Science is Your Guide, Anatomy is Your Savior with Dr. Lorenc

Join world-renowned aesthetic plastic surgeon, Z. Paul Lorenc, MD, as he speaks to LiVDerm about the importance of facial anatomy knowledge and patient safety.

Transcript edited for clarity.

LiVDerm: Hi everyone and welcome to the podcast. We're so happy to be speaking with Dr. Lorenc today.

Dr. Lorenc is a world-renowned aesthetic dermatologist and plastic surgeon who balances surgical expertise with an acute aesthetic sense of composition and proportion in the areas of facial rejuvenation, breast enhancement, and body contouring. Since establishing his private Park Avenue practice, Lorenc Aesthetic Plastic Surgery, he has been actively involved in the research, development, and advancement of new aesthetic surgical and nonsurgical techniques and procedures.

Welcome, Dr. Lorence. It’s so nice to have you with us today.

I’d like to start by asking, why is a mastery of facial anatomy principles non-negotiable for cosmetic dermatologists who offer soft tissue fillers?

I have to tell you, you cannot argue with anatomy. You have to know anatomy. And it’s all about safety. It’s all about patient safety. Unless you know the anatomy, you don’t know where or how to inject the filler. It's probably the most critical aspect of the whole procedure as far as keeping the patient safe. So it prevents, or minimizes, the possibility of complications. So anatomy is key.

LiVDerm: That makes total sense. No doctor wants any complications, correct?

Absolutely. And I think that's really the most important aspect of knowing how to properly inject fillers. Know your anatomy.

LiVDerm: Can you please explain the basic differences between facial fillers and neurotoxins and how to use both injectables in the same patient successfully?

These are two major classes of what we do in our practice. Some fillers are essentially products, typically hyaluronic gels, but there are other products, calcium hydroxyapatite, PMMA, PLLA, many different forms of fillers. And these are agents that fill a depression or add volume. For instance, PLLA in the mid-face creates volume. So anything that adds volume is a filler. On the other hand, a neurotoxin, and there are four toxins that are cleared in the U.S. right now, is a paralyzing agent. Basically, it's an agent that minimizes or prevents transmission at the neuromuscular junction. So, for instance where muscle contracts, you can block that nerve impulse that goes into the muscle to minimize or weaken the contraction of the muscle. And that's used to treat what we call dynamic lines or dynamic wrinkles. Versus fillers which are used to add volume. And you certainly use it at the same time. In my practice, I would use a toxin and a filler at the same time. They treat different things but they are certainly complimentary.

LiVDerm: That makes sense. So, it's on a case-by-case basis, of course.

You'll be leading the intensive Hands-On Cadaver Workshop at the 2022 South Beach Symposium. Can you please explain what attendees will experience during this comprehensive training and how the skills gained will be actionable in their practices?

This is a very comprehensive hands-on training with a didactic lecture. It includes the prosection and dissection of cadaver heads and injection of not only fillers and neurotoxins but also placement of PDO threads and products such as Silhouette Instalift. The attendees will experience firsthand how the product that you're injecting feels. We will also then dissect the cadavers after the injection. The injections, or products, are marked with a dye, and then I will lead the dissection to verify the placement. Not only will we do it through dissection to verify the placement of the products, but also I will be using ultrasound to verify placement and the injection technique.

This is a very comprehensive course and it’s not only on the head and neck anatomy, but it’s also the anatomy of the hand. Attendees who finish this course will be able to incorporate this newfound knowledge and very comprehensive knowledge into their daily practices.

LiVDerm: That is truly amazing. What a time that will be.

I am so looking forward to it. That is actually my favorite part of the whole meeting. Now, I'm totally biased because I am an anatomist, and I just think that there's an important role for anatomy in what we do in aesthetic medicine. It is my mission to make sure everybody knows the anatomy and is able to properly inject fillers and neurotoxins based on their knowledge of anatomy.

LiVDerm: Everyone should definitely sign up for that course.

I think so.

LiVDerm: You’ve pioneered some industry-defining cosmetic techniques and procedures. Can you please explain how these minimally invasive services contribute to patient satisfaction and if the availability of noninvasive cosmetic technologies has resulted in fewer requests for more invasive surgical procedures?

I will take the last one first. It’s just the opposite because providing noninvasive or minimally invasive procedures to patients expands your practice. And that is exactly what has happened in my practice. My surgical practice, or aspect of my practice, has never been busier and I attribute that to the fact that I am known for minimally invasive and noninvasive procedures which bring in patients that might not be candidates for minimally invasive procedures. They then graduate to the surgical procedure. So, it’s just the opposite.

And as far as the devices and the procedures – I have been involved in minimally invasive aesthetic medicine since 1997 when I obtained my first patent and that was for the suspension device, a totally absorbable suspension device that has been used in endoscopic forehead lifts, endoscopic facelifts, endoscopic neck lifts – and based on that particular device, it’s a predict of many different devices that have been developed, completely absorbable devices for the elevation of tissue. What that has done is minimize the length of the incision, the time for recovery, and the type of anesthesia used for the patient. So it benefits the patient ultimately. 

A lot of my other work has been involved in developing fillers as well. I’m a big fan of fillers. When properly used, it’s a wonderful technology that can rejuvenate the face, and not only the face but the body. We have transitioned to inject biostimulatory agents all over the body, whether it’s the decollete, the dorsum of the hand, or even the upper arms or the legs. So, it really benefits the patient without having to go through surgery.  But ultimately, certain patients become surgical patients. So, as I mentioned before, noninvasive or minimally invasive procedures expand your surgical practice.

LiVDerm: Thank you for sharing that. Those are some major procedures and wonderful achievements for you.

Thank you.

LiVDerm: “Science is your guide, anatomy is your savior.” Can you please explain how this quote on your website exemplifies the cosmetic dermatology specialty and how you’ll infuse the concept into your instruction at the Hands-On Cadaver Workshop this year?

I think that is really an idea that I live by. And what I mean by it is that you have to understand the physio-chemical properties of fillers. You have to really understand the points of differentiation between different classes of fillers and how the fillers behave. And once you understand that, you have to match it with the appropriate anatomical area. And obviously, knowledge of anatomy is critical to be able to do that. For instance, in the area of the temple, hollowing of the temple, you have to use a filler that has the correct lifting capacity. So it has to be something like calcium hydroxyapatite, or PMMA, where you want a filler that really expands that hollow. On the other hand, anatomically speaking, a very dynamic area such as the perioral area, let’s say the upper lip, obviously you need a much softer filler that has a lower G-Prime. You have to understand the physio-chemical properties of these particular fillers in order to choose them properly. So, again, matching the physio-chemical properties, which is the science of the fillers, with your knowledge of anatomy. That's why I live by that saying, and I have to tell you, it does minimize the possibility of a complication.

LiVDerm: Very cool. I like that quote. And it makes total sense for your practice and your whole way of life. I'd also like to ask you, if you could be known for one thing in your medical profession or even personal life, what would that one thing be?

I was asked that question by a very good friend of mine, who is an extremely well-known dermatologist. She said to me, “Paul, when is it enough? When are your achievements enough?” And it’s not about achievements. It’s about the intellectual stimulation that I derive from developing new things and new procedures. The answer is that it’s never enough because I’m always working. My brain is always working. What would I like to be known for? That I’ve always tried to improve on what we have learned and know, and accepted before and I always want to make it better, whether it's a surgical procedure or a noninvasive procedure. I’d like to be known for being the person who always tried to make it better and perfect it even more.

LiVDerm: I think you already are known for that so, congratulations. That's a great answer. Is there anything else you'd like to share with our audience today?

I’d like to see everyone at the Loews Hotel in South Beach. I'm looking forward to it. It really is one of my favorite meetings of the year. I love the interaction. I like the multidisciplinary approach. There's a great exchange of ideas and it goes both ways from the faculty to the attendees and vice versa. I learn every time I go. It's a beautiful venue and the meeting is first-rate and I’m looking forward to seeing everyone there.

LiVDerm: Thank you so much. We're looking forward to your workshop as well.


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