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There’s a solid chance you’ve never heard of Nicotinamide Adenine Dinucleotide—that’s probably because you know it by its widely-used acronym, NAD+. Over the last several years, the naturally occurring enzyme has taken the health and wellness industry by storm. NAD+ has rapidly gained popularity because it’s thought to play an important role in [metabolism, aging, longevity, the immune system, and DNA repair. ](https://www.nature.com/articles/s41392-020-00354-w)

In this 101 piece, we interview industry experts to understand the background of NAD+, its benefits, the different ways to get the treatment, and suggested guidelines for optimal results. If you’re new to NAD+ or just curious to learn more about it, you’ll want to read on. 

## **The Background and Celebrity Influence** 

While most of us are just learning about NAD+, [researchers](https://pmc.ncbi.nlm.nih.gov/articles/PMC6342515/#R82) have actually been studying the enzyme for over a hundred years. However, it wasn’t until 1999 that researchers started to uncover that the molecules play a major role in cellular function regulation. A little over a decade later, the first NAD+ supplements were brought to market. But, the rise of NAD+ therapies really took off in 2020 when it gained traction among celebrities. Jennifer Aniston referred to them as “the future” in a [Wall Street Journal](https://www.wsj.com/style/jennifer-aniston-morning-show-season-3-59413d2f) interview; Hailey Bieber said “I’m going to NAD for the rest of my life and never age” in an episode of The Kardashians; and Joe Rogan spoke about its immunity, cognitive, and overall wellness benefits on his podcast. With so many influencer endorsements, the [NAD+ market grew to an estimated $184 million in 2022. ](https://www.voguebusiness.com/story/beauty/nad-is-hitting-the-mainstream-and-skincare-brands-want-in)

## **The Benefits of NAD+ Treatments**

We actually all have NAD+ in our bodies already. But, as we age, our [NAD+ stores decline](https://pmc.ncbi.nlm.nih.gov/articles/PMC7442590/). [Amanda Kahn, MD](https://www.dramandakahn.com/), board-certified internist and longevity specialist in New York City, says that we lose about 50% by age 40. Since the coenzyme plays a critical role in anti-aging by supporting mitochondrial function, DNA repair, and optimizing cellular activity, a decline in NAD+ can contribute to oxidative stress, inflammation, and reduced production of cellular energy called ATP, says Kahn. 

“Decreased ATP can accelerate aging and degeneration of all tissues in the body, including and perhaps most visibly, in the skin. Research suggests that NAD+ helps maintain skin elasticity by promoting collagen and elastin synthesis, improving tissue hydration, and supporting adequate nutrient delivery by supporting the skin’s microvasculature,” explains Kahn. “NAD+ also activates the Sirtuin family of longevity-associated proteins that promote cellular repair and reduce inflammation, both of which contribute to slowing down and possibly reversing the aging process.”

In addition to its anti-aging benefits, many report that the popular treatment boosts energy levels and enhances cognitive function. By supporting mitochondrial health and regulating oxidative stress and inflammation, NAD+ can also improve focus, memory, and mental clarity.

AEDIT Founder,[ Dr. William Kennedy, MD](https://aedit.com/provider/william-kennedy-md-26292), also weighed in on the subject saying "Mitochondria are responsible for producing about 90% of our body's energy. If we improve the health and function of the mitochondria in our body,  we will feel more energized. NAD+ has emerged as a vital oxidoreductase cofactor that maintains mitochondrial health and function.  NAD+ acts as a cofactor for various enzymes, including sirtuins, which are involved in regulating cellular metabolism and energy production. By activating these enzymes, NAD+ helps to optimize mitochondrial function, leading to increased energy production in the form of ATP, boosting our energy levels."

And, if all of the benefits above weren't enough to convince you of the magic of NAD+, it’s also thought to improve metabolism, sleep quality, and physical performance.

## **How to Get NAD+ Treatment**

Since its steady incline in popularity, NAD+ is widely available; you can get it at wellness-focused clinics, like Advitamin at Shafer Clinic, luxury hotels and resorts, or even book a treatment in the comfort of your own home. 

- **IV Therapy:** With more immediate benefits and a larger dose of NAD+, many practitioners recommend intravenous NAD+ therapy. However, Kahn points out that IV therapy can be time-consuming, more expensive, may not be practical for long-term maintenance, and may be more than the body physiologically needs in one sitting. It is typically administered in clinics or wellness centers and can take around two to four hours. Depending on the person’s goals, the practitioner may add vitamins or medications to the treatment. Since it’s absorbed more quickly, some people have difficulty tolerating infusions and experience nausea, stomach pain, dizziness, and headaches during the session. 

- **Oral Supplements:** NAD+ supplements are available in capsule and powder form and are marketed for their potential to boost energy and support longevity. While they offer a more convenient option compared to IV therapy, their effectiveness is patient-dependent since they must first be absorbed through the digestive system. Though, Kahn prefers precursors of NAD+, such as nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN), over direct oral NAD+ supplementation because they are easily accessible over the counter, are bioavailable by mouth, and are efficiently transported into cells. For optimal results, supplements must be taken consistently. As with all supplements, there are potential side effects, such as nausea, headaches, itching, and sweating.

- **Injections and Patches:** While less common than IV therapy and oral supplements, NAD+ can also be administered through intramuscular injections and transdermal patches, either in-office or at home. Intramuscular injections provide a quicker method for NAD+ absorption and are typically administered in a clinical setting. Transdermal patches, on the other hand, deliver a slow and steady release of NAD+ through the skin. 

## **Expert Recommendations for Optimal Results**

Let’s get one thing straight: if you want (good!) results from NAD+ therapies, you absolutely need to work with a licensed professional. Regardless of whether you’re looking to try NAD+ once or just take supplements, it’s critical to work with a knowledgeable team. Because the quality and sterility of internal NAD+ supplementation are critical for safety and efficacy, Dr. Khan urges that NAD+ injections should only be obtained by prescription to ensure medical-grade purity and avoid contamination risks associated with unregulated products.

NAD+ therapies are tailored to each individual, so the best practice is to have a consultation or assessment prior to a prescription. The dose, frequency, and duration of an NAD+ treatment varies from person to person and depends on individual factors like health goals, medical issues, baseline NAD+ levels, and demographics. 

“At Advitam, in order to determine what type of NAD+ treatment is best for our patients we start with a comprehensive consultation including lab tests, biomarkers, and body composition analysis,” [Jamie Gabel, PA-C,](https://www.myadvitam.com/about/providers/) a certified physician assistant at New York’s Advitamin at the Shafer Clinic tells us. And, of course, they can offer abbreviated health screenings for those solely interested in NAD+.

When it comes to taking NAD+ to achieve certain health goals, Dr. Kahn finds it particularly helpful during specific periods in life: while trying to conceive for improved egg quality, during post-partum for a boost in mood and energy, after surgery or athletic injury to accelerate healing or after a seasonal illness for a quicker recovery. 

So, how long does it take to feel the “magic” of NAD+? Though patient-dependent, many notice improvements in energy, sleep, cognitive function, and general well-being within a few weeks of consistent use, says Dr. Kahn. 

## **The Bottom Line**

With rising celebrity endorsement, we expect NAD+ to become even more mainstream in 2025. It’s been marketed as a “miracle molecule,” touted for its benefits in reversing the signs of the skin’s aging, boosting energy, enhancing cognitive function, increasing overall wellness, and so much more. The treatment is available in supplement, IV, patch, and injection forms, making it suitable for all different types of candidates. Regardless of which way you “NAD,” you should always seek professional advice to determine if it’s right for you. It's also important to note, at the end of the day, we think all experts would agree that a consistent skincare regimen (sunscreen!) and healthy lifestyle are a necessity alongside NAD+ treatment to see significant results.

Expert Opinion

Discover how NAD+ supports cellular health, energy production, and longevity. Our experts break down the science and top treatment options in this essential guide.

Is NAD+ the Key to Longevity? Science & Treatment Explained

All of Your Questions About NAD+ Treatments Answered

Image Credit: Adam Hale @the.daily.splice

If you haven’t already noticed, we’re always talking about dermal fillers on The AEDITION. To say we’re obsessed might be an understatement. Over the past six years, we’ve covered everything from [lip augmentation](https://aedit.com/aedition/what-its-like-to-get-lip-filler) to [liquid rhinoplasties](https://aedit.com/aedition/facts-about-liquid-rhinoplasty) and [chin enhancements](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures) to[ filler fatigue](https://aedit.com/aedition/dermal-filler-fatigue). Most recently, we've taken a deep dive into under-eye filler where we laid out all of its benefits and limitations — and we were surprised to learn there’s actually a lot of criteria to be considered a good candidate. So, if you found out that under-eye filler is not for you, you’ll definitely want to read on. We reached out to some of the top plastic surgeons to round up nine filler alternatives to help rejuvenate your under-eyes. 

## ***Under-eye Issues and Causes***

When it comes to under-eye issues, they usually fall into one of three buckets: dark circles, bags, or hallowing. Dark circles, which are sometimes referred to as “raccoon eyes,” are when the skin under the eyes appears darker. Because the skin under the eyes is so thin, we can see a blue, purple, or red tint when the blood vessels are dilated. Under-eye bags, on the other hand, is an issue when there’s an abnormal amount of swelling or puffiness under the eyes. Everyone actually has under-eye bags, but unless there’s sagging skin of excess fluid, they’re usually not noticeable. Lastly, there’s hallowing, which is usually a result of heredity or aging. Some people are born with a more defined tear trough (the area between the eyelid fat pad and the cheek fat pad) whereas others can experience volume loss as they get older. 

While each of these under-eye concerns affects the same area, they each have different causes and treatments. When you meet with your board-certified practitioner, they’ll help you determine the root cause of your under-eye issues. But, these are the main culprits:

- **Age:** When we age, we tend to lose volume and gravity can cause     sagging. 
- **Lifestyle:** Things like insufficient sleep, alcohol consumption, and smoking can cause a whole slew of under-eye issues.  
- **Allergies:** When allergies cause nasal congestion, they can increase the pressure in the blood vessels under the eyes. This can cause discoloration, known as “allergic shiners.” 
- **Health:** Under-eye bags, which can be caused by fluid retention, can sometimes be a symptom of an underlying health condition, like hypo or hyperthyroidism, kidney dysfunction, or liver dysfunction. 

## **Limitations Around Under-eye Injectables**

While tear-trough filler is commonly talked about when addressing under-eye issues, it actually isn’t a great solution for most people. For starters, it’s not going to fix dark circles or under-eye bags. In fact, getting filler to correct pigmentation issues or puffiness is only going to make the problem worse; instead of concealing the dark circles or under-eye bags, filler would accentuate it. 

Injectables do have a very specific time and place though; they can restore lost volume in the tear trough area. So, the ideal candidate would have hollowness without under-eye puffiness or darkness. [Flora Levin](https://www.drfloralevin.com/), MD, Board-Certified Oculofacial Plastic Surgeon, told us that only a small portion of those with dark circles are actually filler candidates.

Most board-certified practitioners would recommend a hyaluronic acid (e.g. Restylane, Juvederm, Belotero, etc) to treat this area. [Meegan Gruber](https://www.drmeegangruber.com/?gad_source=1&gclid=CjwKCAiA9bq6BhAKEiwAH6bqoJXjGRtMQBk6cShOn_UiQ52T1VE0D5I9ejpySe8hvQmfrbtYYzdL-hoCXBYQAvD_BwE), MD, PhD, Aesthetic Plastic Surgeon, says that this is because hyaluronic acid can be easily dissolved if the results are not as desired or if there has been an excess application. 

It’s always important to find a reputable injector, but even more so when targeting the eyes. Because the skin under the eyes is incredibly delicate and full of blood vessels, it’s more prone to bruising and swelling. If injected improperly, patients can develop nodules, experience discoloration (Tyndall Effect), or overfilling. More seriously (but very rarely), improper injections can even lead to tissue damage or even blindness. 

## **9 Alternatives to Under-eye Filler**

We spoke to three top plastic surgeons to find out the best filler alternatives to help depuff, conceal, and rejuvenate the under-eyes. Here are nine of their recommendations:

**Lifestyle changes**

We’ve said it before and we’ll say it again, but having a healthy lifestyle really is a key part of maintaining a youthful appearance. Lifestyle factors like smoking, alcohol consumption, and sleep can all impact our under-eye region. 

According to [Dr. William Kennedy, MD](https://aedit.com/provider/william-kennedy-md-26292), board-certified Head & Neck Surgeon and Facial Plastic Surgeon, and Founder of AEDIT MedSpa™; “While the effects of poor habits are usually reversible, they really can impact the appearance of our under-eyes. It’s not a myth that lack of sleep can lead to dark circles. When someone doesn’t get enough sleep, the blood vessels under the eye dilate. This occurs due to decreased oxygen levels in the eyes causing the blood vessels to expand.  The skin under the eyes is very thin and thus translucent, allowing the dilated blood vessels to become more visible and thus can make the under-eye area appear dark or puffy.” 

**At-home remedies**

For those looking to DIY, there are a number of expert-recommended topicals and tools. Dr. Levin recommends cold compresses or caffeine, which will vasoconstrict and depuff. She also likes creams and concealers to temporarily mask imperfections and even out skin tone. One of Dr. Levin’s favorites is [iT Cosmetics Bye Bye under-eye Bags Daytime eye cream](https://www.itcosmetics.com/skincare/skincare-products/eye-cream/bye-bye-under-eye-bags-daytime-treatment/ITC_1171.html?dwvar_ITC__1171_size=0.5%20US%20fl.%20oz%2F15%20ml&gad_source=1&gclid=Cj0KCQiA_9u5BhCUARIsABbMSPu6m9TrvWI1aGj70yk7mmquV_SzYGY-LyswV3HF5OIlaxa8-CdXgDEaAsuhEALw_wcB&gclsrc=aw.ds), which depuffs, tightens, and smooths.

To achieve a more uniform skin tone, Dr. Gruber recommends retinol or formulations with vitamin C, niacinamide, and vitamin K, which effectively address pigmentation and dark circles. For patients who are looking for added hydration or to enhance elasticity, Dr. Gruber suggests serums containing peptides and hyaluronic acid. But, at the end of the day, Dr. Gruber reminds us that although these remedies may offer some benefits, they typically cannot replace professional treatments. 

**Medication**

While it’s hard to believe, allergies can be the culprit of dark under-eye circles, known as “allergic shiners.” Allergies can be from the environment, specific foods, or any type of irritant. To diminish the allergic shiners, doctors typically prescribe some sort of medication, like an antihistamine, nasal spray, or decongestant.  

The theory behind "allergic shiners" is the result of a combination of physiological responses to allergens, primarily affecting the nose and region around your eyes.  The process begins when the immune system reacts to allergens, which then causes inflammation and swelling in the nasal mucosa.  This swelling causes a slowing of the blood flow in the veins around the paranasal sinuses.  These veins are close to the surface of the skin under the eyes, and when they become congested, they appear darker and puffier, or in lay terms “Allergic Shiners” says Dr. Kennedy.

**Laser**

Laser treatments create a managed burn to the skin at a precise depth to remove the dead cell layer. There are several different types of lasers; some focus on pigments, like sun spots or red spider veins, while others target the water within skin cells. For concerns around the under-eye area, Dr. Gruber says lasers can help lighten pigmentation and boost collagen production to improve skin texture and minimize fine lines. While it depends on the specific laser used and the patient’s skin, most people end up needing several sessions to maximize results. However, Dr. Gruber adds that lasers aren’t the best options when it comes to tackling more profound structural concerns, like hollowing or fat prolapse.

**Chemical Peels**

Peels rely on the application of chemicals to create a gentle, but controlled burn. The micro-injury promotes new skin growth that is typically more rejuvenated with reduced wrinkles. “Peels can assist in achieving a more uniform skin tone and minimize pigmentation concerns that lead to dark circles beneath the eyes,” Dr. Gruber shares with us. “Nonetheless, they don't tackle issues like volume loss, hollowness, or prominent under-eye bags, so they are frequently paired with additional treatments.”

Dr. Kennedy says that: "Dark circles under the eyes appear due to the loss of fat in the under-eye area. The loss of fat allows blood vessels to move closer to the skin and These vessels with their dark color and pigmentation easily appear through the very thin under-eye skin. Any treatment that enhances the thickness of the undereye skin and decreases the pigmentation in the blood vessels, will provide the best opportunity for decreasing the appearance of dark circles under the eye. Although chemical peels are very good at improving skin laxity and wrinkles, it is only 1 part of the equation for the treatment of dark under eye circles. At AEDIT we prefer the dual action treatment approach of lasers, such as the Stellar laser with Optilight handpiece. Lasers will BOTH increase the thickness of your under-eye skin and decrease the blood vessel pigmentation that lurks beneath to give you optimal results."

**Microneedling**

Similar to the effects of a chemical peel or laser treatment, Dr. Gruber says microneedling uses its needles to create a precise injury that encourages the skin to heal, boosting collagen production and cell turnover. “For under-eye concerns, microneedling can improve skin texture, boost firmness, and address mild pigmentation,” Dr. Gruber shares with The AEDITION. “Nonetheless, its impact on dark circles resulting from vascular concerns or fat displacement is somewhat restricted. It is frequently paired with PRP or topical serums to achieve even better outcomes.” 

**CO2 Laser**

CO2 lasers, also known as carboxytherapy, are excellent for tightening skin and minimizing wrinkles, particularly for rejuvenating the under-eye area. That being said, Dr. Gruber says there are a couple of important considerations: they can have increased downtime and also pose a greater risk of pigmentation changes, especially for those with darker skin tones. Like traditional lasers, they also can’t significantly improve hollowing or under-eye bags. 

**PRP**

Platelet-rich plasma (PRP) is a treatment using the patient’s own blood to promote healing. For the procedure, patients get their blood drawn as they would for a lab test, and then the plasma component is separated by centrifuge. When it comes to cosmetics, PRP is most commonly used for hair restoration and skin rejuvenation where it can enhance texture and volume. 

According to Dr. Gruber, PRP works exceptionally well at enhancing skin quality to improve dark circles and slight hollowness beneath the eyes but it is constrained when tackling under-eye bags that are a result of fat prolapse or significant volume loss.

**Lower blepharoplasty**

A lower blepharoplasty is the most effective route for patients looking to reduce the appearance of their under-eye bags. In the procedure, a board-certified surgeon will entirely remove the fat bags so patients shouldn’t have any under-eye puffiness moving forward. However, it’s important to note that it is a surgical procedure, so there is significant downtime and expenses. Dr. Levin says she often combines the procedure with a CO2 laser to improve the skin quality and sometimes with a fat transfer if there is also facial volume loss in the cheeks and /or midface.


If you’ve realized that under-eye fillers aren't your match, don't fret. We've consulted with leading plastic surgeons to bring you nine compelling alternatives for rejuvenating your under-eyes.

Invasive and Non-Invasive Alternatives to Under-Eye Filler

9 Alternatives to Under-eye Filler

Image Credit: Huha | Unsplash

It’s stuck in your head (oh, oh, oh, Ozempic), it’s all over social media, and it’s all around you. Semaglutide treatments (a.k.a. Ozempic, Wegovy, Rebylsus) have taken the country by storm. [Oprah Winfrey, Amy Schumer, and Tracy Morgan](https://www.today.com/health/celebrities-on-ozempic-rcna129740) are just a few celebrities out of many who have jumped on the weight-loss drug bandwagon, but it’s not just for the rich and famous. Semaglutides are affording patients genuine results says [Dr. William Kennedy, MD,](https://aedit.com/provider/william-kennedy-md-26292), Board Certified Head and Neck Surgeon and Facial Plastic Surgeon. It is hard to overstate the positive effects semaglutides will have on the cosmetic as well as medical community with drastic improvemetns in both ones cosmetic appearance as well as cardiopulmonary health.   It seems like just about everyone in NYC is on some form of semaglutide, says [David Shafer, MD,](https://aedit.com/provider/david-shafer-md-153) a double board-certified plastic and reconstructive surgeon and founder of Shafer Clinic in New York City. But, what exactly are semaglutide treatments, and what’s available on the market today? For everything you could ever want to know about the crazed weight-loss drug, read on.

### **What is Semaglutide?**

While frequently used for weight loss, semaglutide is actually an antidiabetic medication commonly used to treat type 2 diabetes. The medication functions as a glucagon-like peptide-1 (GLP-1) receptor agonist. GLP-1 is a naturally occurring hormone that is responsible for several digestive functions, like triggering the release of insulin and sending satiety signals to the brain. When a GLP-1 agonist medication (either a semaglutide or tirzepatide) is taken, it mimics the hormone and triggers the same effects. So, a semaglutide will act the same way as a naturally-occurring GLP-1 hormone, signaling satiety and releasing insulin to signal the body to convert glucose (sugar) into energy. Because of that, semaglutide treatments work effectively to reduce appetite and, subsequently, food intake. 

“We are seeing a number of patients who simply can't shed that extra 10 to 15 pounds despite exercise and proper diet choices. In many cases, this program allows them to jump-start their weight loss and fine-tune the results they already have achieved,” says [Gregory Buford, MD](https://aedit.com/provider/gregory-buford-md-1015), a board-certified plastic and reconstructive surgeon in Lone Tree, CO. 

### **Risk Factors of Semaglutide**

When it comes to deciding whether or not semaglutide for weight loss is right for you, you’ll want to first look at your medical history. In addition to those with a history of heart disease, [William Bruno, MD,](https://aedit.com/provider/william-bruno-md-625) a board-certified plastic surgeon in Beverly Hill, says semaglutide treatments are not for patients with a history of pancreatitis or thyroid cancer, those who are pregnant, those who have suffered from or are currently managing an eating disorder, or those with a BMI under 27. 

That being said, [Jamie Gabel, PA-C,](https://www.myadvitam.com/provider/jamie-gabel-ms-pa-c) a certified physician assistant at New York’s Advitamin at the Shafer Clinic, says that because there are so many variables, the best way to determine if you would or wouldn't be a good candidate for GLP-1’s is through a consultation. 

“At Advitam, we always perform a comprehensive consultation and dig into our patient's health history and daily routine first. Our assessment also involves blood work, body composition analysis, and physical exam and then from there, we can better determine which medications/peptides would be most advantageous. It's not a cookie-cutter approach at Advitam, it's a customized well thought-out program,” says Jamie Gabel.

### **The Big Three: Ozempic, Wegovy, and Rybelsus**

When it comes to semaglutide treatments, there are three main players on the market. The most well-known are Ozempic and Wegovy. The drug for both is the same (semaglutide), but they are prescribed with different doses and indications. While these two brands are injectables, there is also a semaglutide treatment in tablet form under the name Rybelsus. 

In addition to these three brands, a lot of practitioners will also compound semaglutide to personalize the treatment. “Compounding,” as Dr. Buford explains, effectively means that a specific drug is "compounded" or created by a specialized compounding pharmacy to match the exact formulation of the original drug. In this case, Ozempic and other GLP-1s can be compounded. When they are compounded, then they are referred to not by their trade name (e.g. Ozempic, Wegovy, or Rybelsus) but instead by their generic name (e.g. Semaglutide). From there, Dr. Buford says other additives, like vitamins and salts, can be added to create additional desired effects. 

At Dr. Buford’s practice, he offers a compounded semaglutide called Slim Shot because he finds it to be a more comprehensive approach to weight loss. “We know that our patients are going to lose weight and we also know that there will be changes to not only their overall body appearance but also more specifically to their skin, hair, nails, etc. So we discuss these anticipated changes early on and design a plan to specifically and proactively address these potentially unwanted ancillary changes so that as the weight comes off, our patients still look great. This is a big difference in our program as compared to many others that just focus on weight loss and not the patient's overall appearance,” Dr. Buford says.

### **Considerations of Semaglutide for Weight Loss**

When it comes to weighing the options (see what we did there?), there are a few things to consider. First, is budget and insurance coverage. Technically, Ozempic and [Rybelsus haven’t received FDA clearance for weight management](https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-glp-1-treatment-type-2-diabetes); the two have only been approved for people with type 2 diabetes. Wegovy, on the other hand, has been [FDA-approved](https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014) specifically for weight management. The FDA states that Wegovy is indicated for those with a BMI of 30 or greater or a BMI of 27 or greater if there are associated health problems, like high blood pressure, type 2 diabetes, or high cholesterol.

Unless you meet the requirements set by the FDA, your insurance will most likely not cover your semaglutide prescription. When using semaglutide specifically for weight loss, a lot of programs do not go through insurance. Instead, patients will have to pay out of pocket. Dr. Buford says that since many of his patients are not trying to lose a massive amount of weight and are not diabetic, their treatment wouldn’t be covered by insurance.

Another consideration is your lifestyle and preferences for medication. Ozempic and Wegovy are at-home self-injectables that you administer once a week. Rybelsus is available as a tablet to be taken orally, but it needs to be taken daily. Each brand has a different dosage, so some might work better for others.

As with any drug, there can be side effects when taking semaglutide medication. The most common side effects are nausea, diarrhea, vomiting, constipation, abdominal pain, headache, tiredness, upset stomach, dizziness, feeling bloated, belching, gas, stomach flu, and heartburn.

### **How Long Can Semaglutide be Taken?** 

Lastly, it’s important to discuss a long-term plan for your semaglutide treatment. Currently, there are no set guidelines for how long someone should be on a semaglutide, so it really depends on the individual. Dr. Shafer, for instance, shared that he has been on it for about a year and a half and has lost about 30 pounds. And, [Wegovy’s safety and efficacy trial](https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014) was over a 68-week period.

“From a patient perspective, I have learned new eating habits with smaller meals and avoidance of doughy foods which tend to cause some discomfort. So, no more bread, pasta, french fries, etc. Even if I miss a dose, I have learned to avoid those foods which has helped sustain my weight loss,” Dr. Shafer tells us. 

When stopping semaglutide, [research](https://pubmed.ncbi.nlm.nih.gov/35441470/) has shown that many patients gain the weight back since they often revert to their former lifestyles. So, if starting a semaglutide treatment, be aware that you’ll most likely need to have ongoing treatment for maximized results.

### **Experts Predict Semaglutide Treatments for Weight Loss are Here to Stay**

**Dr. Shafer:** Semaglutides and related treatments are definitely a game changer in the weight loss and plastic surgery world. As more understanding and protocols are developed we will see expanded uses and safety profiles. We have seen tremendous growth in our metabolic center, Advitam, at Shafer Clinic. Patients are becoming more sophisticated and understand that beauty and health start at the metabolic level so treating from the inside out is just as important as the external treatments we are performing for them. 

**Dr. Buford:** The GLP-1s are here to stay and we have only seen the tip of the iceberg in terms of their benefits. My prediction is that this sector is going to be the next BOTOX. What started as a drug for diabetics and more massive weight loss is now being used by many centers like mine for not only isolated weight loss but also before and after body contouring surgeries to effectively get at fat that surgery just can't reach. In doing so, we are seeing even better results with this combinative approach and I foresee that the entire category of GLP-1's are going to grow in popularity over time and become a more common part of our approach to total body rejuvenation. 

**Dr. Bruno:** I do believe that this class of injections for weight loss, as well as other peptides, is here to stay and more options will be available to patients over the course of the next few years. There will also be more clinical data available to support their use.

**Dr. Kennedy:** The remarkable weight loss resulting from Semaglutides use has resulted in drastic improvements in people's appearance as well as in their overall health. Exciting adoption of the drugs happens seemingly daily with most recently the Centers for Medicare approving coverage of the drug for patients with elevated cardiac risk factors. Semaglutides are the real deal and are certainly here to stay.

### **The Bottom Line**

GLP-1’s, specifically semaglutide, have completely transformed the weight loss industry. With a daily tablet or a weekly injectable, patients have experienced life-changing results. Just keep in mind that even though these treatments are miracle workers, you’ll still have to maintain a similar lifestyle to keep the weight off! 


A Comprehensive Guide to Medical Weight Loss Drugs

 The Current Skinny on Semaglutides

A Comprehensive Guide to Semaglutide: The Current Skinny on the World's Favorite Weight Loss Drug 

Unsplash/Manny Moreno  - Bye Bye Cellulite, Hello Avéli 

Being a woman has a lot of benefits; on average, we [live longer](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829786/) and have a [higher pain threshold](https://nypost.com/2019/01/11/women-have-a-higher-pain-threshold-than-men-study/) (sorry, boys). But, there are plenty of negatives associated with being female. There’s the obvious: childbirth; the unjust: the gender pay gap; and then there’s the ugly… cellulite. And, while we hate to even mention the C word, [nearly 90%](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10324940/) of us women experience it.

Even though cellulite is omnipresent, it’s been hidden and hushed about for years. But lately, celebs like [Demi Lovato, Olivia Munn, and Ashley Graham](https://people.com/health/celebrities-who-celebrate-stretch-marks-cellulite/) are showing off their natural bodies, cellulite and all. And, brands are also joining the body positivity movement to promote inclusion and acceptance of all body types and appearances. The topic has been so heavily discussed that sometimes the media makes us feel guilty if we don’t fully embrace our natural selves. But, even if we know cellulite is ubiquitous and a normal part of being a postpubertal woman, sometimes we just can’t (or don’t want to) accept it. That’s why doctors are excited about [Avéli®](https://aedit.com/procedure/avelir), one of the newest innovations in cellulite treatment, as a way to help restore their patients’ confidence. 

## **What is Cellulite?**
Cellulite is the dimpling or puckering that occurs around the thighs, buttocks, and hips. While it mostly affects women, about 10% of men suffer from cellulite too. While many find it unattractive, cellulite is completely harmless. It forms when fibrous bands of connective tissue (aka as the septa) contract, tethering the skin to the muscle and pushing the fat upward. Researchers are still trying to determine what causes cellulite, but it is commonly believed that hormones, skin elasticity, genetics, and weight distribution play a substantial role. 

## **There Hasn’t Been a Good Cellulite Treatment…Until Now** 
At times, it seems like plastic surgeons and dermatologists can do the impossible; they can smooth away fine lines and wrinkles, tighten trouble areas, or add volume when we need a little oomph. But, when it comes to cellulite, [professionals have been stumped](https://www.plasticsurgery.org/news/articles/why-is-cellulite-so-hard-to-address-and-what-are-my-options) for decades.

Doctors have approached cellulite correction a number of different ways over the years: microneedling (Cellfina), radiofrequency (VelaShape and Emtone), laser (Cellulaze), and injectables (QWO). But, none of these treatments come without flaws. Some have intense bruising, others require multiple sessions, and, overall, aren’t the most efficacious. 

“Previous strategies were riddled with incomplete releases or not targeting the root cause,” Dr. Hustak adds. “This coupled with bruising and downtime without results, left patients dissatisfied.” 

Enter Avéli®, a recently FDA-cleared cellulite treatment that doctors are saying is a total game changer. 

## **The Technology has Advanced by Leaps and Bounds** 

With so much trial and error over the years, Avéli® seems to be the long-awaited answer for an effective cellulite treatment. Or, as [Kristi Hustak, MD, board-certified Plastic Surgeon, says](https://www.kristihustakmd.com/meet-dr-hustak/), “it’s a revolutionary piece to the puzzle as we look at cellulite.” 

According to [Mary-Margaret Kober, MD, FAAD, board-certified Cosmetic Surgeon and Dermatologist](https://www.jackzamoramd.com/dr-mary-margaret-kober), and Dr. Hustak, the two main advantages of Avéli® are its advanced precision and ability to verify the release of the dimple during the procedure. Furthermore, Avéli® minimizes downtime, provides proven results in a single treatment, and, so far, has shown significantly greater efficacy. 

“The ability to target specific fibrous bands causing cellulite and verify their removal sets Avéli® apart from the competition and offers a promising leap forward in the treatment of cellulite,” Dr. Kober tells us. “Having used multiple cellulite treatments in the past, I can confidently say that Avéli® is the first treatment for cellulite that truly works.” 

“Aveli® is unique among cellulite treatments in that it allows targeted incision and release of each individual septa causing a dimple,” says board certified Head & Neck Surgeon and fellowship trained Facial Plastic Surgeon, [Dr. William Kennedy, MD, board-certified Head & Neck Surgeon and Facial Plastic Surgeon](https://aedit.com/provider/william-kennedy-md-26292), and Founder of AEDIT MedSpa™. “Although, unlike other techniques that use single-use thermal mechanism of septa release such as Cellulaze, Avéli® does not promote collagen production and is a simple release of tethering causing a dimple.”

So, how does Avéli® work? It’s a minimally-invasive hand-held device that has a light blade to cut the complex fibrous networks that are responsible for causing cellulite dimples. When a patient comes to the office for the Avéli® treatment, Dr. Kober says she marks the cellulite dimples and applies a numbing solution (tumescent anesthesia) to the targeted areas. From there, the Avéli® device is advanced under the skin and methodically releases the fibrous bands that cause each dimple. The unique thing about Avéli® is that physicians are able to confirm whether or not all of the offending fibrous bands have been cleared. This is what Dr. Kober and Dr. Hustak say really sets Avéli® apart and truly contributes to its exceptional results.

## **Most patients need a multimodal approach for smoother skin**

When it comes to treating cellulite with Avéli®, Dr. Hustak says that the ideal candidate has dimpled cellulite over the buttocks, back of thighs, or outer thighs even at their leanest. Unfortunately, this is the type of cellulite that isn’t going away with exercise or fat loss. 

More often than not, Dr. Hustak says patients are experiencing cellulite along with low skin elasticity, volume and muscle loss, and increasing fat pockets. “These aspects need to be addressed to improve results and that requires a multimodal approach,” Dr. Hustak tells The AEDITION. “Skin tightening devices, liposuction, biostimulatory fillers, and fat can all be used to improve results, and often at the same time.”

In Dr. Kober’s practice, the team often uses a combination of Avéli® for cellulite and [Attiva](https://www.attivarf.com/) for skin tightening, as a way to address skin laxity concerns. “Depending on the patient and her needs, we also employ liposuction to address fat pockets or fillers, such as [Sculptra](https://www.sculptrausa.com/?utm_campaign=2023paidsearch&utm_source=google&utm_medium=cpc&utm_content=Exact-CONS&utm_term=sculpta&utm_id=SCUL2023JVEPDZ99YO&c3apidt=p77177680451&gad_source=1&gclid=CjwKCAjw7-SvBhB6EiwAwYdCAcjEwDqiDoLqQ_m64VbZyEVQeqJ8F3s6G2PaBYfs3PsDn2v5q7gOexoCY5MQAvD_BwE&gclsrc=aw.ds), to increase volume. We are able to combine multiple modalities in a single treatment,” Dr. Kober shares.

Because Avéli® solely targets cellulite, not skin laxity or volume, results will vary from person to person. Dr. Hustak says that the more severe and deep the dimples, the less dramatic the results overall. This is because some of the deeper dimples might have volume missing under them, which would benefit from a touch of filler. That being said, Dr. Hustak and Dr. Kober both report that their patients have been happy with the improvements and feel more confident in their skin.

## **Conclusion**

For those of us who have been wanting to say farewell to cellulite for years, Avéli® might be the final piece to the puzzle. While we support the media's messaging around loving our bodies "as-is," we also acknowledge that approach doesn't work for everyone and are firm believers that the pathway to becoming your most confident self should be solely up to you. Regardless of if plastic surgery is involved, we believe in empowering people in their desire to enhance their natural beauty. At the end of the day, shouldn’t we all feel happy and comfortable in our skin? 








Expert perspective on the distinctive qualities of Avéli® and its departure from conventional cellulite treatment approaches.

Understanding What Sets Avéli® Apart Fom Other Cellulite Treatments

Bye Bye Cellulite, Hello Avéli®

FlamingoImages/iStock min

If you’re interested in a cosmetic procedure – be it Botox, a breast augmentation, or anything in between – you know there is plenty of research to be done. Finding and choosing the right provider is perhaps the most important decision you will make. But with social media feeds flooded with alluring before and after photos and new aesthetic practices seemingly popping up every day, it can be difficult to cut through the noise and find a highly qualified option.

Here at AEDIT, we believe there is nothing more important than patient safety and satisfaction, which is why we take provider vetting so seriously. Our AEDIT Provider Network exclusively features physicians who are board certified in four key specialities – plastic and reconstructive surgery, facial plastic and reconstructive surgery, dermatology, and oculoplastic surgery. 

We refer to this quartet as the 'core four' of aesthetic medicine, and below is a closer look at what board certification means, why it matters, and how AEDIT can help you find the best provider for your needs.

## **Why Board Certification Matters** 
Titles like ‘cosmetic surgeon,’ ‘plastic surgeon,’ and ‘cosmetic dermatologist’ have seemingly become interchangeable as of late, but the qualifications of such doctors can vary greatly. 

Because there is very little regulation governing how physicians refer to themselves, understanding your provider's board certification(s) can ensure you are consulting with a doctor or surgeon who is formally trained in plastic and reconstructive surgery, otolaryngology, ophthalmology, or dermatology (i.e. the specialties that most relate to aesthetic medicine).

Unlike a medical license, board certification is not necessary to practice medicine in the United States, but it is an important tool in distinguishing whether or not a provider has specialized – and continues to specialize – in a particular area. Many medical specialty boards require recertification every decade or so, ensuring doctors keep on top of their skills.

## **How Doctors Become Board Certified**
A licensed doctor is not the same as a board certified one. A medical license is required for all doctors who wish to legally practice medicine in the U.S. Medical licensure is handled at the state level, and physicians must receive individual licenses in each state they wish to practice in. Board certification, meanwhile, signifies that the doctor has successfully completed a residency in their chosen specialty. 

In order to become board certified, a physician must have completed his or her undergraduate education, medical school, one-year internship, residency in their chosen specialty, and passed the residency board exam. 

## **The ‘Core Four’ Board Certifications at AEDIT**
The AEDIT Provider Network is comprised of medical doctors (MDs) and doctors of osteopathic medicine (DOs) who are board certified by specific member boards of the American Board of Medical Specialties (ABMS) and American Osteopathic Association (AOA) or a very select group of unaffiliated boards for specialties like facial plastic and reconstructive surgery and oculoplastic surgery.

Here is closer look of the specialties that make up the AEDIT Provider Network:

### **Plastic and Reconstructive Surgery**
General plastic and reconstructive surgeons complete three to five years of general surgery training followed by a two to three year cosmetic and reconstructive plastic surgery residency. Plastic and reconstructive surgeons listed with AEDIT can pursue board certification via the American Board of Plastic Surgery or American Osteopathic Board of Surgery - Plastic and Reconstructive Surgery. In the case of the former, they may be dual-certified by the American Board of Surgery. While these physicians are board certified to perform cosmetic and reconstructive surgeries from head to toe, their work may focus on the breasts and body. 

### **Facial Plastic and Reconstructive Surgery**
After completing a five-year residency in otolaryngology (a.k.a. ears, nose, and throat), facial plastic and reconstructive surgeons pursue year-long fellowships in cosmetic and reconstructive procedures specifically related to the face and neck (think: rhinoplasty, facelift, chin and jaw surgeries, etc.). 

There is no ABMS Member Board specifically for facial plastic and reconstructive surgery. Instead, facial plastic surgeons in the AEDIT Provider Network are board certified by the American Board of Otolaryngology – Head and Neck Surgery or the Otolaryngology/Facial Plastic Surgery certification within the American Osteopathic Board of Ophthalmology and Otolaryngology - Head and Neck Surgery. The American Board of Facial Plastic and Reconstructive Surgery is also an accreditation that many facial plastic surgeons seek.

### **Dermatology**
Medical dermatologists diagnose, treat, and prevent conditions affecting the skin, hair, and nails. All dermatologists affiliated with AEDIT are board certified by the American Board of Dermatology or American Osteopathic Board of Dermatology, which means hey have undergone non-surgical, cosmetic dermatology training during their residency program. Dermatologic surgeons refer to physicians who are qualified to perform surgical procedures like liposuction, fat transfer, and Mohs surgery, in addition to non-invasive treatments. They are often fellows of the American Society for Dermatologic Surgery.

### **Oculoplastic Surgery**
While a facial plastic surgeon is able to perform eyelid surgeries like blepharoplasty, oculoplastic or oculofacial surgeons are experts in procedures that reconstruct the eyelids, tear ducts, and orbital area. At AEDIT, they are board certified by the American Board of Ophthalmology or have an Ophthalmology certification within the American Osteopathic Board of Ophthalmology and Otolaryngology - Head and Neck Surgery. Many also have additional fellowship training with the American Society of Ophthalmic Plastic and Reconstructive Surgery.

## **Fellowships & Societies**
Doctors who wish to further specialize in a particular area of medicine may choose to continue their training and education via a fellowship. Fellowship programs are often highly competitive and last one to three years each. Due to the lack of ABMS Member Boards in certain subspecialties, fellowships may be used to denote expertise. An ophthalmologist who wishes to subspecialize in oculoplastic surgery, for instance, would complete a two-year fellowship through the aforementioned ASOPRS. 

Society memberships, meanwhile, offer another way that is separate from licensing, board certification, and fellowships for providers to continue their education, in addition to offering mentoring and networking opportunities. Below are some of the academies and societies related to aesthetic medicine, cosmetic surgery, and dermatology:

American Academy of Aesthetic Medicine (AAAM)
American Academy of Cosmetic Dentistry (AACD)
American Academy of Cosmetic Surgery (AACS)
American Academy of Dermatology (AAD)
American Academy of Facial Plastic & Reconstructive Surgery (AAFPRS)
American Society of Aesthetic Plastic Surgery (ASAPS)
American Society of Cosmetic Laser Surgery (ASCLS)
American Society for Dental Aesthetics (ASDA)
American Society of Dermatologic Surgery (ASDS)
American Society of Hair Restoration Surgery (ASHRS)
American Society of Liposuction Surgery (ASLS)
American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS)
American Society of Plastic Surgeons (ASPS)

While these affiliations are voluntary, a doctor may display their memberships as an indicator of interest and engagement in their specialty.

## **The Takeaway**
There is perhaps no more important task in your aesthetic journey than finding the right physician to perform your procedure and understanding the board certification process is a key part of that. We’ve sought to simplify the research process by presenting you highly qualified, pre-vetted providers who specialize in aesthetic medicine. With the AEDIT Provider Network, you can compare the background and work of skilled physicians in your area before going in for a consultation, so you can ensure you get the best care for your needs.


Breaking Down the ‘Core Four’: What Board Certification Means at AEDIT 

Unsplash/Tyler Nix 

It is said that summer bodies are built in the winter. That logic can extend to any time of the year and is true of both at-home nutrition and fitness plans and in-office [body contouring](https://www.aedit.com/procedure/body-contouring-solutions) treatments. “There is no such thing as an overnight sensation,” says [Amy Wechsler, MD](https://www.dramywechsler.com/), a board certified dermatologist and psychiatrist in New York City. But what if a special event or trip popped up and your timeline is tighter than, say, the six months between the winter and summer solstices – are there any toning and tightening treatments that can get the job done sooner? 

The answer is yes, if your expectations are properly managed. “It takes three to six months for any invasive procedure to have optimal results,” says [Joseph Zakhary, MD](https://breastreconstructionaz.com/about/practitioners/dr-joseph-zakhary/), a board certified plastic and reconstructive surgeon and co-founder of Southwest Breast & Aesthetics in Arizona. “Less invasive procedures may have speedier recoveries, but expectations should be tailored as the result is usually less dramatic when compared to a surgery.”

So, while there may be, as Dr. Wechsler notes, no substitute for “eating healthfully, exercising, sleeping enough,” and budgeting a proper amount of time, there are some body contouring procedures that can sculpt key areas of the body with minimal downtime and – relatively – quick results. Here, we’re breaking them down (and level-setting your expectations) with the help of expert dermatologists and plastic surgeons.

## **The Most Popular Areas for Body Contouring**

Before we dive into the procedures that can tone, tighten, and sculpt, let’s talk about the areas of the body that are most often treated. “Common areas of body contouring for women are the lower abdomen, outer hips, and flanks (love handles), as well as the outer and inner thighs,” says [Lyle Leipziger, MD](https://www.drleipziger.com/), a board certified plastic and reconstructive surgeon and chief of plastic surgery at North Shore University Hospital and LIJ Medical Center on Long Island. “The distribution is different for men, so these areas would be more limited to the trunk, upper and lower abdomen, and hips and flanks.” In some cases, guys may also be interested in sculpting the chest, he adds.

For men and women alike, the waistline is “by far” the most popular area to address, says [Max Polo, MD](https://miamiplasticsurgery.com/), a board certified plastic and reconstructive surgeon at Miami Plastic Surgery. “That includes the abdomen in front and the flanks on the side and in back,” he notes. Speaking of the back, women may seek to slim the mid-back or so-called “bra-fat” area, and the “buttocks is, of course, very popular these days for contouring,” Dr. Polo shares. 

Another way to think about this is in relation to the concerns you are targeting. “The most common areas for patients seeking fat reduction are the abdomen, love handles, arms, and thighs,” says [Jessie Cheung, MD](https://drjessiecheungnyc.com/), a board certified dermatologist who practices in NYC and Chicago. “Besides the face, the buttocks remain the most popular area for filler augmentation.” When it comes to strengthening and toning, “the most common body areas treated for muscle building are the buttocks, abdomen, arms, and calves,” she adds. And let’s not forget cellulite in the trunk area – especially heading into the summer months.

## **Managing Expectations**

Here’s the good news. “There are some treatments that offer some immediate change,” says [Jennifer Levine, MD](https://www.drjenniferlevine.com/), a double board certified facial plastic and reconstructive surgeon in NYC. And here comes the ‘but’ – “most need more than one treatment and have visible results in four weeks with maximal effects at 12 weeks,” she adds.

Downtime is one part of the process where you can save some time. “Many body contouring procedures available have minimal downtime as compared to surgery,” says [Elizabeth Callahan, MD](https://sarasotadermatologist.com/about/dr-callahan/), a board certified dermatologist at SkinSmart Dermatology in Sarasota, FL. But that doesn’t necessarily have any bearing on when you see results. “Even when you do a procedure like CoolSculpting®, you still have to wait for the body to eliminate the treated fat and that can take up to three months,” she notes. “This is one of the main reasons we recommend patients pursue treatments in the winter – so they can be feeling great about their results by summer.”

If time is not on your side, you’ll want to have a conversation with your provider about what’s possible given your circumstances and aesthetic goals. “It's important to educate patients that results from body contouring aren't always immediate – even liposuction takes months to see the final results due to swelling and delayed skin tightening,” Dr. Cheung cautions. “Non-invasive fat reduction, skin tightening, and muscle-building procedures will typically need a series of treatments to see dramatic results, while buttock augmentation with fillers is an instant gratification procedure with minimal downtime.”

The takeaway: “Preparation, planning, and setting expectations is key,” Dr. Zakhary says.

## **The Best Minimally Invasive Body Contouring Procedures**

Now that you have a better sense of the most common treatment areas and what is actually possible to achieve with in-office treatments, it’s time to take a closer look at the minimally invasive non-surgical and surgical body contouring procedures to tone, tighten, and sculpt.

### **For Non-Surgical Augmentation**: Dermal Fillers

**Downtime**: None, though bruising, swelling, soreness possible
**Results**: 1 to 12 weeks

If you are looking for an instant result, hyaluronic acid-based fillers sculpt the face and body upon injection. Biostimulatory injectables, like hyper-diluted [Radiesse®](https://www.aedit.com/procedure/radiesse) and [Sculptra®](https://www.aedit.com/procedure/sculptra), require a bit more time to set in but are still pretty speedy and can improve skin quality and add volume. “Radiesse®, in particular, will have an immediate effect,” Dr. Levine notes, though you’ll see more of the benefits at the four-week mark and even more at 12 weeks. She recommends one to four treatments spaced four weeks apart for best results. 

To boost your backside, Dr. Cheung says “the best buttock augmentation is filler injections.” She says they can be completed within one to three initial sessions depending on your desired outcome. “These need to be continued once every six to eight weeks, and minimal downtime includes possible bruising, swelling, and soreness,” she notes.

### **For Non-Surgical Fat Reduction**: CoolSculpting®

**Downtime**: None, but expect mild swelling and redness
**Results**: 4 to 12 weeks
[CoolSculpting®](https://www.aedit.com/procedure/cool-sculpting) and the newer [CoolSculpting® Elite](https://aedit.com/aedition/malin-akerman-coolsculpting-elite) use cryolipolysis technology to freeze away unwanted fat cells. “It works by applying the applicator to the targeted area and securing it, cold energy is then delivered and destroys the fat cells with no irritation or damage to the skin,” says [Ariel Ostad, MD](https://drarielostad.com/), a board certified dermatologist in NYC. “CoolSculpting® Elite can treat many areas including the abdomen, back, arms, inner and outer thighs, double chin, and love handles.” What’s more? “It is a non-surgical procedure with no downtime,” he notes. “The most common side effect is mild swelling and redness that usually goes away in 24 hours.”

While there has been a renewed focus on rare but serious adverse effects like [paradoxical adipose hyperplasia (PAH)](https://aedit.com/aedition/paradoxical-adipose-hyperplasia-after-cryolipolysis), the majority of our experts recommend the treatment. “Despite recent bad press, this is still very effective technology with very rare complications,” Dr. Polo shares. “It is best for small areas of fat.” Because of its targeted nature, the treatment is highly customizable. “CoolSculpting® can treat almost any area on the body and usually takes two treatments spaced a month apart for optimal results,” Dr. Wechsler explains.

Since the fat cells need to be removed from the body, it takes several weeks to enjoy the full effect. “Patients see results from CoolSculpting® in three months,” Dr. Callahan shares. “This is due to the biology of fat reduction in the body, which takes some time.” Even so, Dr. Levine says she has noticed the updated CoolSculpting® Elite gives at least a sign of what’s to come much sooner. “It can have effects seen as early as two weeks, she notes.

### **For Non-Surgical Muscle Toning**: Emsculpt® Neo

**Downtime**: None, but soreness and puffiness are common
**Results**: 4 to 12 weeks
The OG [Emsculpt® ](https://aedit.com/procedure/emsculpt)used high-intensity focused electromagnetic technology (HIFEM) to mimic the effects of 20,000 crunches in a 30 minute treatment. The updated version of the device, [Emsculpt® Neo](https://aedit.com/aedition/what-its-like-to-get-emsculpt-neo), combines HIFEM with radiofrequency (RF) fat reduction for even better results. “The best muscle building treatment is Emsculpt® Neo,” Dr. Cheung says. It is used to tone and sculpt the abdomen, arms, buttocks, and thighs. 

Dr. Levine likes it because of the lack of downtime and the progressive nature of the results. “We recommend four to six sessions spaced one week apart,” she shares. “Some patients notice an immediate change, but visible results are seen at four weeks with the maximal effect at 12 weeks.”

### **For Non-Surgical Fat-Reduction & Skin Tightening**: Radiofrequency

**Downtime**: 48 to 72 hours
**Results**: 4 to 12 weeks
If you are looking to non-surgically target both skin laxity and excess fat concerns, radiofrequency (RF)-based treatments can do both. [Morpheus 8 ](https://aedit.com/procedure/microneedling-with-radiofrequency)combines RF with microneedling (a.k.a. collagen induction therapy). “This modality boosts collagen in the skin to thicken skin and smooth wrinkles and creases,” Dr. Polo shares. Think of it as microneedling on steroids. “The needles emit radiofrequency energy into the skin layers, causing the skin to heat and tighten,” Dr. Ostad explains. “This added heat promotes the production of collagen at a much greater level than traditional microneedling.”

It is used to treat the face, neck, abdomen, arms, and legs, and three treatment sessions spaced four weeks apart are needed for the full effect. Redness and swelling are common for a few days after treatment, and you can resume wearing makeup after 48 to 72 hours. “Results are seen from a few to several weeks after each treatment and are maintained for several months to years after completing three sessions,” Dr. Polo says.

For a non-surgical alternative to liposuction, Dr. Polo is a fan of [BodyTite™](https://aedit.com/procedure/bodytite) or radiofrequency assisted lipolysis (RFAL). The “internal probe treatment,” is similar to “a small liposuction procedure,” he says. One treatment under sedation anesthesia can reduce fat and firm the skin. “This treatment is effective for dissolving small amounts of fat and achieving higher definition in already lean individuals,” Dr. Polo says. “Even more effectively, it tightens skin.”

Unlike some of the other procedures on the list, there is downtime, in addition to swelling, bruising, and tenderness. “There are only two days of downtime at most,” Dr. Polo notes. “Results are seen from a few to several weeks after treatment and are maintained for years.” He says BodyTite™ can be performed as a stand-alone procedure or in combination with liposuction to achieve a smoother contour.

### **For Non-Surgical Neck & Jawline Sculpting**

**Downtime**: None, but swelling is likely
**Results**: 4 to 24 weeks

We’re mostly talking about the body, we’d be remiss not to mention a couple of the minimally invasive sculpting options that exist for the neck and jawline. [Kybella®](https://aedit.com/procedure/kybella) is an FDA-approved medication that, when injected under the chin, destroys fat cells. “It contains deoxycholic acid, a substance found in the body that breaks down dietary fats,” Dr. Ostad shares. “This treatment restores a more youthful jawline with minimal downtime.”

Depending on your anatomy and aesthetic goals, two to six treatments spaced at least a month apart are needed. Patients see results about four to six weeks after each injection. Swelling and soreness are common, but there is no downtime.

If submental and facial skin tightening is what you are after, Dr. Callahan recommends [Ultherapy®](https://aedit.com/procedure/ultrasound-skin-tighteningultherapy). The non-invasive treatment employs microfocused ultrasound technology to the face and neck to kickstart the body’s own collagen production processes. There is no downtime, but “results take about six months due to the nature of collagen stimulation and growth,” she notes.

### **For Smoothing Cellulite**

**Downtime**: None, save for some minor swelling and bruising
**Results**: 4 to 12 weeks
If smoother skin is what you’re after, there are a few minimally invasive treatments for cellulite that will start showing results in four weeks or less.

- **Avéli™**: Performed under local anesthesia, the procedure identifies and releases the septa that cause cellulite dimples on the buttocks and thighs in just one treatment. Dr. Levine says some results are immediate (once bruising and swelling subside), but they continue to improve for up to 12 weeks. 
- **Cellfina®**: The one-time treatment targets the structural cause of cellulite by releasing tension on the connective bands that are woven into the fat in the thighs and buttocks. Bruising is common, but there is no downtime. The initial results of [Cellfina®](https://aedit.com/procedure/cellfina) are quick (think: days not weeks), and “patients can be bathing suit-ready as soon as one month after,” Dr. Polo shares.
- **Sentient Sculpt™**: This energy-based treatment can address a myriad of concerns – including cellulite. It uses 2.45 gigahertz of energy, 80 percent of which is sent directly into the fat tissue and cellulite fibers. In addition to the smoothing benefits, Dr. Cheung says “it’s the best fat reduction with skin tightening treatment.” She recommends four sessions once a month, with visible results within the first month. 

### **For Surgical Fat Reduction**: Liposuction

**Downtime**: 5 to 7 days, plus up to 6 weeks of swelling
**Results**: 3 to 6 months

The word ‘surgery’ may have you envisioning being holed up in the house for weeks, but [liposuction](https://aedit.com/procedure/liposuction) is one of the least invasive cosmetic surgeries and yields some of the most transformative results for patients looking to reduce fat. “Liposuction is the ‘minimally invasive’ procedure that possesses the opportunity for significant change with the least downtime and scarring,” Dr. Zakhary explains. “It is still surgery, but the incisions are one to two centimeters in length and positioned in areas to address the treatment zones.”

There are a number of types of liposuction that achieve the same goal – albeit with slightly different techniques. “I would recommend [tumescent liposuction](https://aedit.com/procedure/tumescent-liposuction) because it is more effective, safer, and less painful,” Dr. Ostad explains. “We utilize microcannulas, which are blunt instruments that are able to extract the fat through tiny entry points on the body.” Those incisions are so small, he says, there is no need for sutures.

He performs the surgery under local anesthesia and customizes the procedure based on areas of concern, which can include the abdomen, waist, back, arms, outer and inner thighs, and chin. “The procedure time varies with each patient, but you are able to return home at the end of the day and may return to work at least five days post procedure,” he shares.

If a more chiseled look is what you are after, Dr. Leipziger offers [liposculpture](https://aedit.com/procedure/liposculpture) as part of a liposuction procedure. “This involves using very fine cannulas to carefully sculpt problem areas to provide maximum results,” he explains. “The healing time to see full results is usually about six weeks, however, people may return to their normal activities within two weeks of the procedure.”

Regardless of the type of lipo you opt for, the post-op pain is “extremely manageable and leads to minimal downtime,” Dr. Zakhary says. “Patients will spend four to six weeks in a [spandex compression garment](https://aedit.com/aedition/benefits-of-compression-garments-after-cosmetic-surgery).” There will be about two weeks of moderate swelling and bruising that resolves over time from there. One way to move things along? “Aggressive [post-op lymphatic massage](https://aedit.com/aedition/benefits-of-lymphatic-drainage-massages-after-cosmetic-surgery) can accelerate this process and speed recovery,” Dr. Polo notes.

In terms of results, Dr. Polo says you can start to see them “as early as a few weeks after treatment,” but “usually four to six weeks are required before most swelling has resolved and the surface contour is smooth and natural again.” All told, budget three to six months for the full effect.

## **How to Maximize Body Contouring Results**

Here’s the thing, in-office body contouring procedures – while highly effective for the right candidates – are not silver bullets. Achieving sustained results takes commitment. “Just like in surgery, there are no good short cuts for achieving great results,” Dr. Zakhary says. “A healthy diet and physical fitness regimen are important, and it is also important to minimize things that cause skin damage – as in, excess sun exposure or smoking cigarettes.”

Working with a personal trainer or nutritionist can help you find a regimen that works best for your aesthetic goals, but it’s all about developing a routine that works for you. “Diet and exercise are the biggest tips I have for keeping your body toned and tight,” Dr. Ostad says. “Keeping up a healthy lifestyle is very beneficial for many different aspects of your life – including how you feel mentally and physically.”

Body contouring procedures can complement these efforts, but, ultimately, they are more of a catalyst than an end-all solution. “Don't think of these procedures as a quick fix because if you don't change your lifestyle and mindset, you will gain the weight back,” Dr. Cheung concludes. “Think of these procedures as a tool that helps you get to your desired shape when you are disciplined and put in the work of eating healthy and exercising.”


11 Body Contouring Procedures That Offer Quick Results and Minimal Downtime

Photo: Unsplash/Dom Aguiar

Whether it’s that person you see in your hot yoga class who seemed to magically drop 15 pounds or the coworker who is on a more significant weight loss journey, the tool everyone seems to be buzzing about these days is semaglutide injections. Better known by the brand names Ozempic® and Wegovy®, the medications are helping people lose weight via both on- and off-label uses.

The successful slimming is not without side effects, however, and the aesthetic changes some patients see are sending them to their plastic surgeons and dermatologists for help. ‘Ozempic Face’ and ‘Ozempic Body’ are the buzzwords being used to describe everything from the loss of volume to skin laxity that may accompany the use of these drugs, and we spoke to top plastic surgeons to get a better understanding of why it happens and how to treat it.

## **What is Ozempic?**
Ozempic® and Wegovy® are two of the best known semaglutide injections on the market today. Ozempic® was approved by the U.S. Food and Drug Administration (FDA) in 2017 to treat type II diabetes in adults. Wegovy®, meanwhile, was FDA approved in 2021 for chronic weight management in overweight or obese adults. More recently, there has been an uptick in people using semaglutide off label to lose smaller amounts of weight.

Both Ozempic® and Wegovy® involve a once-weekly injection of a specific dose under the skin of the thigh, upper arm, or abdomen. Semaglutide is part of a class of medications that ensure the pancreas releases sufficient insulin when blood glucose levels are high. Additionally, the glucagon-like peptide 1 (GLP-1) drugs make a person feel fuller longer and delay gastric emptying. The result? Fewer calories consumed. When coupled with diet and exercise, the effects can be dramatic.

Aesthetic providers are increasingly treating patients who are on the drugs for various reasons. “There are several new weight loss peptides and one of the most popular is Ozempic® or semaglutide,” says [David Shafer, MD](https://www.aedit.com/provider/david-shafer-md-153), a double board certified plastic and reconstructive surgeon and founder of Shafer Clinic in New York City. “We were ahead of the curve on this trend, as I started our metabolic aesthetic center at Shafer Clinic several years ago.”

Patients taking semaglutide injections for significant weight loss may incorporate aesthetic medicine into their treatment plan. “We see patients who use them in our practice and actually promote use of this and other semaglutides for weight loss, when indicated, under the care of a primary care provider to optimize overweight patients for flap surgery,” says [Joseph Zakhary, MD](https://breastreconstructionaz.com/about/practitioners/dr-joseph-zakhary/), board certified plastic and reconstructive surgeon and co-founder of Southwest Breast & Aesthetics in Arizona.

## **Why Everyone’s Talking About Ozempic**
If semaglutide has been on the market for a few years now, you may be wondering what all the recent fuss is about. “Ozempic® has been around for a while,” says [Jennifer Levine, MD](https://www.drjenniferlevine.com/), a double board certified facial plastic and reconstructive surgeon in NYC. “The weight loss aspect of the medication has been more prevalent for the past year.”

For one thing, it started gaining attention on social media due to celebrities and influencers subtly or not-so-subtly talking about it as a weight loss trick of sorts. “I don't think ‘trick’ is the right word to describe this given that Ozempic® is an effective drug used for type II diabetes and/or obesity,” notes [Oren Tepper, MD](https://orenteppermd.com/), a board certified plastic and reconstructive surgeon and director of aesthetic surgery Montefiore Medical Center in NYC. “What has happened over recent years is that the criterion for its use is becoming somewhat less strict.” 

As he explains, semaglutide was initially intended for people with a body mass index (BMI) over 30 or for those with a slightly lower BMI who had other significant medical issues related to being overweight. While that is still the FDA-approved use of Wegovy® (which is a weekly 2.4 milligram dose), smaller doses of semaglutide are being prescribed off-label for more moderate weight loss.


At Dr. Shafer’s practice, patient’s receive a comprehensive examination and evaluation to see if they are candidates. “Ozempic® should not be taken as a standalone medication, but rather as a customized treatment plan,” he shares. “This is not something that you just call your doctor or find online and ask for a prescription without being seen or evaluated.” 

It takes time to establish the right dosing that minimizes side effects and maximizes results, but Dr. Shafer says there is no secret as to why semaglutide injections have become popular. “First, it is very effective and people see quantifiable and visible results,” he explains. “Second, the side effect profile is very mild, and it is well tolerated when it is dosed correctly.” Another plus: “It is an easy once a week dosing,” he adds.

When it comes to treating patients who are obese, Dr. Zakhary says he has noticed the positive effects of semaglutide to “optimize weight loss” more and more in the last year or so. “This leads to patients who see us with a wide spectrum of weight loss… not dissimilar to the patients who had surgical procedures such as a gastric sleeve for weight loss,” he explains. 

## **What Is So-Called ‘Ozempic Face’ and ‘Ozempic Body’?**
If you are familiar with the old ass versus face dilemma, then you have a pretty good sense of what ‘Ozempic Face’ and ‘Ozempic Body’ refer to. “With any weight loss, there are positives and negatives,” Dr. Shafer explains. “When losing weight, we feel better, our clothes fit nicer, conditions like diabetes and hypertension and hypercholesterolemia can all improve.” Here comes the but. “However, with quick weight loss by any method – other weight loss medications, gastric bypass, lap band, etc. – we lose volume in our face and our skin can become looser,” he adds.


For many patients losing smaller amounts of weight, the face is where you notice it. “When we start getting up to 15 to 20 pounds of weight loss, you'll definitely start to see the changes,” explains [Amir Karam, MD](https://www.drkaram.com/), a double board certified facial plastic and reconstructive surgeon and founder Carmel Valley Facial Plastic Surgery and Aesthetic Center in San Diego, CA. “But even as little as five to 10 pounds can have a noticeable effect on the face.”

The most common impact is on facial volume, which can lead patients to feel like they look tired or older, Dr. Karam shares. This is especially true, he says, in people over 40. “Anytime somebody loses weight in their forties and fifties – with Ozempic® or without – their face is going to lose weight in a more accelerated way than their body,” he notes. “Therefore, even small amounts of weight loss will affect one’s face more than their handles.” 

Facial skin laxity is also a concern, particularly in patients losing large amounts of weight in a relatively short period of time. “What is often surprising to patients is the impact that this may have on the face,” Dr. Tepper notes. “The impact of semaglutide to the face includes loss of volume in key structural areas like the cheek, or temples, as well as sagging skin along the jawline and neck.” 

But it’s not just the face. Semaglutide injections can lead to rapid weight loss, which means the effects are not dissimilar to what is seen after a bariatric surgery. “These procedures, much like Ozempic®, can lead to weight loss that occurs very quickly,” Dr. Tepper explains. “With rapid weight loss, it is often difficult for the overlying skin to contract at the same rate, thus resulting in the skin being quite loose.” This most commonly affects the abdomen, breasts, upper arms, or upper thighs. 

## **The Best Procedures for Treating ‘Ozempic Face’**
As we’ve discussed, ‘Ozempic Face’ refers to the loss of facial volume and skin laxity that may accompany weight loss. “When it comes to the face, changes caused by rapid weight loss are best treated with a two-pronged approach,” Dr. Tepper shares. The first is removal and tightening of the skin and the second is the replacement of volume. 

The best way to address these concerns is with “procedures that help with lifting and laxity and promote collagen and elastin production,” Dr. Levine notes. Below are the best surgical and non-surgical solutions for ‘Ozempic Face’:

### **For Restoring Volume**
If your weight loss has resulted in a more gaunt appearance in the cheeks, temples, or other areas of the face, volume can be restored with dermal fillers and fat grafting. 

**Dermal Fillers**: Depending on your aesthetic goals, either hyaluronic acid (HA)-based fillers (think: [Juvederm®](https://www.aedit.com/procedure/juvederm)) or biostimulatory fillers (i.e. [Sculptra®](https://www.aedit.com/procedure/sculptra) and [Radiesse®](https://www.aedit.com/procedure/radiesse)) can effectively sculpt the face. “Biolstimulatory fillers such as Sculptra® or hyperdiluted Radiesse® also help to produce collagen, improving laxity, skin quality and texture,” Dr. Levine shares. The results take longer to see but are more lasting than HA fillers.

**Fat Grafting**: For patients who have unwanted fat on the body, [fat transfer](https://www.aedit.com/procedure/facial-fat-grafting) can be an alternative to synthetic fillers. “In my opinion, fat is a much better option for this because it is long-lasting and can more safely be replaced in larger volumes without additional risks,” Dr. Tepper explains. Fat is harvested via liposuction from a donor site like the flanks or thighs and transferred to areas of the face that have lost volume. Dr. Tepper’s ‘Boomerang Lift’ restores upper cheek volume in – you guessed it – a boomerang-like shape. “This technique works very well for Ozempic-type weight loss because it targets the sagging of the cheek and loss of volume that is caused by this medication,” he says. 

It’s important to remember that fillers address volume, not laxity. Depending on your age and skin quality, fillers or fat transfer might be enough to address your concerns. For others, skin tightening may also be needed. “If somebody is in their thirties and they lose some weight, it's unlikely they're going to have significant sagging,” Dr. Karam says. “They might look a bit more gaunt, and, in that case, they would only require some volume from either a fat transfer or some fillers in very select areas.”

### **For Non-Surgical Skin Tightening**
There are many modalities on the market that have the ability to firm the skin without cutting. They include, radiofrequency, microneedling, ultrasound, energy, and laser to name a few. “Renuvion® skin tightening is a great alternative to help tighten skin without large incisions,” Dr. Shafer says. “For non-invasive treatments, Ultherapy® helps tighten deeper tissues, while helps tighten more superficial skin and is great for lower eyelids.”

Dr. Levine likes Ultherapy® because it “uses microfocused ultrasound to treat the SMAS – which is the layer lifted during a facelift – and helps the body produce new and healthy collagen and elastin.” EmFace® (from the makers of [EmSculpt®](https://www.aedit.com/procedure/emsculpt)) is another one of her go-tos. “It combines radiofrequency with electrical stimulation of the facial muscles,” she explains. “It works on the muscles of elevation to tone and increases the density of the facial muscles for natural volume.” She says it also helps with wrinkles and skin quality.”

### **For Surgical Skin Tightening**
Non-surgical skin tightening can only go so far, and patients experiencing more significant skin laxity concerns would benefit from a facelift and/or neck lift. “A neck lift or facelift can help with the sagging skin around and below the and jowling associated with loss of facial volume,” Dr. Zakhary says. “Some, but not all, of these procedures can be performed at the same time.”

Surgical intervention is usually the most effective course of treatment for patients over 50, Dr. Karam shares. “If someone is in their late forties to fifties, it is likely that their weight loss will lead to sagging or unveil the level of sagging that the person already had due to aging,” he explains. “When someone’s face is fuller due to fat, it actually camouflages and hides facial sagging. But when the weight comes off, the underlying sagging is revealed.” In such cases, a facelift and/or neck lift is the only treatment option, he adds. 

For patients who also have concerns about volume loss, fillers can be coupled with surgery – but fillers alone will not necessarily be enough. “In my practice, I would suggest a vertical restore because fillers in this age group will not improve sagging,” Dr. Karam says. “The important point to make here as far as treatment is: If you have laxity, the treatment is going to be surgical; if you simply have volume loss, but your jawline and neck are pretty taut, the treatment is going to be fillers.”

### **For Improving Skin Quality**
All of these surgical and non-surgical procedures are for naught, if you are not taking care of your skin. “The best thing you can do now or at any point along the aging continuum is to get serious about sun protection and be consistent with cleansing, vitamin C, retinol, as well as additional active ingredients,” Dr. Karam shares. “This was where the concept of the KaramMD Trifecta came from.” The most important rule of skincare: “Consistency is key,” he emphasizes.

Dr. Levine is also a proponent of skincare and is a fan of SkinMedica TNS Advanced+ Serum or Neocutis Bioserum for the face.

## **The Best Procedures for Treating ‘Ozempic Body’**
Much like the face, the treatments for ‘Ozempic Body’ depend on the amount of pounds shed and the aesthetic concerns of the patients. “There are no reliable non-surgical options to address significant skin laxity after massive weight loss,” Dr. Zakhary notes. Excess skin surgery is the only treatment option for such cases, and he says patients must be weight stable for six months at their final goal. “For ideal results, we should agree in consultation that the patient's current weight is where we need it to be to achieve the best postoperative outcome for the patient,” he adds.

There are, however, some non-surgical modalities that can improve tone and firmness following less significant weight loss. Below is an overview of both surgical and non-surgical treatment options for ‘Ozempic Body’:     

### **For Non-Surgical Skin Tightening**
Energy, laser, and ultrasound-based treatments can be used on the body to tone and firm the skin and, in some cases, aid in additional fat reduction. “A great non-invasive treatment is TruBody® by Cutera which uses radiofrequency technology which can actually help tighten skin, reduce fat, and strengthen muscle,” Dr. Shafer says. He is also a fan of NuEra® by Lumenis, which is another RF technology. 


While Dr. Levine likes EmFace® for the face, she is a proponent of EmSculpt® Neo combined with Emtone® for below the neck because it “really helps for laxity and toning of the body,” she says. “Ultherapy® can also be used on the body for laxity and crepiness.”


### **For Surgical Skin Tightening**
Just as surgical lifts are the best ways to address more advanced skin laxity on the face and neck, so too are they best for most areas of the body. “Arms and legs can be treated with an [arm lift](https://www.aedit.com/procedure/arm-lift-brachioplasty) or [thigh lift](https://www.aedit.com/procedure/thigh-lift), while the trunk benefits from an [abdominoplasty](https://www.aedit.com/procedure/abdominoplasty) or – more ideally – a lower body lift,” Dr. Zakhary says. 

### **For Restoring Volume**
Volume loss doesn’t just impact the face, it can also be a concern on the body – especially when it comes to the breasts and buttocks. “For loose buttocks, either a [Brazilian Butt Lift (BBL)](https://www.aedit.com/procedure/brazilian-butt-lift) transferring fat from other areas of the body into the buttocks to lift the skin or using dermal fillers such as Juvederm®, Sculptra®, or Radiesse® is great for replacing lost volume,” Dr. Shafer shares. 

When it comes to the breasts, [breast augmentation with implants](https://www.aedit.com/procedure/breast-augmentation-with-implants) or fat transfer can increase the size and improve the shape of the chest. In some cases, a breast lift may also be needed to restore perkiness. “A combination breast procedure can be needed in females but is very exam and goal specific,” Dr. Zakary notes.

### **For Improving Skin Quality**
We’ve said it before and we’ll say it again, the best cosmetic surgery in the world can’t disguise poor skin quality. “A nice treatment for loose skin of the arms and chest is hyperdiluted Radiesse® plus Ultherapy® to help stimulate collagen and tighten the deeper tissues,” Dr. Shafer says. 

Dr. Levine also likes using diluted biostimulatory injectables on the body (think: chest and decollete), in addition to skincare. For the skin below the neck, she recommends Alastin TransFORM Body Treatment.

## **The Takeaway**
For the right patient, semaglutide can be a transformative weight loss tool. But dropping those lbs can lead to unwanted aesthetic side effects including lost volume and skin laxity on the face and body. Depending on your aesthetic goals, there are surgical and non-surgical procedures that can help plump, smooth, and tighten from head to toe. Consulting with a board certified dermatologist or plastic surgeon can help you get a better sense of the treatment options that are best for you.


The Best Procedures for Combatting ‘Ozempic Face’ and ‘Ozempic Body’

Maximize your Botox and Filler

[Botox®](https://aedit.com/procedure/botox) and [soft tissue fillers](https://aedit.com/procedure/dermal-fillersinjectables) have gained immense popularity over the years. The two accounted for nearly 60% of all minimally-invasive cosmetic procedures in 2020 — and there’s good reason for it. Relative to other, more invasive, cosmetic surgeries, [Botox®](https://aedit.com/procedure/botox) and [dermal fillers](https://aedit.com/procedure/dermal-fillersinjectables) are much more affordable, require significantly less downtime, and carry fewer health risks. That being said, there is one major drawback: the results are temporary. Fortunately, there are certain behaviors and habits that we can introduce — or eliminate — to get the most out of our treatments.

So, what can you do to widen the gap between dermatologist visits? Read on for tips and considerations to maximize your [Botox®](https://aedit.com/procedure/botox) and [dermal fillers](https://aedit.com/procedure/dermal-fillersinjectables).

## **How Long Do Injectables Last?**
For better or worse, injectables like Botox® and dermal fillerswear off over time. Botox® typically lasts three to six months and most dermal fillers last around six to 12 months. There are a number of factors that play into the longevity of the injections —  some in our control and others not. The location of the injection is a key factor for how long the injectable will last. In general, muscles that are used more frequently will break down the toxin or filler at a faster rate. Muscles around the forehead, eyes, lips, and mouth are typically more active and, as a result, Botox® and filler may fade away more quickly when targeting those areas. Our metabolisms are another factor that impact injectable lifespan. Having a strong metabolism is a blessing for a number of reasons, but not when it comes to Botox® and dermal fillers. A fast metabolism can break down the toxin and filler  at a higher rate.

“Making sure the patient is the right candidate and accurately determining which injectables to do and where is highly important to ensure best results,” says [Amanda Doyle, MD](https://aedit.com/provider/amanda-doyle-md-31526), a board certified dermatologist at Russak Dermatology in NYC. “Going to a board certified dermatologist and / or plastic surgeon is likely to yield the best outcome. Even with the right doctor and right injections, if you have a fast metabolism, it’s possible that the treatments may not last as long.”

For patients who want longer-lasting results, the release of DAXXIFY™, a new anti-wrinkle injection and Botox® alternative, may be a better option once it’s commercially available in 2023. DAXXIFY™’s effects have been shown to last six to nine months, making it an appealing option for those wanting fewer injections. According to [Dr. Doyle](https://aedit.com/provider/amanda-doyle-md-31526), maintenance for DAXXIFY™ looks similar to Botox® and other neuromodulators like [Dysport®](https://aedit.com/procedure/dysportr) and [Xeomin®](https://aedit.com/procedure/xeomin). Whether it’s DAXXIFY™, Botox® or filler, the following expert advice is sure to help you get the most out of your treatment.

## **Expert tips on how to maximize Botox®  and filler injections**


### **Be extra attentive the first 24 hours**


Given the hefty price tag, the last thing you want to do is disrupt the injections as they make their way through the face. With that in mind, it’s best to leave the targeted area stationary and isolated to prevent the injections from dissipating. NYC-based board certified dermatologist [Brendan Camp, MD](https://aedit.com/provider/brendan-camp-md-34645), warns against lying down for at least four hours post procedure to avoid diffusion of the product. Further, [Dr. Camp](https://aedit.com/provider/brendan-camp-md-34645) says facial massages, exercises with inversions, like yoga, and hats or headbands are all a no-go for at least the first 24 hours. Washing your face within the first day is doctor-approved, but you’ll want to be extra gentle and wait at least a few hours after the treatment. 

### **Avoid sun Damage**

It’s no secret that the sun’s harmful rays can cause skin damage in the form of redness, discoloration, and wrinkles. While it’s always important to protect the skin from ultraviolet (UV) rays, it’s even more pertinent for those undergoing dermal filler treatments. Research has found that the sunlight’s UV rays can degrade the hyaluronic acid found in fillers. [Dr. Camp](https://aedit.com/provider/brendan-camp-md-34645) explains that unprotected sun exposure can stimulate enzymes in the dermis, which contributes to the breakdown of normal skin and injected hyaluronic acid. Not only would unprotected sun exposure decrease the lifespan of the fillers and demand more frequent injections, but [Dr. Camp](https://aedit.com/provider/brendan-camp-md-34645) says it can also continue to cause fine lines and wrinkles and a need for a higher dosage of neurotoxins to relax the skin.

### **Manage Stress**

We know, easier said than done. We’re not suggesting you need to eliminate stress completely, but it’s beneficial to work on stress management — if not for your mental and physical health, then for your Botox® and filler. Increased stress can trigger the release of the hormone cortisol which has been known to sometimes reduce our own body’s ability to produce hyaluronic acid. “When this happens, volume loss may become even more noticeable more quickly even when hyaluronic acid filler is part of the regimen,” says [Dr. Doyle](https://aedit.com/provider/amanda-doyle-md-31526). Further, stress can cause us to inadvertently change our facial expressions and recruit more muscles between our eyebrows and around our eyes. When muscle movement is increased, [Dr. Doyle](https://aedit.com/provider/amanda-doyle-md-31526) explains that the effects of the toxin injections may not last as long. Consider incorporating a stress-relieving activity, like yoga or meditation, into your daily routine. 

### **Skip the high intensity workouts**

High intensity workouts may be good for your overall well-being, but they’re not good for the longevity of your Botox® or filler. Exercise can stimulate your metabolism which, in turn, increases the rate at which the neurotoxins and fillers are broken down. “If someone is committed to making their aesthetic investment last as long as possible, it is recommended to integrate more low and moderate intensity workouts into their routine,” says [Dr. Camp](https://aedit.com/provider/brendan-camp-md-34645). The takeaway? Next time you’re thinking about attending your gym’s HIIT class, consider a long-distance run instead.

### **Keep a healthy wellness routine**
Practicing healthy habits is another critical piece to maximizing Botox® and filler injections. While the treatments help reduce the signs of aging, they have their limitations. Botox® and dermal fillers won’t clear up your skin’s complexion, but maintaining a healthy lifestyle sometimes can. Sugar and unhealthy fats can cause inflammation, breakouts, and uneven skin while inadequate hydration can lead to dry skin, eczema, and discoloration. Maintaining a good skincare routine, refraining from smoking, and limiting alcohol consumption can also lengthen the results of fillers and Botox®.

### **Integrate hyaluronic acid into your skincare routine**

Botox® and dermal filler can do wonders when it comes to smoothing out fine lines and rejuvenating the skin, but to achieve even better results, [Dr. Doyle](https://aedit.com/provider/amanda-doyle-md-31526) recommends pairing with hyaluronic acid serums and Revision Revox. The hyaluronic acid helps support and hydrate the skin and the Revision Revox can mimic the toxin injections by softening fine lines and wrinkles. Adding these two products into the mix can improve the results of the filler injections and make your skin look even more flawless.




What can you do to widen the gap between dermatologist visits for your Botox® and filler injections? Read on for tips and considerations to maximize your results.

How to Maximize Your Botox and Filler Injections

shutterstock 1593164065

From chemical peels to pimple patches, here are expert-approved breakout banishers.

Dermatologist-Approved At-Home And In-Office Acne Treatments

8 Dermatologists Share Their Favorite In-Office And At-Home Acne Treatments

brian-asare-RxVfMN7xyno-unsplash

It goes without saying that looking at a photograph is not the same as seeing something in real life. A two-dimensional snapshot simply cannot capture the nuance of a three-dimensional world, yet selfie and [social media culture](https://aedit.com/aedition/march-2020-study-shows-relationship-between-social-media-cosmetic-surgery) too often fails to respect that important distinction. Whether it’s through makeup, lighting, or face tuning apps, the photos that fill our feeds are not necessarily indicative of reality. But, increasingly, people are turning to cosmetic treatments to recreate a specific aesthetic that might look great in a picture but doesn’t translate to a natural-looking appearance in person because it lacks the movement and expression we expect to see. This is where an additional dimension of beauty – one that accounts for life in 2D *and* 3D – comes into play.

Recently, we hosted an Instagram Live with [Julius Few, MD](https://aedit.com/provider/julius-few-md-15580), a board certified plastic and reconstructive surgeon in Chicago and creator of [Aforé Beauty](https://www.aforebeauty.com/), to learn more about his concept of “four-dimensional beauty” and how it influences his approach to aesthetic medicine to achieve the most natural and holistic results for his patients. Watch the entire conversation below or read on for a breakdown of five key takeaways.

<a href="https://www.youtube.com/watch?v=6QcFwi8ptxQ" class="embedly-card" data-card-width="100%" data-card-controls="0">Embedded content: https://www.youtube.com/watch?v=6QcFwi8ptxQ</a>

## **1. Defining Four-Dimensional Beauty**
Dr. Few has been in practice for over two decades. While the original outpost of [The Few Institute](https://www.fewinstitute.com/) is in Chicago, he has a satellite office in Los Angeles where he tends to some very famous faces. As he explains, treating public figures has taught him a lot about our understanding and perception of attractiveness. “One of the things that struck me was how I could see a household-name celebrity, who, in a photograph or in a movie, looked a certain way and by all accounts was attractive,” he shares. “But you saw them in person and they went to even a more dramatic and more appealing level.” 

It’s that dichotomy between what he calls the “in-person encounter” and the “print version” that led him to formalize the idea of four-dimensional beauty. “What that represents is the concept that we deal with the three dimensions we all know – length, width, and distance – and the fourth dimension is time and moments in time,” he explains. “We're not talking about days, hours, minutes – we're talking about microseconds of movement and what is communicated both in terms of verbal and non-verbal communication.” 

While there are extreme examples of people overdoing it, even just a little too much filler or neurotoxin can look off if it impacts the natural movement of the face, he says. “That really is what four-dimensional beauty represents – that transition from moment to moment in interpersonal interaction that can either make or break a moment,” he shares. 

## **2. Photo vs. Video**
Even if your in-person schedule is not quite back to pre-pandemic strength, days spent in Zoom meetings, scrolling through TikTok, or rolling your eyes at Instagram’s ever-conspicuous push for video content are a reminder that we do, in fact, live in a three-dimensional world. The best way to look your best IRL is to consider how the result of whatever you are having done is going to impact your features and expressions. 

Dr. Few says the onus is on the provider to properly assess the patient. “Probably the most important thing that any cosmetic plastic surgeon, dermatologist, or provider of any kind really needs to hone in on is the idea that you have to look at animation during that in-office visit,” he shares. One way to educate the patient and further drive home the point is by supplementing traditional [before and after photos](https://aedit.com/aedition/importance-of-before-and-after-photos-in-plastic-surgery) with video. “I've started to incorporate more and more videography into the assessment, so I can show people,” he says. “I do believe that's going to become the norm in many ways.” 

With the ability to put a smartphone with a 4K camera into the palm of anyone’s hand, all providers need to do is standardize their lighting setup and positioning (à la traditional B&A photos). Dr. Few and his team recently [published a study](https://academic.oup.com/asjopenforum/article/doi/10.1093/asjof/ojac002/6515787?login=false) in the *Aesthetic Society Journal* based on the clinical results of using the [Aforé Beauty CR Emulsion](https://www.aforebeauty.com/products/cr-emulsion) – a serum that blends 0.2 percent retinol, [cannabidiol (CBD)](https://aedit.com/aedition/cbd-beauty-skincare-wellness-benefits), peptides, and hyaluronic acid to improve skin tone, texture, and hydration – that included a dynamic video component. “It gave us a platform to develop the videography assessment tool, which is in its infancy,” he says. “We're still working on it in terms of validating and putting it together, but we're well on our way.”

Long term, Dr. Few sees video as “a great equalizer” that will foster transparency. “There will be more and more of a demand for influencers and the like on social media to have videography versus a static picture,” he notes. “What different people got away with just because they had a great 2D picture, that's not going to be good enough.”

## **3. The Rise of Prejuvenation**
It’s usually easier to prevent something than correct it, and that is certainly true of age-related skin and aesthetic concerns. There is a lot to be said about rejuvenating procedures, but, in the last decade, the conversation has expanded to include the idea of ‘[prejuvenation](https://aedit.com/aedition/i-was-practicing-prejuvenation-before-it-was-a-trend)’ (i.e. preventative treatment). “I kind of came up with that term ‘prejuvenation’ at a multi-specialty meeting probably 10 or 11 years ago,” Dr. Few shares. “The whole concept came up during a panel because, at that time, I was just starting to really kick into taking care of a lot of models and actors, and that group really was keen on the idea of avoiding the knife.” Instead, they were interested in less invasive solutions that they could start earlier in life to potentially delay or eliminate the need for more invasive measures down the line. 

But it’s not just celebrities who want to get ahead. Dr. Few says he has long had patients who are predisposed to deeper frown lines or have a family history of jowling and want to address them as early as possible. “You can preempt that whole phenomenon just by simply targeting that area when it first starts to form, and then you hold it in suspended animation,” he explains, adding that it’s not about stopping the clock or dramatically altering someone’s appearance. “I believe if you try to take that given point where things are transitioning in maybe not the most positive way and hold it, well then that’s mission accomplished,” he says. “You've now made somebody achieve their goal of looking naturally beautiful and aging in the most graceful way, which, in my opinion, is the way to go.” 

Returning to those four dimensions of beauty, it’s all about enhancing what is already there in the most natural way. “It's not about aging ungracefully or in any artificial way or even not aging at all,” Dr. Few explains. “To me, where the artistry of cosmetic medicine and surgery comes through is in creating subtle contrast.” For example, “you have somebody who maybe has gray hair but, at the same time, has a youthful kind of very subtle cuteness that shines through,” he says. “That's their own individual expression.”

## **4. Blending Surgical & Non-Surgical Solutions**
Just because Dr. Few is a plastic surgeon doesn’t mean that every patient of his is going under the knife. “I am somebody who's kind of formed an expertise in both the surgical and non-surgical space – especially for facial rejuvenation and prejuvenation,” he says. In his view, it’s not so much surgical versus non-surgical but rather a continuum. “I try to position things in a way so that if somebody is not sure which direction they want to go, it's easier to do something that's a bit more temporary – that's non-surgical – that then can lead into a surgical option if that's what they want,” he explains.

Generally speaking, prospective patients fall into three categories: 

1. I definitely want surgery.
2. I definitely don’t want surgery – regardless of what I need.
3. I’m undecided and want to know my options.

After determining which bucket someone falls into, there are a trio of factors Dr. Few considers during a consultation to formulate a treatment plan: skin quality, volume loss, and facial laxity. “When you look at those three components, then I get to go into my toolbox and decide what are the options that work for it,” he shares. “For the skin, it may be different forms of resurfacing lasers, peels, etc., and then you look at non-surgical versus surgical lifting.” Seeing as he remembers the days when [Restylane®](https://aedit.com/procedure/restylane) was only one hyaluronic acid-based filler on the market, today’s innovation – especially in the non-surgical space – means there are now “more options than you could even hope to use.” As such, “it becomes much like picking the right paint brush for the component of the canvas you're painting on,” he says.

Finding the right balance between surgical and non-surgical has actually spurred hybrid solutions over the years. Dr. Few cites the evolution of the so-called [Nefertiti neck lift](https://aedit.com/aedition/where-to-use-botox-from-head-to-toe) as one such example. While injecting neurotoxin into neck bands can have a dramatic impact on texture and contour, the effect is temporary. For a longer-lasting result, Dr. Few developed a slightly more invasive neck band procedure. “That's where I can use a special needle that's called a no cord needle to actually go in and break up the bands of the muscle – much like the [Xeomin®](https://aedit.com/procedure/xeomin), [Dysport®](https://aedit.com/procedure/dysportr), or [Botox®](https://aedit.com/procedure/botox) would do – but it does it in a more permanent way,” he says. “You can marry these concepts, which is what makes it fun.”

## **5. The Benefit of ‘Stackable’ Treatments**
Long before the pandemic made the idea of [maximizing in-office time](https://aedit.com/aedition/best-aesthetic-procedures-to-combine-to-maximize-appointments) with your provider a must, Dr. Few was honing the technique of what he calls “stackable treatments.” “When I first came up with ‘stackable treatments’ as a concept, it was the combination of [Ulthera®](https://aedit.com/procedure/ultrasound-skin-tighteningultherapy) and lasers and fillers – doing that all in one setting,” he shares. As he explains, the combination approach was, initially, “purely out of necessity.” “When I first started seeing patients in New York, I didn't have the luxury of trying to space it out over six months,” he notes. But then he realized the multimodal nature of the appointment was more than just convenient. “There's synergy in it,” he shares, that actually improves the results that would be possible with each treatment individually. 

But not all stacks need to happen at once. Lately, one of the popular pairings at his practice involves combining Dr. Few’s signature [thread lift](https://aedit.com/aedition/pdo-thread-lift-for-facial-rejuvenation) with [Sofwave™](https://aedit.com/aedition/sofwave-for-skin-tightening-collagen-production), a new non-surgical skin-tightening treatment that uses ultrasound waves to firm the skin, and [Kybella®](https://aedit.com/procedure/kybella) to address an array of age-related concerns in the lower face. “I'll do thread lifting, get a result, and then we can come back and do Sofwave™ to further enhance,” he explains. “It seems to really play on that matrix that has been created by the thread lifting.” But that’s not all. “If they still have a little bit of jowl fat, I can do a bit of off-label Kybella® injection to shrink it down,” he adds. “All of a sudden we're creating this approach that can deliver a progressive result.”  

Perhaps most importantly, this trio is not designed to create a trendy, overly snatched jawline. “Always bearing in mind four-dimensional beauty, we’re not trying to do anything just for the sake of a photograph on social media,” Dr. Few says. Instead, the procedures subtly-yet-substantially sculpt the lower face and neck for a more youthful countenance. The result: You’ll look like a rejuvenated version of yourself.

Board certified plastic and reconstructive surgeon Julius Few, MD, breaks down the concept.

A Guide To Four Dimensional Beauty For Natural-Looking Results

Why You Need A Four-Dimensional Approach To Beauty

shutterstock 1760754215

Hyaluronic acid-based fillers work somewhat like magic. Injecting them into the appropriate facial planes allows for deflated areas – such as the [cheeks](https://aedit.com/procedure/cheek-augmentation-with-fillers), mid-face, temples, and [lips](https://aedit.com/procedure/temporary-lip-fillers) – to experience an immediate improvement in volume and contour. Often, dermatologists and plastic surgeons veer on the conservative side and take a less is more approach when filling. After all, adding too much volume in any one area, at any one time can lead to an unnatural appearance. However, some patients require more volume than others, which may call for multiple syringes to achieve the desired effect.

Lately, we’ve talked a lot about [overfilled facial features](https://aedit.com/aedition/hyaluronidase-to-dissolve-dermal-filler), [filler migration](https://aedit.com/aedition/why-lip-filler-migrates), and [filler fatigue](https://aedit.com/aedition/dermal-filler-fatigue), which are just a few of the reasons why the concept of injecting large amounts of filler may sound scary. The truth is, in inexperienced hands, it can be. But, if you are working with a highly skilled injector who understands your aesthetic goals, it’s possible for the specialized technique to be both safe and effective. Here, top physicians break down everything you need to know about large-volume filler. 

## **Large Volume vs. Overfilling: What’s the Difference?**
The term ‘large-volume filler’ is relative. It depends on the treatment area and the anatomy of the patient. Generally, it refers to injecting more than the ‘typical’ amount of filler required for a noticeable change in the average patient, says [Jonathan Cabin, MD](https://aedit.com/provider/jonathan-cabin-md-956), a double board certified facial plastic and reconstructive surgeon in Arlington, VA. “I consider ‘large volume’ anything more than a single syringe (one cc) of filler,” he explains. For context, about five syringes of filler are needed to achieve one teaspoon's worth of volume, says [Joshua Zeichner, MD](https://www.instagram.com/joshzeichnermd/?hl=en), a board certified dermatologist in New York City. He adds that a typical ketchup packet contains about seven syringes worth of filler — just a little food for thought.

While large-volume filler equates to a larger, albeit appropriately used, dose, there is some confusion between it and [overfilling](https://aedit.com/aedition/how-to-correct-overfilled-facial-features). A clear distinction exists between the two:

- Overfilling refers to excessive and inappropriate filler placement
- Large-volume filler precisely injects more-than-average doses into the appropriate facial planes

Dr. Zeichner explains that, when placing more volume, the outcome is 100 percent determined by the skill and aesthetic of your injector. “It is no different than going to the museum and seeing a Monet versus a van Gogh,” he shares. “It's the same oil paint just used differently on the canvas.” If the injections are appropriate, the results should be natural and complement, not hinder the patient's appearance. “When the filler is not placed where it should be, patients often look odd or overfilled,” Dr. Zeichner adds.

We all know what an overfilled face looks like, and, unless that's the aesthetic you're going for, most people try to avoid it at all costs. For that reason, it's understandable why some patients get nervous that they will end up looking overfilled when their provider lays out four or five syringes of filler. Seeing a medical [tray of needles](https://aedit.com/aedition/guide-to-needles-used-for-cosmetic-injectables-botox-filler) does more than send off sirens that a substantial bill waits for you at the front desk. Dr. Zeichner says patients are more so afraid of looking overfilled and fake, than the price tag.

## **The Ideal Candidate**
Whether you need half a syringe or five ccs, a full assessment is vital before your provider injects a single drop of filler into your face. This includes studying the anatomy of the treatment area and its relationship to the rest of the face, in addition to learning more about your aesthetic goals. Not every patient needs the major volume technique, and the degree of evident aging determines who benefits from it and who doesn't. 

Typically, those with a significant [volume deficit](https://aedit.com/aedition/best-procedures-to-restore-facial-volume) and/or [asymmetries](https://aedit.com/aedition/cosmetic-procedures-for-body-asymmetries) are candidates for multiple syringes of filler. As such, age is not a factor when it comes to who can reap the benefits. More mature patients who require significant volume restoration and younger patients who mandate facial balance are often contenders, says [Michael Schwartz, MD](https://www.drschwartz.com/), a board certified plastic and reconstructive surgeon in Los Angeles. “Full facial balance restoration improves proportions and [creates harmony](https://aedit.com/aedition/facial-harmony-in-aesthetic-medicine) within the features instead of augmenting one area,” he explains. “It requires more product because we treat the face entirely to achieve natural results.” However, patients seeking intentional exaggeration of specific features that are not harmonious with the face's natural contours may not be well-suited for large volume injections, adds [Shirley Madhère, MD](https://elementsandgraces.com/about), a holistic plastic surgeon in NYC and founder of [Jet Set Beauty Rx](https://jetsetbeautyrx.com/).

Sometimes, it can be challenging for doctors to educate their patients on how much volume loss they have – and for patients to accept it – “but it is an important conversation to avoid potential disappointment, especially if a patient does not get the result they are looking for when using fewer syringes,” Dr. Zeichner explains. The last thing any provider wants is for a patient to invest in their face and not be happy with the results simply because there is a need for more product.

## **The Right Way to Do It**
What constitutes large-volume filler depends on each patient's face and how much filler they can safely benefit from, says [Kenneth Mark, MD](https://kennethmarkmd.com/), a board certified dermatologist with offices in New York, Aspen, and the Hamptons. Despite the volumizing benefits, he finds patients can be skeptical of substantial amounts of filler because of the suboptimal outcomes they’ve seen on social media from either too much of the wrong filler or poor injections in the wrong places. This rightfully creates legitimate concern amongst patients when they hear the words ‘large-volume filler.’

Using filler as an alternative to traditional cosmetic surgery procedures (like a [rhinoplasty](https://aedit.com/aedition/facts-about-liquid-rhinoplasty) or [chin implant](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures)) and in areas that require more noticeable correction (think: jawline, temples) call for larger volume – often two syringes of filler or more – says Dr. Cabin. “The nose and chin are unique in that fillers create changes in two-dimensional shape in the profile view, as opposed to three-dimensional facial volume change goals with other areas,” he explains. The chin typically requires one to four ccs of filler to create the necessary balance. When injecting insufficient amounts of filler, the results will not be noticeable and can even call unwanted attention to a specific feature.

In the hands of an expert injector who understands the nuances of filler and anatomy, using more than moderate amounts of product can create an aesthetically pleasing result, especially when the placement is deep. “It makes a big difference," says Dr. Zeichner, who regularly uses five or more syringes (often in a single session). “Most of my injections tend to be deep, down to the level of the bone,” he notes. This technique helps provide structure, support, and mattresses to lift and reposition the overlying soft tissue and skin. “If all of the injections are superficial, it weighs down the face and makes the patient look overfilled,” he cautions. Deep placement creates the opposite effect.

Deep injections also create a smoother appearance – sans bumps, lumps, and irregularities. Not injecting more robust fillers deep enough can cause superficial lumps, nodules, and a blue tinge to the skin, known as the Tyndall effect. “When injecting thicker fillers into the skin, it is important to employ a technique that places the filler in the layer of skin that is appropriate to accept the dynamic properties of that filler,” Dr. Madhère explains.

In the case of large-volume fillers, Dr. Mark likes to use a layering technique. Layering is just what it sounds like and consists of placing fillers in various depths of the skin and locations as needed over time. He says layering filler and staging it out over multiple sessions avoids overcorrection and provides natural-looking results. “Utilizing this method and pinpointing precise placement has allowed me to avoid complications and obtain optimal cosmetic results,” he adds.

Technique aside, injecting the right fillers in the right place is essential. Dr. Madhère says thicker hyaluronic acid-based fillers, like [Juvéderm® Voluma](https://aedit.com/procedure/juvederm) and [Restylane® Contour](https://aedit.com/procedure/restylane), occupy more space. But it's not just hyaluronic acid filler that fits the bill. Injectables that fill more robustly, including [Sculptra®](https://aedit.com/procedure/sculptra), which provides a scaffold for a volumizing effect, may be used. “Additionally, thick and long-lasting calcium-based [Radiesse®](https://aedit.com/procedure/radiesse) can also be used,” she explains. “So can [fat injections](https://aedit.com/procedure/facial-fat-grafting), but they involve a surgical procedure and additional costs.” No matter what filler you and your provider ultimately decide on, it's always important to find an injector that understands the differences between the products and where to place each one.

Just like every patient isn’t a candidate for large-volume fillers, not every facial feature should be treated with the technique either. The parts of the face that tend to respond well include the temples, cheeks, midface, and jawline. Dr. Madhère advises against using a lot of volume in the [forehead](https://aedit.com/aedition/cosmetic-forehead-procedures) and [eye area](https://aedit.com/aedition/under-eye-filler-pros-cons), as they can swell and cause undesirable puffiness.

## **One Session or Multiple: Which Is Best?**
There are plenty of patients that only need a bit of filler and respond well to an average dose. Yet, the ‘a little filler goes a long way’ rule doesn't apply to everyone. Dr. Zeichner says that “more filler goes a long way” for many of his patients. And, when there is a need for significant volume and it is within a patient's budget, he prefers injecting it all at once. “This means less anxiety over the visits and a single period of downtime versus multiple visits with potential bruising after each one,” he shares.

Some providers, meanwhile, choose to space out the injections. For example, Dr. Cabin rarely does large volume filler in a single appointment. Instead, he performs spreading out large-volume injections over a few visits because, as he says, there’s a greater chance of unnecessarily high levels of short-term swelling. “The filler tends to settle better when I inject it over several sessions,” he notes. “It settles and creates a more natural correction.”

[Swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery) may be one reason to break the injections up, but there's also the potential for volumetric changes that patients don't know to account for. A filler may be a specific volume when it is going in and, most of the time, that volume increases since the product naturally pulls in water from the surrounding tissue (hence, post-treatment swelling). Some of this extra water can remain, causing what Dr. Cabin describes as a more considerable volume change than you would anticipate from the syringe volume alone. Volume fluctuations are another reason why some providers avoid injecting large amounts of filler at once.

## **How Long It Lasts**
The more product your provider injects, the longer it can take to break down and for the area to return to baseline. So, injecting more filler may equate to longer-lasting results, but there is a lot that goes into how long filler results last. “Longevity depends on several factors, including, but not limited to, the main ingredient, chemical composition, amount injected, and patient's metabolism,” Dr. Madhère explains. 

While injectable brands provide an average of how long each product lasts given its intended use (i.e. up to one year), those timeframes vary from one person to the next. “Everyone metabolizes fillers differently, so I like to start with full correction treatment and then follow-up with a [maintenance plan](https://aedit.com/aedition/how-frequently-to-get-non-surgical-cosmetic-procedures-like-dermal-filler-botox-chemical-peel) to keep the results up,” Dr. Schwartz says.

## **The Takeaway**
If your doctor says you'll benefit from multiple syringes of filler, it doesn't mean you will end up with an overfilled face that looks doughy or unnatural. In fact, some patients sport numerous syringes of filler, and no one but them and their injector knows. More often than not, it’s poor injection technique and improper placement that will land you in the ‘done and don't’ category. Ultimately, the decision is yours, but, with the help of an expert injector who understands how to use more robust amounts of filler to replace lost volume or correct asymmetry, you may be happier with the outcome. In the right hands, more can be more.

Dermatologists and plastic surgeons break down the benefits of injecting large volumes of filler for certain patients.

The Pros And Cons Of Large-Volume Filler Injections For Volume, Symmetry, Contour

Why Injectors Say Not To Be Afraid Of Large-Volume Filler

selene-marie-ZUxdy0-FoYg-unsplash

There’s no wrong way to have a vagina – they’re all beautiful – but personal preference is just that, personal. [Vaginal rejuvenation](https://aedit.com/procedure/vaginal-rejuvenation-solutions) is the umbrella term that refers to an array of surgical and non-surgical solutions that can address both functional (think: urinary incontinence, vaginal dryness, vaginismus, etc.) and aesthetic (i.e. vaginal skin laxity, labia shape and size, etc.) concerns related to the vagina and the vulva as a whole.

For many women, conversations about sexual health primarily happen between friends, and they don’t necessarily center around things like appearance, hormonal changes (postpartum and [menopause](https://aedit.com/aedition/menopause-specific-beauty-skincare-hair-products)), or other functional concerns. If the discourse steers towards that topic, it’s often by comparison and without a clear solution. After all, not everyone is friends with medical and sexual wellness experts. 

That’s where we come in. We’re here to have that in-depth chat with a true expert in the field, [Usha Rajagopal, MD](https://aedit.com/provider/usha-rajagopal-md-1330), a board certified plastic and reconstructive surgeon and founder of [San Francisco Plastic Surgery & Laser Center](https://www.sfcosmeticsurgery.com/) who specializes in vaginal rejuvenation, to get clear answers to your ‘below the belt’ questions and learn more about the in-office procedures that exist to treat an array of [female sexual wellness](https://aedit.com/concern/female-sexual-wellness) concerns. 

## **1. It’s Not Just One Procedure**
First things first, the term ‘vaginal rejuvenation’ doesn’t refer to any one thing. “Vaginal rejuvenation is really a combination of vulva rejuvenation along with vaginal rejuvenation,” Dr. Rajagopal explains. Translation: there are options. We break them down below:

### **Surgical Solutions**
- **Labiaplasty**: “To improve the aesthetic appearance of the labia minora and labia majora, we offer a [labiaplasty](https://aedit.com/procedure/labiaplasty),” she shares. The surgical procedure can benefit those experiencing discomfort during exercise, urinary tract infections, painful intercourse, and other physical activity. The surgery can be performed alone or as part of a [mommy makeover](https://aedit.com/concern/mommy-makeover).
- **Monsplasty**: For those who have excess skin and/or fat in their upper pubic area that is impacting their quality of life, Dr. Rajagopal recommends [monsplasty](https://aedit.com/procedure/monsplasty) (a.k.a. mons pubis reduction or pubic lift). It can involve liposuction (to remove fat), surgical excision (to remove skin), or a combination of the two. 

### **Non-Surgical Solutions**
- **Emsella®**: “[Emsella®](https://bodybybtl.com/solutions/btl-emsella/) consists of high-intensity focused electromagnetic stimulation (HIFEM) that is similar to MRI magnetic technology,” Dr. Rajagopal explains. “It stimulates and enhances the function of the pelvic floor muscles.” She says the treatment is ideal for those experiencing urinary incontinence and/or an inability to achieve strong orgasms. The non-invasive treatment (you sit on a chair-like device that stimulates the muscles) calls for six 30-minute sessions in a three-week span.
- **Botox**: Yes, you read that right, Botox for vaginal health. The neurotoxin is used off-label for the treatment of [vaginismus](https://aedit.com/aedition/botox-injections-for-vaginismus), a medical condition that causes involuntary vaginal muscle spasms that can make inserting tampons and penetrative sex painful —  if not impossible. Botox is injected into the bulbospongiosus muscle (i.e. the muscle that surrounds the opening of the vagina) to relax it and relieve the spasms.
- **Infini™ RF**: If a surgical labiaplasty isn’t for you, Dr. Rajagopal says “you can also have just a labia majora reduction with [Infini™ RF](https://aedit.com/procedure/infini-rf).” When used on the vulva, the RF microneedling treatment can firm the tissue of the labia majora to enhance its appearance and even tighten the vaginal canal after natural childbirth. “We call it a vagi-facial,” she notes.
- **Laser Therapy**: Dr. Rajagopal uses [FemiLift®](https://almainc.com/products/femilift), a fractional C02 laser, to treat patients with vaginal dryness due to age and vaginal atrophy (a condition that can cause painful intercourse). The [intravaginal laser](https://aedit.com/procedure/vaginal-rejuvenation-with-laser-energy) is inserted into the vaginal canal (she assures us the treatment is much more tolerable than it sounds). Some patients enjoy the benefits after the first appointment, but Dr. Rajagopal recommends three sessions in three months for best results. 
- **PRP**: To improve pleasure, the so-called [O-Shot](https://aedit.com/procedure/oshot) injects platelet-rich plasma (PRP) into numbed areas of the vagina, clitoris, and labia to heighten orgasms and improve sexual wellness. For some, the effects are immediate, while an initial series of treatments may be needed for others. Results can last three to six months.

## **2. It’s Highly Customizable**
The vulva is made up of multiple organs – including the vagina – and just about all of them can be addressed. While vaginal rejuvenation is often talked about in relation to childbirth, hormonal changes, genetics, and even stress can impact both the form and function of the genital area. “There can be functional issues that may interfere with her lifestyle and how much pleasure she gets out of sex,” Dr. Rajagopal shares. “There can also be aesthetic issues that she may want to address and that’s what we offer.” 

Many of the procedures listed above can be combined to create a treatment plan that best addresses a patient’s unique anatomy and goals. Consulting with a board certified plastic surgeon or gynecologist who specializes in vulva rejuvenation is the best way to learn more about your options.

## **3. Candidates Vary** 
As with any procedure, those interested in vaginal rejuvenation should consult with their provider to ensure their preferred procedure(s) is right for them. As we mentioned, treatments that address vaginal health and appearance aren't one-size-fits-all, nor should they be. “With each treatment, we have an examination first to see who is a viable candidate,” Dr. Rajagopal explains. Topics such as medical history and overall health and wellness should also be discussed during the examination process. Women may also want to consider whether or not they are planning to have children or want to further expand their family. While some of these solutions treat sexual health concerns, others have the ability to be impacted or undone by pregnancy or childbirth.

## **4. Sensitivity Can Be Compromised** 
Although it’s uncommon, a decrease in sensation is always possible after cosmetic procedures – and vaginal rejuvenation is no exception. There is no surefire way to prevent this, though cosmetic gynecology performed by a highly skilled provider who specializes in the practice is the best way to ensure a safe and effective outcome. Prior to booking a procedure, be sure to use the [consultation process](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation) to learn more about your provider. Research their credentials, review before and after photos, inquire about how often they perform the procedure(s) you are interested in, and even seek out patient testimonials to ensure you find the right fit. 

## **5. Recovery Is a Process**
The beauty of many non-surgical solutions (vaginal rejuvenation or otherwise) is that they come with minimal [downtime and recovery](https://aedit.com/aedition/best-plastic-surgery-recovery-nurses-centers-products). Even so, there may be some guidelines as to when certain activities, including sex, can be resumed. Be sure to ask your provider about any recovery protocols. 

Recovering from surgery is a bit more involved. Depending on the procedure, a few days to a week of downtime may be needed. Side effects of most vaginal rejuvenation surgeries include swelling, bruising, and discomfort. Infection is a greater risk due to the nature of the area, so practicing good hygiene after surgery is key. Those who have vaginal rejuvenation as part of a [larger mommy makeover](https://aedit.com/aedition/mommy-makeover-recovery-healing-process) will need to factor in the recovery of the other surgeries as well. 

## **The Takeaway** 
From genetics to age to childbirth, there are a wide variety of reasons you may be interested in vulva rejuvenation. For too long, women haven’t had reliable resources to learn more about their options. It’s time to change that. “It has been taboo to speak on female genitalia, while men’s concerns aren’t,” Dr. Rajagopal says. “They have medication to help with erectile dysfunction and aesthetic surgeries to improve the appearance, so I think the time has come for women to feel confident with that area.” Hear, hear!

Female sexual wellness is too often spoken of in hushed tones, but we’re going ‘there’ to answer the questions you have about vaginal rejuvenation.

What To Know About Vaginal Rejuvenation, According To A Plastic Surgeon

5 Things You Need To Know About Vaginal Rejuvenation

AEDITION for men-min

Expert Opinion Collection | The AEDITION

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The Duchess of Cambridge’s nose. Penélope Cruz’s lips. Angelina Jolie’s cheekbones. Ask any plastic surgeon and, chances are, they've encountered any number of patients entering their office with pictures of those celebrity facial features. It’s certainly not surprising that people going in for cosmetic surgery would ask that the body part in question be made to look like that of a certain Hollywood star deemed “perfect.” But any surgeon worth his or her weight in [Botox®](https://aedit.com/procedure/botox-facial) will tell you that proportion — not perfection — is the secret to looking your best.

“In our social media culture, we definitely see patients coming in requesting this person’s nose and that person’s eyes. But I tell them that I’ll make you the best you," says board certified Philadelphia facial plastic surgeon [Jason Bloom, MD](https://bloomfacialplastics.com/). "It’s so important to have a conversation explaining why everything from the patient’s skin type and texture to their ethnicity dictates what will look right on them — not to mention the proportions of their face.”   

## **The Mathematics of Beauty**
While we're all familiar with the phrase "beauty is in the eye of the beholder," plenty of research has been done into what physical attributes so-called "beautiful people" have in common. The Ancient Greeks discovered the Golden Ratio of nature (which may or may not be able to be duplicated in the human body — though Leonardo DaVinci used the mathematic marvel when painting the Mona Lisa), and, needless to say, the interest in perfection has only spiraled from there.

Here's the thing: There’s a reason why Kate Middleton’s nose is so admired. With its 106-degree nasal tip rotation, the Duchess' sniffer is about as close to “mathematically perfect” (yes, you read that correctly) as it gets. [Research shows](https://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/1883794) that noses angled between 104 and 108 degrees are considered the most attractive. Scarlett Johansson, Kate Beckinsale, and Jessica Biel are similarly #blessed with the ideal proportion, but that doesn't mean it's right for everyone.

Dr. Bloom explains that Kate's nose wouldn't necessarily flatter someone with thicker skin or more sebaceous glands. “[Rhinoplasty](https://aedit.com/procedure/ethnic-rhinoplasty) is certainly one surgery where you have to take these factors into consideration — on top of nose shape and facial symmetry,” he says. 

## **Proportion vs. Perfection in Cosmetic Surgery** 
In 2016, Amber Heard's face was found to be [91.85 percent accurate](https://www.londonfacialplasticsurgery.co.uk/facial-balance/) to the elusive Golden Ratio, followed closely by Kim Kardashian and Kate Moss. But taking any one of their features and putting them onto someone else's body wouldn't necessarily yield a desirable result.

“The key to facial beauty is proportions, not just particular features," says Nashville-based board certified plastic surgeon [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649). "This means beauty is actually found in how various features relate and interact with one another on someone’s face. It's why big features like the eyes or cheekbones of Angelina Jolie work very well on her face, but would not on others.” 

Speaking of Jolie, her plush pout is a case study in proportion. According to a [study in JAMA Facial Plastic Surgery](https://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/2601230), one-third of the fullness should be on the top lip and two-thirds on the bottom lip-chin area. 

“If you look at Angelina Jolie, her lips look perfect on her face because they follow this ratio,” explains Dr. Bloom. “So, when a patient says they just want their upper lip filled, I explain that it won’t look natural. They won’t look their personal best, if it’s not recreating that ratio. You often see when this goes wrong because that’s when people have duck lips.”

The ratios extend to the rest of the face, too. It may be hard to visualize, but, horizontally, the ideal width of a face is about five-eyes wide — meaning, if you measure your face across, there would be space for another eye between your two actual eyes and room for one more eye on each temple. 

Vertically, meanwhile, the face is divided into thirds, with an equal distance between the [hairline and brow](https://aedit.com/procedure/direct-brow-lift), brow and nose, and nose tip and chin. Rather than trying to recreate the alleged perfect face, a cosmetic surgeon can employ any number of tricks to add balance and, yes, proportion as needed. 

“If you have a surgeon who is focused on proportion, he or she can find ways to lengthen or shorten these areas using optical illusions,” says Dr. Bloom. For someone who wants his or her forehead to look smaller, Dr. Bloom can visually minimize the temples by injecting them with [filler](https://aedit.com/procedure/under-eye-filler). Conversely, if the bottom half of the face is too stout, filler may be injected into the chin to create length. 

## **The Takeaway**
All of this is not to say that you shouldn't arrive at your next plastic surgery consultation with inspo pics of your favorite celebs in tow. The visual cues can be a good way to show your surgeon your preferred aesthetic. But, ultimately, it is important to let your own facial structure — and your doctor — be your guide in creating a look that could only be yours.

When it comes to cosmetic procedures, it’s proportion — not perfection — that will ensure you look your best. Here, plastic surgeons explain why the key to a “perfect” face is all about balancing your features. 

Plastic Surgery Perfection vs. Proportion: How To Achieve The Ideal Look For You

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No longer exclusive to the dermatologist’s office, non-invasive procedures like injectables (i.e. [Botox®](https://aedit.com/procedure/botox-facial), [fillers](https://aedit.com/procedure/under-eye-filler), etc.) and laser treatments have made their way to plastic surgery practices as well. According to the [American Academy of Facial Plastic and Reconstructive Surgery](https://www.prnewswire.com/news-releases/aafprs-2018-annual-survey-reveals-key-trends-in-facial-plastic-surgery-300782534.html), four-fifths of all treatments performed by facial plastic surgeons in 2018 were cosmetic non-invasive (read: not surgical) procedures. So, why have so many plastic surgeons embraced non-surgical services? And, in turn, which procedures make perfect pairs?

“In my practice, non-invasive procedures are frequently done in conjunction with cosmetic surgery to improve the overall result or to provide a more efficient treatment plan for patients,” explains [Dara Liotta, MD](https://www.facialplasticsnyc.com/), a facial plastic and reconstructive surgeon in Manhattan.

One popular non-invasive and invasive cosmetic procedure combination in Dr. Liotta’s practice is the coupling of Botox® and [upper eye lifts](https://aedit.com/procedure/upper-eyelid-blepharoplasty) because "injecting while a person is sleeping keeps tension off the surgery incisions and improves the overall result." 

She also frequently pairs [lip fillers](https://aedit.com/procedure/temporary-lip-fillers) and [nose jobs](https://aedit.com/procedure/open-rhinoplasty). “Lip filler is often paired with a rhinoplasty because tweaking the lip shape helps balance the new proportions of the face," she shares. "Also, injecting around the mouth can be painful, so doing it while a patient is under anesthesia helps save her from extra discomfort."

[Melissa Doft, MD](https://aedit.com/provider/melissa-doft-md-63), a Manhattan plastic surgeon and clinical assistant professor of surgery at Weill Cornell Medical College, has a similar approach. "Dermal fillers are painful, period," she says. "So, doing them when you are already under sedation is appealing."

Dr. Doft regularly incorporates injectable fillers into cosmetic surgery — even if the filler is not necessarily complementary to the surgical procedure (e.g. lip fillers with a [breast augmentation](https://aedit.com/procedure/breast-augmentation-with-fat-transfer)). She also adds lip fillers and [PRP](https://aedit.com/procedure/acell-and-prp-injections-for-hair-loss) (platelet-rich plasma scalp injections that stimulate regrowth) to [facelift](https://aedit.com/procedure/deep-plane-facelift) surgery. “Many older patients who are ready for a facelift are often also suffering from thinning hair and lips," she explains. "So, many decide it is both efficient and painless to address them all at once."

Another popular "extra"? [Laser resurfacing](https://aedit.com/procedure/ablative-fractional-lasers).

Both Dr. Doft and Dr. Liotta say lasers are a go-to non-invasive add-on to plastic surgery procedures that already require a considerable recovery period (think: eyelid surgery or facelifts). 

“In addition to elevating the facelift result by improving the texture of newly lifted skin, lasering during surgery can save the patient extra downtime on the backend,” explains Dr. Liotta. “After surgery, most patients opt to stay out of sight for at least a week, so adding deeper laser resurfacing — which leaves the skin red and raw — saves the patient from two rounds of downtime. Post-op, they stay home and recover from both the surgery and lasering simultaneously.” 

But it's not always about minimizing pain or maximizing downtime. Some effective combos are more spa-like in nature.  

Dr. Doft says she frequently combines liposuction with a lymphatic massage — a non-invasive therapeutic treatment. “I work with an excellent masseuse who specializes in lymphatic drainage," she says. "I have found that having her massage a patient three to four times after [liposuction](https://aedit.com/procedure/laser-assisted-liposuction) makes the end result more uniform and it can significantly decrease post-op swelling, sometimes cutting recovery time by a third or even in half.” 

Multitasking is a marvelous thing.

Many plastic surgeons now offer non-invasive cosmetic treatments and often suggest complementing a surgical procedure with an add-on or two. So, what are the best combos? The AEDITION talked to the experts.