Dr. Ava Shamban
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Chest Rejuvenation with Injectables Décolletage rejuvenation calls for a multimodal strategy that treats structural laxity, collagen loss, and photodamage separately: high-intensity, non-focused parallel ultrasound beams induce dermal thermal remodeling for laxity and crepey texture, while injectable poly-L-lactic acid biostimulates gradual collagen deposition for dermal support rather than volumization. Intense pulsed light corrects dyschromia and erythema through melanin- and hemoglobin-targeted chromophore absorption, and dual-wavelength 1927/1550 nm nonablative fractional lasers pair superficial pigment correction with deeper textural remodeling. An emerging adjunct, topical insulin, shows promise for post-procedural tissue repair based on wound-healing data and a 2025 split-face RCT combining it with microneedling RF for acne scars, though chest use remains investigational and off-label. Combining these modalities addresses structure, tone, texture, and skin quality more comprehensively than any single treatment alone. |
Dr. Joel cohen
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Avoidance and Management of Complications with Injectables and the Role of Angiosomes in Vascular Occlusion Preventing filler-related vascular complications requires detailed knowledge of facial arterial anatomy, including the temporal, lateral nasal, supratrochlear and facial arteries. Vessel course, depth, and anastomotic connections can vary significantly from patient to patient and dictate injection risk. Cadaveric dissection courses, articles and textbooks are the best way to build this anatomic foundation. Clinical vascular events may align with underlying angiosomes, the perfusion territories of facial arteries, whose thinner walled perforator vessels may be more vulnerable to injury. Whether to routinely aspirate before injecting remains debated, and no single technique reliably prevents intravascular placement. Practices should keep vascular-occlusion protocols and supplies on hand, since prompt recognition and treatment, including hyaluronidase directed at the affected angiosome, are what separate transient blanching from necrosis or vision loss. |
Dr. Ted Lain
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Regenerative Skincare, Exosomes, Polynucelotides, and the Skin: What’s the Truth? Emerging regenerative skincare is moving beyond traditional collagen stimulation toward cellular and epigenetic targets. Topical rapamycin tested in a randomized split-hand trial of photodamaged adults reduced markers of cellular senescence with no treatment-related adverse events. Polynucleotides and polydeoxyribonucleotides — traditionally salmon-derived but now producible from Lactobacillus rhamnosus — improve hydration, ECM integrity, and wound healing via the A2A pathway. Dihydromyricetin selectively erases age-related DNA methylation changes and improved multiple epigenetic aging clocks in cultured keratinocytes, while combined SIRT1/3/6 activators boosted in vitro collagen production by 174% after just three days. Plant-derived exosomes (cabbage, rose) show anti-inflammatory and proliferative effects in early studies, though the field still lacks standardized isolation protocols and regulatory guidelines, with delayed reactions already being reported with intradermal use. Much of this evidence has not yet been validated in robust human trials, and more human data are needed to establish safety and efficacy before wider clinical use. |
Dr. Terrance Keaney
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Treatments for Non-Invasive Fat Removal, Body Contouring, & Cellulite: What's New & What Works? Cryolipolysis remains effective, but patients are often undertreated in practice. Paradoxical adipose hyperplasia occurs in roughly 1 in 3,000 treatments (0.033%) and is managed with liposuction. An injectable ice-slurry approach to cryolipolysis showed a 29% reduction in treated fat with well-tolerated pain in a first-in-human pilot study. Cellulite is now understood to involve volume loss and dermal thinning in addition to fibrous septae. Collagenase clostridium histolyticum has been discontinued due to bruising and hemosiderin staining. Targeted verifiable subcision (Aveli) has emerged as a capital-equipment-free alternative that selectively releases only the septa causing visible dimples under local anesthesia with minimal bruising. |
Dr. Omar Ibrahimi
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Energy-Based Device Treatments in Skin of Color Safe energy-based treatment in skin of color starts from melanosome biology, not phototype. Darker skin carries larger, singly-dispersed, slow-degrading stage IV melanosomes that persist into the stratum corneum and compete with target chromophores at every wavelength, so a history of prior PIH and keloid tendency predicts complication risk better than a Fitzpatrick number. Six levers reduce that risk — longer wavelength (1064 nm as the workhorse), larger spot size, longer pulse duration, aggressive cooling, lower fractional density, and topical priming/photoprotection — with density emerging as a dominant driver of PIH. Ablative fractional resurfacing carries substantially higher PIH risk in Asian patients, and even "color-blind" modalities like RF and cryolipolysis can still cause thermal- or cryo-injury-related pigment change. Across common indications for energy-based device treatment in skin of color, the consistent protocol is low energy, low density, more sessions, and test spot before treating visible areas. |