Tuesday, December 12, 2017

Dermal Fillers: Juvederm, Restylane, Radiesse, Bellafill, Sculptra, etc.

So why are dermal fillers so popular and why do we need/want them?

The reason we use dermal fillers is because as we age, we naturally loose some of our youthful features including fat pockets which either shrink or shift and hence we loose that soft cushioning under our skin which reflects light in a positive manner off our face to give us a healthy glow.  Of course the collagen and elastin fibers also reduce with age, causing us to loose that lush, soft hydrated glow. There is also structural bone loss that occurs and contributes to undereye and cheek hollowing.  Fillers can help correct these problems.

The common areas for volume loss include the temples, lateral cheeks, central cheek, undereyes, chin and the lips.  Many patients come to the office with concerns of the nasolabial folds or laugh lines looking deepened and while we may at times inject fillers directly into those lines, a more natural appearing approach is to lift the skin upwards by restoring volume in the midface, lateral cheeks and temples.  Adding volume along the jawline also gives amazing and beautiful results as does adding volume to the chin area to soften the jowls.  

When a patient presents with more significant volume loss, it's a great idea to build up collagen using Sculptra and Bellafill, both of which give a more long lasting improvement and stimulate your own skin to make new collagen.  Bellafill is also FDA approved for acne scars and performs very well.  Both Sculptra and Bellafill lay down a matrix upon which we can build with other fillers if needed.  It does often take a combination of fillers to achieve the best results.  The fillers don't have to be injected all at once either.  We can space the treatments out a bit and approach the volume loss stepwise.

The most popular injectables for patients of all ages are the hyaluronic acid fillers such as Voluma, Juvederm and Restylane of which there are several varieties.  Some are more hydrophilic, meaning they attract more water and others are a bit thicker and stickier for areas such as the cheeks.  We also like to use Radiesse which is a calcium based white product that also helps to stimulate your own collagen growth.  The hyaluronic acid fillers provide excellent volume but do not stimulate your own collagen.  Even though fillers do gradually diminish over time, they don't completely go away all the way and subsequent treatments build nicely upon the prior treatments.  

Perhaps the most important aspect of getting filler injections is making sure you have an awesome injector with a good eye because the product placement and end result should look natural without looking overfilled or puffy.  the lips, eyes, cheeks, temples are all areas I love to inject in.

Also, the hands are nicely rejuvenated using Radiesse filler to plump between harsh appearing tendons and puffy veins.  

There are some other great uses for fillers, such as Sculptra for cellulite and for lifting the buttock area and for improving lines in the decolletage.  

I hope some of this has been helpful to you.  Of course we welcome you to come in for a consultation and we'll devise a customized plan just for you.

Please also visit our website at www.cincinnatiskinandlaser.com for more information.  We are passionate about your skin and restoring your youth! 

Thursday, November 30, 2017

Kybella for Jowls, Bra Fat and Lower Buttock Banana Rolls

Kybella is an excellent option not only for chin fat reduction but also for the puppy jowls, bra fat and the annoying lower buttock "banana roll".  Kybella permanently disrupts fat cells in the treatment area and can have very satisfying and long lasting results.  The skin also tends to contract nicely as the fat dissipates within 6-8 weeks. The number of treatments required is generally two, but some patients may require fewer or greater treatments depending on how much fat is in the area.   Kybella was originally designed for treatment in the chin area, but is now being successfully applied to areas such as those puppy jowls, the annoying bra fat that bulges out under your arms and the little banana roll that doesn't look pleasing in tight jeans or tights.  If any of these areas are of concern for you, you can consider Kybella treatments to treat yourself to a more confident you.  Kybella treatments are quick and easy.  There may be some swelling and tenderness to the areas for up to 4-5 days.  Bruising is rare.  The procedure is entirely non-invasive and has become a popular choice with both men and women to remedy the double chin, jowls, bra fat and lower buttock banana rolls.

Wednesday, November 29, 2017

Coolsculpting, Vanquish and Sculpsure

Coolsculpting was developed by the laser guru physicians of the Massachusetts General Hospital at Harvard Medical School based on the observation that cold popsicles caused cheek fat loss in children.  We have learned now that fat cells are sensitive to extreme temperatures, whether cold or heat.  At our office we have all spectrum of treatments from freezing fat cells with Coolsculpting to Vanquish radiofrequency treatments that cover large areas to Sculpsure laser treatments with precise targeting of the fat cells.  When you come for your consultation, we are not limited by whichever shiny machine we have available, but rather by what we feel will give you the transformation you are looking for.

The advantages of Coolsculpting, Vanquish and Sculpsure include no recovery time and no garments to wear like with liposuction.  If this approach seems appealing and you are ready to transform your body, you need to be ready by understanding how these procedure will work to give you the body you want.  It is important to know that Coolsculpting, Vanquish, Sculpsure and Liposuction are not a weight loss procedures.  Rather, they will give you a more beautiful silhouette and shape by eliminating unsightly bulges.  You will also likely need two or three treatments to the targeted areas and multiple applicators to get not just bulge reduction, but a pleasing silhouette.  If you want to achieve poster perfect results, it will take a little time and financial commitment, but it is entirely achievable and gratifying.  Learn more at: https://goo.gl/ncpEkB

No Tox

No-Tox refers to a toxin free Botox treatment for those weary of having botulinum toxin injected into their skin or muscle. But does a product like this actually exist? Not a product, but there is a procedure available and several topical creams or serums that claim to gain a space in the ever popular space of diminishing frown lines!

First, a little about Botox (and why there is very little reason to fear it). Botulinum toxin has been in use for around 30 years now for cosmetic improvements with an excellent safety profile.  Even though it is true that Botox is made of bolutinum toxin, the amount of toxin is very small.  Even if the entire dose of Botox were to accidentally be injected into a blood vessel, it would be easily diluted and not cause any dangerous symptoms.  Local spread of the botulinum toxin into neighboring muscles can occur occasionally.  The most disturbing for facial aesthetic treatments are a temporary eyelid ptosis (eyelid droop) if botox spreads into the eyelid muscles or an asymmetric smile if botox diffuses incorrectly during a depressor angularis oris treatment to soften the downward lip movement that shows sadness.  But even the most feared symptoms dissipate quickly as Botox is not permanent and breaks down over just 3 months.  There are currently three brand names of Neurotoxins:  Botox Cosmetic, Dysport and Xeomin.  In our practice, we use Dysport and Botox Cosmetic primarily as they give good long lasting improvements.  We also keep Xeomin for patients who may be allergic to egg products.  

Several topical preparations have been made but they are not strong enough to give the same effect as Botox that is injected specifically and directly into the muscle of concern.  Some of them have shown to be mildly effective and may prolong the effect of Botox injections.

No-Tox can also refer to injections of dermal fillers instead of Botox to soften wrinkles.  This can work well but the dermal filler may wear off quicker than normal if the creasing the lines continues as it will break down the filler.  In a small number of cases, fillers can also move slightly away from the line or wrinkle itself with movement of the line.  I recommend using fillers in conjunction with Botox for best results if the lines are very deep.


There are two procedures which are fairly similar referred to as No-Tox as well.  They are known as GFX treatment (Glabellar Frown Treatment) and ThermiRase.  These treatments utilize a small radiofrequency probe directed at the nerve fibers which innervate the glabellar complex of muscles as they arise from the temples.  Both procedures work beautifully for the frown lines in between the brows for an immediate and long lasting to potentially permanent improvement of the frown lines.  If 2 cm of the nerve is treated, generally the treatment can be expected to be permanent.  We have successfully helped many of our patients to never require Botox in their frown lines again.  However, the shortcoming here is that this procedure really only works on the frown lines between the brows sometimes referred to as the 11's.  GFX and ThermiRase are not recommended for forehead lines or crow's feet.  One other interested application however is for neck bands, though clear protocols have not yet been established for this area.  

So, as a patient, you definitely have some options for how you choose to get rid of frown lines that make you look angry, depressed or anxious.  You will feel naturally happier too as there is evidence that relaxing these muscles actually does improve mood and depression.  For headache and migraine sufferers, this can be nothing short of a miracle too.  



ThermiRase before and after photos.

Friday, November 10, 2017

Botox for scars, pucker lines, sweat and acne?

Did you know there's yet another interesting use for Botox?  Studies have shown that if Botox is injected around a fresh sutured incision, that the incision heals with significantly less scarring?  It is believed this is because the Botox eliminates tension and disruptions to the healing wound which allows it to heal more smoothly.  The scars are visibly less apparent when treated with Botox!

Botox is also great for pucker lines around the mouth.  It does prevent a strong pucker, but in turns helps the lines smooth out.  Also, if placed correctly, can give a nice little flip upwards of the lip which gives the appearance of a fuller lip without a dermal filler.

Botox is awesome for hyperhidrosis or excessive sweating.  When placed superficially under the skin it blocks the sweat glands and hence, no more sweating.  The most common areas treated are underarms, hands and forehead or scalp.  Some patients are even requesting a "blowtox" as it allows patients not to sweat from their scalp after a workout and saves a hairwash afterwards!  A single treatment can last from 3 months to a year, partly dependent on the number of units of Botox used.  A few of our patients have noticed marked reduction in sweating longterm after several treatments and now require very few visits if any.  We do also offer ThermiDry which is a one or two time procedure which also dramatically reduces the sweat glands and odor longterm.

Finally, Botox can be useful in Acne.  In dilute amounts, it can be carefully injected in the more acne prone areas to reduce sebum production and helps the skin heal with significantly less scarring.  The skin of course also appears more healthy, smooth and glowing wherever the Botox is injected.

www.cincinnatiskinandlaser.comPlease call us at 513-985-9885 with any questions or visit our website at www.cincinnatiskinandlaser.com.

Thursday, November 9, 2017

Treating Ocular Rosacea with VBeam

Ocular rosacea is often present isolated or in patients with facial rosacea.  It presents with frequent tearing, redness and irritation of the eyelids.  The most common treatment is oral antibiotics such as Doxycycline or Minocycline.  Patients find variable response rates to these medicines and often don't like the idea of taking antibiotics long term.

In our practice, we have treated numerous patients with ocular rosacea using the VBeam laser.  VBeam is a pulsed dye laser, emitting a 595 nm wavelength light beam which beautifully targets surface blood vessels.  The VBeam has a special linear spot treatment, which along with cryogen (blast of ice) pre and post pulse cooling, allows for effective and safe treatment of the eyelid margins without burning or bruising.  We also use a circular larger spot size for treatment of surface vessels on the cheeks, chin, nose and forehead for facial rosacea.  Patients usually respond even after a single treatment though we suggest a series of 3-5 initial treatments to gain control of the problem followed by once a quarter treatments for maintenance.

Ocular rosacea patients who have received VBeam treatments from us have been able to discontinue their antibiotics and topical rosacea creams and enjoy an increased quality of life with less embarrassment due to red, watery eyes or flushing cheeks.

The VBeam laser, though now often replaced by Intense Pulse Light machines such as BBL and other IPL's, continues to be one of our most favorite lasers for the superior and results it provides and the diversity in which it can be used.

Other uses for VBeam include the removal of warts, patches of psoriasis, stretchmarks, acne and acne scars, breakdown of skin bruises and overall skin rejuvenation.

Give us a call to learn more and if you know anyone who suffers from Rosacea and/or Ocular Rosacea please do tell them to consider this option.

Friday, July 1, 2016

Combining treatments for the best cosmetic surgery outcomes

Over the past fifteen years of my practice, I have found that patients are often looking for a one treatment, one procedure, fix it all type of solution.  For certain skin problems there may be a one treatment, one procedure fix it all solution.  Very often though, I find that the patient's true concern will need a medley of a few procedures to solve the problems that are contributing to the concern.  For example, a patient may come in with complaints of the parantheses (lines around the mouth) or nasolabial folds being too deep.  They have read that these lines can be filled with a filler.  Yes, perfect.  In many cases, just adding a bit of strategic filler directly into the folds will solve the problem.  In some cases, however, the volume loss that is contributing to the folds may be closer to the temples, upper cheeks, tear troughs and jawline.  Restoring volume via filler to these areas can give a very natural, soft, and more dramatic improvement to the original problem as the filler places the skin back into position.  Often accompanying this loss of volume in the face is also the fact that the skin is loosing collagen.  Under normal circumstances, we loose about 1% of our collagen content per year.  Genetics and lifestyle contribute to various degrees of deterioration over time.  The loss of collagen makes the skin less elastic, thinner and weaker.  Luckily, we have ways to combat this collagen loss with various procedures which heat the skin and force the skin to make new tightly woven collagen fibers.  If we start stimulating the collagen at the earliest signs of loss, it can go a long way in keeping our skin young as we age.  So, the patient with the nasolabial fold concern may not be happy with just fillers, but may also need some tightening of the skin to achieve the best, most natural and dramatic results.  Procedures such as Skin Tyte, Thermage, Exilis Elite, ThermiRF and Ultherapy can all be used depending on what degree of tightening is required and the patient's budget.  Of the tightening procedures, ThermiRF and Ultherapy win.  Or the patient may need a skin resurfacing procedure, if along with the loosening of the skin, there is also sun damage and wrinkling involved.  Venus Viva (fractional radiofrequency), Profractional, Fraxel laser and Broad Band Light can all be useful tools among others to improve the quality, texture and glow of the skin.  

Similarly, for body sculpting procedures, we may wish to combine procedures for the best results.  For example, we love what the Vanquish focused radiofrequency technology can do to eliminate 60-80% of fat cells in 4-6 treatments.  We love even more what Vanquish combined with Velashape will do to much more dramatically and quickly achieve desired results.  Velashape uses infrared, radiofrequency and suction to pull the skin up and massage the released fat from the treatment area towards the lymphatics.  The extra heat futher ensures optimal fat killing (also known as apoptosis).  We absolutely love it when patients are able to combine two to three procedures such as Vanquish, Liposonix, Sculpsure, Velashape, Vaser Liposuction, Smartlipo, ThermiRF and Exilis Elite to get the best benefits for themselves.  This combined approach is sometimes concurrent or it can be spaced out over some time.  In certain cases, we insist on a concurrent approach if we know from our experience that this approach will yield a far more dramatic result for the patient.

We welcome you to come into our office.  Our website www.cincinnatiskinandlaser.com should hopefully have some very useful information about the available procedures for those who like to do their research.  On our website, you can also research by the concern you are wanting to improve...just remember, we may end up suggesting a combination approach. We can fine tune and give our best recommendation during the consultation.