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How Long Do Dermal Fillers Last…..It Depends!

It happens everyday. Patients ask how long they can count on their dermal filler lasting. The problem is, is that there is no quick and easy answer. There are a number of variables that factor into filler longevity, with the ultimate unknown being that there is no way that a physician can determine how one’s body is going to degrade a particular filler.

In the US, the majority of patients are injected with Hyaluronic Acid (HA) fillers. The commonly known HA fillers are: Juvederm Ultra, Juvederm Ultra Plus, Restylane, Perlane, Voluma, and Belotero. The differences between the HA fillers are their manufacturing process, and the concentration of the HA in the filler. The harder the HA is for the body to break down, the longer it will last. A larger particle of HA has less surface area then multiple smaller particles taking up the same space. Less surface area means there is less area for the cells to “chew up” the HA. In general, larger particles will last a little longer than smaller particles. Another factor in HA fillers is how tightly the particles are bound together. Cross-linking, adding bonds between molecules of HA, has been shown to significantly add longevity. All HA fillers are a combination of cross-linked and non cross-linked HA. Too much cross-linking leads to a filler that is very hard to inject, and has led to more complications (in a filler that is no longer on the market). Non cross-linked fillers last only 3-4 months and are hardly used anymore. One last variable in HA fillers is their ability to attract water, their hydrophylic properties. The more they attract water, the longer the HA filler gives a correction.

The fillers that are collagen stimulators, tend to lead to longer longevity. Fillers in this group are: Radiesse, Sculptra, and Bellafill. While studies have shown a very mild collagen response to the HA fillers, the visible volume correction with the HA fillers is the gel, not the collagen. With the collagen stimulators, the body responds to what is injected by creating an inflammatory response and lays down collagen. Until the particle is degraded by the body, collagen will continue to be produced. Radiesse is made of calcium hydroxylapatite, and is the shortest duration in this group. Artefill should be considered a permanent filler, because its component, Poly Methyl Methacrylate (PMMA), does not get broken down by the body. Sculptra has consistently given about 2-3 years duration in studies and in the authors experience.

The location in the face a filler is injected is one of the most important factors to determine longevity. Areas where there is more movement, there is faster breakdown. In order of increasing duration in the face, the order is (in the author’s experience):

Lips
Marionette
Nasolabial Folds
Tear Troughs
Cheeks
Temples

(Forehead, nose, earlobes are variable)

A couple more very important variables that should be mentioned. The more filler that is injected, the longer it will last. This applies to all the fillers. Also, filler doesn’t stop working all of a sudden. It takes months of gradual loss to notice a difference in volume. In fact, even when the patient believes there is no longer results, biopsies have proven that there is still filler present.

After all the above explanation, the author’s experience with the commonly used fillers is:

Lips: HA fillers give about 4 months, longer with recurrently injected lips.
Tear troughs: HA’s – about 9-12 months, Sculptra and Bellafill – years. Juvederm could last years and should never be injected in tear troughs.
Nasolabial: similar to tear troughs
Temples: HA’s – 12-18 months, Sculptra and Bellafill – years
Cheeks: HA’s – 18 months, perhaps 2 years with Voluma; Sculptra and Bellafill – years

Remember that individual results are unpredictable. These are generalizations and offer no guarantee as to how long a patient’s results will last. There are many variables that factor into longevity that are listed above, not to mention how each individual responds, degrades, a certain filler.

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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.

Fractional Coagulation is in, Bulk Heating is out for Radiofrequency (RF) Skin Tightening

Ever since Rox Anderson suggested that treating a portion (fraction) of skin while leaving untreated healthy tissue behind as the basis for the Fraxel Skin resurfacing laser over 10 years ago, patients have been having less downtime, less risk, and less discomfort with their laser procedures. Healing is dramatically improved because the adjacent nontreated dermis is able to provide the needed blood supply, nutrients, and local immune response much faster than the traditional treatments and results have been shown to be very similar in efficacy.

Until recently, all RF devices have applied heat to the skin/dermis in a nonfractionated approach, called “Bulk Heating”. Whether the RF device is Bipolar or Monopolar, if the heating element does not penetrate the skin, the energy is pushed into the deeper layers using this method. The implication of bulk heating is that all precision is lost. Exact placement of the heat is impossible, with large opportunities for errors in depth of penetration and/or temperature control. When treating skin, heat from the RF device using bulk heating can be placed too superficial, leading to burns or pigmentation changes, or too deep, leading to fat loss. The dermis needs to be heated to 42 degrees C for 3 minutes to affect collagen stimulation. Only if skin temperature is measured can the operator be sure that the 42 degrees is reached with bulk heating, which is not the case for most bulk heating devices. One last temperature issue is that bulk heating devices are unable to obtain coagulation of the tissue, which occurs at about 67 degrees C, which is needed for maximal tissue contraction and collagen stimulation.

The Infini uses microneedles to deliver the radiofrequency energy IN A FRACTIONAL manner. Its unique array of needles allows the energy to flow between the needles, creating 49 coagulation points AT A SPECIFIED DEPTH in the dermis. Surrounding tissue is sparred, which makes for very little downtime. The superficial layer of skin is spared (because the needles are insulated), leading to no wound care, and markedly reduced risk of burns and pigmentation issues affecting the epidermis. The temperature created in the areas between the needle is enough to create coagulation, for maximal tissue contraction and collagen stimulation.

(Not all microneedling RF devices are fractional. Fractora uses microneedles, but because the energy is directed from the needles to the skin surface, the heating is in a fashion similar to bulk heating devices. Also, because more tissue is affected using this heating method, discomfort is much higher and local anesthetic needs to be injected in most cases.)

It has taken a long time for RF devices to catch on to the fractional technology revolution. The Infini has created much more precision in the delivery of RF energy to the dermis, allowing for higher degrees of skin tightening, while affording the safety and quick recovery time that fractional technology has created.

All Botox Providers are NOT the same. Choose carefully!

Botox injections are the most popular cosmetic procedure performed worldwide. Millions of patients are injected each year with the wrinkle fighting drug. Its popularity is attributed to:

There is minimal downtime – 15 minutes of bumps from the injection
The procedure is highly effective in improving wrinkles
Discomfort is usually minimal
Side effects are few and rare
Cost is fairly reasonably, but depends on how many areas are done
The time it takes to get a treatment is less than 10 minutes

So why is the “Was it Worth It” review on Realself.com for Botox only 69%? This can be attributed to multiple reasons, which be further elaborated upon in this blog. (A large volume practice should have a satisfaction rate in the >95%.)

Although the Botox procedure looks very routine to the observer/client, don’t equate this to being a simple procedure that all injectors can master easily.

All patients will age differently, so what areas need treating for optimal cosmetic results needs to be tailored specifically to each patient. A cookie cutter approach to every patient will not work. There are several areas of the face which can be considered advanced: lips, corners of mouth, neck, gummy smile, under eye, bunny lines, inner eyebrows which require a highly trained and experienced injector, or you will live with a disfiguring facial appearance for 3 months.

The trend is moving away from the frozen, no movement, very obviously treated face to a more natural appearance. Rather than blasting and overwhelming the forehead with Botox, a technique using very small, precisionly placed aliquots that allows for movement but with diminished wrinkles. This is a more difficult technique to master.

Shortcuts are often routine in regards to Botox. A majority of practices will draw up syringes of Botox in the morning, or the day before, by a nurse, medical assistant, or office staff. That means the patient will need to get injected in multiples of what is contained in a syringe, leading to limited customization. Also, errors in dilution and sterile technique are possible when filling the syringes is not done by the same person that is injecting the Botox. (Botox comes in a powder form and needs to have saline added to reconstitute it to become an injectable solution.) Dr. Weiner mixes all his Botox personally, and will draw up the appropriate amounts for each patient in the room, just prior to injection.

Discomfort related to the injection can be minimized using various techniques. Using preserved saline has been shown to result in less pain than using regular saline. Needle size, speed of injection, and using proper needle placement is also a key factor affecting comfort. Dr. Weiner also uses several distraction techniques, capitalizing on the Gate Theory (the brain has difficulty processing more than one sensory input at the same time).

Varying the concentration of Botox is a technique Dr. Weiner has used for years. Certain areas require different dilutions to lead to maximal cosmetic benefits.

Touch ups to correct minor imperfections require an advanced injectors experience. They also need a responsive provider, easily available for a drop in or work in patient.

Getting injected by an unknown provider at someone’s Botox party, is never a good idea, and almost always leads to problems that one has to live with for 3 months. The “savings” never is worth it.

Although Botox is extremely popular, as the Realself.com stats show, there are many people that are not pleased with their experience. This is not the norm for the high volume, experienced injector. As explained above, there are many intricacies which can contribute to better results. Hopefully the public will understand that Botox should not be considered a routine cosmetic procedure, and they need to select their providers carefully.

Recent Advances in Coolsculpting – 2014

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Coolsculpting is a noninvasive technique to permanently reduce unwanted fat. It was FDA approved in 2009 for treatment of the flanks. It has subsequently been FDA approved for abdominal fat and, as of April, 2014, has the indication for treating thighs.

Up until this point, all the handpieces required a suction to adhere to the area that was going to be treated. There needed to be a roll of fat that could be “grabbed” by the suction or the area couldn’t be treated. The development of the newest handpiece, the Coolsmooth, allowed for areas to be treated without the use of the suction, such as the thigh area. It also enabled the person with smaller amounts of fat or tighter skin to be treated. At the present time, each application of the Coolsmooth handpiece requires 2 hours but this will most likely be reduced to 1 hour in the future.

“Treatment to transformation” is a technique whereby multiple applications of the Coolsculpting machine are applied in either one or several sittings. By overlapping areas treated or by treating some areas 2 or 3 times, results are now approaching what liposuction can achieve – without the downtime or risk associated. The technique has been pioneered by Dr. Grant Stevens, from Marina del Ray, California.

Massaging immediately after removal of the handpiece has been shown to increase the fat loss in a recent study. This has been done in our office for at least 4 years.

Although loose skin is a theoretical risk after losing fat underneath it, Dr. Stevens has shown that this is absolutely not the case. He has seen skin contraction with his patients and has not seen cases of excess skin.

A recent study presented at ASLMS 2014 showed effectiveness in patients with gynecomastia. Two treatments were required and most patients were satisfied with their results.

Future handpieces are being developed to work on the neck/chin area, ankles, and one specifically for breast tissue. Cellulite reduction is also being studied and it looks promising. Treatment for uneven results after liposuction seems to be greatly improved with Coolsculpting as well, and the new Coolsmooth handpiece will be a huge advance in this treatment.

Revance (RVNC) RT001 is Going to Improve Crows Feet and Sweating WITHOUT Needles

Revance Therapuetics, RVNC

Revance RT001 is a topical treatment that is a neurotoxin or “neuromodulator”. This means that it decreases the muscle activity, similar to Botox Cosmetic, Dysport, and Xeomin. However, unlike the current FDA neuromodulators, Revance RT001 can penetrate through intact skin, whereas all the others require needle injections. Although the Botox injections are fairly quick and cause minimal discomfort, it is the belief by the company, Revance (RVNC), that there are many people that are avoiding treatment because of the needles. It has been reported that only 10% of the candidates for getting their crows feet treated are currently getting treated and that when offered a topical, the number of people getting treated will go up significantly. Unfortunately, the only area that has shown promise on the face in their studies has been the crows feet. The frown lines (glabella) treatment was not significantly improved with Revance RT001, and that’s most likely related to differences in the position of the muscles in this area (deep) when compared to the crows feet (superficial).

Revance topical treatment, RT001

The treatment will be applied in the doctors office and will need to stay on the skin for approximately 20 minutes. This will NOT be a home remedy. Results might actually be better than the injections, for the crows feet, because the application will be more uniform to the area as opposed to the injections which are done in a sequential, interrupted manner.

Another use of Revance RT001 being researched is for excessive sweating, hyperhidrosis, in the underarm (axilla). Treating this area with the injectable neurotoxins (Botox, Dysport) requires about 30 punctures on each side. Clearly, Revance will be a huge step forward in comfort for patients being treated for this problem. A growing trend has been using Botox to treat genital/pubic area sweat. Needless to say, most people would prefer topicals in this area to several injections. It doesn’t seem to be effective in the hands or feet at this time because the thickness of the dermis prevents proper absorption of the drug through the skin. Research is also being done on its use for improving acne.

It looks like Revance RT001 will get FDA approval because of its great safety and efficacy in their current FDA trials. When will it get approved? Probably late 2014 or early 2015. This will be a welcome relief to all the needle-phobes with prominent crows feet.

Dr. Weiner is a Facial Plastic Surgeon who laid down his scalpel in 2005 and concentrates solely on noninvasive and minimally invasive Cosmetic Procedures. He is Johns Hopkins trained and Board Certified.

Website: http://www.theclinique.net

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

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Hair and Eyebrow Restoration Completely NonSurgical using PRP and ACell

PRP was injected for hair regeneration, from Prime Journal article

PRP was injected for hair restoration, from Prime Journal article, one treatment

PRP was injected for alopecia areata. From Prime Journal, one treatment

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PRP is “Platelet Rich Plasma”, a portion of whole blood that is separated from the red blood cells through centrifuging. It should contain concentrations of platelets that are at least 4 times that of what is found in whole blood to get the maximum benefits. Its use in medical conditions started in the 1990’s mainly by Orthopedic Surgeons, Dentists, and Oral Surgeons, but has recently been expanded to the Cosmetic Surgery arena.

(Please note: Not all PRP is the same! Most PRP systems don’t get the concentration of the platelets above the 4x level needed to get the full benefits from PRP. The system that has proven to have consistent 4-7x concentrations is the Magellan “TruPRP” system. It cost much more that the other systems, but the results will be superior to all other PRP systems available on the market. In a recent lecture that Dr. Weiner attended in Paris at IMCAS 2014, 13 different PRP machines were evaluated. Some systems didn’t even result in platelets that had higher concentrations than whole blood!)

When an injury occurs in the body, platelets are the “first responders”. Platelets have been found to contain the following growth factors and cytokines:

Platelet derived growth factors
Transforming growth factor beta
Fibroblast growth factor
Insulin-like growth factor 1
Insulin-like growth factor 2
Vascular endothelial growth factor
Epidermal growth factor
Interleukin 8
Keratinocyte growth factor
Connective tissue growth factor

PRP use in hair restoration began during hair transplantation 5-7 years ago. Surgeons found that bathing the harvested hair follicles led to improvements in the “take” of the transplanted follicle as well as more hair growth, and denser hair growth. Injecting PRP in the harvested area led to improved healing of the scar. It was then discovered that when PRP was then injected into areas of hair loss without transplanting hair, that there was new hair growth. Adding ACell (a derivative of porcine bladder) and Vitamin D3 and B complex gave even further improvements. In a study published in “Prime” Journal, patients were found to have improvements in their hair growth from 12-63%, and notably, there was improvements in all the patients studied. Growth seems to start at about 4 months, and starts to fade at about 11 months. Improvements are more dramatic in females than in males.

The mechanism proposed for the improvements seen is that the PRP leads to increased vascularization of the hair follicles, leading to a “waking up” of previously poorly perfused hair follicles. The growth factors also stimulate the hair follicles to produce hair.

Interesting findings have been thickening of hairs that have been growing but have miniturized (become thin). It will not cause hair to grow in areas of scarring or in areas where there was never hair. It’s also been found that new hair growth is sometimes pigmented in areas where hair had turned gray, representing a “youthful” follicle.

Recommendations are for at least one treatment yearly for females, and 2 for males. Topicals such as Rogaine or Propecia should be continued.

The process starts by drawing blood, 60-120cc. It is put in the Magellan processor to separate the PRP, which takes about 15 minutes per 60cc of blood. During this time, the scalp in numbed up with both topical creams as well as injections. When numb, the scalp in injected with the vitamin and mineral mixture as well as with the ACell solution. The PRP injection in then performed. The final process is using the Dermapen microneedling device to create very fine holes in the scalp. A by product of the Magellan PRP system is “PPP” which is platelet poor plasma. PPP has growth factors, but to a lesser degree than PRP. This solution is spread on top of the scalp and will be left there overnight. Washing the hair can be done the following morning. Sometimes extra PPP will be given to the patient to apply to the scalp at home. The total in office time is about an hour or an hour and 15 minutes. A second treatment (for men) is scheduled at 2-3 months.

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VBeam (for Rosacea, Redness, Vessels) questions answered by Dr. Steve Weiner, Facial Plastic Surgeon

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Q: Is it safe to use V-Beam laser on the face if Juvederm has been injected into the cheek area?

A: VBeam will not affect Juvederm or other fillers

There have been numerous studies showing no affect of lasers on any of the dermal fillers. The VBeam is actually a fairly superficial laser as well.

Q: Will the vbeam be a good recommendation for me?

A: Redness after acne eruption, VBeam is a perfect solution

The VBeam is made to improve redness. State of the art. It is also good to improve acne. So in your case you will get a double benefit: acne and redness improvement. There is minimal downtime, just some redness for a few hours. You will need 2-3 treatments

Q: Is the Vbeam Perfecta Laser Good to Get Rid of Red Marks Left from Acne? (photo)

A: VBeam is the go to laser for redness after acne

The VBeam is tried and true for this particular problem. It takes about 3 sessions to get the improvement but everyone is different. It also helps with ongoing acne. Steve Weiner, MD, Destin, Panama City Beach, FL

Q: Has Anyone Used the V Beam to Treat Redness from a Chemical Peel? I’m 20 Weeks Post Peel (40% TCA Done by a Plastic Surgeon).

A: VBeam will work for post peel, post laser resurfacing redness

The VBeam is very well suited for treating your condition. Usually 2-3 are needed to decrease the redness. It’s about a 10 minute procedure with no downtime, no topical, and nearly painless.

Q: How Many V Beam Treatments Needed for Broken/dilated Capillaries?

A: Vessels and Redness need 2-3 treatments with the VBeam

In general, 2-3 treatments with the VBeam can improve enlarged vessels and redness. Over time, these can return. Some people this is a year, some a few years. There is no major side effects other than slight redness and maybe some swelling which lasts a couple hours, at most, overnight.

Q: Perfecta V Beam Okay for Asian Skin Type?

A: VBeam on Asian Skin is ok if skin is not too dark

There are studies treating Asians with the VBeam showing it’s safe and effective. It treats all vascular lesions such as hemangiomas, telangietasias, Portwine stains, rosacea, red scars, agiomas, and can treat acne.

Q: Will VBeam Treat White Stretch Marks?

A: VBeam for stretch marks works only in they are red

If the stretch marks are mature and white, the VBeam will not work. Stretch marks are tough to treat and you can only expect mild but real improvement with the Fraxel Dual. I don’t think using the CO2 laser on your skin type is a good idea but it is also used for stretch marks. I don’t think pigmentation should be a problem it you treat with hydroquinones before and after.

Q: Can I V-Beam my Ears?

A: VBeam can be used on ears to treat small vessels (telangiectasias)

Yes, the VBeam is excellent for treatment of vessels on the ears. The only place it doesn’t work well is on the legs because the pressure in these vessels is higher and the vessels are deeper.

Q: How Soon Can I Fly After Recieving a Vbeam Procedure?

A: Flying immediately after VBeam is perfectly ok

I have the VBeam Perfecta, the top of the line, latest version. It’s algorithms are set so there is very little chance of bruising. The most I see is usually only mild redness and occasional swelling. Flying afterwards will not affect your outcome at all.

Q: Can V-beam Perfecta Effect Hair Growth After Treatment Like Cause Hair Loss on the Body Where It is Used

A: VBeam should not affect hair growth in area treated.

A VBeam may temporarily remove hair in the area treated but there is no long term hair removal by the VBeam. It can vaporize the hair but not get deep enough to affect the hair follicle.

Q: V-beam Recovery, Is Delayed Pinkness Common?

A: Redness after VBeam is normal

After having a VBeam, it is not uncommon to have some redness which can last up to about a week. You can have some bruising as well. In general though, the redness is very mild, and the social downtime in minimal after having a VBeam.

Q: Will V Beam Help with Acne?

A: VBeam good for both acne and redness associated with it

The VBeam is a rather easily tolerated laser for treatment of redness associated with acne. It also helps improve the acne. It is usually done in a series of 3-4 treatments separated by about 3-4 weeks. Of course, topical medications are needed to treat acne as well.

Q: Can V Beam Help Diffused Redness if IPL Didnt Help?

A: VBeam is better than the IPL for redness

The VBeam was specifically designed to take care of redness. It’s actually safer than the IPL because it has DCD cooling which keeps the skin cooler than an IPL and because it is more specific for the redness than the IPL is. As far as discomfort, the VBeam is extremely comfortable too. It can take more than one treatment to get optimal results.

Q: Is V-Beam Good for Facial Erythema / Ruddy Complexion?

A: VBeam is great for Facial Erythema and Ruddy Complexion

The VBeam laser is the gold standard for treatment anything that is vascular or red. It is great for treating generalized redness, enlarged vessels (telangiectasias), rosacea, hemangiomas, vascular lakes, poikiloderma, and port wine stains, You must make sure that the ruddy complexion is not a cummulation of actinic keratosis, which would be best treat, in my opinion, with Levulan followed by activation with the VBeam.

How to Score Some Points with Your Plastic Surgeon/Aesthetic Physician

Getting on the good side of the doctor that makes you look better can definitely have its benefits. Following these suggestions can get you some brownie points.

Stay well informed. Search out your Doctor’s website, Facebook Page, Blog, and YouTube Channel to learn about the procedures that are offered. This can make the initial consultation go more smoothly. You can narrow the options before the office visit according to your lifestyle and concerns. Watching videos of the procedure being performed can greatly improve your comfort level by knowing what to expect.
Be Nice and Smile. Smiles are contagious. We are all here to make you look good and feel better about yourself.
If you have a budget, let us know. It’s very important that everyone is on the same page when deciding on a particular treatment. For example, lasers are usually more expensive for treating certain skin conditions (sun damage), but they get faster and better results than the less expensive options (chemical peels). Treatment plans can be tailored to meet all budgets.
Try to stay with one physician. The lure of a “Groupon Special” on Botox or fillers is enticing. However, pricing should not be the primary motivation for choosing where you go. Qualifications, experience, and customer service should be much more important factors in your decision-making. It’s often hard to piece together what was done if you have gone to several different physicians.
If you have a social event, try to get treated a week or two in advance. Waiting too close to an event can cause undue anxiety when there is some minor bruising or swelling. Give us doctors a little leeway (a week) so that everything can settle down from your filler administration. Even though Dysport may kick in faster than Botox, it still needs 3-5 days to see its full effect.
Try to hold off the blood thinners when coming in for injections. If you take herbal supplements, aspirin, anti-inflammatories, vitamin E, or fish oil, the chance of having bruising is much higher than if they were held for a few days (aspirin needs about 12 days). Even a physician with the most delicate touch and technique can’t always avoid bruising when injecting someone who has “thinner blood”. Of course, if the thinners are medical necessary, you must continue their use.
Don’t ask your doctor to make your lips too big. Remember, every patient is a walking billboard for the doctor’s practice. Most doctors want to be known for natural looking enhancements. There needs to be dialog between the patient and doctor when the patient’s wishes are beyond the realm of what is naturally appearing.
Don’t tan or use sunless tanners before laser procedures. The risk of pigmentary issue goes way up when lasers are used on tan skin. Usually at least 3 weeks are needed to be out of the sun for laser work. The problem with sunless tanners is that the pigment in the product can absorb or reflect the laser and cause potentially even more damage to the skin than a tan would.
Follow the recommended post treatment instructions. To get the maximum benefit with the least amount of side effects, there are certain do’s and don’ts after all procedures. Most physicians will either give a printed instruction sheet or will have them on their website.
Don’t use grandma’s homeopathic remedy on your skin after peels or lasers. After a laser resurfacing, the skin is 50 times more sensitive to topicals creams. Please use the skincare regime outlined by your physician.
If there is some issue after a procedure, LET US KNOW! Almost always, there are minor little adjustments which can be made to your Botox or filler treatment that can correct an undesired result. From a doctor’s perspective, we want to have happy clients. We would much rather have you call or come in for any issue rather than lament at home.
Give us a shout out. If you are extremely pleased with how you look and feel after a treatment, tell your friends. In fact, bring your friend(s) with you to your next visit. Write a review on Facebook, Yelp, or Google Plus.

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

Are superficial chemical peels obsolete? The Spectra Laser Peel (“Hollywood Peel”) might make that happen.

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Chemical peels have been a staple for skin care for decades. There are dozens of different types treating various skin conditions. This blog will be directed at the superficial chemical peels used to treat: fines lines, pigmentation, sun damage, acne, large pores, and to rejuvenate the skin. These peels are usually placed by an aesthetician in a spa or physician’s office. After about 2-3 days, the peeling starts and lasts for a couple of days and sometimes up to 5 days. During the peeling phase, there’s various amounts of flaky skin, treated with moisturizer. The skin eventually looks great, 3-7 days after the initial placement of the peel.

Let’s turn to the Spectra Laser Peel. The Spectra Laser is a Q switched 1064 laser that has a tremendous affinity to pigment. It is designed for (and state of the art for) tattoo removal and treating various pigmented lesions (freckles, seborrheic keratosis, lentigos, cafe au lait, nevi, post inflammatory hyperpigmenation, and melasma). The laser peel begins by placing a carbon liquid on the skin for about 10-15 minutes. The carbon is absorb superficially in the skin. This liquid is essentially tricking the laser into thinking its attacking pigment when it is applied to the face. As the laser is first passed over the skin, the carbon absorbs some heat which is passed to the underlying skin. The next several passes cause vaporization of the carbon as well as a very superficial layer of the skin – 15-30 microns. What’s better is that there is no discomfort during the procedure!

The end result is a glowing and radiant skin tone with NO associated peeling or recovery time.

I believe the effectiveness for the various skin condition (acne, pores size, fine lines, pigmentation, melasma) is marked better with the Spectra Peel than with traditional chemical peels. Active acne outbreaks seem to resolve within days. Just like other laser procedures, the Spectra Peel can’t be performed on tan or recently sun exposed skin, or people on Accutane. It can not be done on darker skin types as well.

If you’re looking for a quick skin rejuvenation with essentially no downtime, do what they are doing in Hollywood just before they hit the red carpet, The Spectra Laser Peel.

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

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

Website: http://www.theclinique.net

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Are superficial chemical peels obsolete? The Spectra Laser Peel (“Hollywood Peel”) might make that happen.

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