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.

 

 

 

 

A DRINK THAT MAKES YOU FEEL AND LOOK BETTER! WIN/WIN!

8greens

A drink is not what I expected to be featuring on this blog, but I have become a fan of this particular product.  I struggle to drink the fluid I am supposed to, (other than my morning coffee and a margarita here or there!)  so a product that tastes good and has health benefits is a win for sure.

8greens or 8G was developed by a woman looking to improve her own health.  Dawn Russell, a cancer survivor, was seeking ways to improve her daily intake of nutrient rich food, greens in particular.  Over a number of years she was able to perfect her recipe and deliver a product that tastes good (refreshing citrus flavor) and provides the consumer with a kick of energy producing nutrition.

8G contains spinach, wheatgrass, kale, bluegreen algae, spirulina, aloe vera, chlorella and barley grass.  This proprietary blend, according to the web site, has:

  • as much Vitamin C as 6 oranges
  • as much B12 as 7 cups of milk
  • as much B5 as 15 cups of broccoli
  • as much B6 as 6 cups of spinach
  • as much zinc as 10 cups asparagus
  • is alkalizing
  • decreases inflammation
  • increases circulation
  • increases collagen

It does not have:

  • sugar
  • wheat
  • gluten
  • allergens
  • dairy
  • preservatives
  • salt

The greens are dehydrated (with no enzymatic or chemical  breakdown of the nutrients  in the process) and are in small effervescent tablets that dissolve quickly in water.

One a day is recommended although as many as 3 a day are considered fine.  I felt the need to figure out the price per serving as the product is not inexpensive.  I buy the six packs which are $78.  Each tube has 10 tablets so that comes out to approximately $1.30 a serving.  My soda machine here at work is $1.00 a soda so it actually seems pretty reasonable to me.  And a whole lot healthier!

What I notice when I drink an 8G is more energy and focus, likely due to the B vitamins.   I like the idea of getting extra greens as I love my veggies and eat a lot of salads, but know I frequently do not get the recommended daily intake of greens/veggies.   It is a way to help with my hydration, which I struggle with.  I try to have one 8G a day and a cup of green tea.  Two  fluids with health benefits.  I tell myself my morning coffee is also loaded with antioxidants:-)

The product is available on the 8G website, 8greens.com, and at Nordstrom and Neiman Marcus.

If you are a soda drinker, this is a great replacement.   Cheers!

 

 

CURRENT FAVORITE EYE PRODUCTS

I have a few eye products in my rotation and feel they all have passed the test of time.  I have been using several of them for a number of years.

My two favorite eye creams, which I have at all times, are:

Alastin Eye

Alastin™ Restorative Eye Treatment™

  • Tri-Hex Technology™ which is a group of peptides that help to stimulate elastin and collagen, minimizing fine lines and increasing skin turgor around the eye area.
  • strengthens skin which helps to minimize any sagging, especially of the upper eye lid.
  • reduces puffiness and dark circles
  • brightens and evens skin color
  • has a gel like consistency,  although it is a cream, I like using it as an AM eye cream because it wears well under eye make-up.

microeye

Neocutis Micro⋅Eyes Rejuvenating Balm

  • Utilizes MPC™ technology which is also a group of peptides which have anti-aging skin benefits.
  • minimizes fine lines, crepiness, puffiness and dark eye circles.
  • wild yam and moisturizing lipids fight dryness and textural issues.
  • THIS is a super hydrating eye cream if you have issues with dry skin in the eye area.  It is like butter! (in a good way)
  • I like this product at night, as it is hydrating enough that I prefer a lighter cream during the day under make-up.

 

maybelline

Maybelline  Instant Age Rewind® Treatment Concealer

  • This very reasonably priced product has been on the market for a number of years and is available at your local grocery or drug store.  It is a product I use under my eyes everyday as part of my make-up routine.  It works just as well as any high end under eye concealer I have used and has the added benefit of having several peptides in its ingredient deck.  I prefer the brightener, which is a pinker shade and really brightens the undereye area.  The product is available in multiple shades for a variety of skin tones.  My feeling is if I am using an under eye concealer on a regular basis, why not have it have benefits for my skin!  I think I have been using this for 7+ years and occasionally try a higher end option, but go back to this tried and true product.

 

VYCROSS TECHNOLOGY

 various vycross

It has been a while!  I hope everyone had a good summer and that the new school year is off to a good start!

I thought I would do a quick blog on some of the newer HA (hyaluronic acid) dermal fillers that have come on the market.  As an injector I have been utilizing Allergan’s offerings with Vycross® technology.  These products inject very smoothly, have good malleability and moldability and tend to create less swelling for my patients. (not ZERO swelling, but less)   As an injector it makes my job easier and for my patients the treatments are well tolerated.  Additionally, the product lasts longer due to Vycross® technology.

The Juvederm® family of products have been available for a number of years.  Juvederm Ultra® XC and Juvederm Ultra Plus® XC utilize hylacross technology, the predecessor to the newer line of products.   Vycross® technology blends different molecular weights of hyaluronic acid and have enhanced cross linking to increase the duration of the product in the dermis.   The newer products, Juvederm Voluma®, Juvederm Vollure™ and Juvederm Volbella® have given injectors and patients more options to choose from.

The products have differences which make them suitable for different areas of the face.  Voluma® has 20 mg/ml of Hyaluronic Acid, tends to be very cohesive and is frequently utilized in the mid face to replace lost volume and to create lift.  Vollure™ has 17.5 mg/ml of Hyaluronic Acid and tends to be much less cohesive than Voluma® and works well in areas where finer correction or more subtle volume is desired.  Volbella® has 15 mg/ml of Hyaluronic Acid and works well in fine lines, such as perioral lines (smoker lines).  Volbella® smooths very easily once injected.  In general, the less the HA concentration the softer and smoother the product.   You and your provider can determine which products to use to achieve your aesthetic goals.  It may be that you can benefit from several of the products.

vycross face

All of the products mentioned have 0.3% lidocaine added to make the injections less painful.  I also pretreat with topical numbing and use ice during the treatment.  There are also occasions when a 2% lidocaine dental block is helpful.  For example, lip injections.

The duration of the products varies patient to patient and the companies literature tends to promise more than it can deliver.  BUT, I do find these products are outperforming their predecessors and longevity has improved.  All of the HA fillers have a good safety record and have minimal side effects.