Injectable Solutions:

Botox:
Origin: purified botulism toxin used since 1989 for relieving eye spasms and/or excessive sweating. Excellent safety profile.

Uses: to block the ability of muscular contraction that results in wrinkling. Most commonly used around the eyes (crowfeet), in between the eyebrows (frown lines) and the horizontal creases on the forehead (furrows).

Longevity: Most patients will experience an average of 6 months duration per treatment. Recent literature suggests that repeated treatments with Botox may result in atrophy or weakening of the muscles treated whereby even after the effects of Botox wear off, the muscle may not be able to contract to the same degree that it previously had.

Side effects: slight bruising/tenderness at the site. If administered incorrectly, can lead to unwanted, albeit temporary, paralysis of facial musculature. Bottom line is, once again, go to an experienced practitioner.

Summary: We have been using Botox in our practice for approximately 4 years and have found it to be amazing in what it can accomplish. It is minimally invasive and significantly impacts lining in wrinkling.

Restylane:
Origin: colorless transparent gel consisting of stabilized hyaluronic acid. Hyaluronic acid is a natural substance found in great abundance in young skin, synovial fluid and other tissues in humans and animals. The gel is sterile and free from products of animal origin, so pre-testing for hypersensitivity is not required.

Uses: The manufacturer has developed three formulations to effectively meet the vast majority of patient needs. Perlane is used for deep folds, facial contours and lip enhancement. Perlane is injected into the deep layer of the dermis and or the surface of the subcutis. Restylane is for moderate wrinkles and lip enhancement. Restylane is injected into the middle part of the dermis. Restylane Fine Lines is the third formulation used for the correction of very thin, superficial lines. It is injected into the upper part of the dermis.

Longevity: Clinical trials show that Restylane is effective for up to six months. Most patients choose to have a follow-up treatment between six and twelve months after initial treatment.

Side effects: Immediately after treatment you can expect some redness, swelling, tenderness and an itching sensation in the treated area. This is a normal result of the injection.

Summary: Restylane was developed in 1996 and has been used in hundreds of thousands people worldwide. Restylane has enjoyed very positive media coverage and in our practice, it has been very successful.

Sculptra:
Origin: Sculptra is an injectable form of poly-L-lactic acid (PLLA), which is used to restore volume and/or correction of fat loss to the face. Sculptra is not made from human or animal sources and does not require a skin test. Poly-L-lactic acid is biocompatible (will not harm the body) and biodegradable (able to be broken down by the body). PLLA has been widely used for many years in dissolvable sutures, soft tissue implants and other types of implants.

Uses: Sculptra can be injected anywhere on the face, except for the lips, where fat loss, and/or wrinkling have occurred. It has also been used on the backs of hands to restore volume in those patients who have extremely prominent veins secondary to volume and fat depletion. Sculptra works by stimulating cells in the skin called fibroblasts, to manufacture more collagen in the areas where volume loss has occurred. When more collagen is laid down, the skin thickens, and lines, wrinkles and hollowed indentations are filled out, thereby diminishing the appearance of these hallmarks of an aging face.

Longevity: The method by which Sculptra corrects aging changes is very innovative. By stimulating the body to produce its own collagen to correct the volume loss, Sculptra does not provide an immediate result. It takes time for the body to lay down the new collagen thus correction occurs gradually over a period of 3-6 months. Some correction may be noticeable prior to that time, but the full correction won’t be realized for approximately 3-6 months. The upside is that the effects of Sculptra will last much longer than the filling solutions we currently have available such as Restylane. Typically, the results from Sculptra can last, according to the latest clinical reports, for up to 2 years after the first treatment session. Restylane, by contrast, is a filling solution which means that it is the product providing the correction and the effects are seen immediately, but do dissipate by about 6 months. Another important difference is that Restylane can be used in the lips, whereas Sculptra cannot because there aren’t enough of the cells that produce collagen residing in the lips to render the product effective. Both are safe, non-surgical options to correct aging by working in very different ways.

To reach optimal results, a typical treatment regimen for Sculptra is three treatments, spaced approximately 6 weeks apart.

Side effects: As with other injectable solutions, temporary bruising/swelling at the site can occur for a few days after product administration. With Sculptra patients are instructed to carefully massage the treatment site several times per day for the first 5 days following treatment.

Summary: We are very pleased to have another safe, non-surgical treatment to add to our family of injectable offerings. We have recently begun using Sculptra and look forward to seeing the long-term results. It has an excellent safety profile in Europe (in use for 7 years) and we are confident that it will produce consistent and desirable aesthetic results for our patients as well.

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Eyelid Surgery

Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat--usually along with excess skin and muscle from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes - features that make you look older and more tired than you feel, and may even interfere with your vision. However, it won't remove crow's feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or browlift.

In a typical procedure, the surgeon makes incisions following the natural lines of your eyelids; in the creases of your upper lids, and just below the lashes in the lower lids. The incisions may extend into the crow's feet or laugh lines at the outer corners of your eyes. Working through these incisions, the surgeon separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are then closed with very fine sutures.

The results of your eyelid surgery will be a more alert and youthful look that will last for years. For many people, these results are permanent.

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Facelift

As people age, the effects of gravity, exposure to the sun, and the stresses of daily life can be seen in their faces. Deep creases form between the nose and mouth; the jawline grows slack and jowly; folds and fat deposits appear around the neck.

A facelift can't stop this aging process. What it can do is "set back the clock," improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck. A facelift can be done alone, or in conjunction with other procedures such as a forehead lift, eyelid surgery, or nose reshaping.

Incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear (or just inside the cartilage at the front of the ear), and continue behind the earlobe to the lower scalp. If the neck needs work, a small incision may also be made under the chin.

In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle and membrane, pulls the skin back, and removes the excess. Stitches secure the layers of tissue and close the incisions; metal clips may be used on the scalp.

Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. The surgeon may also wrap your head loosely in bandages to minimize bruising and swelling.

There isn't usually significant discomfort after surgery; if there is, it can be lessened with the pain medication prescribed by your surgeon.

Having a facelift doesn't stop the clock. Your face will continue to age with time, and you may want to repeat the procedure one or more times-perhaps five or ten years down the line. But in another sense, the effects of even one facelift are lasting; years later, you'll continue to look better than if you'd never had a facelift at all.

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Laser Skin Resurfacing

In laser skin resurfacing a CO2 laser is used to remove areas of damaged or wrinkled skin, layer by layer. The procedure is most commonly used to minimize the appearance of lines, wrinkles and textural irregularities, especially around the mouth and the eyes. However, it is also effective in treating facial scars or areas of uneven pigmentation. Laser resurfacing may be performed on the whole face or in specific regions. Often, the procedure is done in conjunction with another cosmetic operation, such as a facelift or eyelid surgery.

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Nose Surgery

Rhinoplasty, or surgery to reshape the nose, is one of the most common of all plastic surgery procedures. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems.

Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and your surgeon's preferred technique. Finally, the skin is redraped over the new framework.

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Browlift (Forehead Lift)

A forehead lift or "browlift" is a procedure that restores a more youthful, refreshed look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired.

In a forehead lift, the muscles and tissues that cause the furrowing or drooping are removed or altered to smooth the forehead, raise the eyebrows and minimize frown lines. Your surgeon may use the conventional surgical method, in which the incision is hidden just behind the hairline; or it may be performed with the use of an endoscope, a viewing instrument that allows the procedure to be performed with minimal incisions. Both techniques yield similar results -- smoother forehead skin and a more animated appearance.

If you're considering a forehead lift, this brochure will provide a basic understanding of the procedure -- when it can help, how it's performed and what results you can expect. It won't answer all of your questions, since a lot depends on your individual circumstances. Be sure to ask your doctor if there is anything you don't understand about the procedure.

The Best Candidates For a Forehead Lift

A forehead lift is most commonly performed in the 40-60 age range to minimize the visible effects of aging. However, it can also help people of any age who have developed furrows or frown lines due to stress or muscle activity. Individuals with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can achieve a more alert and refreshed look with this procedure.

Forehead lift is often performed in conjunction with a facelift to provide a smoother overall look to the face. Eyelid surgery (blepharoplasty) may also be performed at the same time as a forehead lift, especially if a patient has significant skin overhang in the upper eyelids. Sometimes, patients who believe they need upper-eyelid surgery find that a forehead lift better meets their surgical goals.

Patients who are bald, who have a receding hairline, or who have had previous upper-eyelid surgery may still be good candidates for forehead lift. The surgeon will simply alter the incision location or perform a more conservative operation.

Planning Your Surgery

For a better understanding of how a forehead lift might change your appearance, look into a mirror and place the palms of your hands at the outer edges of your eyes, above your eyebrows. Gently draw the skin up to raise the brow and the forehead area. That is approximately what a forehead lift would do for you.

The endoscopic forehead lift: Typically, an endoscopic forehead lift requires the same preparation steps as the traditional procedure: the hair is tied back and trimmed behind the hairline where the incisions will be made.

However, rather than making one long coronal incision, your surgeon will make three, four or five short scalp incisions, each less than an inch in length. An endoscope, which is a pencil-like camera device connected to a television monitor, is inserted through one of the incisions, allowing the surgeon to have a clear view of the muscles and tissues beneath the skin. Using another instrument inserted through a different incision, the forehead skin is lifted and the muscles and underlying tissues are removed or altered to produce a smoother appearance. The eyebrows may also be lifted and secured into their higher position by sutures beneath the skin's surface or by temporary fixation screws placed behind the hairline.

When the lift is complete, the scalp incisions will be closed with stitches or clips and the area will be washed. Gauze and an elastic bandage may also be used, depending on your surgeon's preference.

After Your Surgery

Endoscopic forehead lift patients may experience some numbness, incision discomfort and mild swelling.

Incision site pain is usually minimal, but can be controlled with medication, if necessary. Endoscopic forehead lift patients usually experience less of the itching sensation felt by patients who have had the classic forehead lift.

The stitches or staples used to close the incisions are usually removed within a week and the temporary fixation screws within two weeks.

Your New Look

Most patients are pleased with the results of a forehead lift, no matter which surgical method was used. Often, patients don't realize how much their sagging forehead contributed to the signs of aging until they see how much younger and more rested they appear after the lift.

Although a forehead lift does not stop the clock, it can minimize the appearance of aging for years.