My Neck and Face are falling. I need help!

Aaah!  The Aging Neck

Among our patients' greatest concerns is that of looking older than we feel.   We all want to look our best because it gives us the confidence to express our personality and thoughts without feeling self conscious of our appearance. 

Several technologies have come along over the years to help with the neck and face falling problem.   There is always a surgical neck or face lift, which may be absolutely essential for patients who have waited a bit too long to take preventive measures and where the skin laxity is too great to correct nonsurgically.  However, for the vast majority of patients, we can accomplish neck tightening without the worry of a long scar along the hairline or ear and without extended recovery times and most importantly, without the danger and fear of looking “overdone”.   Even if a prior facelift has been done, maintaining with these less invasive approaches is important to save one’s investment.

 

Among the two best approaches are Ultherapy and ThermiRF. 

 

ThermiRF is the latest kid on the block.  It uses monopolar radiofrequency energy that is delivered via a thin probe to the SMAS (Superficial Muscular Aponeurotic System).  This is the tissue under the skin which covers and binds all the facial muscles.  During a surgical facelift, the SMAS is sutured in a manner to effectively shrink it and hence tighten the muscles.  With ThermiRF, the SMAS is shrunk using RF heat (essentially think of it as controlled electrocautery).  The procedure is extremely safe with temperature readings coming from the tissue, the probe and through an external heat sensing camera, which helps achieve both therapeutic and safe target temperatures for controlled shrinkage of tissue.  Excess fat tissue can also be targeted and destroyed, such as under the chin, at the same time.  Finally, the heat radiates to the skin itself and stimulates the production of new collagen and elastin fibers.  ThermiRF is performed entirely under local numbing.  The patient is awake and may drive home on their own post procedure.   There is no discomfort during the procedure.  A compressive chin strap garment is all that is required for 48 hours.  No sutures are placed as the three tiny puncture access points close up within 24-48 hours.

 

 Ultherapy is also a highly effective procedure and can be used to treat not only the neck and jowls as ThermiRF can, but also the cheeks, chest and eye areas.   As both a surgical facelift and ThermiRF affect the SMAS, so does Ultherapy!  We can easily see that in order to be effective, the procedure must affect the SMAS.  The difference is that Ultherapy is applied directly through the skin using HIFU (High Intensity Focused Ultrasound).  The tissue is directly visualized via ultrasound so we know exactly where the energy is being delivered.  There is some discomfort as the ultrasound waves travel through the skin to the underlying SMAS target tissue but is well tolerated and well worth it in the end.  There is no real recovery time, outside of mild redness and swelling.  One can resume social obligations and public appearances immediately.  Ultherapy also targets the dermis to stimulate collagen production with a second pass that is highly recommended.  The lips and delicate skin under the eyes are also very responsive to this technology. 

It takes about 4-6 months to see results.  The same is true with ThermiRF.  A procedure called SmartLift uses the SmartLipo probe to deliver heat under the skin and could potentially mimic ThermiRF.  The difference is in the control and constant feedback of the heat delivered to get effective yet safe treatment.  We are not using SmartLift/SmartLipo as much in our practice now due to having the more advanced ThermiRF. 

Please take a look at results from ThermiRF and Ultherapy below.  The patients who have had a combination of both procedures, have seen especially dramatic results.   Please also check out our website www.cincinnatiskinandlaser.com for more information.

 

STOP sweating Forever with #ThermiDry

STOP sweating Forever!

And STOP wearing deodorant Forever!

 

 

 

 

 

 

 

Do these scenarios look familiar?  Tired of your expensive clothes getting nasty sweat stains?  Embarassed of smelly underarms that sweat in an instant without warning—especially when presenting that important project in front of a room full of people?  You have tried all the deodorants on the market, even prescription strength ones—nothing is working.  Baby powder, talcum all to no avail.   Have you tried the underarm sweatshield pads? 

 

 

 

 

 

Well, if you’re not too keen on sporting these beauties or spending money and time washing and buying new ones, there are certainly some great options that get rid of sweating AND odor!  The best on the market and our favorite is ThermiDry

1)      ThermiDry is an awesome procedure.  Here is how it works.  After doing a sweat iodine test to locate where the sweat glands are located, the area is numbed with a local anesthetic.  You are completely awake and alert for this procedure.  Once the numbing takes effect, there is absolutely no pain.  A tiny needle puncture is made and a small canula is placed under the skin.  It is slowly threaded in and out in a fan like pattern directly under the skin, until all the sweat laden skin areas are treated.  The energy emitted from the tip of the canula is Radiofrequency (controlled electricity) that heats and disables the sweatglands, PERMANENTLY!  Once the areas are treated to the desired time and temperature, the canula is removed.  The tiny needle puncture usually closes within 24 hours and is difficult to even locate.  No Pain, and that’s it!  The procedure is extremely safe as a thermal camera makes sure the skin temperature stays in a safe zone.

2)      Botox:  Tiny injections with neurotoxin into sweaty areas works like magic to stop the sweating and odor.  Sadly it is not permanent, but can last sometimes up to a whole year in some patients.  I have even seen some patients no longer requiring Botox injections after a few visits…almost as if they are cured.  However, in reality, Botox does not provide the permanence of ThermiDry.

 

3)      Vaser Liposelection.  Instead of the ThermiDry probe, the Vaser ultrasound probe can also be used to heat and destroy the sweat glands.  It’s a good option, but it does not have the control of ThermiDry.  Therefore, our preference is definitely ThermiDry for superior, safer and more controlled results. 

The other consideration is the potential dangers of using deodorants.  80% of what we put on our skin gets absorbed!  There are many chemicals such as parabens which are in skin products such as deodorant that end up in areas like biopsied breast tissue.  It can't be good.  The above procedures can help eliminate these from our medicine cabinets for good and help us lead a cleaner, healthier life.

To this end, I have created my own line of organic skin care creams for the face, as well as an awesome scrub and masque.  You can find these at www.mokshaorganics.com  and include an Anti-Aging crème, Skin Repair crème, Skin Brightening crème, Skin Tightening crème, Face & Body scrub, Face & Body masque.

 

 

 

 

 

 

Luscious Artistic Lips with Fillers by Dr. Gupta

With age, volume loss occurs in not only face and hands but also the lips.  The upper lip lengthens with a drooping of the cupid’s bow.  The lips loose volume and become more flattened.  This causes the mouth to appear wider and the corners of the mouth droop. 

Here’s how it looks:

 

Filling of the lips is an artform.  Too much in the wrong place and one can look ducky.   But placed correctly, it gives an instant facelift, giving a younger youthful appearance immediately. 

Besides adding volume to the red part of the lip, the upper lip skin needs to be addressed first, as this is where the lift comes from.  The lengthening of the upper lip has to be shortened, the cupid’s bow has to be restored and the philtrum rebuilt.  After this, the red of the lip can be slightly inflated.  It is natural for the upper lip to project slightly beyond the lower lip.  The lower lip needs equal attention to match the upper.

Fillers such as Juvederm UltraPlus XC, Restylane, Perlane and Voluma are great choices for lips.  They are made of hyaluronic acid (sugar polymer) which is naturally occurring in our skin and is hydrophilic (attracts water).  This gives a good plumpness and longevity of at least 1-2 years.  We have found that lip fillers tend to hold much longer than fillers applied to other parts of the face.  The same is true for under eye fillers, which also tend to last longer than injections elsewhere on the face.

Treatment is performed with a tiny needle.  A nerve block or topical numbing can be applied ahead of time.  However, I find this is usually not necessary.  Many patients don’t like the numb feeling that can persist after a nerve block for a few hours.  Topical numbing is not overly effective.  Recently a patient who had filler by another physician insisted on topical numbing cream.  I told her to try without, and she actually found it less painful with my technique.  And, of course, she loved the results!  The products we use all have local anesthetic mixed into the formula, providing increased comfort for the patients. 

There will be some immediate swelling and possible bruising.  This can be minimized by icing afterwards, taking arnica montana tablets, and avoiding aspirin, ibuprofen, fish oil, and garlic supplements prior to the procedure.  Most patients, however, love the swollen appearance, and wish it would stay just so! After a few days to a week, the swelling will settle down, revealing new plump lips.  If more volume is desired, it can always be added in at this point.  I recommend starting with a minimal amount and building up gradually to the final desired appearance.  Each patient’s desires and end goals are different and being in tune with that goal is extremely important to achieving the right result for each patient.  It is truly one of the most enjoyable and rewarding aspects of my work. 

Best Hand Rejuvenation Options with Dr. Gupta in Cincinnati

Don’t forget about your hands!  As we age, our hands may show our age even as we take care of our face, neck and décolletage.   The hands become less full appearing, more easily showing veins and tendons.  The skin becomes thinner, lending to wrinkling.  Brown spots and keratoses (raised spots) begin to appear.  It’s important to apply sunscreen and antioxidants to the hands just like we do for our face, neck and décolletage.  However, at some point, a little help from a few simple procedures can make a big difference.  It’s best to begin when the earliest signs of deterioration are noticed.

To combat plumpness, we can add volume back to get rid of the bony and veiny look.   Radiesse is a great choice for this problem.  It is especially suitable for injections into the hands. Carefully placed and gently spread through the hands, it adds an instant lift.  Recovery time can include some initial swelling and bruising.  It’s best to avoid blood thinning medications such as ibuprofen, aspirin, fish oil and garlic supplements for 10-14 days in advance.

Injection foam sclerotherapy is also a great option when the veins are especially prominent.  This can be seen even in younger patients and can easily masculinize one’s appearance.  Just like superficial unwanted leg veins, hand veins can also be eliminated with injection sclerotherapy or laser vein treatments, though sclerotherapy is usually the first choice.

Laser resurfacing procedures such as Fraxel are wonderful in stimulating new collagen and elastin fibers for frail skin.  A few simple treatments and the hands will look refreshed and healthier.  Fraxel laser is great for wrinkling and pigmentation.  If the brown spots are especially prominent, the Q-switched 532 nm laser works best for eliminate and wipe the spots away.  Broad Band Light is also an option that can be helpful when the spots are flat.  For elevated brown spots and lesions, other specialty lasers are great at smoothing out the spots.

As the premier cosmetic dermatology destination, we are able to offer 25 different lasers and technologies to help you achieve your goals using the best technology that is best suited and will give the best results for a given problem.  We really pride ourselves in keeping ourselves up to date and able to give the best solutions to our patients.   All procedures are carefully thought through and administered to give the best results.  

We highly recommend protecting your hands early on.  Use the same products you use on your skin on your hands.  Especially apply an antioxidant serum daily, containing Vitamin C, Resveratrol and/or green tea extract.  Sunscreen is great, but it wipes off with handwashing, whereas the antioxidants will give more lasting protection and do not wipe away with handwashing.  Our specially formulated organic, chemical free antiaging creams are also an excellent choice.  When driving, watch the amount of sun exposure your hands are receiving and try covering with a light scarf.  UVA radiation is able to reach through car windows!

What should I do about my Cellulite?

With Spring and Summer approaching, that means warmer weather and it means more of your skin will be visible as it escapes the confines of winter clothing.   For many women, cellulite, veins, hairs and brown spots are common concerns.  Fortunately, there are some simple ways to help you enjoy the warmer weather with confidence.  Veins can be treated with sclerotherapy or laser, hairs can be zapped away with lasers too, and brown spots do great with, you guessed it, lasers, too.

 

But cellulite-- how do we deal with the lumpy areas and indentions under our skin?  Not even liposuction is overly successful at removing cellulite.  Cellulite is a combination of 1) Thinning of the skin-- with age collagen is not as tightly wound up; 2) Overgrowth of fat lobules which poke through the thinned skin—they cause constriction to the vessels traveling through the fibrous septae; and 3) Constriction of the fibrous septae due the overgrown fat lobules near the skin surface.  To address cellulite successfully, all three aspects need to be addressed.

We have two methods of treatment.  The first are the noninvasive treatments.  These include Velashape, Thermage and Exilis Elite.  Velashape uses a combination of suction, infrared head and radiofrequency energy to heat and knead the skin.  The idea is to achieve localized fat apoptosis, to lengthen the fibrous septae and to stimulate collagen in the skin.  When performed diligently by an experienced and dedicated clinician, the results are actually very good.  Periodic maintenance after a series of treatments is a good idea to keep the areas smooth. Thermage and Exilis Elite both use monopolar radiofrequency to deeply heat the tissue to induce apoptosis of the fat cells and stimulate collagen in the skin, essentially achieving very similar results.  Thermage is an excellent treatment and can be accomplished in a single visit (though a repeat treatment after 3-6 months would yield heightened results), but it is painful.  Exilis Elite is performed in a series of 4 weekly treatments.   Hydration is very important with all these procedures as well hydrated skin allows for delivery of higher temperatures through the skin for greater efficacy. 

The second method are the minimally invasive technologies which include Cellulaze, VaserSmooth, and the latest ThermiTight.   With all three procedures, the skin is first numbed using a local anesthetic solution.  All of these procedures require wearing a compression garment immediately following treatment for 1-2 weeks and all three follow a single treatment protocol.  With Cellulaze, a spagethetti thin canula is threated back and forth through the cellulitic areas to 1) melt and destroy fat cells, 2) pop and break through the fibrous septae and 3) stimulate collagen via heat delievered directly under the skin.  VaserSmooth works in an identical fashion, but instead of laser energy, uses the gentler power of ultrasound to accomplish the same three goals.  The advantage of VaserSmooth is less disruption to the vessels and nerves, where the laser cauterizes through these structures.  Therefore the recovery time is a bit faster with less bruising and less swelling.  The third method called Thermitight again accomplishes all three end goals, but utilizes Radiopfrequency instead.  The greatest advantage with Thermitight is the strict temperature control of the device both internally and on the skin.  An infrared camera is constantly watching the skin temperature to keep it in a safe therapeutic zone and the tiny probe under the skin also allows delivery of exact therapeutic temperatures to effectively destroy fat cells, break through the fibrous septae and tighten the skin.  Of all three technologies, Thermitight yields the best skin tightening effects and effectively treats the fat and septae as well.  These minimally invasive treatments are perhaps more permanent than the noninvasive options.   Recovery time is typically one to two days with return to exercise after 2-3 weeks. 

Which method to choose can become a challenge, especially when there are so many great options.  The first consideration would be whether a minimally invasive option is acceptable for the patient.  If so, VaserSmooth or ThermiTight would both be great permanent treatments.  If minimally invasive doesn’t sound appealing and there is no time for wearing a garment or recovery, the noninvasive options are all great choices.   The newest of the noninvasive procedures is Exilis Elite.  Even though it is a series of treatments, patients prefer the price point and the comfort during treatment (compared to Thermage which can be painful while being administered). 

We highly recommend doing some research and then coming in for a consultation for further discussion.

ThermiTight 

 Results from ThermiTight

VaserSmooth Results

Exilis Elite Results

Thermage Results

Collagen Induction Therapy compared to Fractional Lasers

We began using Collagen Induction Therapy (CIT) technology back in 2003 with a roller that ran over the skin with tiny spiky needles all the way around a broad wheel.  There are now similar devices you can use at home with very short needles.  The one we used had long needles that penetrated into the deep dermis and caused immediate pinpoint bleeding. It definitely worked and had benefits for skin laxity, scars (including stretchmarks) and wrinkles.

Along came the fractional lasers and we found those a bit easier to use.  Also, we could control the depth of penetration, number of spots per cm and could add coagulation to heat the skin for better shrinking and tightening ability.

Today, CIT has made a comeback, almost like an article of clothing that goes out of fashion for a while and is reintroduced as something new and exciting.   But the technology has changed too for the better.  Gone are the rollers.  In are the pens, of which there are many.  Tiny needles, usually around 12 or so are attached to the end of the pen on a spring.  They can penetrate anywhere from 0.5 mm to 3 mm into the skin delivering thousands of pinpoint sharp punctures into the skin per minute.  Conceptually this is similar to the fractional lasers.  However, there are some important differences to consider.  First, there is no heat generated with the pins.  Hence, the safety is better especially for our ethnic patients.  There is no sloughing of the skin as there is no "ablation" or vaporization of any skin tissue--just the little tiny pinpoints.  Hence, the recovery time is much shorter.

All of our technologies have a place in our practice, and selecting the right procedure for each patient is our specialty.  Many factors are taken into consideration when deciding which procedure to use including recovery time, skin color, lifestyle factors, the problem we need to improve and what it will respond best to, etc.

The results with CIT are really quite awesome.  Please take a look:

Give us a call at 513-985-9885 to schedule a complimentary consultation with us.  We want to see you Glow!!

The Nonsurgical Facelift--A Dream Come True!

By Santrina Fletcher, NP & Shalini Gupta, MD


It is absolutely amazing to experience the advances in technology lately! Cosmetic dermatology procedures are becoming less invasive and involve less down time. One example of this is Ultherapy, which is a facelift that is executed with the power of focused ultrasound.  Ultherapy is the first non-invasive procedure cleared by the FDA that uses ultrasound to safely and effectively  lift the skin on the face, neck and decolletage (chest area).

So, how does it work?
You may be familiar with the concept of ultrasound when identifying the sex of a baby, or during vascular procedures. Ulthera has taken this concept to the next level. The Ultrasound energy is delivered in a focused high intensity beam and targets specific depths for maximizing results.  Unlike other FDA approved skin tightening devices such as Thermage, Exilis Elite, Venus Freeze, Skin Tyte, Titan, LuxIR deep, etc. which utilize either Infrared light or radiofrequency to deeply heat the collagen, Ultherapy allows me to visualize the layers of the skin and I know exactly where the energy will be delivered.  Also, the Ultrasound can penetrate deeper and target the right structures without dissipating the energy to areas where it is not needed and hence lost.  The first area that we target under the skin is known as the SMAS--a term you may know if you have looked into a surgical facelift.  This is the fibromuscular tissue that covers the facial and neck muscles and naturally weakens with time and gravity.  During a surgical facelift, it is sutured in a pursestring fashion to shrink and contract and hence lift the skin.  With Ultherapy, we are able to contract this tissue through the skin without having to make any incisions.  The second layer that is addressed is the dermal collagen. Collagen is the protein that gives skin its strength.  It degrades over time, contributing to sagging and wrinkling in the skin.  Applying energy to this area of the skin stimulates new collagen formation, a process known as neocollagenesis.  Although there are some immediate tightening results seen, you will not see final results until about 3-6 months later.  


The Nitty-Gritty:

First, there is a hand piece that is placed on top of the skin to identify the layer that we want to target. Once the fibromusclar and collagen layers are identified, pulses of ultrasound energy are delivered directly to those layers without disturbing the skin. It's just that simple.  No bandages, no recovery time.

The procedure takes between 30 minutes and 2 hours depending on the amount of surface area covered. There is absolutely no down time since it is non-invasive and there are minimal side effects. Some people experience light bruising along the jawline or cheeks and report tenderness near the jawline. There is some slight discomfort during the treatment but is generally tolerated very well with Ibuprofen on board prior to treatment. 

So, the next question is: How long will it last?
Since aging can't be stopped (unless we maybe enter , results from any procedure can never be permanent, but unlike Botox or fillers which wear off in 3-24 months, the effects from Ultherapy are yours to keep.  Think of it this way: If Ultherapy can improve your skin and reverse your "age" by 5-10 years, you will always be that much further ahead as you continue to age.  If this information is getting to you as you're just starting to see those first signs of sagging, it's an excellent time to get started.  If you're a bit further along but hate the idea of surgery, this is the next best alternative by far.  It is also an excellent insurance policy after a facelift to help maintain the tightness in your skin tissues.  Continuing to lead a healthy lifestyle (good food, no smoking, minimize alcohol, avoid sun exposure, moderate exercise, using retinol and antioxidants on your skin, etc.) will certainly help you maintain your results.  Certain vitamin supplements are also excellent.  In fact, insurance is now covering these supplements for a $15 copay.  Contact us if you would like to be signed up to receive these as well.

We are really seeing some "wow" results with this technology for face, neck and eye lifting!  Visit our website for more info: http://www.cincinnatiskinandlaser.com/ulthera/

And please don't hesitate to contact us at 513-985-9885 to ask more questions.

Here's one of our patients after Ultherapy and Thermage for the upper eyelids Combo treatment.



And more Ultherapy patients: