SkinMedica Archives | The Aesthetic Clinique

Rejuvenation of the Eyes – Completely Nonsurgically. Details the Factors Affecting the Aging of The Eyes.

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Studies have shown that the eyes are the most important area of the face for gauging attractiveness. Unfortunately, the eyes are one of the first areas to show aging. Several aspects of aging affecting the eyes are:

Dropping of the eyebrows
Tear trough formation
Eyelashes that are shorter, fewer, and less pigmented
Thinning of the eyelid skin (crepey skin)
Prominent fat bulges or bags
Hollowing of the eyes
Wrinkles in the crows feet

To understand the treatment of these problems, we have to delve into the reasons that they occur. Unfortunately, as a face ages, fat, muscle, and bone is lost. Imagine if our facial skin was a dress and it was a size 6 and it fit well at age 25. At age 45-50, we still own the same dress, but the facial support (bone, muscle, fat) is now a size 2 or 4. It looks like your dress (skin) is sagging and doesn’t fit well. The eyes are affected by multiple areas of loss:

The temple fat pad loses fat so the eyebrows lose some support and fall.
Several fat pads underneath the eyes become smaller and fall leading to tear trough and malar groove formation and loss of medial and upper cheek.
The eye socket (orbit) loses bone and becomes bigger making the eye look hollow and the fat to look like it’s protruding when in reality it didn’t move (pseudoherniation). [There are other factors affecting the orbital fat too – thinning and stretching of the membrane supporting the fat as well as this fat sometimes gets larger which can be camouflaged but not entirely corrected with nonsurgical treatment.]

Aging which affects our entire body is magnified in the eye area:

Just as the hair on the head gets thinner and less plentiful, the same thing happens to the eyelashes and eyebrows.
The skin becomes thinner, less hydrated all over the body but very apparent in the eye area, particularly the lower eyelids.
The muscles around the eye becomes stronger, creating wrinkles in the crows feet and pulling the eyebrows down when it contracts.

Improving the volume around the eye will deliver the most significant change in appearance. Dermal fillers such as Sculptra, Restylane, Voluma, and Artefill are used to reflate the temples leading to a lifting of the brows as well as rounding of the upper face. By enlarging the upper face, the focus of attention of the face is brought back to the eyes, as it is in a youthful face. Volume is also needed to replace bone and fat loss all around the eye in the tear trough, upper cheek, and orbital rim (palpable bony ledge around the eye). Filler needs to be placed under the eye, lateral to the eye, as well as above the eye (in the forehead area). In certain instances, filler can be placed inside the upper orbital rim, mainly in the inner aspect, but this can lead to swelling in some people that is not tolerable.

Botox is a mainstay of orbital rejuvenation. Treating the crows feet, frown lines, and injecting for a brow lift is essential to improving the eye appearance. Some people have excessive muscle in their lower lid that could be relaxed with Botox, but this can only be done in people with not a lot of laxity in their lower lid. Some people also want a more rounded appearance of the eye and this can be obtained by injecting in the middle of the lower lid. Youthful eyes are “wide eyes”.

Crepiness of the skin around the eyes is improved with skin care products designed specifically for the eye like SkinMedica’s TNS Eye Repair and Lifeline’s Eye Firming Complex which both contain growth factors. More invasive treatments, with more appreciable results are obtained with laser resurfacing (non ablative or ablative) and radiofrequency (RF) devices such as Infini. The standard of care is currently the ablative lasers (CO2 or Erbium). Non ablative laser have been shown by Dr. Biesman to have minimal affect on the eyelid skin. Ablative lasers have downtime (1-2 weeks) and can take months to blend in with the color of the surrounding skin. The tide will soon be turning to the Infini (MicroNeedling Fractional RF) for the lower risk and ability to treat all skin colors with minimal downtime.

If further lifting of the brow is required, Ulthera is a great nonsurgical option. A 15 minute procedure, which can be repeated, has been shown to effectively raise the eyebrow in most patients. Ulthera uses focused ultrasound which causes tissue contraction and collagen stimulation. The Infini has been showing promise in this area as well, but for now, Ulthera is the work horse for brow elevation.

Latisse has proven itself as a very effective treatment of the eyelashes and brows. It’s mechanism of action is prolonging the growth phase of the hair follicle. After initial application of once a day, it can be throttled back to once every 3 days when the results are met at around week 16 (78% of study group had results). The only side effects which have been noted with any frequency are skin irritation and that has happened mostly in client overusing the medication.

The eyes are the center of one’s beauty. Don’t let aging affect your eyes. There are multiple ways to improve the appearance around the eyes which are nonsurgical in nature and have little to no downtime.

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

Press Release about Dr. Weiner’s Eye Rejuvenation

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.

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

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

Website: http://www.theclinique.net

What the Heck is Going on with Hydroquinones? Are they about to be banned in the US?

Hydroquinones have been the standard of care in the US for over 50 years for treating skin pigmentary problems such as: melasma, chloasma, post inflammatory hyperpigmentation (PIH) and sunspots (lentigos). It’s mechanism of action is proposed to be that it competes with tyrosine in its conversion to melanin thereby leading to less pigment production by the melanocyte but it may also have a toxic effect on the melanocyte. Despite its long safety record, there is a growing opinion amongst state legislative boards to ban the use of hydroquinones. Just recently, Obagi stopped shipping hydroquinone products to Montana, New York, Massachusetts, and New Hampshire. In 2011, Texas banned the use of hydroquinones and a reinstatement of its use was veto’d by the Governor in mid 2013. The European Union has placed a ban on its use since 2001. Japan and South Africa have similar laws and there are strict guidelines in several countries in Asia and Africa. In 2006, the FDA put a temporary restriction on hydroquinones but ruled them safe after a several month investigation. So what’s the problem with this highly prescribed topical skin treatment?

There seems to be 3 factors going against hydroquinones:

There is a question of whether hydroquinones are carcinogenic. In high concentrations (greater than the typical 4% found in medical offices) when used in mice, it has been shown to cause cancers. In a report from the American College of Toxicology and OSHA, hydroquinones are categorized as “mutogentic” with the potential to cause alterations in DNA and cancer. To my knowledge, there has not been a case of human cancer directly attributed to topical use of hydroquinones.
Abuse of the hydroquinones can cause ochronosis which is a dark blue/black pigmentation of the skin. This seems to be a problem mainly in foreign countries where people are using higher concentrations (up to 10%) and not under medical guidance. Ochronosis is a very difficult problem to treat. Having lighter skin in Asian countries is a sign of wealth because your skin hasn’t been exposed to the sun while working in the fields. Abuse of hydroquinones is common in these countries.
Many people seem to get a rebound hyperpigmentation that may be worse than the original problem. Because the product decreases the amount of melanin in the skin, it becomes more sensitive to the sun as well, leading to hyperpigmentation. Dr. Obagi has now recommended taking breaks from hydroquinone to allow the melanocytes to stabilize. He also never recommends using greater than 4% concentrations of hydroquinones. There are also a subset of people who are sensitive to hydroquinones, developing redness in the area its applied.

Last year, SkinMedica, the second largest skincare line in US physicians offices, discontinued production of hydroquinones after Lytera was introduced. Dr. Obagi (no longer associated with the Obagi skincare products) who has been a staunch supporter of hydroquinones, has a new skincare line promoting non hydroquinone pigment control.

Given the fact that there are now fairly good alternatives (ie LYTERA from SkinMedica) for treating hyperpigmentation conditions, it seems the use of hydroquinone will gradually be discontinued in the US. Negative sentiment seems to stacking up despite its long track record of safe usage.

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

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

Website: http://www.theclinique.net

Don’t Forget The Hands and Decolletage When Thinking About Your Cosmetic Refinements!

Before and after hand volumization with Radiesse.

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Most of the procedures advertised and touted have to do with rejuvenating and beautifying the aging face and neck. This blog is to bring attention to the often ignored areas: The Decolletage (chest) and The Hands. There are some simple, quick, and little to no downtime procedures that can be performed to bring these areas up to speed with your face and neck cosmetic improvements.

Just as the other parts of the body, the hands and chest lose volume from fat loss, and thinning of the skin. In the hands, the vessels and tendons become more apparent, and in the decollete, wrinkles form the “cleavage” area. The easiest way to improve this problem is with filler. Using micro blunt cannulas, the procedure becomes nearly painless and without any downtime. Filler of choice for the hands would be Radiesse, and for the chest, Sculptra. For the Sculptra treatment, it will take 2-3 sessions, but this will give 2 or more years of improvement. It thickens the skin by stimulating the skin to produce collagen.

Most people these days protect their face from the sun, but the chest and hands are neglected. Sunscreen is important fo r these areas as well. Sun damage on these areas presents as:

Hyperpigmentation, “sun spots”, lentigos
Wrinkles
Thinning of the skin
Skin cancers and pre cancerous lesions

Hyperpigmentation is treated with skin care, peels, and lasers. Proper skin care can include: Sunscreen, Retin A or Retinol (for the chest), Growth factors like TNS Essential Serum (for the chest), and body skin care like Environ which exfoliates and hydrates. For more extensive damage chemical peels can be done, or laser procedures. If just wanting a few spots removed, the Spectra Q-Switched Laser is state of the art to remove individual spots. They will darken and then flake off over 2-3 weeks. If the skin is covered with pigmented lesions, the Fraxel Dual 1927 is required. This will require 2-3 treatments and is a nice laser peel that rejuvenates the underlying skin as well and thickens the dermis. Peeling from the 1927 takes about 2 weeks to resolve. Subsequent treatments can be done after 1 month. The Fraxel Dual is also a great tool to remove and prevent pre cancerous skin lesions called actinic keratosis. It is FDA approved for this purpose and is equal in efficacy to the topicals used for this like: Aldera, Efudex, and Carac.

There are 2 technologies which have yet to be used extensively in the chest and hands but offer promise. Ulthera (Ultherapy) and Infini. These devices create small injuries in the dermis which lead to the body tightening the overlying skin, laying down collagen, and thickening the skin. There are already FDA trials of the Ulthera on the chest. Infini is a very new technology and Dr. Weiner is one of the first in the country to have it. Soon hands will be done with the Infini at The Aesthetic Clinique and results will be posted.

Often people who look much younger than their stated age, the truth is seen in their hands. Don’t ignore this area, as well as the chest! There are several easy ways to get them to match your youthful facial appearance.

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

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

Website: http://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.

Rejuvenation of the Eyes – Completely Nonsurgically. Details the Factors Affecting the Aging of The Eyes.

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

What the Heck is Going on with Hydroquinones? Are they about to be banned in the US?

Don’t Forget The Hands and Decolletage When Thinking About Your Cosmetic Refinements!

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

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