Wednesday, July 30, 2014

Treating Aging Hands With Dermal Fillers

Aside from being asked to treat wrinkles on the face and neck, you may also be asked to address aging issues that occur on the hands using dermal fillers. Before this can happen you need to examine your patient’s hands for signs of both intrinsic and extrinsic aging.

Intrinsic and Extrinsic Aging

There are two types of aging that affects the hands of older person. 

Extrinsic aging effects are more outward in appearance.  It affects the epidermal and dermal layers of the skin due to an overexposure to the sun, smoking and chemicals.  This can result in aging spots known as sunspots such as solar lentigines, punctate hypopigmentation and solar purpura.

By contrast, intrinsic aging comes from within the softer deeper tissue planes creating a condition of decreased skin elasticity, soft and atrophied tissue. This can manifest as translucent, waxy looking thinner skin and more prominent veins joints and tendons.[1]

There are a number of methods for restoring the appearance of aging hands using injections that are taught in the Pinewood Institute for the Advancement of Natural Medicine Dermal Fillers course.

Hyaluronic Acid for Aging Hands

All aging is due to the depletion of endogenous hyaluronic acid that plays and important role in the hydration of tissues and joints, maintaining the biomechanical integrity of the body and preventing it from oxidative stress. Intradermal injections of HA increases the dermal thickness and elasticity of the skin.

Hand fillers treated with hyaluronic acid may need further treatments as it is a temporary solution.

Calcium Hydroxylyapatite

Calcium hydroxylyapatitie is an inert filler with a lot of applications in dentistry and bone repair. It has been used as a filler for hands. It is sold by the commercial name of Radiesse.  The color and viscosity of CaHa makes it a good option for concealing unsightly veins.

Other Dermal Filler Options for the Hands

Bovine Collagen has been used as a dermal filler in cosmetic surgery fro years even though it is not currently on the market.  The results are a bit iffy with this treatment but there have been reports of more success using porcine bovine fillers. In both the case of bovine and porcine collagen injections, the results only last a year.

 Poly-L-Lactic acid (PLLA) has been used for over thirty years in surgical implants. However treatment with this acid requires multiple injections and is expensive. Granuloma and visible bumps under the skin could also develop with injected Poly-L_Lactic acid.

Injection Techniques for the Hands

Injection technique is taught in full as part of the Pinewood Institute’s Dermal Fillers course. You will learn techniques for volume restoration including:

Tenting – injections through pinched skin
Serial punctures – injecting small amounts of filler along a line
Microdrooplets- injecting tiny amounts of filler across a large number of points
Tunnelling- injecting the dermal filler while withdrawing a needle at the same time
Fanning- injecting dermal filler radially without withdrawing the needle

There are many other techniques to learn as well that apply to individual cases.
Learning how to inject dermal fillers without damage to the hands is another important issue.

For more information about The Pinewood Institute for the Advancement of Natural Medicine courses including course outlines, detailed descriptions of courses and information about upcoming training sessions, please go www.pinewoodinstitute.com.  You can also send us an email using our email form at http://pinewoodinstitute.com/contact.aspx or call us at 416-656-8100. If you prefer to fax the number is 416-656-8107.





[1]  Ulrich Kuhne and Matthias Imhof, Treatment of the Aging Hands With Dermal Fillers, Journal of Cutanaeous and Aesthetic Surgery, Medknow Pubulfication, 2012 5(3): 163-189.

Monday, July 28, 2014

Combining Dermal Fillers With Other Procedures


Once you add cosmetic injections to your practice you will soon find yourself in conversations with patients who are also going through other various anti-aging treatments including laser treatment, chemical peels, Botox, radiofrequency treatments and aesthetic plastic surgery.  Here is a look at how you might possibly find yourself treating each one should your dermal injections be part of combination of therapies.

Fillers and Chemical peels

It is likely that you will encounter a patient that is undergoing a chemical peel to smooth out the face. You might also be asked if you can a chemical peel after you have administrated dermal fillers. 

For the most part you should avoid administering injections to skin that is inflamed as this can cause degradation of the filler.  It is best to wait a few days to do even the mildest of chemical peels however a superficial chemical peel can be tolerated by a patient.  Very deep tricholoroacetic acid peels and collagen remodeling using a peel are procedures that should never go hand in hand with dermal fillers.  A wait of two weeks is recommended in these cases.

Fillers and Botox

Fillers and Botox are now being applied in tandem to rejuvenate the look of the space, however not during the same office visit. It is best to apply the Botox first, because it relaxes the muscles and then administers fillers two weeks or so after that.

The only exception to this rule is possibly in the case of the patient with a very deep nasolabial groove. In this case fillers are injected first followed by the Botox.

Fillers and Laser Treatments

As most lasers use water as a chrompohore there is the risk that the use of them can dissolve hyaluronic acid-based fillers.  This is not an area where a lot of studies are done and even though some doctors do administer both laser treatments and dermal fillers at the same time, it is usually not recommended.  This is because discoloured pigment in the skin can be the result, especially if your patient has darker skin.

Fillers and Radiofrequency

Popular home radiofrequency tool
This is not an area where there has been a great deal of clinical research but for the most part the two therapies are considered to be copasetic, but not necessarily synergistic. To be safe, do these treatments separately.

Fillers and Plastic Surgery

Fillers are indeed used on a patient a few weeks after plastic surgery. Once surgery fillers contour the face can help add volume to the face and achieve finer corrections.  Fillers are often considered to be like the final polish to a plastic surgeon’s work.

Perhaps the rule of thumb to remember is that it is best to separate treatments wherever possible to avoid any complications, no matter how tempting it might seem to you or your patient to do two procedures at once.

For more information about The Pinewood Institute for the Advancement of Natural Medicine courses including course outlines, detailed descriptions of courses and information about upcoming training sessions, please go www.pinewoodinstitute.com.  You can also send us an email using our email form at http://pinewoodinstitute.com/contact.aspx or call us at 416-656-8100. If you prefer to fax the number is 416-656-8107.

Saturday, July 26, 2014

The Safe Practice of Dermal Fillers


Dermal fillers are popular cosmetic additions to your practice and you will find that your patients are very enthusiastic about this new modality you are adding to your office. However, there are some things that you need to be vigilante about if you are going to run a successful practice. Here is a look at some of the safeguards that you should be aware of before you begin injections.

Pre-Procedure Care

First of, make sure that you have a thorough understanding of how the skin ages and understand that this is not a uniform process in some people.  Treat the skin in sections as needed and do not fix what is not broken.

Avoid antcoagulants like Aspirin  
Secondly, familiarize yourself with the fillers that are available to you. Make sure that your clients are aware of all of the different options you can offer them. Know what is in them, whether or not they are monophasic or biphasic in nature and the length of their shelf life.

 It is also crucial that you make sure that you are using the right kind of filler on the right area of the face. This is something that is thoroughly covered in the Dermal Filler course at the Pinewood Natural Health Institute.

Make sure you are well practiced and know how to handle a needle. In the Pinewood Natural Institute courses, we practice dermal fillers on human subjects so that you are not confronting your first patient without any experience.

Make sure that your procurement of fillers is from a legitimate source as there is no quality control on black market products.

Assessing the Patient

You should never skip getting to know your patient.  If you think a patient has unrealistic expectations then there will be no satisfying them no matter how great your work is. Make sure that they are all right with the idea of having the fillers administered using topical anaesthesia.

Be very aware of the medical history of your patient and make sure that they are not hypersensitive to certain substances.  Warn them about the use of aspirin and other anticoagulants before they get the shots as this can cause excessive bleeding.

Part of assessing the patient is an evaluation of the goals of the patient and then your evaluation of what is needed to accomplish this and what is possible. Be sure to ask the patient if they want to restore their looks to a previous appearance or if they would like a new look. 

Make sure that when you examine the patient that he or she is sitting up right. When people lie down the force of gravity pulls the tissue back and alters the position of the wrinkles or grooves. It is also important to identify areas of the face that are naturally asymmetrical or lopsided.  Be sure to point these features out to the patient so that they are aware that it is not your procedure that has made their face crooked. Many people are not really aware that their visages are naturally lopsided or uneven.

It is then your responsibility to choose the appreciate filler for your patient depending on whether or not you desire longevity, permanence or non-allergenic options.

For more information about dermal filler training and about The Pinewood Institute for the Advancement of Natural Medicine courses including course outlines, detailed descriptions of courses and information about upcoming training sessions, please go www.pinewoodinstitute.com.  You can also send us an email using our email form at http://pinewoodinstitute.com/contact.aspx or call us at 416-656-8100. If you prefer to fax the number is 416-656-8107.

Sunday, July 20, 2014

Hyaluronic Composition in The Human Body – A Primer!


Hyaluronic acid injections may be an important addition to your practice just because there are so many different applications for both.  Hyaluronic acid is not a specialized substance. It is found everywhere in our lives. It is found in health food products, cosmetics, mouthwashes, moisturizing lotions, skin creams, shampoos and eyewashes,

Hyaluronic acid is also found in pharmaceutical products used to improve joint function and it is also utilized as ophthalmic surgical aids.

Hyaluronic acid is a substance that attracts water to the skin and retains it.  In fact, just single gram of hyaluronic acid can hydrate two to six liters of water.  It is what is called a viscoelastic substance, which means that it is highly elastic and able to return to its original shape. It can also be administered in various consistencies. When highly concentrated it behaves like a gel.

Hyaluronic Composition in the Human Body

At birth, humans have a very high concentration of hyaluronic acid in the body with the highest concentrations being in the umbilical, cord, eyeballs, joint fluid and skin.

The vitreous body that make up the fluid that fills the area inside the eyeball contains large amounts of hyaluronic acid and helps the eyeball retain its shape. An absence of hyaluronic acid in the eye could cause floaters.  The vitreous body of the eyeball contains very high concentration of hyaluronic acid; this plays a role in the cushioning of the eyeball in the skull.

All three layers of the skin also contain large amounts of hyaluronic acid including the epidermis, dermis and subcutaneous tissue. The dermis (top layer of skin) is ten times thicker then the sub-layer called the epidermis and it contains large amounts of hyaluronic acid, which helps keep it from drying out.  We have the most amounts of this acid in our dermis when we are born which explains why the skin of an infant is so soft and supple.  The skin loses its elasticity and the surface becomes dry when moisture is lost.

Large amounts of hyaluronic acid are also found in the joints in the synovial fluid. The acid serves as a lubricant to prevent the friction of bone moving on bone. Injections into cartilage can help relieve joint pain from stress. This is why injections work so well to handle joint paint and to restore mobility to them. One of the most effective applications of hyaluronic acid injections is to improve joint function. Injections can help treat individuals suffering from osteoarthritis and periarthritis issues including knee pain and frozen shoulder syndrome. Many patients have reported a reduction in inflammation with the injections as well.

By the time most people are forty years old we start to lose hyaluronic acid causing issues such as wrinkling, dry eyes and other issues related to aging. Hyaluronic acid injections, for both medical and cosmetic purposes can help address these issues.

Learn How to Inject Hyaluronic Acid

To learn more about hyaluronic acid injectable fillers, platelet-rich-plasma and other modern injectables it is suggested that you investigate the Pinewood Institute in Toronto’s course offerings.

For more information about The Pinewood Institute for the Advancement of Natural Medicine courses including course outlines, detailed descriptions of courses and information about upcoming training sessions, please go www.pinewoodinstitute.com.  You can also send us an email using our email form at http://pinewoodinstitute.com/contact.aspx or call us at 416-656-8100. If you prefer fax the number is 416-656-8107.



Friday, July 18, 2014

When Your Patient Wants a Temporary Dermal Filler

Our faces change, styles of beauty change and so does the preference of your average patient. Nowadays it is quite common to have a client ask you if there is such a thing as”temporary filler.”  Half the time this is because they do not want to feel that they are going to be stuck with the result forever.

Restylane, temporary dermal filler, is safest and most commonly used of the temporary fillers for your patient.  The beauty of being to offer this is that it is like giving your patient the opportunity to “try on a new face” for a while and decide if they would like to stick with it.

As an added bonus, the temporary fillers ten to look a little more natural than other types as the person ages and the filler dissolves.

How Restylane Works

Restylane is a clear gel that is completely synthetic and biodegradable so it is well suited to your patients who do not like to use animal products.  The gel is injected into the dermis in very tiny amounts using a find needle.  This produces an easily controlled volume that can plump the lips or shape the facial contour in a way that looks very natural.

The most popular areas to be treated with Restylane include lipstick lines around the mouth, the nasolabial lines that run from the corners of the mouth to the base of the nose and fissures running from the corner of the mouth to the chin. Restylane also plumps up the lips and can correct uneven lips.

Your patients will love the fact that the average treatment takes less than thirty minutes.  Once they see how beautiful the results are they will then ask you how long this type of filler might last.  How long the filler endures in the body really depends on the individual and how fast his or her body gets rid of the product.  Usually they last for about six months.

Many practitioners also offer their clients a booster shot of Restylane if they have a special event to go to. However, if your client schedules a booster shot like this, make sure they do it at least a week beforehand (but preferably two) to prevent any redness, swelling and potential bruising.

Post-Treatment Care

Most patients do see experience redness and swelling immediately after treatment. The swelling can last a few days if they get their lips down.

You should advise your client to avoid touching the treated area or wearing make-up, which can slow healing, for at least six hours following the treatment so that the area can heal.  It is also not a good idea for your client to exercise the gym or sit in a sauna, or sunbed for at least 48 hours. Very active sports like snowboarding, skiing or jogging should also be discouraged shortly after a treatment

Are you interested in taking a course in injectable dermal fillers?  For more information about The Pinewood Institute for the Advancement of Natural Medicine courses including course outlines, detailed descriptions of courses and information about upcoming training sessions, please go www.pinewoodinstitute.com.  You can also send us an email using our email form at http://pinewoodinstitute.com/contact.aspx or call us at 416-656-8100. If you prefer fax the number is 416-656-8107.



Wednesday, July 16, 2014

Tips for Handling Filler Issues From Clients


As is true of any medical treatment, there is a risk when you use a dermatological treatment on a patient.  However, in the case of aesthetic medicine, the complaint is usually about the aesthetic effects of the dermal treatment on the face. Fortunately most complaints are resolved by the passage of time, which suits all but the most impatient of customers.

Common Complaints From Patients Post-Treatment

After administering dermal filler to your patient, he or she may come back to you with any of the following very complaints:

  • Bruises that last for weeks
  • Asymmetry (a lopsided or crooked look opt the face
  • Puffy looking overfilled areas
  • A lumpy or bumpy service

A serious consequence is a blocked blood vessel but the occurrence of this type of result is very rare. The symptom is a blotchy or red rash that extends out from the dermal filler. This needs to be treated immediately to avoid scarring.

Yet another common complaint is that the patient might feel that he or she does not look any different than before.

Avoiding Common Dermal Injection Mistakes

Eating pineapple helps with bruising.
Too much bruising can occur for reasons beyond the practitioner’s control. To avoid this as a result recommend that your client avoid aspirin, Aleve and Ibuprofen for 1 week prior to treatment. They should also avoid drinking alcohol, eating garlic and taking Vitamin E as these are all substances that thin the blood. The thinner the blood is, the more likely your skin is to bruise!

To avoid bruising advice your patient to take Arnica orally and eat pineapple two to three times a day. Pineapple is a natural anti-inflammatory.

Lopsided results are often a side effect of the treatment. While it is normal to have some asymmetry to the face, dermal fillers can exaggerate this. Many patients who complain of asymmetry do not realize that their face is swollen and that the effect may not be permanent.  Usually what looks like an over-injection disappears in a week to ten days.

If the lopsided effect to the work is still there after a week, then it may be necessary for you to balance the effect out by using a bit more filler on the side that has less volume. You also might consider using an enzyme like hyluronadase to reduce the fullness.

Lumps or bumps under the filler are actually small bruises and like lopsided looks, they usually go away in ten days. If they don’t then hyluronadase can also be injected to smooth them out.

For more information about how to properly inject dermal fillers and related aesthetic procedures contact The Pinewood Institute for the Advancement of Natural Medicine. On our website we offer educational opportunities in this area of cosmetic medicine including course outlines, detailed descriptions of courses and information about upcoming training sessions, please go www.pinewoodinstitute.com.  You can also send us an email using our email form at http://pinewoodinstitute.com/contact.aspx or call us at 416-656-8100. If you prefer to fax the number is 416-656-8107.





Monday, July 14, 2014

The History of Fillers in Aesthetic Medicine


The History of Fillers in Aesthetic Medicine

The pursuit of beauty and the desire to reverse the effects of aging is thousands of years old but the actual use of injectable devices and solutions has really only been around for the past 100 years. Before the last century, most people wanting to look a bit younger had only creams, lotions and potions to help them restore volume to facial tissues. Of course, this was a never-ending routine of constantly plumping the skin up with externally applied moisture and also drinking lots of water because the injection needles, commonly known as the syringe had not been invented yet.

Paraffin Injections

The syringe, or hollow needle as it was first called, was first invented in 1844 by Irish physician Francis Rynd.  Fourteen years before that a German chemist, baron Karl Ludwig von Reichenbach was researching the medical applications of dry distilled beech-wood tar.  He named this unreactive substance paraffin, from the Latin parum (barely) and affinis (affinity). [1]

The first reported use of paraffin injected into the body for cosmetic purposes was by Robert Gersuny who used liquefied paraffin to inject fluid into the testicles of a patient who had been partially castrated. Paraffin was subsequently used for nasal augmentation and other cosmetic purposes.  Paraffin was unstable and often developed plaques at the injection site.  A famous individual who suffered complications from these injections was the Duchess of Marlborough when the paraffin collected in her chin causing an unattractive appearance.

Over the years vegetable oil, mineral, lanolin and beeswax were used until substances that did not migrate to other places in the body were discovered.

Liquid Silicone

Liquid silicone injects were all the rage in the 1960s. This inert, clear oil substance was easily injected and absorbed into the human body but it also was prone to migraine. This polymer substance was first marketed in the 1940s in Japan and by 1965 Dow Corning invented a purified silicone that could be used for injection.  Unfortunately, the body often had an inflammatory response to the plastic that caused unpleasant symptoms that lasted for years.[2]

Doctors in Europe, Canada, Mexico and in the U.S. still use medical grade silicone injected with micro needles for cosmetic purpose even though in most countries it is now federally banned.

Bovine Collagen

In the late nineties bovine collagen was a widely used filler, including Zyderm1, Zyderm II, Zyplast and Evolence. Evolence, produced by Johnson & Johnson is no longer in use.

These products were quite effective at restoring facial volume in the lips and outline of the face, reducing fine lines and treating nasolabial folds. 

Autologous Solutions

Nowadays we have other ways of safely injecting volume, prompting skin to heal itself by using fluids and materials from the patient’s own body. This is safe and causes minimal risk of plaques, allergic reaction and other problems.  Injectibles from human and other sources have also been purified and refined so that they are tolerated well by patients.

To learn more about injectable fillers, platelet-rich-plasma and other modern injectibles it is suggested that you investigate the Pinewood Institute in Toronto’s course offerings.

For more information about The Pinewood Institute for the Advancement of Natural Medicine courses including course outlines, detailed descriptions of courses and information about upcoming training sessions, please go www.pinewoodinstitute.com.  You can also send us an email using our email form at http://pinewoodinstitute.com/contact.aspx or call us at 416-656-8100. If you prefer fax the number is 416-656-8107.

Saturday, July 12, 2014

Questions Your Cosmetic Patients Wlll Ask About PRP


If you are including the latest cutting-edge techniques in your practice, be prepared to answer many questions about Platelet-Rich Plasma Therapy from your clients. Here is a guideline as to how to answer those frequently asked questions (FAQS) about the cosmetic applications of PRP.

What is PRP?

PRP is an acronym for platelet-rich plasma therapy, which involves withdrawing your own blood serum, spinning it in a special machine to enrich it with your own blood platelets, and then reinjection it, using tiny needles called microneedles,into damaged places in the body in order to rejuvenate and repair the skin. 

Is PRP a brand new treatment?

Blood Serum in a test tube


This type of treatment has been used for wound healing, plastic surgery and bone replacement procedures for many decades.  It is used clinically in mesotherapy treatment and cosmetically for skin rejuvenation.

What can be improved using injections of PRP?

Platelet rich blood therapy can treat many different cosmetic issues including –
  • Improvement in skin texture
  • Improvement in skin tone
  • Improvement in the overall color of the skin
  • Fixing large pores
  • Fixing broken capillaries
  • Healing scars from acne, burns or surgical scars
  • Removing skin discoloration that is the result of too much sun
  • Eliminating fine wrinkles
  • Thinning the skin
Will the results I get look natural?

This procedure naturally rejuvenates and refreshes your look without scarring or invasive surgery. It is a great treatment for treating dark circles, the thinning of the skin under eyes as well as wrinkled upper lips and other cosmetic aging issues.

What does microneedling mean and will it hurt?

Microneedling is a relatively painless procedure where the skin is slightly injured in order to trigger a big healing response.  The skin is numbed with a cream and then a pen-like device called a micropen or derma pen is used to create minute channels in the skin.  Your extracted platelet-rich serum is then injected into the skin to expedite the healing process.

How do you extract the serum from the body?

The blood from your body to be used for the serum is typically withdrawn after the area to be treated is numbed with a cream.  A tube of your blood is taken and then spun in a special machine that separates the red blood cells from the platelets. The platelets are then processed so that they are concentrated in the serum and the processed blood is ready to be injected back into your skin.

How long does it take for the skin to heal after the treatment?

The procedure usually takes an hour and you can expect to have some down time for three to four days depending on what area was treated.

Does the procedure have to be repeated?

It is highly recommended that you get three or four treatments over a period of several months for this to be the most effective.

Does this process work on darker skin?

Unlike some anti-aging treatments that use a laser, this process is completely safe to use on darker complexions.

Can this type of therapy be combined with other cosmetic procedures?

The answer for the most part is yes and in fact, plasma rich blood injections are often combined with other procedures such as Botox, laser treatments and plastic surgery with no side effects or complications.

When you take the Pinewood Health Institute’s new course in Platelet Rich Plasma Therapy you will be taken through the entire assessment, treatment protocol and after care regiment that is suitable for your patients.

For more information about The Pinewood Institute for the Advancement of Natural Medicine courses including course outlines, detailed descriptions of courses (including the PRP course) and information about upcoming training sessions, please go www.pinewoodinstitute.com.  You can also send us an email using our email form at http://pinewoodinstitute.com/contact.aspx or call us at 416-656-8100. If you prefer fax the number is 416-656-8107.