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.


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.


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.


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.


Dysport & Botox- Sisters But Not Twins

February 25, 2011

So which do you prefer, Skippy of Jif?  What’s better, a Mercedes or a BMW?  You know the answer, the one you like is better.  But we can all agree that the world is a better place with choices.  For about twenty years, Botox was the only choice for patients in the USA.  But in May, 2009 the FDA approved a second choice- Dysport.  Botox and Dysport are very similar medications.  They both work by temporarily weakening muscles, which allows cosmetic surgeons to use them to reduce wrinkles and give you a more relaxed, pleasant expression. (as promised in my last post…in the future I’ll talk about other neat things that these amazing medications can do).

First some background.  Dysport is certainly the new kid on the block, but it is no beginner.  It has been used around the world for about the same length of time as Botox.  Even though patients have been treated with Botox and Dysport for about 20 years,  there are no really good research studies comparing the two.  As doctors we like to rely on science.  We just don’t have the answers yet when it comes to comparing the two medications side by side. 

However, I am pretty comfortable telling you the following “facts” about these two great treatments.

  1. Both Botox and Dysport seem to be safe medications.  I believe that the majority of doctors who have experience with both feel they are equally safe.   I can tell you that my wife and I use both and we would recommend either to a family member.
  2. Clearly,  both medications are effective at weakening muscles, and if administered correctly, both give very good results.
  3. Botox takes effect in anywhere from one to fourteen days.  Dysport seems to work a little faster for most people.
  4. Most doctors that I know feel that Dysport and Botox last about the same length of time in most patients.  Usually 3-4 months, but sometimes a little longer.
  5. About half of my patients who have tried both, feel that they can not tell the difference between Botox and Dysport.
  6. About 25% prefer Dysport and 25% prefer Botox.

So how do you decide?  There is no great answer.  Some people switch from one to the other because they have not been totally satisfied with their results (this is pretty rare).  Others choose one or the other because one of the companies is offering a rebate.  Some people are just adventurous and like to try something new.  Bottom line, as long as you see an experienced cosmetic surgeon, you are pretty likely to like either…. but you may prefer one over the other. 

Choosy mothers choose Jif.  Personally I like Skippy.

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If you would like to read more about Botox and Dysport, please visit our website here.
If you would like to read the FDA approved medication guides for these treatments…..  Botox or Dysport


First There Was Botox

February 15, 2011

If you are taking the time to read this blog, you probably know at least a little about Botox.  In future posts I’ll be talking a lot about Botox.  In this post we’ll cover Botox 101.  That way we can refer back to this as we talk about all kinds of neat Botox topics.  The FDA has created very strict rules about informing people about Botox.  If you would like to read the FDA approved safety information about Botox, click here

Botox started a revolution in cosmetic surgery.  It is the mother of all lunchtime cosmetic treatments. When you get Botox, you can walk into your cosmetic surgeons office on your lunch break, get a treatment, have a quick lunch, and still get back to work on time.  The results are fantastic and the treatment is safe.  Are most patients satisfied with Botox? Yes.  Just look at the numbers.  In 2009, there were about 2.5 million cosmetic Botox treatments in America.  That is the most common cosmetic procedure performed in the US….. by a huge margin.  To give you an idea of how huge, Botox is given twice as frequently as the number 2 treatment, Hyaluronic Acid dermal fillers (Juvederm, Restylane, and some others).  Here is another fact: Botox treatments are about 10 times more common than the most popular cosmetic surgical procedure, breast augmentation.

So how does it work? 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 (we’ll talk about all the neat things Botox can do in another post).  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. 

Let me tell you what to expect when you get a Botox injection. 

  1. First you will need a consultation with your Botox 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 Botox is 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 decide to proceed, 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.
  4. You’ll feel the injections, but the discomfort should be pretty mild.  In our office we use the smallest possible needle and that helps.  We also use a messaging pillow on your neck to distract your nerves from feeling the injection….it works.
  5. Then you can go home (or to work, or to wherever).  You don’t need to limit your activity or do any special care.
  6. Depending our your biology, Botox will start to work  as soon as 24 hours or as long as 2 weeks.
  7. In our office we have people come back 2 weeks after their first treatment to be sure that everything is a good as possible. Some patient get a little bit more here or there to have the best possible result.
  8. The Botox should last at least 3 months.  In many people it lasts longer.  When it wears off you have the option to do it again.  Be warned…..if you are like most of our patients, you’ll want to do it again.

So those are the basics.   There is a lot of fun stuff we can do with Botox, so there is plenty of material for future posts.  If you would like to learn more right now click here.


Welcome. This is the place to learn about cosmetic surgery

January 24, 2011

Dr. Marc Cohen & Dr. Nancy Swartz

 Hi.  Welcome to botoxdocs.  Here you can learn the latest about cosmetic surgery….and hopefully have some fun while you’re at it.  We all know that the web is full of information about cosmetic surgery.  Some of it is even true.  If we do our job right, it will be obvious that this is a place that you can come to get the truth about cosmetic surgery.   We love what we do and feel that, if you are interested, cosmetic surgery can really be a lot of fun. 

This is our first post so let us introduce ourselves and tell you a little bit about who we are.   Our practice is run by two of us,  Marc Cohen, MD and Nancy Swartz, MS, MD.  We are both ophthalmic plastic and cosmetic surgeons, which means that we focus on making people’s faces look better.  At our office we really focus on Botox, Dermal Fillers (Juvederm & Restylane), Cosmetic Eyelid Surgery, and Cosmetic Skin Care.  We have three offices, all in the Delaware Valley (Center City, Main Line, and South Jersey).  We have been in practice for about 20 years, and our office is a very happy place. Oh, one more thing, we’re married which is one of things that makes our practice pretty unique (more about that in later blogs).  If you would like a better mental picture of who we are, you can visit our website http://www.cosmetic-eyes.com or check out this one minute video.

Our goal is to do several things with this blog:

  1. Give you the latest information about cosmetic surgery (we’ll talk about all kinds of things but most of it will be about your face).
  2. Answer the type of questions that we are asked by our patients.
  3. Answer your questions
  4. Entertain you, and have some fun ourselves by telling you things that we find interesting, and think you will too.

You have a lot of great ways to spend your time.  Hopefully taking a look at our Blog now and then, will be worthwhile for you.

If you ever have any questions that you would like to ask us privately, please email us at doctors@cosmetic-eyes.com.


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