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.

Any treatment suggestions for deep marionettes lines and jowls?

Dr. Dean Kane Q & A.

Q. I have a heart shaped face which is slim. I'm 47 and do not want a facelift. What are my best options to smooth out deep marionette lines and jowling. Had Juverderm late last year and some Voluma added to cheeks to try and lift and plump my mid face a little. Right now my face looks miserable even when I'm not, because the corners of my lips drop downwards. I exercise a lot too. Which treatment would be most economical? Any advice would be greatly appreciated. Thank you!

A. Various options for facelifting, minimally and non-invasive facial enhancements and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need.

​Your question centers over the use of fillers yet your description sounds as though you have a significant amount of skin laxity. Fillers do a wonderful job up to a point but if you can "pinch more than an inch of skin along the jawline in front of the earlobe" I recommend you consider surgery to redrape the underlying soft tissue descent and skin lift with skin excess removal.
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​Please consult with a Board Certified, well experienced Plastic Surgeon or ENT Facial Surgeon for your best evaluation and recommendations.
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​A patient with significant skin laxity may note some improvement with facial fillers alone but the value is in lifting the tissues and removing the skin excess first and then filling in volume loss thereafter. Don't forget skin tightening therapies like ZO Obagi Skin Health.
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​Both surgical and minimally invasive / non-surgical options are listed below.

Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material.

Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift.

Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed.

The most popular of the fillers, Restylane and Perlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting "cousin"Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial ("parentheses") and marionette folds, the brow ("number 11") lines and fill and lift the cheeks and lateral brow or chin.Voluma is the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!

Non-surgical facial contouring is possible with fillers such as Radiesse, a bone mineral for the nose or cheeks, jaw and chin as well.

Sculptra is the latest of the injectibles stimulation collagen at different levels of the skin adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent.

Botox and Dysport too have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles!

Dr. Obagi's new, second generation ZO Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin.

IPL and fractionated lasers such as CO2 and erbium and now RF (radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation.

Face lift and / or neck lift or any of the other procedures and their combinations should be discussed following a proper examination by a Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he or she is limited in their skills.

​I hope this has helped! All the best!

What do you think? Facelift/neck lift? Fillers and Botox or fat transfer?

Dr. Dean Kane Q & A.

Q. I'm 43 but feel like I'm 23. The past few years I've noticed less volume, for the record I think I already have a thin face. The upper eyelids stand out along with the tear trough. My dermatologist told me no on the face/neck lift but I submitted my photos to a plastic surgeon. He also said I wasn't a candidate for the lifts. He suggested an upper eyelid surgery and fat transfer! I don't want to spend thousands on that if in a few years I will need a facelift. Please help with your opinions. Thank you!

​A. Thanks for sharing your photos! You will notice that your best appearing presentation are the photos in which your cheeks are the most prominent and your jawline is most angular. This is due to a "heart-shape", convex presentation where there are more highlights then shadows.
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​You, like many patients may achieve these features with facelifting options, injectibles, peels and laser. Each has its own advantages and disadvantages, onset and duration, recovery and cost. Your personal needs must be evaluated with a well experienced, Board Certified Plastic Surgeon or Facial ENT Surgeon that provides all options so they are not biased based on a lack of skill level.
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​I have many patients choose fillers, retinoids, peels / lasers when they won't consider surgery, have the funds or recovery time for surgery.  Others, recognize the advantages of surgery to reduce / lift the jowls, widen and fill the upper cheek and redrape the lax skin while maintaining a thinner facial appearance and obtaining a longer duration of results.
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​Both of these and other combinations are options you will determine with a trusting physician.
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​I hope this has helped! All the best!

Why do some patients have great outcomes after a non-invasive treatment & others only have little improvement w/same procedure?

Dr. Dean Kane Q & A.

Q. When looking at before & after photos of patients who have had identical treatments, same treatment locations, same number of treatments & post-photos take the same number of months post-treatment of coolsculpting or thermage (& similar non-invasive treatments), you can see that some patients have dramatic results and others seem to have almost no change. Is it patient age or treatment location or body size or post-treatment diet/lifestyle or doctor's skill or length of treatment? Thanks.

​A. This is a very perceptive question requiring a very complex answer. The simple answer is every patient is different and needs to be matched to their best option to achieve a particular result.
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​The more complex answer is based on the following and many other individual factors:

1. ​Age: younger patients will tend to have thicker firmer dermis, thinner epidermis and more fat with rounded contours in more pleasing places
2. ​Aging: the physiologic changes associated with skin laxity, shifting / thinning / separation of soft tissues accelerate in your 30's.
3. ​Environment: more weather and UV exposure will oxidize tissues, injure skin and age the tissues faster.
4. ​Metabolism and disease: each of us carry a unique set of genes which will accelerate or decelerate and repair aging and damaged tissues.
5. ​Familial and ethnic quality: you inherited these traits.
6. ​Personal care: use of retinoids, care for acne, tobacco, alcohol, etc
7. Patient perception on what they hope to achieve based on exposure or education to any / all available options

​I have observed the following general trends in how patients respond to rejuvenation procedures.

1. ​Individuals with thicker dermis, oilier skin and more pigmentation will tend to age slower but may present with more pigmentation damage. They will tend to take longer for scar thickening to reduce.
2. ​Those with thinner, northern European thinner, less resistant (to folding and creasing) dermis, drier more reactive skin will age earlier and show more aging skin changes. They will tend to "heal" faster with less scar thickening.
3. Patients with more reactive red tones in their skin (due to more active histamine and inflammatory response) such as a ethnic history with Irish and American Indian backgrounds will swell more but may also respond better to technology which creates redness and inflammation.

In addition, each individual should choose or be selected for particular procedures according to:

1. ​Cost
2. ​Recovery, onset of effect and duration
3. ​Amount of involvement in the procedure or after-care
4. MD, RN, aesthetician skills
5. Availability of differing procedures, technology
6. ​Desired results

I hope you can now better understand why a patient responds to different rejuvenation options differently.
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​All the best!

What would your advice be if I walked to your office? Botox?

Dr. Dean Kane Q & A. 

Q. I have this horrible lines on my neck (deep ones) and I am so young I shouldn't have to be worrying about it... I think its genetics so... there is only so much I can do, but I definitely will proceed on something against them since I'm fairly slim and I just want them to get toned out and vanished as much as possible. Ive tried aloe vera, collagen pills... etc. you name it; I've tried it. I feel hopeless... Oh, and when I was 15-18 I was a bit chubby but not anymore. Thank you in advance.

A.  ​​​​Thank you for sharing your photos!
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​As advancements are made in surgical and non-surgical cosmetic improvements, concerns not previously addressed are now facing (no pun intended) the limelight.
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​Neck creases or necklace lines may now be more apparent as the computer-cam generation and "selfie" revolution highlights these and other personal concerns including the weak chin, the open nose and facial asymmetries not previously appreciated. The necklace creases may be created by the more repetitive flexion of the neck looking down toward these devices.
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​While there is a sheet of muscle called the platysma under the neck creases, it produces vertical folds more than horizontal creases. Botox will relax the muscles creating "dynamic" lines like those of the crows feet and not easily reduce the visibility of neck creases.
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A continuous evolution of heating technologies (laser, ultrasound and radio frequency) to produce collagen thickening and skin tightening by combining the body’s own natural healing process to tighten loose skin has been less than overwhelming.
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​I have experienced a greater improvement in "necklace" line reduction and thickening of dermal thinning with resistance to creasing with an off-label use and dilution of the injectible "filler" called Sculptra. This is very injector dependent and not for routine use but illustrates how technology and technique are helping enhance our personal lives and aging’s consequences.
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​Please consult with a Board Certified, well experienced injector specialist to examine you and review with you, your options.
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​I wish you well!

Could I be a Restylane Candidate?

Dr. Dean Kane Q & A.

Q. I am so over these eye bags. I'm only 30, but I feel 100! Help! Should I get Restylane fillers, or should I go with a lower blepharoplasty? Thanks.

A. Thanks for sharing your photos. ​Yes, Restylane is an alternative to mask the bags by elevating the folds. It takes special skills so choose your injector wisely.

​It would also be important to have your thyroid hormone levels checked and a proper evaluation of your eyes, lids and boney structure. Eyelid surgery is a possibility but in your photos, I detect some eye bulging and asymmetry. This may indicate an overactive thyroid gland or other anatomic concerns regarding your options.
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​Consult with a well experienced and Board Certified Plastic Surgeon, OculoPlastic Surgeon and  / or Facial ENT Surgeon who perform eyelid surgery regularly.
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​I hope this is helpful. All the best!