What to know about cosmetic injectables

By Julian Dossett I Photos by Jim Weber



Santa Fe New Mexican



What to know about cosmetic injectables Perhaps it’s smartphone cameras inspiring people to be photograph-ready at any moment. Or maybe it’s the pandemic-related rise of video chat apps like Zoom and FaceTime. For whatever reason, Americans are increasingly seeking out cosmetic procedures. In 2020, the latest year for which data are available, the American Society of Plastic Surgeons reported that 3.3 million people aged 55 and older had minimally invasive procedures, such as injections of botulinum toxin type A (Botox) and soft-tissue fillers such as Juvéderm Ultra. Such treatments can smooth facial wrinkles and restore facial contours, respectively; overall, they can lessen the signs of aging. “People always ask, ‘How can I get rid of my wrinkles?’” says Jessica Gonzalez, a nurse practitioner and co-owner of Santa Fe Skin Institute. “That’s the first question I get.” At Santa Fe Skin Institute, injectables are by far the most requested cosmetic procedures. Opting for these solutions should involve an informed conversation with an expert provider. Here, Gonzalez, who is certified by the International Association for Physicians on Aesthetic Medicine, walks through common questions and what new patients can expect when they walk into a clinic. Botox, a neuromodulator, blocks the communication between motor nerves and their corresponding muscles. “For instance, the repetitive movement of moving your forehead or those lines between the eyebrows,” Gonzalez says. “So we can paralyze that muscle by using Botox, and then we can help to stop that wrinkle from appearing.” The effects of Botox typically last three to four months. What are cosmetic fillers? Synthetic fillers increase dermal volume to add artificial plumpness. “As we age, we lose a lot of fat in our face in different places,” she says. “It moves around, and we lose some muscle and bone — that’s what causes the skin laxity.” Gel-like fillers sit below the skin and can restore volume for six months to a year before dissolving. “I feel like injectables are definitely an art, and every patient is a little bit different,” Gonzalez says. “You have to look at their face and come up with their own individualized plan.” What are the risks? With neuromodulators like Botox, patients can experience ptosis, which makes the upper eyelid droop. “It usually lasts about four weeks and goes away,” she says. “But that can happen.” Botox can also cause a patient’s eyebrows to rise up, creating a surprised look. “We always do a followup in two weeks after their initial appointment,” Gonzalez says, “to see if they need any touchups, if there are any adverse effects.” With fillers, side effects can occur; the most serious is vascular occlusion. “This is where the filler is injected into a vessel — it occludes that vessel, and if that vessel supplies blood to the eye or part of the body like the chin, you can actually cause that whole area to become white and necrotic,” she says. Without intervention, vascular occlusion could lead to serious long-term disability, such as blindness. But if there is an issue with filler, Gonzalez says, the clinician can dissolve it immediately after the injection. What expectations should patients have? Gonzalez talks with her patients about realistic expectations. “We are going to enhance your natural beauty that you already have and just rejuvenate,” she says. “I think setting that expectation right away actually creates a lot more patient satisfaction in the end, because they already know what to expect.” With cosmetic procedures, patients get what they pay for. “Just make sure that where you’re going, everybody is highly trained,” she says. “You may get something cheaper somewhere else, but look at the credentialing and who is actually going to be performing [the procedure], because sometimes when you pay a little bit extra, you’re paying for the expertise that you’re getting.” What can patients expect? When Gonzalez sees a new patient, she begins with a consultation to examine their features and facial expressions. “I say, ‘Can you squint your eyes, furrow your brow, raise your eyebrows, pucker your lips.’ I have them do all of these movements,” Gonzalez says. “So I can really see where these lines are coming from and what kind of facial movements they’re doing.” Because injectables involve administering medication through needles, patients can expect to feel some pain and discomfort. “It’s not super-painful,” she says. “We do have a patient ice beforehand.” Gonzalez says typical appointments last 30 to 45 minutes, depending on the procedure. Both Botox and fillers can be administered in one appointment, depending on the patient’s cosmetic goals. Patients can also request numbing cream. That request extends the appointment because the cream requires time to take effect. How can patients extend the effects through long-term skin care? While cosmetic procedures like Botox and fillers can decrease facial lines and skin laxity, a daily routine for maintaining healthy skin is also important for long-term care. “Skin care is like going to the gym. It’s maintenance, right?” Gonzalez says. “You’ve got to be on good skin care and good skin care products.” She recommends using retinol, a form of vitamin A used in a variety of skin care products. “Over time, [it] helps to stimulate collagens [proteins that provide skin structure and strength] and helps to rejuvenate the skin,” she says. “So that’s by far the number one thing that everybody should be using.” Santa Fe’s 300-plus days of sunshine every year makes finding a good sunscreen another important part of skin care. “I say SPF of 30 or above, on the face and body, every single day,” Gonzalez says. “Some people say, ‘Well, I don’t really go outside much,’ [but] driving in the car — think about it — your hands, your neck, your face are still exposed to the sun,” Gonzalez says. “Sunscreen is the biggest preventive measure you can take.” She also recommends vitamin C for skin care routines as well. “It actually helps to fight the free radicals from the sun that have been accumulated over time. By putting the vitamin C on the skin, you’re just going to see brighter skin and less sun damage,” she says. Who are these injectables right for? A patient’s medical history affects whether he or she can undergo cosmetic injectables. For example, some are not appropriate for people who have previously had eyelid surgery. “If there’s been any surgery on the upper face, we want to know,” Gonzalez says, “because those muscles might not be where we want them to be.” Patients taking blood thinners should also inform the provider prior to a procedure. Julian Dossett is a “Vida” contributing writer.