Non-Surgical PROCEDURES
MORPHEUS 8
OVERCOMING THE PAIN FOR BEST EFFECT
THIS IS EXCITING TECHNOLOGY AND WE ARE PUSHING THE BOUNDRIES combining with MICROLIPOSUCTION AND NANOFAT
Morpheus 8 is a micro needling device that delivers RF (radio frequency) energy beneath the skin to promote shrinkage. Microneedling alone is popular, but very bloody when the needles go deep enough to be effective. The RF in morpheus 8 cauterizes the tissue, minimizing bleeding. I had a full face and neck treatment and went to work 1 hour later with minimal discomfort.
BUT, many of my patients could not tolerate the pain and did not return for their next two treatments. The treatment is given in three levels in the face, 3mm, 2mm, 1mm. A 4mm, 3mm, 2mm handpiece is used in fatty areas such as abdomen and thighs. I found the 3 and 4 mm depth treatment is well tolerated. But the 2 and 1 mm levels are increasingly painful and poorly tolerated. We think that the 1.5 mm level is the key to optimal shrinkage.
SO, we are offering our patients twilight sleep for optimal results and comfort. There is no after pain with this procedure. Return to work the next day.
TESTED ON MYSELF
I made the mistake of buying an Ultherapy machine without testing it myself only to find it was a waste of time and money and I could not in good conscience use it on patients.
So I tested this new technology out myself. I felt no pain on high power with topical numbing cream for one hour.
But the sweet spot seems to be 1.5 mm and many patients find this intolerable. So we are providing twilight sleep so we can really work the sweet spot for maximum effect in the face and neck.
SUB-MENTAL (UNDER CHIN) FAT
Removal of sub-mental fat has been a challenge. Liposuction alone was wanting because the skin did not always shrink enough. Bumps and ripples were not uncommon.
Non-surgical thermal machines such as Thermage and Ultherapy proved to be unreliable and terribly disappointing.
Then came the injection fad.
The injection fad was disastrous with pain, swelling, irregularities, and some nerve injuries.
Morpheus 8 (micro-needling with heat) alone required many treatments. Better but still not up to my expectations,
We are now combining micro liposuction with Morpheus 8 under local anesthesia in the office with excellent results in our test group.
NANOFAT
MORPHEUS 8 & NANOFAT
We are currently combining Nanofat injections and Morpheus 8 for creases in the chest area. This can be done in the office under local anesthesia and patients return to work the next day. two to three treatments spaced 6 weeks apart, depending on the severity of the skin crease and mobility of the skin.
Microfat (small fat cells) are harvested with a small bore cannula under local infiltration. This is converted to Nanofat by shuffling the the micro fat through progressively smaller filters, rupturing the fat cells and releasing their contents. After final filtration to remove the cell fragments, the remaining fluid also contains abundant stromal vascular fraction cells and adipose-derived stem cells, which help restructure dermal support elements, such as collagen, and regenerate younger looking skin. Unlike microfat, nanofat particles provide no noticeable volumizing effect. But the fluid consistency of nanofat allows it to be injected directly into areas requiring
tissue regeneration, such as scars, chronic wounds, and facial rejuvenation. It is a long term process, but our three-year followups have confirmed the benefits of this easily administered technology.
The red areas on the patient’s chest was an experiment. Micro-needling was used to make the skin porous and receptive to topical nanofat which could be applied topically for up to 24 hrs. The bleeding and redness was not convenient. Now we micro-needle with Morpheus 8 which does not bleed or leave a raw wound and the nanofat can be absorbed with no down time.
BOTOX / XEOMIN / DYSPORT
WE DO IT DIFFERENT
Even in incompetent hands, neurotoxins are unlikely to cause permanent damage, unlike fillers. You are just likely to be scared for a few weeks.
“Botox” is commonly used to refer to the common denominator of a number of neurotoxins , botulinum neurotoxin type A (BoNT). Forget everything you have been told. Probably 80% of “Botox” injectors don’t know the anatomy, or how the neurotoxin works. Bad advice abounds. We started researching wrinkle suppression with this neurotoxin when it was called Oculinum back in 1989 and was FDA approved for strabismus.
BOTOX = XEOMIN = DYSPORT
Botox and Xeomin are 100% identical in onset and duration. How do I know? I did the research and wrote the paper and presented it in Boston at the American Society of Plastic Surgery Meeting. My limited testing of Dysport suggests it too is identical if you compare one bottle of each.
Come experience our technique of passing along the muscle bundles with safe doses, instead of numerous vertical stabs. Then judge for yourself.
No nurse or technician will ever inject you, only Dr. Villar. Every patient is a little different and he has the expertise to customize the treatment at very reasonable cost.
Do not waste time thinking about units, he will determine the best amount for you regardless of units needed, which varies.
$225 per site (forehead, glabelar, crows feet, master, etc.). Monthly specials.
Nurses, teachers, police, veterans, firefighters ask for discounts.
OUR EARLY EXPERIMENTS WITH OCULINUM
In 1987 Dr. Jean Carruthers, a Vancouver-based ophthalmologist first experimented on his secretary, Cathy Swann, for wrinkles with a botulism based neurotoxin used for strabismus. In 1989 John Connelly MD asked me to inject his wrinkles with Oculinum toxin. “What the hell is that?”, I asked.
He told me and I tracked down the product which was off label. I diluted the 100 unit bottle with 10cc of saline and experimented.
Presenting findings at ASPS Meeting, Boston
XEOMIN VS BOTOX
When the Botox competitor Xeomin came out, the reps would say that it does not take effect as fast and does not last as long. A Xeomin rep was lamenting this, explaining the active ingredient was identical and there should be no difference.
All my career I was seeking a brilliantly simple experiment, which the novice observer could judge for himself. This was it!
Botox and Dysport have complexing proteins which may be leading to about 15% of patients developing antibodies to these products. This explains why some patients see declining efficacy of the injections. I have only seen one of these. Possibly stopping for a year or two until antibody titers subside may offer hope, but testing is not readably available.
FILLERS
FRAUD ALERT FILLERS FILL, they DO NOT LIFT
Even in competent hands, fillers in the mid face, lips, and glabellar region have resulted in a few cases of blindness and soft tissue necrosis. In my practice, no nurse or technician will ever inject a patient. I have been referred too many disasters.
When Voluma was launched, they claimed that by injecting deep on the maxillary arch the nasolabial fold would be pulled up. I did not believe it, so they invited me to be trained by an “expert” from California. (I was the only surgeon there, the rest were nurses to my surprise). The “expert ” explained that by injecting deposits of this dense filler right on the periosteum of the cheek and maxillary arch, the cheek would be pulled out which would pull the lax skin of the nasolabial fold up.
I explained to the expert, that this made no sense because skin has a mechanism of maintaining a regulated tension. That is why pregnant women do not explode. 🤔 🙄
The skin stretches and relaxes as the fetus enlarges. After birth, the lax skin tightens. Not everyone tightens the same, but they all tighten.
So if the filler pulls up the fold, it will rapidly fall back as the skin accommodates. Patients will return for more, and more, and more as their cheeks become distorted and unnatural without benefit.
At the Baker Gordon Meeting in Miami , I asked Val Lambros what he thought. “I don’t know but I will have an answer for you at the next meeting. He had been doing 3D photography of patients for 15 years to observe the facial aging process and had presented his pioneering work at the BG Meeting. He went back to California and 3D photographed a series of patients before Voluma, then immediately after and compared the results. At the next Baker Gordon Meeting he approached me. “Sorry Lou, you are wrong. The filler does not pull up the lax naso-labial fold, then lose the effect as the skin relaxes. IT NEVER PULLS UP THE NASO-LABIAL FOLD AT ALL.” 🤔
The pioneering work of Val Lamros MD in 3D photography to study the aging process revealed a very good use for Voluma and other dense fillers. The first thing to go in young women is a triangular fat pad that breaks the contour of the jaw line and gives the impression of a jowl before it becomes a real jowl which requires surgery. This can be filled to restore the jawline with dense fillers.
BEWARE OF "LIQUID" FACELIFTS
An enormous number of nurses, technicians, and physicians are bailing out of their specialties due to miserable working conditions and reimbursements that cannot sustain their overhead. They are not surgeons, so they only offer non-surgical options. You may be advised to get thousands of dollars of fillers pumped into your face, with poor results because you really needed surgery but the provider did not have the skills or training. You may be wise to get second opinions from Board Certified Plastic surgeons. But always get three opinions because not all surgeons are created equal.
PRE-WETTED FILLER by Villar
Number of my colleagues around the globe and I are learning that hyaluronic fillers are lasting far longer than we expected. This has been confirmed by MRI. Also, the material migrates from the original injection site!
These materials are hydrophilic ( meaning they attach to water molecules ) and swell up days and weeks after injection. Overfilling the face has resulted in rounded bloated faces that look unnatural though they looked fine at original time of injection. OOPS! 🤔
This patient has the perfect wrinkles for Pre-Wetted treatment. These wrinkle folds are soft and respond to pulling back gently.
Dozens of fillers are on the market. But experience shows that one or two dense fillers can be used full strength on bone to push up areas like the triangle atrophy of the jawline, or be Pre-Wetted for more superficial places on the face.
Only one or two syringes of filler are plenty for a single session. We have discovered Less is Better.
HEMMORHOID LIPS ARE NOT A SEXY LOOK
Those who claim that the golden ratio (1:1.618) or “divine proportion “ enables the “artistic injector” to enhance a person’s beauty by injecting “just enough” to come as close as possible to the golden ratio, are perhaps full of themselves beyond the ratio.
One ratio does not fit all, as one operation does not fit all. The artistic injector, it seems to me, uses the eye to calculate the inherent ratios of the patient, which are rarely ideal, and follow basic concepts such as the lower lip is fuller than the upper lip. A ruler is unnecessary to understand that equal upper and lower lips resemble hemorrhoids more than a sensual organ of communication. It may be a fad, but an asinine one.😜
Injecting into the lip muscle for fullness results in a loss of animation. I call it the “puppet monster effect”. They may look ok when stationary, but the minute they speak the upper lip stays in one place in a most unnatural way. And just try kissing a once soft, tender, sensitive, silky organ that now is like immobile rubber. Not for me or my patients! Less is better, and precision placement is paramount.
A CAUTIONARY TALE
FIRST USE OF A 3D CAT SCAN TO EVALUATE A RADIESSE LIP INJECTION DISASTER
Twenty years ago, a beautiful 30 year old young lady walked in with lips from hell. She had been injected with Radiesse by a facial ENT surgeon. It was a disaster because collagen and hyaluronic acid fillers can be squeezed out or dissolved by hyaluronidase enzyme. But Radiese could not be dissolved nor could it be squeezed out because after injection, the tissue grows into it. It has to be cut out or it will be reabsorbed in a few years. Bad news in this case.
The material had been injected into the lip from the inside passing through the muscle. It infiltrated beyond the boundaries of the lip irregularly. Nodules of material formed bumps everywhere. It was painful and unsightly!
