Thank you very much for the Botox and Juvederm and Boletero review. It’s very much appreciated. And I will continue to do my best to improve and live up to those high standards written in these very kind reviews.
Belotero Balance vs. Juvederm – initial thoughts in Modesto, CA
Today I used two syringes of Belotero Balance and two syringes of Juvederm in today’s line of work. I’m happy to report that Belotero didn’t disappoint. I’ve done many tear troughs before with Juvederm and I’ve always injected deep. For Belotero, I injected more superficially.
For both syringes which I’ve used, I mixed in a small amount of Lidocaine with Epinephrine.
Belotero is a dermal filler which was recently approved by the FDA in December of 2012. Belotero FDA approval.
The Belotero Balance Syringe
This is much smaller and much more ergonoic than their Radiesse syringe also made by Merz.
There was no cracking or splitting of the syringe which I’ve sometimes seen when I attach the Juvederm to my 3 way valve. I could probably get a better connector; however, the three way valve is something that is handy in my office because I use it for vein sclerotherapy in it’s foamed version.
The syringe itself is smaller than the the Juvederm syringe; thus it made it somewhat easier to inject initially where the thumb doesn’t have to stretch out as far. It’s a small advantage for those with small hands – such as me. I think this was done on purpose – to make the syringe shorter.
There were, however, some parts of the syringe that snap off – perhaps this is on purpose. The luer lock itself came off when I first connected it to the 3 way valve. The flanges for the syringe itself also slides off, and when playing with the syringe after injecting the product, the rubber tip of the plunger can also become dislodged. Regardless, these are very minor issues – which mostly arise because I like to fiddle with the syringe itself.
Initial Conclusions on Belotero in my Modesto practice
On injection, it feels smooth, and can be easily molded after injection into the skin. I used one syringe on tear trough and the other syringe on the accordion type lines around the side of the skin. I used a superficial approach to these lines – in attempt to use less product. It seems to work well.
It is on the opposite spectrum of their other product – Radiesse – which is a harder substance. Belotero is very soft and pliable but lacks the intense hardness and lift capacity of Radiesse.
I believe that Belotero has a place in the palette of “paintbrushes” we use in our cosmetic injection craft. But I think that more than one syringe is necessary to fill out fine line wrinkles in faces.
Disclaimer: Much of what is discussed above is considered off-label FDA usage of Belotero and Juvederm Dermal Fillers. More info about my Belotero Dermal Filler practice. Belotero has been mispelled – sometimes as Boletero, Bolotero, Belotora, Belatoro. “Belotero” is the correct spelling. An example of a dermal filler consent form, see an example of the Radiesse consent form.
I tend to get wordy – scroll down to the bottom for the summary of the three worthy FaceBook pages related to Surgical Artistry in Modesto, CA.
How do I find the Surgical Artistry page on FaceBook?
This is confusing because somehow FaceBook has a page created for Surgical Artistry – but regardless of how I try to “edit” that page – it doesn’t take my “suggestion” for redirecting to a page we created – which we consider the “official” Surgical Artistry FaceBook Page.
This is my partial collection of empty Botox bottles.
Here are some success habits I think these great injectors have in common.
1. Most of the MD injectors are the injectors of their practice without delegating to a nurse or PA
2. They are constantly looking for newer and better ways to do things.
3. They are eager to explore new products.
4. They selectively use cannulas for some of their injections.
5. They are very willing to share / talk / publish.
6. They make injections a priority in their practice.
7. They often go back to basics which includes knowing the anatomy, and exploring new anatomical concepts.
8. They are not be afraid to show off their grey hair – but will make some attempt to hide their wrinkles.
9. Most importantly they do not view fillers or Botox as a COMMODITY. In other words, it’s not a Botox per unit price or cost per syringe of Juvederm (the PRODUCTS), rather it’s the injector’s SKILL which is the true value. And this is how they provide the best VALUE – through the best skill and materials.
There are also a great number of amazing Nurse and Physician Assistant injectors. I haven’t had the opportunity to attend sessions and lectures by them (yet – I’d like to see what makes them successful as well, so it’s on my list). All the lectures and meetings and demonstrations that I’ve attended in the past few months were by Surgeons and Dermatologists.
Also, these aren’t necessarily “habits.” It was just a catchy title. These are more like “attributes” or “traits.”
To start with, how about a picture of these cannulas?
Why the need for Cannulas in comsetic filler injections?
You might say that Juvederm, Restylane, Radiesse, Belotero, Perlane, Prevelle injections have been just fine with a plain needle. But why increase the difficulty of the procedure? The reason? Less bruising? Smoother results? Safer? Those are excellent reasons for having your injector / surgeon work harder.
What are cosmetic fillers?
Fillers are like they sound – they fill spaces up to replace volume that we’ve lost as we’ve aged. Familiar fillers are Juvederm, Restylane, Perlane, and Radiesse. There are many more brands of cosmetic injectible filler implants. However these are some of the common ones used in my Modesto office: Surgical Artistry. Botox isn’t a filler – Botox relaxes muscles. Here’s a link to my page: Anatomy for Botox. Both fillers and Botox are used for facial rejuvenation.
Why the opening on the side of a cannula?
The opening is on the side for extrusion of the filler such as Juvederm so that the tip can be made in a blunt fashion. If the opening was at the tip, there would be sharp ends. Thus the opening is on the side. Is this good or bad? It’s both. It’s good because now the tip can be blunt. It’s bad because we lose a bit of the precision which we were used to with the tip of a regular needle.
Why the blunt tip on the cannula?
This is the key ingredient for safety and less bruising. Because the tip is blunt, it won’t easily go through vital structures such as arteries, veins and nerves. It glides through fat. In fact this blunt tip cannula idea is used in surgical liposuction. The safety is in the prevention of cutting vital structures. The less bruising is because there’s less internal bleeding due to the cutting of blood vessels.
Cannulas increase the difficulty of the cosmetic filler procedure
Yes, the difficulty is increased and it feels more like a complex procedure. However, the risks diminish and many of the positive results increase – including patient satisfaction, smoother results, and less downtime. I think this is worth the increased time and complexity – something surgeons think about all the time.
Needle vs blunt-tipped micro cannula. Safety is the #1 reason I like cannulas.
Where can cannulas be used?
For most injections where the fillers are introduced below the dermis of the skin. This is a plane where the cannula can glide. Superficial lines – probably a difficult space for the cannula – I would most likely continue to use a needle in the superficial plane. Examples of places for cannula use:
Pre auricular area
Lateral Eye Brow fat pad area – helps to raise the eye brows too.
There’s a need to use a pilot needle (which can still cause a bruise) to create the opening in the skin for the cannulas to slide through.
Cannulas are flexible and there can be physical hang ups (getting stuck), and difficulty driving the cannulas from a distance (longer needle). And because they are flexible, sometimes they are harder to feel their presence under the skin.
The hole is on the side of the needle not in the front.
Sometimes it’s difficult to gauge the depth of the injection
What’s the main reward for using a cannula?
Patient safety. When a blunt tipped cannula is used well by an experienced injector, there is much higher patient safety. Using needles – one could puncture subcutaneous structures which would otherwise like to stay unpunctured.
What are other great benefits of using cannulas?
Patient safety (mentioned above as the #1 benefit)
Tip is blunt – actually might hurt less.
Tip is blunt – won’t injure as much under the skin such as blood vessels and nerves.
Less bruising – because there’s fewer injury to blood vessels and thus less internal bleeding.
Less swelling – for reason above.
Flexible cannula – allows for safety – the cannula moves or wiggles around some of the stiffer structures within the fatty tissue planes.
Longer length – thus fewer skin puncture sites.
There’s also the benefit of calling this instrument a cannula rather than a needle – less scary sounding.
What is my favorite cannula?
Cannulas come in many different styles and lengths. I currently use Magic Needle and Dermasculpt cannulas. I haven’t had the chance to try other cannulas on the market. I believe they would be excellent. The Magic Needle cannuals are more flexible – perhaps a little bit too flexible for my current tastes. I know my tastes will change with time – it has before – I remain flexible myself in my choices of cannulas. As for favorite size/length of cannulas. I like the 27g 1.5 inch cannulas for most of my Juvederm injecting. I use this cannula mostly for temples and cheek augmentation.
Do I think that cannulas are game changers in the world of injectable fillers?
I think so. For the sake of patient safety and smoother appearances. Plus with the added benefits of shorter recovery period (less bruising, less swelling).
Do I use cannulas instead of needles for everything
No. There’s a role for each tool.
These are my thoughts (Calvin Lee). No specific medical information here.