Injectables

Neuromodulators (Botox®, Dysport®, Xeomin®, Jeuveau®, and Daxxify®)

These medications utilize botulinum toxin type A and are given through a small injection to the targeted muscle(s). They block the ability of the muscle to contract, or at least weaken its ability to do so depending on the dosage. The most commonly indication, in the face, for these medications is to soften or eliminate wrinkles. They work best for dynamic wrinkles, which are those wrinkles present with motion. Since we block your ability to move the targeted areas, the wrinkles simply can’t be etched into our faces! 

These medications have been around for many years. The results are fast and so gratifying! You can expect results to start in days and last for months. 

These medications are also VERY safe. There is no long-term toxicity from these medications either. Dr. Spalla likes to say this is the good and bad with these medications. The good is that they are safe and yield great results in experienced hands. There are no long-term side effects. However, if you don’t like the effects of it, it will wear off. The bad is that they wear off. So, if you love the results (as most patients do), the injections need to be repeated in the future.

What are indications for neuromodulators?

There are cosmetic and non-cosmetic indications for these medications. Dr. Spalla’s practice almost always uses these for cosmetic indications. 

The most common reason Dr. Spalla uses these in the face are for wrinkles. As mentioned earlier, they work best for wrinkles created by motion (dynamic rhytides), but they can be used for wrinkles at rest, in select cases. Nearly any area of the face and neck can be treated with these medications, but keep in mind, that most areas outside of the forehead and around the eyes are considered off-label uses and should only be performed by very experienced providers with an intimate understanding of the anatomy and physiology of the face and neck. Fortunately, Dr. Spalla has spent years lecturing on these subjects and has operated on countless faces, so he brings a wealth of experience to every patient visit.

Neuromodulators can be used, over time, to reduce muscle volume. This can be especially helpful for female with prominent masseter muscles which causes the jaw to look widened and thus, more masculine, in appearance. Repeated injections to these muscles can them to loose some of their bulk which can slim the jaw gradually. Similarly, repeated injections to the muscles between the eyebrows (corrugators) is very helpful to help soften the “11s” that often develop here. The “11s” are those pesky vertical lines between our eyebrows caused by repeated furrowing of this aspect of our brow.

When should I start neuromodulators?

Anyone over 18 without contraindications such as pregnancy, breast feeding, neuromuscular disorders, bleeding disorders, and certain medications can consider starting these. Dr. Spalla has seen countless younger patients coming in to have these injections done to prevent the wrinkles from ever forming. Overall, they are a wonderful way to dip your toes in the pool of cosmetic surgery.

What does it feel like? I’m scared to have injections done.

Dr. Spalla will work to make the process as painless as possible for you. We have several options available to make it easier than you can imagine. It’s over quicker than most people even realize, and the most common thing we hear from first-timers is, “That’s it? I’m done???” We love hearing that!

If you are truly needle-phobic, Dr. Spalla will talk to you about ways to still have this done, if you really want to, but if you’re adamantly opposed, we completely respect this, and fortunately, we have a couple other options for people who want softening of fine lines and wrinkles. 

What is the downtime for neuromodulators?

There is almost no downtime at all. Generally, you’ll have small areas of swelling where the injections were performed which dissipate rapidly. The areas sometimes feel kind of tight, and this goes away quickly as well. 

We ask that you refrain from lying flat for 4 hours to avoid diffusion of the toxin towards the eyes, and we ask that you don’t do any vigorous facial massage for 4 hours or strenuous activity for 24 hours. 

Which one is best for me?

There really isn’t a “best” toxin for everyone, and that’s one reason there are several options. Some people come in asking for specific brands based on prior experience, what they’ve read, or the recommendations from friends. Dr. Spalla is happy to work with you and explain what he recommends and will work with your desires to find what you’re most comfortable using.

Facial Fillers (Restylane®, Juvéderm®, Belotero®, Revance®, Radiesse® and many more!)

Facial fillers are substances injected beneath the skin to add volume to a region of the face or neck. They can be used to volumize a region of the face such as the cheeks or jawline. They can also soften folds, like the ones we develop along the junction of our mouth and cheek (nasolabial folds) and to fill in fine facial lines. 

Also known as dermal fillers, these injections are in-office procedures that are minimally invasive options to treat many cosmetic concerns. They can serve as an alternative to more invasive cosmetic procedures in many instances. Patients often undergo facial filler injections to achieve a more youthful appearance with as little downtime as possible. Fillers are available to target nearly any area of the face, including the lips, cheeks, jaw, and around the eyes.

Most fillers used in the face are hyaluronic acid, a naturally-occurring substance in our skin that slowly disappears as we age. When we lose hyaluronic acid, our skin doesn’t have the same water-retention, volume, or elasticity. By restoring this, we can turn the hands back on the clock of aging.

Other filler materials are useful as well, but their indications are not as broad, and they are more limited to specific situations. 

What are indications for fillers?

The most common reason Dr. Spalla uses these in the face is to add volume to an area. The two most common areas requested include the lips and cheeks. Nearly any area of the face can be treated with fillers, but some areas are more risky than others. These injections should only be performed by very experienced providers with an intimate understanding of the anatomy and physiology of the face. Fortunately, Dr. Spalla has spent years lecturing on these subjects and has operated on countless faces, so he brings a wealth of experience to every patient visit.

What areas can be treated?

Nearly any area can be treated, as long as it’s done cautiously and in moderation. As mentioned previously, the lips and cheeks are the most common areas we are requested to inject. The great thing about fillers is that the results are immediate. There will be small changes over the coming days, but you’ll see a change in the mirror as we fill your areas of concern.

Lips: Dr. Spalla likes to give the lips a nature appearance and avoids making the lips look like they are formless tubes around your mouth. Additionally, the small lines around the mouth can be treated with filler as well. Unlikely many injectors, the advantage of seeing a facial plastic surgeon is that Dr. Spalla can also offer surgical correction through lip lifts, chemical peels, and laser resurfacing to enhance the entire area around the mouth. 

Nasolabial folds: These are the pesky folds we develop along the junction of our mouth, cheek, and nose. They are causes, in part, by a decent of our cheek tissues as we age. A combination approach of cheek augmentation and filler to the fold itself (sometimes with a neuromodulator as well) usually works best.

Cheeks: A projected cheekbone is a sign of youth. As we age, the fat compartments shift and sage and we lose bony volume in our face. Fillers help to restore this youthful appearance. Dr. Spalla also offers cheek implants for patients desiring permanent volume restoration. 

Jaw: Some patients desire a strong chin projection. A “weak” chin can be augmented with filler to give a strong projection. This is helpful in men to make the jaw more classically masculine in appearance, and in women, it helps to balance out facial proportions of the lower third of the face. Filler can also be used along the angle of the jaw to help add definition. Losing the definition between the face and neck become more common as we age, and augmenting the jaw can help restore this balance. Dr. Spalla also performs facial implants which allow for permanent volume correction of the jaw.

Does Dr. Spalla offer a non-surgical rhinoplasty? Liquid rhinoplasty?

Yes, Dr. Spalla does perform fillers to select patient noses. Liquid rhinoplasty can be useful in camouflaging small nasal irregularities or by adding some volume to the dorsum. 

Unlike many injectors you may encounter, Dr. Spalla is a board certified facial plastic surgeon as has more than a decade’s worth of experience performing rhinoplasty. This has given him intimate knowledge of the intricacies of the nose. This gives you the advantage of seeing a specialist who can not only see the nose from an injector’s perspective, but you’ll also get the opinion of an experienced rhinoplasty surgeon which is quite unique in the competitive field of fillers. 

When should I start fillers?

Anyone over 18 without contraindications such as pregnancy, breast feeding, neuromuscular disorders, bleeding disorders, and certain medications can consider starting these. Dr. Spalla has seen many young patients come in to have injections done, and he is happy to meet your needs. Fillers are a wonderful way to dip your toes in the pool of cosmetic surgery.

What does it feel like? I’m scared to have injections done.

Dr. Spalla will work to make the process as painless as possible for you. We have several options available to make it easier than you can imagine. We can use a variety of means to make it very easy to undergo such as topical anesthesia, nerve blocks, cooling, and vibration. During your consultation, Dr. Spalla will work out a plan that makes you the most comfortable.

If you are truly needle-phobic, Dr. Spalla will talk to you about ways to still have this done, if you really want to, but if you’re adamantly opposed, we completely respect this, and fortunately, we have a other options for people who want facial rejuvenation. 

What is the downtime for fillers?

There is almost no downtime at all. Generally, you’ll have areas of swelling where the injections were performed. The areas feel kind of tight at first. Swelling is usually at its maximum around 48 hours after the injections. When this occurs, just remember that the swelling will improve and go back to what you saw during the procedure with Dr. Spalla. 

Applying cool packs to the area can help with preventing any immediate bruising and also helps with swelling after the procedure as well. We ask that you don’t do any strenuous activity for 24 hours. Gentle massage of the area may be recommended and will be discussed with you at the time of your visit.

Which filler is best for me?

There really isn’t a “best” filler for everyone, and that’s one reason there are so many options. The choice of filler is often based on what area we are treating. Different fillers have different properties, so one type of filler may be better for the lips while another may be better for the jawline. During your consultation with Dr. Spalla, he will teach you about the various options and help you choose what’s best for you. Some people come in asking for specific brands based on prior experience, what they’ve read, or the recommendations from friends. Dr. Spalla is happy to work with you and explain what he recommends and will work with your desires to find what you’re most comfortable using.

Fat Dissolution/Dissolving Fat

KYBELLA®

Kybella®® is the first and only FDA-approved non-surgical injectable treatment that contours and improves the appearance of submental fullness (“double chin”) by destroying excess fat cells below the chin. The active ingredient in Kybella®® is deoxycholic acid. Deoxycholic acid is a naturally-occurring molecule in the body that aids in the breakdown and absorption of dietary fat. Once these cells are destroyed, they can no longer store or accumulate fat, so further treatment is not expected once you reach your desired aesthetic goal. 

How many injections are necessary?

The number of injections varies, but most patients need 2-4 injections spaced a couple months apart done here in Dr. Spalla’s office

What can I expect after the procedure?

Your submental region will feel quite tight. Over the next couple days, the swelling will increase. This can be a little dramatic in some individuals, so taking a few days off is strongly recommended. This area can become somewhat firm as well to the touch.

Are there other options available?

As far as injections go, there are currently no other FDA-approved options for this situation. Dr. Spalla is a surgeon and can offer lipocontouring of this region in younger patients and lipocontouring along with a neck lift in older patients. The difference between these patient populations is that the skin doesn’t snap back in older patients and you’d be left with neck waddles. Dr. Spalla doesn’t want you to trade one problem for another and is able to address these issues for you without needing to refer you out like most injectors.