Friday, November 26, 2021


By:  Michelle P. Zappas DNP, FNP

I am a family nurse practitioner for the past 10 years. But my main expertise (and where I work clinically) is in aesthetics or aesthetic dermatology. I currently work in Luxe Aesthetics Center as a clinician or as a family nurse practitioner in Yorba Linda, CA. The CEO of The Luxe Aesthetic Center who is an awesome colleague and mentor in clinical aesthetics. So we do a lot with Botox, Neurotoxins, Fillers laser techniques to bring enhancements to patients, helping them to look and feel their best.

Thanks to the connective powers of LINKEDIN, I was approached by NY Cancer Imaging Specialist, Dr. Robert L. Bard about co-authoring in a multi-disciplinary text project about IMAGE GUIDED AESTHETIC PROCEDURES.  Having learned about him as a globally recognized figure in clinical education and medical publishing,  I also marveled at his vision to unite the many areas of medicine through collaborative research and integrative presentation concepts.  Meanwhile, to co-write about clinical aesthetics in this unique capacity was a remarkable opportunity no educator in my field could pass up.

 So when doing hyaluronic acid filler, it is really important to know which areas are dangerous. Then it basically breaks down to nerves and arteries. Obviously you don't want to occlude an artery or with filler itself or too much filler into an area where that presses on an artery, because that can cause vascular compromise avascular necrosis, it can cause blindness if the artery supplies the eye with blood and also you can cause a palsy if there is occlusion or compression of the nerve.

 So those are really the major vessels and anatomic areas to avoid-- the, the big subgroups.  But obviously within the face, there are a lot of vessels and arteries to note and to avoid when you are injecting. So this chapter really breaks it down. We go through the face upper face, lower face in terms of where to inject safely, what vessels and arteries that are in that area and what to avoid- plus other clinical techniques in order to make sure that you are injecting the hyaluronic acid safely.

I am definitely interested in public education, informing patients and all providers about best practices with regard to aesthetics, other techniques and modalities.  I’d like to contribute in informing the public about aesthetics before getting these procedures, especially in support of the many patients of enhancement or regenerative professionals.  I’d also like to promote safety programs and prevention techniques because a lot of damage and injury can happen out there, particularly with fillers but also with lasers if it's not done correctly. So it's really important when we're talking about patient safety for the provider to be able to walk the line between being aggressive enough to get somebody good results but (especially in terms of lasers) not work too aggressively to burn somebody or to cause somebody scars or blisters.

So Intense pulse, light or IPL is a type of laser that can target the main chromophores (hemoglobin, water, and melanin) and so these are a lot of the molecules that patients complained about in chunks of  dyschromia or erythema on their face and other parts of their body. A lot of times people are coming into decrease the Pohnpeian with the little blood vessels in the skin. IPL is wonderful for that.

One of my points about my IPL chapter is that it's not just for aesthetics; there are a lot of dermatologic inflammatory.  Multi-system conditions and diseases that IPL can be used for include ROSACEA, Meibomian Gland dysfunction, Acne,  Port-Wine Stains related to Sturge–Weber syndrome and Mangiomas. There are a wide variety of conditions that can cause patients discomfort- including mental discomfort,  suicidal ideation and  depression that can be treated and a radiated with IPL as one of the modalities for treatment.  Hence, I find this to be a remarkable laser for a lot of different health conditions while also strongly making a significant difference in the areas of aesthetics as well as dermatologic conditions.

In terms of our fillers, using image guidance via ultrasound, we can visualize vessels, nerves (and) all sorts of different things that allow the practitioner to safely inject. And so that is a great technique to not occlude those vessels that you don't want to occlude. To transform somebody's face and give them a youthful appearance, but safely without the risk of blindness or vascular necrosis or any other of the potential adverse effects that can come from that kind of hyaluronic acid or other filling modalities.

Clinical aesthetic modalities as a whole works on the visual of the patient but also greatly improving their mental wellbeing and their ability to interact with the world (resulting to improved self-esteem). And I don't want to get lost on the vanity aspect of it because aesthetics actually running a whole lot deeper than that. My philosophy behind that is to “do what the patient wants” in terms of what bothers them.  However, I do not buy into all of these new modalities necessarily without seeing the evidence. I really want the evidence to support the procedure. So patients who invest in these modalities deserve my research, my clinical understanding and I want to make sure that what I am providing them that is backed by evidence. So that is probably where I talk some patients out of some of the newer things that they see in the blogosphere and YouTube from the many influencers- and I say, “let's go back to what has been tested, where we can have the evidence—that’s what makes for a sound and professional clinical aesthetics practice!”



Thwarting Surprise "Surgical Land Mines" with PreOp Scans

By. Dr. Robert L. Bard

For all my friends in the practice of Cosmetic Surgery, DIGITAL PRE-OP is a highly useful stage for many patients who may carry hidden issues that can turn into a pandora's box of complications. I have performed this vital service for European plastic surgeons since 2001 in their centers  while currently performing domestically as a digital diagnostics partner for serious physicians and surgeons fulfilling similar needs.  Pre-operative imaging is widely performed to verify tissue planes and measure fat depth.  Since patients may have forgotten prior treatments, new scans sometimes reveal extensive sub-dermal calcium deposition, unsuspected fluid collections or thick fibrosis distorting the expected anatomy.  Anatomic variants may be observed and avoided. Moreover, patient confidence is enhanced by the extra care provided by this advanced technology.

Some of the most common POST-PROCEDURE COMPLICATIONS include:
- Suture loosening and granuloma formation following blepharoplasty
- Lipoatrophy or fat necrosis following PRP or abdominoplasty
- Filler complications and implant migration 

- Doppler verification of vascular compromise (venous or arterial) following facial therapies allowing immediate intervention to prevent blindness or tissue necrosis (See complete article)


Springer Medical Publishing proudly presents the first installment in clinical aesthetic procedures. This detailed and up-to-date overview of image-guided procedures focuses on the many aesthetic and reconstructive strategies delivered by some of today's renowned leaders in the clinical aesthetics community. They share their valuable expertise and field-based findings throughout this feature-rich textbook. The wide list of audiences for this text (ie. dermatologists, plastic surgeons, aestheticians, general surgeons) will enjoy an insider's look at each treatment program while providing remarkable field-based knowledge for the general non-medical audience seeking the latest information in non-invasive and minimally invasive aesthetic procedures.  Produced and edited by Dr. Robert L. Bard, this collective project showcases the most highly sought-after cosmetic treatments in each priceless chapter- through detailed breakdowns, experiential insights and a generous graphic tour of before and after progress visuals.  Thanks to the additional safety benefits of clinical imaging, our treatment professionals express added confidence in the pre-operative and post-op areas. In addition, many aesthetics procedures noted also brings significant advantages (of accuracy and efficiency) to the actual treatment process from real-time image guidance. Some of our top contributors include: Dr. Beth Haney, Dr. Michelle Peters-Zappas, Mary Nielsen Aesthetics, Dr. Arun Garg, Dr. John Catanzaro, Dr. Randall Weisel, Dr. Stephen Chagares, Dr. Cari Green, Dr. Richard Kushner, Dr. Lio Yu, Dr. Peter A Everts and January Howard, CMA (this is an abridged list of our contributors).


Dr. Michelle (Shelly) Zappas is a Clinical Associate Professor at the USC Suzanne Dworak-Peck School of Social Work in the Department of Nursing. She received her Bachelors’, Masters’ and Doctorate in nursing from Columbia University. Dr. Zappas has nearly a decade of experience as a family nurse practitioner in primary care clinics in New York City and Los Angeles. Dr. Zappas has authored multiple publications and presents at both state and national nurse practitioner educational conferences. In aesthetics she has been trained in advanced injection techniques using neurotoxins and dermal fillers as well as training in IPL and lasers. Dr. Zappas has a profound interest in dermatology and skin care and enjoys helping her patients put their best face forward.  

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