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BOTOX

Deep lines between your eyes make you look tired, angry, sad, or upset. Your facial expressions cause wrinkles in and around your eyes and forehead. There is asymmetry in your eyebrows or face that can be corrected by relaxing a muscle. You suffer from migraine headaches and botulinum toxin may provide relief from this condition.

BOTOX Also known as BOTOX® Cosmetic, Dysport®, or Botulinum Toxin Type A

Botulinum toxin (Type A) is a cosmetic injection that blocks the nerve signals that cause muscles to contract. This effect relaxes and smooths the look of lines and wrinkles caused by repetitive movements on the face—most commonly, between the brows, crows-feet around the eyes, and horizontal forehead creases. Botulinum toxin is also used cosmetically to balance facial asymmetry and relax tight neck bands, as well as medically to reduce perspiration and to treat migraine headaches and muscle spasticity.

Are you a good candidate for botulinum toxin injections?

You may consider botulinum toxin injections for cosmetic reasons if you are developing lines and wrinkles on your face due to common facial movements. Depending on genetics, lines can appear on the face as early as your late twenties to as late as your early forties. If you are prone to developing lines and to making facial expressions that lead to wrinkles, your plastic surgeon may also recommend using botulinum toxin as a preventative measure.

Certain wrinkles or creases in the face caused by the weakening or sinking of the soft tissue, such as the nasolabial folds, which extend from the sides of the nose to the corners of the mouth, are generally best treated with fillers, fat grafts or surgery (although occasionally botulinum toxin is used to soften or partially improve them).

Pros

  • Injections are relatively painless and carry a low risk, with little-to-no downtime.
  • Can help you appear less angry and more approachable
  • Make subtle changes that give you a refreshed or well-rested look

Cons

  • Effects of injections will only last three to six months
  • Risk of droopy eye or muscle if injected incorrectly
  • If area to be injected is sensitive, bruising may occur

Detailed Procedural Info

How is a botulinum toxin procedure performed?

Botulinum toxin injections can usually be completed on the same day as the initial evaluation. They do not require hours to perform or days to recover. Once you and your surgeon have decided on an appropriate treatment, he or she will prepare you and the medication for the procedure. The injection site will be cleansed and will usually not require anesthesia prior to injection. The needles used are very short and thin, causing minimal pain. Depending on your specific concerns and condition, a number of injections will be needed to achieve the desired result. Slight pain, short-lasting swelling, and minimal redness and bleeding will likely occur as a result of your procedure.

Once the neurotoxin has been injected, it will take several days to reach full effect and a follow-up visit is often scheduled weeks to months after the initial injection.

After the injections you can return to your regular activities immediately; however, strenuous activity is discouraged for the remainder of the day. Redness and swelling that occur at the time of injection usually resolve quickly. Any bruising that might occur will usually resolve over a week or two.

Avoid massaging or touching the injected area afterwards; this may inadvertently cause the botulinum toxin to spread to an unintended area. Lying down or inverting the body shortly after injection can also cause complications. Avoid strenuous or vigorous activities for the rest of the day.

Also know as dermal fillers and soft tissue fillers

Fillers are a type of minimally invasive aesthetic medicine used to add volume, alter the contours of the face, and fill in wrinkles. Common areas to inject fillers are in the face, neck, and hands, resulting in a fuller, smoother and more youthful appearance. Dermal fillers are among the most popular aesthetic procedures because they carry immediate results, very few risks and little recovery time.

Are you a good candidate for fillers?

The following are some common reason why you may want to consider fillers:

  • You have lines or wrinkles around your mouth, eyes or forehead.
  • You’d like to enhance the volume in areas such as the cheeks, jaw line or lips.
  • If you have scars and depressions in the skin resulting from acne, injury or congenital imperfections.
  • Injectable fillers can help diminish the appearance of deep nasolabial lines.
  • Adding volume to areas like the cheekbones can create a more defined countor.

Pros

  • Filler injections are quick and only require a topical anesthetic at most
  • Results are immediate and there is little to no downtime
  • Fillers provide a subtle look that can be adjusted to meet your aesthetic needs

Cons

  • Fillers are temporary and require repeat injections to maintain your goal
  • Some people may be sensitive and experience bruising and swelling
  • Results are dependent on the experience and qualifications of your injector

Detailed Procedural Info

How is a fillers procedure performed?

Fillers are administered with a syringe to various areas on the face and head, including around the eyes, along the jaw, around the lips and in the forehead. The number, location and depth of the injections depend largely on the type of dermal fillers used and the desired results. Some fillers contain a local anesthetic like lidocaine to enhance comfort during injection. Numbing cream may also be used.

There are three types of fillers commonly used: temporary, semi-permanent, and permanent. 

Temporary Fillers

Collagen-Based Fillers: Collagen is a naturally occurring protein that adds strength and structure to the skin. Collagen was the first filler on the market, but the arrival of hyaluronic acid-based fillers has decreased its popularity.

Hyaluronic Acid-Based Fillers: Like collagen, hyaluronic acid is a naturally occurring substance and primarily used to promote fullness and volume.

Calcium Hydroxylapatite: Heavier and denser than hyaluronic acid, this filler is injected deeper, underneath the skin, and does not usually cause immune or allergic responses because the material is usually found in bones. 

Semi-Permanent Fillers

Longer-lasting dermal fillers typically contain thicker substances, such as the biodegradable synthetic filler known as poly-L-lactic acid. These types of soft tissue fillers are used to treat deeper facial lines, and though they offer semi-permanent results, it’s possible that you’ll need an occasional “touch up” several weeks after your initial injections.

Permanent Fillers

Permanent fillers are made of polymethylmethacrylate (PMMA), which are microspheres that are not absorbed by the body. The filler also contains collagen and is only recommended for thick-skin areas such as the nasolabial folds. It is not recommended for any areas around the eyes or for the lips.

FILLERS

If you have deep lines around the eyes, brow or mouth. If you would like to change the contours of your jaw or lips. If you are interested in a minimally invasive procedure

What are the brand names for fillers?

There are a number of soft tissue filler brand names, but some of the most common are:

  • Hyaluronic Acid-Based Fillers: Restylane®, Restylane® Lyft, Restylane® Silk, Juvederm, PREVELLE Silk, Hydrelle, Belotero
  • Collagen-Based Fillers: Cosmoplast, Cosmoderm, Evolence
  • Semi-Permanent Fillers: Sculptra, Radiessee
  • Permanent Fillers: ArteFill

Immediately after injection

You will likely see the results of your injections immediately following the procedure, though it’s not uncommon for patients to experience swelling or minimal bruising in the area of the injection site. Your physician may give you an ice pack or cold compress to help stem swelling. The period of swelling will depend largely on the type of soft tissue filler you received, though most swelling, bruising, and redness should dissipate within one week to ten days.

Recovery time frame

One of the most enticing features of soft tissue fillers is their minimal recovery time. In the approximate week it takes for swelling and bruising to disappear, your doctor may advise you to avoid wearing hats or other headgear and only use small amounts of makeup.

Results

The length of results from your dermal fillers is dependent on the type of injection you received:

  • Collagen-Based Fillers: Results will last from two to four months.
  • Hyaluronic Acid-Based Fillers: Results vary, though results of most common brands will last six to twelve months.
  • Semi-Permanent Fillers: Results will last between twelve and eighteen months.
  • Permanent Fillers: Results are typically still visible after five or more years.

DERMA-PLANNING

Dermaplaning is not designed for people with acne or those who experience frequent breakouts because it can trigger over activity of the sebaceous glands. When someone has acne, they need their vellous hairs to expunge the oil that typically builds up under the skin. If the vellous hairs are removed because of the dermaplaning procedure, the individual may experience more breakouts and even more severe acne.

Description

Derma-planing is a simple and effective method of exfoliation that consists of using a surgical scalpel to gently scrape off the top layer of dulling dead skin cells and the very fine vellous hair, often referred to as “peach fuzz” in order to reveal a smoother brighter complexion. Dermaplaning is not designed for people with acne or those who experience frequent breakouts because it can trigger over activity of the sebaceous glands. When someone has acne, they need their vellous hairs to expunge the oil that typically builds up under the skin. If the vellous hairs are removed because of the dermaplaning procedure, the individual may experience more breakouts and even more severe acne.  Removal of the outermost layer gets rid of the dead cell build-up which allows products to penetrate more readily into the deeper layers of the skin.

Procedure

A sterile surgical scalpel blade is held perpendicular to the skin and scrapped across the face in a brisk sweeping motion removing the dead skin and fine hair from the face. Cost $100 per treatment. Several treatments throughout the year give better results.

Post-treatment

The procedure causes no trauma to the skin, it is pain free with very slight redness/swelling post- treatment, and has no downtime. Because of its safety it can be performed every few weeks but skin may peel naturally. Emollient-rich moisturizer must be used day and night to ensure skin does not become too dry.    

Benefits

  • Safe for all skin types
  • Good for acne prone skin 
  • Exfoliates skin with broken capillaries         
  • Helps exfoliate skin with broken capillaries
  • Offers better results than traditional microdermabrasion 
  • Little downtime
  • Skin is only slightly red and puffy after the treatment
  • Can temporarily remove fine, downy hair with ease

Description

Kybella is a non-surgical injection treatment that eliminates the fat responsible for the appearance of a “double chin” or “turkey-neck”. Kybella is the only fat melter approved by the FDA to improve moderate to severe sub-mental fullness and tighten and tone the skin around the chin, creating a sleek, sculpted profile.

Procedure

Kybella is a synthetic formulation of Deoxycholic acid, a naturally occurring molecule in the body that aids in the breakdown and absorption of fat. Because it acts the same on all fat, including the protective fatty sheath surrounding nerves, its indication is currently limited to a small area under the chin. A very specific protocol is followed, mapping in detail each individual injection site and identifying the areas to avoid.  Although the injections themselves are given quickly, the treatments take 15-30 minutes because of the marking. Initially there is minimal pain, but as the treatment progresses, it does intensify as the medication at the first injection site begins to breakdown the fat. The procedure is over fast but anesthetic is available if necessary.  The cost of the treatment is $1200. Optimal results are rarely achieved after 1 treatment, 2-3 treatments every 8 weeks are recommended, but the final result is permanent.

Post-treatment

Immediately after treatment, the area becomes very red and swollen. A moderately sharp pain is felt for about 10 minutes but soon changes to a dull ache lasting about a week. Significant redness & swelling of the chin can lasts 30-40 minutes up to 12 hours. The results start to be visible at about 2-4 weeks. Once the desired result is achieved it lasts forever.

Benefits

  • Improvement of mod-severe sub-mental fullness
  • Increased tightness and tone to skin under chin 
  • Sleek, sharply sculpted neck profile

KYBELLA

MICRO-NEEDLING

Description

Micro-needling is a rejuvenation procedure involving an automatic hand-held device with 12 very fine rotating needles.  The needles produce punctures in the skin and create numerous micro-injuries. These tiny injuries signal the skin to repair itself and trigger the agents required during the healing process.  The skin’s production of Collagen, Elastin and various Growth factors increases and results in a thicker epidermis giving a softer, more youthful appearance. 

Procedure

The Micropen is a type of needling device used to perform the treatment and it safe for all types of skin and for all parts of the body. Treatments take 15-30 min. depending on size & area being treated. Procedure is mild-moderately painful (feels like sandpaper across the skin) and topical anesthetic is provided. Cost per treatment is $350. A series of 3-6 treatments, spaced at 4-6 week intervals is ideal for optimal results in most patients.

Post-treatment

Immediately following the treatment , the skin will appear pink and flushed, similar to a mild sunburn. There may also be mild swelling and tightness. This appearance is temporary and typically resolves within 2-48 hours. Total healing time depends on skin type, depth of treatment, and condition being treated.  Initial improvements are seen 3-5 days after treatment. The skin feels softer and has a “healthy glow”.  Results from increased collagen production are visible approximately 2-4 weeks after treatment and can continue for up to 6 months.

Benefits

  • Overall, long lasting, “healthy glow”
  • Improvement in skin’s texture, tone, and color uniformity
  • Decrease in wrinkle and pore size     
  • Elimination of age spots and irregular pigmentation 
  • Reduction in the appearance of fine lines and acne scaring
  • Lightening of and stretch marks and traumatic scars
  • Increased penetration and effectiveness of topical skin care products

Details

Platelets are one of the main components of blood. They are responsible for clot formation after an injury and they contain numerous Platelet Derived Growth Factors (PDGF).  After an injury, healing Platelets rush to the affected area and create a strong fibrin mesh. This fibrin mesh signals the release of growth factors that nourish the tissue, improve circulation, and remove metabolic waste. The fibrin mesh also stimulates skin cells to divide and to increase their production of fibroblasts, the precursor to collagen protein and hyaluronic acid.  This increased production of collagen & hyaluronic acid in tissue repair is also what helps correct the visible effects of wrinkles. In addition, the hyaluronic acid also increases skin tone and volume resulting in a more youthful appearance. since the PDGFs have so manyskin related benefits and the other blood components aren’t really needed, the current practice is to separate the Red & White blood cellsfrom the Plasma using a centrifuge. By centrifuging at a specific rate, the blood separates from the Plasma in such a way, that the platelet poor plasma is left in the tube with the other blood cells and the remaining serum contains only Plasma Rich Plasma (PRP).  This process concentrates the Platelet count to about 4X normal and the serum is often referred to as “liquid gold”. This “liquid gold” (PRP) has long been used in Orthopedic and Dental procedures and is now used in Sports Medicine for Athletes with soft tissue injuries and in Wound Care for tissue repair. Although PRP is relatively new, it has still become one of the Top 10 most requested service.

PRP Procurement

(Same for all PRP therapies) One or two test tubes of blood is collectedand processed in a centrifuge to provide the concentrated plasma serum (PRP, “liquid gold”) need for the treatment. After the “liquid gold” (PRP serum) is activated by addinga small amount of calcium chloride, the activated plasma serum behaves identical to theway the body would respond if there were an injury. The fibrin mesh is created after an actual injury or a controlled injury (i.e. microneedling), and the healing process continues with both types of injury. The end result is also the same; healthier overall appearance, thickened dermis (reducing fine lines & scarring) improved tone & texture, smaller pore size, more even color)

Procedures

PRP Rejuvenation

Platelet serum introduced to skin by injecting directly into wrinkled area or a an area with loss of volume. Can be used in all areas, it is especially beneficial for forehead wrinkles above the eye where Botox can’t be given, “dark circles” under the eyes, and re-volumizing midface or cheeks . Cost $350 per syringe. Initially, 3-6 treatments 4-6 weeks apart are recommended for optimal results. One-Two treatments per year, suggested for maintenance. Improvement of skin texture & tone can be noticed within 3 weeks, improvement continues for the next 6-8 months. Results can last up to 2 years.

PRP Rejuvenation + Micro-needling

PRP serum is applied topically before needling treatment to provide a smooth, gliding motion of the device across skin. The Needling action during treatment forces PRP deeper into the skin. Upon completion, the remaining PRP is massaged into the skin.  The tiny channels created during treatment increase penetration, absorption, and effectiveness, of other products applied topically as well.  (i.e. PRP, skincare products, prescription creams, etc) Cost $650 per treatment. 2-6 treatments, spaced 4-6 weeks apart, until desired effect is recommended. Improved appearance visibly noticeable by 3 week, improvement continues for the next 6-8 months,1-2 treatments annually for maintenance. This treatment is especially beneficial for scarring and has shown promise with stretch-marks.

PRP Rejuvenation + Fillers

Incorporating fillers jnto a PRP treatment will enhance the facial shape and volume. Fillers Injected in layers immediately after PRP injection, enable the Fibrin mesh to act as a scaffolding giving the injectable produce a place to attach to. The PRP prolongs and amplifies the filler correction with the need for less filler per treatment and a longer duration. Cost is $350 added to the cost of the injection.

PRP + Microneedling for Hair Restoration

Growth factors released by the platelets to help stimulate inactive hair follicles to produce new hairs, which replace the falling ones. This helps to combat both hair thinning and balding. It also promotes healing of the skin and the scalp should become much healthier over time due to active production of new tissue. Cost $750 per treatment. 2-6 treatments, spaced 4-6 weeks apart is recommended for optimal result. 1-2 treatments annually for maintenance.

PLATELET RICH PLASMA (PRP) THERAPIES