Big Pores and Oily Skin

There are certain complaints and requests that are frequently mentioned by patients, but are problems for which we don't have good treatments. High on this list is the complaint about large pores. A cosmetic specialists we want to please our patients and give them outstanding results. It is frustrating to both physician and patient when we're forced to say that we don't have a decent treatment for a problem.

That's not to say that there have not been claims advanced by many device makers that their machine will reduce pore size, and there are a many providers out there offering these treatments. However, there is a long tradition of treatments that have been marketed and then fallen into disuse when it became clear that they produced no significant results. The placebo effect is significant, and it is not difficult to persuade patients that they have improvement, when little is visible.

We try to avoid such situations since we build long term relationships with our patients, and failing to deliver on our promises destroys the trust that is necessary for these relationships to develop.

In the March 2013 issue of the Dermatologic Surgery Journal there was a report of using intradermal injections of botulinum toxin to reduce the oiliness of the skin (sebum production) producing a high degree of patient satisfaction. Similar studies have suggested that pore size is also reduced by these treatments. If these observations hold up we will have the first effective and practical method for reducing pore size.

It should be noted that in this technique the depth of product placement is critical. Too superficial placement can fail to produce results and too deep placement can result in undesireable weakening of some muscles of facial expression. This procedure should be performed by an experienced and highly trained injector, not a family practitioner, gynecologist or nurse practitioner. Dermatologists developed and perform the largest number of these noninvasive procedures and, in general, have the greatest expertise in dealing with problems that may arise. 

Too often we see patients who have been treated by ancillary providers who are told, when a problem develops "You need to find someone who can help you". When you choose someone to provide cosmetic services, one of the things you should evaluate is how well they will be able to deal with a problem, if one develops.

Gerald N. Bock MD

California Skin & Laser Center

Stockon & Lodi, CA

Serving Galt, Valley Springs, Manteca, Modesto, Sacramento, Davis, Rio Vista, San Francisco, Fairfield, Concord and other Northern California communities

Yes...Your Face is NOT Symmetrical

It is through continuing education that we get better and better. This past weekend I attended a workshop on the fine points of filler injection. Although we have been doing this for many years, our understanding continues to improve and our technique continues to advance.

No one has a completely symmetrical face, but symmetry is associated with beauty. As the face develops the two halves develop somewhat independently, and they are more like siblings than identical twins. It takes practice to appreciate the small differences between facial halves, but they are there if you look carefully enough. Having the ability to recognize this is the first step toward being able to correct this, resulting in a subtle but very noticeable improvement, producing a fresher and more youthful appearance.

When you look at yourself in the mirror you get primarily a two dimensional view of yourself. However, others see you from multiple angles and see you in three dimensions. With recent advances in understanding the anatomy of the face, and the locations of tissue loss with aging, new injection techniques have been developed that not only fill in the defects but recreate the curvatures and projections of youth. The results are often dramatic, while still looking very natural and subtle. Furthermore these new injection techniques greatly reduce the risk of bruising and are more comfortable than the older techniques.

To learn how this might apply to you, call us for a consultation at 800-500-5842 or 209-956-4260, or request an appointment through our web site www.californiaskinlaser.com.

Gerald N. Bock MD

California Skin & Laser Center

Stockton & Lodi, CA

 

 

Dramatically Improved Treatment for Melasma

Occasionally there becomes available a new treatment for a condition that we have had difficulty treating in the past. That has now happened with the treatment of melisma, the brownish discoloration on the face that occurs most commonly in women, but also occurs in some men. This is frequently seen with pregnancy and birth control pills and has also been called “the mask of pregnancy”.

The treatment involves performing a microdermabrasion followed immediately by treatment with a laser used for tattoo treatment. There is no downtime after the treatment, and the treatment is not painful. It requires between one and four treatments for significant improvement.

This is important because melasma is a common problem and has been a very frustrating condition to treat.

Gerald N. Bock MD

California Skin & Laser Center

Stockton & Lodi, CA

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.

Fillers

Fillers are becoming an increasingly important tool in facial rejuvenation. It is interesting that most patients are unaware of the range of uses that fillers can be put to. Collagen was the first filler to find widespread acceptance, but, because of its short effective life, it is now used much less.

The MACS-Lift (Short Scar Facelift)

In 2001 Belgian physicians Patrick Tonnard and Alexis Verapelle described the MACS-Lift (minimal access cranial suspension lift), a modification of the S-lift. Because of its effectiveness, combined with the short down time and relative safety, the MACS-Lift has become the most requested facial rejuvenation procedure in Europe.
The MACS-Lift differs from a traditional facelift in that the incision is only anterior to the ear and does not extend behind the ear. There is much less skin undermining so the blood supply is sturdier and the risk of tissue loss is much less when compared to other lifts. The underlying tissue is suspended with firm sutures and, in the extended MACS-Lift, additional sutures are placed to elevate the malar fat pad, reducing the nasolabial fold. In the MACS-Lift the skin is pulled upward rather than partially backward as in the traditional facelift. This results in a more natural appearance as contrasted with the "wind tunnel" look often seen with the traditional facelift. Because of the more limited undermining the post operative swelling is much less and recovery is quicker.  In most  cases the MACS-Lift  produces results that are  equal or superior to the  facelift.  At the  same time the MACS-Lift  offers the advantage of being  less invasive,  less expensive and safer than the facelift.

Youthful skin

Youthful skin has certain characteristics that separate it from older skin. Youthful skin is all of the same color. Despite those who think that freckling is "cute", this beginning pigmentary change can be one of the first steps in what has been called dyspigmentation. It is only a matter of time before other discolored areas begin to appear, leading to an unsightly "muddy" appearance. Sun exposure is the most common, but not the only cause for this condition. Pregnancy, hormone use and other factors can also contribute.
Youthful skin has high light reflectance and radiance. It is smooth and soft. With age, muscle movement and environmental exposure the skin becomes less smooth and sometimes rough. Fortunately we now have a variety of ways to turn back the clock and make skin look younger and behave like it's younger.

Volumizing 2

Filler can be used not only to restore volume, but to redistribute it. Even people who do not have much in the way of wrinkles can benefit from the addition of volume. The earliest signs of aging begin around the eyes and upper cheeks. Hollowness and flatness develop under the eyes at a relatively young age. The "bags" that people start developing under the eyes are almost always the result of deep tissue loss revealing the normal musculature of the lower eyelid.
High cheekbones are a sign of youth, of high estrogen production. These disappear with time, and can be recreated with filler. The same holds for a youthful appearance of the lower eyelid and nearby cheek. People are currently unaware that this can be done, but when they see before and after photos, they are almost uniformly attracted to the results. See the results at this link to our web site Facial Sculpting

Volumizing

The loss of volume, due to shrinkage of the deeper tissues is a critical part of the aging process. This is becoming more widely recognized and is the newest frontier in cosmetic surgery. It used to be thought that removing the excess skin would be enough to make people look younger. In some cases it is, but more often than not the use of filler is still necessary for an optimal result. The people who have a lot of extra skin are usually of normal weight, or on the thin side. When the skin is tightened, hollows become more evident. Use of fillers at this point greatly enhances the result. The time may come when we may do major correction of aging faces with filler rather than with surgery, but that is cost prohibitive at this point.