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Archive for May, 2010

As we age our mid face degrades, deflates and descends giving that dragged out tired look of ‘old age‘.  The area between the lower eyelids and the mouth is considered the midface. As you age, the effects of gravity, repeated muscle contraction, and lifestyle cause the skin, fat, and muscle in this region to move downwards. When this occurs, the cheeks begin to look saggy or flat, lower eyelids can become puffy or hollow, circles begin to appear under the eyes, and the lines between the nose and the corner of the mouth deepen.

Midface suspension ribbon lift, also referred to as a cheek or midface lift, corrects sagging midface tissues by surgically repositioning them up and to the side. This accomplishes several goals: volume enhancement of the midface region, elimination of hollows in the area, and a gentle smoothing of the tissues just below the eyes. A successful midface suspension can be a key step in achieving the youthful appearance sought after in minimally invasive facial rejuvenation procedures.

Good candidates for mid face suspension ribbon lift are those patients who are starting to see some droopiness of the brow, cheeks, jowls and/or neck and would like to see a lift effect, but do not want the risk, scars, or recovery of a real browlift, facelift, or necklift operation. The ribbon lift procedure can achieve 60-70% of what a real invasive surgical procedure can deliver without the need for hospital care or general anesthesia. During a midface suspension procedure, the surgeon makes small incisions in the area above the ear, and in some cases through the mouth. Small instruments are introduced through the incisions to lift the delicate midface tissues off the cheek bones. A surgical ribbon implant  is then passed through the cheek tissue and secured to the soft tissues above the ear. In some cases, the suspension ribbon is introduced through the skin and secured without elevating cheek tissue off the bones. In all cases, the surgeon relies upon the implant ribbon to temporarily fixate the suspended cheek in its new position. The ribbon is slowly absorbed and the tissues created by the body hold the tissues fixed in position.

Midface ribbon suspension restores the natural curves and fullness in the cheeks by moving soft tissues back to where they were earlier. This is achieved by elevating the soft midface tissue from the bone, repositioning it upward towards the eyes, and fixating it in place until it adheres naturally to the bone. This restores cheek volume and establishes more youthful midface contours. The result will be a natural, revitalized appearance that doesn’t appear overdone or “pulled.”

When performed skillfully, a midface ribbon lift will deliver a natural but noticeable improvement. It is frequently performed with other procedures. However, for many younger patients, under 45 years old, midface suspension is often a standalone procedure. Good candidates must have realistic expectations and be prepared to follow the postoperative recovery protocol and must be accepting of the risks. Poor candidates include those patients with unrealistic expectations, have uncontrolled medical illnesses that affect wound healing, are grossly overweight (with heavy faces) or are excessively thin, loose skin. The mid face ribbon suspension may be combined with other, more minor surgical procedures, such as fat transfer, Botox, Injectable Fillers, Thermalift, Thermage, Fractionated skin resurfacing, deep chemical peel or Fotofacial intense pulse light treatments. All procedures can be completed using local anesthesia by a cosmetic surgeon as in-office minimally invasive facial rejuvenation.

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Newborn skin is clear, smooth and has that glow of youth. Our skin is a living record of our personal exposures and personal experiences since birth. Exposure to sun, wind, chemicals, toxins as well as the signs of scars give a detailed record of our skin. Many people appear older than their calendar years—due to exposures and experiences. Photo rejuvenation is an aggressive medical skin treatment to reverse the signs of aging and thereby improve the health and vitality of skin. In some cases, photo rejuvenation may reverse pre-cancer lesions of the skin.  Photo-aging results in age spots, actinic keratosis, wrinkles, broken capillaries, blotchy skin, and hyper pigmentation. Most patients wish for easy yet effective solutions to clear their skin; solutions that do not disrupt their busy lives. Clinical advancement and sophisticated laser systems offer new treatment options for these signs of weathered aged skin.

IPL, or Intense Pulsed Light Therapy, is an exciting procedure that can diminish the appearance of age spots, facial flushing, purple or blue veins on the face, port wine stains, tattoos, flat birth marks, hypo-pigmentation, fine wrinkles, broken capillaries, freckles, redness, and minor sun damage. This treatment can even be used for facial/body hair reduction.

IPL can be used to treat the face, chest, neck, and hands, and treatments only take 15 to 30 minutes per session. Almost anyone can be a candidate for this procedure but only your doctor can fully determine if your skin type is compatible with IPL. This treatment is a painless alternative to chemical or laser peels and in many cases patients report a reduction in pores and smoother skin. IPL is a quick, non-invasive procedure and best part is that there is virtually no downtime. The light passes through the facial tissue where it is then absorbed by either blood or melanin. The injured tissue is then removed by the body’s natural processes and the skin appears fresh and even.

Photodynamic therapy is an exciting new medical procedure that opens the door to a new FDA approved era of non ablative laser and pulsed light treatments. This therapy combines the application of a photosensitizer (5 ALA, or Levulan) with a laser pulsed light, with dramatic improvements and little downtime or discomfort.

Photodynamic, or blue-light, therapy for actinic keratosis can help treat and reduce the number of precancer lesions of the skin. Pioneered in Europe, the therapy works by applying a light-sensitizing chemical solution to the skin area that needs treatment and then exposing that skin area to blue light. The photosensitive chemicals, which have been absorbed into the aged skin or abnormal skin, react with the particular wavelength of blue light to generate reactive oxygen radicals that destroy the potentially precancerous or cancerous skin cells. Photodynamic therapy can treat large areas of the patient’s skin, usually with little discomfort, and offers some advantages over other treatment methods.  Longer-standing treatments for actinic keratosis include cryotherapy, which involves freezing the skin with liquid nitrogen. Unlike Photodynamic therapy, cryrotherapy is not practical to use for large areas of skin damage.

The ideal candidate for photo rejuvenation has sun damaged skin, actinic keratosis, rosacea, acne, acne scarring, hyperpigmentation, moderate wrinkles, enlarged pores, or poor skin texture.

Following treatments, skin is smoother, softer, and even toned-youthful. Acne diminishes or disappears, and pores are smaller. Results of photo-rejuvenation procedures often exceed people’s expectations.

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All skin resurfacing procedures function in basically the same way. The top layers of skin are eliminated, leaving smoother, tighter skin on the surface after a period of healing. In other words, one has to trick the skin to think that it has been damaged in order for it to go into a healing phase. Along with healing, tissues are renewed, regenerated and ultimately younger looking. There are several advantages to laser skin resurfacing that aren’t available with other resurfacing procedures such as deep chemical peels or dermabrasion. One benefit of the laser is that it heats the deep layers of skin, stimulating collagen production. Collagen and elastin are the foundation materials which gives skin thickness, texture and pliability. Another benefit is a decrease in downtime for final healing.

Laser skin resurfacing is a time-tested procedure using a carbon dioxide (CO2) laser beam to eliminate damaged outer layers of skin at specific and varying depth levels. This resurfacing replaces the damaged skin with new, fresh skin. Many of the systems used for this process are capable of deep, moderate, or light resurfacing depending on the level of damage. The process is also known as laser peel or skin resurfacing. It may be used to improve the appearance of just certain areas of the face or the whole face, but is mostly beneficial for reducing fine lines in the areas around the mouth, forehead, and eyes. This procedure can also be useful for treating acne scars or areas with brown spots or uneven pigmentation.

Many are familiar with the older formal CO2 laser skin resurfacing. The older CO2 laser treatments cause skin damage as an ablative procedure. A majority portion of the upper layers of the skin are damaged, similar to a 2nd degree burn. This damaged layer of skin peels in sheets revealing new skin resurfaced. Results with formal CO2 laser resurfacing can be dramatic; but with drawbacks. Ablative resurfacing carries higher risks for skin pigment changes, scarring and longer downtime for healing.

New cutting edge technology has developed fractionated laser treatments. These advanced laser techniques fractionate the laser beam to produce thousands of tiny localized highly focused laser beams. These microscopic beams damaged skin in columns known as MicroThermal Zones. These zones define an area that will undergo replacement and an area of normal skin that will remain untouched. The laser beams can be of different wave lengths–YAG, CO2, Erbium. Each have different levels of penetration and benefits. During the healing process, collagen and elastin are regenerated and a defined portion of the skin is resurfaced with each session. The “fractional” treatment area is what makes the healing process work so quickly. Instead of the body facing a large portion of skin to re-grow, it can focus on smaller micro areas for skin renewal. Deeper layers of the skin stimulate collagen remodeling to give the skin a much healthier, firmer appearance over six months after the laser treatment. The new skin effect can last for years.

Before

After Laser Skin Resurfacing and Mini Lift

Laser skin resurfacing is typically performed under local anesthesia, meaning one will be awake, but feel no pain, and be given a sedative to help with relaxation. Sometimes with more extensive procedures for scarring and deep wrinkles, deep sedation IV anesthesia is administered. After the procedure patients are required to apply some kind of cream or ointment may be used to protect the treated skin. The skin will be pink with crusts formation over a few days. The length of recovery may vary depending on the level of damage to the skin. Most people can return to regular makeup after about 5-7 days, but is extremely important to stay away from sun until the new skin has changed to a healed state. Of course, this means using sunscreens and wearing a hat.

Some are not good candidates for laser skin resurfacing. Skin color types of black, brown, or dark olive are at high risk for changes in pigmentation after laser resurfacing. Anyone who has used accutane in the last 2 years or who has frequent skin infections may not be good candidate.

Patients are finding out that they don’t have to pay high costs or take many days off work to enjoy smooth, youthful-looking skin. Both women and men often notice improvements in wrinkles and acne scarring at the surface within the first few weeks following fractionated laser treatments, and the long-term effects of laser resurfacing can be more dramatic. After limited downtime recovery, with proper care one’s skin will appear younger and fresher for many years to come.

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Luscious Eyelashes

There is a prescription treatment recently approved by the U.S. Food and Drug Administration which actually makes eyelashes longer, thicker and darker. No longer do women need to turn to mascara or false eyelashes for lengthy and luscious eyelashes. The drug LATISSE , known generically as bimatroprost, initially was used by ophthalmologists  to lower intraocular pressure in people with open-angle glaucoma or ocular hypertension. This medication has been around for years–but recently was approved for its cosmetic effects.

Many medications have untoward side effects, however bimatroprost has an unusual side effect,  eyelash growth–growth in length, numbers and thickness of eyelashes. This grown is gradual— with full results after 12 to 16 weeks of daily therapy. Patients being treated for glaucoma noted dramatic changes to their eyelashes.  Sustained growth with longer and thicker eyelashes.  Once the product is started, it must be continued on an ongoing basis for best results to maintain the length, numbers and thickness of the new eyelashes. Remember results are gradual over time with bimatroprost.

LatisseYou may have recently seen model Brooke Shields and Jewel  display the benefits of eyelash enhancement in TV commercials.  By an unknown mechanism the bimatroprost solution causes dormant eyelashes to change to an active growth phase. A drop of the product is placed on an applicator and applied horizontally to the upper eyelash line, each night before bed. The solution rapidly dries.  Younger patients see rapid changes in eyelash growth and women 40 and older typically will see results in four to six weeks of therapy. At this point the  FDA has approved the product for upper eyelashes only.

In a clinical study, 78% of participants experienced a significant increase in overall eyelash prominence. Eyelash prominence (including elements of length, fullness, and darkness) was noted after using bimatroprost for 16 weeks. Most patients tolerated the solution without problem. The most common side effects of an itching sensation in the eyes and/or eye redness,  were reported in approximately 4% of patients. Other less common side effects, typically occur on the skin close to where the solution is applied, or in the eyes. These include eye irritation, dryness of the eyes, and redness of the eyelids. Skin darkening (or hyperpigmentation) is another less common side effect. This condition causes areas of skin to become darker than the surrounding skin color, but has been reported to be reversible after discontinuation of the product.

Throughout clinical trials, some users did experience itchy eyes and eye redness. However, some users found that these irritations went away once they became accustomed to the product or began applying it properly. As with any prescription treatment, always consult with your doctor for information and proper usage for best results. Increased brown iris pigmentation has occurred when similar medications were instilled directly into the eye to treat elevated intraocular pressure/glaucoma. Although iris pigmentation was not reported in clinical studies, patients should be advised about the potential for increased brown iris pigmentation which is likely to be permanent.

Patients who wish to start bimatroprost should contact a physician trained to guide them in application. A history and physical examination should be completed to insure that you are a candidate for therapy. Risks, benefits and options should be discussed along with completion of baseline photographs.

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