Fill Me In: An Aesthetics Podcast
On Fill Me In: An Aesthetics Podcast, Jon LeSuer NP-C and Nicole Bauer FNP-BC dive deep in the world of aesthetics. As aesthetic nurse practitioners with their own medical practices, Jon and Nicole fill you in on everything in their field.
Fill Me In: An Aesthetics Podcast
The Ultimate Beginners Guide to Botox and Fillers | Episode 18
Join Jon and Nicole as they discuss the essentials of Botox, fillers, and regenerative medicine in this beginner's guide. They address common patient questions, the differences between Botox and fillers, and their uses. Dive into topics like muscle movements, doses, injections, and holistic skincare regimes. Whether you're a new injector or a curious patient, this episode sheds light on everything from Botox touch-ups to the anatomy of filler treatments. They also touch on regenerative treatments like Sculptra, PRP, and the newer platelet-derived growth factors. Get ready to embark on a journey for a youthful glow!
On Fill Me In: An Aesthetics Podcast, Jon LeSuer NP-C and Nicole Bauer FNP-BC dive deep in the world of aesthetics. As aesthetic nurse practitioners with their own medical practices, Jon and Nicole fill you in on everything in their field.
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https://www.instagram.com/injectorjon/
Exhibit Medical Aesthetics website:
https://exhibitmedicalaesthetics.com/
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https://toxandpout.com/
Jonathan LeSuer, MSN, NP-C
Jonathan LeSuer graduated from Le Moyne College with his Bachelor’s in Nursing in 2014 and a Family Nurse Practitioner degree in 2017. He began his career at St. Joseph’s Hospital as a Registered Nurse on a cardiac medical-surgical unit. He transitioned to the Nurse Practitioner role in 2017, working for Hospitalist Medicine, where he became the coordinator for the team’s Physician Assistants and Nurse Practitioners. In 2020, he started his career as an Aesthetic injector and quickly found out that this was his passion. On March 15th, 2022, he opened Tox & Pout Aesthetics. He is now a Master trained injector & National trainer for Allergan Aesthetics, offering Botox, Dysport, Hyaluronic acid fillers, Kybella, SkinViVe skin booster, and Sculptra. Jonathan is known for his empathy, profound bedside manner, and outgoing/warm personality. He has a deep love for aesthetics, and his patients’ confidence is his main priority.
Nicole Bauer, MSN, APRN, FNP-BC.
Family Nurse Practitioner
Nicole graduated with her Associates in Applied Sciences and began her journey as a registered nurse 10 years ago in 2014. She worked hard to combine her love for beauty with her passion for caring and healing others, attending aesthetics school while working as a hospital night nurse. After graduating as a licensed aesthetician, Nicole left the hospital where she had been for 3.5 years and began working as a registered nurse for a plastic surgeon. An experience of over 6 years that would leave her with so much knowledge and respect for the aesthetic world. It was during those 6 years that she pursued her Master’s Degree and obtained her license as a Family Nurse Practitioner, leading the way for where she is now; owning a state of the art medical aesthetic practice and being a national Allergan Trainer. Nicole takes pride in treating her patients holistically, focusing on facial balancing and enhancing one’s natural beauty. She believes education stands as the cornerstone of aesthetics and is why she is dedicated to both training others while always focusing on expanding her own knowledge as well.
Producer of Fill Me In: Joseph Ginexi
Welcome back to the filming and podcasts where we dive deeper into the world of aesthetics. I'm injector John
and I'm aesthetic nurse, Nicole,
and welcome back guys. We missed you. We had a little hiatus during the holidays, but we're back and we're here to talk about the basically Botox and filler sculpture of regenerative medicine, the beginner's guide to all of this.
both for the patients and the injectors point of view.
Yeah. I feel like we get a lot of DMS and questions, even patients coming in, especially if they've never done anything before, um, you know, kind of asking, well, I don't really even know where to get started. So I felt like a guide would, you know, a podcast episode about basically creating a beginner's guide to all of this would be, would be fun.
Well, and it's a new year, so, you know, new year, new year, new face. So let's get the ball rolling. It's
a good time to start.
And it's a, and it's a huge time in any type of office setting where a lot of new faces are walking through the door. So, um, and we're getting a lot of new patients this time of year that are wanting to work on themselves, their confidence, they want to, you know.
Start a new skincare journey. All the things. So, um, basically we're gonna talk about like, you know, if you're a patient coming in and you are brand, brand new to Botox or filler, I'm gonna talk a little bit about Botox. You want me to do that, Nicole? Yeah, that's
perfect. We can start there. Yeah, yeah. And
talk about that point of view.
Yeah. Because I feel like too, some patients even come in and they're like, I don't even know the difference between Botox and filler. Like, or they think theyre the same.
Yeah. They think they're the same thing. Mm-hmm . Exactly. Yeah. If you're a brand new patient and you're coming in and you're wanting to improve fine lines and wrinkles, a lot of people think that, especially in your forties, fifties and sixties, if you have deep, deep lines, it's really hard for them to completely go away in one visit.
And sometimes you might need other modalities, meaning. Um, skin treatments or radio frequency, microne like that to stimulate c those lines in the skin. is say if you're in your in your thirties and you person and you created an whether it's between your That line at just, Oh God, Nicole, this is the most movement I've ever seen with Nicole.
She's pregnant. For those of you guys that don't know, Oh my God,
I can now show you.
Yes. But if you, if you have a deep line. Sometimes that line can etch a scar in your skin. And once it does that, it's really hard for it to completely go away. And even after like two or three, four visits, sometimes it's still there, but it's much, much less.
The whole goal for Botox is to minimize muscle movement. That's causing lines and wrinkles in the skin. It's preventing at like the science level, basically acetylcysteine from attaching to that. that receptor, which acetylcysteine is responsible for muscle contraction. So it's blocking acetylcysteine from joining that receptor and causing muscle contraction.
Um, so Botox usually kicks in in about three to five days is kind of the, whether, whether, um, you're getting Dysport, Botox, Dexify, you name it. Um, and then fully kicked in in 10 to 14 days. Um, I think another thing we've talked about in many of our other episodes are touch ups. You know, we like to see new patients and a lot of our routine patients two weeks after just to follow up to make sure that the results are good, that they're happy.
Um, a touch up is normal. Like if you go to an injector and they say it's not normal to have a touch up, they're wrong. It's very normal. You can get Botox for years and you can still sometimes get a mild Spock of one eyebrow. And a Spock brow is basically when you're lifting and one brow is moving and the Botox settled.
Um, maybe one brow settled better than the other and you just might need one or two units over that brow just to relax it and then everything will be even.
Right. And that can happen really anytime. Any treatment can be different. And it can happen because maybe we hit a little vein and the vein took the Botox away, floated it to another area, which A small amount of Botox.
It's totally fine. Um, or you were just like too superficial. You didn't hit enough fibers. There's so many things that can happen. Um, or even a bruise. Sometimes you bruise real bad and it just kind of, you know, floats away. So,
or sometimes Botox, you know, I mean we're injecting under the skin. Sometimes we can actually enter a little vein or a capillary and then the Botox goes into that vein or capillary.
So that's another reason too.
It's carried away.
It does. Yeah.
I think another major question. Um, with Botox is like, well, how do I know that I should start to become like making sure that I'm being preventative? And I always like to say, when you start to notice lines at rest, that's when you want to start.
If you have no lines at rest, great. You don't truly need it yet. Um, I think I'm a great example. Especially right now, if you're seeing these little lines at rest, like you can kind of see through the middle of my forehead, that's probably a good time to start before they get much deeper. And if I let this go five, 10 years, Botox alone is probably not going to cut it.
And remember guys, it's easier to prevent than it is to correct. And that's why we say, and you're seeing a huge trend of people coming in younger, um, to get these treatments done just so that way they can prevent themselves from getting deeper lines and wrinkles.
Right. Right.
And you're actually going to save money in the long run if you start earlier, because if you start later, then you're going to have to depend on other advanced skin treatments to help break up the scar tissue, which is from that line and wrinkle that's been caused and promote collagen production to smooth it.
You're going to have to do other modalities to help try to smooth your lines and wrinkles.
Right. Right. And I think to a question we get all the time is like, how do I know my dosage? What's too much? What's too little? Um, so I think a good thing to go over right now with all of you patient or provider is that the FDA approved a dose approved dose for three months is actually 64 units for all three areas.
Uh, I feel like a lot of providers don't do that amount and On certain patients. I don't either. It really depends on your anatomy. Uh, but 64 units is the researched amount that got to three months. So if you're doing under 64 units, probably by that two, two and a half months, you are going to have some movement in certain areas.
Um, you know, some of us have smaller foreheads and there's just no way we could tolerate the 20 units that's approved in that area. Um, so you might unfortunately have movement there first, but between the brows and around the eyes, you don't. You know, and it's kind of finding what works for you.
Yeah.
It's very individual. You, you're not going to get the same amount of units that your best friend, sister, mother, you know, have, you know, it's, it's going to vary person to person. It's also going to vary how many units you get based on your goals. Like if you're someone who is in their forties, fifties, sixties, seventies, eighties coming in and.
You're saying that you feel like your eyes look tired or you're feeling hooded and you want your eyes to look more open. That's another conversation, you know? And I guess that's where we kind of get into the muscle movement, what the muscles do. The forehead is a lifting muscle, right? The glabella, which is between the brows, it's a depressor muscle.
It goes downward. And then the muscle that's around the eyes, the orbicularis oculi muscle goes inward, downward and inward, right? When you put Botox into those muscles, the muscle is going to do the opposite thing. So the forehead is a lifting muscle. We put Botox in the forehead. It's going to relax it.
It's not going to lift anymore, right? And then the glabella, which is between the eyebrows, if we put Botox there, hopefully you'll get just a little bit of a medial brow lift, okay? And then Botox around the eyes here will help to actually keep the eyebrow arch the way it is at rest and hopefully even Open it up maybe just a little bit, um, to get a really good eyebrow lift.
And we hear this all the time with patients coming in. I want an eyebrow lift. I want an eyebrow lift. I
hate tick tock and Instagram for this because there's no such thing as like an incredible Botox brow lift. It doesn't happen.
It doesn't happen. We can try our best, but it's not surgery. Um, and you know, getting a surgical brow lift and things like that.
But, um, basically to get a good brow lift, you have to treat the glabella. With the FDA approved dose. I like to do 20 units and then I like to treat the crow's feet or the upper part of the lateral canthal area as well. And basically what that's doing is just going to help to open up the eye. If you treat the forehead and get a normal good dose.
Right. Of like 10 to 20 units in the forehead. You're not going to go to get a good eyebrow lift. Right. Right. Nicole. I mean, it's, it's, it's impossible. And there's different things that you can do. There's a lot of people that want to come in and they're like, I want an eyebrow lift, but I want the lines and wrinkles on my forehead gone too.
That's another conversation. I can make you frozen, right? But in order to get rid of the lines in your forehead, I gotta make you have minimal movement, which might mean you don't get a good brow lift, right?
Or you can kind of try to train the muscles by only treating that medial portion of the forehead.
But they spark spark. Some patients don't mind sparking. They prefer sparking, but it definitely again depends on your anatomy. Because if you have the anatomy that can handle a spark, fine. Some people spark and it looks Wild.
It looks wild. Yeah. Like it doesn't look right. You look surprised all the time.
So you have
to be really careful.
It's kind of a jump scare sometimes. Yeah. Or patients that go to their neurologist, you know, and they're getting their migraine Botox. Great. Good for you. But sometimes they come in. And I'm like,
Oh,
what
happened? Their eyebrows are way up here and I'm like, well,
yeah,
you know,
then again, because they're not doing it for any kind of aesthetic treatment.
They are now they're targeting like nerve branches and things like that. Yeah. So that's why you're not getting that aesthetic look. And that's why you come to us to kind of, you know. work with your neurologist and then also make sure that you have that appearance and you're not spocking. I would say for any injectors listening, like you said, if you want to try to get a brow lift, that's always what I tell my patients is let's start in between the eyebrows at the glabella and then do the crow's feet and leave the forehead.
Let's see how much lift we get with that. And then from there we can add in the forehead. Maybe if I feel like you can tolerate it. So always that two week follow up and you have to be careful with the glabella injections if you're following. So for our listeners that watch, I'm going to also explain, but yeah, so if you're following the skin.
You could end up way too high and into the frontalis and that
drop medial brow. Exactly.
And that's how you get people that angry bird. Even if you're not going too high, it could also be spread of product. So there are certain patients that I may use a one to one dilution. in the glabella region instead of a 2 to 1 or 2.
5. Um, to be completely honest, I do 2 to 1 on almost everyone, but I keep my injections right at the hair of the eyebrow. So even though it might look like you want to be up here, you really want to be right where that hair starts at the brow and even, and you never want to be anywhere near the arch, but even low here.
And
the corrugator, which we're talking about with the glabella here. Okay. Like the medial part of the brow. That's the corrugator muscle. Okay. And honestly, the corrugator muscle is literally right in the hairy part of the brow. Like when we've done cadaver labs, Nicole, right, it's right, right into the medial brow.
And some people go, Oh my God, that's too low. It's really not, you know, and I know you use a two to one, um, reconstitution and the 11th, I use a one to one. It's just, well, everybody's different. I think for men, there's times just because their muscles are so strong, I'll switch to a two to one just because I want it to diffuse a little bit more, make sure I'm covering everything.
Um, but otherwise in the forehead, I'm using a two to one and then around the eyes and most everywhere else, I'm using a two to one. Um, but yes, the other thing with, uh, the newbie injectors out there too, when you're treating the glabella, sometimes that lateral canthal, um, injection here, um, what was it?
Sebastian Kodafana that just came out and said that you have a less, less likely of a, um, chance of, um, of ptosis. inject basically towards, what is it, medially? If you inject medially right in the lateral canthal, it's hard to explain sometimes. Um, but basically in the, um, medial, uh, corrugator here, your first injection, you're going to inject 90 degrees right to bone there pretty much because that's where the muscle attaches nice and deep.
And then I usually, instead of going 90 degrees, I'll face the needle towards the nose. Um, and then I'll do it very superficial and I'll do like three, maybe four units there. Um, But if you basically turn your needle towards the nose doing it this way, there's a less chance of that Botox leaking down into the super orbital space and into that muscle there.
That's going to cause. That's what I was trying to talk. No, that was
great. No, because yeah, the, the foramen is. It was a long
winded explanation. I was acting like Doreen right now from the Beverly Hills.
No, that was good. But yeah, your foramen is in this area and if you're going directly in and you're too deep it can, the thought process behind it is it can get, it can enter the foramen and that's how it gets down into that levator muscle of the eyelid and causes the ptosis.
So you want to make sure that you're, I guess the needle would be parallel. Next to the skin. And you're going in immediately towards the nose and superficial for that last injection.
You're very superficial. Like, sometimes you want to see that white blob
right there in the lateral.
Yeah. Yeah.
Yeah.
And the lateral corrugator.
Yes. Yes.
If I said can't go before, it's because I'm tired. I
don't think I would have noticed. Hopefully.
Oh my God. Good. I
don't know. We'll listen back and find out. Oh my
God. Yes.
Hey guys, just popping in. If you're enjoying our podcast, please subscribe. And don't forget to follow us on Instagram, Injector John and Aesthetic Nurstical.
Yeah. Botox. There's just, there's so much that goes into it. And that's only, that's only the upper face. So the upper face is the only, not actually the only thing anymore, but it was the first FDA approved areas. Now we have the platysma bands of the neck too. So that's going to be on label. And we also do have some off label uses in the chin and kind of DAO.
So like your pre jowl area, uh, the masseter muscles. So it can be great for people with TMJ. Or if when you bite, you're very wide, we can kind of slim the face that way by treating the masseter muscles. So there's so many uses.
There's so many uses. And just to add to your point of the masters, I mean, it's life changing for patients.
Like I have patients that can barely open their mouth to eat a sandwich and they've come in, I've done treated them with master Botox and they can now open their mouth fully and enjoy a meal. Like, I mean, that's improving people. Patient's quality of life. I just had a patient actually come in who, which is pretty amazing to call it.
He came in and he had, um, laryngeal cancer and he had, it was in remission. It ended up coming back. They had to do chemo and then also radiation. Well, the radiation caused some fibrotic tissue that was around his mandible and like around his master TMJ joint area. And he could only open his mouth. Just a sliver.
Oh my goodness. And so he was eating soup and like smoothies and he said he could barely even do that. Right. And his doctor actually recommended that he try master Botox to try to basically loosen up the joint maybe or loosen up the muscle or relax it so that way it can maybe open a little bit. He went from opening his mouth maybe.
I would say five centimeters to then maybe 40 50 centimeters. It was pretty amazing. And I saw him a month later and he's coming to me now every six months. So
I love that.
It's very transformative. Like Botox isn't just for cosmetic purposes, like for the, for the newbie injector and also the patients watching that have never had anything.
It's, it can do a lot of different things. Um, And in injectors, like, you need to need to treat the lower face. Like, we are in that era now. Like, Botox isn't just for the upper face. We need to treat the lower face. If someone's coming in and they're feeling saggy, you know, Nicole and I are going to kind of go in depth about the different things Layers of aging of the face, and one of them is the muscles.
Mm-hmm . Our muscles are nice and tight when we're younger, right. They're keeping our fat pads in place. Um, we're making us look more youthful as we get older. Our muscles start to relax. Just like the skin gravity, right? Yep. We get skin laxity. We lost the collagen, elastin. Our, our muscles start to relax and kind of droop down a little bit, which contribute to the jowling, and also just some sagging in the lower face.
So treating the muscles in the lower face are gonna do the opposite. They're going to lift. that area and improve the appearance of the lower face. And if someone is Brand new to injectables to start them out with Botox and doing the upper and lower. That's a great place to start And then eventually hopefully you can convert them over to filler To replace some volume loss and to help kind of disguise the jowls and give that more lifted contoured appearance
Yeah, and if you're gonna be treating the lower face I always suggest having that patient come back at two to three weeks because it is a subtle change But when you see the pictures next to each other, you're like, oh my god.
Yeah. Yeah, so definitely Yeah. Treating and then having them come back so that they can genuinely see the change, especially that like 90 or 45 degree angle, they see such a difference in, in the jaw line itself. Um, because that jowl, like I explained it, like the patissimum muscle comes up and over almost like a hand sitting right on that jaw line.
So think about every time you make a certain movement, it's. It's pulling your face down. It's creating that jowl. It's causing that marionette. So if we're able to control that and relax it a little bit, it kind of pops everything up and everything looks straighter and smoother. Uh, but it is going to be a subtle change.
Again, these are not surgical procedures
now,
but if you, if you do it young enough and catch it young enough, it makes a big difference.
It is like miraculous. I think like, I mean, I think people notice if there's any change that's like 30 to 40 percent better, people will notice it. Right. And I know for me, like, yeah, I know guys, I'm 32 years old.
I'm not young. Okay. I'm turning 33 in a few weeks. Um, but I noticed though, over the, over this past year, I would say the skin in my neck has changed a little bit. Um, I never wear sunscreen growing up. Like I always got burnt. I mean, being burnt was in my mom always. Yeah. Oh my God. My mom was like, Oh, you're healthy.
You got burr. I'm like, okay. We'd lather with
oil.
That's a really messed up response. Um, but anyway, but I've noticed more skin laxity in my neck and I've done collagen inducing treatments like RF microneedling, you know, Erbium skin resurfacing and stuff to help, um, you know, decrease that. But um, one thing I've never done was doing Botox, my platysma and also doing some micro talks to the neck, which is superficial injections of Botox to the neck.
And let me tell you. It was like the most, I literally called Nicole and I'm like, I feel snatched. Like if I didn't feel snatched before, I feel more snatched now. I do. And you can actually feel it. Like you just feel tighter. Um, and it just looks better.
Yeah. And I think too, the Botox wouldn't superficially place like the micro talks.
It definitely does help kind of. Shrink those pores together a little bit, reduce some oil. So it does, it does tighten up a little bit. A
hundred percent.
Yeah.
Yeah. Um, is there anything more with Botox, Nicole, that we need to cover? Like, especially for a new patient coming in and for like new injectors?
I think we went over all of it.
So let's just talk about one last thing I want to discuss about Botox is that it's not a constant. So you're not gonna get from that injection day to that three to four months of this constant result.
Thank you. That's what we were missing. Yes.
Yes. So
basically what she's saying is, is Botox has a peak and it has depressions, right?
So some people think that they're going to be frozen or minimal movement. It's going to be the same thing the entire three to four months. That's false. So it fully kicks in. You're at your peak at the two week mark and then usually around week eight. So Two months after injection is where you start to get a little bit of movement and that is normal.
So Botox, this doesn't go up and then stay up here and then at the four month mark, just dip down. It goes up, it kind of plateaus and then it starts to go down a little bit and that's normal. Especially if you've been getting Botox for years and years, some people go, go, no, it's not working. It's not working.
Well, maybe you need a dose adjustment. You might need more. Um, but it's, that's a normal, normal thing.
Right. Right. And there's always different brands too. Like I always explain to people, if you've been using Dysport for this long, we can try Botox or vice versa. Um, but I find it funny too, because I had never gone more than probably four months without treating myself.
And like, I would even think sometimes like two months, like, Oh, it's worn off. Like, Oh my God, it's already wearing off. Look at me now, go eight months and let me know if you think your Botox was truly worn off at three months.
Do you ever like there's sometimes like in the morning, like I feel like I'm like, Oh, like I'm moving.
And then towards the end of the day, I'm like, wait, it's less. Yeah. And it makes sense because your muscles are more tired, right? You know, as the, as the day goes on, as the day goes on. And if you're more consistent with your Botox, your muscles will atrophy more. So it. That's why in the morning your muscles are stronger because they've rested.
Right. And then towards the end of the day, when you use it more, you have, you do have less movement because of the Botox it's working.
Right. It's doing its job. Yeah. But I think that's, I think we covered. Everything. Newbie Botox wise.
Fillers a big one. I mean, that's, that's, that's a huge topic. I feel like we could talk about, um, new injector filler and also patients as well.
I think the big thing. I wanted to start with Nicole with filler is patients coming in and worried that there's this, um, filler phobia going on, you know, and I feel like there's some people that are fear mongering out there saying, don't get filler, be natural, we don't need it, or it's going to make you look fake or a certain way.
I think a lot of celebrities have made people scared from seeing their pictures. And a lot of times it's surgery that's caused that I could be. Okay. Also injectables as well, but I do think surgery also plays a role. Um, but you know, these fillers, Juvederm, Restylane, Revinus, RHA, all of them, they're all hyaluronic acid based fillers, right?
We have hyaluronic acid that makes up our body, right? So when it's injected, yes, it's a foreign object, but it actually integrates within the skin and people don't get that. Like I think they think that when it's injected, it just stays like a blob.
Yeah.
But like through cadaver labs, when me and Nicole are, you know, we are injecting and then, you know, we're peeling back the face, the filler is integrated within the face and within the muscles or the skin tissue or the fat pads.
Right, right. And there's different ways that we inject. Sometimes we inject needle to bone. And if we're doing that, a lot of times it's to create structure and lift, right? We're using a filler. That is higher. And viscosity is more robust, higher G prime. We call it higher cohesivity. So it's going to provide more lift and contour.
If we're using a cannula or injecting a little bit more superficial than bone, then it's mimicking certain superficial and deep fat pads, right? And those superficial deep fat pads dissolve over time as part of the aging process.
You could explain the layers of the cake here, if you'd like.
Sure. I'll, I'll explain the layers of the cake
since you're talking about the deep and superficial.
So basically it starts with, and a lot of people wonder how they get jowls, right? And I like to explain it in this layered, this four layer cake, you have your bone, we have bone absorption that happens as we age. So we lose bone, which is a major structural component of the face that provides lift and structure.
Right. Number two is, is we lose the superficial and deep fat pads of the face as we get older, right? Right. Right. And number three are. muscles. Like I said before, our muscles are nice and tight when we're younger. So when we're nice and tight, then they're going to keep those fat pads in place, right?
Everything's going to be held up and they're going to be beautiful. But as we get older, those muscles start to with gravity, they start to become more elastic and then they start to stretch and they start to sag a little bit, which contributes to the jowls and more sagginess in the lower face. Number four is we lose collagen.
We lose elastin. Um, which make up our skin and those are responsible for keeping her skin looking tight and youthful, different environmental factors like sun
plays a
huge role in aging of the skin, um, on that visual aspect of aging.
Yep. Yeah. And there's certain fat pads that we target. the deep ones are going to be underneath the muscle.
The superficial is going to be above the muscle. So depending on what you're trying to treat, like before you're saying lift and contour and things like that, like when we're, when we're back on the cheeks or even in the front a little bit, we're aiming to be deep and in that deep fat pattern on the bone.
Um, and then in certain areas, like maybe closer to that medial cheek or under eye, the lip, we're going to be more superficial, um, or like the laugh line area might be a little bit more superficial. So there's. there's different techniques in different areas to create different results.
100%. Yeah.
Knowing your anatomy as a new injector, I think is super beneficial because obviously there's certain areas on the face where if you are injecting superficially, it might give a poor appearance to the area that you've treated.
So kind of knowing best practices and investing in your training and things like that can be really beneficial. And as a patient, I think There's no harm in interviewing your injector or doing your research beforehand and really, you know, finding out and making sure, sorry, a patient just tried to get in and it distracted
me.
Oh my God. Scandal.
No, we have a sign on the door, but it's all glass. So like, you're like, hi, Mike. Um, but to lead us back into filler phobias, like it's kind of, you know, find an injector who's before and afters align with, with what you are looking for. Um, and then, you know, doing your research on them, but there's no need to be.
Afraid of filler if it's done correctly, even I mean, I treat multiple people a day with 5 to 6 to 7 syringes and you still look like yourself. You're not going to look over done. You're not going to look puffy. There's a way to do it. And I think. Especially like some injectors online right now, it's so, there is a lot of fear mongering and there is like, Oh, you know, you shouldn't be treating this said area, uh, when in reality you may need to, you know,
and we all need filler or losing volume.
Exactly.
Exactly.
Like, I'm sorry. Like, you know, if you want the non surgical approach to, you know, for anti aging and for improving jowls or, you know, sagging, like you, you're going to need filler and it's just about. Like you said, interviewing different injectors or different providers, and if you feel or if you trust them at the end of your consultation, go with them, because I know if you're sitting in mine or Nicole's chair, we're never going to make you look fake.
The other thing I wanted to say, like, obviously I started injecting almost six years ago, and I remember when I first started, I mean, I wanted to know everything. I saw all these people on social media, all these injectors. even like you, Nicole, probably. And I didn't even know you yet. And I'm like, Oh my God, she's so good.
They're so good. They get it. They're busy, you know, and I wanted to know everything. But at the time I was, I needed to feel what a syringe felt like in my hand. I needed to feel like what bone felt like, you know, as I was injecting, or if I was using cannula, what it felt like to be in the right plane or what to do, what to do with my non dominant hand.
Things like that. I mean, there's so many things with filler and all I can tell the new injectors listening is to be patient and you're going to want to rush. I wanted to rush to be the best, but that's going to make you an amazing provider and ejector. Okay. And just know that you will get there and that.
It's okay when you're first starting to just familiarize with the syringe and, you know, okay, I'm on bone. Okay, great. Maybe you're not in your head thinking of what, you know, what the anatomy underlying anatomy is. Or maybe you don't even know what it is yet because there's just so many things. Yeah. Yeah.
But. You know what? I remember when I first started, I'm like, okay, I'm injecting the cheek. I'm on bone. I aspirate for three seconds. I inject no blood return. We're good. You know, those are safety things. When, if you're on bone, you're usually safe. Yes. Yeah. Considered safer. Yes. Yeah. And if you're using a cannula, right.
I think, what is it? The percentage it's like 70 to 75 percent lesser chance of occlusion and getting blood return, but you know, the injector is watching. Um, you know, more advanced or newbies, I've had a positive aspiration with, um, using a cannula. So it can happen too.
It's never 0 percent with that cannula.
You always want to still aspirate. And with the cannula, the thing is too, you're always moving for the most part when using a cannula. So a moving needle or a moving cannula is always going to be your safest. Cause if you're thinking about if you enter and you're, when you enter, you're in an artery or a vessel.
you move that around, basically. you're going to come out of it. So even if you do drop, it's probably going to be a little bit that the body can clear itself, you know, so a moving needle or a moving cannula is always considered your safest boluses are always going to be a little bit more of your high risk.
Um, but that's why we aspirate for a good amount of time and don't do too high of a bolus
also. And I was. Um, told us before in a training and it kind of makes sense and it was actually in a sculpture training that and actually how I inject my sculpture and I actually less than the chances. I use a needle when I inject sculpture.
There's some people that use cannula. I, you know, with the new reconstitution with. Sculpture is actually great. Like, I don't have issues with, um, any of the sculpture particles clogging my needle or cannula, but I will say that I have more clogging of the cannula just because it's longer, but I use a 25 gauge one and a half needle when I'm doing sculpture.
And actually, as I'm injecting sculpture, I'm actually I insert the needle under this into the skin and I'm in that subcutaneous layer. Okay. And I'm actually injecting pushing on the syringe as I'm. Okay. Integrate and retrograde constantly as I'm moving. And if I do that, you're actually pushing vessels away.
You know what I'm saying? So, even like, if you're back to your point about injecting filler, using a cannula, if you're constantly moving and constantly pushing on that syringe, I think that'll also push some. of those vessels or capillaries away, right? So that will hopefully lessen the chance of a vascular occlusion, which by the way, with sculpture, you will not get a vascular occlusion.
There's no worry with that because the particles are so small and usually it usually just dissolves and there's no issue. Yeah.
Yeah. Yeah.
Usually clears. Yeah.
Um, I want to go back and I don't know if Joey will want to edit this or not, but I want to just show and he could like put the actual picture and I want to just show Like what six syringes looks like?
Oh, yeah
So for our people again that watch on youtube or instagram tiktok Um, I just want to show a transformation of six syringes so even though like it might be your first time coming in and I I quote you six to 10 syringes. Here's what I think you may need. And you're like, Oh my God. Then I pull out my little handy dandy book of before and afters, but this is someone I just did the other day.
It's backwards on here, but obviously this is the before and this is the after, but like still looks just like herself.
Oh, yeah,
but you can see such a difference in she just looks so much more rested and youthful and contoured. So it's not like you're changing your whole appearance. You're just you're just supporting and replacing volume that they've lost with time.
It's amazing. I know. And filler, filler should never look fake. We're just enhancing enhancing your beauty. I actually want to show if you're showing yours, there's another one that I want to show. And you said yours is six syringes. Yeah. Yeah. So I have this patient that, you know, we'll show you if you're watching on YouTube.
Um, this patient came in, I did eight syringes on her about three or four months later, we did another nine syringes on her. Okay. She had a very thin face, Um, she needed volume support. We've done sculpture, she's done, she's now doing RF microneedling to address her skin, but it's been a journey. Um, but she's one of my favorite transformations, and here she is, here.
I'll kind of move this up a little bit.
Oh my god, amazing.
So obviously, this is her before, and this is her after.
And such a difference in the jawline, the jowl, the under eye, like that's what people forget too, that lid cheek junction, like, oh my god, it's beautiful.
Nicole, I didn't even treat her under eye.
But you treated her cheeks and it helped. And
it helped, right? And it's because, am I right, like in this, just to explain to our audience. If you're treating the midface and treating the anterior medial cheek or even just the structures around it, the ligaments of the under eye will then be supported because what's happening is as we age, and sometimes it's genetic, some people are born with hollowing, um, you know, they have a genetic predisposition, but also the aging process, just losing your superficial and deep fat pads in the area, then the ligaments kind of flatten and then it accentuates that hollowing under the eye.
Exactly. Yep. So even a lot of people, cool. Aren't true under eye candidates. And if we do it, it can make it worse. And if we're saying no to you, there's a reason we're saying no to you, but we can treat your cheek and we can treat right below those ligaments to help support that area and pick everything up.
And it does help prevent further aging down the line too. So it does make a difference for sure.
We should talk about lip filler, Nicole, because I feel like one of our main audiences. Is new injectors and new injectors are doing Botox and lip filler all day, every day. Yeah. Right. And it's
kind of where everyone starts is that Botox and let me tell
you, lips are hard.
They're not easy.
They're not easy. I remember when I first started, I'm like, okay. You know, there's no structural support. You're not injecting the bone. You're trying to make sure you're in that superficial plane. Um, and you're contouring, you're shaping. It's a lot. Like I, it was, this was a few, actually it was, it was last year when I was training, um, my injector, her name's Alicia at my office.
She's an RN and she's incredible
by the way.
Oh, thank you. She's, oh, she's amazing. She's grown so much. Um, and she, I was training her on lifts and like she almost, you It, it almost, I almost like reeducated myself on lips and I remember I, in the beginning I was like, oh, they're so hard. Then I got, I thought, good at them,
And then you get so confident, you're like, oh my God. They're like, easy. Like you've had, once you've had a few outcomes, you, you get a lot of confidence, right? Yep. And then people coming in and you get, you're starting to get known as the lip person, right? In the area. Like you, Nicole, you were the, in your area
was Yep.
You know, of course, sometimes, you know, you get complacent and then I know, and I wasn't complacent, but just retraining with Alicia made me almost like, wow. You know, the way we inject lips are way different than we did six years ago. So different products. Some of the products are even different. Some of those products we can still use, but you just have to depend on the type of lip that you have.
Exactly. Um, but anyway, yeah, pretty, pretty cool.
I think the reason lips. become such a big thing right off the bat is because the anatomy is a little bit more simple in a way. The problem is it's, it's a high activity area. So the way that you inject also really matters. You obviously don't want to be too deep.
If you get any product in muscle, you're just, they're going to look terrible. Um, but I think Newer injectors have an easier job of kind of stabilizing their hands in that area, whereas like doing cheeks or jawline or chin, it's a little bit more different because they're not laid back. You can't, you can't use their face to rest on.
Like, you have to really figure yourself out there. So I feel like that's why lips is, is where everyone kind of starts and then builds from there. But definitely, yeah, definitely. It's funny
also. So, um, doing three cadavers this year, I realized how close the supra and inferior infralabial arteries are to the vermilion border.
Yes. Now, everyone's different. There's some that are, you know, it's a little bit above, so you're fine. But let me tell you, I think pretty much, I think two out of the three cadavers, the superior and inferior labial arteries were literally right in the vermilion border, if not like within the
lip.
And I, I left there and I'm like, Oh my God, I am literally right there, the oral commissure.
I am always, always aspirating and I will tell you, I aspirate more now in the lip than I ever did before.
Yeah, I
do. I mean, in certain areas I don't, you know, but definitely when I'm down towards the oral commissure right here, I'm, I'm always just, just, I want to sleep at night. Yeah. Yeah.
I always aspirate in the oral commissure in the lip.
I don't at all, but I always examine the lip. to make sure that I can't visibly see any pulsations or yeah, exactly. Yeah. Yeah.
And I think also too, I mean, it's scary. Like sometimes you'll get a bruise and it looks like a vascular occlusion or you don't know what it is. Obviously go with your gut. If your gut is telling you to do something, just highland exit, dissolve it, start fresh.
I mean, like I said, you want to sleep at night, but there is a difference. If you have a vascular occlusion, it Literally, it'll turn dusky. It's a different color. That's what I tell people
in trainings. They're like, well, how do you know? I'm like, you will know,
you'll know it's different. You will
know a bruise has that like warm purple center, and then it might have like a white hue around it.
But like, if you have a true occlusion, you, you will know the skin looks very dusky. It looks modeled and you can tell like, right. Right off the bat, like I'll never forget when I got an occlusion after doing, um, voluma in the cheek and then I did skin vive on top of it and I got a little occlusion like right where the transverse, I'm guessing it was the
Was this like a little bit of compression though too?
Yes, yeah, and it cleared itself. I just
did aspirin warm compress. Yeah. Um, and it was fine, but like. You're injecting and you're like, Oh, that doesn't look good.
You know,
you, you can tell, you can tell. And again, that's never to scare anybody, especially our patients that listen. It's that these things happen.
A lot of the time your body can clear it on its own, even if it's not caught. But if it's severe enough where it would require
And injectors, I would always keep at least 12 vials of hyaline X in your office at all times. Yes. Okay. And you know, community over competition. I mean, be really friendly with all of your directors in the area because if you ever need anything, give them a call in nine times out of 10, they're going to help you 10 times out of 10.
They're going to help you.
And it will happen whether, whether it's hyaline X or something else, like you, you will need them. A friend in the area. Oh yeah. So make that. Oh my
god, Nicole, like this holiday season, especially with the UPS strike and stuff. It was nuts. I was having to reach out to other vendors or, you know, medical suppliers to get supplies.
It's crazy. Yeah. Yeah. No. So it's,
it's smart to have friends.
Yes.
Um, so we touched base on Botox, which is your neuromodulator. It's going to paralyze the muscles so that you don't create lines. We then touched on filler, which is going to be your hyaluronic acid. So that's really just going to create volume, um, you know, help with lights and shadows.
Now I want to get into sculpture, bio stimulators. PRP, things of that nature,
hyper dilute radius, all the things. Yes. Yes. Yeah.
So I personally don't work with hyper dilute radius. We are getting into sculpture, which I'm going to make John come and train me on. I don't.
Oh, exciting. I actually don't do hyper dilute radius.
Okay. Yeah. Yeah.
I figure you can use sculpture. Um, it's all very similar and then you're not having to dilute it on your own. I mean, don't take my word for that, that radius may have its own perks, uh, but I just prefer the ease of one product
from what I've heard from patients, right? Sculpture, right? It does.
It doesn't kick in right away. It takes at least two to three weeks to start kicking in and it maximizes in three months. A hyper dilute radius is. Basically, I think the reason why some providers like it more is it gives patients a little bit more of an immediate satisfaction, right? Okay. Um, but, but then it also has that collagen stimulation as well.
So then you're going to see more after that, right? Right.
Radiesse is a filler just for the listeners of patients that may not know, or even newer injectors that may not know. Radiesse is a filler, so it has a hyaluronic component, but it also has a calcium component. So it's not Okay. technically fully dissolvable.
It does have its own antidote. It is a bitch.
It's a bitch to dissolve. Yeah, it really is. And I've had some patients that have had hyper daily radius and some with sculpture. I'm going to say both that have developed a little bit of nodules within the skin, whether it's their neck or their area. I've seen more though with hyper daily radius and that's why I don't carry it.
Yeah,
I am not negating it. If you do it great. There's some people that have no issues with it. You have it down. The post care is perfect. Great. I just for myself. I would, I much rather sculpture for my office. Yeah. Yeah. And basically what sculpture is, for those of you that don't know what it is, whether you're a patient or an injector, it's a bio stimulator.
So it's poly L lactic acid is the generic name. It was actually made, um, I believe in the late eighties, early nineties, um, for, uh, uh, patients with lipodystrophy or like AIDS patients that were very gaunt. Um, and basically it's a powder and it's. Uh, reconstituted with sterile water. Um, and then we inject it under the skin and basically that molecule basically stimulates the body to, in layman's terms, to produce collagen and elastin, which are pivotal in, um, keeping the skin firm and tight and youthful, but also it restores some natural volume as well.
And it does usually fully kick in in three months and it lasts as long as two to three years. Which is great for me and my practice for injectors that are listening. I like using it in conjunction with fillers, especially it's a nice icing on the cake. You know, once you get patients looking great with neurotoxin, like your botox is poor and then filler.
I love doing sculpture just because. It really does give the skin a really nice glow and it helps to restore volume really well, sometimes in that submalar area. So the area between the zygoma and the jaw, and it's really nice for some of those fine lines. Um, kind of those right through here in the cheek area as well.
We can use SkinVeve there as well. I was just going to say that's a
good option. We
love SkinVeve.
But SkinVeve won't create that
reproduction
of that collagen, correct?
Leslie Fletcher was watching. She was saying that you're going to get some neocollagenesis from it. There are studies that back it up and I'm aware of that.
But it wasn't what
it was created for. So it's kind of what we're seeing as we're using it. I personally love SkinVeve and I think for people that do have those more like radial lines and they smile and things like that, it's really great to kind of chase those a little. Um, and I've been using it a lot for acne scarring.
And specifically on myself, I can see now that I haven't been able to have skin beef and before I got pregnant, I probably hadn't had it in a couple of months. So I've noticed that it's fully worn off and a lot of my acne scarring is more visible now than it ever was because of the skin beef. So
I don't know.
I think you're very hard on yourself, Nicole. She's like, John, no, she's literally perfect. And you're like doing so much, so much. skin care right now. Like pregnancy safe skin care. Um, I am, I'm
trying to make sure that I do everything I can in the meantime.
All of this like regenerative medicine, this is, you know, our good friend Olivia Salmon who lives down in Nashville, Tennessee.
Um, she is. I feel like huge with regenerative medicine, everything that's coming down, you know, in the pipeline, especially that's overseas in Europe. We're a little bit behind than Europe. They're doing, I think, a lot more over there, but it's, it's starting over here and, you know, obviously, sculpture was the start, but then PRP, PRF injections, which is basically taking your own blood, it's We spin it in a centrifuge and then it basically strips it down to your own platelet rich plasma or platelet rich fibrin, which has your own growth factors and stem cells and patients are, you know, we were doing it, the vampire facial that Kim Kardashian started, right?
Like, you know, she was, you know, doing microneedling and inject and they were microneedling in her own PRP. And that's kind of what started that. Um, and then people said, well, yeah. If it's simulating college in that way or decreasing downtime, why can't we inject it under the skin? So patients are now, like you, Nicole, like you just taught me how to do PRP under eye.
Um, and I'm starting to do that in my office because not everybody is an under eye filler candidate. So we're starting to do PRP under eye for them. And that is helping with the creppiness under the eyes, some, some natural volume. Um, and patients are loving that.
Yeah. No, definitely. And it's, again, it's your own growth factor, so you really don't get much better than that.
And now we have an option, which it doesn't have an FDA indication yet for under eye injections or injections under the skin, but PDGF, which is platelet derived growth factor, which is, um, it was made by a company, Ari Essence, um, it's kind of the newest in regenerative medicine. And it's kind of taken.
the US by storm. I think, um, we're using it now at toxin pow. And right now it's FDA approved, um, to use on compromised skin after radiofrequency microneedling, um, after erbium skin resurfacing, things like that to decrease your downtime and what platelet drive drive growth factor is, is what it is. It's so basically it was formed to actually regenerate.
Um, skin tissue for diabetic foot ulcers, which is pretty amazing. And then orthopedic surgeons took it and they were using it to augment bone or fractured bone and they were finding that bone was healing much quicker. Now it's in the world of aesthetics and it's being used topically after those, um, those skin resurfacing and radiofrequency microneedling treatments.
basically it's got a thousand, it's a thousand to 3000 times more potent. Then PRP or PRF alone. So it has a thousand to three thousand times more growth factor than your own PRP, which is great. So, and people are now using it
to get your,
and that's the huge thing. So if you don't want needles, needles, right.
You know, taking your blood drawn. Some people get really squeamish with that and you can have PDGF now, which a lot of practices are offering.
Yeah. Yeah. Well, I'm curious to see like a couple months down the line. I
had it done and I'll have. And I will have to show anyone who is watching us on YouTube will show my before and after.
So I had radiofrequency microneedling done in November and I immediate, and I'm more pale skin. I have, I'm a French descent, so I get very, very reactive and very red. And usually after RF microneedling, I'm red for two days and then pink and then back to normal. So kind of like two days of downtime, I did PDGF and you leave it on for six hours after the treatment.
I woke up the next day. It looked like nothing was done. Like my husband was like,
And it's great for people that can't really afford the downtime, PDGF is wonderful. And I've tried PRP on top of it. It's PDGF is just so superior. It's incredible.
I actually called John after that and I was like, talk to your rep. Can I use this while pregnant? Probably not. The answer was no, but.
And then in our office, we're going to start, um, injecting PDGF in this, in the scalp to stimulate hair growth as well, just because it has that thousand to 3000 times more potency than PRP.
So there's a lot more that's going to come to it. I think other practices are starting to inject it, injecting it under the eye or mixing it with fillers, SkinVeve, things like that, and injecting it superficially. Like I said, that's off label and it's, I think it's in, it's in the studies right now. People are starting to work on that, but I can't wait for more data to come out from that.
Yeah. Yeah. No, it's going to be very interesting. And I'll always, I always love to throw my little two cents. Always check your states,
check your states, laws and
regulations before you add anything in topically. It's usually fine. But if you are going to start to think about injecting it, I would, I would just talk to your, to your lawyers first.
Yeah. Um, I don't know, to kind of end with all of this, I think that. It's really important for patients that are watching or watching or listening to us that there you're, you're not going to cure everything in one office visit. It's impossible. And a lot of patients come in and they want one treatment that's going to get rid of all their problems.
And it's honestly going to take patience and time to solve your problem. You're going to see, you know, some improvement. you know, with each session or each treatment, but it's a journey, right? I, we, we all get every injector. Every provider gets it. It's expensive. These are all out of pocket things, right?
But if you're, if you're going to an injector and they're saying that they can get rid of all your problems in one office visit run, it's not going to work. And they're lying. And this comes, comes from experience. Right. And I have a couple of patients to this day that, you know, they're like, you know, I thought I'd see more after, you know, three sessions of microneedling, but they have.
years and years of sun damage, right? But they didn't want the downtime of a skin resurfacing, surfacing lasers. So we started with microneedling, right? So it's like, yeah,
it's a journey and you have to be willing to not only invest the money, but the time, you know, but the
time, yeah.
And. I would always say, just remember that there's five layers.
It's not just one layer, you know, you got your, you got your two layers of fat, you got your muscle, you got your skin, you got your bone. There's so much that goes into it. Um, so your regenerative medicine, your lasers, your skin, your fillers, your Botox is all going to work together. And not to mention. Are a little teaser for our next episode, but focusing on your holistic wellness.
So you know, like really your hormones, any kind of aging, checking your blood work, eating healthy, you know, making sure you're hydrated. There's so, so much that goes into it.
So much, so much. I agree. Oh my God. Well, this was a really fun episode.
I feel like. We went over everything and I hope we explained it like, I
hope we explained it well, kind of explain it in layman's terms.
So that way anybody who has never heard of these terms or, you know, anything that would understand it. And if there's ever any topic for any of our viewers that are listening that you want us to talk about, just shoot. The filming in podcast, a DM on Instagram. Um, and just let us know what you guys want us to talk about.
Yeah. And also find us on Instagram and shoot us a dm like eventually we'll respond and, 'cause we're always looking for new topics. Yes.
Always. Always. And if you liked this one, I think you would love our Myth busters one that's, oh my God, a couple episodes back. Uh, so if you're just kind of. Starting out or just learning as a patient or provider, the myth one, the myth busters is a really good one too.
Well, thank you guys for tuning in to this week's episode of the Fill Me In Podcast. I'm Injector John
and I'm Aesthetic Nurse Nicole. Till next
time. Bye guys. Bye. Love you.