face lift Archives | The Aesthetic Clinique

PDO Threads – The Latest Minimal Invasive Lifting Procedure

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Thread lifting is not a new concept. It was first developed in 1999 by Dr. Sulamanidze in Russia. APTOS Threads (a non absorbable suture made of polypropylene) were used for lifting and tightening skin without surgery. Contour threads of similar make up were introduced in the US in the early 2000’s. There were problems with these procedures. Placement was fairly complicated, requiring deep fixation points with hooks on the suture. The downtime was several days, skin redundancy was frequent, and sutures extruded or needed to be removed. Complications rates were very high and by 2007, the Contour threads were taken off the market. Thread lifting was not ready for “prime time” at this point.

After heading “back to the drawing board”, a simpler, less invasive, less risk thread was developed, PDO Threads. PDO (also known as PDS) sutures have over 30 years of safety use in Cardiothoracic, Plastic, OB Gyn, and Trauma surgical procedures. This material (polydioxanon) is highly flexible, elastic, strong, and absorbable. It is hydrophobic (does not absorb water) so swelling is kept to a minimum. Gradually over 4-6 months, the suture is degraded by the body’s immune system and replaced with collagen. Patients with immune system diseases, on immunosuppressants, or smokers are not good candidates for threads.

The placement of these PDO sutures is done with minimal discomfort (somewhat similar to filler placed with a cannula). They are placed just underneath the surface of the skin and don’t require the deep fixation that the prior threads needed. Downtime is minimal, with only possible bruising holding you back from social events. The risks and complications have been significantly reduced as well. It is extremely rare that a thread needs to be removed because they are much smaller (therefore less noticeable) than prior threads and because they can be dissolved with using heat (most often RF energy). The ability for the threads to dissolve over time increases the comfort level of all involved in PDO Threads. Results can last from 12-18 months, depending on the area treated (lip area is maximum 4-6 months). Only about 30% of the full result is seen immediately. It takes about 3-4 months to see the final result as the body reacts to the thread.

There are 4 design variants of the PDO Threads:

Smooth threads: these are used in areas where collagen stimulation (dermal thickening) is needed. Often they are placed in a cross-hatched pattern. They are commonly placed in areas of superficial wrinkles or crepey skin. Common areas used are: cheeks, neck, marionette lines, glabella, temples, forehead, lip lines, lips.
Twisted threads: these are smooth threads which are coiled. They give more collagen production than the smooth. These are used mainly in the nasolabial folds and marionette areas.
Single Barbed threads: these threads have barb on them (cut with a laser) to lift and tighten sagging skin. Once they are placed, the physician runs his hand over the thread to engage the barbs to help pull the skin up or back. The ideal areas for these threads are the mid/lower face, jowls, and upper neck. Keep in mind these can be used anywhere on the body and some physicians are using these in the knee area, chest, and breast area. Think of these threads as “creating a collagenous tendon” as the body breaks the PDO down and replaces it with collagen.
Double Barbed threads: similar to the single barbs but they have 2 sets of barbs going in opposite directions. They are placed slightly differently and require an exit point as well. Once the suture is in position and engaged, both ends are cut at the level just below the skin. These are used in similar areas as the single barbed threads when cheek fullness is desired or additional lifting is needed.

PDO threads aren’t for everyone. Severe skin laxity won’t be improved with these. It is important that patients are volumized to their fullest prior to or during the procedure. It is vitally important that patients and physicians have realistic expectations for threads. The results won’t be comparable to surgery but will offer improvements which might push surgery out for a few years. The great thing about the threads is that more can be added down the road to maintain or get additional correction.

Dr. Weiner is a physician trainer for PDO Treads (Nova Threads) and was one of the earliest adopters of this new procedure in the US.

Blog: https://stevenfweinermd.wordpress.com/

YouTube: http://www.youtube.com/user/StevenFWeinerFacial

Website: http://www.theclinique.net

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Amazing Things That Can Be Done (By the Experts) With Dermal Fillers

This is the golden age for minimally invasive cosmetic procedures. Who would have ever thought 15 years ago, that procedures done in the office in a matter of 20-30 minutes could result in demonstrable improvements in one’s appearance with results lasting, in some cases, a year or more? Without the need for downtime, anesthesia, or significant costs, cosmetic procedures have flourished, with many people who never would consider enhancements, “dipping their toe” in these procedures. The concept of “preventative maintenance” has spurred the younger generation to start earlier, with smaller, less dramatic, but noticeable procedures as well.

At the forefront of the wave of cosmetic enhancements are dermal fillers. When Restylane was FDA approved in 2003, a revolution in the field was born. Although the main focus was to improve the nasolabial folds, the “smile” lines, in its inception, the broad “off label” use of it, along with subsequent FDA approval of other fillers, treatments have spread to just about every area of the face. There are now about a dozen dermal fillers on the market, with the majority of them based on hyaluronic acid, a naturally occurring substance that is found in skin and joints. Hyaluronic acid fillers (Restylane, Perlane, Voluma, Juvederm, Belotero) provide a soft, very well tolerated fill, with an extremely safe profile. There is also a level of security knowing that these fillers are generally completely reversible, using the widely available enzyme, hyaluronidase, that can dissolve hyaluronic acid, in minutes to hours.

Although less popular, it must be mentioned that there are other dermal fillers which are FDA approved, each with their own niche market. Radiesse is composed of microspheres of calcium hydroxyapatite, and is known as a very robust filler, that has a very high G prime, a measure of it’s lifting ability. Sculptra is composed of Poly L Lactic Acid (PLLA), also naturally occurring as a sugar in the body, and is known as a collagen stimulator. Its use is for global, long lasting, volumization of the face. The longest duration FDA approved filler is Artefill. It is composed of microspheres of Poly Methyl Methacrylate (PMMA) which is a synthetic molecule. Artefill is considered a permanent filler and works as a collagen stimulator, similar to Sculptra.

The understanding of the aging face has made great strides in the last decade. It is now widely understood that loss of volume is the primary cause of the aging face. Leading this volume loss is the shrinking of the multiple fat pads of face, primarily of the cheek and periorbital area. This is why aging often begins to show around the eyes. Gravity contributes to our aging problems and often manifests itself by the descending of these fat pads. Relegated to a less relevant problem than 15 years ago, is the aging related to excess skin. Plastic Surgeons have tightened loose skin for decades during facelifts, often leaving people appearing skeletonized and hollow, but without wrinkles. It is now understood that most of the redundant skin can be improve with proper volumization of the offending fat pads, and most facelifts incorporate this during surgery presently. (In the author’s opinion, most of the patients undergoing the knife could have had their concerns addressed using a combination of fillers and skin tightening devices.)

The common manifestations of volume loss are:

Temporal hollows
Loss of cheek volume
Tear trough deformity
Excessive crows feet and forehead lines
Low hanging eyebrows
Hollowness of the eye (orbit)
Jowls
Poorly defined jawline
Small lips
Dropping of nasal tip
Lip lines (smokers lines)
Corners of mouth dropping causing sad look
Saggy neck
Elongation and narrowing of the face

All the above mentioned aging effects can be improved with dermal fillers. Expertise is required to recognize exactly what areas need to be treated to replenished the lost volume, while still maintaining a natural appearance. It’s been shown that the brain can recognize less than a 1mm change in brow position. When corrections are not done properly, it is very easy for the brain to catch it. Poor corrections of the lips probably stands out in most people’s memory, where they are either too full, out of proper proportion, or there was poor attention to landmarks.

Experienced dermal filler injectors are no longer “chasing lines”, the symptom of aging. The goal is to lift and replenish lost volume by addressing the cause of the aging of the face. Of note, even the neck’s problems can be improved by properly injecting the face. Choosing a doctor that has experience in recognizing the areas affected by volume loss and has the knowledge and expertise to improve those areas is essential for optimal patient outcomes.

Here are Dr. Weiner’s top 5 things “Not to Do” to improve your skin and looks.

There are hundreds of articles on beauty and skin telling you what you should be doing to improve your looks and skin health. I’m going to take the opposite approach. There are numerous activities and habits I see in our office that is just plain counterproductive to what I’m trying to improve. If you just stopped these 5 things, your skin, looks, and sometimes overall health would be significantly better.

Don’t smoke! Without a doubt, this is the worst habit for your skin’s health. The nicotine causes the small vessels in the skin to contract. This “strangulates” the organs and deprives the skin of oxygen and it’s vital blood supply. Toxins from the tobacco enter the blood stream and are distributed throughout the body and skin as well. Worst of all, smoking gives you smokers lip lines – a very difficult problem to fix.
Don’t use tanning beds! I’m surprised that tanning beds are still legal. There is no doubt in the medical community that tanning bed use increases skin cancers: basal cell, squamous cell, and even melanoma. Looking beyond cancers, severe premature aging of the skin is a result. Just as sun exposure does, tanning beds cause breakdown of collagen and elastin fibers leading to loose, thin, nonelastic skin. Volume loss associated with aging is exaggerated.
Don’t pick! I see numerous scars related to acne, particularly deeper cystic acne, that the patient tries to “improve” by picking, poking, and needling. This can lead to a worse infection, sometimes MRSA, that requires antibiotics and creams to improve. The end result is often scarring and hyperpigmentation which can require skincare, peels and often lasers or RF treatment.
Don’t listen to your friend/neighbor who recently became a skincare expert! Isn’t it funny that your friend now knows all about what’s good for your skin and they have the perfect product that will do miracles that they want to sell you. For additional convenience, they will also ship it to you on a monthly basis. Keep your guard up with these folks. Most often, the products are nicely repackaged creams available OTC from multiple different companies. Only physicians can sell certain products which are prescription strength or certain product lines that have peer reviewed research behind them. Aestheticians spend months in the classroom and devote their livelihood to skincare and are truly experts in guiding your skin care regime. At The Aesthetic Clinique, we have 4 fulltime aestheticians, 1 nurse, and Dr. Weiner to give you a team approach to your skin. We offer multiple skin care lines which we have chosen for their particular strengths in certain age and disease related processes.
Don’t expect a face lift to fix everything! It happens daily in our office. “I’m trying to decide if I should do skincare, peels, filler, lasers, Botox, Ulthera, Infini or JUST GET A FACELIFT”. A facelift will help with laxity, improve the jowls, improve some wrinkles but there is so much more that won’t get treated. In most cases, some sort of neck lift must be done to improve the jawline and “to match the face”. Getting a facelift does not mean you can eliminate Botox. A facelift will do absolutely nothing for the skin damage that would benefit from lasers, skincare, and peels. Volume loss is not addressed by a facelift unless a secondary procedure with fat grafting is performed. It’s been my experience that patients who have had facelifts actually have more volume loss related to fat atrophy in the preauricular area as a result of the flap elevation (lifting the skin). Rejuvenation around the eyes is not part of a standard facelift and requires another procedure called a “blepharoplasty”. The point is that it takes a multifaceted approach to improve all the aspects of the aging face, and a facelift only addresses a small part the problem.
Bonus (Addendum) Don’t drink from straws. This habit leads to those ugly lip lines, even if you don’t smoke.

Dr. Steven Weiner is a Board Certified Facial Plastic Surgeon practicing in Santa Rosa Beach, Florida, between Destin and Panama City Beach, Florida. After laying down his scalpel in 2005 he has devoted his practice to Lasers and Injectables.

Blog: http://stevenfweinermd.wordpress.com/

YouTube: http://www.youtube.com/user/StevenFWeinerFacial

Website: http://www.theclinique.net

Oral Supplements for Skin Health, Beauty, and Longevity – Heliocare, GliSODin Skin Nutrients, TA65 and Megaresveratrol

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The focus of the Aesthetic Clinique is restoring and optimizing one’s appearance. Skin treatments such as lasers, injectables, and topical creams cannot entirely achieve these results. Hence, oral supplements are needed to help us improve our beauty at the cellular level. The Aesthetic Clinique has been recommending GliSODin Skin Nutrients and Heliocare for over 5 years and we have recently added TA65 to our repertoire.

Heliocare

The first product that we selected almost 7 years ago was Heliocare. Heliocare is an oral supplement used to protect the skin from the sun. UV rays from the sun can increase free radicals on the skin’s surface, which leads to cell damage and premature aging. Antioxidants help to stabilize free radicals within the body. Heliocare uses the natural antioxidants in Polypodium leucotomos extract- derived from a tropical fern plant- to help maintain the skin’s ability to protect against sun related aging. This product has been researched at Harvard Medical School. It is a product of Spain and has been used in Europe for over 30 years, there are no known side effects. Heliocare starts working with the first dose, thirty minutes after taking it. Sunscreen is meant to be used in conjunction with this product. Suggested use is 30 minutes prior to sun exposure and if a full day in the sun is planned a second dose should be taken midday. For clients with melasma recent research has shown this condition to worsen even with visible light. Sunscreens do not provide protection for these wavelengths but Heliocare does, so daily use is highly recommended by Dr. Weiner for melasma suffers.

GliSODin Skin Nutrients

GliSODin Skin Nutrients are a nutritional beauty product line that is taken orally to give you healthy, radiant skin. Formulated by dermatologists and nutritionists the product contains 100% natural ingredients that are easily absorbed into your system. GliSODin is the key ingredient in every GSN product. It is extracted from a non genetically modified melon that contain high levels of SOD (Superoxide Dismutase), also known as “the enzyme of life”. SOD acts as the first line of defense against toxins and cellular breakdown caused by free radicals. GliSODin has a patented protective coating that enables the body to safely absorb the powerful enzyme. Primary antioxidants like SOD have a huge benefit. One SOD molecule can attack a free radical and go on to the next, targeting up to one million free radicals. Secondary antioxidants like Vit C, cocoa and super fruits can only neutralize one free radical at a time. SOD targets free radicals allowing secondary antioxidants to focus on their essential cellular tasks. Aesthetic Clinique has researched this product line, traveling to their headquarters in Toronto to meet with their executive director and endorses it. The GliSODin Skin Nutrients consist of formulas to promote beautiful healthy skin and compliment medical aesthetic procedures. It is recommended to start with the Advanced Detoxification Formula first to help flush out unnecessary and harmful toxins from your system, while promoting total body wellness and increasing energy levels. The Detox not only cleanses your system, it rejuvenates your skin, leaving you with a clearer smoother complexion. Our staff can help you determine which of the formulas to use to address your specific goals and needs. The formulas the Aesthetic Clinique provides include: Advanced Anti-aging Formula to hydrate and nourish your skin, reducing the appearance of fine lines and wrinkles. It provides your skin with nutrients and minimizes the effects of aging by boosting your body’s natural antioxidant system and reducing inflammation, resulting in younger looking skin. Advanced Brightening Formula promotes a bright, smooth and even complexion by helping to repair skin damage caused by exposure to the sun. Used along with a topical SPF, this formula provides you with an extra layer of protection against UV rays, and supports a healthy, even skin especially after aesthetic treatments. It is a great compliment to laser treatments, peels and topical skin brighteners and topical antioxidants. Advanced Slimming Formula is a safe and effective product that promotes healthy weight loss and management by supporting the body for proper metabolism and use of nutrients. By promoting lean muscle mass, balancing sugar levels, controlling appetite and increasing fat metabolism, the Slimming Formula is a safe and effective way to achieve and maintain your weight.

TA 65

TA 65 is a supplement that can help restore telomere length. Telomeres are repetitive DNA sequences located at the ends of chromosomes. Telomeres are responsible for maintaining the integrity of our DNA and play a role in cell aging. Every time a cell divides the telomeres get shorter and when they become critically short, the cell no longer functions properly and dies. A Nobel Prize was awarded for the discovery of the role of telomeres in aging and cell death. Telomerase is the enzyme that maintains telomere length in order to prevent cell death. TA65 is the only proven telomerase activator on the market. It is a single small molecule obtained by ultra purifying and concentrating one of the many bioactive compounds found in the astragalus root. When the telomerase gene is activated it adds new DNA onto the ends of telomeres thus lengthening the shortened telomeres. TA65 is a telomerase activator, which has the ability to activate the telomerase gene to create telomerase. This causes the telomeres to grow longer which allows cells to continue to divide and proliferate. TA 65 was launched in 2007 as a dietary supplement to maintain and improve telomere length and inhibit accelerated aging. Research has shown a wide range of health benefits including improvements in skin elasticity, bone health and insulin balance. It is one of the only supplements that not just stops the clock, but reverses it! There is actually a blood test which can be run to check your telomere length so you can see where you stand before and throughout treatment.

UPDATE: We have added Megaresveratrol, please see the link for more information.

The Combination of Sculptra and Ulthera is better than a Facelift and here’s why!

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Dr. Weiner answers questions about Ulthera

Dr. Weiner answers questions about Sculptra

Let me first explain that I’m a Facial Plastic Surgeon, trained at The Johns Hopkins Hospital. I “laid down my scalpel” in 2005 and since then, have devoted my practice solely to noninvasive and minimally invasive cosmetic procedures. The public has demanded cosmetic enhancement to have little to no downtime, appear natural, and be affordable. Surgical procedures such as facelifts, brow and forehead lifts, blepharoplasty have all had declines in their numbers while injectables, laser resurfacing, and noninvasive skin tightening are continuing to grow at a rapid pace.

Remarkably, it has been only over the last 10 years or so that the aging of the face has been recognized as primarily due to loss of volume. After landmark cadaver dissections, it was shown that there are several different fat pads in the face which all seem to atrophy over time. These are located in the temples, cheeks, under eyes, chin, preauricular (in front of ear) and above the lip. Using CT scan analysis, the boney structure of the face has been shown to change as well. The orbit (eye socket) enlarges leading to hallowing of the eye. The upper and lower jaw retract, and there is bone loss at the angle of the jaw. By losing fat and bone (as well as some muscle), the skin of the face loses support and droops. The strategy in the past by Plastic Surgeons was to cut the excess skin away. This lead to a face with tight skin and less wrinkles, but you looked like a skeleton. These days, it is all about filling the face to replace the lost volume from fat and bone loss.

After the science background above, we can now address why facelifts are a dying procedure. Facelifts have the following undesirable attributes:

Requires a surgical procedure which inevitably leaves some type of incisional scar. Sometimes this is fairly noticeable and requires further procedures (more surgery, laser) or topicals to correct.
There is the risk of anesthesia (cardiac, stroke, pulmonary) and the side effects of anesthesia (nausea, vomiting, etc.).
There is pain requiring pain medication
Recovery time can be lengthy, usually at least a couple weeks, sometimes up to a month for swelling and bruising to subside.
The cost is significant. Frequently a facelift is bundled with neck lift, and blepharoplasty. Adding in the cost of anesthesia and the cost of lost wages for 2-4 weeks, you could easily be looking at $15-20,000.
A facelift does not address volume loss, which would require fat grafting. Fat grafting adds in another cost, another procedure (liposuction), and additional anesthesia time. Fat grafting doesn’t always take, so further procedures are usually needed to get to full volume correction.
Often people which have had facelifts don’t end up looking like “themselves” and there is nothing they can do about it.
There are significant risks other than those mentioned which include permanent numbness, nerve damage, hemorrhage, need for corrective surgeries.

A little background about Sculptra and Ulthera is in order. Sculptra is a “collagen stimulant” which is used to replenish volume to a person’s face. It is injected in a series of treatments (usually 3) in the office in a 15-20 minute procedure. The results aren’t appreciated for about 6 weeks, the time it takes the body to create the collagen. It has been FDA approved since 2004. Initial concerns regarding nodules have been addressed with using different protocols and now that problem is less than 1%. Ulthera is a noninvasive skin tightening device. It has been FDA approved for over 3 years. It uses high frequency ultrasound to heat up the deeper levels of the skin to contract, lift, and produce collagen. It can improve the neck, brows, cheeks, and jawline. The procedure is done in the office with just topical anesthesia in 30-90 minutes, depending on how many areas treated. Further information on these procedures can be obtained by reading my blogs and watching my YouTube videos.

The reasons that Sculptra and Ulthera are better than a Facelift:

There is no significant downtime with either Sculptra of Ulthera besides the possibility of some minor bruising.
There are no scars, no anesthesia risk, and no post procedure pain significant enough to require pain medication
There is no time required to stay out of work, therefore no lost wages.
Ulthera can address skin laxity in the entire face – forehead, eyebrows, cheeks, jawline, upper and lower neck whereas these are all separate surgical procedures with their associated additional costs and risks.
Ulthera can be repeated for additional tightening without any additional risk (a redo facelift has significant increases in risk) and there are NO LONG TERM reported risks.
Sculptra is an “off the shelf” long lasting volumizer, not requiring liposuction (fat grafting does). Sculptra addresses the primary reason for facial aging by replenishing the volume in the areas where fat and bone have been lost.
By addressing loss of volume with Sculptra, there is a lifting effect on the cheeks, jawline, upper neck, and around the eyes and eyebrows.
The cost of the combination of Sculptra and Ulthera is much less than comparable surgical procedures particularly if you include loss of work compensation.
The results take several months to achieve and are a gradual and natural enhancement. No shocking your friends with a different looking “you”.

We are entering into a new age of cosmetic enhancements. Procedures are less invasive, less downtime, less risk, and more natural. The Gold Standard of having a facelift for correcting the aging face is having some serious competition from the facial volumizer Sculptra and the noninvasive skin tightening procedure Ulthera.

This link shows the limited benefit of facelifts. Only 3 years knocked off your looks and no improvements in attractiveness. http://www.dailymail.co.uk/news/article-2382922/How-facelifts-make-look-younger-just-3-years.html?ito=feeds-newsxml

Blog: stevenfweinermd.wordpress.com

YouTube Channel: StevenFWeinerFacial

Website: www.theclinique.net

Dr. Steven F. Weiner’s Top 10 Beauty and Longevity Recommendations

After being a physician for 25 years, I have read countless medical journals and listened to hundreds (if not thousands) of lectures. I have sifted through all those years to come up with my top 10 recommendations for a long and beautiful life. Here is my last 25 years summed up:

Topical Retin A – Some sort of Retin A, Retinol, Tretinoin used regularly will keep the skin youthful, vibrant, less pigmented, and minimize acne breakouts. It accelerates skin turnover, decreases sebaceous secretions, thickens the dermis, hydrates the skin, and reverses DNA damage which could lead to cancers. There is over 25 years of research behind this compound so don’t worry over side effects from prolonged use.
Antioxidants – Oxygen free radicals are the main cause of aging and cancer. These are produced daily throughout our body and skin. There are numerous articles touting the benefits of red wine, chocolate, and fruits for their health impact which is mainly due to their antioxidant qualities. Dr. Weiner is especially fond of GliSODin Skin Nutrients which contains the very powerful enzyme, Superoxide Dismutase (SOD). Antioxidants (several are found in SkinMedica TNS Essential Serum) placed directly on the skin help protect from the damaging sun rays. Resveratrol, the antioxidant found in red wine has been thoroughly studied to have benefits for multiple medical conditions (we sell MegaResveratrol). Other oral antioxidants I recommend: bromelin, tumeric, astragalus, polypodium leucotomos (Heliocare), vitamin C, co-enzyme Q10, selenium.
Aspirin – A daily baby aspirin, 81mg, will help prevent strokes, heart attacks, and cancers. Make sure it’s a coated aspirin to prevent stomach ulcers. Remember that the blood thinning effects will last 12 days.
Stay trim – This is a fairly broad recommendation which includes eating right, regular exercise, and choosing active recreational sports. Don’t be a couch potato.
Don’t smoke – Smoking strangulates the skin and other vital organs. The blood vessels contract with the drugs in tobacco. Smoking cessation can reverse most of the damage created so it’s never too late. There is no question at this time that a smoker’s risk of heart attack, stroke, cancer, and lung disease are significantly elevated.
Minimize sun exposure – The number one cause of collagen loss in our skin is sun exposure. Protecting with sunscreen and antioxidants will reduce this breakdown. Skin cancers – melanoma, basal cell, squamous cell, have all been linked to sun exposure. Cataracts can also be caused by the sun so wear sunglasses. Wear hats, rash guards, and use an umbrella when at the beach.
Moderate Alcohol Consumption – There has been numerous studies which tout the benefit of 1-2 drinks per day. Some studies have shown this to be almost as efficacious as exercise. The benefits are lost with consumption that is higher than 2 drinks per day and becomes detrimental.
Daily Exercise – Keeping in good physical shape is beneficial to the heart, lungs, bones, and mental health. It also helps maintain your body weight which is very important as stated in #4.
Don’t wait too long to see a doctor when having problems – I can’t tell you how many times I’ve seen people walk into my office with an obvious cancer. The treatment becomes much more difficult the longer you wait. Its not going to go away if you ignore it. So if you experience a growth, abnormal bleeding or bruising, rapid weight loss, prolonged fevers, night sweets, chest pains, non traumatic body aches, or new neurologic symptoms, please see your doctor soon.
Maintain social awareness, activities – Its important to keep abreast of current affairs, participate in local activities and maintain friendships. It keeps your brain stimulated and mental health stable. Challenge your brain with learning new things, word and math problems, reading, and new hobbies. Go back to school, change jobs or careers to keep stimulating yourself. Don’t fall into a routine which becomes mundane.

Ultherapy – Non Invasive skin tightening with no rivals

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Dr. Weiner answers questions about Ulthera

Ulthera (or Ultherapy) was introduced in 2010 in the US. It uses ultrasound (high frequency) to cause an extremely predictable controlled injury at a certain depth (1.5, 3, 4.5mm depending on the hand piece) and a certain tissue volume. On the face, the level treated corresponds to the tissue called the SMAS, which is the area tightened during a facelift. So in essence, the Ulthera is tightening the SMAS without any incisions. The treated area is tightened and lifted gradually over the next 3-6 months as collagen is laid down in response to the treatment. Clients will notice a firmer jawline, less turkey neck, elevated cheeks and eyebrows, and less fine lines around the eyes. The newest hand piece, 1.5mm, is designed for the superficial fine lines around the mouth and eye area.

Almost all the other technology available (Thermage, Affirm, Exilis) for non invasive skin tightening uses radio frequency (RF) to heat up the underlying tissue to cause a thermal injury. Although Thermage was the gold standard for years, it’s problem was unpredictable results. That is because RF needs to heat the tissue to about 41-45 degrees C. Any more than that, too much damage is caused, and any less, no improvement is seen. RF requires the treated tissue to conduct the energy through existing collagen fibers, and the conductivity of people’s skin is different, and not predictable. (As previously stated, Ulthera will lay down it’s thermal injury at the exact skin depth and energy level in ALL PATIENTS similarly.)

The future of Ulthera is exciting. As experience grows, treatments are becoming more aggressive. More treatment line, more levels of treatment, seem to be able to create better corrections. Off the face treatments are beginning on the chest, knees, and soon buttocks.

Keep in mind that Ulthera does nothing to improve the outermost skin (pigment, vessels, texture) and does not create much additional volume. That is where lasers and fillers are needed to complete the total package of facial rejuvenation.

(We are very fortunate to have recognized the value of Ulthera and were very early adopters. Sandy, our RN, is a major contributor in the Advance Providers Round Table discussions at the company headquarters.)

Website: http://www.theclinique.net

After years of evaluating Sculptra, “I’m a believer”.

Patient had volume loss from weight loss and age. She was treated with 6 vials of Sculptra. Right side of picture is 1 year after treatment.

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Dr. Weiner answers questions about Sculptra

DR WEINER IS NOW A PHYSICIAN TRAINER FOR ADVANCED SCULPTRA INJECTION TECHNIQUES

Sculptra is a unique facial filler. It uses the body’s own collagen to create volume to the aging face. It is made up of Poly L Lactic acid, which is broken down to lactic acid, a natural occurring substance in the body. It comes as a powder to the physician, and is mixed with lidocaine and saline in the office days before the procedure. A series of 2-4 injection sessions is needed to get the full results, with at least a 6 week interval (because it takes 6 weeks to see the complete result of the prior treatment). After the treatment, your face will appear filled, but only for a day or two, and then the saline is absorbed. Gradually over the next 6 weeks, the Sculptra will stimulate the collagen, and create the volumization. Results are said to last 2-3 years. Touch ups are recommended at 12-18 month intervals.

Sculptra was initially FDA approved in 2004 for HIV associated facial atrophy, however it was used off label for cosmetic use soon after that. In 2009, it was formally FDA approved for cosmetic use. So what took me so long to get on board? There were problems with people developing nodules (bumps). Although, these were usually minor and not visible in most cases, they were a problem for some. I’m finally comfortable that this problem has been addressed and minimized. The steps take have been:

Make the Sculptra more dilute by adding more saline and lidocaine when mixing
Inject deeper in the areas where it is possible
Mix the Sculptra up days ahead of time instead of the night before
Have the patient massage the area
Do not inject too close to the mouth, lip, or eye area, the areas where most of the nodules were noted
Do not inject patients with autoimmune disease

Following these guidelines, the formation of nodules is now <1%, and comparable to the risk of developing these with Restylane and Juvederm.

Sculptra is unique in that it can volumize the entire face (except close to the eye, mouth, and lips) for a long duration. Considering its longevity, it is a cost effective solution when compared to Restylane and Juvederm. When comparing to fat grafting, its advantages are:

No need to harvest fat (a minor surgical procedure)
More predictable results than fat grafting
Less post-procedure swelling and downtime
Less discomfort

So if you have age or exercise related facial atrophy, Sculptra is a great choice for a long lasting correction.

Call The Aesthetic Clinique to learn more. 850.622.1214

Blog: http://stevenfweinermd.wordpress.com/

YouTube: http://www.youtube.com/user/StevenFWeinerFacial

Website: http://www.theclinique.net

Steven F. Weiner, MD, Aesthetic Clinique; Making 30A, Destin, and Panama City Even More Beautiful

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Maybe a little late to blogging, but let’s give it a try. I’m Steven F. Weiner, MD, a Board Certified Facial Plastic Surgeon in the Panhandle of Florida, between Destin and Panama City. I devote my entire practice to non surgical approaches to cosmetic enhancements and have done so since 2005. My practice is called, “The Aesthetic Clinique”, and consists of 4 full time aestheticians, one of which, my wife Sandy, is also a RN.

I trained at the Johns Hopkins Hospital, in the Department of Otolaryngology, Head and Neck Surgery. The hospital and department have been rated by their peers as number one for at least 10 years according to US News and World report. I was on staff at The Johns Hopkins Hospital for 2 years, then moved on to private practice.

I have been using Botox since 1994 and lasers since 1988

Dr. Weiner is a lecturer and trainer for:

Galderma: Restylane, Restylane Silk, Restylane Lyft, Sculptra, and Dysport
Suneva: Bellafill
Lutronic: Infini

The services offered at my office include:

Coolsculpting (First in the panhandle to do this procedure in 12/2009)
Fraxel Dual (one of the first in the country to perform in 9/2009)
LightSheer Duet (laser hair removal which is fast and comfortable)
Exel V for redness, rosacea, telangiectasias, enlarged vessels
ThermiVa
Spectra Q Switched laser for tattoos, pigmentation, and Spectra Laser Peel
Sculptra, Bellafill
Botox, Dysport, Juvederm, Restylane, Restylane Silk, Restylane Lyft, Restylane Refyne, Restylane Defyne, Radiesse
Facials, Chemical Peels, Waxing
ZO Skin Health
Blunt Cannula technique for facial fillers since 2/2011 – less bruising, less swelling, less discomfort than customary needle technique

Website is: www.theclinique.com

Facebook: http://www.facebook.com/pages/The-Aesthetic-Clinique/178656455073

Twitter: http://twitter.com/#!/theclinique

Youtube: https://www.youtube.com/user/StevenFWeinerFacial

PDO Threads – The Latest Minimal Invasive Lifting Procedure

Amazing Things That Can Be Done (By the Experts) With Dermal Fillers

Here are Dr. Weiner’s top 5 things “Not to Do” to improve your skin and looks.

Oral Supplements for Skin Health, Beauty, and Longevity – Heliocare, GliSODin Skin Nutrients, TA65 and Megaresveratrol

The Combination of Sculptra and Ulthera is better than a Facelift and here’s why!

Dr. Steven F. Weiner’s Top 10 Beauty and Longevity Recommendations

Ultherapy – Non Invasive skin tightening with no rivals

After years of evaluating Sculptra, “I’m a believer”.

Steven F. Weiner, MD, Aesthetic Clinique; Making 30A, Destin, and Panama City Even More Beautiful

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