This week the FDA has expanded Restylane’s indication for use to include that of lip enhancement. Restylane was the very first hyaluronic acid, injectable filler approved in 2003 by the FDA to fill in the nasolabial folds. Once the FDA approves a product with regards to its safety profile, physicians may choose to use it “off-label” for other reasons. Since being approved for use in the nasolabial fold, physicians have also been using Restylane and other hyaluronic acid fillers in other areas of the face such as the lips, cheeks, and marionette folds.

The expansion of Restylane’s indication for use in the lips now allows Medicis, the company that sells Restylane in the US, to directly market this use to physicians and patients. This will result in an increased awareness of the product and its possibility for use to enhance the appearance of the lips. Remember, it is essential that you seek out the care of a physician who is knowledgeable, experienced and artistic in their use of Restylane in the lips in order to obtain the best possible results.

Click on this video to understand the artistic nature of using fillers in the lips

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.

We are starting to see incredible results from our new Lutronic eCO2 premium laser (Fractionated CO2 Laser).  All of our patients have been thrilled with their treatment and results.  The premium eCO2 laser combines the benefits of CO2 laser technology with the benefits of limited healing time of fractionated technology (such as Fraxel).  In addition, our CO2 laser is very versatile so that I am able to alter the settings (energy forms and patterns)  in order to achieve the most desirable results.

Below is a video of one of our patients who had her Acne scars treated with the fractional CO2 laser. My philosophy on acne scar treatment is based on directing treatment based on the type of acne scar present. Since acne scars come in different varieties (shapes and forms), laser surgery for acne scars works very well on particular types of scarring patterns, but not as well on others. I will often combine modalities at the same time. Treating acne scars in this fashion leads to the best possible results.  

As time goes on, her skin will continue to build new collagen and I am looking forward to the progress.

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.