Sculptra: An Old Filler Resurrected

 Sculptra is a unique filler that was first approved in the US in 2004, for treating facial lipoatrophy (fat loss) in AIDS patients. It consists of a suspension of particles of poly-L-lactic acid, a material that has long been used in the skin as an ingredient in absorbable sutures. Although it was legally used for cosmetic purposes immediately after its initial approval, it received official FDA approval for this indication in July 2009.

Change Your Eye Color With A Laser?

Currently, if someone wants to change their eye color, they're limited to using colored contact lenses. However, Dr. Gregg Homer, a US physician, is currently testing a laser that will permanently change eye color from brown to blue. 

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.

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.

The "Wow" Effect

There are precious few procedures that we perform where, immediately after the procedure, we can hand the patient a mirror and their typical response is "wow". The injection of filler is the outstanding example of this phenomenon. The results are immediate and frequently very impressive. The final result, however, is more of an art, rather than a science. This is especially true now that filling has evolved from plumping up a specific groove to re-contouring the face, producing a more youthful facial structure. This is very operator dependent and it is unusual to see physicians who are not members of "core" cosmetic specialties (dermatology and plastic surgery) venture into this arena.

"I love you, Dr. Bock"

That is how I was greeted last week by a long time patient. She had undergone a number of noninvasive procedures in the past few years, but two weeks before I saw her I had, for the first time, injected filler in her cheeks. The aging of the mid-face has, with the development of better and linger fillers, become recognized as one of the primary events that makes a person look aged. The young face is full, with smooth, convex surfaces, while the aging face becomes concave, with the loss of deep tissue and other structures. This produces depressions such as the "tear trough", a groove that extends downward and sideways from the inner (medial) part of the eye. It was this area that was filled in my patient. She was smiling as she reported that even her teenage son, without knowing that anything had been done, told her that she looked good.

It Pays to Look Good

As cosmetic procedures become more affordable, more and more people, both men and women, are taking advantage of the opportunity to improve their appearance. Since all these procedures have a cost, it's reasonable to ask why this increase is taking place. One obvious answer is that people feel better about themselves when they look in the mirror and are pleased by what they see. Another contributing factor is that attractive people are treated better by strangers. This is one of the points made by Nancy Etcoff in her book "The Survival of the Prettiest". She says that "Good looking adults are more likely to get away with anything from shoplifting to cheating on exams."  There is also good evidence that  attractive people do better financially.