Quick Facts:
- Botulinum toxins (Botox®, Dysport®) are used to select facial muscles to smooth lines and modify shape e.g. elevating drooping eyebrows, picking up downturned corners of the mouth
- Injectable fillers are used to replace the facial volume lost with the aging process. The cheeks, lips, lines around the mouth, temples, and hollows under the eyes are common places to administer fillers
- Lasers are used to treat wrinkling and brown discoloration of the skin
- Surgery is used to remove redundant (extra) tissue or resuspend tissues that have fallen (eyebrows, eyelids, jowls, etc.)
Numerous changes occur in our faces with the passage of time and the influence of a variety of environmental factors. Our skin loses its elasticity and may develop brown or red discoloration, our faces “deflate” as the soft tissues that provided the fullness characteristic of our youth descend and become smaller, deep lines and wrinkles develop from the repeated action our facial muscles, and we may even develop sagging of the eyebrows and/or eyelids, loss of definition of the jawline, and jowling of the neck.
Facial rejuvenation involves the correction of these changes in such a manner that a more youthful yet natural appearance is restored. Rejuvenation does not mean elimination of all wrinkles and lines; such a look is typically artificial. Rejuvenation in its true sense refers to the return of a younger look without introducing characteristics that had never been previously present.
Treatment options available to achieve facial rejuvenation may include the use of lasers or light sources correct skin discoloration, wrinkles, and textural changes, noninvasive skin tightening such as Thermage treatment, injectable agents such as botulinum toxins and fillers to reduce lines and restore facial volume, and surgery to remove excess tissues or return sagging tissues to their proper position. Many individuals develop multiple signs of aging simultaneously. As each treatment option accomplishes only 1 or 2 objectives, it is common for a comprehensive treatment plan to involve several parts.Facial rejuvenation refers to the process of making someone look more as they did when they were younger, not just eliminating wrinkles and lines.
Botulinum toxin type A is a medication that has been used since the late 1970s as a muscle relaxant. Its initial applications were for the treatment of crossed eyes and uncontrollable facial spasms. As early as the mid 1980s the potential benefits of botulinum toxin for Aesthetic applications were considered. In 2002 the Food and Drug Administration approved a form of botulinum toxin manufactured by Allergan, Inc. known as Botox to treat wrinkles and lines between the eyebrows. Since then Botox has become the nation’s #1 noninvasive aesthetic treatment by a margin of more than 2:1. Until very recently Botox was the only botulinum toxin product available in the United States. Very recently (June, 2009) a competitive product known as Dysport was released by Medicis, Inc. Dysport, like Botox, is a form of botulinum toxin although chemically the 2 drugs are not identical. Dysport has been used in Europe for approximately 10 years so, while new to the US, it is not a new drug. Botox and Dysport are often referred to generically by the term botulinum toxins, abbreviated BoNTs.
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Quick Facts:
- Treatment of acne scars typically requires a combination of subcision, excision of scars, laser resurfacing and filler injections or dermal grafting
- The laser treatment of choice for treating acne scars is ablative fractional resurfacing with devices such as the Pearl Fractional or Deep FX.
- More than 1 session of surgery and/or laser resurfacing may be required
- Treatments are performed in the office without the need for general anesthesia or intravenous sedation
- The outcome anticipated after treatment should be improvement and not elimination of all scars.
- Individuals affected by facial acne scarring are typically extremely self conscious about their appearance.
- They sometimes lack self confidence and see their scars as being more dramatic and noticeable than the objective observer. Fortunately, there are now better treatment options for acne scarring than ever before.
Treatments:
- Affirm™ Fractional Laser Skin Resurfacing
- Pearl® and Pearl® Fractional Laser Skin Resurfacing
- Scar Revision/Correction
- Restylane®
- Active and Deep FX Laser Skin Resurfacing
Quick Facts:
- Soft tissue volume loss is one of the most important signs of aging
- Soft tissue fillers are used to enhance or replace volume that was never present or was ost with aging
- If administered properly, fillers should produce a natural, rested look and should not be readily apparent to even a careful observer
- Restylane, Perlane, and Juvederm are the most commonly used fillers for treating facial wrinkles and lines, enhancing lips, filling in dark circles under the eyes, enhancing the cheeks, chin, and contouring the jawline
- Sculptra is used to fill in hollow cheeks and temples. It may also be used in some other areas but is not used like the HA fillers (Restylane, Perlane, and Juvederm)
- Fillers complement laser resurfacing, skin tightening, Botox, and even surgery. They are not mutually exclusive of these other procedures
- Only HA fillers should be used beneath the eyes
- Permanent fillers can lead to permanent problems
Treatments:
Injectable fillers have been used for many years to fill wrinkles and lines. Bovine (cow-derived) collagen was the first product used in this manner and for nearly 30 years was the only injectable filler available in the United States. Collagen was used primarily to enhance lips and treat facial lines such as the nasolabial fold (the line extending from the nose to the corner of the mouth). As it was an animal-derived product, skin testing was required prior to collagen injections. The duration of effect following bovine collagen injections was somewhat limited with most patients experiencing lasting benefit for only a few months. Over the past several years, products made from hyaluronic acid, a naturally occurring molecule that is a normal component of skin, have become available in an injectable form. The hyaluronic acid products have a more natural look and feel than collagen and as well as a much longer duration of effect. Learn MoreIdeal Use:
Unwanted hair is an extremely common complaint amongst men and women ranging in age from teen years through adulthood. Women most often are interested in having hair removed from their cheeks, upper lip, sideburns, chin, underarms, bikini area and legs. Men often seek hair removal from the chest and back although sometimes request treatment of the beard area so as to decrease the need to shave as frequently. Learn MoreQuick Facts:
- Lasers are the treatment of choice for small vessels on the face typically referred to as"broken capillaries"
- 1-3 sessions are usually required to achieve ideal outcomes
- Lasers can play a role in the treatment of leg veins but I feel that injection therapy should be the first treatment modality for this condition
- Leg veins that are too small to be treated by injection may be treated with lasers
- 2-4 sessions are usually required when performing laser treatment for leg veins
- Compression stockings are not required after laser treatment of leg veins
- Blue eyelid veins can be treated safely and effectively with laser therapy
Treatments:
While IPL treatments are highly effective for improving the appearance of diffuse red discoloration, lasers must be used if larger, discrete blood vessels such as “broken capillaries” and Leg veins are to be eliminated. Red colored vessels are typically safest and easiest to eliminate. This is particularly true of vessels located on the face but also those found on the legs. Larger blue vessels also respond favorably to laser therapy but carry a somewhat higher risk than do smaller vessels due to the amount of energy required. Small red leg veins and any vessels that are resistant to therapy with other methods are excellent candidates for laser treatment. Learn MoreTreatments:
- PDT - Photodynamic Therapy
- Laser Assisted Hair Removal
- photomodulation (gentleWaves®)
- Intense Pulsed Light Treatment (IPL)
- Blue Light Therapy
- The Blue Peel
- Obagi®
- Vitalize Chemical Peel
- Laser-assisted treatment of tattoo
- Latisse™
Quick Facts:
- 1st Generation fractional skin resurfacing treatments produce improvement in the appearance of fine wrinkles and brown discoloration.
- Recovery time after 1st generation laser skin resurfacing treatments minimal. The skin will be pink for several hours but there is no crusting, blistering, or “downtime”. Makeup may be applied immediately after treatment.
- 4-6 1st generation laser skin resurfacing treatments are needed to produce best outcomes.
- 2nd generation laser skin resurfacing techniques produce smoothing of fine to moderately deep wrinkles, significant reduction in brown discoloration, and improvement in acne or surgical scarring.
- 5-7 days of recovery time are typically required after 2nd generation fractional skin resurfacing treatments.
- 1 treatment is typically sufficient to achieve excellent results in patients with mild to moderate sun damage of the skin. Additional treatments are usually needed when treating patients with advanced acne scarring
Treatments:
- Affirm™ Fractional Laser Skin Resurfacing
Quick Facts:
- First generation fractional resurfacing is used to successfully treat fine wrinkles and lines, sun damage, acne and surgical scars, and to improve skin texture
- Recovery time (0-2 days) is much shorter than with traditional or second generation fractional skin resurfacing
- First and second generation fractional resurfacing is associated with a much lower risk of complications than traditional skin resurfacing treatment
- 4 to 6 treatments are typically required with first generation fractional resurfacing vs. only 1-2 treatments with 2nd generation treatments
- Fractional resurfacing does not treat red discoloration or “broken capillaries”
- I have performed extensive research on both first and second generation fractional resurfacing techniques including development of eyelid treatments and development and refining of combined fractional resurfacing and skin tightening techniques.
- More aggressive fractional resurfacing treatments using second generation fractional resurfacing lasers will produce more dramatic improvement in skin laxity, deep wrinkles and lines, acne and surgical scars, and even stretch marks with fewer treatments.
- These more aggressive treatments are associated with longer recovery periods
Treatments:
- Zeltiq™ for Noninvasive Fat Reduction
- Thermage™ Noninvasive Skin Tightening (Face/Eyelid/Body)
- Ultherapy™ Noninvasive Skin Tightening
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