Injectables

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Hi friends and followers! Here I am with my mask on and I am doing this to demonstrate how very important now our eyes are going to be. And, because of that I want to have a dedicated discussion with you about any ageing treatments around the eyes. So, as many of you all know, I love to inject and I love to use devices and more importantly, I love to combine things so that I can really individualise a person’s treatment depending on their needs and what their goals are. And, I want to discuss things from beginning to end about the eyes. The firs thing I want to discuss is eye care. The most important thing is when around your eyes, never rub. Don’t be at all harsh. Be extremely gentle with how you remove your eye makeup and your mascara. I strongly believe that you should avoid using waterproof mascara because it is much more difficult to remove it and there is a tendency for the eyelashes to fall out. Now, in regards to eyelashes, I think everyone knows that Alphalash which has been on my portfolio of products in my office for about 5 years now is a game changer for most of us to help our eyelashes get long and lovely, thicker and longer. Not just longer, but thicker as well. And you know, eyelashes are important because eyelashes define the eye area and give you a look that you are awake and alert when your eyelashes are very long and thick and flushed outward and forward and curled. So this has been a very important product in my practice. You can also use it on your eyebrows as well – it workers faster on the eyelashes usually you see improvement in 4-6 weeks with the eyelashes and with the eyebrows it takes at least 3 months but it does work for them also. And it is important to watch out with eyelash extensions because when you put the extensions on the eyelashes, that glue weighs the lashes down and makes the lashes more prone to breakage and falling out. So I am not against them per se but wearing them all the time and using them as your method of longer lashes in the long run is not good for your lashes. Just like nails. Allowing your nails to grow naturally is always better than putting treatments on it than involve a lot of acetone and drilling and filing and buffing which can damage the top of the nail and weaken the nail over time. So as is with many things in life, a lot of things will give you a short term benefit but in the long term it is not always a good idea. ou know certain things that we do to our hair can damage it. Be aware and if you are using extenders, I recommend you start using Alphalash now so that your lashes that grow out will be stronger and won’t fall out as easily. In addition my other go-to product for ageing around the eyes, since I am older, is the Root of Skin MDI Preparation and the reason is this, this has the stem cell derived growth factors that older skin needs in order to behave younger, to give it a firmness. One of the things that you might want to do, if you suffer a lot with dark circles, is look at your global health in your sinus cavity. And what I mean by that is if you have a constant post nasal drip, if you are snoring, if your nose is stopped up easily, you may have a sinus condition that is actually causing venous dilitation in the sinus tract. It can actually cause a backup of the venous system and your sinuses will cause your eye area to be both puffy and darkly colored. But the darkness is not pigment which occurs from sun damage or by the way from rubbing. Because when you rub your eyes from allergies, when you rub the skin, it thickens and it darkens. And that’s not a good look for around your eyes. So, address any sinus issues you have. One of my pearls is to use a preservative free saline eye flush twice a day and to use a saline nose levage if you will, it can either be the arm and hammer, the kneel, it can even be air and just spray saline twice a day at least and then blow your nose. What those things do is they allow the pollens and the irritants to be flushed out of the eye and the nasal cavity before they can trigger that immune response that causes eye itching, nose stopping up, nose running and the symptoms of seasonal allergies which can cause dark circles under the eyes. Of course, another cause of dark circles under the eyes is having a redundant and a weak protuberant fat pad underneath the eyes and that causes a bulge here and an indentation here. Whereas I can improve the indentation with my technique with filler, the optimal treatment for that is actually to see a Board certified occuloplastic surgeon and to get that eye fat pocket removed or at least repositioned and to tighten the muscle and the skin and give you a very long lasting result. When I do fillers for people who really need surgery, I am very clear and explain to them that this is really a, what I call a base hit, but the surgery would be a home run and I often will refer people to a reputable Board certified occuloplastic surgery person for that procedure. Now, let’s talk a little bit about devices around the eyes. So, in my office as you know I have a lot of devices and the good thing about that is that I can cherry-pick them and I can choose the device that’s good for your needs and around the eyes we do radiofrequency, we do both the axillis, radiofrequency and ultrasound combined and we also do the Thermage FLX, the Thermage Flex. The Thermage FLX is a relatively new Thermage. So when you hear about Thermage from your provider, make sure they have the FLX because that one really has been a game changer for a non surgical technique to tighten the upper eyelids. We put a shield to protect the eye and we actually treat over the eyelid and there is no downtime for this procedure because with radiofrequency, remember we actually bypass the skin and go beneath the skin to tighten the deeper dermal structures and so Thermage can be used on all skin types, so can Axilis and these are my go-to for tightening. Now some times people have a lot of crepiness and a lot of sun damage around the eyes and for those patients we will often either use the Fraxel Eyes which is a special tip and all devices that are fractionated lasers are not Fraxel, just like every tissue is not a Kleenex.You want to use Fraxel. Fraxel is the one and I know it’s been around for a long time but it has been around for a long time the way Botox has been around for a long time because they are good, they work. And doctors are very comfortable, because we really really have more data on publications about Fraxel than just about any other device you can think of. And its indications and stuff, it is truly an amazing device. It can be used on all skin types and so Fraxel is a good option but I also do the CO2 laser. I use the Active FX and that’s a marvelous procedure when you have kind of a lot of brown, a lot of crepiness, a lot of looseness, a lot of wrinkles. Sometimes we have to go straight to the CO2. There is downtime with that one but I call it my big gun which I sometimes pull out and I always do the CO2 resurfacing. I do not delegate that procedure because it is a very tricky procedure and you want to make sure that the person is doing has a lot of experience. Now, beyond the devices, I want to mention what I do with fillers around the eyes and why. Now, I can tell you that it is very individualised. It is not a one-size-fits-all and that’s why when I say be sure you are seeing a Board certified dermatologist who does all of these injections, it is so important. Because the most important thing about any of these is the experience, not only doing the procedure but the experience to know when to do it and when not to do it. And, no procedure is without complications. So you want to have someone who does enough of these things that they can recognize a complication early because with most complications early intervention means no long term sequel , no long term problem, no long term complication. And, it takes experience to understand what you are seeing and when there is a complication that you need to jump on. So believe me, we don’t ever try to whitewash things. We are very honest with our patients and we try to give them their options and guide them with their decision and I feel always very comfortable making the decision because you know I am about to start in July my thirty seventh year as a cosmetic dermatologist and you know you learn a lot over thirty seven years, believe me. So these are just some of the things that I do and I emphasise that this may not be some thing you need but you need to know the myriad of things I do in my office. So one of the first things that I do when I look out the eye area is I look at the temple bcause a lot of people don’t realize that a condition called temporal fat pad atrophy causes the temples to sink in and the reason that’s bad is for the eyes is because when that goes, you lose that lateral flare to your eyebrow and that lateral flare for a female is essential. It is a very very important aesthetic look. And when the fat pad goes away, that eyebrow that goes from here and then it goes straight down rather than flaring laterally. So you must have your temple reexpanded appropriately. Now, what do I use? Believe me, I use what you need and the most important thing to realize is that this is a very vascular area and the doctor has to be mindful about safety measures to make sure that you don’t have a serious complication. So, I would say sometimes I use Sculptra but I have used HAs and I have used Radiesse in this area. And often what I love about Sculptra is it affords me a better opportunity to fan it a little bit behind the hairline safely to give even more expansion of this. And, believe me, at almost 66 this area in here on me has been injected several times but it lasts a long time there. That’s the bonus is when you get your correction, it is very long lasting. Now, sometimes the temple doesn’t need it but the tail of the eyebrow does so I have a technqiue where I just do filler in the tail of the brow. Again, I don’t know what you need. I am just telling you some of the things that I do and I decide when I need to do what. So sometimes I do tail of the brow. Sometimes I will do a technique for these lower crow’s feet are a boog-a-boo to try to get rid of. Because with Botox, when you are older, you can really significantly improve your upper quadrant of crow’s feet because when the way I inject, I get that lateral and superior aspect of the obiquillary saculi and by the way when I do that enhances the lateral flare. But the lower crow’s feet are significantly impacted by the zygomatic cosmature muscle which goes from here to here and it pushes and it is what give you your big cheekbone when you smile but it also as you get older causes your skin to scrunch. So for the lower crow’s feet, you almost never can get rid of it with Botox or Jeuveau. And Dysport in this area is really risky because of its diffusion patterns, you can easily not count someone’s smile if you are injecting in this lower area with Dysport. Whereas, Jeuveau I find is the most precise meaning that it diffuses the least. Then Botox, Xeomin is very similar to Botox, in my opinion. In its clinical effect, it just sometimes takes a little bit more, in my experience, than Botox. And, it often doesn’t take last quite as long but Xeomin is an excellent product and very very safe as is Botox and Jeuveau in this area. But even those are not going to give you a home run when you are older. So what you have to do is this is where we use our devices, you can do the genius radiofrequency microneedling, regular non radiofrequency microneedling will help a little bit. In addition, the Fraxel will help and a product that I like for these...

The most important thing in a patient treatment is the ‘why?’. Why are we treating the patient? With different physicians, the ‘how’ can vary. Do they use a needle? Do they use a cannula? The depth that they inject. The ‘what’, which fillers chosen, which neurotoxin is chosen. Very personal decision, very much like a chef in a kitchen as to what dish, how they prepare it, what ingredients and the proportions of the ingredients. But, the most important thing with a physician-patient relationship with a non-surgical rejuvenation is that you agree on the ‘why’ and what the patient needs to achieve it. So, what we have here, the patient who’s never had any filler before. She has a very narrow face and it is very long. She’s got loss of the fat pads here, here, here, here and here. In addition, she has a tendency to turn her mouth down and she has a tendency to frown and look a little mad. So what we want to do is we want to expand the lateral face on her, do minimal work on the central face and to give her a smoother, more relaxed and refined and somewhat of a serene look to the face. So we are going to start superior and I am going to start with using Sculptra in the temple, the use of Sculptra is important to understand what the patient that this is not going to give as immediate effect as the gel fillers. But, I like Sculptra in this area because of its safety. We have the assistant immediately hold pressure to each area. Now, the next thing we are going to use, we are going to use RHA 4 in the cheek. Chin up for me. Now, the way I decide where you need it in the cheek is several ways. If you notice when I do this , there is a depression here. See it comes up here but it is depressed here. So that tells me that there is volume loss in this area here. In addition, smile. When I smile you get a cheek projection here but not here and she is a little flat here and we will get to that. So what I like to do with the RHA4 is to stay in the subcu. This is a product that is very soft and natural. It has nice flexion. I don’t like to bury it on the bone like we do with the Voluma. And, there is a reflex with each injection. And you are going to hold here, lateral it. In addition, we are going to put just a little bit right in this mid cheek spot because she has a tendency to flatten out here. We are just going to put a drop there. That’s going to start to make the tear trough look and feel better. Now, the next thing we are going to do is we are going to use the Voluma along the jawline. The reason I like Voluma here is it is firmer and gives a little bit more projection and a little bit more structure. So what we are going to do is destruct, as if to build a jawline laterally and Voluma is great in that you get a very nice result immediately and it seems to look even better, about 6 hours later. And that’s going to create more of a jawline for her and then we are going to do a little bit here and the purpose of this is to give her a little more angularity to the jaw and a little bit more lateral projection. Now the next thing we are going to do is we are going to use a cannula, to use the Juvederm Ultraplus in the peak of the nasolabial fold and the reason I am doing a cannula is for safety purposes in this area. I also like that I can go different depths without changing the needle position so we are going to go a little bit more superficially. Now the nice thing about doing this first, it is going to give her some anesthesia for when we do her lips. With the lips today, just because I am in the mood, I am going to use a reslain kit. Reslain kits is rather new. So I don’t have long term experience with the duration. We don’t want to give her a lot of lip. We don’t want to emphasize her central face. We want to emphasize her lateral face. But we want to soften everything and you look softer when you have a little bit more lip as you age. So what we are doing is we are just doing in the subnucosa, just to build a little volume, a little projection. And the lips which can be a more painful area is usually very well tolerated with a combination of the topical anesthetic that we use. We also have the patient using a vibration device. It is called distraction therapy and it helps divert the brain’s attention away from the area that’s being injected. Now we are going to put a little bit of the Voluma now. Notice that I have been working from superior to inferiorand then working on the lateral face before the medial face. But, we want to give her a little projection of the chin here. So we are putting a little Volume right in the tip of her chin because with a woman, you don’t wan to do the pre jowl sulcus marionette without doing a little in the chain. Because if you do you can square off that chin and make it look more masculine. In addition, we are going to use a little bit of the kiss in the corner of her mouth to give it a little bit of lift. Now we are going to do this side of her face and then we are going to do the other afterwards. To shorten the video. But I think you can see the better projection, here and here and a little bit better lip on this side, than on this side. Now, we are going to Jeuveau and we are going to do the Jeuveau to give her a little bit of a lift to the brows. Would you make a face like you smell something unpleasant? Everybody’s muscles move differently. So what we are doing is we are doing her nasalus and her persarus first. It is important not to ignore those when you are injecting. If you don’t treat them, you can recruit them and get them stronger. Now like you are mad at me. And then you want to grasp a muscle and make sure you are above the orbital rim. Push it up and above the orbital rim. Now she has a low forehead, so we are not going to do anything to her forehead today. We are going to see how much of a brow lift we get and then we are going to adjust the forehead later. Now, would you pout for me? Notice when she pouts, she pulls the muscle down here, so we want to inject that. And, would you flex your chin like your really mad at somebody. I am going to do this side first. (not clear) We want to grabt that platisma muscle and also right here where the jowl is, is also a submandibular salivary gland that when you inject it will shrink and it will make the jowl look less apparent.

This is where we use our devices. Well you can do the Genius radiofrequency microneedling, regular non radio frequency microneedling will help a little bit. In addition, the Fraxel will help and a product that I like for these in this area is called Revax 7, it is by revision. And it has peptides to strengthen the skin but it also has some activity like a Botox to relax the muscles. This is an excellent area to improve things with the dermal placement of Botox. In an Aquagold like device that stamps the toxin in a superficial manner and it doesn’t penetrate into the muscle where it is going to have that effect is really just in improving some of the hydration in the area. Especially when you mix it with a little Beletero in the bottle. I love to do that procedure in some people. The other thing we do sometimes is we take a hyperblended hyaluronic acid, that means I thin it out. And I will (not clear) this area a little bit, right beneath the dermis to stretch the skin without building the cheekbone. It doesn’t go into the muscle to give you cheekbone, it is going in the skin to help refine the skin in that area. So that’s another little trick I do in some people as well for the lower crow’s feet. Obviously we all know about the tear trough. But one of the lectures I gave back about 10 years ago was about placement of filler in the tear trough and I emphasized that the lateral tear trough, if present is much more important to correct than the medial tear trough. When we concentrate filler medially, whether it be in the nasolabial fold, the marionette or in the tear trough. You run the risk, if you are not totally assessing the patient of the patient looking like their nose is wider, that they get that rolled sort of (not clear) or monkey look by completely overcorrecting the nasolabial fold. With a woman, when you inject a lot in the pre jowl sulcus, in the marionette here, you can cause the chin to get wider which is masculine. And so you want to make sure that from here to here, on a female there is what I call angularity. An angularity means that it is a little bit on the sharp side, it is a little more feminine. Now, when the cheekbone is high and you get older, that sharpness can get overly sharp and it goes from being defined and angular to being gaunt and tired looking. So that occurs because as we age, the cheekbone itself, it’s not that it gets flatter, the fat pad flattens, the cheekbone stays the same but what’s happening is that the orbit is lengthening and getting wider and the cheekbone ends up by being narrow. And that gives you this sharp drop off right about here. So one of the tricks, this is nothing to do with the eyes, but it is a trick that I use that I want to at least mention. On making sure that the inferior aspect of the maxilla is softened so that you can maintain your cheek but lose some of the gauntness that you can get when you are older, when your cheekbones are super high. And don’t let someone make you look like you have golf balls in your cheekbones. Please talk to your doctor, look at their ‘before’ and ‘after’ pictures. One of my little tips is look at your doctor, if your doctor looks weird, there is a good chance that you are going to look weird. Because that’s their aesthetic eye, you know. Doctors who do a lot of injections are artists. And my art may not be your art and vice versa. So it is very important to have a meeting of the minds aesthetically when you talk to your physician and that you are on the same page with them and that you are not a traditionalist and they are a modernist and you are going to look like Picasso. So, please you know talk to your doctor and make sure you are on the same page. Tell them your concerns about how you don’t want to look and trust that you have done your homework in going to a doctor who can make you look the way you want to look. So we have talked about the tear trough, the importance of the lateral. So the lateral will actually compensate for the fact that that orbit is getting wider and longer and making you look tired and gaunt and that sunken-in look. And when you fill the lateral tear trough first, it gives a little pull this way which makes you need less in the medial tear trough. So you have to address it as a unit and that takes experience to see that. Now, let’s talk a little bit about ways to shape the brows. So I talked about the fat pad. I talked about a little bit in the lateral brow. I talked about doing Botox here to give a lateral lift to the brow because when you hit the Botox or Jeuveau here you are getting the superior aspect, the superior lateral aspect of the obiquilar saculi and it kind of pulls the eye down. So you relax it and get a counter compensation upward. But we do a lot here and here to shape the eyebrow. And I am going to be showing you on another talk some actual pictures and the process of brow correction and sort of a teaser for things to come. So one of the things that is important to understand is with the neuromodulators such as Botox and Jeuveau, it is sometimes not as important where you inject but where you don’t inject. Because if you inject it in one area. So if I inject here and not here, this part of my muscle is going to get stronger and it is going to raise this part of my eyebrow when I don’t inject here. But I inject here. Conversely if I inject here and don’t inject here I am going to get a little bit more of a lateral pull. Everyone is aware of spocking which is when you are uneven in the person’s eyebrows kind of go up like that. And that’s not a good aesthetic because you look like you are mad at everybody because this medial aspect is relatively low compared to this and a low medial eyebrow, the translation of that position is that you are angry or mad. So you want to get a lift here. You don’t want to get too much of a lift here because if you get too much of a lift medial, what happens you start to look sad, look at me, look how sad you look. So you want to have an eyebrow that is lifted and flared. So, but you have to be very precise. The doctor has to see how your muscles move because noone’s muscles move the same. If you are following a grid to put your botox in, I promise you you are not going to get great results because muscles are so different. Another mistake I see from novice injectors is they lower the medial brow too much, they make people look kind of like this and what they have done wrong is they have accidentally injected the inferior aspect of the frontalis and you have lost your ability to lift your medial eyebrow. They were trying to get the corogators and they missed and got the frontalis. So you want to make sure that you really in that muscle and pinch it when you are going for that because when you get to corogators, you get a little bit of a brow lift when it’s done correctly. Also the prosceris and the nasalis as a unit can cause the medial aspect of the brow to come down so when you inject here you will get a little medial eyebrow left. So the point is that when I am talking to the patient, I am listening to them but I am listening to their muscles and their muscles are talking to me in a silent conversation. And I know where the muscle is strong, where their muscle is weak. I can usually tell people, you know like, a patient will come in and I will ask them and they will say ‘you know what I did botox before and oh my eyebrows were so heavy.’ Well I know, you know that wasn’t the Botox, that was the injector of the Botox, injecting you too low for your eyebrows. So, I hope this has been helpful. I am going to kind of do a powerpoint that I think I am going to try to put on Instagram, on TV, that kind of walks through a little bit more of these principles. But your takeaway should be, as I have often said, it’s not the filler, it’s the filler, it’s not the device, it’s the devicer. It is who is devising your plan, who is the architect of your face, who is understanding your face and how it is to be renovated and I encourage you to send me messages. I am happy to help. You board certified dermatologists out there know that I teach at cosmetic bootcamp and in one year alone I had as many as 13 preceptors spend 1-2 weeks mentoring under my instruction at my office. So teaching is very important to me because the more people I teach, the better results that are out there and every good result is a feather in the cap of dermatology. So thank you all for listening and see you next time.

So today we are doing Juvederm Ultraplus on the employee of the month who is Christie, my laser tech. Now Christie is in her 40s, we won’t tell you how 40 she is. And she has been getting HA fillers for about twenty years. And she loves Juvederm Ultraplus the most and what we are going to do today is I am going to use Ultraplus and I am going to do a combination of both needle and cannula. I am going to start in this area. Now she has no numbing on and I am going to do a series of little injections. Sometimes we do cannula and sometimes we do needle. And, it is always the best judgement of your physician as to which one they want to use for which condition. We are also going to be addressing a dog bite scar, a little bit. That was from about two months ago. This is getting some Fraxel treatment as well but while we are at it we doing a little micro juvederm in there. And this is what you can expect from a needle. Now I am going to hold pressure there. So what I am going to do now is I am going to switch a cannula technique. And the reason I am going to use a cannula is because I can go a little bit deeper more safely and then I can pivot over to her cheek and give her cheek a little bit of a lift. So what I am going to do is I am going to put a little insertion point for the cannula right about there. And that’s going to give me the ability to go both medial and superior to where I was injecting the first time. And I am going to switch to a 25 guage 1.5 inch cannula and we are going to go in the spot and then we are going to fan. And we going to go under and give her a lift. As we get older our nose tends to go down and this will give it a lift. And then we are going under and deeper in order to lift the entire nasolabial fold and avoid giving her what I call the ‘dreaded monkey’ look. In addition, we are going to pivot a little bit also to the cheek. And do a little to give her cheek a lift. So the beauty of the cannula is it allows me to go in an almost 180 degree circle and inject all the areas that need to be injected.

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So, here’s another injectable minute. So, over here we have some of the many options we dermatologists have to use as an injectable filler. And here we have four options for neuromodulation. A lot of people really don’t understand the difference between the Botox family of products and the filler family of products. So, in general fillers are used to fill, to lift and to .... The neuromodulators sometimes known as Botox is used to ... muscle movement that causes .. but you can also use .... to help lift the brows and improve the jawline contour by decreasing the movement downward on the neck of the ... muscle.

So, at the Lupo Center we use all four, FDA approved neuromodulators. Of course, everyone knows about Botox. Botox was the very first. It was FDA approved in 2002. Many of us were using it for many many years before that ... off label to improve frown lines and crow’s feet and forehead lines. Dysport became FDA approved in 2009. This has a somewhat unique distribution pattern and maybe an optimal treatment for people with a very very high, large forehead. Xeomin is the most purified of all of the products. It has no complex in proteins. This product was approved in 2010 and is a favorite choice for some doctors. Finally this here, we got Jeuveau. Jeuveau is the first FDA approved product in this category since 2010. It has new, what we call high pure technology that causes the product to be very pure and to give very very good results. I have been using this in my practice now since mid-May. So, I’ll let you know in a few more months if it is lasting longer.

By making it less deep right there, so I will ... and use the filler in the upper one-third here and then put the rest of it out right here and then maybe put a .. to support her here because she’s beginning to sink in a little bit here. So, that will be an example of how I am going to approach it and you too have that somewhat lateral sloping brow, so the lateral brow there which is different from regular brow types. A chemical brow lift is not about wrinkles, it is strengthening the lifting muscles and weakening the depressing muscles. So it is like a ... And when you weaken the depressors, at the elevators that are not injected it’s stronger is called compensation. So, we use the principle of compensation to.. we can show it, which muscle on the forehead, where do we want to raise and where do we want to lower. Makes sense.

So, why don’t more people do cosmetic injections. Well, the number one reason is fear of pain. One of the things I prioritize myself on is to do everything I can to make the injection experience pleasant which means less painful. So, what I do is I use topical anaesthetic which really helps to diminish that initial needle stick. In addition, I change my needles frequently in order to make sure that the needle is sharp because a sharp needle is a painless needle. The other thing I do is, I use which is called distraction therapy. One way to do this is with a vibrator. This little device when put on the bone, registers messages to the brain. Well, guess what our brain can handle only so many messages. So, it is the .. of pain and when you use a stimulant you don’t actually feel the needle sticks as much. And finally we call it talkasthecia. We will typically talk about a lot of things while you are being injected. It might be your favorite football team, it might be your favorite restaurant, it might be many many things. But we try to keep it light and distracting to diminish your sense of pain.

So, now we are talking about another barrier that prevents patients, who really need injections from actually doing them. So we talked before about fear of pain but another big fear is the fear of looking weird. And that is ... concern. One of the things I suggest to do is to discuss with your doctor, what your needs are and what your goals are and make sure that you are the doctor are on the same page. Another good trick is to look at the doctor. If the doctor looks weird, there’s a pretty good chance that that’s the aesthetic norm and you might look weird too. So, it’s always good to make sure that you pick a physician who is an expert at injecting, a board certified dermatologist or plastic surgeon and make sure that they understand that you want to look like a better version of yourself and you do not want to look weird.

So, this is the last in our series discussing the barriers that patients have, that prevent them from doing the injections that they need to look their best. And it is the fear of complications. And this is ... concern. There is no procedure that has zero risk of complications. But there are ways that expert injectors, know about to reduce your risk of complications. So, always discuss with your board certified dermatologist or plastic surgeon, what your fears and concerns are and listen to their answers. If the answers ring true and make you comfortable, then you are ready to go and get those injections.