Wednesday, May 7th, 2014
For many years fillers have been injected with a syringe and multiple sticks with a small sharp needle. This was moderately uncomfortable but relatively quick, taking 5-10 minutes. The only way to decrease discomfort was to apply numbing cream or do nerve blocks. Numbing cream is messy and needs to be applied 30-60 minutes prior to the injection. The affect is variable and even at its best does not eliminate much pain for most patients. Nerve blocks, injecting regional nerves with novocaine, need to be performed 5-10 minutes before the filler injection. Most patients find doing the nerve block itself hurts more than the actual injection of filler. Both of the techniques can distort the tissue, making it more difficult for the physician to determine the amount and location of filler injection.
A number of years ago most filler manufacturers started adding numbing medicine (xylocaine) to their filler. This decreases discomfort quite a bit, but the first few needle pricks can still be felt. The numbing medicine definitely helps when the physician has to make 2nd and 3rd injections in the same spot, which is not uncommon. Patients tell me they greatly prefer the filler with the numbing medicine.
The latest advance for filler injection is the “blunt needle” technique. There is no question that this technique also significantly decreases discomfort and minimizes the risk of bruising. Only 2-4 very quick pinches are required. A tiny blunt tipped needle is threaded under the skin to deposit the filler. Because the needle is rounded at the end, not sharp, it slides around blood vessels and nerves and causes less tissue trauma than a sharp tipped needle. Discomfort is minimal and the risk of bruising is decreased. This technique is great for injecting the lip, which is an extremely sensitive area. It can also be used for cheeks, marionette lines, eyelids, and other areas of the face. Most fillers can be injected with this method, but blunt injection can not be used when the filler needs to be injected very superficially.
In my office, I use fillers with numbing medicine and the blunt needle technique whenever possible. Although we have not eliminated discomfort, it is much easier today have fillers with these newer techniques.
Thursday, March 7th, 2013
Many patients ask me “what can I do to make my face and neck look better?” Of course this is a very general question so I try to organize their thinking and my response. I usually divide my assessment into three catagories: skin surface problems, sagging or drooping issues, and volume disorders.
Skin surface problems include: sun damage, pigmentation, fine line and wrinkles, surface irregularities, acne scars, and red spots. “Resurfacing” is required for these conditions and is usually done with lasers, dermabrasion, peels, and skin care products. These treatments do not significantly tighten the skin or tissues.
Sagging and drooping is usually evident in the following areas: jowls, cheeks, eyebrows, eyelids, and the neck. As we all know, unfortunately, drooping is a major part of the aging process. These conditions are best treated by surgical lifting procedures (e.g.-face lift, brow lift, neck lift, eyelift). Surgical procedures will result in the most significant improvement. There are also some non-surgical lifting techniques using ultrasound (e.g.-Ulthera) or radiofrequency (e.g.- Thermage) to stimulate contraction (tightening) of the tissue. The non-surgical lifts will result in much less lift but are less expensive and have less down time.
Recently, the significance of volume loss in the face has been recognized as a vital cosmetic issue. Aging causes downward movement of facial fat. Cheek fat will descend causing puffiness along the jaw (jowls), cheek depressions, and indents under the eyes (tear troughs). The fold from the edge of the nostril to the corner of the mouth (Nasolabial Fold) will deepen. Folds at the edge of the mouth will deepen. These conditions can be treated with fillers that are injected to replace lost volume. There are commercially available fillers (e.g. Restlylane, Juvderm, Radiesse) that can be injected in the office in just a few minutes. These fillers last 6 months to one year. Your own fat can also be used. This is a slightly more complex and expensive procedure but usually lasts quite a bit longer (2-5 years or more).
In some cases, volume may need to be removed, particularly in the neck. Usually liposuction is used for this.
Of course each patient has different combination and severity of problems. If this sounds a bit complex and confusing - it is to the untrained individual. The exact nature of each person’s issues needs to be assessed during a consultation by a legitimate BOARD CERTIFIED PLASTIC SURGEON. A PLASTIC SURGEON who has the training and experience to do all of these treatments is the best doctor to determine the options that are appropriate for you.
Thursday, October 4th, 2012
Get the best results from fillers and Botox
When done appropriately by skilled, board certified, artistically trained doctors, fillers and Botox® administered in the office are simple, safe, 10-15 minute treatments that can significantly refresh and rejuvenate the face. But be careful! Due to a high demand, all sorts of people are trying to become providers and suppliers. The Botox/filler market is a jungle with many dangers and traps. Even these simple non-surgical treatments can result in disasters when done by inappropriate and unscrupulous people.
When you are considering filler and/or Botox treatment, cost should NOT be your first priority. Your main concerns should be SAFETY and QUALITY. The doctor administering these treatments DOES MAKE A DIFFERENCE. I could teach anyone to poke a needle through the skin and inject some material. Obviously there is a lot more to this then just the actual injection. Some of the major concerns are: when not to inject; what to inject; where to inject; how much to inject; what these injectables can do and what they can’t do; how to maintain a natural look; better options to achieve the best results; and how to avoid complications, just to mention a few. An injector with an artistic eye and knowledge of facial aesthetics and anatomy is essential. Stay away from untrained, unlicensed, non-medical people. If you want the best result with the least risk, look for a Board Certified Plastic Surgeon or Dermatologist to administer your fillers and Botox. Many other types of doctors, dentists and nurses may offer fillers and/or Botox in their office even though these treatments are out of their usual area of expertise. Technically this may be allowed, but their ability, training and artistic skill will vary greatly and may be severely lacking. In my opinion, medical personnel should stick to their own area of expertise and training. I wouldn’t want a Cardiologist or dentist injecting my face with fillers or Botox.
Recently, we had a patient call our office stating that she could get Botox somewhere else for $85.00. That is significantly below the “wholesale” cost of legitimate Botox. We have all heard of Botox and filler “parties” with very low cost. A red light should flash before your eyes when you hear of these situations or “offers”. Usually you get what you pay for. In addition to obvious issues like sterile technique and appropriate sterile equipment for the injection, make sure you are getting genuine, FDA approved, USA made, current products. There are cut rate products out there that may be out dated or may contain diluted material, just water, or worse- something toxic. Always ask for the name of the material you are getting. You can even request to see the box/bottle. Ask how many units (for Botox) and/or what volume (for fillers) is being used. If you only go to Board Certified Plastic Surgeons or Dermatologists you should be safe, but it is always important to be careful and informed. If something sounds too good to be true – it probably isn’t!
Wednesday, February 1st, 2012
ELASTIderm® Eye Complete Complex™ Serum
A NEXT-GENERATION, PATENTED ELASTIDERM EYE FORMULATION THAT HELPS IMPROVE THE STRENGTH AND RESILIENCE OF SKIN AROUND THE EYES
ELASTIderm® Eye Complete Complex™ Serum helps tighten delicate periorbital skin
Patented formulation with caffeine provides an added boost
- Bi-mineral complex: Helps replenish elasticity and support collagen for tighter,?smoother-looking skin
- Malonic acid: Helps stimulate the production of healthy skin cells?for overall skin improvement
- Caffeine: Improves appearance of under-eye puffiness
Soothing, innovative rollerball technology
- Helps reduce under-eye puffiness
- Optimizes delivery of serum for firmer, youthful-looking eyes