Reading: Dr. DuPéré Injects Luxury (and Botox) in High-End Yorkville Practice

Dr. DuPéré Injects Luxury (and Botox) in High-End Yorkville Practice

Would you? Did you? Are you going to? There is no denying that botox and other aesthetic enhancements are de rigeur; especially for those of us who have spent their younger years drinking in the sun sans SPF. So we sat down with Dr. Marc DuPéré, an aesthetic plastic surgeon with 18 years experience, to ask the questions we all want to know before hopping in the hot seat. And if the man designs faces the way he designs spaces, your looks are in good hands.

What should you ask your aesthetic plastic surgeon to get the most natural results?

The patients must be clear with the doctor as to the “look” they are aiming for: slight movement, no movement at all, brow lift or not, etc. Pictures help. The plastic surgeon must also be able to listen and “hear” what the patient is seeking. Then a discussion of what is feasible and advisable can be had. Most patients do ask for something natural and not “frozen”.

What age should you start getting injectables?

There is no ideal age. For example, I had three horizontal lines on my forehead when I entered medical school at 19. But I also see patients in their 50s no lines on their forehead and who are not using Botox or Dysport (another Botox-like toxin available in Canada). I also have a few patients in their 80s who are still benefitting from Botox and skin fillers. Although “preventative Botox” is a new social “requirement” and likely overused, there is no doubt that waiting too long for the fine wrinkles appear will require a more complex corrective treatment such as a combination of Botox, fillers, and laser resurfacing.

How do you avoid the much-maligned ‘filler face’?

Trusting an honest injector who can suggest what is best for you, an injector who is not afraid to say no to some unnatural request. An injector who has a proven track record of respecting the “normal” ratios in facial aesthetics, the Golden ratio of Nature 1:1.6. And injector who appreciates the nuances and differences between men and women, between ethnicities but most importantly, who can differentiate from what we see on TV and social media versus reality.

What new products have you seen on the market?

I’ve always preferred the “old-and-tested” Restylane and Juvéderm. They have been around since the beginning, and they have strong research behind them in both efficiency and safety. They both now have longer-lasting fillers by having stronger cross-linking between the molecules making it harder for the body to dissolve them. The newer Restylane Volyme, Defyne and Refyne are quite promising and so are Voluma, Volift and Volbella, by Juvederm.. As far as lasers are concerned, the new HALO laser is quite remarkable for its efficiency on sun spots, fine wrinkles and texture issues with now a minimal time for recovery. Finally, the newest fat-burning non-surgical technology – TruSculpt ID – is extremely promising by combining fat burning AND skin tightening with radiofrequency, the latter missing with ColdSculpting which often leaves patients with uneven and sagging skin. TruSculpt is quite effective in treating isolated areas such as small muffin tops, love handles, chest rolls, etc. Under chin area is also a popular area for radiofrequency and fat burning.

Are the effects long-lasting? How long will it last?

The classic Restylane, Juvéderm, Theosyal, Esthelis, etc. will last on average 6-9 months. A filler will last longer if: 1. using larger molecules 2.there is minimal movement in the injected area 3. the filler can be placed deep below the dermis, such as over the bones 4. if the cross-linking is stronger between the molecules. For example, the lesser-lasting area will be the lips: small soft molecules, tons of movements, superficial. Fillers will last longer over the cheekbones and over the jawline, as we can use bigger fillers, injected right over bones in an area of low movement. The newer produts by Juvederm: Volbella, Volift and Volyme, and the newest by Restylane: refine, define and will last up to 18 months.

As for Botox and Dysport, the effects have always been (when reconstituted honestly by your injector – as the toxin comes to us as frozen powder and we must reconstitute it with sterile solution) about 3.5 to 4.5 months.

Is receiving botox dangerous or are there any side effects?

Botox is a medication and as such, comes with its sets of benefits and complications. Botulinum toxin has been used clinically for almost 50 years; it is used today from muscle spasms in children and adults with cerebral palsy, strabismus and double vision, esophageal, bladder, anal and vaginal contraction problems, heavy sweating, migraines and headaches, pain control, wrinkle treatments of the face and scrotum, etc. It is even currently being studied to treat premature ejaculation. The dose used in cosmetic procedures is very small and will target the muscle where it is injected. It must be reconstituted properly and under sterile condition. Injections should be done in a sterile surgical fashion. Complications are rare when done by an experienced injector such as plastic surgeons, as plastic surgeons know best the human facial anatomy. Complications include infection, asymmetry, bruising, eyebrow drop (ptosis), eyelid drop (ptosis), redness, headaches, double vision, lack of facial expression, etc. Botox injections cannot be performed if the patient is pregnant or breastfeeding.

Does getting botox in one area create wrinkles in another?

It can and, it can be fixed. It’s called “recruitment”. The brain, not knowing why the eyebrows are not moving as much as before, will “recruit” other muscles. The most common one I see is the recruitment of the nasalis muscles, the so-called bunny-lines over the nose. When this happens, few more units of Botox will suffice to stop it.

What question do clients most ask you?

Will it hurt?

Barely. At VISAGE Clinic, we use topical anesthetic agent and/or ice packs to dull the skin to the pain. I use the smallest needle available to us. I also change the needle after a few injections as the tip of the needles tend to become duller. We use a vibration device to activate the “gate-theory of pain” and blend the nerve information traveling to the brain, mixing pain and feeling and vibration impulses, “diluting” the amount of pain information going to the brain (and it is a Canadian theory from professor Melzack in Montreal!)

How long will it last?

3.5 to 4.5 months for muscle inactivation. 6-9 months on average when used to block heavy sweating (hyperhidrosis). Botox happens to stop the SAME neuromodulator between a nerve ending and the muscle, the same neuromodulator found between a nerve ending and a sweat gland. So Botox is commonly used to decrease sweating in hands, underarms, moustache area, soles, etc.

Will I have a natural look?

You should, and it all relates to your injector and the communication and expectations that will be discussed with him/her.

Will people know I do Botox?

When done well, no one will know. An expert injector will allow a small amount of movement in strategic areas of the face such as the outer forehead. Not only will it look natural but it will also lift slightly the outer part of the upper lids for a more-rested more-awake younger look.

Can I do Botox if I am pregnant?

No. Neither if you are breast-feeding. Although it was never tested in humans and pregnancy, because it is an aesthetic treatment, no injectables should be done when pregnancy and breast-feeding.

Any treatment myths you’d like to address?

Botox can be preventative:

TRUE. When starting early but in small doses, Botox will delay the appearance of wrinkles and will prevent the need to combine fillers and Botox for deep passive static lines

Botox is only for rich people:

FALSE. I have patients of all ages and all economic backgrounds. It is about priorities for patients. It is often an extension to their cosmetic routine, from hair colouring, nails, laser hair removal, etc. Botox is more affordable than surgery and everyone wants to look his/her best.

Botox can be done by anyone:

FALSE! Many things can go wrong when done by inexperienced injectors and the mistake may last for months. Not only is infection control a must, appropriate consent in a medical environment and the deep knowledge of the facial anatomy is crucial. You only have one face.

Botox can be done in condos and corner spas:

FALSE! Although it may look like a benign procedure, it is a medical procedure where the skin is punctured, therefore the risk of infection is real. No alcohol nor recreational drugs should accompany this treatment. Proper consent should be obtained. Everyone should first see a medical doctor. No social pressure should be allowed as seen in those Botox parties. This is true for Botox but also for fillers; countless examples of tissue loss, lip necrosis and blindness have happened in an uncontrolled, non-medical environment where certified doctors are often nowhere to be found.

Botox can be done without ever seeing a doctor.

FALSE. In Canada, it is MANDATORY for a doctor to assess you first and then “prescribe” Botox. Failing to have access to a doctor prior to injections is a medical/nursing offence not tolerated by the College of Physicians and College of Nurses.

What’s the difference between Botox and fillers?

Botox acts by weakening the connection/communication between a nerve ending and the muscle, making the muscle “silent” to any nerve impulses (and therefore no or weaker contractions) over 3.5 to 4.5 months.

Fillers are more static than the dynamic Botox and will “fill” and area of volume deficiency; fillers today are mostly hyaluronic acid molecules, an important component of our skin and joints. It is exactly the same as the human molecule so the risk of allergic reaction is almost zero. Although we used to use bovine and porcine collagen as fillers 25 years ago (collagen would last only 2 months or so), the new HA can last up to 18 months today.

What can we expect before and during a botox treatment?

A thorough consultation with my patients, going over her/his medical history, medications, allergies, etc. I listen to my patients concerns when discussing his/her face and will perform a thorough facial assessment, mirror in hands, debating the asymmetries present, the wrinkles, the areas where volume is missing, etc. I will discuss a plan with my patient and a strategy over time. A quote will be given and pictures will be done for the file. Once done, we clean the face from all the make-up, prep the face and drape it as I would do with a minor procedure to avoid any risk of infection, use a frozen pack to dull the skin slightly and then inject small amount of Botox in each of the muscle I intent to weaken. This latter part is relatively short. Bruising is very rare as the needle is super small and injection very superficial. We recommend to move the muscles for 10-15 minutes post-treatment and to avoid any make-up for 1 hour or more. No pressure over the treated areas for 4 hours. All patients can return to work right after.

Fillers are slightly more involved as more artistry and techniques are required. I use the cannula technique, which reduces the risk of entering an artery or vein, therefore minimizing the risk of embolization considerably and bruising/bleeding.

How frequently do you need to come back for more botox?

Botox is active for 3.5 – 4.5 months but the muscles will only regain full strength and its original size/thickness/strength within 6 months. Although some of our patients will want no movement at all, ever, and will come every 4 months, many chose to do it every 6 months or so, always planning their treatment a few weeks before an important life event such as Christmas, Rosh Hashanah, a birthday, a trip, a high school reunion, etc.

What is an unexpected treatment for men?

The “P Shot” (PRP to penis to enhance sensation and vascular engorgement, similar to the female equivalent of “O Shot”), beard and eyebrow hair restoration, Brazilian Butt lift (male “Latin” version)

What is the most popular treatment for men?

Botox, fillers, PRP (face, hair thinning, P Shot), Radiofrequency non-surgical fat reduction with TruSculpt ID technology, Hair restoration with the newest technology: FUE (follicular unit extraction, a technique NOT requiring the telltale sign of a straight linear scar behind the scalp), eyelid surgery, neck lift, liposuction and etching. Another popular procedure is treatment of “Man Boobs” a condition called gynecomastia, where men develop breast-like tissue mixed with fat and I would perform gland excision and some chest liposuction, including the chest rolls. Finally, I would also add that because I am the Canadian leader in soft tissue augmentation, I see a large amount of Canadians traveling for pectoral, calf, biceps, triceps, buttock, chin, jaw angle and cheek augmentation and “ab etching”.

What is an obscure treatment or procedure men receive?

I would not say obscure but undiscussed and tabooed and often unknown.

  1. Scrotoplasty (some males have low-hanging testicules and a “lift” will rejuvenate their scrotum)
  2. Scrotox (Botox to scrotum for 1. Reduce heavy sweating 2. Reduce the amount of wrinkles and allow the testicles to come lower – and appear larger – when males suffers from contracted “smaller” scrotum
  3. Cheek augmentation
  4. Jaw Angle augmentation with implants
  5. Temple augmentation with implants for temporal wasting
  6. Filler injection to penis to increase girth

What is your favourite thing about being a cosmetic doctor?

My favourite thing is I am not only a cosmetic doctor, but I am an aesthetic plastic surgeon. I say this because NOT ALL cosmetic surgeons are plastic surgeons, a common source of confusion in Canada and USA. Cosmetic surgery is NOT a profession, but plastic surgery, dermatologist, urologist, etc. are. Cosmetic surgery is so ingrained as a term that we are still using it in Ontario, BUT it is now MANDATORY since 2010 to mention your specialty as not to mislead the patients. Many patients believed in the past that their cosmetic surgeon was a plastic surgeon while it was not always the case, and they often received less-than-optimal results.

I am 100% dedicated to aesthetics.

I get to work in a beautiful, chic, and clean environment right on Hazelton Ave, in Yorkville. Because I own my clinic and medspa, I can cater my services with the highest level of care, excellence, and safety.

I get to travel the world in search of new expertise.

Finally, aesthetic plastic surgery is never a routine. And I am not a fan of “routine.” Every day is different, the amount of procedures I perform (over 250) brings a rich variety to my practice, I see a variety of different cultures, different genders including transgender patients, males, and females, etc. I never have a dull, repetitive day!

Your office design is stunning; what was your inspiration behind the decor/interior design?

French, Italian, and Brazilian. Touch of elegance, of modern design and some hot, tropical vibes. Ultimately, nature was my inspiration.

If you weren’t a cosmetic doctor, what career would you have pursued?

Architecture has always been a second passion of mine, forever, and you can be sure I was involved in every single detail of my clinic and MedSpa, from the choice of material, the chandeliers, the handles, wallpapers, faucets, etc.!

I would add that more recently over the last 7-8 years; I also have a charming non-profit organic small production farming and beekeeping so farming might become a later career for me after retirement, in 25 years, to keep myself busy.

Any words of advice you would like to give future patients?

Invest in quality works, including injections. Injectables seem banal and straightforward but can be associated with severe permanent damages. Find a plastic surgeon with experience, who listens to you, who is, with his team, always present and helpful in your recovery. Talk to patients who have been with the doctor before. Follow him on Instagram and Facebook to see some of his work and to get to know him/her and see if there is a “connection.”

Post created in partnership with Visage Clinic. Whether we have Botox…..we’ll never tell.