All the Groundbreaking Ways Doctors Are Using Popular Cosmetic Treatments
By Emily Taylor | May 07, 2019
While they may not be brand-new, the creative ways doctors are using these tried-and-true aesthetic solutions continues to grow.
Although Botox Cosmetic has only been FDA-approved to minimize frown lines, crow’s-feet and forehead wrinkles, innovative doctors have been using it for years to treat other issues. For example: “Patients who have excessive sweating in the hands, feet or underarms may be recommended Botox,” says Greenwich, CT dermatologist Kim Nichols, MD. “It helps relax the muscles and sweat glands in the places it is injected.” And when injected into the masseters on either side of the jaw, Botox can help relax the muscles that can cause TMJ and bruxism. “Treatment of the masseter muscles in the setting of chronic teeth clenching is a game changer for patients,” says Houston dermatologist Jennifer Segal, MD. “It relieves clenching and results in a soft contouring of the face.” As Greenwich, CT dermatologistMitchell Ross, MD points out, nightly jaw strain can also take a major toll on teeth. “Those who clench their jaws while they sleep can have the equivalent of the weight of an elephant sitting on their teeth, which leads to destruction of tooth enamel.”
Though most often used to restore volume to areas with deep creases and lines, fillers are being used off-label in a variety of places. Experienced injectors have been placing HA fillers or the long-lasting PMMA-based collagen filler Bellafill up behind the hairline to give a subtle lift to the forehead or cheeks. Filler can even enhance the nose: “We have many patients wanting to improve the profile of their nose without surgery,” says Dr. Ross. “For a hump on the bridge or a droopy nasal tip, hyaluronic acid filler can be used off-label for a ‘nonsurgical nose job.’ The treatment entails injecting filler and molding the nose to appear straighter and lifted.” The biggest danger? If the filler is incorrectly injected, it can block blood flow to tissue and cause the tissue to die. To avoid complications, go to a board-certified doctor practicing within scope.
Lasers aren’t just for wrinkles; they can help enhance the smile too, says New York cosmetic dentist Nargiz Schmidt, DDS. “Biolase is typically used for the treatment of periodontal issues, as well as gingivectomy, or removal of gum tissue, when indicated,” she says. “But, I also use Biolase for the treatment of highly hyperpigmented gums—the procedure removes very thin layers of gingival tissue to gently eliminate pigmented areas.”
FRACTIONATED RADIO FREQUENCY
Westborough, MA facial plastic surgeon Min Ahn, MD uses fractionated radio-frequency (RF) treatments during rhinoplasty to help re-drape thick nasal skin. “In rhinoplasty procedures, we rely on the skin to ‘shrink-wrap’ so we can see the new shape of the cartilage and bone. Skin that is thin or medium-thickness shrinks well, but thick skin does not. The traditional surgical approach with thicker-skinned patients was to increase the projection of the nasal tip, like a tent pole, to make it appear more refined. However, this makes the nose stick out further, which some patients don’t want.”
Most commonly, doctors have prescribed oral tranexamic acid to treat those with hemophilia to aid in blood clotting, as well as mitigate heavy menstrual cycles. Topically, the ingredient proved to be a super brightener in SkinMedica Lytera 2.0 ($154; SHOP NOW) and SkinCeuticals Discoloration Defense ($98; SHOP NOW), and doctors are experimenting with oral dosing of transexamic acid to treat stubborn melasma. “We’ve recently found it can inhibit the production of melanin in the skin,” says Dover, OH facial plastic surgeon David Hartman, MD, though he notes the medication is best used in moderation. “The risk of thrombosis is one a patient with severe melasma should gauge before starting, now that there are also OTC treatments without that risk that are easy, reliable, inexpensive and safe.”
PLATLET-RICH PLASMA (PRP)
A panacea of sorts, platelet-rich plasma therapy is touted to help with a myriad of maladies. “PRP sprayed into the facelift or browlift wound prior to closure enhances healing and minimizes potential bruising,” Dr. Hartman says. “We also use PRP for fat transfer procedures because it enhances the viability of the fat. We mix PRP into our harvested fat just prior to reintroducing the fat into the donor sites.” New York dermatologist Marina Peredo, MDalso uses PRP to heal skin during in-office facials. “First, a gentle laser replaces damaged skin with healthier, younger skin,” she says. “Then, we create millions of tiny treatment zones with our plasma needling treatment, which infuses a customized blend of plasma, growth factors and antioxidants we refer to as ‘liquid gold.’ The combination improves discoloration, texture and tone. It is great for acne scarring and uneven pigmentation, and also helps build collagen.”
For patients with hard-to-treat hypopigmented skin, Fort Lauderdale, FL dermatologist Dr. Matt Elias is using eyelash treatment Latisse off-label to add color to whitened skin. “A known side effect of Latisse is periocular hyperpigmentation—a darkening of the skin around the eyes,” he says. Combining Latisse with a treatment that creates microchannels in the skin—like microneedling, Fraxel or Clear + Brilliant Permea—allows the bimatoprost-based solution to “produce melanin, and in turn replace lost color,” Dr. Elias says. (Because this is so new and not FDA-approved, there is no long-term data on how long the results last.)
Absorbable polydioxanone (PDO) threads, like Silhouette InstaLift, are now being used off-label to lift loose tissue from head to toe. New York dermatologist Doris Day, MD places five to 10 threads longitudinally into “the barcodes” to smooth lip lines. Beverly Hills, CA plastic surgeon Ritu Chopra, MD lifts crepey knees with threads. “This is a difficult area to treat with filler, but facial threads work great,” he says. As doctors continue to experiment with how to best employ threads on areas like the buttocks, Dr. Day says the results are encouraging. “We are in the infancy of learning all that we can do with this newer form of rejuvenation, but I believe it’s here stay.”
Microneedling takes the phrase “beauty is only skin deep” to a whole new level. Microscopic needles—on a roller stamp, or energy device—pin-prick the skin and enact a reparative response to stimulate collagen production. Doctors are taking advantage of the skin’s temporary permeability by immediately applying a topical. According to Kansas City, MO dermatologist Audrey Kunin, MD, microneedling paired with minoxidil—an ingredient that stimulates hair growth—allows the hair-growth helper to penetrate the scalp deeper. “Combining the treatments helps the minoxidil reach the hair bulb where it is needed to boost hair growth.” However, there’s currently no data proving this method is effective.
DISCLAIMER All of the doctors included in this story mentioned just how important creative, off-label use is to the medical community, but more strongly stressed seeing a board-certified practitioner who has vast experience and knowledge on the treatments in question. “Always see a board-certified dermatologist or plastic surgeon,” says Dr. Nichols. “Off-label use can be safe when done by an experienced dermatologist who specializes in that off-label treatment. A dermatologist or plastic surgeon may also produce research showing efficacy of the off-label use, has been trained on the off-label use, or performs it regularly. Of course, all cosmetic treatments can have a potential risk whether on or off label and this is why it’s important to see a properly board-certified doctor to review your skincare goals and consent for treatment.” Dr. Hartman agrees: “I absolutely am in favor of off-label use of treatments that are showing promise in solving medical problems. Certainly, a full informed consent, including the facts that it is not FDA approved for this use, may be experimental, there may be no data about the procedure, efficacy and complications is the cornerstone of any off-label use.”