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.

 

 

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.

 

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.

 

FAVORITES OF 2016

There are a few stand-out products from 2016!

Alastin Restorative Skin

The Alastin Restorative Skin Complex® has become a part of my daily routine.  I have found an improvement in the texture and tone of my skin using this product regularly.  The skin around my eyes (especially under my eyes) has firmed and there are fewer fine lines.  This product has peptides that help your skin grow collagen and elastin.  Restorative Skin Complex has been written up in numerous publications and has been recommended by multiple dermatologists and plastic surgeons.   It is worth every penny.

c-e-ferulic

Skinceuticals C E Ferulic rotates in and out of my regime, and has for years.  There is unequivocal evidence that this product, loaded with antioxidants, helps neutralize UV and free radicals.  Used with sunscreen, your protection is improved significantly.  90 % of visible premature aging is caused by environmental free radicals.  Sunscreen alone is not enough.  Adding an antioxidant such as C E Ferulic or Phloretin CF gives the skin significantly improved protection.

elta-spf-40-daily

Elta MD® UV Daily Broad-Spectrum SPF 40 is always on my bathroom counter, in my purse and in my car.  With 9 % zinc oxide, the sun protection is superior to any chemical sunscreen.  The formula is not at all heavy, and with  hyaluronic acid , it is hydrating.   I love this sunscreen.

metacell-renewal-b3

Skinceuticals Metacell Renewal B3 is also always in my rotation.  This product helps with hyperpigmentation and, with niacinamide, redness as well.  It has a smooth and hydrating feel without feeling heavy or greasy.  Great product.

voluma

Allergan Juvederm Voluma™ has become one of my favorite dermal fillers.  It is FDA approved for filling the midface, although I use if off-label in temples, tear troughs and lower face.  This filler is wonderful at restoring lost volume while looking very soft and natural.

voluma-2

And, as always, the tried and true merits of Botox® and Dysport® can not be disputed.   The preventative and corrective effects of both of these botulin products are proven in terms of efficacy and safety.  They are here to stay, and when in the right hands, can create a rested appearance.  We have all seen a “Botoxed” face, but that is not how it has to be.  There can be movement and expression  when the muscle activity is minimized rather than frozen.  A rested appearance is the ideal outcome.

Botox cropped

dysport

One more product I have enjoyed this year, and in previous years, The Vi Peel.  In a perfect scenario we would all have a peel every 3-4 months.  Peels help to lift damaged and dull skin, stimulates collagen, fades hyperpigmentation and clears stubborn breakouts.  I love my skin 10 days after the peel is applied.  The Vi Peel is strong enough to see a difference ,but not so strong that there are weeks of downtime.    Great glow!

vi-peel-2

All products and services mentioned are available here at TOC Medical Spa in Austin!

I hope your 2017 is off to a great start!  Here is to your health and happiness!

DO YOU WANT TO SAVE A LITTLE $ ON YOUR COSMETIC TREATMENTS?

There are several programs offered by the aesthetic pharmaceutical companies that are meant to drive patients back in for additional treatments.  They are effective for the companies AND they save the patient money.

I think it is worth utilizing these programs if you are a consumer as it does save you $ on something you were probably going to do anyway.

bd2

Allergan, the makers of Juvederm®, Botox®, Kybella™, SkinMedica® products and Latisse®, has a program called Brilliant Distinctions®.  You accrue points by receiving treatments with your provider, purchasing skin care, and in the case of Latisse®, filling a prescription at your pharmacy.  You simply sign up at www.brilliantdistincionsprogram.com.  When you receive an aesthetic treatment with an Allergan product remind your provider to issue you points at check out.  When purchasing SkinMedica® products also ask the person checking you out to issue points on your skin care purchases.   Check your account before your treatments to see how many points you have accrued and create a coupon.  The coupon are worth anywhere from $10-$80 depending on what you have accrued.  (I have seen patients have more than $80 in their banks)  Points do expire after 9 months so keep an eye on them.  Brilliant Distinctions® also has an on line mall where purchases from participating retailers can also create dollars in your account.  The list of retailers is extensive and includes many commonly shopped businesses.  Maybe your holiday shopping is going to pay for your next Botox® treatment!

aspire2

Another program, from Galderma, the makers of Restylane® products, Sculptra® Aesthetic and Dysport®, is called Aspire.  Once again, you accrue points as you receive treatments.  Go to www.aspirerewards.com to sign up.  You are also able to accrue points in Aspire by taking monthly quizzes, participating in surveys and referring friends.  The Aspire program points last longer than Brilliant Distinctions® points,  although they do eventually expire.

Both programs have smart phone apps that make it that much easier to access and utilize.

If you are a fan of medical aesthetic treatments check these out.  It can only save you money!

YOUR KISSER

cartoon-lips

Lips are an area that we augment frequently in aesthetic medicine.  Contrary to popular belief, lips can be done to look fuller without looking like a cartoon character or Goldie Hawn in “The First Wives Club”.

We lose volume in our lips with age in addition to a certain amount of inward rotation.  Women frequently complain about the loss of volume and fine lines surrounding the lips in to which lipstick bleeds.  These issues can easily be addressed with dermal fillers such as Juvederm® or Restylane®.    The selection of products keeps growing, allowing you and your provider to select the product which best suits your lips.  The Restylane® family of products has  Restylane®, Restylane® Silk and Restylane® Lyft.  The Juvederm® family of products includes Juvederm® Ultra, Juvederm® Ultra Plus, Juvederm® Voluma and, the newest to the market, Juvederm® Vobella.  These are ALL hyaluronic acid fillers and can be reversed with a product called hyaluronidase if needed.

The fillers differ in characteristics including the mg/ml of hyaluronic acid and the cross linking of the particles.  Some of the products are firmer (more cohesive) and are better for structure while others are softer and more malleable for finer work.  Some of the fillers attract more water, or are more hydrophilic,  than others. Your provider  takes all of these properties in to consideration depending on where the product is being placed and what your goals are.

lip-anatomy-2

In terms of the lips we like to add structure and volume.  Redefining the cupids bow and philtral columns in the upper lip can have a dramatic impact without adding any volume to the lip itself.  Our philtral columns tend to flatten with time and we lose the dimensions we had when we were younger.  Your provider will assess with you what you are wanting to achieve while also pointing out to you the anatomy of your lip and where product placement will have the most impact.  The goal is to make your lips look their best, not to make your lips look like somebody else’s lips.  (ie: We have all had patients request Angelina Jolie lips, which would look absurd on most people)

Patients definitely express concern related pain with lip injections.  All of the products contain lidocaine and most providers will numb you with a topical numbing cream prior to injections.  Ice can also be very helpful.  Another option,for those who want to be really numb,is a dental block which numbs the whole region.

Another option around the mouth is small doses of Botox® to weaken the oral muscle that pulls the lip in and creates the fine lip lines.  The dosing needs to be conservative as the goal is to relax the muscle but not paralyze it.

Here is an example of lips before:

lips-before

And lips after:

lips-after

The above patient was treated with 1 ml of Restylane® .

If you have ever considered lip filler, hopefully this will help you to better understand what is available and minimize any anxiety surrounding the process.

We inject lips every day at TOC Medical Spa.