The Stella Center

Spent the last weekend at Galderma Train the Trainer meeting in Las Vegas. What a great event!

I was invited to teach ultrasound anatomy and join a panel on injectable safety and the role of ultrasound in practice.

So happy to see real attention to anatomy and safety, especially with the new indication for temple treatment! All live injections were done with ultrasound mapping and guidance.

Thank you to Galderma, , and for the invitation, and for taking education and safety seriously!

I’ll be teaching more on injectable safety and complications prevention and treatment at my course in July.

.usa

Our dear Rosa Sigrist led an international multicenter study on Doppler findings in vascular occlusion.
The manuscript is now available as a preprint while awaiting peer review.
Grateful to be part of this collaboration and looking forward to the final publication.

.dermo

Do you know what is under your patient’s skin surface?

Can you avoid the blood vessels? Can you dissolve old filler and treat other complications?

Next ultrasound training - July 2026. Most of my training courses are now private, do this is the only one for the year. We do one- and two-day courses.

Hope to see you there!

This is what healed scars from a facelift are supposed to look like. I take my time so it could look like this.

IMCAS 2026 in Paris is coming!
I’m excited to see my friends and colleagues, learn and teach.
I’ll be presenting several topics at the Thinkin pre-meeting, then Ultrasonography summit, and then the main meeting. Join me to explore the future of aesthetic medicine and aesthetic ultrasound!

Do you know what the patient’s anatomy looks like under the skin?
Do you want to actually see and understand what you’re injecting?
And do you know what to do when complications happen?

Ultrasound is the most valuable tool in my practice, and I cannot imagine practicing in 2026 without real-time anatomical assessment.

My courses are intentionally very small, usually 4 - 6 participants. Most of my training is private.
You cannot learn ultrasound in a meaningful way in a large group.

I strive to make sure you actually learn and go back to your practice and start using ultrasound.

Our participants get extensive hands-on scanning, guided anatomy on real faces, and plenty of time to ask questions and troubleshoot.

You will scan. A lot.
You will be tired by the end of the day.
And you will leave inspired, and seeing anatomy and your own techniques very differently.

If you’ve been waiting for the right time, 2026 dates are now open!

To sign up, go to Link in bio, or comment Course

Since we’re talking about Botox not working…
IsBotox resistance real and what can we do about it?

We’ve been getting a lot of requests for Myobloc, perhaps Reddit and ChatGPT picked it up somehow.

I’m always very careful with these patients. Before recommending Myobloc, I want to make sure it’s the right next step. So if we don’t schedule you right away, please don’t be mad at me, or especially at my staff. They’re just doing what I’ve asked them to do. The goal is to save you time, money, and unnecessary treatment.

A detailed review of prior treatments helps. What looks like resistance can be related to dosing or injection technique.

That said, true neuromodulator resistance does exist.
In selected cases, botulinum toxin type B (Myobloc) can be a useful option, but it’s not a miracle fix. Knowing the details of anatomy and toxin behavior really matters.

We spend a lot of time educating our patients.
It’s also something I teach in my ultrasound courses, including ultrasound-guided techniques when appropriate.

Do you have questions about Botox resistance or Myobloc?

Is this toxin resistance?

Same masseter muscle.
Different tissue.

Long-term (Bo)tox can change muscle architecture, replacing contractile fibers with denser, fibrotic tissue.
If the tissue is different, should it really be treated the same way?

Let me know what you think.

If you start your Botox today, what will you look like in 5 years?

This patient does not just avoid aging. She looks more balanced and refined, not frozen or overtreated.

Botox is not one size fits all, and it is not about doing more. It is about doing the right amount consistently with intention.

Facial muscles behave differently over time. Sometimes we need to use ultrasound to guide injections and improve our results.

Your face is unique. Your treatment should be too.

So… is filler good or bad?

The answer isn’t as simple as it’s often made out to be.

As many of you know, I run an ultrasound-based complications clinic and regularly see the full spectrum of aesthetic outcomes. I also see the issues with fillers. In most cases, the true problem isn’t the filler itself, but the placement or amount.

Occasionally, changes in structure over time can create issues as well. And every once in a while an inflammatory response or infection is to blame.

Here’s an example where we removed AND added filler for optimal outcome.

This patient came in with persistent under-eye puffiness from filler placed elsewhere. Using ultrasound, we identified the issue and were able to treat it in a single session. One session isn’t always enough, but in this case, it was.

Once the tissue settled, the puffiness resolved, and she didn’t need any refill in that area. Subtle, restrained treatment of the chin and lips improved her overall facial balance.

Before anyone puts words in my mouth:

I stand by my belief that filler is not the villain.
Overfilling and poor technique are.
And with the right approach, most of these issues can be fixed.

Questions about your own filler or swelling?
Let me know or book a consultation.