Lasers: No Pain, No Gain?

Lasers have earned the status of "miracle treatment" for many skin concerns: rosacea, age spots, wrinkles, hair removal, scar treatments and more. But the idea of having a laser zap your skin directly, possibly in multiple succession? That would make even the toughest of us squirm a little.

Truth be told, in the land of lasers there is a common misperception that you have to grit your teeth and bare it. It's time to toss this idea. No matter what laser procedure on your calendar, you shouldn’t have to be gearing yourself up mentally for it by chanting the mantra “no pain, no gain.”

The key? It's simple: pain management. Pain killers, numbing creams and advancements in laser technology are all ways to minimize—even eliminate—laser-related pain. Your doctor should advise you on your best options based on his or her knowledge of the lasers in the practice and also be the one who provides those solutions. Laser companies also know that if they can minimize pain and enhance comfort, they’ll keep both patients and practices happy. For example, one way newer laser technologies can achieve this is with an attachment that literally cools the skin during treatment.

At the end of the day, you shouldn't find your laser treatments painful and uncomfortable. If you do, it's time to request a different laser or move on to a different practice!

Get Your Winter Glow On

Feeling pasty and pale this winter? Ditch the idea of turning to the damaging effects of indoor tanning, and save your money on those expensive (and very temporary) spray tans! Turns out, you can eat your way to golden skin—Whether it’s carrots, sweet potatoes, pumpkins or squash, if it’s got a high levels of carotenoids (and these yellow and orange vegetables do!), it’s great for your skin color!

Dr. Ian Stephen and colleagues at The University of Nottingham conducted research earlier this year that showed that eating a healthy diet rich in fruit and vegetables gives you a healthy glow that mimics that of the sun. But even better, they claim that eating lots of fruit and vegetables is actually more effective. Their paper was published in the Journal Evolution and Human Behaviour.

Here’s what they found...

Those who eat more portions of high-level carotenoid fruit and vegetables each day have a more of a naturally golden skin color. Carotenoids are antioxidants, which are important for our immune systems, combatting those damaging compounds produced by the stress, strain, and disease. How do you know if what you’re eating has carotenoids? Color. If it’s red, orange or yellow, it’s just the glow-getter you’re looking for!

The researchers report that when test subjects compared suntanned skin and carotenoid-colored skin, they preferred the natural glow of the carotenoid-colored skin. Their conclusion? “... if you want a healthier and more attractive skin colour, you are better off eating a healthy diet with plenty of fruit and vegetables than lying in the sun."

Your Botox Best

Getting the best out of Botox? It’s simple. The general guideline is to go in to your doctor’s office every 3 to 4 months for re-treatment. But whether you’re cost conscious or simply have trouble committing to appointment dates months out, you may want to wait until you know it’s time for a Botox brush up. The question is, how do you know?

Without a doubt, the easiest way to maintain your wrinkle-free results, is to follow the standard guidelines and plan to schedule your appointment on a regular basis. However, according to Dr. Few, there are a couple of tell-tale signs that signal a green light for your next treatment.

First, you may notice that you involuntarily find your eyebrows lifting along with your entire brow. This is a case of your elevator muscles (the ones that pull the brow up) coming back to life before the depressors do (the muscles that pull the brow down and work with the elevators to maintain balance).

Second, you may experience a slight twitch around the eye.

In either case, Dr. Few explains these as “signs of your muscles waking up after being asleep for awhile.”

And even if you are the type who commit to a regular schedule, knowing when it’s time to re-treat will come in helpful if and when an adjustment in your schedule may be needed. Consider this: Recent research has shown that over time, that you may need fewer treatments per year to maintain your results.

A study published in the medical, peer-reviewed journal Dermatologic Surgery this June treated fifty women between the ages of 30 and 50 for two years. They found that if patients receive Botox every 4 months for 2 years, treatment can be reduced to as little as every 6 months.

In this case, knowing whether it’s 2 or 3 treatments you need could mean having an extra $500 in your pocket. And that, ladies, you can take to the bank!

Your Best Winter Skin Yet

Ladies, it’s time to leave dehydration to fruit snacks. This winter get your skin fix by knowing the facts.

Winter brings with it a double skin drying whammy: cooler temperatures and artificial heat. Add some unprotected sun exposure to the mix and you’ve got the perfect recipe for parched winter skin. But you don't have to accept these unwanted seasonal skin symptoms. With three simple points, you can NO to dehydrated winter skin and YES to your best winter skin yet.

1. Recognize it. You know your skin is dehydrated when it feels dry and tight. Severely dry skin often looks scaly and flaky. But beyond discomfort and lack of aesthetic appeal, skin in this condition is also more susceptible to premature aging and wrinkles.

2. Understand it. In the winter months, dehydration can cause an imbalance in your skin’s pH levels, compromising the skin’s ability to produce sebum and retain moisture. The skin becomes dry and accumulates dead cells, yet another barrier to the products you apply topically for moisture.

3. Prepare it. Whether it's your favorite over-the-counter facial scrub or glycolic acid treatment or a lunchtime peel at your cosmetic surgeon's office, preparing your skin is the first step in preparing your skin for optimal condition. The second step? Using the right products, of course! Consider a physician-developed line such as JF Aesthetic, which is formulated to balance the skin and retain or restore the skin's natural moisture barrier.

Making of the 'Mommy Makeover'

It’s a fact: Multiple pregnancies can leave your formerly perky girls hanging out to dry—literally. And unless you’ve got great genes and a naturally slim physique (which is no guarantee either!), that formerly trim tummy is wrinkled, protrudes, sags—maybe all of the above. Ladies, after you’ve given it all up for your kids, it’s no wonder you’ve made the breast augmentation-tummy tuck combination procedure, otherwise known as the “mommy makeover,” a growing trend!

But what was initially just a trend, today, nearly a decade after the phrase was first coined, it’s certainly earned status as a tried-and-true combination of procedures that restores (perhaps even improves) the original contours of your body.

So while technologies may evolve and products come and go, one thing’s for sure: As sure as we’ll continue to procreate, the mommy makeover is here to stay.

Mini Lift: A Thing of Beauty

Traditionally, sagging facial skin has been corrected with a brow, face and neck lift. Along with that comes a three to six-hour trip to the operating room and a recovery of at least two to three weeks. If you have less drastic signs of facial aging, skin laxity, and jowling, however, you may be able to have a mini facelift.

According to Dr. Few, a mini-lift has a shorter incision area around the ear, and is only invasive enough to pull the muscle and tissue (SMAS) under the skin and achieve a nice result. As for downtime, a long weekend is generally all that’s needed, he says. (Compare that to the 2 to 3 weeks of downtime required by the traditional nip and tuck!)

Wrinkle Wars? Your Secret Weapon...

Almost every skin expert will tell you, if you’re over 40 you should be using a retinol. A retinol is a derivative of vitamin A that speeds up cell turnover to reduce fine lines and wrinkles and even out the skin.

While your dermatologist can prescribe a power-punched retinoid (such as Retin-A), over-the-counter versions (such as our very own JF Aesthetic) are also available. While prescription-strength retinoids deliver results in as little as 4 weeks, they also tend to be more harsh, often resulting in dry, easily irritated skin. Non-prescriptions retinols, on the other hand, take up to three times longer to get results, but are significantly milder and more appropriate for intolerant skin.

5 Retinol Dos and Don’ts

Whether you go the prescription or non-prescription route, there are several points that will ensure your experience with retinol products is a good one:

1. Do Start Slow

Because retinols can irritate the skin, begin by using them every other night so your skin can adjust. Also, apply only a pea-sized amount. More does not equal better results in this case.

2. Do Use At Night

Because retinols can make your skin more sensitive to the sun, apply at night only.

3. Don't Forget Your Sunblock

Yes, your skin will be more sensitive to the sun, so now more than ever be sure to wear a daily SPF. Increased skin sensitivity also makes waxing a no-no.

4. Do Use a Good Moisturizer

Retinol acts to increase skin cell turnover, so your skin may dry out, flake off or peel. The key to comfort? Keep it moist!

5. Don't Use if You're Pregnant

Or breastfeeding, for that matter. Studies have demonstrated skeletal deformities in the offspring of pregnant rats who were treated with retinoids.

Lasers, Lashes & Lips, Oh, MY!

Looking for a little post-summer pick-me-up? We’ve got 3 quick fixes for freshening up for fall.

Whether it’s wrinkles, sun spots, thinning lashes and lips, or all of the above, each of these emphasize the fact that you’re getting older. But don’t call to make that facelift consult yet (oh, no!). At TFI, we’ve got three ways you can enhance your face without going under the knife:

1. Lasers

Skin rejuvenation with the fractional erbium 2940 laser will improve all those tell-tale signs of summer sun damage—fine lines, wrinkles, sun spots and skin laxity—that can make your face appear older than its years. and. The beauty of this low energy laser is that it limits damage to the skin thereby increasing post-procedure comfort and healing time. In just a few days, you’ll be ready for your close up!

2. Lashes

While innovative non-prescription lash products abound, big price tags and unproven results make Latisse the industry gold standard. Just like the commercial says, Latisse grows longer, thicker, darker lashes in as soon as 8 weeks, with full results in 16 weeks. Of note, you have to continue to use Latisse to maintain your new and improved lashes. If you stop using it, they'll return to their original state. The reason? Eyelashes, like your hair, follow a regular growth cycle: they grow, fallout, then grow again.

3. Lips

Most experts agree: If you want to enhance the lips, the best place to start is with a hyaluronic acid (HA) filler such as Juvéderm. Juvéderm is a smooth, clear gel, which is injected into the lips with an ultra-fine needle and immediately adds volume. Plumper lips are visible immediately following treatment, although your lips will be larger than the desired end result because of post-procedure swelling. But don’t worry: Swelling resolves in 2 to 3 days and your lips will have that full and sculpted look you’re going for. Results generally last from 3 to 8 months.

Q&A: Should you moisturize acne-prone skin?

In a word, yes! Even if you have oily skin, a daily moisturizer can help to improve your skin’s hydration, create a protective barrier and make it soft without leaving it feeling oily or looking shiny. Using a daily moisturizer will also help ease the dryness, peeling and flaking that can be caused by certain acne medications (Retin-A, Accutane, benzoyl peroxide). In fact, research has shown that even if you don’t use an acne medication, simply moisturizing alone can help acne.

4 Tips for picking the right products:

1. Look for water-based, non-comedogenic moisturizers
2. Moisturize after applying acne treatments
3. Use a lotion, not a lipid-containing cream
4. Use a moisturizer with SPF

A Natural Beauty

Twenty years ago, plastic surgery had a reputation for expensive, recovery time-intensive procedures that were likely to make you look as artificial as Joan Rivers. Today, however, the hallmarks of great plastic surgery are natural, often imperceptible changes that aim to make you look just like yourself, only better.

So what’s changed?

Where surgeons once nipped and tucked wrinkled skin, today the goal is to revolumize the cheeks and midface thereby softening lines, not simply pulling them tight. But, cautions Dr. Julius Few, you don’t want to simply add volume where a surgical lift may be necessary. Overfilling the face creates just as an unnatural look as overpulling.

Finding the Sweet Spot

According to Dr. Few, there are three variables of the aging process, which determine the nature and extent of the cosmetic procedures:

1. Skin changes (wrinkles, age spots)
2. Volume loss (flattened cheek area)
3. Facial sagging, or ptosis (skin that literally hangs, eg, jowls)

Dr. Few’s approach to each face centers around his surgical and nonsurgical "blending" concept, which essentially limits surgery or the extent of surgery by addressing variables 1 and 2 with nonsurgical solutions. (Less surgery with better results? Now that's sweet!)

Surgery out of the question?

If you’re opposed to surgery or simply don’t have time for it, and you’re willing to accept limited results, then Dr. Few advises using hyaluronic acid (HA) as a bridge to surgery. Not only will an HA filler provide a roadmap for permanent results if and when you decide surgery is part of the solution, but it’s also reversible if you don’t like your results. (The proverbial cherry on top!)

Eyes Wide Open

Eye Openers: 2 Signs you may be in need of rejuvenation

They say the eyes are the windows to the soul... They indicate if we’re happy or sad; they sparkle with excitement and cry with laughter. But as we age, the eyes can also misrepresent how we feel. Heavy upper lids can make us look angry. Puffy and wrinkled lower lids can make us look tired... and, well, old.

No doubt about it, the eyes are the focal point on the face, and as such, it’s no wonder eye rejuvenation surgery (blepharoplasty) was the third most performed cosmetic surgical procedure last year, according to statistics published by the American Society of Plastic Surgery. Blepharoplasty, a surgical procedure that can repair these signs of aging, can be performed on healthy individuals under local anesthesia, right in the TFI office-accredited surgery suite. Dr. Few is a worldwide expert on eyelid surgery and has received special, advanced training in this field. If you are unhappy with the appearance of your eyes and would like a natural-looking correction, schedule an appointment with Dr. Few to determine what cosmetic options may be available to you.

5 tips to repair your skin

Wrinkles, sagging and age spots, oh MY!

At the end of every summer, each of us has some (be it a little or a lot of) sun damage to show for it. Ultraviolet radiation from the sun breaks down collagen and elastin fibers, which over time causes the skin to lose its strength and flexibility, leading to deep wrinkles and sagging skin.

While the sun is the primary culprit of premature aging, there is good news. Here's 5 things you can do to repair that sun damaged skin:

1. Topical Treatments JW Aesthetic Kojilac-C Serum treats hyperpigmentation (sun spots) and JF Aesthetic Retinol 50 Serum is used to reduce those fine lines and wrinkles. Alternating these products every night can lead to a noticeably brighter and more youthful-looking face. Products available in the TFI/SkinSuite offices.

2. Laser Resurfacing Intense pulsed light (IPL) noninvasive laser treatment can reduce age spots and sun damage. Used on the face, neck, hands and chest, this high-tech tool will restore and rejuvenate your skin.

3. Chemical Peels These topical treatments will have you waving “bye-bye” to dry, dull skin and “hello” to an even skin tone and brightened complexion. Try our our Glo Therapeutics Salicylic Acid 30% Chemical Peel or our GLO Therapeutics Modified Jessner 14% Chemical Peel.

4. Hydrate Use a hydrating moisturizer daily. The sun can leave your skin feeling and looking dry. Try TFI Aesthetic Moisturiche, www.TFIskinsuite.com

5. Protect Prevention is Key! Once you’ve treated sun damage, be sure to prevent it from returning. Wear sunscreen year round (yes, even in the winter months!). Apply at least a 15 SPF everyday and reapply when necessary.

Arnica on the A-List?

Slim down, clear up and get glowing... No, this isn’t the tag line for the latest in decadent destination spas, but what A-listers seem to think they can achieve with a supplement form of a yellow mountain daisy that grow in Europe: Arnica montana (leopard’s bane). A recent story published in the New York Times suggests that arnica has become the latest celebrity pill-popping “must” to keep the skin clear, reduce bloating and minimize bruising and inflammation. All that in a pill? Sounds like a modern miracle. Question is, is it just trendy tenor or does this seemingly biased bite of natural remedies really have teeth?

It’s a Fact...

Plastic surgeons often prescribe arnica to reduce the chance that you’ll bruise with injectables (Botox, soft tissue fillers). And arnica has a legitimate history as a natural remedy for bruising and inflammation (though the results are admittedly mild).

As for the entire list of claims (to slim you down, clear up your skin, prevent muscle soreness, relieve strained muscles, minimize bruising, prevent swelling, decrease inflammation, prevent cramps, minimize symptoms of vertigo, and, yes, even to reduce hair loss), it's probably safe to say that any of these related to inflammation just might see some relief with arnica. (Hair loss? Not so sure...)

The idea of taking it regularly as a supplement?

That may not be such a good idea, say the experts. Arnica contains the toxin helenalin which can be poisonous. (Contact with the plant can also cause skin irritation.) If enough of the arnica plant is ingested, the helenalin produces severe gastroenteritis and internal bleeding of the digestive tract. It’s also associated with uterine stimulation, so it’s a definite no-no if you’re pregnant.

But before you start the next Facebook Friend chain post that proclaims the horrors of this homeopathic remedy, the toxic results with arnica are usually a result of eating large amounts of the plant itself. Minor doses of arnica are unlikely to exert any adverse reactions because of the minimal amount ingested (homeopathic forms of Arnica 24X or more are not toxic as they contain very little arnica after dilution). Taking a supplement three days after trauma (injections, an intense workout, you get the idea...) is generally safe. But it's probably not a good idea to take it everyday, week after week, as toxicity can build over time.

Sun Damage? Un-Damage

As most of us know, the sun is the primary culprit of speeding up the aging process. Damaging UV rays create deeper lines around the eyes and mouth, an uneven complexion speckled with age spots and broken capillaries, and yes, that dreaded increased risk for skin cancer.

Granted, these days we're smarter: sunblock is part of the daily product regime, tanning is passe. But despite our best protection efforts, chances are at the end of the sunshine season, our skin could use a little help to combat the effects of the summer sun.

Meet the fractional erbium 2940 laser. Skin rejuvenation with this low energy laser improves fine lines and wrinkles, sun damage and mild skin laxity. (Got acne scars? It’ll improve the appearance of those too!).

The fractional technology available today offers several advantages over the traditional ablative technology of decades past. Because it creates limited damage to the skin, it's more comfortable, healing time is faster (which minimizes the chances of scarring, infection and long-term pigment changes), and downtime is limited to a few days as compared with 2 weeks for ablative laser resurfacing.

Here’s how it works: The fractional laser creates microscopic points of injury into the skin, leaving surrounding tissue intact. As part of the body’s natural healing process, new healthy tissue forms, boosting collagen in the skin and also creating a tightening effect. Once healing has taken place, skin texture improves and lines soften. Results are gradual and you can expect to see improvements over the 3 months following your treatment.

So as we bid adieu to summer, and turn our faces to post-summer skin damage repair, let's think fractional laser for facial rejuvenation.

Need a Lift? Needle vs Scalpel...

If your neck needs a lift, chances are so does your face. In fact, these two procedures are often performed simultaneously. Today, however, we've learned several things about the way the face ages and those insights have influenced the way we approach facial rejuvenation. Your face may need a lift, but it doesn't necessarily involve a scalpel.

We know today that facial aging is a 3-dimensional process: wrinkles and sun damage to the skin, loss of volume, and general drooping of tissue. Instead of pulling it all up and snipping it off in a traditional facelift procedure (can you say "wind-blown" look?), surgeons today are filling lines with soft tissue fillers (Restylane, Perlane, Juvederm) or fat, and picking up that excess skin by revolumizing the midface (cheeks). Often referred to as a liquid facelift, if the needle can effectively meet your goals, a surgical facelift not necessarily indicated.

But that isn't to say that the facelift is a thing of the past. If you haven't taken preventive measures along the way, have significant drooping skin, and the aging process has simply caught up with you, a surgical facelift may be needed to meet your rejuvenation goals.

At the end of the day, it's all about a customized approach to your face. If there's one thing we know for certain in the aesthetic industry (contrary to past approaches), one size does not fit all!

Facing Fat Facts

Whether it's your own fat, synthetic fillers, or both for your facial rejuvenation goals, the same adage applies: One size does not fit all

Despite the aesthetic industry’s evolving attitude toward fat as functional facial filler over the past several years—from cynical to skeptical to accepting—Dr. Few has been fat grafting for more than 12 years. Today, no doubt about it, fat is fabulous. (Who’d have predicted that?)

Fat, says Dr. Few, may be uniquely “green” (a great way to recycle that unwanted collection from the waistline, no doubt), and offer a nice, long-term facial result, but, he points out, it isn’t a filler that completely transcends the overall filler category. In other words, just as certain synthetic fillers are indicated for specific components of facial rejuvenation, (ie, hyaluronic acids are used to fill lines, plump lips, put the apple back in your cheek), fat too has it’s strengths. Unfortunately, that doesn’t include filling fine lines.

“Fat is only good for volume, not superficial wrinkles,” says Dr. Few, a fact he often points out to counter the misconception among his filler patients.

While fat is routinely used for cheeks, chin and jawline, if you’ve got fine lines to fill, those are best left to the HA fillers (Restylane, Juvéderm, Perlane). In Dr. Few's hands, it's Restylane. And if fat just isn't your thing (or if you simply don't have the tissue to spare—ahem, nice problem to have!), Dr. Few says you can opt for Restylane all the way.

Side by side, here's generally how fat and Restylane stack up (all that's left is to decide is, which one is right for you?):

Fat vs Restylane

	Procedure Time, min	Cost	Longevity
Fat	45	$4000	Indefinitely*
Restylane	15	$1500 (2 syringes)	up to 18 months

*75% patients won’t need another filler for several years; 25% patients will need another round of fat in 3 to 12 months.

True or False: A good plastic surgeon = scar-less surgery

False! (Unfortunately...)

The reality is, anytime an incision is made into the skin a scar will result. A scar by definition is the seam where the skin heals back together. It's the seam itself that can vary-from a hairline scar that is barely perceptible to one that is red, raised and hypertrophic or, at the most extreme, a keloid.

What a good plastic surgeon can do is to make it inconspicuous by putting it in a discrete place and minimizing the scar itself. But, take note, even a good surgeon is at the mercy of the healing process. The fact is, some patients are more susceptible to scarring. (This is often determined by your personal history of scarring: If you've never had any problems, chances are you'll continue on that same path, and vice versa.)

The good news is that new and innovative treatments are in development to manage less-than-ideal scars. In fact, Dr. Few will be giving a presentation at the annual meeting of the American Society of Plastic Surgeons in Denver this September on an injectable substance to limit scarring. Stay tuned for more on this hot topic!

Dark or light skin tones: which do you think is more sensitive to aging?

Last week we asked you on Facebook to answer the question, Dark or light skin tones: which do you think is more sensitive to aging? Your answers varied. Here's what Dr. Few has to say:

Lighter and darker skin have their advantages and disadvantages. Lighter skin tends to be more susceptible to aging because of it's greater susceptibility to sun-related damage. Lighter skin also tends to be thinner and less oily than it's darker counterparts, making it more susceptible to environmental forces such as cold, dry weather and smoking.

Darker skin has inherent SPF in it, helping to minimize the damaging effects of the sun. The disadvantage with darker skin is related to an increased risk of hyperpigmentation (darkening) and bad scars with trauma.

Lip Service

When it comes to the perfect pout, what do your lips say?

While we used to frequently encounter that so-called "trout pout" of the last decade, today there’s definitely a backlash against any enhancement that looks obvious and “overdone.”

“It’s about enhancing your natural lip contours,” says Dr. Few. “If you try to change the shape, you could have a very unnatural-looking result.”

But how do you know? Dr. Few offers up 5 lip tips that will wipe the pout off your lips and leave you all smiles:

1. The upper lip shouldn’t be larger than the lower lip.
   “Although Julia Roberts has a larger upper lip [and pulls it off!], it’s generally an unnatural proportion and will result in an unnatural looking lip,” says Dr. Few.
2. Enhance your natural lip definition.
   “Don’t just make your lips bigger. This is a common mistake that creates those unnaturally protruding ‘duck lips’.”
3. Don’t expect to erase all your lip and mouth ridges and folds.
   “If you inject too much filler, the skin will stretch and create what we call ‘sausage lips’.”
4. Maintain your filler. (Restylane lasts approximately 6 months.)
   “Regular maintenance of your lips will create a more natural look, so don’t wait until it disappears to get a refill.”
5. Avoid permanent fillers in the lips.
   “While the idea of a permanent filler is appealing, if you don’t like your result, you’ll have to have it surgically removed. As we like to say in the industry, permanent fillers, permanent problems.”

Rethinking Anti-Aging

Media love to jump all over the still young and beautiful who feel compelled to stop aging in its tracks before it even begins. (Hello, Botox Babies!) If you think about it, it’s the quintessential attempt to “anti-age.” Imagine: no lines, no wrinkles and, yes, no sign of life’s experience… pros and cons to be sure.

But is that what we’re really after, anti-aging? I’d venture to say, most of us wear the odd line proudly. My very own are indications to the world that I’m not a baby and have indeed earned the respect that goes with my age and experience. Of course, I don’t want ALL of them left unchecked. (Yes, I do like my Botox, thank-you-very-much!)

So in a recent conversation with plastic surgeon and industry leader Julius Few, MD, of The Few Institute in Chicago, Dr. Few told me that he doesn’t use the term “anti-aging” in his practice. Wow. (Right?) I was intrigued by his perspective and it made me stop and ponder how the industry has changed and is continuing to change.

Let’s start with the Botox Babies phenomenon of the past decade. Pretty obvious. We don’t want to let time slip by and become the 50-something-year-old woman who faces the hard choice of (a) major surgery to get the results she wants or (b) settling for less-than-significant results with less invasive procedures (fillers can’t always replace a facelift!).

But that doesn’t mean we need to start erasing all signs of aging before they begin to avoid the “big” surgical procedure. According to Dr. Few, it’s all about timing and customizing your cosmetic treatment protocol based on the way your particular face and skin age (we all have different aging traits). The idea is to begin an individualized, step-up approach to facial rejuvenation that combines less invasive procedures with selective surgical procedures—at the right time, over time.

The take home message? It’s all about gradual, subtle change that changes with your aging face, rather than trying to change your face.

So it isn’t about anti-aging, it’s about managing the aging process selectively and strategically, embracing elements of aging while maintaining a youthful quality to your skin and facial contours. It’s that age-old (pun intended) expression: Age with grace.

Vegas Extravaganza

The Las Vegas Multispecialty meeting, held last week,  was a tour de force!! I was honored to be a part of the meeting and felt it was a world class educational experience. I lecture every day and helped to manage two symposia within the meeting.  What did I take away? After having panel discussions on minimally invasive technologies, such as focused ultrasound to tighten and lift the skin, to novel uses of injectables, to less traumatic surgery, I am more invigorated than ever to expand my Blending Concept. I believe that we are truly at a place of science fiction, for Star Trek fans remember the instant skin tightening device, all kinds of devices to make tissue better with less insult! I believe it is a brave new world and it is great to share this with dear, respected friends and colleagues at such a fantastic venue!! Bottom line, the combination of multiple applications, laser-focused energy devices/ultrasonic-injectables-skin care-minor surgery, creates a synergy that surpasses the independent value of any one alone, with more value to the patient!

Botox and Show Your Emotions: You Can Do Both!!

I am struck by an article in today's NY Times, http://mobile.nytimes.com/article?a=805027&f=26. This is an article that sites research studies that suggest Botox impairs our ability to show our true emotions. I find this interesting because I am often telling patients of the importance of saving some ability to express feelings. Experienced injectors can do Botox (or Dysport) treatments and still allow the patient to express themselves. Expressive Botox treatment can be done using less product, more widely distributed, in a strategic pattern. The results still last and you avoid the "frozen look". I believe this is the difference between a good Botox treatment, that no one can tell and the obvious, funny look that belongs in a circus. The responsibility is ultimately yours, go to an experienced plastic surgeon or dermatologist and make sure they know you want some movement ability in the given area of treatment!!

Controversy can bring out our best in Aesthetics!!

I was honored to be part of the faculty for the inaugural Summit in Aesthetic Medicine, Dr. Bass and Dr. Zachary did a brilliant job! It was very interesting to see differing approaches and to share opinions, positive and negative, on all things surgical, energy, and non surgical in Aesthetic Medicine. I made a plea for safety first, avoid aggressive treatments that alter graceful enhancement and related aging. I picked up some useful pearls on the use of lasers, I plan to bring these home! We all seem to be in agreement that aging is more than just sagging skin, it is a mix of volume loss-the balloon has lost some air, drooping of the tissue around the facial muscles, and wrinkling of the skin. Any successful cosmetic treatment has to include all three pieces of the puzzle-volume, droop, and skin! I am at the airport in Orange county now thinking of using my Ulthera-the ultrasound tissue tightener- in areas that I have injected filler. We may see even more improvement with the technology! These are some of the ideas at hand, more to come....

Style is not just for NY!

This past Sunday, I had the opportunity to read the style section of the NY Times and came across an interesting article- "The Case for Laugh Lines by Dominique Browning". She gives an entertaining review of the growing interest in non surgical, injectable fillers and agents like Botox and Dysport. On first review, as a plastic surgeon, you may think this is an article downing the growing industry, but you have to look a bit deeper (a point that applies to beauty in general - it is more than skin deep!). As she puts it, "This is not an essay about why I am categorically against cosmetic surgery. I am supportive as the next......", she simply makes a colorful plea for BALANCE!! None of us want to see people walking around with their lips 4 times the normal size or overfilled face, we should all strive for balance in life and that clearly relates to cosmetic medicine. I was proud to participate in the recent FDA panel in order to see a new indication for filler injection to the lips. This is so important for reasons illustrated in this article - a need for universal education and shared best practice. This is an exciting time, but more is not always better. One needs to find an aesthetic minded plastic surgeon that believes in good taste and has an approach that is focused on balance. Fortunately, there are many good ones to choose from and balance should be emphasized. For the reasons, I have focused the past 3 years on blending of minimally invasive cosmetic surgery with non surgical treatments, such as injection treatment and lasers, to achieve a result that offers a tasteful way to look at healthy aging and focuses on minimizing disruption to ones natural look or lifestyle. This is the essence of her article and I really enjoyed seeing such a colorful view. The moral of the story, moderation is the key to a happy life and looking as good as you feel is a key part of the story!!

Non Surgical Facial Rejuvenation: A Sum of Parts

Yesterday, after finishing a busy clinic, I was reviewing our experience with Ulthera-focused high energy ultrasonic energy- for non surgical facial rejuvenation. What we, Elizabeth/Crescent/Andrea/LaNesha, realized is that the most amazing results came from a combination of fillers, Botox/Dysport, and Ulthera combined. This gave an amazing refreshed look without looking "Plastic". In addition, the patients simply looked globally better, in a way that required close inspection to understand exactly what happened. There were a series of subtle highlights that made the look very appealing but no so drastic as to make people say when did you get plastic surgery.  I should not be surprised by this realization, as  we have seen the same idea with facelifting surgery. Often, facelifting alone is inadequate to achieve the most desirable result and we find that fat injection or other supporting procedures are needed to achieve the most natural outcome. This is very exciting to me and I feel closer to the idea that we can offer real, viable, alternatives to cosmetic surgery in the right person. I concluded that Ulthera alone may have its limitations, the combination of techniques is very powerful and exciting!

Return from American Brazilian Meeting

I am just now catching my breath after a very busy American Brazilian Meeting, in Park City, Utah. The meeting was truly international, with members of 14 countries present.  A broad variety of cosmetic topics were covered and I came home more energized than ever to practice the art of Plastic Surgery.  My presentations went very well and I was struck by something as I was presenting my work.  There really are three categories the Plastic Surgeon can work in; 1. The early or youthful patient wanting to age in a balanced way, hoping to avoid major intervention in the future, treated non surgically, with filler and Botox/Dysport 2. The patient who really is a surgical candidate but does not want to have surgery and is willing to accept limitations of current non surgical technology 3. The surgical patient who, for a variety of reasons, may have fallen short of the desired outcome and does not want more surgery, the so called surgical buffer/salvage.  On a daily basis, I work on all three categories and patients are getting more dramatic improvement than I ever could have imagined.  While patient expectations continue to climb, fortunately, technology is out pacing their expectations. Several plastic surgeons came up to me after my presentation and said they never thought of cosmetic enhancement in the way I presented, the so called "Aesthetic Enhancement-Lite".  I am excited for the future and feel we are seeing a powerful wave and I am proud to be riding it!

Traditional Tummy Tuck is not always the answer!!

When I was in training more than 10 years ago, we really only had one option for the woman (or man!) who had extra skin and fat on the tummy.  While traditional tummy tuck is the gold standard and a good option for many, there are many cases where you can get a wonderful/even better overall result with the mini tummy tuck and/or laser assisted liposuction.  How is this possible and why is this such a different way to look at cosmetic surgery.  The reality is less cutting and fewer points for scaring is better for many patients.  In particular, the mini tummy allows for tightening of the stomach without a scar around the belly button and the scar above the pubic area is quite short and easy to hide.  The reason a mini tummy tuck can work now when it was not as good an option more than 10 years ago is the availability of laser and ultrasound assisted liposuction.  These technologies allow for impressive fat reduction, especially in the upper belly, while also allowing for skin rejuvenation to the upper abdomen (belly).  The mini also allows the surgeon to tighten the six pack muscles (the rectus muscles) and/or repairing a belly button (umbilical) hernia.  The recovery is usually easier, with many patients back to work within a week.  Did I mention the surgery is less expensive as well.  There may even be patients who are really candidates for traditional tummy tuck (abdominoplasty) but they are concerned about the extent of surgery, cost, and/or are willing to compromise on the extent of the surgical result.  They may choose laser liposuction, ultrasonic liposuction, or mini tummy tuck even though the traditional tummy tuck would give the best "cosmetic correction".  Obviously, if someone has lost a lot of weight or has a significant amount of loose skin after pregnancy, then the traditional tummy tuck is the way to go and worth the extra work and potential recovery.  Bottom line, pick what is most important to you and make sure your surgeon is aware of your priorities and desires!

Fat injection can be enhanced with sculptra

I have encountered a finding that I am very excited about, sculptra injection to further enhance a previous facial fat injection patient. Here is the deal, an attractive women I treated with facelifting and fat injection a couple of years ago. She wanted further enhancement and needed it in the cheeks and had limited reserves for further grafting. We decided to do sculptra and 2 treatments later she looks amazing with no down time. I have noticed a response, even after the first injection, that is better than previous patients treated with sculptra alone. I am excited to perform this combination in future patients, as this approach has not been described.