
While they may not be brand-new, the creative ways doctors are using these tried-and-true aesthetic solutions continues to grow.
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BOTOX COSMETIC
Although Botox Cosmetic has only been
FDA-approved to minimize frown lines,
crow’s-feet and forehead wrinkles, innovative
doctors have been using it for years to treat
other issues. For example: “Patients who
have excessive sweating in the hands, feet
or underarms may be recommended Botox,”
says Greenwich, CT dermatologist Kim Nichols, MD. “It helps relax the muscles and
sweat glands in the places it is injected.”
And when injected into the masseters on
either side of the jaw, Botox can help relax
the muscles that can cause TMJ and bruxism.
“Treatment of the masseter muscles in
the setting of chronic teeth clenching is a
game changer for patients,” says Houston
dermatologist Jennifer Segal, MD. “It relieves
clenching and results in a soft contouring of
the face.” As Greenwich, CT dermatologist
Mitchell Ross, MD points out, nightly jaw
strain can also take a major toll on teeth.
“Those who clench their jaws while they sleep
can have the equivalent of the weight of an
elephant sitting on their teeth, which leads
to destruction of tooth enamel.”

FILLERS
Though most often used to restore volume
to areas with deep creases and lines, fillers
are being used off-label in a variety of places.
Experienced injectors have been placing
HA fillers or the long-lasting PMMA-based
collagen filler Bellafill up behind the hairline
to give a subtle lift to the forehead or cheeks.
Filler can even enhance the nose: “We have
many patients wanting to improve the profile
of their nose without surgery,” says Dr. Ross.
“For a hump on the bridge or a droopy nasal
tip, hyaluronic acid filler can be used off-label
for a ‘nonsurgical nose job.’ The treatment
entails injecting filler and molding the nose
to appear straighter and lifted.” The biggest
danger? If the filler is incorrectly injected, it
can block blood flow to tissue and cause the
tissue to die. To avoid complications, go to a
board-certified doctor practicing within scope.

BIOLASE
Lasers aren’t just for wrinkles; they can help
enhance the smile too, says New York cosmetic
dentist Nargiz Schmidt, DDS. “Biolase is
typically used for the treatment of periodontal
issues, as well as gingivectomy, or removal of
gum tissue, when indicated,” she says. “But,
I also use Biolase for the treatment of highly
hyperpigmented gums—the procedure
removes very thin layers of gingival tissue
to gently eliminate pigmented areas.”

FRACTIONATED RADIO FREQUENCY
Westborough, MA facial plastic surgeon Min Ahn, MD uses fractionated radio-frequency
(RF) treatments during rhinoplasty to help
re-drape thick nasal skin. “In rhinoplasty
procedures, we rely on the skin to ‘shrink-wrap’
so we can see the new shape of the cartilage and
bone. Skin that is thin or medium-thickness
shrinks well, but thick skin does not. The
traditional surgical approach with thicker-skinned patients was to increase the projection
of the nasal tip, like a tent pole, to make it
appear more refined. However, this makes the
nose stick out further, which some patients
don’t want.”

TRANEXAMIC ACID
Most commonly, doctors have prescribed
oral tranexamic acid to treat those with
hemophilia to aid in blood clotting, as well as
mitigate heavy menstrual cycles. Topically,
the ingredient proved to be a super brightener
in SkinMedica Lytera 2.0 ($154; SHOP NOW) and SkinCeuticals Discoloration Defense ($98; SHOP NOW), and doctors are
experimenting with oral dosing of transexamic
acid to treat stubborn melasma. “We’ve recently
found it can inhibit the production of melanin
in the skin,” says Dover, OH facial plastic
surgeon David Hartman, MD, though he notes
the medication is best used in moderation. “The
risk of thrombosis is one a patient with severe
melasma should gauge before starting, now that
there are also OTC treatments without that risk
that are easy, reliable, inexpensive and safe.”

PLATLET-RICH PLASMA (PRP)
A panacea of sorts, platelet-rich
plasma therapy is touted to
help with a myriad of maladies.
“PRP sprayed into the facelift or
browlift wound prior to closure
enhances healing and minimizes
potential bruising,” Dr. Hartman says.
“We also use PRP for fat transfer procedures because it enhances the
viability of the fat. We mix PRP into
our harvested fat just prior to
reintroducing the fat into the donor
sites.” New York dermatologist Marina Peredo, MD also uses PRP to heal skin
during in-office facials. “First, a gentle
laser replaces damaged skin with
healthier, younger skin,” she says.
“Then, we create millions of tiny
treatment zones with our plasma
needling treatment, which infuses a
customized blend of plasma, growth
factors and antioxidants we refer to
as ‘liquid gold.’ The combination
improves discoloration, texture and
tone. It is great for acne scarring
and uneven pigmentation, and
also helps build collagen.”

LATISSE
For patients with hard-to-treat hypopigmented
skin, Fort Lauderdale, FL dermatologist
Dr. Matt Elias is using eyelash treatment
Latisse off-label to add color to whitened skin.
“A known side effect of Latisse is periocular
hyperpigmentation—a darkening of the skin
around the eyes,” he says. Combining Latisse
with a treatment that creates microchannels
in the skin—like microneedling, Fraxel
or Clear + Brilliant Permea—allows the
bimatoprost-based solution to “produce
melanin, and in turn replace lost color,”
Dr. Elias says. (Because this is so new and
not FDA-approved, there is no long-term
data on how long the results last.)

THREADS
Absorbable polydioxanone (PDO) threads,
like Silhouette InstaLift, are now being used
off-label to lift loose tissue from head to toe.
New York dermatologist Doris Day, MD
places five to 10 threads longitudinally into
“the barcodes” to smooth lip lines. Beverly
Hills, CA plastic surgeon Ritu Chopra, MD
lifts crepey knees with threads. “This is
a difficult area to treat with filler, but facial
threads work great,” he says. As doctors
continue to experiment with how to best
employ threads on areas like the buttocks,
Dr. Day says the results are encouraging.
“We are in the infancy of learning all
that we can do with this newer form of
rejuvenation, but I believe it’s here stay.”

MICRONEEDLING
Microneedling takes the phrase “beauty
is only skin deep” to a whole new level.
Microscopic needles—on a roller stamp, or
energy device—pin-prick the skin and enact
a reparative response to stimulate collagen
production. Doctors are taking advantage
of the skin’s temporary permeability by
immediately applying a topical. According
to Kansas City, MO dermatologist Audrey
Kunin, MD, microneedling paired with
minoxidil—an ingredient that stimulates
hair growth—allows the hair-growth helper
to penetrate the scalp deeper. “Combining
the treatments helps the minoxidil reach
the hair bulb where it is needed to boost
hair growth.” However, there’s currently
no data proving this method is effective.
DISCLAIMER All of the doctors included in this story mentioned just how important creative, off-label use is to the medical community, but more strongly stressed seeing a board-certified practitioner who has vast experience and knowledge on the treatments in question. “Always see a board-certified dermatologist or plastic surgeon,” says Dr. Nichols. “Off-label use can be safe when done by an experienced dermatologist who specializes in that off-label treatment. A dermatologist or plastic surgeon may also produce research showing efficacy of the off-label use, has been trained on the off-label use, or performs it regularly. Of course, all cosmetic treatments can have a potential risk whether on or off label and this is why it’s important to see a properly board-certified doctor to review your skincare goals and consent for treatment.” Dr. Hartman agrees: “I absolutely am in favor of off-label use of treatments that are showing promise in solving medical problems. Certainly, a full informed consent, including the facts that it is not FDA approved for this use, may be experimental, there may be no data about the procedure, efficacy and complications is the cornerstone of any off-label use.”
