Speaker 1 (00:00):
This is Behind the Double Doors with Dr. Bob Basu.

Dr. Bob Basu (00:11):
I'm Dr. Bob Basu, and today I've brought back Madison from our beautiful Post Oak Galleria office and medical spa. Madison is one of our expert aesthetic injectors, and almost every day I hear from our patients how much they love their results, especially lip injections. So welcome, Madison.

Madison (00:29):
Thank you. Hello.

Dr. Bob Basu (00:31):
So Madison, you're an expert of all things injectables and fillers. What are some of the hottest trends in injectables right now?

Madison (00:39):
Lip filler went through a period where the large lip was really popular. I think a large lip is still popular, but it's calmed down a bit. You still see the millennial generation wanting that fuller lip. I think all women want some form of a full lip, but my philosophy on that is to create a natural enhancement that works with your natural features. And so that's what I like to say that I specialize in, getting a natural result, but also enough volume that you can see, but something that you can walk away with that you're happy with, that somebody isn't going to look at you like you've done something very, very different to your face.

Dr. Bob Basu (01:22):
So most recently, you had a patient a few days ago who had filler in her lips that were done somewhere else, and that filler migrated. What did her lips look like when she came to you and how did you approach helping her?

Madison (01:36):
It's more common than you think, and it's, of course, like many things is multifactorial. Patients go to med spas that they may not know the credentials of who's injecting them and things like that. It depends on how the injection was done, and it also depends on the type of filler in my opinion as well. So products that don't necessarily have a lot of structure but are very hydrophilic, meaning pulling in a lot of water content, that are made to enhance volume but not necessarily enhance structure, and that the injection technique has allowed that filler to migrate past what's called the vermilion border, basically the line of your lip, in layman's terms, the line of around the lip that's kind of at that color transition. When you start to see volume outside of that vermilion border, I'm concerned for migration, and that's when I say it's in your best interest to have some of that dissolved.

Dr. Bob Basu (02:34):
So how did you do that? How do you dissolve too much filler and fillers in a place where you don't want it to be?

Madison (02:41):
You want to maintain some of that volume component, of course, with the filler that is inside the cutaneous lip itself, but when I see it outside of the vermilion border, I'll take a cannula, which is basically similar to a needle, but it's blunted at the end, so in theory, it has less trauma to the soft tissue. I'm going in and using something called Hylenex, or hyaluronidase, that dissolves that filler component where I want it to go away. By doing that and taking away the fullness above the vermilion border, I take away what's keeping me from elevating the lip structure, because if I don't, I'm going to always be fighting against gravity, so to speak. If something's sitting on top, I can't make it go higher unless I take off what's weighing it down.

Dr. Bob Basu (03:32):
Excellent. So if you're listening and you think you have too much filler that was put in, or your fill has migrated, Madison has some great options to help dissolve it and reverse some of those undesired effects. So Madison, can you tell our listeners how long did this process take to correct the migrated filler?

Madison (03:51):
It's not a one and done. Sometimes dissolving, it takes a step or two. I have patients come in every one to two weeks so that I can assess. Hylenex, or hyaluronidase, does dissolve filler pretty immediately, but we also have swelling associated with the procedure that may confound the result, or IE make me not able to see how much effectiveness it's had. So I have patients come in every two weeks once I've dissolved them once, and then they come back again to see if they need more. Once I'm satisfied with that, then I can come in and refill them.

Dr. Bob Basu (04:28):
So for our listeners who may have too much filler or the filler's migrated and they want to reverse it or correct it, Madison, is it obvious when they're receiving Hylenex, meaning that dissolving agent, do they look bad while this processes is going on? Can you give us your insights on that?

Madison (04:46):
Twofold answer. So sometimes patients don't know that they need dissolving, because they don't know what the problem is, and so it's up to the injector and their expertise to kind of tell them what the issue is. But on the other answer of that question, when I inject Hylenex, or hyaluronidase, it is a liquid, so when I'm injecting it, it can make the lip pretty swollen looking or very full, but usually that goes down in two to three days. And then obviously the swelling tends to last a little bit longer than that, of course, one to two weeks. But the liquid itself will start to kind of be taken care of on its own after two or three days, but it can look a little bit fuller after I inject the dissolving agent, definitely.

Dr. Bob Basu (05:30):
I'm also noticing that you're treating several patients every day who are looking for more jawline definition. So where did you first see this trend? Which filler do you like to use for jawline definition?

Madison (05:42):
I guess I first saw this trend years ago, but I guess predominantly on Instagram it's gained some popularity and a lot of women want that chiseled jaw look. They want the definition. A lot of celebrities present with that jaw definition that makes them look skinnier and more youthful for sure. So I think that's probably why it got as much popularity as it did.

Dr. Bob Basu (06:07):
And which filler do you prefer for the jawline?

Madison (06:10):
I love Restylane Defyne, the reason is it provides enough structure, but it's also an expression technology filler. So the mandible area is something that we're using all the time with chewing, ie: mastication. You need something that is nice enough to hold, but also fluid enough to go through the expression that you're constantly making on a daily basis.

Dr. Bob Basu (06:34):
So it's not you're getting a frozen face, it's dynamic, meaning it moves with your face so it looks more natural.

Madison (06:39):
Correct.

Dr. Bob Basu (06:40):
Now, how long does this filler that you prefer for the jaw last?

Madison (06:44):
Restylane Defyne is indicated for one year. I do find that this area tends to last a little bit longer than that, but FDA approval is for one year.

Dr. Bob Basu (06:57):
And who's a good candidate for this treatment?

Madison (06:59):
The answer to this question is a tough one. A lot of people are a good candidate. However, higher BMI patients aren't always the best candidate. Because they present at baseline with fuller jaws, it can actually not look as great for them. And so we want to be careful about who is a good candidate and who isn't, because filler fills a volume deficit, and if we over inject the jawline with somebody who has a higher BMI, we could not make it look as ideal as we want.

Dr. Bob Basu (07:31):
So patient selection is key, just like with everything we do in aesthetic plastic surgery.

Madison (07:36):
Right.

Dr. Bob Basu (07:37):
What other trends are you seeing? What are your patients asking for?

Madison (07:40):
I often get the patient that points to the nasolabial fold area and says, "I don't like these. I want these to be filled."

Dr. Bob Basu (07:48):
And for our listeners, the nasal labial fold area is?

Madison (07:51):
The fold between the nose and the lips.

Dr. Bob Basu (07:56):
So it's the crease line that's just lateral to the corner of your mouth on each side.

Madison (08:01):
Mm-hmm. A lot of people point to the wrinkles because that's the fold and that's what they see is the issue without considering what is the foundation to the house. The foundation to the house that holds up the face is the cheek, and the cheek is the center of the treatment that a good injector should at least always be considering, because if the cheek is not optimized, everything else will fall. You start to weigh down the lower face if you don't optimize the cheek. And so a lot of times patients come in for a concern and I end up injecting something that they never thought or intended, but it's given them a full face result that will look much better in the long run, and I'm doing them a service in the end.

Dr. Bob Basu (08:48):
As an expert in injectable fillers, how do you keep people from all looking the same and looking too overfilled? I mean, we've seen it, right? You walk around town and you see people that have had way too much filler. So tell us what's your approach?

Madison (09:05):
I pride myself on every patient that walks in the door optimizing their natural features. A good injectable patient outcome is something that should not be noticed. And if I can look at somebody's natural features and enhance those natural features, that's what I'm going to do.

Madison (09:24):
If somebody comes in and they're overfilled, what do I do and what do I say? Most of the time when somebody wants a filler in a certain area, and I think it's either overdone or other areas are not optimized, I will be honest with them. I will tell them, "Look, this would be outside of the proportions of your face," and I'm okay with turning them away. But most of the time patients listen to the professional, and if I think that another area can be optimized so that they are happy walking away, then I do that. And most of the time they listen.

Dr. Bob Basu (10:00):
Madison, what advice do you have to our listeners to find the best injector for them?

Madison (10:08):
There's a lot of great injectors in Houston, so a lot of great experience out there. You want to look for somebody that is able to analyze the face. You want somebody that has experience in doing that and knowing the anatomy and knowing where to inject and what's safe.

Madison (10:25):
Additionally, you want to find somebody, ideally, that has surgical component experience. As a PA having training in the craniofacial plastic surgery realm, I know the face from the inside out. I know how to be effective, where the soft tissue is, where the muscles are, where the nerves, arteries, veins are. And so that's all important to be a good injector and also a safe injector.

Madison (10:52):
And the last thing is that we are under a plastic surgeon, and so having a board certified plastic surgeon at our office is important for safety reasons. But also, if injectables is not the answer, we have the next best solution for you.

Dr. Bob Basu (11:07):
I think Madison's been very humble. Yes, there are a lot of great injection providers, both physicians and nurses and PAs that are out there, but there's a lot that are not. Let's just be honest. It's very easy to become an injector in the United States. You take weekend courses and you start injecting and you gain your experience, but it's hard to be a really good one. And I think when I say a really good one, number one that you have an anatomic understanding of facial anatomy. There's a lot of stuff in our face, some of it's dangerous. And so how do we keep patients safe?

Dr. Bob Basu (11:38):
Number two, you have to have an aesthetic eye, which Madison and our other nurse injector today have a fantastic and very sophisticated aesthetic eye to achieve balanced, refreshed results. Look, we've all been out and we've seen so many patients that are overfilled, overdone duck lips, it doesn't look good. And so it's all about balanced results.

Dr. Bob Basu (11:59):
And thirdly, injectable fillers are so commonly available. I think one of the things that makes our Post Oak Galleria and our Town Lake office different is we take a center of excellence approach. What that means is that we work as a team. Madison is constantly discussing cases with Denay, they're constantly discussing cases with me. We're really trying to find the best solutions for our patients so they're happy and they get balanced, refreshed results.

Dr. Bob Basu (12:28):
You've been at Post Oak for a little while now, so it's now your local hood, so what are some of the one to two best secrets around our Post Oak Galleria office?

Madison (12:39):
I've thought about this for a little bit. The cool thing about our Post Oak office is that we have a good bit of services, all the way from aesthetics to plastic surgery. It's almost like a one stop shop for all your needs to be addressed. The other thing is that at Post Oak, we have such a loving, caring team of staff that if you're being treated next door with Emon, our aesthetician, and then you come in and are treated with me, we all work together to optimize your care.

Madison (13:13):
I think another great point is Denay and I have such a beautiful, amazing relationship that the 13 years that she has of experience and my surgical experience, when our minds collide, it's like magic. And so we talk about things every day and how to make things better. And having two injectors that have such a great relationship, that are always teaching and learning from one another, is really great too.

Dr. Bob Basu (13:41):
And if you wanted to make an afternoon of it, meaning visiting our Post Oak Galleria office and you want to make an afternoon of it, where else would you go?

Madison (13:49):
We're above some restaurants, North Italia. We're above Ninfa's, which is some good Mexican. There's also JOEY Uptown is one of my favorite restaurants. It's right in front of the Galleria and it has a cute, fun, happy hour. There's shopping. Obviously the Galleria is within walking distance. Another good happy hour lunch spot is Moxies. All good spots for some nice shopping, entertainment, and some good food.

Dr. Bob Basu (14:16):
You can find Madison at our Post Oak Galleria location. It is located at the intersection of San Felipe and Post Oak. So take a screenshot of this or any podcast episode with your phone and show it at your consultation or appointment to receive $50 off any noninvasive service at Basu Aesthetics + Plastic Surgery.

Speaker 1 (14:39):
Basu Aesthetics + Plastic Surgery is located in Northwest Houston in the Town Lake area of Cypress. If you'd like to be a guest or ask a question for Dr. Basu to answer on the podcast, go to basuplasticsurgery.com/podcast. On Instagram, follow Dr. Basu and the team @basuplasticsurgery. That's B-A-S-U Plastic Surgery. Behind the Double Doors is a production of The Axis, the axis .io.