Injectable vs. Light~Based Devices

In the ever-evolving landscape of aesthetic medicine, the debate between injectable treatments and light-based devices continues to spark curiosity and discussion among practitioners. As clinics seek to optimise their offerings and cater to diverse client preferences, the question arises: What holds greater significance for an aesthetic practice – injectable treatments or light-based devices? Both modalities offer distinct benefits, addressing various cosmetic concerns with efficacy and precision.

The combination is key!

When it comes to choosing between an injectable-based practice or a machine-based practice, different practitioners may have varying preferences. Dr Shefali Trasi-Nerurkar, MD Skin and Consultant Dermatologist, Dr Trasi’s Clinic & La Piel, believes in maintaining a balanced approach between energy-based devices and injectables, as the interplay between the two plays a crucial role. She says, “when a patient seeks treatment, it is essential to assess the specific problem first and then determine the most suitable approach for their needs, without bias towards any particular procedure.

Dr Priti Shenai, Skinworks Skin, Hair & Laser Clinic; and Dr Soma Sarkar, Dermatologist and Aesthetic Physician, Dr Soma’s Aesthetic Clinic and Academy, also concur that having a combination of both injectables and machines is key. Dr Sarkar points out that in any practice, possessing both skill sets is vital. As the industry has evolved over the years, she mentions that when she started her career, she had to rely more on machines since injectables required a different skill set and were not as popular at the time. However, as preferences shifted, it became essential to comprehend the science behind each procedure and effectively communicate that information to patients, manage their expectations, and deliver the desired results.

Build practice with patience

Aspiring to enter the aesthetic industry can be both exciting and overwhelming, prompting the question of whether to invest in a fully equipped setup right away or take a step-by-step approach. “If the question was asked 15 years ago, when I started my practice, the scenario was different,” says Dr Shenai. There was a lack of knowledge and awareness. “The answer to this question also depends on the area in which you are setting up your practice. In certain metro cities, with high-end clients in posh areas such as Juhu, the practitioner might have to go all out. So, how you kick-start your practice depends on various factors such as – which locality are you setting up the practice in; awareness in the area; what are your competitors doing; your finances.”

On her part, Dr Sarkar responds, “If you have a non-medical background, how do you set up the practice? While the topography matters, one needs to also identify the practice area you would like to excel in. If you have the wherewithal to buy machines, you must, but it does not end there. There has to be an RoI involved. There are many other investments apart from machines, as the current scenario calls for branding and marketing as well. But one machine that the beginner should pick up is the laser hair reduction or pick a machine that will give results, is safe and efficacious so that RoI generation continues.” Over the course of practice, you can keep adding other machines. Also, remember to look at the brand, physics, and output, and take demos before picking out a machine.

For Dr Trasi-Nerurkar, “When you begin, patients will come to you with simple problems like acne or pigmentation wherein they would like to gauge you first. Here even a simple prescription plays an important role. As a newcomer, you need to have a good understanding of the medicines you would be prescribing.”

When you are not financially well off to buy one machine you are most comfortable with, get the required RoI and then buy another one. Also, in that amount of time, you will be able to understand what does your practice incline more towards – hyperpigmentation, slimming, scars – thus helping you figure out what your next machine should be and you invest accordingly.

As a newcomer, when you do not have the finances to invest in any technology, invest in chemical peels, advises Dr Shenai. Today, media-facials are the game-changers, and you must consider investing in them. There are two kinds of practices – clinician practices and technician practice. So, even when I am traveling and not in the office certain services will be taken care of by the technician and my revenue will continue to roll in.

Dr Anju Methil, Celebrity Dermatologist & Cosmetologist, Skin & Shape Clinic, practices in Andheri where there are a number of beauticians and parlors who have started investing in laser hair removal and offer services at a very cheap rate. She says, “Because of my topographic presence, I would prefer another laser machine – maybe, a Q-switch rather than hair removal. It again depends on where you are practicing and what you want to target.”

Counselling is crucial

Counseling plays a crucial role in addressing patient perspectives on machines and injectables. According to Dr Sarkar, “patients may initially find injectables intimidating, regardless of the practice location.” During consultations, understanding patient expectations is key, allowing for tailored treatment plans that may prioritise either machines or injectables. Satisfaction rates vary for each treatment, with machines targeting superficial issues and injectables offering different modalities, making comparisons challenging. Dr Trasi- Nerurkar emphasises the need for patient-centered discussions without pushing specific treatments. And spending quality time with patients, listening to their preferences, and delivering confidently are essential elements of successful counseling, as stressed by Dr Shenai.

Treating Acne

Dr Trasi-Nerurkar focuses on addressing acne’s infective pathology by ensuring proper treatment to eliminate active infection. Next, she targets the acne sequelae, such as scarring or pigmentation, using a combination of technologies and chemical peels. For deeper scars, skin boosters become essential. She explains, “For acne sequelae, I will use EBDs, micro-needling radiofrequency, erbium glass, and Co2 laser for acne scarring. For pigmentation, I will opt for Q-switch lasers or stronger chemical peels like phenol peels or TCA peels.”

Go-to Treatment for PIH and Scars

Dr Shenai’s preferred treatment for post-inflammatory hyperpigmentation (PIH) is the Q-switch ND: YAG laser, coupled with a carbon peel (laser toning) followed by the Q-switch. Additionally, she addresses red acne spots (erythema) using gold toning - 585 nano wavelength. “When it comes to acne scars, my go-to is micro-needling RF along with PRP injection in the same session, and I prefer pacing out sessions over two months. Proper prescription is crucial to support procedural treatments and manage inflammatory acne.”

Dr Sarkar points out the challenges of acne scars, with different types requiring specific modalities. She believes CO2 provides excellent ablative destruction of fibrosis, with its wavelength working at 10,600, penetrating the skin layers where the chromophore is water. “CO2 usage on Indian skins raises concerns about post-inflammatory hyperpigmentation (PIH) due to the abundance of melanin.” However, in her 15 years of practice, she has not encountered a single case of PIH, thanks to her investment in counseling, post-care efforts, follow-ups, and the right prescription products to safeguard results.

It is crucial to set realistic expectations for acne scar treatments, as complete disappearance of scars is not possible. A 100-per-cent recovery rate cannot be expected, and practitioners must communicate this fact to their patients during counseling sessions.

For Pigmentation

Dr Trasi-Nerurkar prefers using Q-Switch ND:YAG lasers, carbon peeling, and chemical peeling to treat pigmentation. Dr Shenai explains that the treatment choice for pigmentation depends on the type, and she may use a Q-switch ND:YAG laser, chemical peels, and skin boosters accordingly. Dr Sarkar recommends intense pulse light (IPL) for pigmentation with a vascular component. Additionally, she utilises Q-switch lasers, carbon peels, and toning methods, combined with skin boosters to create the illusion of reduced pigmentation by hydrating the skin and enhancing light reflection.

For glow and skin lightening

Dr Sarkar recommends injectables and skin boosters for achieving a glowing effect.

Dr Trasi-Nerurkar suggests chemical peels for instant results, while skin boosters and vampire facials are ideal for subtle, longterm improvements.

Dr Shenai tailors her approach based on patient preferences. For quick results before an event, she may recommend medifacials, dermafrac, microneedling, and infusion. For patients willing to invest more time, Q-switch lasers and other laser treatments with skin boosters are considered.

For anti-ageing

Dr Shenai divides the face into three parts – upper face, midface, and lower face – and employs different treatments for each area. Injectable toxins yield the best results for the upper face, while EBDs are less effective. For the mid-face and under the eyes, fillers are preferred. EBDs are used before fillers for the lower face.

Dr Sarkar takes a comprehensive approach to anti-ageing, considering factors such as fat pads, laxity, dynamic and static lines, and volume loss. She combines various treatments, including EBDs, threads, toxins, and fillers, depending on the severity. The patient’s severity index, assessed with a visual analog scale, helps guide the most suitable treatment plan.

Dr Trasi-Nerurkar’s anti-ageing approach involves injectables and fillers for the upper face, with fillers used based on sagging and contouring needs for the mid-face. For areas like ear trough, thread lifts, and EBDs are preferred. Lower face treatments include EBDs, thread lifts, and fillers for contouring due to the higher fat content in Indian skin.

Dr Methil emphasises assessing skin texture and laxity when deciding on treatments. Fine lines may be addressed with lasers, MNRF, or CO2 lasers, while injectables are recommended for volume loss. If a fat pad displacement occurs, threads or injectables can be used accordingly.

Dr Trasi-Nerurkar highlights the ongoing nature of anti-ageing treatments, advising patients to maintain their results through simple treatments like PRP and micro-needling to preserve collagen content for the future.

Risks and limitations

Dr Shenai emphasises the importance of complete anatomical knowledge for injectable treatments, including understanding the face’s vasculature, fat pads, tissues, and ligaments. Lack of such knowledge can lead to undesired results, hitting the wrong vessel or fat pad. Hence, proper training is crucial to ensure safe and effective injectable procedures. Additionally, understanding rheology, such as high G prime and low G prime, is vital for selecting the appropriate filler for each area.

Regarding laser and injectable treatments, Dr Sarkar stresses that complications can arise if not handled with care and proper knowledge. As injectables require skill and expertise, new practitioners may encounter complications despite their understanding of anatomy. The ability to reverse adverse effects becomes essential in such cases.

Dr Trasi-Nerurkar shares her views on handling complications. Reversals can be challenging, and injectable complications are often more severe than those related to machines. While machine-based complications might cause hyperpigmentation or hypopigmentation, vascular complications are rare. Hence, indepth knowledge of anatomy remains crucial. Regularly revisiting anatomical understanding, staying up-to-date, and continually upgrading skills are essential aspects for safe practice.

Dr Methil points out limitations with devices, highlighting their inability to replace volume, which is a task for injectables. However, for pigmentation concerns, light-based devices are more effective.

In conclusion, the debate between injectable treatments and light-based devices remains an essential topic in the aesthetic medicine field. While both modalities offer distinct benefits and address various cosmetic concerns, the key to success lies in a balanced approach, tailored to individual patient needs. A combination of both injectables and machines, coupled with thorough patient-centered counseling and continuous learning, enables practitioners to provide safe and effective treatments, achieving optimal results for their patients.

(The above insights were gathered from a panel discussion at the recently concluded Aesthetic Medicine Conference in Mumbai.)