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.