Belotero: A new (and better) way to fix lipstick lines and other fine wrinkles

December 31, 2012

Dermal fillers are like magic.  They are one of the best, and safest, ways to long younger instantly.  Over the past 5-10 years the undisputed kings of dermal fillers have been Juvederm and Restylane.  We still recommend Juvederm and Restylane for the majority of our patients.  However there is now a very talented new kid on the  block, Belotero.  Belotero has some properties that make it a fabulous addition to our bag of tricks to make you look great.

Here is what we told you about Juvederm and Restylane about two years ago….

The first safe dermal filler was collagen. Collagen was injected into wrinkles to fill them out and smooth the skin. Collagen was the king of fillers until the mid 2000′s when hyaluronic filers came along.  Hyaluronic fillers last about twice as long as collagen and they are reversible.  For that reason hyaluronic fillers have replaced collagen, which is no longer available.  There are lots of different hyaluronic acid fillers.  The ones we like best are Juvederm and Restylane. 

Right around the time that Restylane and Juvederm became available, there was a major paradigm shift in how we view ageing of the face.  Good cosmetic surgeons started to understand that as we age, our faces loose volume.  We used to think that faces fell.  We now know that they deflate and sink inward.  I’ll talk about this in more detail in future posts.  For now just believe me, when we age, our faces loose volume.  That loss of facial volume is the main reason that most of us look older.  So, for most people, the best way to look younger is to add volume.

Belotero_Before_and_After

All of that is still true.  Adding volume to your face, in the right places, makes you look younger.  But what about those pesky fine lines?  People hate the fine lines that form around the lips, cheeks, necks, etc.  It would be nice to get rid of those too, right?  That’s where Belotero comes to the rescue.

We use Belotero to erase fine lines and wrinkles in your skin.  Many years ago we used to use collagen for that problem.  Unfortunately, a collagen treatment usually only lasted about 3 months.  Because Belotero is a Hyaluronic Acid filler, like Juvederm and Restylane, it lasts a lot longer….and it gives beautiful results.

So if you have fine lines on your face (like lipstick lines), consider Belotero.  Its great.

If you would like to learn more about Dermal Fillers like Belotero, Juvederm and Restylane click here.

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Posted by Dr. Cohen

What is Revance?

September 29, 2011

The buzz in cosmetic surgery is all about Revance, the new “Botox” that does not require an injection.

As you know Botox is an amazing treatments that soften wrinkles. Botox works by temporarily relaxing muscles. By relaxing the right muscles, Botox can help you get rid of wrinkles that come with facial expression. A great example of this is the vertical lines that form between your brows when you squint, or the crows feet you get when you smile. Botox also can help with a lot of other things, from raising your brows to getting rid of the little bumps you get on your chin when you frown Botox is temporary. It last, for most people about 3-4 months and then wears off. If you like the results, you’ll probably want to do it again. Most people who are really in to it get Botox about 3 times a year.

Botox for crowsfeet

Nothing is perfect. The one issue with Botox is that it requires injections. The truth is that the injections are given very gently, with a tiny needle, so you hardly feel it at all. People who try Botox, quickly learn that it is certainly worth the injections. However, we can all agree that it would be nice if you could get the same results without injections.

Enter Revance. Revance is a gel that is made to deliver a medication similar to Botox without any injections. The gel is applied to the skin, by your cosmetic surgeon, and then removed at just the right time a few minutes later. The idea is that you can get rid of some of your lines without an injection.

So whats that catch? Well the main catch is that Revance is still being tested to be sure that it works as well as it claims, and to be sure that it is completely safe. For that reason it is not yet FDA approved, and it is not available at this time. Most doctors think that Revance will get FDA approval in the next year or so. The second catch is that early reports claim that Revance works well for crowsfeet where the skin is thin, but not as well in areas of thicker skin, like between your brows. Time will tell, and we’ll know the answer about how well it works, and where it works, by the time it has completed testing.

For the time being we have Botox (Dysport & Xeomin) all of which work incredibly well. Stay tuned to hear more about Revance as information becomes available.

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Posted by Dr. Cohen

How to get the most from Latisse

May 1, 2011

There is just no doubt about it, Latisse is the best way to get longer, thicker and fuller lashes. In this post I will give you the inside scoop on how to get the most out of Latisse. Complications from Latisse tend to be rare and mild, but who wants even mild complications, so we’ll discuss how to avoid those problems, too.

Longer Lush Lashes with Latisse

In this post I will be saying some things that are “off label”. In other words , ideas that are different than the official FDA recommendations. To read the official FDA medication guide click here.

Hair (including eyelashes) goes through a growth phase and a resting phase. The longer the growth phase, the longer and thicker the hair. As you might expect, the growth phase of the hair on your head is much longer than the growth phase of your eyelashes. That is why the hair on your head grows long and full, and your eyelashes are much shorter and thinner. Latisse works by stimulating hair growth by keeping it in the growth phase for longer.

The trick to getting the best results from Latisse is to make sure that you get just enough of it on the base of your eyelashes. Any Latisse that gets onto other skin is just a waste of money. Even more importantly, Latisse placed in the wrong place can cause side effects (like unwanted hair growth and darkening of the skin).

Here are the special instructions that we tell our patients (after a good eye exam) when they get Latisse. Please remember that these are “off label” suggestions.

1. The brush that comes with the Latisse is not ideal. It is a bit too thick. For that reason we suggest that you use a thinner brush to apply the medication. Your two choices are: a) Buy a good lip liner or eye liner brush at the drug store and use that (just keep it clean) b) Carefully cut about 75% of the bristles off of the brush that comes with the Latisse, to make it thinner. The result of using a different (or modified) brush is that you will be able to target the Latisse to the exact spot it is needed (at the base of the lashes) without wasting any of the medication or getting the medication on the skin where it can cause side effects.

2. You can get your bottle of Latisse to last much longer if you get the most out of each drop. The way you do that is to use just one drop each day. Here is how to do that: a) Place one drop in the cap of the bottle b) dip the brush in the cap and apply to one upper eyelid c) dip the brush in the cap again into the cap and apply to the second upper lid.

3. There is no need to apply the Latisse to the lower eyelashes. Just by blinking some will get to your lower eyelid and that is enough to make those lashes grow.

4. If you get any Latisse on the outside corners of your eyelid (past where you want lashes) or on the skin under your eye, wipe it off. Remember, Latisse can make hair grow where you don’t want it and it can make your skin temporarily darker. If either of those things do happen, don’t worry because those problems are reversible if you stop putting Latisse on that skin.

I hope you find these Latisse tips helpful. We’ll be talking more about Latisse in future posts. If you would like read some more about Latisse click here.

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Posted by Dr. Cohen

Great Skin In Three Easy Steps

April 21, 2011

The secret to beautiful skin is healthy skin.  So how do we make our skin healthier?  How can we repair damage and protect our skin?   Knowing one fact helps us find the answer.  As we get older, most of the changes in our skin come from sun damage.  Wrinkles, age spots, and loss of elasticity all come from the sun.  Don’t believe me?  First take a good look at the skin on your face.  Then compare it to your skin on parts of your body where the sun don’t shine.  Case closed.

Sunburns aren’t the only way that the sun causes skin damage.  Every time the sun’s harmful UV rays reach your skin, they create free radicals in your skin. Another word for free radicals is oxidants, and oxidants cause the chemical reaction, oxidation.  Oxidation damages your skin.   The three steps to beautiful skin involve preventing the formation of free radicals, getting rid of the ones that form, and reversing the damage that they cause.

The best way to have beautiful skin is to completely avoid the sun.  But that isn’t really practical.  Many of us enjoy outdoor activities that make sun exposure inevitable.  And remember, the sun’s rays travel right through glass.  So when you’re sitting in a car or sitting near a window, even in January, the sun is hurting your skin.  And there’s no doubt about it.  The less sun you get, the better your skin will look and the healthier it will be.

Beautiful Skin is Healthy Skin

Unless you are going to lock yourself in a closet, if you want healthy skin, you’ll need a plan to protect yourself.  Any good skin care plan starts with avoiding as much sun as you reasonably can.  When you need to be in the sun, wear a wide brimmed hat, wear sunglasses with 100% UV protection, and wear a good sunblock.  Sunblock is like wearing shoes. You don’t have to wear it, but if you don’t, it won’t be long before you get hurt.

Some sunblocks are better than others.  We all know that you need to use a sunblock with an SPF between 15 and 30.   Sunblocks with lower SPF’s don’t give you enough protection.  And sunblocks with higher SPF’s tend to cost more without really offering better protection.  But the SPF number doesn’t tell you the whole story.  You need to know about the two different types of sunblock: physical and chemical.

  • Physical blocks contain Zinc or Titanium.  These products put up a physical barrier, the way rubber gloves protect your hands from water.  They actually block the sun’s harmful rays from getting to your skin.
  • Chemical blocks have chemical names.  They work by absorbing the sun’s harmful rays.   The sunblock absorbs the rays to prevent free radicals from forming directly in your skin.  The problem is that when the sunblock absorbs the sun’s rays, free radicals form in the sunblock.  And these free radicals can also damage your skin.

So Step #1 to having great skin:  use a physical sunblock (one with zinc or titanium) every day.

Okay, we are blocking most of the harmful rays with a physical sunblock.  But nothing works 100%, and we can’t block all the rays.  Some free radicals are still going to develop.  What do we do with the free radicals that weren’t blocked by our sunblock? Remember, free radicals are also called oxidants.  And you get rid of oxidants with anti-oxidants.  One good way to get antioxidants is by eating the right food (like berries) and taking at the right supplements (like vitamin C and Omega-3 fatty acids.)  But the best way to neutralize the free radicals in your skin is to apply an antioxidant directly to your skin.  And the best topical antioxidant is Vitamin C.  The most effective formulations are clear liquids that come in a brown bottle with a dropper, to prevent sunlight from changing them.  So Step #2 on the road to great skin is to apply Vitamin C to your skin every day.

Sunblock and Vitamin C are an amazing team protecting your skin.  But many of us already have some damage.  And even when we use a great sunblock and apply Vitamin C, we still can’t prevent all damage.  Some of those rays still manage to cause a little trouble.   So our final step in great skin care is to reverse the damage that has already formed.

We can get rid of damage with lasers and peels, but we don’t have to be so aggressive.  We can reverse damage and stimulate our skin to produce collagen fibers, elastic fibers, moisture, and new healthy cells with tretinoin.  The best known brand of tretinoin is Retin-A.  Tretinoin is a proven treatment to reverse sun damage, and it is FDA-approved.  Because it stimulates collagen production, it helps get rid if wrinkles.   Because it stimulates the production of elastic fibers, it improves your skin’s elasticity, making it tighter, less loose and saggy.  It increases blood flow to your skin, increasing the nutrients and moisture in your skin.  It stimulates the production of new, healthy cells and the shedding of old cells.  It has even been proven to reverse skin cancers, but we usually treat skin cancers more aggressively.  You need a doctor’s prescription and guidance so that you get the most benefit from tretinoin and avoid getting dry, red and flaky.   We’ll talk about that more in future posts.  So Step #3 is to use tretinoin to repair damaged skin. Let’s review the three steps:

  1. Avoid the sun and use a good physical sunblock.
  2. Use Vitamin C on your skin as an antioxidant.
  3. Use tretinoin with the supervision of your doctor.

There are plenty of other tricks that will keep your skin looking great.  We’ll be talking about that in future posts.

To learn about our customized skin care line, Swan Skin Care, click here.

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Posted by Dr. Swartz

Looking Tired? Maybe it’s your eyelids

April 7, 2011

Cosmetic eyelid surgery (Blepharoplasty) is the third most common cosmetic surgical procedure performed in the US. That’s not surprising, because for many people eyelid surgery is one of the best ways to improve your appearance. Our eyes are the windows to our souls. They also are the part of our face that people look at the most. There is a lot to talk about when it comes to eyelid surgery so we’ll start with this post. You could call this post eyelid surgery 101.

First there are some terms that you should know.

Ptosis- that is when your upper eyelids are actually droopy. In other words the part of your eyelid with the lashes sits too low when your eyes are open. That is due to a problem with the muscles or nerves that open the eye (usually the muscles)

Dermatochalasis- that is when you have extra skin & or fat around the eyes. It can be extra skin hanging over your upper eyelids or sagging skin and fat on your lower eyelids.

Fat prolapse- This is what people call bags. Usually people think of this as a lower lid problem, but some people have fat prolapse or excess fat in their upper eyelids as well.

Cosmetic eyelid surgery addresses any or all of these problems, depending on the needs of the patient.

Let me tell you what to expect when you have eyelid surgery.

1. First you will need a consultation with your cosmetic surgeon. At that time he/she will ask you what you would like to improve about your appearance. Then, after an exam, you’ll find out if eyelid surgery is a good idea for you and what will be corrected at the time of surgery.

2. At that point you can decide if you want to schedule surgery, or go home and think things over. Cosmetic surgery can be great, but it is elective. You should only go ahead if you are completely comfortable with what you have learned, and with your doctor.

3. If you decide to proceed, the surgery is performed at an accredited surgical center as an out- patient. Prior to surgery you will need to discontinue any medications that thin the blood (aspirin, motrin, Vit E, and others). Always check with your family doctor to be sure that it is safe for you to stop your blood thinning medication before proceeding with this elective surgery. Depending on your age you may also need to have some pre-operative tests (like blood work and an EKG).

4. You should not have anything to eat or drink after midnight before the day of surgery. In the morning you can take your regular medications with a sip of water (except for medications that thin the blood).

5. You’ll arrive at the surgical center about 1 hour prior to your surgery. First you’ll be examined by a nurse as well as the anesthesiologist. In case you have any last minute questions, you’ll also have a chance to talk to your doctor before the procedure

6. Surgery is usually performed under sedation (twilight sleep). The surgery usually takes between 1-2 hours but the time goes by very fast, because you will be asleep for the surgery.

7. After the surgery you will awaken in the recovery room. There will be ointment in your eyes, so your vision may be a little bit blurry. There will also be ice cold compresses on your eyes to help prevent bruising.

8. Once you are fully awake you will be able to go home (you’ll need a driver). At home you should take it very easy for 4 days. During that time you will apply medication to you eyes and use cold compresses frequently. You may need pain medication the first day. But it is rare to have any significant discomfort after the first day. Bruising happens over the first few days after surgery. You’ll probably have some bruising, but less is better. Taking it easy and using cold compresses helps reduce bruising. It is also helpful to sit with your head elevated (above your heart) when you are awake.

9. You will see your doctor over the next few days. If you have stitches they will be removed in about 6-10 days depending on the type of surgery that was performed.

10. Most patients are back to their near normal routine one week after surgery. You may not be able to put on makeup near your eyes for about 2 weeks (depending upon which procedure you have). You also need to avoid the sun until your skin returns to normal.

11. Most people start to see the results by about 2 weeks. But you’ll still look like you had surgery at that point. If you want to be “camera ready” (like for a wedding) you should plan to wait about 6 weeks to be safe.
So that is the basics. We’ll talk a lot about eyelid surgery specifics in future posts.

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Posted by Dr. Cohen

Dermal Fillers: A real game changer in cosmetic surgery

March 10, 2011

Of all our posts, the one that has gotten the most buzz was about Botox 101 (First There Was Botox) So, in this post we’ll cover dermal fillers 101.  Hopefully you will find this one interesting as well. We’ll use this post as a springboard to talk about many interesting topics related to fillers .

Botox started a revolution in cosmetic surgery in the 1990′s. Dermal fillers started a revolution of their own in the mid 2000′s. Here’s the scoop on dermal fillers.

The first safe dermal filler was collagen. Collagen was injected into wrinkles to fill them out and smooth the skin. Collagen was the king of fillers until the mid 2000′s when hyaluronic filers came along.  Hyaluronic fillers last about twice as long as collagen and they are reversible.  For that reason hyaluronic fillers have replaced collagen, which is no longer available.  There are lots of different hyaluronic acid fillers.  The ones we like best are Juvederm and Restylane.  In future posts I’ll talk more about that.

Right around the time that Restylane and Juvederm became available, there was a major paradigm shift in how we view ageing of the face.  Good cosmetic surgeons started to understand that as we age, our faces loose volume.  We used to think that faces fell.  We now know that they deflate and sink inward.  I’ll talk about this in more detail in future posts.  For now just believe me, when we age, our faces loose volume.  That loss of facial volume is the main reason that most of us look older.  So, for most people, the best way to look younger is to add volume.

Before & After Juvederm Treatment

Voila! we have Restylane and Juvederm which are perfect to add volume to your face.  So rather than just using filler to erase wrinkles (which is nothing to sneeze at)  we now can also use them to add volume to our face. Adding volume in just the right places can subtract years from your appearance.

Hyaluronic acid fillers are so effective that they have become the second most popular cosmetic procedure in the US (Botox is number 1).

Let me tell you what to expect when you get a Juvederm or Restylane injection.

  1. First you will need a consultation with your doctor. At that time he/she will ask you what you would like to improve about your appearance. Then, after an exam, you’ll find out if hyaluronic acid fillers are a good idea for you.
  2. At that point, you can decide if you want to proceed with a treatment, or go home and think things over. Cosmetic treatments can be great, but they are elective. You should only go ahead if you are completely comfortable with what you have learned, and with your doctor. 
  3. If you are going to have filler injections, particularly around your eyes, you may bruise.  You can reduce the chance of bruising by stopping medications that thin the blood for a week or two before the procedure.  Some common blood thinners are aspirin, Motrin (and all of its NSAID relatives like Advil), Vit E, and fish oil.  One very important point, if you were placed on a blood thinning medication by your doctor, talk to that doctor before stopping the medication, of course. 
  4. If you decide to proceed, you’ll have numbing cream applied to the areas that will be treated.  If you are going have your lips treated, you may want a numbing injection (like the dentist would give you).  Lips can be very sensitive.
  5. The doctor will then give you a series of small injections. The number of injections and location depends on what you and your doctor are trying to achieve with the treatment.
  6. Then you can go home (or to work, or to wherever). You may have some redness, bruising or swelling right after the treatment.  It is best to avoid strenuous exercise for that day (you can bruise for a few hours after treatment and excercise can make that worse).  By the next day….back to the gym.
  7. In our office we have our patients come back for an evaluation 2 weeks after their first treatment to be sure that everything is optimal. It is worth waiting that long because it make take the filler some time to get into balance with your body.  Initially, there may be some swelling in certain areas that look like lumps.  Those usually go away during the first week or two.
  8. When you come back for your follow-up visit you may want to get a little bit more here or there to have the best possible result.
  9. If there are any small lumps or bumps those can be massaged away by your doctor.  Or they can be instantly dissolved with a small injection of a medication call hyaluronidase.  We’ll talk more about hyaluronidase in future posts.
  10. The Juvederm or Restylane usually lasts at least 6 months, in some areas of the face (like under your eyes) it lasts much longer. When it wears off you have the option to do it again.

That is my review of dermal filler basics. There is plenty of material for future posts. If you would like to learn more right now click here.

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Posted by Dr. Cohen

Botox & Dermal Fillers- Cousins But Not Sisters

March 1, 2011

In our last post we talked about Botox and Dysport.  The bottom line is that they are very similar medications that are used to treat the same group of problems.  Botox and Dysport are part of a group of medications called neuro-modulators.  Neuro-modulators are the number one cosmetic treatment performed in America.  The number two most common treatment is hyaluronic acid dermal fillers. 

Hyaluronic acid dermal fillers are also injected in the office as a lunchtime type, minimally invasive treatment.  That means that they also have very little downtime (though they have a little more downtime than Botox and Dysport).  Dermal fillers add volume to the skin or fat pads.  They make you look younger because, as we age, we lose volume in our faces.  By adding that volume back, we look younger.  In future posts I’ll explain in much more detail why adding volume to you face can really make you look younger.  For now I am going to tell you about some of the products on the market.

There are many types of dermal fillers.  However, by far the most popular are those made of hyaluronic acid.  Hyaluronic acid is a natural skin substance, so these fillers are safe and healthy to use.  They are a soft gel that looks very natural in the skin.  They also have the advantage of being reversible.  If for some reason you are unhappy with your treatment, some, or all of the filler can be safely dissolved in a matter of minutes.  That makes this treatment very unique.  You can try it knowing that if you are not happy, it can be completely reversed.  Even if you love your treatment (the most likely scenario) it does not last forever.  These fillers generally last about six months to a year, depending on the part of your face that is treated, and your metabolism.

There are many different brands of hyaluronic acid fillers.  In our opinion there are two brands that outshine the rest.  These are Restylane and Juvederm.  In future posts I’ll talk about the differences, but like Botox and Dysport, they are more similar than different.  Restylane comes in two different forms.  The most commonly used is Restylane.  The same chemical comes in a thicker form called Perlane.  So Restylane and Perlane are like two strengths of the same thing.  Juvederm also comes in two forms.  The most common is called Juvederm Ultra and the thicker form is called Juvederm Ultra Plus.  Again two different strengths of the same medication.  Both of the Restylane and Juvederm products come with out with out a numbing medication call lidocaine.  That makes the injections more comfortable.  I won’t confuse you with the names of the products with and without lidocaine.  You don’t need to know that.  You can just ask you doctor if you are getting the Juvederm, or Restylane with the numbing medication included.  He/She will know what you’re talking about.

Dermal fillers changed everything in the field of facial cosmetic surgery.  In future posts we’ll talk about how they work, what it is like to get a treatment, and a whole lot of other fun stuff about these remarkable treatments.  If you would like to read more about Juvederm and Restylane click here.

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Posted by Dr. Cohen

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