As the first cases of coronavirus in the US were confirmed, grocery stores saw an overwhelming rush of customers clearing out shelves of toilet paper and Clorox wipes. But that wasn’t the only in-demand spot in the days leading up to stay-at-home orders.
Dermatologists were also seeing an influx of patients looking for last-minute Botox and filler injections. “Right before we went into quarantine, I had probably four times the amount of cosmetic patients for those two weeks leading up to it,” said Dr. Dendy Engelman, a New York City dermatologist and dermatologic surgeon.
“People who I hadn’t even met were coming in, and they wouldn’t even have had the consult – they were already numbed and sitting in my exam room,” Dr. Dendy said of how busy her office was until it officially closed its doors to cosmetic procedures on March 18. “I was like, ‘But you don’t even know me,’ And they would say, ‘Do whatever you think. I’ve read about you,’ or ‘I know so and so that you’ve treated.’”
Cosmetic dermatologist, Dr. Paul Jarrod Frank, experienced a similar phenomenon in his New York City office. Dr. Frank, who is the chief medical officer and founder of the PFRANKMD™ Brand, also worked with Madonna to help formulate her MDNA Skin line.
“The whole thing really happened within 10 days, where all of a sudden, we became conscious of the virus,” Dr. Frank said. “That final week I was probably only working at 70% capacity, but I was surprised by how many people I did see,” he added.
Since those early days, Los Angeles County has extended lockdown until August and New York City until at least June 13. As stay-at-home orders stretch past month two, Dr. Dendy and Dr. Frank weigh in on how long the most popular injectables last, their post-COVID-19 plans for treatment, and most importantly, why breaking the rules for at-home injectables could cost you more in the long run.
‘They called me up asking for an emergency appointment and my answer to them was the same – your cosmetic stupidity is not an emergency’
If you suspect some people have been breaking stay-at-home orders for a refresh on their injectables, you’re not wrong.
Last month, Rolling Stone spoke with several anonymous influencers who stated that they were still receiving everything from in-office injectables to cosmetic surgery during the quarantine.
“I know of many dermatologists, non-dermatologists and med spas not only making house calls but opening up shop against government mandates not to do so,” Dr. Frank confirmed.
“There’s money involved here. People are suffering, they’re trying to pay rent – and in the cosmetic world, there was a lack of ethics at a lot of fronts before this started happening,” he went on to say.
“And you’re always going to find someone willing to pay and be stupid to get the procedure done. I’ve had three patients contact me who have, contrary to the mandates, gone to someone locally or got someone to inject them, and they had problems or they just look silly. They’re calling me up asking if I can [do an emergency appointment to] fix it, and my answer to them was the same – your cosmetic stupidity is not an emergency,” Dr. Frank said about the importance of following government and healthcare official orders.
“Those weird eyebrows or the fact that you can’t speak because you had Botox falsely injected around your mouth or you have one cheekbone looking stupid compared to the other, you’re just going to have to sit that out,” he said of the risks patients take by turning to an injector who isn’t properly qualified.
“And anyone that’s willing to do something against the government’s mandate in the middle of the pandemic, maybe you should question not only their ethics but their skills.”
Dr. Dendy similarly noted that her office has been open for emergency patients only.
“As much as I love Botox – and I do it myself – if you miss one cycle or two, it’s not the end of the world,” she said.
“At the end of the day, we’re still doctors, and we still have to keep the global health top of mind. I obviously would not put anybody at risk for something that’s nonessential,” she said of neurotoxin and fillers being nonessential. “I want to make sure that I’m there for my skin cancer patients and for people who have acute infections and things that they’re really concerned about to keep them out of the urgent care, where they could really get sick.”
‘A lot of people, at least in the US, never wait for their injectables to wear off 100%’
The longevity of neurotoxin and filler varies slightly from patient to patient, but both Dr. Dendy and Dr. Frank noted that patients can expect their fillers to hold up longer.
“I think a lot of people, at least in the US, they never really wait for their injectables – meaning their Botox or their fillers – to wear off 100%,” Dr. Frank said.
“They’re used to coming in when they’re like 50% worn off for maintenance. So this, for a lot of people, may be the first time where they’re actually seeing things wear down more. It’s like watching your roots come in more than they normally would between having your hair colored,” he explained.
“Most of these products, they all degrade and are metabolized slowly. So although patients will commonly feel like it happens overnight, psychologically, it’s not really the case biologically. Usually, it’s a gradual thing, there’s just that psychological tipping point where people are like, ‘I woke up today and I feel like my Botox is gone.’” Dr. Frank added.
As for a specific timeline, Dr. Dendy said your fillers will probably be fine during quarantine, but your neurotoxin will degrade. “Botox lasts between three and four months,” Dr. Dendy said. “For hyaluronic acid, the shortest lasting filler is Restylane, which lasts for six months,” she said of the filler commonly used for lips, cheeks and nasolabial folds.
“And the longest-lasting of the hyaluronic acid fillers is Voluma, which is 18 to 24 months,” she said, noting that Voluma is used for mid-face augmentation. Dr. Dendy explained that there are also fillers that fall somewhere in between that timeline, such as Volbella, which she prefers for lip injections and can last up to 12 months.
Even as your filler degrades, Dr. Dendy said clinical studies have shown it might still be working.
“If we injected you with Voluma and in two years, we took a picture – and presumably all of the filler is gone and you’ve aged two years – studies have shown there was clinical significance that you still look better two years later, post-injection,” she explained, adding, “So, either there is a tiny bit of filler that’s still there, or it helps stimulate your body’s own collagen so that even though the filler is gone, your body has now replaced the collagen.”
The most in-demand injectables
While Dr. Dendy and Dr. Frank both stressed that the exact injectable used and its placement is determined based on the individual patient, the most popular types of injections are neurotoxin (think forehead wrinkles and even brow lifts) and fillers (think plumped up lips and cheekbones).
“Botox is certainly the number one aesthetic procedure that I do,” Dr. Dendy said of the type of neurotoxin she uses in her office.
“After that, it’s dermal fillers. And certainly, we do contribute this phenomenon to the Kardashians and more of the celebrities being honest about what they do and kind of demystifying the process and making it very mainstream,” she added.
“It’s like, if you want to age like J.Lo, nobody thinks that that is physiologic aging. It’s not,” Dr. Dendy explained. “It’s not natural to look like that at 50 or 51 without some intervention. And so the concept now has been, if you head things off at the pass and at the first sign of a fine line or a wrinkle, if you correct that, then you will maintain your youthful appearance for decades longer than you would if you had to then wait and start doing massive corrective injections,” she said of how injectables can delay the signs of aging.
“Celebrities like J.Lo and Sofia Vergara – who will be 50 in July – they look incredible, but they also don’t look done,” said Dr. Dendy, who counts Vergara as one of her patients.
“That is why everyone is so intrigued with ‘How does J.Lo do it?’ Because she doesn’t look like Goldie Hawn or Meg Ryan, or people who have really distorted their facial features. She looks identical, if not better than she did two decades ago. But you can’t tell what she’s done, and that’s the beauty of good work. You do it in very subtle ways to just kind of replace the volume that was lost or relax the fine lines that were created from years of facial expression, but not over enhanced or to the point where people aren’t capable of making facial expressions.”
For neurotoxins, Dr. Frank tends to use different options. “I use all four of the neurotoxin products that are available in the US, but I love the two products Xeomin and Jeuveau,” he said, adding, “I like doing little bits frequently on my patients.”
When it comes to fillers, there are way more varieties available, though both Dr. Dendy and Dr. Frank named hyaluronic acid dermal fillers as their favorites.
“I tend to only use filler in the hyaluronic acid category because they’re the safest of all the fillers,” Dr. Dendy said, noting that she uses various types of Juvéderm filler (like Voluma and Volbella) depending on the placement.
“Once you inject fillers like Radiesse, which is calcium hydroxylapatite, or Sculptra, which is something called PLLA that is basically ground up suture material – once it’s in, it’s in. There is no removing it, and you can get granulomas or nodules,” she added of potential risks other types of fillers pose. “Or if someone doesn’t like where it was placed, too bad. It’s just there until it dissolves, and it can take years to dissolve.”
Meanwhile, hyaluronic acid fillers can be dissolved on the spot if a patient doesn’t like the result, thanks to an injection of an enzyme called hyaluronidase.
Can you try this at home?
There isn’t anything you can do to extend the lifetime of your injectables, but there are at-home products you can use to help improve your skin’s overall appearance.
“Retinol and vitamin A derivatives are great for stimulating collagen and elastin and helping to minimize wrinkling,” Dr. Dendy said.
“And I do think that this is an awesome time for anyone who is retinol naive or retinoid naive to start one because the thing that limits most people from doing it is, ‘Oh, I can’t have the downtime, I can’t have the peeling or the redness,’ which are potential side effects that come with retinizing the skin,” she explained.
“But now, it’s like who cares? We’re all at home, and if you’re a little red on a Zoom call, nobody really cares anymore.”
Dr. Dendy also recommended hyaluronic acid topicals for at-home use, which give a temporary plumping effect to the skin, and are particularly effective under the eyes. “And there are some topicals that have very mild effects on the neuromuscular junction that can mimic a Botox-like effect.
“They’re better in eye creams because those muscles are more superficial and weaker than your glabella muscles that give you the ’11’ lines, for example,” she said, naming Indeed Labs Snoxin II Serum as favorite.
The new normal
As we get closer to easing our way back into our everyday routines, both Dr. Dendy and Dr. Frank expect to see their offices full as soon as it’s safe to open to their cosmetic patients again.
“I’m anticipating an onslaught of Botox requests when I start back,” Dr. Dendy said. “We’ve been out for about six weeks, so if people didn’t get in right before we closed, then it’s definitely going to be time. Also, for those who are prone to overusing injectors, I’m excited to see people at their baseline,” Dr. Dendy added.
“Some of my patients that I’ve inherited have had injections for a long time, and it’s sometimes good to start fresh and redo some things. It’s a hard topic to broach, to be like, ‘Look, we gotta melt all this mess that I didn’t do, and start over.’ Instead of just working around what they already came in with. But it might be nicer to see people in their uninjected state. So we can start fresh and go from there.” she said.
“People are going to be coming in – hopefully in a couple of weeks or a little longer in certain parts of the country – and they will need a little bit more work than they’re used to to get back to that point where they have comfort,” Dr. Frank said of post-quarantine treatment.
“There will be a little bit more artistry so to speak or more product to get them back to that maintenance. It is going to be a different world with a different way of seeing patients, but I’m happy to have a job that’s waiting for me,” Dr. Frank said. “I think a lot of changes are going to happen, but not the desire to feel and look good.”