Miami Cosmetic Dermatologist Mariano Busso MD — The Regenerator
Tucked away in Coconut Grove, Florida, Mariano Busso MD (www.drbusso.com) is a board certified dermatologist known for, among other things, having essentially written the book on injecting Radiesse® Radiesse an FDA-approved “filler” used for the correction of facial wrinkles and folds. Dr. Busso has developed and perfected techniques with toxin and filler that now serve as benchmarks for facial rejuvenation, or as he refers to it: facial regeneration. His approach is magnificently symphonic and his outcomes are nothing short of miraculous and, with an eye towards the return to a natural, more youthful appearance, Dr. Busso seems to achieve the impossible with a toolkit of fillers, toxins and topicals. The interview following gives a glimpse into the mind of a true master.
What prompted you to focus your dermatology practice on cosmetics?
I began my practice treating AIDS patients in 1995. They asked me for help in “repairing” some of the damage done to their appearances due to the disease and it was that motivation — to help rebuild a patient’s confidence through improving appearance – that ultimately lead me to cosmetic dermatology.
Have you always had an interest in more “artistic” endeavors?
Cosmetic dermatology provides the perfect combination of art and science. There is no cookie-cutter approach as each patient is unique. I was always interested in science; I developed my artistic side.
Please tell me about how you approach the cosmetic analysis of a new patient’s face?
First, I work to develop a vision of the original anatomy and the functional interaction of units and layers of the face. It’s important to work to restore the face to its original anatomy versus imposing a cosmetic vision of what someone may feel is the right shape. The most functional shapes are the ones we relate to as being the most beautiful. There is a strong correlation between structure and function so you can say that anatomical structure at optimal functional activity is beautiful. The most functional shapes are the most youthful-looking ones.
Okay, so we definitely want functional faces! Define “functional” as it pertains to facial anatomy.
Facial muscles can function best when supported by underlying fat. Younger faces tend to have more fat and therefore better structural make-ups that support, for example, the eyes. This is reflected in their appearance. When gravity begins to win the battle and fat loss around the temple begins, the corners of the eyes drop.
You place a significant amount of importance on the eyes. Why is that a focal point for your technique?
I begin correction of the face with the eyes because there are greater repercussions on all other structures of the face. The higher the correction in the upper face, the less amount of correction is required in the lower part of the face. The tendency is to lose fat in the upper face and gain it in the lower so filler has a more important effect on the upper face.
Do you feel that an “eye” for aesthetics can be trained or is it something intrinsic?
You have to like it. Experience, commitment and a rational approach are all essential.
What is your most frequently asked request?
To look natural
What is the age range of patients you see?
25-90 years old but most of my patients are 35-55 years old
There are now several toxins on the market. What are the differences among the toxins you use and what and why is your preferred toxin?
Most of my experience has been with Botox® Cosmetic (Botox Cosmetic) and patients request it by name. I haven’t seen other toxins show superiority, which is what would be necessary to adopt them into practice.
Similarly, there are many competing fillers; how do you choose which filler to use in different areas of the face and for different purposes?
This is more complicated. Because it does not migrate or bulge, I prefer Restylane® (Restylane/) for the lower eyelids, temples and forehead. Because Radiesse® (www.Radiesse.com) is more cohesive and gives greater lift, it is good for lateral cheek enhancement. For the lips, Juvederm® (Juvederm is good for its longer perceived duration and softness.
Tell me about your filler technique and how do you get the natural, yet significant, results you achieve?
I just follow the anatomy. I don’t try to create arbitrary shapes. I look for areas of volume deficiencies and follow the anatomical path for the least amount of side effects such as swelling and bruising.
Do you think most injectors still treat lines (versus replacing volume)?
It’s changing now but it’s where beginners begin. You need a lot of patients and a lot of experience to advance and that takes time. It’s slow growth at the beginning.
What should a patient know before he/she seeks out a cosmetic physician?
Each physician yields difference results. You have to look beyond the pictures and, if possible, ask existing patients. I would tend to go with whoever writes the books.
Are there any products coming down the pike that interest you? If so, why?
We are good with what we now have. HAs (hyaluronic acid fillers) are safe and work well.
What do you believe to be the the future of facial aesthetic?
Fully non-invasive. We have enough tools to restore anatomical features that are considered youthful without having to do surgery. This, of course, assumes that it is done relatively early on and anatomical structures are still intact. The combination of toxin, filler and tightening focused ultrasound machines, like Ulthera® (Ulthera), can restore a youthful appearance.Your advice to physicians and ultimately to patients that are seeking optimal results?
Physicians need to do more “volume management” versus tissue augmentation and be respectful of anatomy and functional structures. Changes in the face are due to volume gain, volume loss and volume shift. Most patients have a combination of these. With better techniques, physicians can reposition volume without the need for volume augmentation resulting in a more natural look and happier patients.