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!