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.

The Ten Minute Nose Job

People who were born with lumpy or bumpy noses had, until recently, only one choice if they wanted to correct things. That was nose surgery, or rhinoplasty, a procedure that costs thousands of dollars and is said to be one of the most technique sensitive of the cosmetic procedures. Side effects, including excessive bleeding, loosening of the cartelage, irregularity and scarring occur in up to 18% of patients. Now, through the use of fillers, very nice results can frequently and easily be obtained through the use of fillers. Improvement of the shape of the nose through fillers is much less expensive than surgery, and has no downtime, when compared to the 6 week downtime of surgery. This filler can help people who are unhappy about the shape of their nose, but not those who are unhappy about the size.

LED Phototherapy: Hype or Hope

The use of light emitting diodes (LEDs) to improve skin tone and texture has gained prominence in some offices and spas. Previous studies were performed by manufacturers and suggested some improvement in fine lines. Recently there was an independant study evaluating the effectiveness of Gentlewaves, one of the most commonly used units.

Longer Eyelashes?

The Food and Drug Administration has approved the use of the prescription medication Bimatoprost, which was originally used as a treatment for glaucoma, to be sold under the name of Latisse, to promote longer, thicker darker eyelashes. The medication will be available by prescription only. Latisse gets applied along the upper eyelashes, while the glaucoma drug, Lumigan, was used as eyedrops. The change in eyelashes was observed as a side effect in patients using Lumigan.

"Keeping Up Appearances in a Downturn"

An article in the December 23 issue of the Wall Street Journal reports that people are continuing to spend money on Botox, fillers and laser treatments, while deferring more expensive cosmetic treatments. They quote Maralyn Burr of Omaha Neb. who lost her job as a district sales manager for Borders Books. She's $140,000 in debt from her daughter's musical education and has cut her spending and stopped eating out. However, she still continues with her Botox and Restylane. "It's like soul food" she says.

Dark Circles Under the Eyes II

Other than fillers and lasers, there are less well established methods for treating dark circles under the eyes.  Chemical peels, in particular TCA and phenol peels, have been used with some success in treating this condition. There are no studies to back this up, and occasionally peels can produce adverse effects, including scarring. Dietary supplements have been claimed to improve dark circles, but the supporting evidence is very sparse. There is a single study in an obscure European journal that reported that people who took a dietary cocktail consisting of soy extract, fish protein polysaccharides, extracts from white tea, grape seeds and tomato, as well as vitamins C& E, zinc and chamomile extract had, after 6 months, significantly greater improvement of skin conditions, including dark circles when compared to those who did not take the mixture.

Eyelid Tightening

As we get older, drooping and wrinkling of the eyelids can be a distressing acquisition. Surgery has long been an option for dealing with this, but it is not a good approach for dealing with fine wrinkling. Generally, if one attempts to pull the skin tight enough to eliminate the fine wrinkling, especially of the lower lid, there is a significant chance that the additional tightening, that occurs as a part of healing, will produce distortion of the eyelid shape. This is known as "round eye" or "scleral show."

The Return of Resurfacing

Skin resurfacing appears to have originated among the ancient Egyptians who used rough alibaster masks to smooth and beautify their skin. Since then, many other substances including fire, acids, various mineral and plant extracts and sandpaper like materials have been used for a similar effect. Generally it has been observed that the more aggressive procedures were associated with better results but also with a higher risk of side effects.

Medical Devices in the Treatment of Acne

Acne is the most common skin disease in the United States. Approximately 25% of all visits to a dermatologist are for acne. Since the introduction of Accutane in 1982, there have not been significant advances in the treatment of acne. Various topical and systemic antibiotics have been released in new formulations or new pill sizes, and various topical agents have been released in combinations or in new bases with claims that these were significant improvements. Nothing dramatic has been evident.