Elle recently posted an article entitled, “Your Dermatologist Has a ‘Secret Menu’”, which highlighted the popularity of cocktailing injectables. What are some common ways dermatologists cocktail injectables? What are the potential drawbacks? What should dermatology clinicians know before cocktailing injectables?
For an expert’s take, I reached out to Jacqueline Watchmaker MD, a dermatologist in Scottsdale, Ariz. Dr. Watchmaker will lecture on non-surgical rejuvenation at the upcoming ODAC Dermatology Conference.
How common is it for cosmetic clinicians to have a “secret menu”?
It’s quite common for cosmetic clinicians to have a secret menu. There are many different “cocktails” that dermatologists use, such as hyperdilute biostimulator fillers to improve skin quality on the body and hyperdilute neuromodulators to improve skin quality on the face. Some clinicians are also combining platelet rich plasma with commonly used fillers. Many injectors have subtly different techniques on how they mix their products. While commonly used, these are not FDA approved techniques.
What’s the history behind cocktailing injectables?
Over the last decade, experienced clinicians have played with different combinations or “cocktails” of injectables. More recently there have been studies done looking at some of these off-label techniques that dermatologists have been using in the clinic for years.
What are some common ways clinicians cocktail injectables?
Common ways of cocktailing injectables include hyperdiluting Sculptra and Radiesse to improve skin quality on the arms, chest, legs and buttock. Another way is to hyperdilute Botox to improve skin quality and reduce flushing. Some clinicians have been mixing platelet-rich plasma (PRP) with injectables as well. Before SkinVive came out, I heard of dermatologists hyperdiluting Belotero to give a skin booster-like effect.
I personally mix my Botox and other neuromodulators with different dilutions of bacteriostatic saline to get the effect I want. For example, on areas of the face where I don’t want the neuromodulator to diffuse at all (like the corrugators), I use a hyperconcentrated formulation of a neuromodulator. On areas of the face where I want a little diffusion (for example, in the forehead of a patient who can only tolerate a few units of Botox), I use a more dilute formulation.
Are there some injectables that lend themselves to dilution more than others?
Most people dilute Sculptra and Radiesse more than the hyaluronic acid fillers, although cocktails with hyaluronic acid fillers can be done. Also, I love using different cocktails and concentrations of neuromodulators.
What are the benefits of cocktailing injectables or is this practice just marketing hype?
Cocktailing and hyperdiluting injectables like Sculptra can help boost collagen production and improve skin quality rather than adding volume. So on areas of the body where we want to improve skin quality (like the chest) but don’t need or want to add volume, hyperdiluting a biostimulatory filler can be helpful.
What are the potential drawbacks of cocktailing injectables? Does this practice increase risks of complications?
Cocktailing injectables is not FDA approved. But many of the things we do in dermatology are not FDA approved. I personally think hyperdiluting often leads to fewer complications than non-hyperdiluting, though I am not sure if there have been any studies on this.
What should dermatology clinicians know before cocktailing injectables? What level of expertise is required before considering this practice?
Before cocktailing injectables, dermatology clinicians should know general guidelines for cocktailing. Thankfully, there are multiple publications in the literature now that look at different methods. Sometimes lidocaine is added to hyperdilute mixtures, so being mindful of the amount of lidocaine injected when doing larger volume procedures is essential.
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