Is it possible to combine Sculptra and fat grafting?

Dr. Dean Kane Q & A.

Q. Hello doctors ! My question: is it possible or profound to combine Sculptra and fat grafting for tightening and revolumizing the face?

A. ​The idea of volumizing and firming is the next page in the rejuvenation / regeneration story.

​For decades, many molecules have been added to fat to improve its survival. Maybe Sculptra will be that molecule.

​So far there have been no research articles on this idea but there should be. I use both injectibles and both stimulate the immune repair system to send signals to the fibroblasts either via a stimulator molecule, poly-L-lactic acid (Sculptra) or as stem cells (fat) to regenerate blood supply and produce collagen, elastin, hyaluronic acid and other youthful skin components.

Both injectibles do not work simultaneously so at this time, I recommend beginning with Sculptra to begin the revascularization and scaffolding. 1 to 3 months later inject the fat with anticipated greater survival and volumizing rejuvenation of the tissues.

Thanks for this question!

All the best!

Can I have Fraxal and Botox?

Dr. Dean Kane Q & A.

Q. I had Fraxal around the eye area but can I have Botox as well 9 days later when I'm booked in for Botox.

A. ​Botox is a protein than can be denatured and therefore lose its potency with heat. The fractionated CO2 laser penetrates the skin to heat the tissues and can therefore reduce the effects of Botox or like muscle relaxers. Current understanding is that Botox has linked irreversibly to the nerve ending and performed its job within an hour of injection.

​The swelling associated with laser therapies will also increase swelling in the area performed. While I know of no studies to the effect, I can anticipate that the added fluid in the area may dilute the muscle relaxer and possibly cause diffusion effects depending on injector technique.

If you do plan to have both a laser procedure like Fraxel and Botox performed, I prefer they be separated by a day with Botox on the first day followed by laser the next day. ​ Your best results when combining such procedures would be inject Botox and wait for its maximal effects 10-14 days later, then have Laser.

​Please discuss this concern with your injector / laser specialist.

​I wish you well.

Dr. Dean Kane Q&A – Botox and Facial toners. Can they complement each other to prevent muscle atrophy?

Question from England, AR: I recently had botox in my forehead & above the eyebrows. I use facial toners for saggy skin around the eye & jowls etc. It could be psychological but I felt it helped. I read articles recommending using facial toners in conjunction with botox to prevent muscle atrophy as a result of botox, even if it only targeted the surrounding non-botoxed muscles. Not much was injected so I still have some movement. How long after the injections can I use these devices & is there a risk of the botox moving?

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:
​Expression appearances are created when muscles which are attached from the bone to the skin produce dynamic furrows, wrinkles and lines. ​ Permanent lines in the skin develop from the continuous creasing and thinning of the skins various layers. 

​Botox and Dysport are muscle relaxing medications injected cosmetically in micro amounts to relax and reduce dynamic wrinkles and lines created by over-used expression muscles. 
​
The ​"Facial Toners" you speak of are electrical stimulators of the underlying muscles to create an increased tone or contraction with the desired effect to shorten or "tighten" the skin. Skin does not tighten in this manner. Skin will only "shrink-wrap" with the created rejuvenating effects of forming collagen, elastin and other molecules which are lost with aging, sun-damage or disease.  Facial Toners may in fact worsen the dynamic creasing of the skin resulting in wrinkles and lines. Retinoids with their ability to stimulate production of these molecules and lasers which heat the molecules to shrink or form collagen-scar result in a tighter appearing skin.
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​As you can understand then, Botox and Facial Toners produce opposite effects. These and proper skin care, chemical peels and lasers all have different actions on the skin. There are trade-offs to each option and these should be presented to you following a proper consultation by a well experienced and Board Certified Plastic Surgeon, Facial ENT or Dermatologist. 
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​I hope this was helpful! All the best!