Injectables

Takeaways from the Emory Aesthetic Center’s Getting Ready for the Holidays Live Chat

eac-holiday-260x200Thank you to everyone who joined us on Tuesday, October 13th, for our live online chat on “Getting Ready for the Holidays”, hosted by Emory Aesthetic Center’s facial plastic surgeon, Dr. Anita Sethna.

Believe it or not, the holidays will be here before we know it. In this live chat, Dr. Sethna provided advice and answered questions on how to get your skin glowing for the festive season. She discussed effective non-surgical treatments that will give you a brighter, rejuvenated look. She also answered questions around cosmetic surgical options and recovery to ensure your are ready just in time for the season. Here are just a few highlights from the chat, including one question we didn’t have a chance to answer:

Question: Can you perform a nose job with injections? My friend said that he had it done and I can see a difference.

anita-sethna-avatarDr. Sethna: Non-surgical rhinoplasty is a relatively new concept in injectables, but not one that should be taken lightly. There are no FDA-approved injectables for injection into the nose. That being said, in very select cases either after a rhinoplasty has already been done, or if a small issue in the bridge needs to be corrected, injection of a hyaluronic acid filler (juvederm , restylane for example) can be injected to correct the concern. A rhinoplasty surgeon familiar with the anatomy and blood vessels of the nose should be the one performing the injection. The risks of improper placement or unintended consequences can be severe in the nasal skin if performed by an untrained individual. As always, a consultation with a rhinoplasty expert to determine whether your concerns are even amenable to non-surgical (injectable) rhinoplasty is recommended prior to any interventions.

Question: What is the simplest thing someone can do to look fresher and rejuvenated?

anita-sethna-avatarDr. Sethna: On a daily basis, skin care is probably the easiest and biggest bang for your buck. The ingredients that are most helpful are tretinoin, or some type of retinol, that is essentially a daily exfoliant that is helpful in stimulating collagen and removing surface dead skin cells.

 

 

Question: When would you recommend a chemical peel and what does it best treat? Wrinkles? Complexion? Wondering if I should have one.

anita-sethna-avatarDr. Sethna: There are many different types of chemical peels and many different concentrations that can be used to achieve a different type of cosmetic result. Very limited amount of down time can be achieved with a lower concentration of peel solution and can improve overall brightness of the complexion and possibly improve the appearance of darker spots or age spots. If deeper wrinkles are present or overall skin tightening is desired, most of the time a deeper peel will need to be performed in an operating room or under sedation, with a recovery time of closer to seven days. Most peels can be repeated to get more drastic results and can be repeated with varying intervals depending on the depth of the original peel. Ultimately, the best recommendation on whether or not it will be helpful will be to come in for a consultation to address what your overall goals are and whether a peel could accomplish those.

If you missed out on this live chat, be sure to check out the full list of questions and answers on the chat transcript. You can also visit emoryaesthetic.org for a full list of services and treatments offered by the Emory Aesthetic Center.

If you have additional questions for Dr. Sethna, please feel free to leave a comment in our comments area below.

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or call us at 404-778-6880 to schedule a consultation.

How to Prevent and Treat Crows Feet

happy-ladyCrow’s feet, or laugh lines around the eyes, can be a challenging area to treat from a cosmetic perspective. On one hand, expressions of joy transmitted through the eyes are beautiful in their own right, but deeper lines and creases in this area can often draw attention to the changes associated with aging and loose skin.

My personal approach is to attempt as much as possible to prevent the lines from becoming deep, or in some cases, even forming to begin with. There are two main methods to achieve this – skincare to plump and stimulate collagen (such as tretinoin or Retin-A©), and Botox® (or equivalent Xeomin® or Dysport®) to reduce the muscle movement in the area and thereby reducing crease patterns. These options can be started at any time, even in the early 30s before real creases have begun. A combination of treatments early can prevent the formation of obvious deeper creases. At this stage, Botox can be performed as little as twice a year before creases have actually formed.

Once the creases are present, the above combinations of skincare and Botox can still make a significant impact and can lessen the appearance of lines around the eyes. Often, this is all that patients are interested in so that they can still appear to have movement while improving their overall appearance. If a more drastic improvement is needed, a series of peels or even fractional laser treatments can be undertaken. The choice of intervention depends on the comfort level of the surgeon and the amount of downtime or recovery the patient is able to give.

If a week of downtime is tolerable, fractional laser resurfacing can be performed relatively aggressively to specifically treat the area around the eyes. Makeup can typically be worn to reduce the appearance of redness during the recovery period. Because we usually cannot be aggressive enough with one treatment to wipe out these lines, a repeated treatment may be needed 3-6 months later. During that period of recovery, Botox can be used to give the skin a continued break from creasing as well.

Facial peels can also be performed, often at varying depths, depending on the amount of recovery or downtime afforded. Often, a peel will have 3 days of recovery and can be repeated every 4 to 6 weeks for a total of 3 to 4 treatments to allow improvement in this area. It is a slower, but less intensive treatment plan. Continuing skincare and Botox through this period will also boost results.

All in all, a multi-pronged approach is often needed to treat the eye area. The good news is that crow’s feet respond to treatment quite well if all options are utilized. Other treatments, such as fillers, can be used as well if indicated, but are not routine as they can be fraught with unexpected complications. With judicious use of Botox and a rigorous skincare routine early, an ounce of prevention is definitely worth a pound of cure.

Come meet with one of the board-certified physicians of the Emory Aesthetic Center. We can discuss your goals and determine what combination of treatment is right for you.

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or call us at 404-778-6880 to schedule a consultation.

About Dr. Sethna

anita-sethna-avatarDr. Sethna understands that facial plastic and reconstructive surgery demand a marriage of science and artistry, and she enjoys using precision, skill, and vision to make her patients’ dreams reality. Dr. Sethna’s meticulous attention to detail and her passion for maintaining a natural look ensure optimum results for her patients.

A dedicated teacher, Dr. Sethna is devoted to assisting residents in facial trauma or reconstructive cases at Grady Hospital. She relishes the opportunity to educate residents and medical students in all aspects of patient care. Dr. Sethna has a strong interest in several areas of facial plastic surgery research and has presented at national meetings on the importance of resident and fellow education in rhinoplasty techniques and adjunctive measures to decrease discomfort during cosmetic procedures.

Ensuring Safety with Dermal Fillers and Botox

botox-injectionWith the prevalence of advertising injectables, and with specials running on every corner, it can be difficult to make a decision regarding where, when and who should be performing your nonsurgical facial rejuvenation.

The most common question I get from my patients is whether or not Botox® and dermal fillers are safe to use in the long-term. This is a reasonable question – after all, there is no shortage of exposures these days that we later discover have been harmful to us all along. But I reassure my patients that Botox (and its counterparts, Dysport© and Xeomin©, which I will refer to under the heading of Botox for simplicity) has been used in the treatment of facial wrinkles since the 1980s and 1990s – although it was only approved in 2002 for cosmetic use. We have therefore been watching the effects and risks of this potent and effective treatment for over 30 years now. There are also few other medications that have been studied quite as much as Botox for both cosmetic and non-cosmetic uses.

Dermal fillers, you may be surprised to know, have been used in their collagen form since the 1980s. The problem with using collagen fillers was that it required allergy testing and the effects of the filler only lasted about 3 months. With the onset of hyaluronic acid fillers, and some of the other longer lasting options available, results can last from months to years depending on the type and placement. Hyaluronic acid options are generally considered extremely safe, as this is a component of our own cellular structure and therefore does not require additional allergy or skin testing. It also has an excellent safety profile because it can be dissolved if the need arises by injecting an enzyme that breaks up the filler.

The issues of primary importance when you are contemplating who or where to have your treatment are the experience of the injector and where the product is obtained. Reputable physicians and surgeons will obtain the product directly from the manufacturer, not a discounted offshoot. There is little the consumer can do to ensure this other than to ask if the product has been obtained from the manufacturer and not a third party. This guarantees the product is pure and sterilely packaged.

The other issue is to have your treatments performed by someone who is comfortable not only with the methods and materials, but someone who has experience dealing with complications. Botox used for cosmetic purposes has risks of local bleeding or bruising, and diffusion into surrounding structures. This can lead to eye drooping or changes in mouth position if injected in these areas. In most cases, for cosmetic uses, the risk of breathing difficulty or swallowing problems does not reasonably occur.

Fillers can carry other risks. As with Botox, some of the common risks are bleeding and bruising. These are temporary and most often do not interfere with the final result. However, fillers should be considered an injectable implant. Sterile technique should always be used – cleaning the face with alcohol to remove all makeup, avoiding touching of the face after preparation and keeping needles and products packaged sterilely until use. Local infections can occur and can result in delayed results or other complications if sterile technique is not used.

Finally, injections of foreign materials into blood vessels can be dangerous and can cause changes in the surrounding tissues in a dramatic way. This can, in many cases, be avoided with proper attention to the anatomy of the face and knowledge of safe areas to inject fillers. Notably, in the U.S., silicone is not FDA-approved for soft tissue injection. Make sure to ask your injector if the product that is being recommended is FDA-approved for facial injection and whether there are specific risks associated with these injections. You can also ask if they can be reversed if a poor outcome or complication occurs. You should always be asked to sign a consent form prior to injection of a new product. Please take the time to read the consent forms. Many patients feel that since these products can be obtained at a spa or without “surgery”, the risks are minimal and not worth reading about in detail. Injectables are still elective procedures and carry risks associated with them. Make sure you understand what the risks are before embarking on this journey.

The overwhelming majority of patients obtaining Botox or dermal fillers are exceedingly pleased with their results. The risks of some of the more worrisome complications is quite low – 0.0001% in some of the available literature. Once you are aware of the possibilities, you are an informed consumer. Be sure to ask questions of your injector and preferably consult a surgeon familiar with the anatomy and soft tissues of the face that utilize injections in their practice on a daily basis. Injectable treatments can be powerful tools for nonsurgical facial rejuvenation with tremendous success.

Let the board certified physicians of the Emory Aesthetic Center provide you with a complimentary consultation to assess your needs and help you think through the options. We will help choose an approach personalized to you and your needs.

404-778-6880
emoryaesthetic.org
Click here to schedule your personal consultation.

 

About Dr. Sethna

anita-sethna-avatarDr. Sethna understands that facial plastic and reconstructive surgery demand a marriage of science and artistry, and she enjoys using precision, skill, and vision to make her patients’ dreams reality. Dr. Sethna’s meticulous attention to detail and her passion for maintaining a natural look ensure optimum results for her patients.

A dedicated teacher, Dr. Sethna is devoted to assisting residents in facial trauma or reconstructive cases at Grady Hospital. She relishes the opportunity to educate residents and medical students in all aspects of patient care. Dr. Sethna has a strong interest in several areas of facial plastic surgery research and has presented at national meetings on the importance of resident and fellow education in rhinoplasty techniques and adjunctive measures to decrease discomfort during cosmetic procedures.

Facial Rejuvenation: Temporary versus Long Lasting Effects

temporary-vs-permanentLike most things in life, when considering a cosmetic procedure to rejuvenate the face, there are many things to take into account. For instance, some procedures are less invasive and have minimal recovery time; others are much more invasive and may require several weeks to fully recover. There is also the cost factor to think through as well. The right procedure for you will depend on many of these factors, along with the goals that you have.

For most patients, this comes down to a question of “Do I need surgery, or will non- (or minimally) invasive procedures give me the results that I’m looking for?”. There is no doubt that non-invasive or minimally-invasive procedures are inherently attractive as an option. They usually offer minimal or short-term discomfort, there are no scars to heal and fade, and patients don’t generally have significant bruising or swelling. Also, the cost of a single minimally invasive treatment is usually significantly less than that of a more aggressive, comparative surgical procedure. Examples of minimally invasive treatments include injectables like Botox© and dermal fillers, lasers and Intense Pulsed Light therapy, high grade skin care products, and skin treatments like chemical peels, facials, or micro-needling. These are some of the most common treatments performed in aesthetic centers.

So with all these great attributes and options for minimally invasive treatment, why do patients still often choose surgery? There are several reasons.

First, minimally invasive treatments are usually temporary. For example, Botox© (and similar products such as Xeomin© and Dysport©) do a great job of relaxing the muscles that create the wrinkles between the eyebrows (“the 11’s”), across the forehead, and in the corners of the eyes (“crow’s feet”). However, these muscle relaxers typically work for 3-4 months and then the effect wears off. This requires the patient to come back to the office for repeat injections. Dermal fillers typically last longer. Depending on the type of filler and the area treated, effects may last anywhere from six months to a couple of years. Some patients simply prefer something more permanent, and they want to avoid repeat treatments.

A second reason is that some aging changes cannot currently be corrected by anything but surgery. Examples include the development of jowling or of significant skin looseness in the neck area. Although some companies might hawk a magic cream or energy device to handle these kinds of issues, these don’t really work and the solution is a facelift (which includes lifting the neck). A facelift can dramatically improve these areas, and the results last for many years. Other examples of changes that require surgery as opposed to non-surgical treatments include significant droopiness of the brows or eyelids.

As plastic surgeons, we are reluctant to call the results of facial rejuvenation surgery “permanent,” although in many ways they are. Let’s say a patient undergoes a facelift and loves the improvement in skin tightness, the jowls, the neck contour, and the folds around the mouth. Once healed, these results will look good for many years. However, over the course of these years, the aging process will continue – skin will become more lax, and tissues may start to droop a bit. At some point, typically after 7-10 years or more, the patient may want to undergo additional surgery to treat these changes. But even at ten or more years after surgery, results are better than they would have been without surgery in the first place. The tendency for some recurrence over time varies by the different area of the face being treated. Brow lifts, upper eyelid tucks, and the neck portion of a facelift tend to last a long time and require repeat surgery less often, or never. Some recurrence of laxity in the lower face, however, is more common. Therefore, many patients may consider a secondary face lift 7-10 years or more after their first procedure. Of note, this secondary procedure may not need to be as extensive as the first procedure.

A third consideration is cost, and there is no doubt that surgical procedures typically cost significantly more in the short term. However over the years the cost of maintenance by means of repeated non-invasive treatments will continue to rise, often to the point that surgery can be far cheaper in the long run.

Finally, it is very helpful to think about temporary (typically minimally invasive) treatments and long lasting treatments (typically surgery) not as an “either or,” but as a “yes, and”. In other words, many patients benefit from both. For younger patients who are not yet ready for surgery, the less aggressive and temporary treatments are an ideal option. For older patients who are undergoing surgery, minimally invasive treatments can enhance and help maintain their results. It is extremely common that we “mix and match” various surgical and non-surgical procedures to offer patients the combination of treatments that will give them the best results.

If you are wondering about temporary versus long lasting treatments, and non-surgical versus surgical, the board certified physicians at the Emory Aesthetic Center can perform a comprehensive skin and anatomical assessment, and can help you think through the options and choose an approach personalized to you and your needs.

 

404-778-6880
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Online personal consultation request: http://www.emoryhealthcare.org/cosmetic-aesthetic/appointment.html

About Dr. Eaves

eaves-iii-felmontDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

Ask the Doctor: How Does Botox© Work?

Botox Before and AfterBotox©, or botulinum toxin, is an injectable medication that stops muscles from moving over a short-term period, usually 3-4 months. In order for muscles to move, they must receive a signal, a chemical transmitter, which attaches to a receptor on the muscle and gives it the signal to contract. Botulinum toxin stops the release of that transmitter, so the muscle cannot move. In nature, though rare, this toxin is considered one of the most deadly toxins, because it can cause the muscles that help you breath to stop working. Over time, and after having been studied and perfected for almost 50 years now, Botox has become the number one cosmetic treatment the world over. Injected in very small doses, this medication can not only treat lines and wrinkles around the forehead, between eyes and the crows feet, but can also prevent the formation of new ones!

Botox is not only a cosmetic treatment, however. The first uses for Botox were for an eye muscle condition called strabismus. Spasms of the eye, migraines, large muscle movement disorders and voice tremors can also be treated with this effective and life-impacting drug.

The indications, both FDA-approved and not approved, for this medication are ever increasing. The key, however, is to ensure your treatment is performed in the very safest way possible. In order to save money, patients may frequent medical spas, attend “Botox” parties, sign up at dental offices, or other non-surgical specialties, thinking Botox at one place is the same as any other. In truth, the risks of having an injection into the wrong muscle group, or at too high a dose, can be far too great to engage in this type of cost cutting.

Make sure you undergo your injections with a board-certified cosmetic surgeon who performs injections on a regular basis, and has the understanding of underlying facial and neck musculature before undergoing treatment. Ask any questions that may concern you prior to your treatment as well as noting any precautions for after being injected. Botox is one of the most-studied medications we use today and has positively impacted the lives of many patients, both cosmetic and otherwise. When used safely, the vast majority is extremely pleased and loves their fresher and more youthful appearance.

If you are considering Botox©, or facial fillers, let the board certified physicians of the Emory Aesthetic Center help you decide what treatment is best for you.

404-778-6880
emoryaesthetic.org

About Dr. Sethna

Anita Sethna, MDAnita Sethna, MD, understands that facial plastic and reconstructive surgery demand a marriage of science and artistry, and she enjoys using precision, skill, and vision to make her patients’ dreams reality. Dr. Sethna’s meticulous attention to detail and her passion for maintaining a natural look ensure optimum results for her patients. A dedicated teacher, Dr. Sethna is devoted to assisting residents in facial trauma or reconstructive cases at Grady Hospital. She relishes the opportunity to educate residents and medical students in all aspects of patient care. Dr. Sethna has a strong interest in several areas of facial plastic surgery research and has presented at national meetings on the importance of resident and fellow education in rhinoplasty techniques and adjunctive measures to decrease discomfort during cosmetic procedures.

How Long Do Lip Injections Last?

Lip InjectionsLip injections have been in the news a lot lately, spawning from recent reports around Kylie Jenner admitting she has used temporary lip fillers. The Kardashian family has certainly popularized the procedure, but it’s important to know what lip augmentation procedures are out there, how long they last and which one is right for you.

Lip augmentation involves injecting or placing a material into the lips to increase the fullness. The procedure generally comes in three different forms: from dissolving fillers such as hyaluronic acid to fat grafting to implants. Each has its own benefits and downsides. It is important to understand these so you can discuss with your physician which is right for you.

Lip injections with hyaluronic acid fillers are likely to be the most popular. Fillers such as Juvederm® , Restylane®  and Belotero®  are commonly used in this instance, though not all are FDA approved for this. They give predictable results, are reversible in cases of dissatisfaction or over-correction, and do not require skin testing or additional surgical procedures. These lip injections require a few minutes in the office and a return to work and regular life immediately. The downside is that these are the shortest duration of all lip augmentation procedures. Commonly, I instruct patients that fillers such as these will likely need to be repeated in three to four months (at most six months) because of the significant motion the lips go through on a daily basis.

Fat grafting is theoretically permanent. Fat is harvested through liposuction or through another surgical procedure often done at the same time as lip augmentation. It is injected with small hollow needles into the lip and needs to be overfilled initially to compensate for the fact that some of it will not survive the transplant. The issues with fat grafting include the need for a donor site and another procedure, and the risk of asymmetric or unpredictable survival of the fat transfer.

Finally, lip implants are usually the longest lasting and most predictable, though as with any type of implant, there are risks of infection and movement of the implant material that can compromise the length of the result.

Overall, there are several good options for lip augmentation, but lip injections with fillers are currently the reigning champion due to ease of use, no downtime and relative low cost. The repetitive need for intervention is certainly a factor to take into consideration, but at the same time, as we age and our anatomy alters, a permanent intervention may not always remain the right solution.

The board certified physicians of the Emory Aesthetic Center can consult with you to determine which lip augmentation procedure would be best for you. Make an appointment for your complimentary consultation.

404-778-6880
emoryaesthetic.org

About Dr. Sethna

Anita Sethna, MDAnita Sethna, MD, understands that facial plastic and reconstructive surgery demand a marriage of science and artistry, and she enjoys using precision, skill, and vision to make her patients’ dreams reality. Dr. Sethna’s meticulous attention to detail and her passion for maintaining a natural look ensure optimum results for her patients. A dedicated teacher, Dr. Sethna is devoted to assisting residents in facial trauma or reconstructive cases at Grady Hospital. She relishes the opportunity to educate residents and medical students in all aspects of patient care. Dr. Sethna has a strong interest in several areas of facial plastic surgery research and has presented at national meetings on the importance of resident and fellow education in rhinoplasty techniques and adjunctive measures to decrease discomfort during cosmetic procedures.

Takeaways from Dr. Eaves’ Body Contouring – Getting Ready for Summer Live Chat

Body ContouringThank you to everyone who joined us for the Body Contouring – Getting Ready for Summer live chat hosted by Emory Aesthetic Center surgeon, Dr. Felmont Eaves. Dr. Eaves discussed body contouring options to help shape the body for summer and tighten excess or loose skin. He described both surgical and non-surgical procedures – including liposuction, tummy tucks, arm and thigh lifts.

We were thrilled with the number of people who registered and were able to participate in the chat. The response was so great that we had a few questions we were not able to answer so we will answer them below for your reference.

If you missed this informative chat, be sure to check out the full list of questions and answers located on our chat transcript. You may also visit the Emory Aesthetic Center website for more information on therapies and solutions to get your body ready for the summer.

Question: What are new procedures for arm lifts?

Felmont Eaves, MDDr. Eaves: Arm lifts continue to evolve as we are doing more of them all the time. Arm lifts can be categorized into short scar techniques, full length techniques, and minimally invasive techniques. The short scar technique leaves a scar that is limited to the axilla (arm pit) and can help looseness in the upper part of the arm closest to the shoulder. But this technique isn’t as effective if the looseness goes far down the arm. In this case a full-length arm lift is recommended, although this does leave a long scar on the inside of the arm. For some patients, if skin laxity of the arms isn’t severe, liposuction alone may give a very nice result with a tiny scar. While there are some companies advertising significant arm tightening with non-invasive procedures, I haven’t seen impressive results with these yet.

Question: I have a normal BMI. How drastic can I expect the results of CoolSculpting to be?

Felmont Eaves, MDDr. Eaves: CoolSculping can certainly make some nice changes, but the results tend to be more subtle than that achieved by liposuction (or excisional surgery). However in patients that have excellent skin elasticity and limited fat deposits, it can do a great job of addressing what you want. It really takes an examination by someone who is familiar with all types of body contouring techniques (non-invasive, liposuction, and excisional surgery) to help you figure out which is best for you.

Question: I have a scar on my stomach from a childhood surgery. Can you fix this?

Felmont Eaves, MDDr. Eaves: That’s a good question. If you are talking about making a scar looking better, then yes, a scar revision can help. Even further, if you have a scar in the lower part of your stomach (below your belly button), that scar might be totally removed with a tummy tuck (although you’ll get a new tummy tuck scar – but it will be better positioned and hidden within the panty or bathing suit area).

Question: Can you get a 6-pack look with a tummy tuck?

Felmont Eaves, MDDr. Eaves: It is possible, but not usually. Having a real “6-pack” requires two things – well developed abdominal muscles (specifically the two muscles in the middle, known as the rectus abdominus muscles) and a very low body fat percentage. When we perform a tummy tuck, we thin out the fatty layers of the abdomen, however it is important to keep the thickness of the tissues in harmony with surrounding areas of the body, otherwise it may look odd. A tummy tuck won’t build up the abdominal muscles.

 

 

 

What Are Dermal Fillers and How Do They Work?

Dermal FillersThe world of facial injectables and dermal fillers can be overwhelming with all the options seen in print and TV ads. The biggest breakdown in classes of injections are between Botox® and it’s counterparts, Dysport® and Xeomin®, (hereby referred to as “neuromodulators” because they affect muscle nerve endings) and dermal fillers such as Juvederm®, Restylane® and Radiesse®. While neuromodulators are best used to affect lines caused by repetitive muscle motion, facial fillers are best used to enhance areas of low volume or deeper folds that are present at rest. For a straightforward example, frown lines between the eyebrows, crows’ feet outside the eyelids, and lines on the forehead are ideal for neuromodulator injections because these are due to motion. Decreased volume in the lips, smile lines around the mouth, or decreased volume in the cheeks is best treated with fillers to improve volume and support soft tissue.

There are many different types of fillers available in the United States. Some are permanent, such as Artefill, but most are absorbed into your body over time. The vast majority of commonly used absorbing fillers are composed of a material called hyaluronic acid, which is part of the normal makeup of our skin. Because of this, it is easily tolerated by the body and rarely has the adverse side effects that are associated with previously used collagen fillers. The hyaluronic acid fillers that are most used include: Restylane®, Juvederm® (including Ultra and Ultra Plus), Voluma®, Prevelle Silk, Belotero® and Perlane to name a few. Some of these are available premixed with lidocaine, a local anesthetic, to minimize discomfort associated with injection.

Radiesse®, also a commonly used filler, is made of a material called calcium hydroxyapatite. It is also dissolving but tends to be thicker in composition and is only injected deeper to avoid risks of visibility or lumpiness.

Sculptra, also categorized as a filler, is best thought of as a collagen-stimulator. This is intended for patients who need larger areas of gradually increasing, more subtle volume. Because of the composition of Sculptra, it is hydrated with water for 48 hours before injecting, and then it is injected in small doses throughout the tissues under the skin. The process of volumizing takes up to six weeks for each vial injected, with the recommendation of at least 3 vials to get to full correction per area treated.

So how do you determine the ideal filler for the area you are interested in treating? The best answer is to consider carefully what areas are most bothersome to you and make an appointment for consultation with a board-certified Facial Plastic or Plastic Surgeon with experience treating the face. Depending on the area of concern, the depth of the issue and the thickness of the material, your surgeon will determine the best product for injection. Each of us has cultivated years of experience with many of the fillers available on the market, and we have individual preferences based on those experiences. Feel free to ask questions, return for a second discussion or look at photos if you deem it helpful. Ultimately, what all of us want is a happy patient, so make sure your desires are communicated effectively to ensure your best result.

The board-certified cosmetic surgeons of the Emory Aesthetic Center can evaluate and work with you to develop a plan that is tailored specifically to your desires and needs.

About Dr. Sethna

Anita Sethna, MDAnita Sethna, MD, understands that facial plastic and reconstructive surgery demand a marriage of science and artistry, and she enjoys using precision, skill, and vision to make her patients’ dreams reality. Dr. Sethna’s meticulous attention to detail and her passion for maintaining a natural look ensure optimum results for her patients. A dedicated teacher, Dr. Sethna is devoted to assisting residents in facial trauma or reconstructive cases at Grady Hospital. She relishes the opportunity to educate residents and medical students in all aspects of patient care. Dr. Sethna has a strong interest in several areas of facial plastic surgery research and has presented at national meetings on the importance of resident and fellow education in rhinoplasty techniques and adjunctive measures to decrease discomfort during cosmetic procedures.

Skin Care throughout the Stages of Life

Skin Care StagesOne thing my experience as an aesthetician for over twenty years has taught me is that each client/patient has individual cosmetic concerns and needs. As you age, as seasons change, and as you go through different transitions of life, your skin will change as well. It is important to have a relationship with an aesthetician so that he/she can help you look your best through every phase of your life. As skincare specialists, we are trained to provide the proper treatments and ingredients to your skin to allow it to be at its optimal health. Below are some general skincare guidelines we recommend for the different stages of life:

  • In your thirties it is time to get serious about your skin care. Stop using bar soap on your delicate skin. Now is the time to begin using a facial cleanser morning and night. It is imperative to wear sunscreen daily with an SPF of 30 or higher – be sure to look for one that has a blend of antioxidants and moisture. For night, we recommend using a light moisturizer containing antioxidants, retinol or Alpha Hydroxy Acid (AHA) to give your skin the help it needs to stay rejuvenated.

Having regular facials every six to eight weeks will help keep the pores clean and hydrate the skin. Also, microdermabrasion is a great way to have your skin exfoliated and give it a very refined and polished look.

With our doctors, Botox®  may be a consideration if you are starting to see fine lines around the eyes and forehead.

  • In your forties you need to step up the game on your skin care. It is time for more advanced active ingredients. You will find these products at your cosmetic surgeon or dermatologist office. It is time to utilize the assistance of a skin care specialist to recommend proper products based on an evaluation of your skin. Washing your face with a cleanser containing AHA will help with exfoliating the skin to give it a nice glow. Using an antioxidant serum like will fight against the free radicals we expose our skin to everyday. Regular use of prescription grade retinol or tretinoin will boost collagen and elastin, as well as help to slow down the hands of time.

Intense Pulse Light (IPL) is a wonderful in office treatment that can assist in removing unwanted brown spots and broken blood vessels caused by sun damage. Medium depth facial peels are also an option to help give the face a lighter, brighter, and more supple appearance.

With our doctors, dermal fillers such as Restylane® , Juvederm®  and Voluma®  can be added to the face to help soften fine lines around the mouth and other areas of the face where needed. Botox®  can soften the appearance of lines around the eyes and forehead. Deeper chemical peels performed in the operating room are done for more advanced sun damage.

  • In your fifties it’s time to fight back the hands of time. Keep in mind that at this stage the skin is dryer and more fragile. Wash your face with a gentle hydrating cleanser morning and night. Never forget your daily sunscreen with an SPF of 30 or higher. Use products with DNA repair, growth factors and stem cells that will help trigger new cell growth. Make sure to continue your prescription retinol or tretinoin to slow down the aging affects. Always use night creams rich in hyaluronic acid that will help retain moisture in your skin.

Fractional Resurfacing is a noninvasive laser treatment that can help in smoothing fine lines and wrinkles. It can assist in tightening the face and neck multiple treatments are required for best results. Intense pulse light can help the appearance of rosacea and brown spots caused by the sun. Micro-needling with a growth factor is also a great choice to help stimulate collagen production in the skin. We recommend facials every four to six weeks to help with hydration and circulation.

It may be the time to build a relationship with a cosmetic surgeon to weigh the options of a liquid facelift using dermal fillers and Botox®  injections versus taking the plunge and having surgery. Finding a physician that you trust and feel 100% confident in is very important. Take the time to get to know your surgeon so that if and when you make the decision to have surgery you will be comfortable with your choice.

  • In your sixties your skin may be much more sensitive so protection and hydration is very important. Use gentle cleansers to wash your face morning and night. Wear a sunscreen with an SPF 30 or higher daily. Using antioxidants and hyaluronic acid will help protect and hydrate the skin. Using a mild exfoliate once a week will help give your skin a nice glow. Using products with DNA repair, growth factors and stem cells will help trigger new cell growth. Applying moisturizers with ceramides will bring long lasting hydration to the skin.

Having facials on a regular basis will ensure hydration and stimulation for your skin. Hydrafacials are a wonderful way to gently exfoliate the skin and infuse the face with antioxidants and hyaluronic acid using a special machine that helps penetrate deep into the skin. For an overall rejuvenation to tighten the skin, regain elasticity, minimize pores, and soften fine lines and wrinkles, we recommend micro-needling.

With our doctors, deep chemical peels can soften or remove lines and wrinkles around the mouth and tighten the skin. Botox®  and dermal fillers are a great non-surgical way to plump up thin lips, fill the lines around the mouth and soften the lines around the eyes and forehead. Discuss surgical options with your physicians if you considering facial surgery.

Call today for a complimentary skincare consultation with one of our licensed aesthetician at the Emory Aesthetic Center Spa.

404-778-6880
emoryaesthetic.org

New Year Refresh: Solutions to Remove Years of Aging

Remove Years of AgingAh . . . the New Year is already upon us, and while we take time to reflect on the year that just flew by, many of us are also looking at our reflection in the mirror. Perhaps that reflection is looking a little tired . . . worn . . . older than the energy you feel inside. Now is a great time to think about what you can do to refresh and rejuvenate that reflection, and get ready for your best year. More than ever before, there are many options to help you achieve this goal.

When you want your face to glow, you can’t ignore great skin care. It is that ongoing skin care that creates a base for everything else you might do for your face. Skin care means really protecting your skin from the sun with the right kind of sun block. It means using the right kind of moisturizers to keep the skin well hydrated. It may mean using targeted cosmeceuticals like retinoids, fruit acids, and other treatments to address fine lines, pigment irregularity, or texture changes. Getting on the right skin care regimen doesn’t have to be complex and it doesn’t have to be difficult – in fact it should only take a few minutes a day – but getting on the right regimen does take expertise. Working together with our licensed aestheticians of the Emory Aesthetic Center Spa, we can help you find the right mix of products tailored for your skin type.

In addition to the base of skin care, there are exciting technologies that you can use to make significant changes in your skin appearance. Lasers, IPL (intense pulsed light), and other energy based devices can tighten skin, fade dark spots, and treat those pesky broken veins. Facial peels can also be used to the same end, but depending on your specific needs, may need to be done in a series – peels are usually milder with minimal down time but may require a building up effect over multiple treatments. Or perhaps you might be a good candidate for a surgical peel or laser that may complete the treatment in a single stage. One newer technology that we’re very excited about is micro-needling, a process that combines tiny needles to stimulate collagen formation and the penetration of growth factors to rejuvenate the skin. Micro-needling takes only a few minutes and you’ll be able to put on makeup and be out the next day.

In addition to great skin care, injectables are highly effective treatments to smooth out wrinkles, grooves, or depressions. These minimally-invasive treatments come in two main forms – those that weaken the muscles that help prevent wrinkles, and those that fill in deeper wrinkles or plump up areas of the face. The “toxins,” such at Botox®, reduce the activity of the muscles of expression. They are used primarily to treat wrinkles of the forehead, between the eyebrows, and the “crow’s feet,” which are the wrinkles from squinting that occur at the corner of the eyes. There are several types of fillers which can be chosen depending on the individual needs and areas to be treated. Typical uses of fillers are to fill out the cheeks, soften the look of bags under the eyes, or to fill in the grooves near the nose and corner of the mouth. While Botox® may take a few days to develop effect, many of the fillers demonstrate an immediate effect. Both types of injections are done during an office visit and you can resume normal activities immediately.

As wonderful as skin care and minimally-invasive treatments are, there are some aesthetic goals that only surgery can produce. Need to get rid of those jowls? Is the skin under the chin loose and saggy? Is the skin of the eyelids loose and droopy, or is the brow low? In these kinds of situations, surgery comes to the rescue. A face lift or neck lift, a brow lift, or a blepharoplasty can provide long-lasting and dramatic results, and the recovery time may be a less than you think.

Depending on your age, skin type, genetics, sun exposure, and other factors, there are many potential treatment options to help you achieve the changes you want. To get the very best results, it is important to come up with a comprehensive game plan that is tailored specifically for you and your individual needs. The game plan may include minimally-invasive treatments like Botox® or fillers, it may include surgery, or it may just require routine skin care and products. The Emory Aesthetic Center can help you pull all these pieces together to create a strategy just for you. Come in for your complimentary consultation.

404-778-6880
emoryaesthetic.org

About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

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