

I believe the price here is $800 per syringe. For overall facial volumizing, the price is based on an injection fee plus a much lower cost per syringe.

As I say, I was really impressed with this and can't wait to try some facial volumizing with it. Very Happy

Hope this helps.

Dr. Rose

free skin care · Sat Feb 06, 2010 2:04 pm

that's wonderful -thank you.
It seems I could have it done not in the UK but in Prague or in Canada with you if you decide to work with it-so it depends where I end up first! Smile

(price per vial is the same)

last questions:
how much of the product would one need to say do one isolated area like eyes (i.e.undereye hollows and tear troughs.) Would that equate to one vial per say?..
and/or for someone in their mid 40's on an overall face volumization 1 treatment basis (like you mention)what might that cost approximately? I realize of course it depends on the individual person's level of aging but if you could give a ballpark figure I'd be very grateful?
Very Happy

I'd also be curious how well it works for lip correction/augmentation. I am always looking for a filler that can actual slightly 'lift' the upper lip..

anyhow-that's enough from me-I know you are only starting with it- so I will look forward to your feedback Smile

free skin care · Sat Feb 06, 2010 10:39 pm

Hi Dr. Rose,
Just wondering if you could answer a couple of questions if you read this before Monday morning. I had two vials of Sculptra done on Wednesday - mostly in the cheeks with a little on the sides of my chin and jaw line. It looked ok at first but starting Thursday I started to develop a lump about the size of a nickel about 2cm out from my nostril. It is painful and quite noticeable especially if I pull my skin taught. It kind of looks like a raised bruise. I have been doing the massage for 5 minutes 5 times a day but the lump is getting bigger and more painful. I have been massaging the area quite vigorously thinking that would help but am now thinking that I'm only making it worse. My smile is also worrying me. It is very lopsided now. When I smile I only have one smile line. The other side of my face has no smile line now and a horizontal crease or indent about a fingers width right beside where my smile line should be. The lump/bruise is on the nostril side of the indent. When I smile the two sides of my face do not come close to looking the same. I am scheduled to see my doctor again on Wednesday but I think I will give her a call on Monday morning as this is quite worrisome to me. My question is do you think I should keep massaging the lump and also do you think that the asymmetry can be corrected? Do you think that the doctor will use more Sculptra to address the problem? When she was injecting me she said that I needed more filler on the one side (the side with all the problems). Thanks in advance for any help you can offer.
Doodles

free skin care · Sun Feb 07, 2010 3:24 am

doodles wrote:

Hi Dr. Rose,
Just wondering if you could answer a couple of questions if you read this before Monday morning. I had two vials of Sculptra done on Wednesday - mostly in the cheeks with a little on the sides of my chin and jaw line. It looked ok at first but starting Thursday I started to develop a lump about the size of a nickel about 2cm out from my nostril. It is painful and quite noticeable especially if I pull my skin taught. It kind of looks like a raised bruise. I have been doing the massage for 5 minutes 5 times a day but the lump is getting bigger and more painful. I have been massaging the area quite vigorously thinking that would help but am now thinking that I'm only making it worse. My smile is also worrying me. It is very lopsided now. When I smile I only have one smile line. The other side of my face has no smile line now and a horizontal crease or indent about a fingers width right beside where my smile line should be. The lump/bruise is on the nostril side of the indent. When I smile the two sides of my face do not come close to looking the same. I am scheduled to see my doctor again on Wednesday but I think I will give her a call on Monday morning as this is quite worrisome to me. My question is do you think I should keep massaging the lump and also do you think that the asymmetry can be corrected? Do you think that the doctor will use more Sculptra to address the problem? When she was injecting me she said that I needed more filler on the one side (the side with all the problems). Thanks in advance for any help you can offer.
Doodles

Doodles this would not be a sculptra nodule yet...it takes weeks to develop and "fluff". So I would guess it it some localised reaction or injury. I would stop massaging and take some arnica if you can get it orr ibprofen to see if it settles. By all means get back to your doctor.

Let us know what happens.

free skin care · Sun Feb 07, 2010 3:42 am

Thanks Mishey....I am so excited about this and can't wait to see what effect it's going to have on my face. A year ago, I was full out ready to have a mid-face lift...but after reading about what fillers can do and that they can give the illusion of a lifted face by replacing volume lost, I thought otherwise.

For one thing, I am only 39...I want to hold off going under the knife until I really, really need it. If I can get the effect of fuller cheeks and a lifted face in the process, it is well worth the $1250 once a year until the day the knife comes knocking on my door Laughing

...considering the average lift lasts about 5 years, I'd say that's not too shabby in regards to cost. And quite honestly, it is the only complaint I have about my face as almost every other issue I have with my face is being caused by this volume loss...I have no wrinkles, so once this volume loss is addressed, the only thing I will have to work on is evening out my skin color, taking care of this sun damage and a few red spots I have...

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