NATURAL RESULTS

At times patients express hesitation about moving forward with aesthetic treatments because they worry about looking “done”.  There have been enough procedures performed where a person does not look natural, and almost looks like a caricature of their former self.   We have all seen people with either lips or cheeks that mother nature would not have created.  Even celebrities, with deep pockets who can afford to be treated by the most reputable injectors, have become victims of “too much”.

courtney cox

Unfortunately, these examples give the whole industry a bad name. (the actress in the above photos has admittedly been over treated and has since then had a lot of the filler dissolved)

Most injectors will discuss your goals with you and come up with a plan to make you look restored and rejuvenated,  but not “done” or radically changed.  It can be helpful to bring photos of yourself when you were younger to allow you and your provider to review where age related facial changes have occurred.  You can then come up with your individualized rejuvenation plan.

Neuromodulators can help to balance out your depressor muscles, which pull down, and your levitator muscles, which pull up, or lift.  Treating fine lines and creating balance in the face with neuromodulators can have a rejuvenating effect.  Additionally, restoring lost volume and correcting asymmetries with dermal fillers can further restore or correct changes in your face that may be bothering you.  We often note that an individual has more volume loss and skin changes on the side of the face they predominantly sleep on.  This can be subtly addressed with filler, restoring symmetry.

In addition to injectables, you and your provider may decide that skin rejuvenation with laser or light devices may help to improve the appearance of your skin.  There are lasers that can do an amazing job removing hyperpigmentation, improving skin tone and texture and tightening and lifting the skin.

If you have thought about seeing an aesthetic provider but have shied away because of seeing individuals who look overdone, rethink it.  Medical aesthetics can offer a wide range of options to help you look your best.

 

 

My HALO Journey

As I mentioned in my last post, we now are offering Halo™ by Sciton at TOC Medical Spa.  I had my treatment March 19th and took a series of photos and took notes about my experience to better inform our patients.

immediate before halo

Before Halo/March 19th

immediate post halo

Immediately after Halo™

The days after treatment:

 

Day One

March 20th

Day Two     March 21st

Day Three      March 22nd

Day Four      March 23rd

By day five and six most of the brown had detached and sloughed off.  Unfortunately my photos from these days were lost:-(

Day Eight

March 28th

(still a small amount of malar swelling)

I wore topical numbing for approximately 45 minutes before the treatment.  The treatment itself felt like prickly heat.  The heat accumulates and becomes more uncomfortable with repeat passes with the laser.   A cool chiller is utilized along with the laser and helps to alleviate some of the sting.   The face is treated in 5 zones: each cheek, each side of the forehead and then the nose.  The perioral area is treated with the cheek zones.  I thought the most uncomfortable areas were the forehead and upper lip.  I think we all experience the sensation a bit differently so 4 people could have slightly different descriptions.  Post treatment, my face felt very hot for 45 minutes.  This seems to be consistent with everyone we have treated.  I drove home with the AC blasting on my face for most of that time.

At TOC we are recommending very gentle products post treatment for up to 5 days.  We are providing our patients Cetaphil Gentle Cleanser, Cetaphil Moisturizing Lotion and Aquaphor.

As you can see in the photos there is redness and swelling after the treatment for up to 5 days.  By day 2 a bronzing appearance and rough (sandpaper like) texture evolve.   This is the microscopic necrotic skin cells coming to the surface.    These slough off, in most cases, by day 5.  It is not unusual to have a few acne blemishes post Halo™, which I did.

I had swelling in the periocular and malar (cheek) area for a solid 7-8 days.  This is not typical, however.  Most patients have resolution of swelling by day 5.

Halo™ by Sciton helps with pigmentation, texture and the appearance of pores.  Improvement will continue to be seen over the coming months as the collagen stimulation triggered by the treatment can take months to be fully realized.

This is me today, 2 1/2 weeks post treatment.

April 5th

The treatment definitely lifted hyperpigmentation and brightened my complexion.  The results are impressive for one treatment with minimal downtime.  (mind you, I felt unsightly for a few days due to the swelling!)

Sun avoidance is very important after a Halo™, so sunscreen and big hats should be at the ready.   Most patients can return to their normal skincare routine at day 5-7, which will always include a sunscreen 🙂  We treat everyone prophylactically with antiviral medication (Valtrex) as the treatment can trigger a outbreak of cold sores.

Hope this helps and that my series of mug shots aren’t too much!

Have a great weekend!

 

 

 

HALO AT TOC MEDICAL SPA

Halo

We are very excited to have a new toy here at work!  The Halo™ laser has joined the office as another tool to help our patients look rejuvenated.  The Halo™ is a hybrid fractional laser which can achieve excellent results in 1-3 treatments.  Some of the fractionated lasers before would take 5-6 treatments to achieve the same results.

The Halo™ consists of two wavelengths, a fractionated ablative 2940 and a non ablative 1470.  Each wavelength is customizable depending and the goals of the particular patient and how much downtime they can afford.  Traditionally, ablative lasers required too much down time and the non ablative lasers would have underwhelming results.  With the hybridized combination of the two we are able to target pigmentation and texture issues in this fractionated laser treatment while providing minimal downtime.  (or ablative like results with non-ablative downtime)

Skin issues we are able to target with this treatment include:

  • wrinkles
  • discoloration/pigmentation
  • scars
  • skin laxity
  • uneven tone and texture
  • the appearance of enlarged pores

The 2940 wavelength really targets the pigment and discoloration in the upper layers of the dermis while the 1470 is able to create an injury deeper in the dermis and initiate the bodies own cascade of wound healing, creating new collagen and elastin.

The Halo ™ glow is what patients are thrilled with after treatments.  The texture and pigmentation which absorbs light normally is gone, allowing the light to reflect off the tissue.  Here is a series of photos of a patient who had a Halo™.

halo day by day

This is what we have seen here with the patients we have treated.  There are approximately 5 days of cosmetic down time.

In addition to the hybridized Halo ™ treatment we are able to combine BBL, or broad band light, with the treatment on individuals with lighter skin types.  The BBL works in synergy with the Halo at targeting discoloration and redness.  Either treatment can also be a stand alone treatment.

Once your skin is where you want it “Forever Young” treatments can be performed with the BBL to maintain the results.  The treatments can be performed 3-4 times a year to maintain the clearing of hyperpigmentation and redness.  Additonally, the BBL can actually affect the DNA/RNA sequencing of the skin cells.  Photo aged and intrinsically aged skin cells can express like younger skin after BBL treatments.

As with all light based and laser based treatments, strict sun avoidance is recommended before and after your treatment.  The use of a sunscreen with zinc is highly recommended.  There are other skin care products that can help to optimize your pre and post treatment course which your provider can help you choose.

Stay tuned for more positive reports on the treatment!

RESTORING YOUR LIPS

When assessing and treating a patients lips there are several subtle changes that can rejuvenate the mouth area without making the lips look “done”.  Although some patients want much fuller lips, a lot of us prefer subtle changes.

old lips

young lips

lip comparision

As we age our upper lip changes in several ways.  We tend to lose the definition along the vermillion border, the philtral ridge/columns (the vertical columns that start at the tip of the cupids bow and end below the nose) flatten and the space between the upper lip and nose elongates.  Subtle changes can be created with easy injection techniques, including defining the vermillion border, restoring the philtral columns and accentuating the cupids bow.  Restoring the philtral columns frequently make the lip lift slightly.  Filling these columns can return the contours that were likely once there.  Vertical lip lines can be softened as well.  Small amounts of filler can be placed within the lip itself to restore lost volume.  There are many fillers to choose from these days,  giving the patient and provider options, depending on the treatment plan.  Fillers vary in their hyaluronic acid %, viscosity, elasticity and cohesiveness.

When assessing and treating the lower lip there are several changes that can have a nice impact,  other than just looking fuller.  Again, the vermillion border can be defined and fine lines can be corrected.  The oral commissures, which tend to turn down as we age, can be turned back up with filler placement techniques.  Volume restoration can be completed to obtain the desired effect.

The ideal balance of upper lip to lower lip is 1/2 to 2/3’s.  This does vary individually and you and your provider can decide the best proportions for you.

In addition to fillers, small doses of Botox® or Dysport® can be utilized to relax muscles in this region of the face.  If a person tends to purse their lips  Botox® or Dysport® can be used in the muscle surrounding the mouth (the orbicularis oris) to minimize the pursing.  This injection technique also tends to roll the upper lip up and out slightly, making it appear slightly fuller.  Additionally, for a gummy smile,  an injection a little higher (closer to the nose) in the upper lip can relax the muscle that lifts the lip up.  This injection prevents as much gum tissue from being exposed with animation.

Another placement of Botox® or Dysport® that can help in the lower face and lip area is treating the depressor anguli oris ,(DAO) which, in some individuals, pulls down the sides of the mouth.  Very small doses are utilized in these muscles to help minimize the appearance of frowning.

As with all facial injections, make sure your provider has a thorough understanding of facial anatomy.   Ask if there is an “emergency kit” for injectables in the clinic.  (a kit containing an enzyme to dissolve filler, should it be required)

Do not worry that having injectables in the mouth area will leave you with unnaturally big lips. (which we have all seen) If you and your provider are on the same page, you can obtain a natural restoration of the volume and definition you once had.

 

TIMING

CLOCK

Timing your aesthetics treatments well can make a big difference.  Regular maintenance or preparing for a special occasion can benefit from good timing.

Botox®, Dysport® and Xeomin® take two weeks to take full effect.  If  you receive your treatment on a Monday hoping to look “relaxed” by the weekend, you will be disappointed.  For special occasions, I recommend doing the treatment approximately a month before the big day so that if any touch ups are required at two weeks there is time for that to kick in as well.  This also allows time for any bruising that you may experience to fade.

For fillers I think a month ahead is also a safe timeframe, for the same reasons.  I have had experiences with patients who have a treatment too close to a special occasion (against my better judgment) and THAT is when they get the biggest bruise ever!  I personally will not do treatments close to a special occasion anymore,   I like to allow time for any negative side effects to resolve.

If you are wanting to improve pigment and texture issues before a special occasion I recommend allowing up to 6 months to complete a series of treatments to improve the appearance of the skin.  For instance, 3-5 IPL’s (depending on the extent of the sun damage) are ideally completed 4-6 weeks apart.  This would be a similar schedule for a series of skin peels.   More aggressive laser treatments would also benefit from a 6 month window to allow the skin to heal and the collagen to build (collagenases).

For those seeking a last minute “pick me up” there are facials, such as Hydrafacial MD®, that can brighten up your complexion with no down time.

Your provider can discuss a plan to address your issues and goals.  Together, you can come up with a plan that allows appropriate timing for the best outcome!

 

 

 

DID YOU KNOW?

Ulthera

Did you know Ultherapy® can help with skin texture issues as well as provide lifting and tightening of the tissues?  There are multiple treatment heads, or transducers, that your provider can choose from to customize your treatment.  During an Ultherapy® treatment multiple transducers are used to target  different depths of the dermis.  The most superficial depth, a 1.5 mm transducer, can be very effective at targeting crêpe skin and superficial lines.  Patients frequently report an improvement in their skins general appearance after an Ultherapy® treatment.  They report an improvement in texture and pore size in addition to lifting and tightening.

Ultherapy ® works by creating a controlled injury in the tissues which stimulates the bodies wound healing mechanisms.  This injury is created with microfocused ultrasound.   Once the body recognizes an injury one of the ways it “heals” is by creating new bands of collagen.  The results are gradual as the neocollagenesis (new collagen) can take up to 6 months.  This treatment is ideal for the patient who is not ready for a surgical option but wants to see improvement with minimal downtime.   This is a treatment a patient can receive and be back to normal daily activities the same day.

If there are small treatment areas where the problem is related to skin texture “mini” treatments can be performed with just the 1.5 mm transducer.   Most practices can customize a plan based on your personal issues and treatment goals.

Ultherapy® is the only FDA-cleared nonsurgical skin tightening device using ultrasound, allowing the provider to see precisely where in the tissues the thermal injury will be delivered.

I

 

DECADES

aging face

Our skin care needs change as we age and it is easy to be overwhelmed by all of the choices out there.  This is a quick guide through the decades.

THE 20’s

In our twenties we are generally enjoying the glow of our youth.  This is a time when we frequently take for granted our smooth and plump skin.  This can be a time when we do a lot of the damage we regret years later.  This is a good time to be committed to a supportive skin care regime.

  • Sunscreen is a no brainer.  Ideally with zinc or titanium to assure long lasting, broad spectrum protection.
  • A topical antioxidant to ward off additional UV and free radical damage. (Vitamin C for example)
  • A retinol or low dose retinoid to keep those skin cells turning over and to help manage occasional breakouts.
  • This is the time to introduce an eye cream.  Remember, an ounce of prevention is worth a pound of cure.  You will thank yourself later in life.
  • For spot treatment of blemishes a product with salicylic acid or benzoyl peroxide can be applied.  More is not better because you may replace your blemish with a dried scab which can then hyper pigment.
  • By now you have probably made the correlation with diet and skin and are aware that a healthy, well balanced diet helps all of your organs, including your skin. (in addition to not smoking!)

THE 30’s

Throughout our thirties we start to see subtle changes from exposure and repetitive muscle movement.  In addition to a supportive skin care regime we might consider extra steps to help during this decade.  We are producing less collagen and elastin by now and are starting to notice.

  • Botox® can be introduced to manage lines from repetitive movement. (frown lines, crow’s feet, etc)
  • Chemical peels can help to lift the outer layers of the skin diminishing pigmentation and fine lines and wrinkles. Collagen is stimulated in this process.
  • IPL’s can minimize pigmentation and redness in the skin.
  • Some patients opt to introduce small amounts of filler in their thirties where they are seeing changes related to volume loss.

THE 40’s

As we begin to experience shifts hormonally and as our estrogen levels drop we lose even more collagen, elastin and facial fat.  Our bones are also shrinking under all of that creating more changes we may not love.  Our sebaceous glands are producing less sebum and dry skin may become more of a concern.

  • Continuing with a skin care regime involving sunscreen, antioxidants and a retinol/retinoid is a must.  You may opt to increase the strength of the retinol/retinoid.
  • Additional moisture is frequently needed.  Look for products with ceramides, for instance.
  • Facial volume loss can be managed with an expanding menu of dermal fillers.
  • Botox® can be used to help “lift” when your injector relaxes the muscles pulling down (depressor muscles) allowing the elevator muscles to lift unopposed.
  • IPL’s and more aggressive lasers (fractionated erbium and CO2 for example) can be utilized to manage skin discoloration and texture changes.  Collagen stimulating treatments, like Ultherapy®, can be used to help combat the loss of collagen.
  • Neck, chest and hands can benefit from all of the above!

THE 50’s , 60’s, 70’s and 80’s (and beyond)

In our fifties  we are likely approaching menopause and are continuing to see age related changes.  As we continue in to our sixties and beyond this becomes more of an issue as post-menopausal skin experiences more age related changes without the support of estrogen.   We probably need to boost our moisture as our skin becomes drier.

  • Continue with the three pillars in skin care: sunscreen, antioxidants and retinol/retinoid.
  • Some find it helpful to cut back on the % of their retinol/retinoid to combat  dryness.
  • Increase moisture as needed.
  • Continue to see your provider to determine if Botox®, filler and various laser modalities can help obtain your aesthetic goals.
  • If surgery is appropriate, find a surgeon you trust and have vetted.