Treatment plan: should I get injections or microneedling RF with PRP first? (Photo)

Question

Wondering what is needed first - injections or micro needling rf with prp. Crepey skin on neck, hollowing around mouth and forehead. What would be the first step?

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nima Shemirani, MD · Answer

Hi @ashannie1023. Thank you for sharing your photos. I recommend starting with RF microneedling (Morpheus 8) followed by Sculptra.

Best of luck,

Dr. Nima

Brandon Richland, MD · Answer

Hi there, thank you for a great question and photos. Microneedling+RF works to improve laxity and volume loss by producing controlled thermal damage in the dermal layers, which helps increase collagen repair/new collagen production and remodel adipose tissues. HA fillers used for temporary augmentation are often negatively affected by the increased heat during non-invasive skin tightening treatments. Therefore, I always recommend that patients complete microneedling+RF energy procedures before injecting dermal fillers so as to not lose money on having newly placed filler immediately degrading with your skin rejuvenation treatment. The other bonus is that with the increase in your natural volume via neocollagenesis, you may no longer feel like you need/want dermal fillers or you can get great results using far less product. I highly recommend you consult with an experienced practitioner regarding your options. Ask to see before and after photos of their work. Best of luck!

Anil R. Shah, MD · Answer

Hello Ashannie1023 my name is Melanie I am a Medical Aesthetician at Aesthetic Skin located in Illinois. we are a Facial Plastics office and specialize in surgical and non surgical facial rejuvenation. Thank you so much for sharing your photos! I would definitely recommend to complete a series of Morpheus 8 first then injectables of possibly Sculptra. This would give a lovely result of a lifted, tightened and smooth appearance.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

Microneedling, which I have been performing for over twenty-three years is an excellent modality for improving very superficial surface texture and color irregularities. It is not particularly effective for any of the issues here. PRP remains an expensive, heavily marketed, technique whose real value in aesthetic medicine (despite the hype) remains largely unproven in large studies and is plagued by variable results. 
The good news is that each of the problems here can be treated quite easily with an appropriate choice of an HA filler. Using the proper injection techniques approrpriate for the region, there are HA fillers that can be used to elevate and smooth the indented forehead and temple hollows. Others, when injected using a special fanning technque to address the parallel laugh lines to the sides of the mouth, and still others that can be used to improve the vertical bands and central neck crepeyness. All of the aforementioned in the hands of an experienced, board certified cosmetic dermatology filler expert, can be performed in one treatment session of about 30-45 minutes, if so desired, or performed in separate treatment sessions. Make sure to ask to see the befores and afters of anyone you consult with prior to agreeing to proceed. Best of luck.

Garrett A. Wirth, MD, MS, FACS · Answer

I generally believe that improving the skin first, such as skin health protocols, peels, etc before injectables can be a better long term solution.  As you addressed microneedlingRF, we have had great success with our SylfirmX technology and I think our patients do better with that treatment before injectables over the long run.  A formal consultation would be needed to do a proper diagnosis and treatment plans.

Camille Cash, MD · Answer

HA fillers can be useful to restore volume to hollowed areas and improve facial contours.  There are various fillers on the market that are designed to address specific areas of concern. Morpheus8 can also be considered which combines RF technology and microneedling to improve overall skin tone and texture.  Visit with an experienced aesthetician at a med spa to learn more.

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Hi there,

Before you do any procedures, I would consult with a plastic surgeon.  See if he can do a little pull for your lower face and neck.  You are young and the results would be amazing.  If that isn't an option, then skin tightening along with micro needling with PRP.   Radiesse in the temple area.