BOTOX, Dysport and Injectable Fillers are becoming more popular these days!  As explained in a recent article in The Capital newspaper featuring Dr. Sandel, the economy is pushing many patients towards less costly and less invasive procedures.  These treatments, although temporary, can really help improve your appearance before you decide to invest in facial rejuvenation surgery.

There are many different types of injectable fillers.  The most common being those containing hyaluronic acid.  Hyaluronic acid is a naturally occurring sugar that is used to plump fine lines and deep skin creases.  This gel takes a long time to be absorbed in the skin, thus allowing the filler to maintain volume for as long as 12 months.

Restylane was one of the first hyaluronic acid fillers introduced in the U.S.  There are now other products such as Juvederm Ultra, Juvederm Ultra Plus, and Perlane.  The difference in these products is in the concentration of hyaluronic acid.  Juvederm Ultra is the least concentrated making it thinner than the others.  Perlane and Juvederm UltraPlus are much more concentrated.  Restylane is somewhere in the middle.

So, what difference does this make?

Restylane, which comes in 1ml and 2ml syringes, is a great all around filler.  Dr. Sandel prefers Restylane for the cheek-lip grooves and downturned corners of the mouth.  It gives the perfect amount of volume for these deeper, harder to fill grooves.  Perlane, though a little more concentrated, is very soft and holds its shape well.  This is primarily used for defining the borders of the lips.  Perlane is excellent at giving the lips just the right amount of definition, volume and shape.  Juvederm, the thinnest of these fillers, is primarily used for very fine lines around the mouth.  Juvederm can be placed close to the surface of the skin without being noticable.

Pam Zagula, LE, LPN

Have you ever stopped to think about the products you are applying to your face, neck and chest? Are you curious about the active ingredients?  What are they and why are they so special?  There are so many products on the market - it’s mind-boggling.  Even for me, the skin professional.  So in my attempt to educate my self, I feel compelled to educate you.

This month I investigated Kinerase Pro+Therapy.  As most of you know I’ve been in the business for a long time.  In 1998 Kinerase was introduced to me as a product I could incorporate into an existing skincare regime.  A product that will produce Retin A like results with out the redness, irritation and peeling that many experience in the initial phases of a retinoid based home care program.

The magical ingredient, Kinetin also known as N6-furfuryladenine, is derived from plant based RNA.  Kinetin is a powerful anti-aging plant hormone that has the ability to protect and repair DNA and proteins from oxidative damage caused by free radicals.  I love this product because it works.

When the original Kinerase went over-the-counter in 2006, Kinerase Pro +Therapy was born and made available to the medical aesthetician.

So how is Kinerase Pro+therapy different? They added another plant hormone called Zeatin.  Studies have shown the combination of these two powerhouse plant hormones increase the skin’s ability to retain moisture within the cells leaving the skin firmer, plumper and more youthful.  You will notice improved appearance of fine lines and wrinkles, skin roughness and hyperpigmentation.  There are many other ingredients enhancing the anti-aging benefits of this wonderful product line such as Antarcticine.  This ingredient protects and regenerates skin by enhancing the production of collagen and elastin, and increases the skin’s moisture content.  It is a very powerful anti-wrinkle glycoprotein obtained via biotechnology from a bacteria strain found on the bottom of an Antarctic glacier.  The Pro+Therapy line also features ingredients such as Vitamin C, E, green tea (to fight free radicals), salicylic acid, lactic acid (to aid in exfoliation), and beta glucan (to enhance the skin’s immune response) just to name a few.  The use of these products daily will prevent and repair damage, taking your skin to the next level.  “Healthy skin is beautiful.”

Pam Zagula, LE, LPN

I have learned so many remarkable things from the incredible women that come to me for my expertise. They share their life experiences with me and I am so grateful for their trust. I am going to share with you why I incorporate dermaplaning into my health and wellness plan for my skin and the skin of my clients. Early in my career I was in consultation with a very beautiful woman I thought to be in her early 50’s. She had not revealed her birthdate during consultation, as many choose not to. As I was explaining dermaplaning to her, she politely listened, then shared with me her secret. To my surprise she was not in her early 50’s. She was 65.  Clearly, she appeared to me to be 10 years younger than her chronological age. She continued to reveal that, while living in Japan, she was introduced to facial shaving. She shared with me the barely known fact; Japanese women shave their face regularly and, historically, have done so since the 16^th century. To my surprise, she had been shaving her face daily for twenty years. Her skin was delicate and had exquisite texture and color.  She was delighted with the idea of having her face dry shaved professionally.

Christina Carlino, a mentor, friend and the past CEO of Biomedic Clinical Care, now La Roche Posey, introduced me to dermaplaning in 1991. Dermaplaning is the third step in Biomedic’s trademarked Micropeel.

 As I researched this topic on line, I found that there were several other names for this technique; “Clinical Skin Resurfacing Facial Exfoliation” and “Razor Facial.” I know it simply as dermaplaning.

Dermaplaning is a mechanical exfoliation as opposed to using chemicals or lasers.  With the steady hand of a trained practitioner, a sterile # 10 - Teflon coated surgical steel blade is attached to a # 3 knife handle.  It is held by the practitioner at a 45-degree angle and then the magic begins.  The guided blade gently scrapes across the skin’s dry surface removing dead skin cells, superficial pigmentation and unwanted facial hair.

In a clinical environment, dermaplaning is a very effective procedure by itself or can be combined with other modalities such as Vibradermabrasion, acid peels, BBL, LASER, LED and others in order to enhance efficacy.  Stripping away the dead, uneven stratum corneum from the epidermis removes the barrier and allows for maximum penetration of active ingredients.  Dermaplaning promotes cellular turnover and stimulates collagen and elastin. Immediately post-treatment the skin feels smooth, appears luminous, fine lines seem to disappear and make up glides on with ease.

Contrary to what many believe, dermaplaning does not encourage the abnormal growth of hair.  If the hair is soft, light and furry it will not grow back thick, coarse and dark.

For the past 19 years I have been shaving my face and the faces of those who seek my expertise. I will continue to offer this treatment for many years to come.

Look out BOTOX®!  Your competition for wrinkle reduction in the United States has finally arrived.  After years of clinical trials in the U.S. and many more years of clinical use and experience overseas, Dysport® has recently received FDA approval. 

For the past 7 years, BOTOX® (botulinum toxin type A, Allergan, Inc.) has been the only choice for injectable wrinkle correction of frown lines around the eyes and forehead.  That changed last month when Dysport® (botulinum toxin type A-hemagglutinin complex, Medicis) received FDA approval in the United States.  

Are you one of the many people who would like to make a change in the appearance of your nose?  

Perhaps you are happy with your appearance but would like to be able to breathe better?  Both of these aspects of the nose can be addressed with a relatively simple procedure called a rhinoplasty.

A rhinoplasty, or nose surgery, is a specialized procedure performed by facial plastic surgeons.  Usually done under anesthesia, the surgeon can make many changes to the shape and function of the nose.  Some of the problems that can be addressed include removing a “hump” on the top of the nose, refining the shape of the tip or ball of the nose, making the nose smaller as a whole, or even opening the breathing passages to allow more airflow into the nostrils.  

How are these changes made?

The first stage of a rhinoplasty usually involves the nasal septum.  This is a thin piece of cartilage that separates the right  and left sides of the nose.  Commonly referred to as a septoplasty, this piece of cartilage is removed or straightened.  If the septum is deviated causing difficulty breathing, this maneuver will help.  Also, part of this septum is harvested in order to refine or make changes to the outer shape of the nose.

The next stage is to remove the hump by softening the nasal bone.  Sometimes in order to remove the hump and make the nose less wide, the nasal bones need to be moved inward.  This may require the surgeon to precisely break the bones so that they heal in a more desirable position.

Once the upper portion is finished, the tip can be addressed.  This is where surgical experience and expertise is of the utmost importance.  Refining the shape of the nasal tip and making the nose look smaller in the lower portion requires very fine techniques.  When performed correctly, the nose looks very natural and softer in appearance.

Does insurance cover the cost of a rhinoplasty?

Yes.  If you have difficulty breathing, then insurance will cover the procedures that help you breathe better.  This can be a significant portion of most rhinoplasty procedures.  If you desire an improved appearance, you would be responsible for that portion of the surgery.

by Pam Zagula, LE, LPN (Advanced Medical Aesthetics)

The cold winter weather is here. It won’t be long before low humidity, cool temperatures, wind, and indoor heat take its toll and cause the skin to become dry, chapped, and flaky, which will cause the skin to look pale and dull, accentuating lines and wrinkles. It may feel rough and itch. Certain skin conditions such as eczema, psoriasis and rosacea may worsen.

There are many things you can do to lessen the wrath of winter weather on your skin. 

·         Drink plenty of water

·         Consume caffeine and alcohol in moderation

·         Eat a diet rich in Essential Fatty Acids

o   EFA’s are found in whole grains, nuts, seeds, olives, avocados, cold pressed oils, and cold- water fish such as wild salmon.

·         A vaporizer or humidifier in the bedroom

o   This helps to reestablish the moisture levels in the respiratory tract and eyes as well as the epidermal layers of the skin.

·         Baths and showers should be warm, not hot and of short duration.

o   When taking a bath, bath oils can be added to bath water to help further moisturize the body.

o   Body oils, lotions and creams should be applied directly to the skin immediately after the bath or shower.

·         Have regular professional skincare treatments.

o   Gently removing the dead surface layer (with a Vibraderm treatment) increases product penetration and improves the skins ability to better absorb topically applied products.

o   Oxygen therapy treatments are incredibly moisturizing and soothing after a professional exfoliation.

o   LED light as well as micro-current treatments gently encourage cell turn over, stimulate collagen synthesis, as well as aid in product penetration.

o   Medications, specialty products may be indicated.

o   Treatments such as broadband light (IPL) will help eliminate exacerbations of Rosacea, broken blood vessels and brown discolorations.

Don’t be fooled by the colder weather, the sun is still a danger to all exposed skin. It is especially important to remember during times of play and enjoyment of wintertime sports the sun’s light intensifies as it reflects off snow. Add low humidity, wind and high altitudes and you can get a whopping sun/wind burn. Cover as much exposed skin as possible and don’t forget to use sun block!

Flying somewhere this winter? 

Before the flight, cleanse the skin and use a mild scrub followed by an appropriate moisturizer.

 During the flight, spritz the face with mineral water frequently, drink 8 ounces of water for every hour in flight, and avoid alcoholic and caffeinated beverages, as they are very dehydrating.  Moisturizing eye drops help to prevent dry, scratchy eyes and using a lip ointment will help to avoid dry, cracked lips.

Your aesthetician is an expert in helping you choose appropriate treatments in the treatment room and will assist you in choosing the appropriate after treatment home care. Products containing growth factors, DNA repair enzymes, retinaldehyde, alpha hydroxy acids, ferulic acid, urea, hyaluronic acid, vitamins A, C, and E will assist you and support healthy winter skin.

HEALTHY SKIN IS BEAUTIFUL!

Traditional Laser Treatments

Lasers have been used for rejuvenating the skin for many years. Traditional treatments have included chemical peels and carbon dioxide lasers (CO2). These treatments are excellent in providing dramatic results with one treatment session. Patients who are selected appropriately with regard to their skin types can benefit from the marked reduction of fine lines, wrinkles, sun spots, discolorations, uneven skin texture, and scarring. Although technology has come a long way, nothing has matched the efficacy of these traditional modalities.

However, the CO2 laser and chemical peels have several risks associated with them that make them difficult to use in untrained hands. Some of these include pigmentation changes, lines of demarcation, redness, long recovery periods and, in rare cases, scar formation. It is important to select a facial surgeon who is highly experienced with these techniques to avoid or minimize these complications.

Exciting New Laser Technology

As laser technology has evolved over the past 5-10 years, exciting new modalities have become available. The latest laser technology uses fractionated patterns of ablation which allow the skin to heal much faster than traditional full ablative resurfacing. There is also much less risk of developing lines of demarcation or prolonged redness. The fractionated laser works by creating small microscopic pinholes in the skin while leaving some normal tissue in between. As the deep collagen layer heals, the skin becomes more firm and youthful and fine lines disappear. Sun spots and pigmented areas are also improved dramatically improved.

Although not quite as effective as the traditional CO2 laser or chemical peels, these new lasers offer outstanding results over one to three treatment sessions, each with little to no downtime. Even the more aggressive resurfacing procedures will heal almost completely in less than 5-7 days. These procedures can be performed in an office setting without requiring sedation. Topical numbing cream is usually sufficient.
It is important that you discuss your concerns with your facial plastic surgeon so that a precise treatment plan can be formulated. Your surgeon should give you detailed information about the specific laser treatment being offered including the risks and benefits associated with it. After the procedure, you should be seen about every other day for the first week to ensure optimized and rapid healing.

Are the eyes really the windows to the soul?  They most certainly reveal your emotions, state of mind, and quite possibly even your overall health.  Ask yourself:  “What is the first thing I notice when looking at someone?”  Overwhelmingly, when we meet or approach someone, our eyes are drawn to their eyes.  This silent first impression tells us a lot about someone even before speaking to them.

In today’s society, stress, long workdays, and little sleep often impact someone’s appearance.  These changes can be permanent even when the stress has long since passed. There is a disconnection with that person’s inner vibrancy and healthy spirit compared to the look they wish to present to the world.  However, this does not have to be the case. Many technological advances are available to help you restore that youthful, refreshed appearance.

What made my eyes look so tired?

In general, as we age the eyelids go through changes.  The upper eyelid skin begins to loosen and the eyebrows start drooping.  Some people even have the upper eyelid fall so much it interferes with their vision.  This heaviness may also be accentuated by small amounts of fat protruding from around the eye into the eyelid.

 The lower eyelids also elongate over time.  The skin laxity can fold over and create “bags” that are also filled with small amounts of fat.  Dark circles form in the skin under the weight of the eyelid giving the classic tired and stressed appearance.  In some patients, the upper cheek contributes to the aged eyelid appearance and makes the lower eyelids appear worse than they actually are.  It is important to not overlook this relationship when examining the eyelids.

How can I get that refreshed appearance back?

In some cases, laser treatments or skin peels may be all that is required.  These patients may have fine lines or dark circles without having excessive amounts of skin or fat.  There are many patients at this stage that simply desire to look less tired.  Using chemical peels or laser treatments, the skin can be firmed and tightened without surgery.  Office procedures such as these are less costly and require less downtime.                                                   

In other cases, surgery is the treatment of choice.  Dramatic and permanent improvements can be made in these patients using relatively simple and inexpensive procedures.  Some procedures require no incisions on the outside of the eyelid.  Others may involve removing fat or repositioning the fat to fill in the upper cheek.  If incisions are required, they are placed just below the eyelash line or in the upper eyelid crease in a manner which produces virtually no visible scar.  In any case, there are many variations in eyelid surgery.  It is important that your surgeon has detailed knowledge and understanding of the relationships between the eyelids, cheeks, forehead, and the rest of the face. 

Henry D Sandel IV, MD

As people age their skin can sustain damage from years of sun exposure.  It is almost impossible to avoid sun on your face or use sun block every time you step outside.  It is even more difficult for people who love the outdoors and thrive in the summer sun.  Over time this damage can lead to skin lesions, brown spots, loss of elasticity, and enhance the loss of tone around the eyes, cheeks, jawline, and neck.  These findings can be discouraging to active healthy people who sometimes do not look as healthy as they feel.

The more common diagnoses found in my office are benign skin lesions called seborrheic keratosis, actinic keratosis, lentigines (brown spots), and nevi (moles).  They appear mostly on sun-exposed areas of the face and neck and can be a direct result of photodamage sustained earlier in life.  Although some lesions require biopsy to rule out cancer, most lesions can be determined to be benign just based on a patient’s history and skin examination.

Benign or noncancerous lesions are mostly found to have been present for a long period of time.  These lesions rarely undergo rapid growth or change in color or appearance.  Many of these lesions appear as flat brown spots, have a raised “stuck on” appearance, or have an even color with well-defined borders.  Some can even become quite large. 

The accumulation of these lesions on the face can have a negative effect on a person’s appearance.  Because of the location on the face, patients are hesitant to have them removed.  Most patients fear that removal will produce a scar or leave a white spot or depression in its place.  However, if properly removed to avoid damage to the surrounding skin, these lesions can be taken away completely with almost no evidence of scarring. 

Cancerous or precancerous lesions are generally those that have appeared suddenly, changed in appearance, or have undergone rapid growth.  They can be varied in appearance ranging from a small red area to a raised nodule, a discolored and irregular, possibly ulcerated lesion.  They can even present as an area that just doesn’t seem to ever really heal or is chronically flaking or peeling off.   These lesions should always be biopsied and sent for pathologic diagnosis.  If the area is found to be cancerous, it should be completely removed in a timely fashion and in such a way that produces a minimal scar and preserves the natural creases of the face.

To learn more about skin cancer, diagnosis, and treatment options visit the National Cancer Institutes website.  National Cancer Institute