All About Dermal Fillers with Special Guest "Master Injector" Sharon Wells, RN

Airdate: 8/25/2013

This is it! Dermal fillers 101! If you’ve been contemplating having this procedure to reduce wrinkles or lost facial volume, tune in to find out which fillers are best, how they work, and what to expect during the procedure. We get the answers you need from Sharon Wells, a registered nurse with years of experiencing working with all of the major fillers in use today.

Paula Begoun: Hi, I'm Paula Begoun with Bryan Barron. And we're "Keeping you Beautifully Informed." We are the Paula's Choice Research Team. Well, actually we're a part of it. There's a whole bunch of other people, but we're here today to talk to you about everything dermal fillers. We are going to speaking in a little bit with our special guest, Sharon Wells, RN, with a title -- and I'm serious about this -- she is Master Injector.
00:00:28 That sounds dirty. It sounds a little…
Bryan Barron: It does. And when I spoke with her before the show she laughed when she said that. She's kind of embarrassed, I think, a little bit about…
Paula Begoun: Is that on her business card? We have to ask her.
Bryan Barron: I don't have her business card.
Paula Begoun: We have to take a look. She works at the Naficy Plastic Surgery & Rejuvenation Center in Bellevue, Washington, which is near Seattle, just over the bridge in Seattle, in Bill Gates' backyard, so to speak.
00:01:00 And what she does, actually she does more than just dermal fillers, because I know she does many other services and treatments over at the Naficy Plastic Surgery & Rejuvenation Center because I actually have spent some amount of time at the Naficy Plastic Surgery & Rejuvenation Center.
Bryan Barron: Yeah.
Paula Begoun: Dr. Naficy did my facelift. Dr. Adami did a special thing to my -- do you know about this?
00:01:28 I don't know that I told you about this. When I had the full laser, I had the deep ablative CO2 laser during my, you know, as part of what I had done while I was under general anesthesia.
Bryan Barron: You did get the whole package! Ha! They gave you a little check card like a room service menu and you're like, "Oh, I'll do this, I'll do this, oh, let's throw in a little bit of this since I'm out."
Paula Begoun: And I have a frequent flyer card actually.
Bryan Barron: Exactly.
Paula Begoun: So, what happens is, you know how sometimes when you see people who have had, you know, procedures and you can really tell they've had procedures, and when they move their face their eye pulls down, their lower eye pulls down?
Bryan Barron: Yes.
00:02:06 I have seen that.
Paula Begoun: So, Dr. Adami, who is an ocular plastic surgeon, he's actually an ocular surgeon who also does plastic surgery at the Naficy Plastic Surgery & Rejuvenation Center, did a procedure at the back corner of my eye before my CO2 ablative laser to keep that from happening. He, lord knows I actually didn't even really want to know what he did, but he but a couple of stitches inside the eye to tighten up that area.
Bryan Barron: Both eyes? Or just one side?
Paula Begoun: No, no, both eyes, to keep them pulled down.
Bryan Barron: Okay. I was just confused because you were saying eye.
Paula Begoun: Oh, eyes.
00:02:40 Definitely both.
Bryan Barron: I thought maybe just one had more of a tendency to do that.
Paula Begoun: No, both eyes. Both eyes. And, yeah, I don't have that look that you see -- you wouldn't know that I had that done. And they did do a good job on my facelift.
Bryan Barron: They did. I mean, I see you regularly and you do look younger and tighter, if I can use that word.
Paula Begoun: You can use younger and tighter!
Bryan Barron: You don't look like you had work done. You don't look pulled.
Paula Begoun: Thank you.
00:03:09 What I often call either the New York Yank or the Hollywood Hulk, which is where they just lift you up and pull you back and you look like Joan Rivers, and Cher.
Bryan Barron: Mary Tyler Moore had that type of facelift.
Paula Begoun: Jack Lemon before he passed away. Robert Redford. I mean, these people, you know, they're like poster children for cosmetic corrective procedures gone wrong.
00:03:34 And well thankfully that isn't what happened for me, and that isn't what goes on at the Naficy Center. They're very reputable. So, actually, before we talk to Sharon, because there are so many questions about dermal fillers, of which the first thing we need to see is when you see those ads saying, you know, for cosmetic products or skincare products and they show a needle -- "Don't go under the needle; aren't needles scary?" Fear. Fear. Fear.
Bryan Barron: Yes.
00:04:02 "Avoid painful injections."
Paula Begoun: "And our product will replace or you'll get as close to or similar…" Lying. Fibbing. Bald-faced lying. Fib, fib, fib. Those ads are not true. No one more than Bryan and I believe in the power of brilliant skincare, but we also, keeping you beautifully informed, know the limitation. And we will never lie to you or never tell you something the research doesn't show is true. And what somebody like Sharon can do with dermal injections and Botox, plastic surgery, whatever it is you choose or choose not to do around medical treatments, the notion that any of those things work like the skincare products you're spending way too much money on is just sad and pathetic.
00:04:53 And you save up that money that you would have wasted on bad skincare products, the ones we don't recommend on Beautypedia.com. Of course, you can always use my Paula's Choice products. I made them. I know what's in them. I'm proud of them. But, whatever you do, because what we care most about is that you get what works, whether they're our products or someone else's. So, speaking of someone else's products, because you know there's always something that riles me up out there in the world of skincare. I don't even quite... -- We'll do this one and on other shows, because you can listen to us archived on PaulasChoice.com.
00:05:35 There is a Bioelements product. So, you know, there's all these websites that say they're just like us, you know, that they do objective reviews and they tell you what's best.
Bryan Barron: Yes.
Paula Begoun: And they tell you what's worst, and of course everything is always best. And there is no objective. They'll say, "Oh, well it got this great review and it does this." They're basically an ad for the product.
00:06:00 So, this is Bioelements Oil Control Mattifier, in a jar -- in a jar -- of course it's in a jar. And basically all it is, it's actually a little surprising as to really how not good it is, because it's mostly just water, thickeners, a couple of plant extracts. They do have an anti-inflammatory plant extract, willowherb, which is actually an excellent ingredient, but it's lacking any skin repairing ingredients. It's lacking any ceramides or hyaluronic acid. Lecithin -- cholesterol. It's lacking really antioxidants, which is so important for barrier repair.
00:06:44 But mostly even though they do have this really great anti-inflammatory ingredient called willowherb, which is really the only thing it contains of interest is -- it's in a jar, which means that for the $36 for 1oz product you would be buying…
Bryan Barron: That's on the pricy side.
Paula Begoun: Yeah.
00:07:02 For a little container. That you would be, you know, it's bye-bye -- the good ingredients deteriorate in the presence of air. Jar packaging is always a problem. Not to mention you stick your finger, and the bacteria you transfer into it will cause the good ingredients to deteriorate even faster. Oh, one other thing. So, people every now and then when I talk about the, you know, don't stick your finger in it and then they say, inevitably, somebody will say, "Well, I use a spatula."
00:07:31 And I'm thinking and how often do you clean that spatula? Where do you put it? In your makeup drawer along with all the other yuck that's in there? I mean, why is that any cleaner than your finger?
Bryan Barron: I know! I know you look in people's makeup drawers, well it's not like I go house to house in doing this, but just speaking of my own, and it's like you see -- there's extra hairs. There might be some clippings, powder whatever.
Paula Begoun: "I use a spatula." Ha!
Bryan Barron: And then, yeah, you're throwing your spatula into that?
Paula Begoun: Are you disinfecting it? Oh please.
Bryan Barron: Do you have a little Autoclave on your counter?
00:07:58 Are you just dipping your spatula…
Paula Begoun: The kind of packaging you look for is the packaging that keeps your fingers…
Bryan Barron: Now, some clean. Some companies like Boscia, the Japanese skincare brand, they use a lot of airless jars.
Paula Begoun: Oh, airless! Anything that…
Bryan Barron: Which is fine, because there are some products, particularly thicker facial moisturizers that work best in a jar. Trying to put something like that in a tube or in a product that you have to pump, it just…
Paula Begoun: It won't work.
Bryan Barron: It doesn't work. It's an exercise in futility.
Paula Begoun: But the major thing is that it looks like a jar and it looks like when you open it you'll get your finger in, but the major thing is packaging that doesn't let light in, that means only opaque packaging, and packaging that doesn't let your finger into the product. And then you get a brilliant product with packaging that keeps brilliant ingredients stable.
00:08:49 Okay, I'm done. I won't rag anymore on poor Bioelements. They can do better than that. Okay, so, we're going to be talking now with Sharon Wells, Registered Nurse at the Naficy Plastic Surgery & Rejuvenation Center. The Master Injector for the Naficy Center. Sharon, are you there?
Sharon Wells: Yes I am. Good morning.
Paula Begoun: Good morning. So, Sharon, you're a Master Injector. Is that like great conversation at a cocktail party?
Sharon Wells: No, not at all. You know, it's funny -- that was a designation when Dr. Naficy was looking for someone with advanced technique and good experience, years of experience.
00:09:30 He said, "We're looking for a Master Injector, not a beginning, not an intermediate. We're looking for someone with great skills." And basically that's someone who has mastered the art of the injectables that we currently have available. And I've been injecting for about 15 years. Another way of saying that might be to say someone who has advanced injection technique and experience.
Paula Begoun: So, what makes you master and not beginner or intermediate? What's the difference between what a beginner or an intermediate injector would do versus what you can do?
Sharon Wells: Truly it's years of experience and training. And that gives you better skill at injecting and having better outcomes, I think.
00:10:24 It's a skill level that's really developed. You know, I have taken numerous courses, preceptorships, and advanced training. But I also have been an instructor, a trainer, for Allergan and Medicis. And I've offered small class groups for physicians and nurses, people who are beginners or looking for advanced experience and better techniques.
Paula Begoun: So, Sharon, give me an idea. I'm still not getting -- what is that skill? Tell me what it is you're doing that a beginner wouldn't be doing.
00:11:03 If you're injecting a needle in my lines, let's say the lines that run between the corners of my nose to the corners of my mouth, which are called the nasolabial folds, you know, the deep smile lines, and you're injecting those areas. That's a very typical area to inject with dermal fillers. What are you doing -- what advanced technique are you doing that a beginner wouldn't do?
Sharon Wells: Well, and of course I can't speak for every beginner.
00:11:32 The ones that I have trained I've tried to give them some better ideas about how they can inject and make it lay nice. But, for example, someone who is newer may not understand that you don't just put down a deep thick row of this product in a fold like that. It's going to lay better, look better, if you apply it in fine threads and sort of a fanning or cross hatching technique.
00:11:59 There are various ways that injections can be done. Some look better than others. If people complain about being lumpy or when I smile you can see a rope-looking row of this product, then that is probably a beginner or someone who hasn't learned the finesse of laying it in there so that it lays very smoothly and nicely. And that might be one example.
Paula Begoun: That's a pretty good example!
Bryan Barron: Yeah!
Paula Begoun: So, Sharon, you said Allergan and Medicis. And those are two companies that make dermal fillers.
00:12:32 Which dermal fillers do they make?
Sharon Wells: Well, Allergan developed and sells Juvederm Ultra and Ultra Plus, and soon -- probably within the year -- another new product that they have called Voluma, which they feel will last longer. That is not available to us yet. But, it should be maybe later this year.
Bryan Barron: Now, Sharon, Voluma, isn't there some other area where that can be used, in terms of that's how it's going to be marketed as well? It's not just long-lasting, but it's better for injecting…?
Sharon Wells: Well, where you want a lot of volume.
00:13:09 And that might be like in cheeks or, you know, temples, or areas where you see a great deficit that you're really trying to get a large amount of volume.
Paula Begoun: Oh, so that hallowed look that you can get with age?
Sharon Wells: Correct.
Bryan Barron: So, with Voluma would you then need to use less product as you would say with Radiesse? Or you don't know yet?
Sharon Wells: Yeah, we don't know fully yet.
00:13:34 But it would stand to reason that that would be the case. That the denser and the more lift and volume that there is, then the fewer syringes you would have to use to achieve a correction that you're looking for.
Paula Begoun: So, one of the things people ask all the time, you know, you look up dermal fillers or injectables, facial injectables on the internet, and the list is just daunting.
00:14:01 I mean, it just goes on and on from A to Z, pretty much A to Z with cadaver skin, autologous, however you pronounce that, you know, your own skin, your own fat, to a cadaver's fat, to…oh geez, all the way down to Zyderm, to collagen. So, of the many, many forms, what are your favorites? What are you using these days that you think are the best ones out there that you're getting the best results with?
Sharon Wells: Well, we use the whole family of hyaluronic acid fillers.
00:14:41 That would be Medicis makes Restylane and Perlane. We offer those. We offer Juvederm Ultra and Ultra Plus, which are the Allergan products. And we also offer Belotero, which is a newer AHA product, and we'll just say AHA but it's a hyaluronic acid gel.
00:15:02 They're very soft, very natural, and yet, you know, depending on the thickness and the concentration of AHA it can make the product persist longer. So, we do use all of those. We also offer Radiesse, which is a calcium-based filler, and that's by the Merz Company. And they make Belotero as well. Then Dr. Naficy does Artefill, which is a polymethylmethacrylate beads in a gel base.
Bryan Barron: Yeah.
00:15:35 That's the one that Paula had done when it was called Artecoll. And Sharon, you were saying, what happened with Artecoll? The company sold?
Sharon Wells: I believe that happened years ago. And it was off the market for a bit, and then back on. And the name was changed to Artefill. So, that is something that Dr. Naficy does himself, prefers to, because it is considered a permanent filler. And I think the only correction that could be done there would be surgical, so I think if he feels he has to correct that surgically, be better be the one who did it.
Paula Begoun: Ha!
Bryan Barron: Yeah. Paula, you've been fairly happy with Artecoll, right?
Paula Begoun: Yeah. I had it done twice over a 15-year period. And I have no depth of nasolabial folds and the marionette lines. He also did some fill between my brows. That was a bit off-label, but this was somebody who had done it --
00:16:31 I think was it Allergen who did -- who used to own Artecoll? I think it was Allergan who owned…
Sharon Wells: No, it was not Allergan. But to be honest with you I can't remember.
Paula Begoun: [Alcon]? I can't remember who did it.
Sharon Wells: Something maybe more -- that sounds more familiar. But it has been quite a few years that it has been bought and reintroduced. So, now that is beyond my memory that far back.
Paula Begoun: It is definitely permanent.
00:17:00 I mean, there is no question.
Sharon Wells: And if it is injected correctly, you will be happy with that permanent placement.
Paula Begoun: Yes! And if it's not, you're going to be an unhappy gal.
Sharon Wells: Correct.
Paula Begoun: You know, it's funny, when I did have it done I knew it was a risk, but I also knew given how high maintenance I am, and I am pretty damn high maintenance, that if there was something I could have done that I didn't have to redo, that that was going to be the road I was --
00:17:29 And I actually did go to Canada to the guy who developed the technique for the company up in Montreal. And I did have a complication. I did have a granuloma that only just recently…
Bryan Barron: So, explain what a granuloma is. I'm sure you and Sharon know.
Paula Begoun: Well, it's kind of a little round dot that you can feel. You couldn't see it on my lips.
Sharon Wells: It is scar tissue basically that has developed where there is a foreign body or something there that the body rejects a bit.
00:18:04 So, it forms firm tissue around the particulate matter of something there. That has happened in different cases. It has not happened, that I'm aware of, with Radiesse or with the AHA fillers, but it has happened with Artefill. And the other filler, or it's not really a filler, but the other thing we use in that category of filler is Sculptra.
00:18:32 And so there have been some granulomas formed with Sculptra as well. But few and far between and, again, placement is very important for that product.
Paula Begoun: In the research there is definitely, I mean, in the literature and the medical literature for almost every single, if not all of the dermal fillers you've mentioned and the ones we've researched, there's always problems. There is a percentage of problems that occur.
00:19:01 The thing that happens with the non-permanent ones is that as the filler dissipates, so does the problem.
Sharon Wells: Exactly true.
Paula Begoun: So, it's not lasting. So, right, which is interesting that Dr. Naficy does Artefill because he knows if it's a problem he's the one.
Sharon Wells: Exactly.
Paula Begoun: I think that's incredible ethical.
Sharon Wells: And, you know, the injection technique I think would be fine. I'm very comfortable with that, but I've agreed and respected his decision to be the only injector of that because he would have to be the one to make any corrections.
00:19:35 So, I think he just felt more comfortable about taking that on, which is fine. We're all happy to let him take that.
Bryan Barron: So, Sharon, switching gears from talking about specific types of fillers, who is the ideal candidate for the dermal fillers the Naficy Center offers and is there an age range that's best?
Sharon Wells: Well, that's a very interesting topic. And, of course, it varies by the individual.
00:20:00 But the guidelines are generally a person between 21 and 60, because that's how the studies were set up. They tested these fillers on people between the ages of 21 and 60. And so that's sort of the round number to discuss. But there's no real limitation. You know, preferably you're not going to be doing this on minors so it would obviously be somebody over 21, but how many 21 year olds need fillers? Probably not too many.
00:20:30 Nor is the price tag something that most 21 year olds have discretionary money to spend on. But, we're likely to find the ideal candidate is probably somebody between the ages of 30 and 50, and that's a little bit broad as well, but it's more when the first signs of aging might begin to show where maybe a little bit of a correction can make a bit difference. And it really doesn't require much.
00:20:59 So, we do have people in that age range between 30, 40, and 50 who really don't need a facelift. They're not really looking for surgery. They just want a little bit of correction to sort of postpone the signs of aging that can create deeper lines and wrinkles. So, they are probably more the ideal candidate.
Bryan Barron: So, I'm 39. I'm going to be 40 at the end of the year.
Paula Begoun: You're kidding! You're actually getting older?! Oh my god!
Bryan Barron: I do age, yes!
Paula Begoun: Sorry.
Bryan Barron: Sorry, we've been working together since I was like 26 or 27, so I think you perpetually see me as being in my twenties.
Paula Begoun: You know, it's true.
00:21:39 I'm sorry, Sharon, forgive me. Just as a departure -- an old boyfriend, somebody who I dated when I was in my late twenties/early thirties, something like that, we're still friends, we still see each other, and every time I would see him I would say, "Gee, you just haven't changed a bit." And then he sent me a picture of when we were dating and I went, "Oh my god are we old!"
00:22:03 Oh, I said, "We not only have changed, we are like…" It's not anymore that I can ever utter the words that you haven't changed. I'm sorry, Sharon, I just…so, Bryan, to me you are still 26 and you are, I mean, just a gorgeous man. But, yeah, definitely not 26. So, I'm sorry, Bryan. You were going to have Sharon help you out here.
Bryan Barron: So, not too long ago I was looking at pictures of myself from my mid-twenties, and I can see that even though it's subtle I'm starting to lose some of that youthful fullness that is the hallmark of a younger looking face.
00:22:42 And I think I'm kind of in that nice little window where you can say that my face is becoming a bit more angular. I haven't lost enough of it yet that I'm starting to look older, or maybe you could say I'm looking more distinguished, but is that a good time to start getting something done in the effort of forestalling it from getting worse later?
Sharon Wells: And, you know, that's a really fair question.
00:23:10 Without seeing you, Bryan, that would be really tough for me to say, "Well, yeah, we could improve your appearance by doing this or that." But, I think in general if there are things that are starting to bother you, things that you're saying, "Gee, I feel like I'm getting a little saggy or I don't look as handsome as I used to," those are the times when maybe you might have a consultation and we could go from there.
00:23:35 Just, you know, a bit of aging, particularly for a man, they can get away with a lot more. For some reason that is so. Being angular, you know, and not gaunt, but angular, that's an okay look, even for a woman. But it really depends on what is bothering you at this stage. And if you have a consult and we look and we agree that, yeah, we could improve that, we discuss that.
00:24:03 Everyone loses volume over time. And certainly in the mid-face that's the first signs of that. So, it does happening for people.
Paula Begoun: So, one of my philosophies has always been that people always say, especially when I was going about getting my facelift and people would say, "Oh, you don't need a facelift." And I was thinking, so, I'm supposed to wait to get a facelift until somebody is thinking, "Darn, what is she waiting for? Look at that face hanging down on her boobs. Lift that!"
Bryan Barron: "Excuse me. I just tripped over your jowls. Could you maybe consider doing something about that?"
Paula Begoun: Are you supposed to wait until everybody thinks you look really terrible?
00:24:46 My strong philosophy is if you're going to choose to do this, if this is a path…
Bryan Barron: And it is a choice.
Paula Begoun: Absolutely, we are hardly the people saying that this is a must. This is a realistic option to look younger. This is really what is that line between what skincare can do and what skincare can't do.
00:25:06 What all the models and celebrities over 40 and 45 are doing, which is why they look so smooth and you don't, unless you've been to the Naficy Center. But, the point is that what I would say, Sharon, very strongly is that if you are thinking of doing it, then the notion is to do it sooner than later.
00:25:31 Sooner to start looking younger and staying younger longer than waiting till you look older and then reversing it. Is that a philosophy you guys have over there at the Naficy Rejuvenation Center?
Sharon Wells: You know, that's a really fair question. And I think we would agree with you. If you start to see the signs, you know, more than a pinch here or there, that maybe it would make a big improvement.
00:25:56 I think more than anything we can do a lot with fillers. If you need just a little more volume or a little bit of lift, or a little correction, we can do that. And that can cause surgery to be postponed. But, if you have a lot of laxity in the skin so that there is just excess skin, you would never want to fill to the point of stretching that amount of skin again and re-inflating it, then maybe it is somewhere in between, you know.
00:26:26 So, we would look at each person and see what it looks like we could improve. But I think Dr. Naficy is very honest and very conservative in that he is not going to be telling a 30 year old she needs to have a facelift. And unfortunately we've seen that happen, too, where people get talked into doing everything really before they even need to. So, we would be honest and fair and do a consultation, but I agree with you. No point in waiting until things look really bad before you do it, especially if the rest of your body and your physique is in good shape.
00:27:03 You want to make the most out of that. I would not suggest you wait until everything is falling down to improve your face. You want it all to harmonize and go together.
Paula Begoun: I'm interested in finding out what fillers could do for me, so I make an appointment with you, and you come look at my face. And you give me some options around what can be done. And you give me a price. Is that pretty much how…?
Sharon Wells: That's exactly correct.
Paula Begoun: And then I make a date to come in.
00:27:36 And then what's the process, what's the instructions when I go home, before I come in to have the fillers injected, and what's my downtime? What do I look like? Am I little dots of -- what happens? Walk me through, after the consultation till I come in and get stuck with needles.
Sharon Wells: Okay. Well, that's fair, and I'm glad you brought that up because it is important. I think there are things that the individual can do ahead of time that may make their outcomes a little better and shorter downtime.
00:28:15 Basically we tell people to be off of all blood thinners about one week prior to coming in for the injections. Blood thinners can be the obvious things like the non-steroidal anti-inflammatories which are Aspirin, Advil, all the names that goes under, Aleve, ibuprofen of any type. Tylenol is okay and people often want to know what they can take if they were trying to stay off of blood thinners. And Tylenol would be the one exception to that.
00:28:47 We would have people if they would like to even get some Arnica, the little tablets or the cream to have on hand for afterwards. If you do get a little bruising or a prick mark or something, many people feel that Arnica will help that resolve a little faster. But, that's optional. But, at least no blood thinners for one week prior to. And you come in, and then of course we prep the skin, make sure it's clean, and we put some topical numbing cream on you that's really got three different kinds of topical anesthetic in it.
00:29:25 We refer to it loving as BLT, but is betacaine, lidocaine, and tetracaine. And that's a prescription that is a very strong dose of topical anesthetic. And that's applied for, you know, 10, 15 minutes, plenty of time. We'll wipe that off and then we would use some, we have something here called the Golden Spoon. It's like using ice or something really cold to add to the numbing factor prior to injections.
00:29:58 And we do that a little bit as we go along. The injections are then done and the results are pretty apparent immediately. You start to see volume. There is some continual improvement depending on the product that we are injecting. The AHAs, for example, are clear gel fillers, but they are humectants. And as they're injected they do absorb water or moisture from your body into themselves and they expand.
00:30:29 So, within a few hours you will see more fullness than you did when it was first injected because it's concentrated. And then as it expands you see a nice floating, sort of a [unintelligible] volume. Its floats up and out and I don't mean by floating that you can see that, but that is what's happening underneath. So, instead of being concentrated little threads or strands of it, it begins to expand and meld together and make a very smooth overall lift and volume.
00:30:59 So, there's not a lot of bleeding that goes along during this. We hold pressure, make sure that you look clean and nice when you leave. Many people can put makeup on immediately and go out and carry on with their activities for the day. The trouble we get into occasionally is where someone doesn't remember to be off blood thinners, and that can even be fish oils, high doses of vitamin E or omega-3s. Those are considered blood thinners as well. So, once and awhile somebody forget that and they come in and they still want the injections done, but there's definitely a higher risk of bleeding which causes bruising.
00:31:34 And in that case, that's a little more difficult to cover. We do hold pressure. We believe that if you inject slowly you're going to have less pressure on the tissues and ultimately less bleeding and trauma.
Paula Begoun: So, two things come to mind. When I had my dermal fillers in my laugh lines, the doctor who did my injections did a numbing thing like what you get from a dentist.
00:32:05 He numbed me from the inside of my mouth. But then I also had my lips done. And when I left with my lips done, oh my god. Oh my god! I thought I had just, I mean, I had balloon lips. I thought…
Bryan Barron: Sort of like Goldie Hawn?
Paula Begoun: Worse. Worse. Oh my god. And I had a speaking appearance in three or four days afterwards, I thought I was going to die. And it did -- it did go down.
Bryan Barron: You had the trout pout.
Paula Begoun: Oh, worse, worse.
Sharon Wells: Well, Paula, you know, that's really important.
00:32:41 We offer that dental block as well. But, I'll be honest with you; the new fillers all have lidocaine in them. So, we find that if we use our topical and a little cold or ice and then we inject the product very gently and slowly, it actually has lidocaine in it, so it's numbing as it goes.
Bryan Barron: So, Sharon, that brings up a good point. And I think one of the reasons a lot of people are much more apt to buy that skincare product that says it's going to work like dermal fillers is that a lot of people are afraid that dermal fillers are going to hurt.
Sharon Wells: Yes. That's true.
Bryan Barron: From your experience in terms of patient satisfaction and feedback, what do you typically hear?
Sharon Wells: People tell me, "Wow, that didn't hurt like I thought it would. That was not bad at all."
00:32:23 And that's really honestly the truth. We have great topical anesthetic cream now that maybe years ago there was Ela-Max or EMLA, and those were like 1% to 5% lidocaine. We're talking 12% lidocaine.
Bryan Barron: Oh wow.
Sharon Wells: You know, great products now. And blending it with different types of anesthetic, we have much better outcomes. So, I can give somebody a dental block, but most people agree that they recover faster and have less swelling without the dental block. So, we're just not finding people want it or need it as much as it used to be.
Paula Begoun: Let me remind everybody that we're speaking with Sharon Wells from the Naficy Plastic Surgery and Rejuvenation Center in Bellevue, Washington, just outside of the Seattle area.
00:34:14 She is their Master Injector. You do other stuff, too, besides doing dermal injections/fillers, right? You do things like Botox and laser procedures? Or do you really just concentrate on the injections?
Sharon Wells: Well, you know, in this office, and I've been here about two and a half years, in the office I do all injectables, so that is Botox and Dysport and [unintelligible] or the other fillers that we have that I've mentioned, Juvederm, Restylane, Perlane, Belotero, Radiesse, Sculptra.
00:34:51 Those injectables, but also sclerotherapy, which is superficial tiny leg vein procedures, so I do that. I am trained and have done laser procedures in the past, but in this office the demand is so great for injectables that really that's what I'm focused on.
Paula Begoun: Just to depart for a second, but then I do want to talk about injecting lips, but you mentioned sclerotherapy and I've been thinking that the little red veins --
00:35:24 I've had it done once, actually I had it done twice. The one time it was so painful I thought I was going to die. I couldn't go through with it. That was with a laser. And then I had it done another time where it was injected. And actually it was painful but I did pretty good with that. And the results were good, but they've come back. Is that just kind of part and parcel? Is that when you inject the little veins with this salty stuff that kind of kills them off the surface veins that they stay away for awhile but do tend to show up again?
Sharon Wells: That is true.
00:36:05 They can be resolved and look better for years, but you know, we're dynamic creatures and always changing. So, over time if you're prone to them you may see a few coming back here and there over time. And you may need another treatment.
Paula Begoun: Do you guys only do the sclerotherapy, which is injecting the salt-whatever solution that stuff is, or do you also do laser to remove the small veins on the surface, or capillaries on the surface of skin?
Sharon Wells: We offer both.
00:36:39 But we do find that sclerotherapy is the gold standard for leg veins. So, we'll focus on that. Now, the only time that we would switch to doing a laser type procedure for leg veins is if the veins are now so tiny that our tiniest needle won't get into them, won't be able to access them. Sometimes they become so tiny that there is no way to really get in them with the tiniest needle we have.
00:37:08 And then in that case then laser would be the appropriate next step.
Paula Begoun: And then does that topical stuff you were talking about, the topical painkilling stuff, does that work for that as well?
Sharon Wells: We use that for laser treatments. We have not found it to be necessary for sclerotherapy. The solutions we use have evolved and are much less painful.
00:37:33 In the old days when I first started, I'm talking 15/16 years ago when I started doing sclerotherapy, we had hypertonic saline which burned. And it would cause a leg cramp.
Paula Begoun: It was terrible!
Sharon Wells: Yeah.
Paula Begoun: It was terrible! So, obviously I've put it off for a long time because of bad memories and the products have evolved past my memory.
Sharon Wells: Yes, they have. There was sodium tetradecyl for a good period of time, and that was less painful. But, you know, still not great. We might have had to do a couple repeat treatments to get them to shrink down a little bit each time.
00:38:10 And finally people, you know, were pretty happy and that was better. But now we use Polydocanol, which is a new solution that had been in use in Europe for a good time, but it took awhile for the FDA to have it approved here. And we find that, again, now is probably the best thing that's on the market. It's painless. And it seems to work better and fewer treatments as well.
Paula Begoun: Let's go to the lips, because I had the Artefill around my lips.
00:38:41 And it's lasted a very, very, very long time. And I'm just now starting to get a very stubborn deep line on the corner in my upper part of my lip, and then a deep line in the lower part of my lip that's just starting to look old. And I'm wondering, because it isn't really the shape of the mouth that's looking old. It's really just these two lines. Now, that's just me asking for personal advice, but in general as the lips start shrinking and the lines start getting really pronounced around the mouth, what do you do for that?
00:39:22 Obviously plastic surgery doesn't work. I know there are lip implants, which sound really bizarre.
Bryan Barron: Paula, we get asked a lot from women who have that concern of lines around the mouth. And oftentimes they're talking about a product that they've seen that claims to fill in those lines, be a lip line, wrinkle filler type thing. And then they buy it and they're disappointed because they will work to a point.
Paula Begoun: Well, they'll work to prevent lipstick from bleeding. They'll look good under or over makeup, very temporarily. But, you ain't getting the lips you used to have.
00:39:59 They're not plumping up the lips.
Bryan Barron: Exactly. Right. They hear the claims that it's going to essentially eliminate lines around the mouth and bring back that fullness and then that doesn't happen, so they're disappointed. And they try a bunch of products, and they will email us and say, "Here's what I've done. Why isn't anything working? What can I do?"
Sharon Wells: Well, I would totally tell you that dermal fillers, the AHA product family, be that Juvederm or Restylane, and even the new Belotero, I mean, these are all different products but they accomplish the same thing in terms of filling in fine lines and making them less noticeable or less visible.
00:40:41 Obviously if you've got a crease or a little etch right in the very surface of the skin, this product can't make every line go away, but it does get injected in underneath that, and it pushes up and out, stretches out the line, makes that less deep. And makes everything blend better. So, that is what we're looking for. But, there are other things, too, that we would recommend.
00:41:05 Certainly laser resurfacing can ablate the very top layer of skin. And as that grows back and heals, and if you had a little filler in there to plump those lines up, it would heal back in a smoother fashion and make the fine lines diminish, certainly smooth them out. It's sort of a combination approach. Filler works when there are lines that are -- they've lost volume underneath.
00:41:32 And it's just from continual movement, the lines get etched in. So, I love using Juvederm and even Restylane in those areas around the mouth. And I think it works really well.
Paula Begoun: Sharon, wait, wait, let me just get this clear. So, when I have one deep line, you can actually target -- and it's not very long, it's maybe a half an inch and maybe a millimeter or two wide, maybe.
00:41:59 You can actually target a filler into an area that small and just plump up that one line?
Sharon Wells: Absolutely.
Paula Begoun: No kidding?!
Sharon Wells: Yeah. Absolutely.
Paula Begoun: How cool is that? And even though I've had Artefill around there, like near that area, it doesn't matter?
Sharon Wells: Paula, Artefill is placed at a deeper level. And when we're going to correct a superficial line we have to place the product superficially, so that means by necessity we switch to an AHA filler because those are the ones that are designed to be able to use in a more superficial fashion. You want to get to the level where the crease is.
00:42:38 And if you're placing Artefill deeper, for deep volume, it still won't address a very superficial fine line. We've even used Botox on occasion to relax the muscle that makes that line. So, a very small amount of Botox can be used if you're pursing your lips and creating those lines. We can do a combination approach. Sometimes a little bit of Botox and we use filler in those few lines that are more noticeable. And we can achieve some improvement.
Paula Begoun: So, Sharon, one of the things -- Bryan, you were just saying because, you know, Bryan gets the questions.
00:43:15 He is responsible for a lot of the questions that get filtered through PaulasChoice.com and Beautypedia.com. And we get asked a lot, you were saying, about hyaluronic acid?
Bryan Barron: Yeah. So, every time, for our listeners, every time Sharon has been mentioned AHA she means hyaluronic acid. That's the chief ingredient in almost all the fillers that we've been talking about on this show. And Sharon, not surprisingly given the wild success of dermal fillers, hyaluronic acid has also become a buzzword ingredient that women are now looking for in skincare.
Sharon Wells: Correct.
Bryan Barron: And from what I've heard, and I'm not surprised by this, they figure that hyaluronic acid will have the same plumping effect on wrinkles or fine lines that it does when it's injected if you apply it topically.
00:44:05 And, first of all, hyaluronic acid is a very good ingredient for skin. We consider it a skin repairing ingredient. It is a naturally occurring ingredient. It's capable of [binding] of moisture. It does a lot of good things when applied topically. But, Sharon, explain how topical hyaluronic acid is not going to be the same in terms of effect as hyaluronic acid that's injected.
Sharon Wells: Well, the big difference is really the consistency.
00:44:31 In our bodies, hyaluronic acid is a viscous liquid and it is just that in products that we apply topically as well. There is a moisturizing effect to it; it's a hydrator. So, we expect that it will do that. But in a case where perhaps there's a great volume loss in the mid face, for example, or even in a deep nasolabial fold, there's not enough volume to it to lift and make a more long lasting correction.
00:45:03 You can hydrate it, but you're still going to have a wrinkle or a deeper volume loss in the areas where you have them. The fillers are cross-linked and they are made to be thicker, so they stay where you put them, largely, stay where you put them, and the more cross-linked the more dense. They have more lift. And they will give you more lift and volume. And so really that's the big difference.
00:45:31 They are the same hyaluronic acid. But, because of the way they're made into a thicker gel, they will give you more lift and volume, which you won't get from a liquid that's just applied topically.
Paula Begoun: Well, and the hyaluronic acid that's injectable in the forms of the products you were talking about -- Restylane, Juvederm, Voluma, and Belotero -- is Belotero a hyaluronic acid on as well?
Sharon Wells: Yes, it is. Yes.
Paula Begoun: Radiesse is the one that's the calcium added one right?
Sharon Wells: Correct.
Paula Begoun: So, it's really about the intense thickness difference.
00:46:05 In other words, you can't rub Belotero or Perlane or Restylane or Juvederm on the skin and have it do anything, right?
Sharon Wells: Correct. That is correct.
Paula Begoun: It's really about a thick placement of a substance that's meant to stay put for as long as possible, wrap around your own collagen layers, and stick there and not go anywhere.
Sharon Wells: Correct.
Paula Begoun: Okay. All right.
00:46:30 So, in other words, in short, there ain't no hyaluronic -- I don't know why I keep saying "ain't" -- there isn't…there aren't any skincare products that contain hyaluronic acid, or collagen, for that matter. Because collagen injections, when they were the popular type of injections, cosmetic companies stuck collagen in their products saying…
Bryan Barron: Some still do.
Paula Begoun: Yeah. And saying they're going to work like collagen injections and plump up skin. And, good moisturizing ingredients, but not replacing what Sharon does. Sharon Wells, Registered Nurse, at the Naficy -- let me just make I mention exactly where you work -- the Naficy Plastic Surgery & Rejuvenation Center in Bellevue, Washington, just over the bridge from Seattle.
00:47:17 Dr. Naficy is my plastic surgeon of record, just to be clear. I'm a happy girl. And Dr. Adami did do some stuff around my eye, so I had successful ablative laser resurfacing. So, Sharon, what do you want to leave us with? What do I need to know before I decide to see you or see someone else, given people all over the -- actually all over the world -- listen to our show. What do we need to know to make good decisions around getting dermal fillers or other types of treatments that are cosmetic corrective treatments?
Sharon Wells: Well, Paula, thank you so much for having me on today and for the opportunity to answer a few questions.
00:48:06 I would suggest anyone if they're considering having dermal fillers that they have a professional consultation. And I can't stress that enough. We answer questions on RealSelf and a lot of people call in. But, there's no substitute for seeing the person and really evaluating their individual needs.
00:48:29 There is no particular set of amount of product that's going to be right for an individual. It really is case by case. So, there's no substitute for that. The other thing is to make sure that you're either seeing board certified physicians or nurses even that are well trained; advanced training is necessary I think for a lot of the areas that are treated. And so that's what I would say.
00:48:58 A reputable office and plan on having a consultation. At the Naficy Rejuvenation Center here we offer free consultations with our nurse injectors and with our patient care coordinators who work directly as the surgery coordinators for the doctors. So, there's no reason to not have a consultation because there's no charge, and it's a few minutes of your time. But educate yourself.
00:49:26 And that's the biggest thing you need to do is come really well educated. And that might mean more than one consultation. You can even visit different offices, but you want to be informed so that you'll be able to make better decisions when the opportunities are raised for you.
Paula Begoun: All right. Sharon Wells, Registered Nurse at the Naficy Plastic Surgery & Rejuvenation Center in Bellevue, Washington. Master Injector. But Master Injector of all bunches of things, from dermal fillers, to Botox, to sclerotherapy that gets rid of surface capillaries and veins. Sharon, thank you so much for taking your precious time today and, of course, because I do come into Naficy Center I'm sure I will be seeing you soon.
Sharon Wells: Thank you.
00:50:13 Absolutely.
Paula Begoun: Take care, Sharon. So…
Bryan Barron: That was great.
Paula Begoun: That was great!
Bryan Barron: If you're still with us, that was a lot of information. And I wanted to let you know that, two things -- on PaulasChoice.com if you go to the Community Section on our main navigation you will see a link for our Radio Show. You can visit our all new redesigned radio page. It's fantastic. And you will find transcripts of this and most of our other shows. You can listen to past shows.
00:50:46 Also at PaulasChoice.com on the expert advice tab we have an article on dermal fillers for lines and wrinkles.
Paula Begoun: Oh, but don't go there yet, I'm updating it.
Bryan Barron: But by the time they hear this it will be updated.
Paula Begoun: Oh, I'm sorry, yes. But it's so difficult.
00:51:02 Oh my god. What an article. You know, there are some articles... -- I'm sorry, Bryan, I'm interrupting.
Bryan Barron: No, no, go ahead.
Paula Begoun: Well, there are some articles we work on, I mean, we do so much research and when we put together information there is so much crazy information out there that just drives us nuts. Product recommendations that we know that they won't help skin but they actually will make matters worse.
00:51:28 Or it's just a very difficult topic. We worked -- I don't even know how long -- it must have been over a month and a half on an article about extreme combination skin. What happens when you have very oily skin and very dry skin, and even some acne going on at the same time.
Bryan Barron: At the same time.
Paula Begoun: And to research that and get the best information together. Sharon, I mean, Sharon's information from the Naficy Plastic Surgery & Rejuvenation Center, I mean, is brilliant, but we have a very comprehensive article listing out the different products and pros and cons.
00:52:05 And how to choose a facility, wherever you are in the world. So, this is just one of those articles that we've been working on that is just daunting because it is such a complicated issue. So, I'm sorry, but yes, we do have an article that will be updated by the time you're listening to this show.
Bryan Barron: Yes. And this is a good time to mention that we have all kinds of articles on beauty-related topics -- skincare, makeup, non-surgical treatments, how to care for different skin types and concerns.
00:52:39 You know, we work really hard on all this, as Paula mentioned, and I don't think we do enough to necessarily promote. Because what we hear from a lot of Paula's Choice customers is, "Oh my gosh, you have an article on that?" A lot of our articles are inspired by the questions that we get, especially those that we get repeatedly from women who are concerned about skincare and not sure what to use.
00:53:00 "I've heard this, I've read this, is this really true?" We debunk a lot of myths. So, the Expert Advice section on PaulasChoice.com, believe me, it is a goldmine of information and spend a little time there. You won't be sorry. You'll learn something new, I promise. And we hope to see you there soon.
Paula Begoun: So, thank you for listening. I am Paula Begoun. And I am talking to the wonderful Bryan Barron who is turning 40. I can hardly believe it. We are going to have one heck of a celebration. We are keeping you beautifully informed. We are part of the Paula's Choice team --
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