Tear Trough Treatment

tear troughs 1

BEFORE

tear troughs 2

AFTER

Are you bothered by dark circles under your eyes?  This is a common complaint from patients and the good news is, you can do something about it!

If volume loss in the tear troughs is a contributing factor to the darkness you are perceiving, a dermal filler can help to replace the lost volume.  The above patient received 1 ml of Juvederm® Vollure, a half syringe per side.  The amount of filler in this area varies depending on the amount of volume loss.  Less can be more as an overfilled tear trough can have an aesthetically unnatural appearance.   I utilized a cannula for this treatment to minimize bruising and risk of intravascular product placement.  The product was placed below the muscle.  A small amount of product was put in the upper medial cheek as well to create a buttress of support.  Frequently, as we age, the tear trough extends in to the cheek (nasojugal groove) which can also be corrected with the filler.

In this case,  the patient left the office with two tiny dots on her cheeks where a needle was used to create an entry point for the cannula. (full disclosure, even with a cannula there can be bruising)  Otherwise, she was thrilled and felt she looked rested and rejuvenated after an easy 30 minute appointment!

There are scenarios in which the shadowing is due to the pigment in the skin as well as volume loss in this area.  In those cases topical products can help lighten the skin slightly.  Darkness under the eyes can be difficult to address due to the fact that the tissues here are quite a bit thinner than other areas of the face.  Right under these tissues is muscle, which is slightly blue, and this can show through these thinner tissues.  Vascular bodies in this area can also create shadowing.  You can evaluate with your provider what can be addressed and what realistic expectations would be in your situation.

If you opt for filler under the eyes avoid medications and supplements that may thin your blood for 1-2 weeks before your appointment. (ibuprofen, aleve,  aspirin, fish oil, vitamin E, etc)  We use HA fillers only for tear trough volume as it has the highest safety profile for this area.  HA (hyaluronic acid) can be dissolved if needed with an enzyme.

Lastly, the good news is,  we find filler lasts quite a while in the tear troughs compared to other areas of the face.  I have had patients who still look corrected at two years.

 

 

 

 

IPL FOR MEN

 

man ipl before 2

man ipl after 2

Men are great candidates for rejuvenation with IPL (intense pulsed light or photo facial).   A lifetime of sun exposure has the same effect on their  skin as it does on us ladies.  Using the broad band of wavelengths available with an IPL we can target numerous skin conditions.

The above individual had 1 IPL to treat the hyperpigmentation and capillaries and saw dramatic improvement. He is a candidate to further clear the  remaining pigment and visible blood vessels.  He had minimal cosmetic downtime with this treatment and was able to conduct his professional and personal obligations without missing a beat.  The normal pigmentation darkening occurred and was gone in a week.

With IPL we are able customize a treatment based on the clients concerns and our assessment.  IPL is typically used to treat hyperpigmentation and redness.   Different filters are selected during the treatment to target a variety of skin discolorations.  Often a number of passes are completed in order to treat all the targets.

Hyperpigmentation (the brown pigment, most often from uva/uvb exposure) typically ‘peppers’, or darkens.   This peppering usually flakes off  by days 5-7.  There is minimal discomfort.  Patients are encouraged not to pick or remove the peppered areas, as this can lead to scarring.  The pigmentation, in some cases, is gone after the peppering resolves.  In other cases the pigmentation is lighter than before, but may need additional treatments.

Redness, either diffuse or individual capillaries, is treated effectively with IPL as well.  In some cases, if the capillaries are larger and dilated, there can be bruising following a treatment.  This is not common, but can occur.  Nasal veins are frequently stubborn and need to be treated more than once, as larger vessels lower in the skin keep those vessels dilated and “fed”.

Encouraging skin care that can compliment these treatments, and help protect the results, is important.  At the very least a topical antioxidant (such as vitamin c) and a sunscreen with zinc should be used on a daily basis.  There are other products that can be introduced depending on the individual and their primary concerns.   A retinol/retinoid can be helpful.  There are situations where there is remaining pigmentation that the IPL is not effectively treating.  A topical combination of a retinoid/hydriquinone/kojic acid/fluocinolone (a steroid)  can be compounded to resolve remaining skin discoloration.  This combination is frequently referred to as Kligman’s Formula.

This is a great time of year to have an IPL, or series of IPL’s, as sun exposure is not as prevalent in the winter months.  Sun avoidance is an important pre and  post care instruction to follow.

man ipl before

man ipl after

I look forward to helping this client further resolve his discoloration.

Fellas, don’t hesitate to seek professional aesthetic treatments if you are noticing changes you are unhappy with.

And, we do everything we can to make it as comfortable as possible!

 

 

MENOPAUSE AND YOUR SKIN 101

MENOPAUSE

Menopause can take a toll on us.  The hormonal shifts have both emotional and physical effects.  Some of it is out of our control, but a lot of it can be managed.

As our estrogen levels drop we notice changes such as hot flashes, changes in our skin and hair, difficulty sleeping, fatigue, irritability and decreased sex drive.  (to name just a few)  As an aesthetic nurse I am frequently asked what can be done to help with some of the skin changes.

Obviously, it goes without saying, that having a healthcare provider to help you manage the medical aspects of “the change” is in your best interest.  HRT (hormone replacement therapy) is a viable option for many of us, but not everyone.  Some individuals may have contraindications for HRT.  If it is an option, estrogen replacement can help alleviate many of the symptoms of menopause.  Each individual has to look at their own medical history and determine what is the best approach for them.

ESTROGEN AND OUR SKIN

As our ovarian function declines,  we lose estrogen production.  A side effect of this is the loss of collagen.  Estrogen helps the body with the production of Collagen I and III.  Additionally, estrogen supports oil gland activity, elastin and subcutaneous fat.  We notice this as we discover our skin thinning, new wrinkles, sagging, dry skin and less volume.  We can provide support to our skin as it experiences menopause related changes.  Here are a few ideas….

  • Eat a healthy diet full of antioxidants. (eat lots of colors!)
  • Try to incorporate soy into your diet.  The isoflavonoids in soy mimic estrogen.
  • Drink plenty of water/stay hydrated.
  • Try to sleep 8 hours a night.  (easier said than done, I know)
  • Wear sunscreen every day, rain or shine!  UV rays break down our collagen.
  • Use a topical antioxidant prior to your sunscreen every day.
  • Utilize a retinol/retinoid (Vit A) product topically at night.  Studies show this helps stimulate new collagen.
  • Utilize peptides in your skin care.  It is proven that various peptides help support the production of collagen and elastin.
  • Use a gentle non-stripping cleanser.
  • Exfoliate your skin.  A physical exfoliant or lighter chemical peel exfoliant.
  • Look for hyaluronic acid in your skin care.
  • Utilize fillers/fat transfers to replace lost volume.
  • If dryness is an issue, make sure your moisturizer is replacing enough moisture so your skin feels comfortable.

There are other issues I hear complaints of related to menopause.  Facial hair growth is a common complaint.  (as estrogen levels drop and our androgen hormones become more dominant)  If there is pigment in the facial hair, laser hair removal is a fantastic option.  If the hair is light or has no pigment, electrolysis is a better option.  There are  also prescription creams that can decrease facial hair growth.

Acne can be a problem that resurfaces at this point.  Again, due to the dominance of androgen hormones our skin can have thicker sebum production.  Retinoids/retinols can be helpful.  For more serious issues your health care provider can help you decide if Spironolactone (a prescription) is an option for you.  The Spironolactone helps suppress the androgen hormones, helping both with hair growth and acne.

Estrogen also helps control our melanocytes.  As we lose the estrogen, hyperpigmentation can become more of a problem.  So, this brings us back to sunscreen and topical antioxidants to protect from UVA/UVB.

For those wanting to go the extra steps to help with collagen production and repair prior damage, there are numerous laser modalities available that make a considerable improvement and difference.  I am currently a fan of  HALO™, IPL’s and Ultherapy®.

I read that we spend 1/3 of our lives in menopause based on the average life expectancy in the developed world.  We can make it feel good and look good ladies!

I’ll finish with a current list of favorites.

SUNSCREENS

The entire line of Elta MD® sunscreens are excellent sunscreen options.

c-e-ferulic

The Skinceuticals line has excellent antioxidants.  Both CE Ferulic® (for drier skin) and Phloretin CF® are great options.

alastin retinol

Alastin® Retinol at night is effective, yet gentle.

Alastin Restorative Skin

The Alastin® Restorative Skin Complex has numerous peptides and antioxidants.  This stimulates collagen and elastin.

Both SkinMedica® and SkinCeuticals offer hyaluronic acid products that effectively boost hyaluronic acid in the skin.

triple lipid restore

SkinCeuticals Triple Lipid Restore is an excellent hydrating cream for those with drier skin.

All of the mentioned products are available at TOC Medical Spa.

We have a sale this month too!

10% off one product

15% off two products

20% off three products

Hope this is a little informative 🙂

 

 

 

 

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.