Botox and Dysport injections are frequently performed to help eliminate facial lines and wrinkles. Another less known use of this products is to improve the appearance of a gummy smile. Some people have a gummy smile when the muscles of the upper lip are overactive. Using Dysport or Botox within these muscles will help relax them and improve the smile. These photos are of a patient 1 week after Dysport injection for a gummy smile.

Fat grafting is a remarkable procedure performed to rejuvenate the face. As we age, we lose volume in the form of muscle, bone and fat from the face. The distribution of this fat loss will vary from person to person. The art of the facial plastic surgeon comes in when deciding where and how to place the fat.

Without question fat grafting is becoming exceedingly more popular. The effects of fat grafting are seen immediately and for years after the procedure. Since fat has a very abundant supply of stem cells within it, some people are calling the fat grafting procedure a stem cell face lift. This might make sense considering that we are injecting stem cells into the face along with the fat, however until I see definitive evidence that the stem cells play any roll in this, I will not tout it in that fashion. What I will say is that fat grafting works well, very well. As the word is getting out about this no incision procedure, more and more people are turning to it.

That being said, the most common question I get is…”How long does it last?” Fat grafting is a permanent procedure. Live fat cells are removed from the body, purified in my lab, and the transferred to the face (all at the same time). The key is making sure that the fat cells survive the sometimes traumatic process of moving it around. Harvesting, processing, and finally injecting the fat in the proper manner will ensure the longevity of this procedure. So bottom line is that the technique is crucial to the outcome and longevity of the procedure, and you must choose a surgeon very experienced in fat grafting to get the best results.

The photo above is of a patient of mine who is 1 year and 2 months after full face fat grafting. The area I want you to pay attention to is that of her cheeks. Although the entire face was injected, we will use the cheeks to demonstrate that after 14 months the cheeks are still full, and even fuller then they were at 2 months. At this point there is no question that the fat has taken and is now a part of her face.

Before undertaking any cosmetic procedure you must first understand what the goals of that procedure are. Since a picture is worth a thousand words, we put together this video of the Deep Plane Facelift complete with before and after photos. It explains the results of the surgery with commentary on the before and after photographs. To see videos about facelift surgery and the recovery involved. Please visit the facelift video page.

It has been said that the eyes are the window to the soul. This speaks loudly, as the goal of any facial rejuvenation procedure is to restore attention back towards the eyes. What happens when that window is missing its drapes!

We often see patients that come in and have had prior blepharoplasty or eyelid surgery, where too much fat or skin has been removed. This defeats the purpose of cosmetic surgery as it does not make you look younger. In fact it makes you look older and un-natural.

A youthful eyelid is almost always associated with fullness around the eyes. Just take a look at any current fashion magazine. Take a look at some of the famous actresses and models today. All of them, almost invariably, have fullness to their eyelids.

That being said, preservation of this fullness must be maintained whenever performing eyelid rejuvenation and blepharoplasty. This means removing just the right amount of skin from the upper eyelid, and in most cases NEVER removing fat from the lower eyelid. For this reason, I perform a fat repositioning lower eyelid blepharoplasty that moves the protruding fat downwards instead of removing it, in order to prevent that hollowed out look. This is a story for another day, but you can read more here.

So what happens if too much skin, fat, etc. has been removed? This can be a difficult problem to treat. It is restorative plastic surgery. The case below is a woman who had no extra skin or fat in her eyelids (from prior surgery), yet she looks older purely because her eyes are too hollow. Since are minds have a harder time thinking in terms of addition (adding volume), I will show you these before and after fat grafting photos to give you a better idea. Take a look at how fat grafting her periorbital region (upper and lower eyes) has given her back years of youth and restored an attractive,youthful eyelid:

The answer to the above question- none of them.

What?! Are you nuts, I can’t believe you just said that! So what do I mean by this?

Simply put, a builder does not build an entire house out of concrete, just as Michaelangelo did not paint the entire Sistine Chapel in brown.

In my opinion, for an injector/physician/surgeon/artist to properly use a facial filler, he/she must have a clear artistic vision and strategy before even beginning to inject. Filling in a deep line is rarely the solution to an overall effective method of making you look younger in the most natural way. A natural looking, youthful appearance comes down to restoring the contour of a youthful face. The proper contour is well balanced and for this reason looks completely natural.

Restylane, Perlane, Juvederm, Radiesse, Evolence, etc. are all great products. I can use these products to contour the cheeks, fill in the tear troughs, enhance the lips, soften the chin and all together improve your appearance. (Notice how I specifically did not mention filling in the nasolabial folds- more on that in a different post) However, they each have VERY unique properties that make them excellent for certain goals, yet terrible for others. Without revelaing the secrets, the best, most natural results are arrived at by combining these products in order to achieve the envisioned end result.

Just as in any surgical procedure, I first envision the appearance that I would like to achieve and then I figure out what tool to use. Facial fillers are the tools that help me achieve these results. They each are unique and have their place in my tool chest.

After a very thorough review process we have introduced the latest addition to our practice, a fractional CO2 laser for skin resurfacing.  Aside from the technical and clinical reasons I chose this particular laser, I want to review why I think this technology is the biggest thing to come out in lasers since the first CO2 laser was introduced for skin resurfacing.

CO2 (Carbon Dioxide) laser skin resurfacing has been around since the 80′s.  The CO2 laser revolutionized skin resurfacing.  There is no question that CO2 laser skin resurfacing is by far and away the best laser method for facial skin rejuvenation and laser skin resurfacing.  ANY laser developed today for purposes of improving skin tone, texture, color, lines, wrinkles, sun damage and uneven skin pigmentation has to be compared to the CO2 laser because it is the GOLD standard.

So why develop new lasers if the CO2 works so well? Quite simply- the downtime and negative effects of the laser .  There is an arduous and involved 10 day healing phase after full face CO2 laser skin resurfacing. During this healing phase, new skin reforms and collagen is produced. The skin stays red for about 1 month and pink for up to 3 months after the procedure.  In addition, this laser should only be used on lighter skinned individuals as the laser itself will cause a permanent lightening of the skin called hypopigmentation.

A huge leap in laser technology came about when the idea of fractionation was introduced. Fractionation refers to the principle of dividing the laser beam into multiple tiny beams that will only treat a set percentage of the skin.  Fractionated lasers only affect a certain percentage of the skin rather then the ENTIRE surface.   1% to 100% of the skin can be treated depending on what settings are used and the laser’s capabilities.  Leaving small bridges of unaffected skin in-between the treated skin allows for a much quicker recovery. Many patients can go back to their full activities the next day and they can start wearing makeup within 4 or 5 days to resume their social activities. In addition, it virtually eliminates the risk of losing skin pigment.  In fact, fractionated technology is safe in darker skinned patients that would normally not be laser candidates.

The latest lasers combine the best of both worlds.  The power of the CO2 laser for skin rejuvenation along with the minimal downtime of the fractionated technology.  Rather then treat 100% of the skin as in with the traditional CO2 laser, a smaller percentage of the skin is treated in a grid-like pattern.

There are several of these lasers on the market including but not limited to the Lumenis Active FX and Deep FX, the MiXto laser, the Lutronic eCO2 laser, etc.  Our evaluation of the fractionated  CO2 laser is complete and we are proud introduce this technology in the platform whch we think is best based on the latest technology.  Fractional laser CO2 is safely performed in tthe comfort of our office.

 Today Medicis has announced that Dysport has been approved by the FDA for aesthetic and therapeutic indications. Reloxin is the cosmetic name for Dysport, which has been available in Europe for some time.  Reloxin has passed through the US Food and Drug Administration’s stringent policies for use in the US.

Reloxin is the much anticipated alternative to the popular Botox cosmetic injections for treatment of wrinkles.  If you are interested in learning more about the differences, please see my earlier Blog here.

One of the most important concepts in understanding facial aging is the idea of deflation. As we age, unlike in the rest of our bodies, the face loses its fullness/volume.  This exposes the underlying bone, allows the skin to sag, and contributes to an aged appearance.

Facial volume is often overlooked when thinking about rejuvenating an aged appearance. A recent research study examined the appearance of identical twins throughout life. The study revealed that the “heavier” twin appeared more youthful then their “skinnier” counterpart. To reiterate: the identical twin, who had more facial fullness, appeared younger then his or her twin, who had a less full appearing face.

The conclusion from this study is not to go out and gain weight so you can look younger. It simply illustrates the importance of volume in facial rejuvenation. This is something which I have been preaching for years now. We see the loss of facial volume begin in our 20′s and its effects are noticed by a change in our appearance as early as in our 30′s.

When I speak of facial volume in this regard, it is not about filling in lines and wrinkles, it is a matter of restoring lost facial proportions caused by volume loss- filling in the areas that have lost volume. This is an art in and of itself that restores your youthful look in a very natural appearing way.

Visit our fat grafting page for more information on this procedure or our facial filler page.

Every day patients come to my office desiring to look younger. There are so many amazing procedures, non-invasive and surgical that can be performed to make you look younger in the most natural appearing way. However, I want to dedicate this blog to a very important product that everyone in South Florida should be using daily, sunscreen.  Yes…its as simple as that- sunscreen.  There are so many products out there that are sold by the cosmetics industry, generating billions of dollars every year.  Most of them are not proven to help at all (except for a few) and are very expensive. The best thing you can do for yourself to delay the signs of aging is to protect yourself from the sun’s harmful UV rays. Oh yeah, it also prevents skin cancer!

In addition to cosmetic surgery I perform reconstructive surgery for patients who have had skin cancer removed. MOHS surgery is performed by dermatologists specially trained in the procedure.  They remove the cancer and then look under the microscope, at the same time, to make sure all of the cancer was removed. The cure rate is as high as 99%.  After MOHS surgery, a hole (called a defect) is left behind.  I repair MOHS surgery defects every week, big and small.  On a personal note, I had MOHS surgery performed on my cheek 5 years ago.  So I can tell you from personal experience, wear sunscreen! (Click to learn more about MOHS Surgery)

UV rays from the sun speed up the aging process. They caus  damage to the skin’s DNA, leading to abnormal skin pigmentation (sun spots/brown spots), fine lines, and wrinkles. Skin peels are procedures performed to treat this condition called solar aging. You will delay and perhaps avoid the need to have chemical peels or laser peels simply by using sunscreen.

The best type of sun protection you can use is sunscreen that has what is called a physical blocker. Zinc or titanium are physical blocking agents that physically blocks the sun from penetrating your skin.  The other types of sunscreens are chemical blockers, which in my opinion do not work as well.  For this reason, my line of sunscreen has a specially formulated physical blocker that in not  visible. Feel free to call my office if you need more information.

There is a new kid on the block. In the next couple of months, the FDA is likely going to approve Reloxin for a cosmetic indication to treat wrinkles. Botox received its cosmetic indication by the FDA in 2002. For the past 7 year Botox has enjoyed a competition free environment. In this same time it has rapidly grown to become the MOST commonly performed non-surgical cosmetic procedure today.

Botox is a simple and painless in-office procedure that produces remarkable results. Women and men as early as in their 20′s are reaping the benefits of Botox these days. Reloxin works in the same exact fashion.

So how do Reloxin and Botox work? The short answer is that they work by weakening the wrinkle causing muscles of the face. For those of you who love physiology, these products prevent the presynaptic transmission of acetylcholine into the synaptic cleft thus preventing muscle contraction. The results last approximately 4-6 months and the injection needs to be repeated to see continued effect and enjoy the cumulative effects of the product.

So what is the difference?
In order to better understand this we need to break down the potential benefits into several categories.

1) Effect- Which will achieve the best results- Botox or Reloxin? Theoretically they both work in exactly the same fashion, so they should be about the same. Anyway you look at it, Botox is the gold standard and Reloxin needs to prove that it is at least as good as Botox. Phase 3 clinical trials usually require that the new product be at least as good as the gold standard. So receiving FDA approval tells us at least that much about Reloxin.

Reloxin is said to spread more easily then Botox. This means that it has an effect farther away from the point of injection. This could be very beneficial in some instances and not so much in others. For example, injecting the crow’s feet or the forehead may require only one injection instead of several. I see this as a moot point since I have never had a patient complain of any pain when I inject their crow’s feet. However, less injection points will lead to less bruising, in the rare instances that bruising can occur. On the other hand, there are areas where you want to minimize the spread of product, Botox may have the upper hand in these regions.

2) Longevity- As Botox lasts 4-6 months, how long will Reloxin last? Several studies have compared the two products. One study, which was NOT biased by support from either company, revealed that Reloxin actually lasted longer then Botox. I wouldn’t close the case file on this just yet because other research studies have shown the opposite.

3) Price- Allergan, the makers of Botox Cosmetic, have enjoyed a competition free environment up until now. Perhaps consumers will reap benefits from increased competition in the marketplace.

In summary, the anticipated release of Reloxin is exciting news in the world of facial cosmetics. Perhaps there will be a role for combining both of these products in order to achieve the best possible results.

please visit the Botox information page in order to obtain more information about Botox Cosmetic