Topical Botulinum Toxin is Coming!

Botulinum toxin first came into clinical use in the early 1990s. Since then it has become very widely used, and is a billion dollar business. It acts by blocking the transmission of the signal from the nerve to the muscle, so the muscle is not stimulated and does not contract. Fortunately, the product is specific for the motor nerves and it does not affect the sensory nerves. Thus there is no localized loss of sensation or numbness associated with the use of botulinum toxin.

From the onset, the product has been injected into the target muscles. The toxin molecule is large, and it is difficult to get large molecules through the skin intact. Furthermore, in many areas the product must be placed precisely, so as not to affect muscles that would give an undesireable effect. Droopy upper lids or an assymetrical smile are examples of unwanted botulinum toxin effects.

Pan-Facial Filling: The End of the Facelift?

As our understanding of what causes facial aging advances, our approaches to this problem are advancing as well. Gravity as an explanation for the aging changes in the face has been discredited. Three factors are now recognized as important in facial aging: changes in the skin quality, mostly due to insults from the environment, but also due to biological changes that are not fully understood; repeated folding of the skin and loss of volume of the underlying tissues that support the skin. It is the last of these changes that I will discuss here.

For a while we have recognized that the loss of facial soft tissue: fat, muscle and connective tissue, have played an important part in facial aging. More recently it has become clear that loss of bone also plays a very important role. The openngs for the eyes are much larger in the skull of a 50 year old, than in the skull of a 20 year old. The jaw bone of a 20 year old is thicker and wider than the jaw bone of a 50 year old. These changes not only cause deflation of the face, but change the proportions. In the young individual the upper lip occupies 1/3 of the distance from the bottom of the nose to the tip of the chin. In the elderly it takes up 1/2.

Fat Injections: A Boon or a Bust?

The popularity of fat injections has risen and fallen, and appears to be on the rise again. The realization that many of the facial changes of aging are due to the loss of volume of both soft tissue and bone, has dramatically increased the use of fillers. Because the commercially available fillers are relatively expensive, fat grafting has been attractive as a relatively inexpensive source of a large volume of filler material, material that is native to the patient and should not cause allergic reactions.

Microlaserpeel + Broad Band Light: 1+1=3

Although patients commonly come in requesting a single procedure, very frequently they will get significantly better results if two or more procedures are combined. That is true of the MACS-lift (short scar facelift) combined with neck liposuction. It is also true of the microlaserpeel combined with the BBL (broad band light)

 

Hand Rejuvenation: An Underappreciated Treatment

"All the perfumes of Arabia will not sweeten this little hand." William Shakespeare, MacBeth

Fortunately, since Shakespearean times, we have become much better at improving the appearance of hands, although perhaps not much better at washing away their sins.

If you look at the hands of children, the skin is smooth and of uniform color. No bones or veins are visible. With time the hand skin becomes sun damaged and irregular discolorations and rough spots appear. As in other areas, the deeper tissues are lost, and bones and veins become more visible. Many people put up with this because they are not aware that treatments are available. We had a patient in this week who is very attractive with clear facial skin. She regularly gets Dysport and filler. Her hands look like the hands of an 80 yer old. When I mentioned her hands, she said that she feels like she should wear gloves all the time. We discussed other options.

Twin Study Teaches Us About Aging

In an article released online, and to be published in Plastic & Reconstructive Surgery, the authors studied and photographed almost 200 pairs of female identical twins at the 2006 and 2007 twins festivals in Twinsburg, Ohio. The ages of the subjects was estimated by independent observers and correlated with questionnaire responses. Some conclusions confirmed previous observations, but there were some surprises as well. It is clear that our life experiences and environmental can play a big role in how our faces age.

Fraxel re:pair (CO2)

This past weekend I went to a Fraxel re:pair seminar at Reliant Technologies. The re:pair is a CO2 laser that uses Reliant's patented scanning technology to lay down a precise pattern of laser  pulses on the skin. There us no doubt, in my view, that Fraxel has the most sophisticated technology in the field. The scanner is fast and precise, and the relatively high power of the laser allows deeper penetration than competing lasers.

Fraxel and the Neck

We just had a patient in today who commented that she had seen Carol Burnett on the television and she commented that it was sad that Ms. Burnett looked so bad. In particular the patient noticed that Ms. Burnett's face did not match her neck, and that the neck looked like chicken skin.

Hand Rejuvenation

Frequently people exert a lot if effort to make sure that their faces look good, but they neglect the appearance of their hands. When old appearing hands are coupled with a more youthful face, there is a disconnect that tells the observer that something is not quite right. There are a number of factors that contribute to an aged appearance of the hands.

Botox: More is less

The advent of Botox has revolutionized the treatment of the frown lines, the forehead lines and the crow's feet. Unfortunately, many people misunderstand the most effective way to use Botox. We frequently see patients who say "I tried Botox a year ago and it didn't work". I tell people that if they're planning to get only a single Botox treatment, they should save their money. We make sure that our patients understand that to get the benefit of Botox, they need to commit to a series of treatments. Furthermore, they need to understand that the dose of Botox needs to be high enough to put the muscles at rest. Over the years, the average dose of Botox used has gradually increased, as this has become better understood.
If the desired muscles are not moving, or are moving very little, two good things begin to happen. First, the creases begin to repair themselves. If a person has a stroke that paralyzes 1/2 of their face, the lines on that side begin to disappear.  The second good thing that happens is that muscles that are kept at rest begin to  shrink  (atrophy).  When this  starts to occur, the Botox begins to last longer.  People generally require the same dose, but the treatment intervals can be lengthened. If you go from having your Botox administered every 3 months, to having it administered every 4 months, you've reduced your Botox usage by 25%. We have an occasional patient who gets Botox only every 6 months.
Less Botox, better results, happy patients...everyone's a winner.