Confessions of a Master Injector: Lori Robertson

Confessions of a Master Injector: Lori Robertson, The Grand
Tell us a bit about your background and training. How did you become interested in aesthetics, namely injectables? 
My background as a practitioner was in ER, ICU, and Family Practice (25 years). In 2007, I went with a friend to get my first Botox treatment, looked around, and thought to myself, “Wow, what a nice environment to work in!”

I started going to cosmetic dermatology and aesthetic seminars, lectures, and hand’s on classes. I was hired in 2007 by a medical aesthetic clinic, worked both Family Practice and Aesthetics for 9 months before quitting family practice altogether to devote my time and energy to my new found passion of helping people feel better about themselves in the medical aesthetic field. And I have never regretted it!

What questions should one ask when seeking injectable treatment, such as Botox? How can one ensure they’ve found a qualified practitioner? When a new patient seeks to have a treatment like Botox/Dysport done they need to make sure of the following:

First, that they are getting ONLY FDA approved products. Some clinics say the toxin is “Botox” only to inject another brand or generic toxin.

*(There is no legal generic BotulinumToxinA in the USA. Only 3 brands are FDA approved; Botox, Dysport, and Xeomin)

Patients need to ask questions:

–What experience does the practitioner have doing a certain treatment?

–What are their credentials?

–Look a practitioner up on the applicable medical/nursing website to verify license and certifications.

-Shop for expertise, not the lowest cost. Safety is paramount.

–Know what issues or concerns you have before you go in. Don’t let someone sell you treatments you don’t need.

What’s in your arsenal for things such as treating cheeks, the “commas” around the mouth, fine lines between eyes, and getting a natural brow lift? At Ajliss Medical, we use both Allergan products (Botox, Juvederm Ultra, Juvederm Ultra Plus, Juvederm Voluma, and Juvederm Vobella) and Galderma products (Dysport, Restylane, Restylane Silk, Restylane Lyft, and Sculptra).

When addressing dermal fillers vs. toxins we need to make sure that the patient knows what goes where, and why.

Toxins: (Botox/Dysport) are placed in very specific areas of a muscle to relax muscle activity that is causing a wrinkle, when the patient is no longer wrinkling up an area, the skin/wrinkle will smooth itself over time.

No provider can cause an eyebrow to lift higher. We can, on the other hand, weaken the muscles that cause the brow to be pulled down enabling the forehead muscles to lift easier causing the brows to appear higher.

Fillers: (Juvederm/Restylane products) are soft gels that are made of a dissolvable Hyaluronic acid (HA) which breaks down over 6-24 months depending on the product. These fillers are made in various densities or viscosities to go at different depths in the tissue. Some are placed near the bone to lift (such as Voluma and Lyft), some are placed more superficially to soften fine lines (such as Juvederm Vobella, and Restylane Silk)

The product chosen is patient-driven; the provider must assess the age of the patient, preexisting volume, along with skin and tissue density prior to any fillers injections to help replace the volume lost with aging.  The goal must be to replace only the volume lost along with exactly where is has been lost to enable the patient to leave looking ‘refreshed” and not “done.”

Saftey of fillers: The HA fillers are all dissolvable. Every clinic that injects with these type of clear gel fillers much have the enzyme (Hylenex) to dissolve the products in case of a vascular blockage, or post treatment issue.

Do you have any tips or techniques for achieving a fuller mouth without the dreaded “duck lip” look? Two products have come out in the last year that has changed the “lip filler” procedure dramatically. Both Restylane Silk and Juvederm Vobella are two products that provide very subtle smoothing and enhancement to the lips along with smoothing the lines that occur above and below the lip lines.

The procedure for lip plumping varies with provider, the general rule is the bottom lip needs to be approximately 1:1.6 ratio to the top lip. If the bottom lip remains fuller than the top lip it will reduce any of the “duck” look that we sometimes see. Also, when the top lip is injected, the lip boarder injection must be very conservative to prevent it from looking fake or “ducky.” Generally, enhancing the cupids bow by certain techniques is always a crowd pleaser.

Can errors with Botox be reversed? If so, what is the process? Neurotoxins are not reversible. The effects are never permanent and generally last 2-6 mos.

Is there anything new or on the horizon within the injectable realm that you’re especially excited about? The pharmaceutical companies are pretty “tight-lipped” about any new products coming out.  Many times we see products used in Europe for years before they are FDA approved here for use in the US.

In the last few years, the focus has been on a more natural, refreshed look. Generally, less fillers are being put in the nasal labial areas with more being placed in the mid to lateral face to help lift the tissue up that has sagged from loss of fatty tissue.

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