Neuromodulators and Injectable Fillers: Advice and Insights

Dr Galadari is an assistant professor of dermatology at the College of Medicine and Health Sciences of United Arab Emirates University. After completing his dermatology residency at the Boston University/Tufts University program, Dr Galadari completed his dermatologic surgery and laser fellowship at the University of California, San Francisco.

He is a fellow of the American Academy of Dermatology (AAD) and a member of several international societies. He also currently serves as Treasurer General of the International Society of Dermatology and Secretary General of the International League of Dermatological Societies, representing more than 100,000 dermatologists worldwide.

Transcript:

Dr Hassan Galadari:  The neuromodulators are currently being looked at into the use of depression. It's been published extensively under that area.

People are thinking, "How's this working? Is it working through the visual feedback effect? If person feels good, then their depressive symptoms become a little bit less, or is there something even further?

"Is the injection of botulinum toxin triggering certain neurotransmitters that are being released in the brain that's causing the depressive symptoms to get a little bit less?" That's still a work in progress in that area. That also touches upon the change of the quality of life.

Here, that brings in the effect of fillers. If fillers are injected and the patient looks great, feels great, that boosts their self-confidence. A boost of confidence and self-esteem makes a person a much more productive individual in society, whether they're at work, whether they're at home. It's extremely important whether you're doing neuromodulators or fillers.

If the person looks good, they feel good. then they actually start acting good. We can't deny that the quality of life definitely changes if it's done properly.

The most important thing is that, first, do no harm. You really have to understand where those materials are supposed to be injected to get the best results for your own patients.

Remember, the neuromodulators themselves are drugs. They are considered to be a biologics under the FDA. You have to be very careful in terms of probable adverse events that might happen.

The good thing about it is that the adverse events that happened with those tend to go away as the effect goes away completely. Then the effect of botulinum toxin is not permanent. It's time as your antidote. It'll just get better with time.

That being said, completely understanding the location and the indication that you're basically treating for to get the best results for your patient is the most important thing. That is not only truly neuromodulators, it is extremely true and very much more important when it comes to your fillers.

Remember you're injecting a filler material that is a gel. Sometimes -- god forbid -- for example, if you inject that gel into a blood vessel, leading to an embolism of that blood vessel or blocking of the blood vessels themselves, and that blood vessel caters to a certain location on the face, then you basically stop the blood from circulating to that area.

There's a potential for becoming developing necrosis. That's quite drastic as an adverse event that can happen.

My pearl of wisdom here is to try to understand anatomy and also the limits of your own abilities, because a lot of doctors would say, "Hey, I can do this. It's easy," but there is a definite level of complexity in terms of when it comes to certain areas of injection, there are certain areas that are very, very sensitive, for example, such as the glabellar areas or the temples.

Know your limits. If you are not comfortable, it's not wrong saying, "Hey, listen, this is not for me, but my colleague, who's basically across the street or somewhere, that would definitely has much better experience, and you definitely will get better results if you get injected there."

If you do refer your patients, patients will feel very comfortable that you're being honest. Your colleague, they will treat that area, and you will realize that they will also send the patient back to you. It's that interchangeable thing.

We really understand the limits. Also, know your knowledge of anatomy, especially with fillers, to truly try to avoid adverse events. That's extremely important.

What makes us different from other, for example, other healthcare professionals is that we are able to identify those adverse events early to prevent from having really permanent scarring effects that can happen a little bit later on.