Posts for: January, 2018
Dr. Alex attended the fourth annual Advanced Aesthetics and Cosmetic Dermatology conference January 19-21, 2018 at the scenic Marina del Rey Hotel in Marina del Rey, CA. This is a multi-specialty conference which focuses on discussing and demonstrating novel treatments, modalities, devices, and techniques in the field of non-surgical aesthetics. The conference was organized by Angela O’Mara and Giles Raine of The Professional Image, marketing and public relations consultants for cosmetic physicians. The course director was renowned Los Angeles dermatologist Dr. Lawrence Moy.
As with other conferences, this was another outstanding educational opportunity for Dr. Alex to learn about what’s new in the field of cosmetic medicine. The weekend started with a practice marketing summit, which included talks by internationally recognized speakers including Ron Harley of Solution Reach and Sam Peek of Incredible Marketing. The speakers focused on how to optimize a practice to provide the best service for patients. The weekend sessions continued with many speakers on a variety of topics such as chemical peels, dermal fillers, and laser rejuvenation. Dr. Alex had the pleasure of attending a seminar by his friend and colleague Dr. Patrick Bitter, Jr., the pioneer of IPL treatments for rejuvenation of the skin, from whom Dr. Alex has learend a significant amount about light-based treatments. This talk focused on a variety of new applications for IPL including treatments for wrinkles, skin tightening, pain, feminine rejuvenation, and male enhancement. Dr. Alex also had a chance to network with a number of friends and colleagues including Dr. Sherley Soleiman of Cosmetic Injectables in Encino, CA, Dr. Kian Karimi of Rejuva Medical Aesthetics in Brentwood, CA, and cosmetic dermatolgist Dr. Jason Emer in Beverly Hills, CA. In addition to the seminars, the program included live demonstrations of treatments such as fillers and thread lifts. These unique sessions are valuable educational opportunities for all participants. The exhibit hall included representatives from many companies including Alastin Skin Care (makers of the Skin Nectar), In Mode Aesthetics, Solution Reach, and Incredible Marketing. Dr. Alex looks forward to attending more such events in the future.
Myth: Botox is not safe.
The safety record of Botox is well established. Botox has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.
Myth: There are creams that work better than Botox.
Topical creams work on the surface of the face. Botox works on the muscles under the skin which cause the deeper wrinkles to form. Once the muscles relax, the skin overlying it can smooth out. When used in combination with A E Skin products such as the Brightening Cream, better results are seen because treatment is directed at both the superficial and deep wrinkles.
Myth: Botox is only for the rich and famous.
According to the Aesthetic Surgery Education Research Foundation Botox Cosmetic Use Survey of 1048 patients (2005) the most common users of Botox are working mothers aged 40-55; and those with an annual household income of less than $ 100,000 are more likely to use Botox than those with an annual household income of more than $ 150,000. And with the Allergan Brilliant Distinctions Program, patients are able to save on every Botox treatment.
Myth: Botox is only for old people.
A common misconception is that Botox is only for those who are in their 60's or 70's. On the contrary, we have a lot of patients in their 20's who receive Botox. This is either for prevention or for those who have expressive faces. I find that the younger one is when one starts receiving Botox treatments the more signs of aging will be delayed. In other words, Botox can be used to prevent wrinkles from either appearing in the first place or from getting deeper over time.
Myth: Botox isn't for men.
A common misconception is that Botox is only for women. On the contrary, similar to women, many men are concerned about their appearance and want to look their best. In the past several years Botox and other cosmetic treatments such as fillers and laser rejuvenation have become more and more popular in the male population. It is also important to understand that men have different facial features than women and a masculine appearance is desired. Therefore, an expert injector should understand the anatomic differences between the genders and know how to use the product to produce desired results. One example is the position and shape of the eyebrow. While the ideal eyebrow for women is high with an arch, men have lower set brows that are more horizontal. It is critical that the product is placed in the correct positions on the face to avoid feminizing the eyebrows.
Myth: It is safe to have a Botox treatment during pregnancy or when breast feeding.
Although Botox is one of the safest treatments offered, there are some situations where it is not appropriate. The safety and efficacy of Botox treatments have not been determined in women who are pregnant, trying to become pregnant, or breast feeding. There is also no evidence that Botox crosses the placental barrier, but such studies have not been published. While some physicians are comfortable treating women who are pregnant, trying to become pregnant, or breast feeding, in the absence of data we err on the side of caution and recommend that my patients avoid Botox and other such cosmetic treatments until they are no longer breast feeding.
Myth: Botox can only be used in the upper face.
Although Botox is most frequently used in the upper face, it can also be used in various areas in the lower face. The nasalis muscle on the bridge of the nose is responsible for the bunny lines that are sometimes seen there when one frowns or smiles. Botox can be placed in the orbicularis oris muscle around the lips to provide a pout to the lips and reduce the appearance of vertical lines around the lips sometimes called smoker’s lines (although they are seen in people who do not smoke as well). Botox can be placed in the depressor anguli oris (DAO) muscle to elevate downturned corners of the mouth which sometimes produce a sad face appearance. Botox can be placed in the mentalis muscle on the chin to address a cobblestone appearance or dimpling on the chin. Botox can be placed in the masseter muscle in the lower face to contour the lower face and address pain associated with TMJ. Botox can be placed in the levator labii superioris alequae nasii (LLSAN) muscle located just beside the nose on either side to address what is called the gummy smile. The gummy smile is seen in some people whose upper lip elevates so high when they smile that the upper gums are seen in addition to their upper teeth. Botox can be placed in a vestigial muscle (seen in some people) called the depressor septi nasii to prevent the tip of the nose from moving downward when smiling. Botox can be placed just under the jawline in what is called the Nefertiti lift to relax the platysma muscle which pulls down on the lower face, thereby improving jawline definition. When placed lower in the neck Botox can address vertical neck bands.
Myth: Botox will leave me with a frozen face.
Many people are concerned about how their appearance will change after a Botox treatment. This is understandable given the amount of both positive and negative publicity there has been around Botox and other cosmetic treatments. Although results are visible, treatment with Botox does not make you look like you had work done. The muscles causing the frown lines are relaxed, so you can still have expressions, just without the wrinkles. When done properly, Botox will provide a natural appearance that makes a person look more youthful and rested. With the increase in popularity of Botox treatments many offices now provide such treatments. It is important to find an office where the injector has experience and expertise in Botox injections. Look for experience, before and after photographs, and testimonials.
Myth: If I stop using Botox, my face will look different than before.
A common misconception is that if Botox treatments are discontinued the wrinkles will look worse than they did prior to starting the treatments. When Botox treatments are discontinued the treated muscles are no longer relaxed and they are able to contract normally as they did prior to starting the Botox treatments. When this occurs, the wrinkles will begin to reappear and will look as they did prior to Botox treatments. This usually takes three to four months.
Myth: Botox treatments are painful.
One of the most common questions regarding Botox is whether the treatment is painful. We use a painless technique to maximize our patients comfort during the treatment. This starts by reconstituting the Botox with preserved saline, which contains benzyl alcohol, to decrease the discomfort with the injection. We use a tiny needle, similar to the size of the needle used for TB test on the forearm. During the Botox treatment, we provide a relaxing environment by playing a calming video with gentle music. We provide stress balls to our patients to hold during their Botox treatment. We apply cold air on the area which serves to numb the skin. We also use the Beauty Bar, which is a vibration device which distracts the patient from the injection of Botox itself. Finally, with experience, we have developed a technique to inject to minimize pain. This includes pinching the area, pushing the skin into the needle (as opposed to pushing the needle into the skin), using a slight rotation, and using gentle pressure. Most patients are surprised at how comfortable the Botox treatment is.
Painless Botox Treatment Demonstration
Myth: Botox can cause Botulilsm.
Botox was originally obtained from the bacterium Clostridium botulinum, the bacteria that causes botulism. These bacteria can be found in certain foods that are not properly preserved. When it is ingested the bacteria multiplies and spreads through the bloodstream releasing a protein called botulinum toxin, the active ingredient in Botox. As the bacteria multiply more and more of the toxin is released. The botulinum toxin attaches to the nerves on large muscles such as those responsible for breathing or those in the limbs. This makes it difficult to breath and perform activities such as walking. The live bacteria are required to multiply and continue releasing large amounts of the toxin. In the absence of the bacteria, as when Botox is used for cosmetic purposes, more toxin is not produced. Also, the number of units used for cosmetic Botox treatments is miniscule compared to the amount required to produce effects such as difficulty breathing. Finally, the minute amount of Botox used in cosmetic treatments is not enough to pass into the bloodstream and spread to other muscles, as evidenced by the lack of systemic side effects.
Changes that occur around the eyes are common. For example, hollowing under the eyes occurs naturally over time and can be associated with a number of things such as age, weight loss, lack of sleep, and genetics. Depending on the person, a number of treatment options are available.
The first piece of advice for anyone with concerns in the area around the eyes is to use a good sunscreen and a good eye cream every day. Look for a sunscreen with SPF of at least 30 with broad spectrum protection. The A E Skin Green Tea Essentials Enlightening Eye Cream is an outstanding product containing vitamins and nutrients to help with concerns in this delicate area. Improvement is seen in terms of fine lines, wrinkles, dark circles, puffiness, and bags.
Loose Skin Around the Eyes
If the skin around the eyes is loose and has fine lines and wrinkles, treatments should address that. These fine lines and wrinkles occur due to lack of collagen. Collagen is the protein in the skin that keeps the skin firm and tight. As we mature we lose collagen and as a result fine lines are seen over time. Treatments such as the fractional CO2 laser resurfacing can provide outstanding results for such concerns. There may be a week or more of recovery time – redness and swelling. But the results can be outstanding and last for years. This treatment sometimes works for bags under the eyes because it tightens the skin. It will also help with pigment in the area.
Hollowing Under the Eyes
Another common concern is hollowing under the eyes, which is very common. This is due to volume loss that occurs naturally over time. At birth we have a fat pad directly under the eye. As we age, the fat pad gets smaller and the bony structure of the face changes such that the fat pad also descends. This volume loss is seen as hollowing under the eyes. Fillers such as Volbella can be placed to restore lost volume under the eyes. This is a quick treatment and most people enjoy their results for six to 12 months.
Crow’s feet are the lines seen around the eyes (between the eyes and ears) when people smile or squint. These are caused by muscles contracting and can be treated with Botox to relax the muscle. Botox is one of the most popular cosmetic treatments in the world. It is very fast, safe, and effective. Full results are seen by two weeks, but most people start to notice improvement in the first three to seven days. Most people enjoy their results for three to four months, at which point a maintenance treatment is recommended.
The eyelashes are also a common concern. Over time we lose the thickness and fullness of the hairs in this area. Latisse is a prescription-strength product that is applied nightly and leads to darker, fuller lashes. Initial results are seen in about four weeks and full results are seen after three to four months of nightly use. As long as you continue using it, you will continue to enjoy the results. Many people also apply it on the brows to thicken the brows.