Posts Tagged ‘facial fillers’

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.

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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.

Does Microdermabrasion Work?

MicordermabrasionMicrodermabrasion is a procedure usually performed at a medical spa for enhancement and brightening of the overall facial appearance. Patients may present with complaints of dull skin texture, or superficial skin irregularities that just need a little freshening. It is more aggressive than a facial, but much less aggressive than dermabrasion. Although the terms are related, the “micro” in microdermabrasion arises from the fact that originally, little tiny crystals were used as an exfoliant within the hand piece to remove dead skin cells from the surface of the skin. More updated equipment relies on different methods of liquid exfoliation, but the effect is the same. Downtime is minimal if any, usually resulting in a few hours of redness or mild irritation of the skin, similar to the sensation of a mild sunburn. It’s important to reduce or eliminate sun exposure after any exfoliation procedure, but other than that, it is a relatively pain-free and uncomplicated endeavor. It may require repeated or regular appointments for maintenance of ideal skin tone. Microdermabrasion can be performed on all skin types and colors safely because the injury is very superficial.

Dermabrasion, on the other hand, is a much more involved procedure. Often performed under sedation or local anesthesia, depending on the area treated, it may even require the use of an operating room. A surgeon or dermatologist will use a special instrument that actually “sands” the top layers of the skin to reveal deeper, fresher skin. Patients in need of dermabrasion may present with deeper scars, acne scars, or traumatic tattoos from motor vehicle accidents or other trauma that require aggressive resurfacing. Recovery takes a week to 10 days depending on the depth of abrasion, and often the skin in the area treated appears lighter or redder in color for several weeks after treatment. As always, sun avoidance and sunscreen are imperative in the healing period, and some time off work is often needed to allow for postoperative wound care. Dermabrasion can be performed safely on most patients of light skin colors, but is often not recommended or very carefully performed on patients of Mediterranean, Asian, Hispanic or African American backgrounds because irregularities in skin color can arise easily if performed aggressively.

At the Emory Aesthetic Center, we request that all prospective patients meet with one of our aestheticians or board certified physicians before undergoing any procedure, allowing us to formulate a treatment plan based on your specific needs, outcomes and recovery time. Let us help you come up with a plan to achieve your desired results.
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.

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.

New Uses for Facial Fillers

AestheticsSure, we’ve all seen commercials featuring fillers for those smile lines, the “parentheses” of the face, and we’ve certainly all seen photos of Hollywood starlets who have added a little more volume to their lips. But can you do anything else with fillers?

Before we get to the fun stuff, it’s important to say that much of what we discuss in the next few lines is known as “non-FDA-approved uses” for fillers. That is to say, when the FDA approved these fillers, they approved them for injection into only certain areas (lips, cheeks and smile lines for example) because those were the areas that have been tested. With time, those of us with significant experience in injectables have expanded their use to other areas that need a little volume. This experience is vital—as cosmetic surgeons, we know where the muscles and soft tissues lie, what injections would have higher risks of complications, and into what tissue plane the least likelihood of risk would be.

Drooping brows: As we age, the tail of the eyebrow can start to droop towards the eyelid. This is in part because of bone loss to the rim of the eye socket, but also because of loss of collagen and movement of the fat pads around the eye. For very significant drooping, surgery may be the only option, but for those just noticing the problem, injection of some Restylane© or Juvederm© (both hyaluronic acid injectables) into this area can give some much needed lift and open the eye area dramatically. It may take more than one injection; some injectors like to use small volumes over 2-3 times, to get a gradual result, while others may inject 1-2 syringes at one time based on their personal preferences and the patients’ degree of volume loss.

Earlobes: Many patients with elongated ear piercings and loss of volume in the earlobe feel their ears make them look older than they really are. Placing a small amount of Restylane© or Juvederm© into the earlobe can support the ear piercing, allowing the patient to make their earrings more of a feature, and sometimes even wearing earrings a little more comfortable.

Temples: Another area often overlooked is the temples. Some patients have excellent cheekbones, and excellent midface volume, but the temples are hollow and sunken. Patients who are thin in the face in general tend to lose volume in this area quite significantly. Once the temples are volumized, the results can be quite exceptional, and allow the face to become more balanced. As we indicated earlier, this is a non-FDA approved area for injection, so experience with tissue planes and injectable types is crucial to obtaining good results. Many different types of injectable agents are used in this anatomic location. The choice will depend on your surgeon’s comfort level and preference, as well as your desire for the length of the result and extent of volume loss.

Radiesse® can be used in the temples as it lasts a long time and is injected deeply, in some cases, right on the bone. Sculptra® can also be used in the temples and is long-lasting as well, but requires some homework on the part of the patient as its main goal is to stimulate the patient’s own production of collagen, not to act as a filler in and of itself. And finally, Voluma®, which can also be injected in the temples, lasts just as long as Sculptra®, but doesn’t necessarily stimulate collagen production as its main purpose.

As experience with injections increases, and trends change, as they are likely to do, more and more uses for these versatile devices is sure to arise. As with all elective procedures, it’s crucial to feel comfortable with your injector. Experience is key, and complications can occur if the best product for a particular area isn’t used, or is used incorrectly.

Here, at the Emory Aesthetic Center, our cosmetic surgeons have extensive experience and can explain the treatment and side effects. We offer a full spectrum of options and will customize a plan that best fits your 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.

Juvederm, Botox, Dysport, Sculptra, Restalyne: Understanding What’s What When it Comes to Injectables & Dermal Fillers

Dermal Fillers & InjectablesWhen it comes to dipping your toes in the pond of cosmetic injectables, the choices can be intimidating to say the least. Don’t worry, you’re not alone! Many patients enter into this arena with an understandable array of questions; hopefully the following explanation can help in understanding some of the available options.

The most common question asked at the Emory Aesthetic Center is often about the difference between “Botox©” and “fillers”. The simple answer is that injectables such as Botox©, Dysport© and Xeomin© (sometimes referred to as “neuromodulators”) work at the site of muscles to stop them from moving for a period of 3 – 4 months. These injectables are best used to treat areas where lines are formed due to repetitive motion: for example, the “frown lines” between the eyebrows, horizontal lines in the forehead, and “crows feet” around the sides of the eyes. Injections can be done in other places on the face, such as “lipstick lines” around the mouth, but these must be done by a surgeon well trained in the anatomy of this area as unintended (and unwanted!) consequences could result.

All three neuromodulators (Botox©, Dysport©, and Xeomin©,) work on the same principle and give similar results but are manufactured by different companies with their own proprietary methods. The choice of which injectable to use depends on the experience and comfort of your cosmetic surgeon as well as the possible subtle differences between them. Again, results last approximately 3 – 4 months in most areas, and take between 3 – 5 days for onset after injection.

It is important to understand that treatment with neuromodulators, like Botox©, does nothing to improve loss of facial volume, but is often a critical part of a well-crafted plan to enhance your overall appearance, improve and open up the eye area, and smooth the overall texture of the skin. Some studies have shown using these injections gives your brain positive feedback and improve your mood because of the inability to frown!

Dermal fillers, on the other hand, are ideally used in areas where lines or folds are seen at rest. Commonly treated areas include the cheeks, “smile lines” that run from the nose to the mouth, hollowing under the lower eyelids, sometimes the lips and even the temple area for loss of volume.

Starting in our 30s, skin has a tendency to lose collagen. Collagen contributes to the “plump” texture seen in the skin of most teens and young adults, but is damaged over time with sun exposure and naturally decreases with age. Along with other natural effects of facial bone loss, this can contribute to areas of hollowing in the eye area, folds around the cheeks and lips and possibly the early formation of jowls.

Juvederm, Restylane, Radiesse, Voluma and Sculptra are dermal fillers, and can counteract some of these changes by adding volume to these areas of loss. The decision regarding which fillers to use, and where, is often one that is guided by your facial or cosmetic surgeon. Preferences may be based on safety profiles for certain facial areas, or personal preferences based on experience and past results.

The longevity of these fillers can vary based on many factors: where the material is injected, and how deep the injections are performed. Some of these products have subtypes that have been formulated to be thinner or thicker based on the specific need. For example, an ultra thick form of a certain filler would be great to use in the cheek area, but not ideal for the subtle volume needed to fill a lipstick line. Sculptra or Radiesse would not be indicated for injection in under-eye areas or around the lips, so these are limited to cheeks, jowls, temples or cheekbones.

All of the injectables used at the Emory Aesthetic Center are FDA approved, however it is important for patients to understand that some of the facial areas listed above are non-FDA-approved areas for injection. Over time physicians have adapted these fillers for use in many areas of the face with good results. Because of this, seeking consultation and treatment with a cosmetic or facial plastic surgeon is not only preferred, but is the safest option. Practitioners who do not perform cosmetic surgery or do not understand the underlying anatomy can cause unnecessary risk, unneeded complication or adverse effects by “experimenting” in these areas.

Although the options seem endless and sometimes confusing, make sure you seek out professional advice from someone you trust, even if it requires more than one visit to feel comfortable. The best relationships will be ones maintained with cosmetic or facial surgeons who are able to address your particular concerns to your satisfaction. Here, at the Emory Aesthetic Center, our cosmetic surgeons have extensive experience and can explain the differences between all these treatments. We offer a full spectrum of options and will customize a plan that best fits your needs.

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Take-Aways from Dr. Sethna’s Cosmetic Injectables & Fillers Web Chat

Dr. Anita SethnaOn Tuesday, November 19th, Dr. Anita Sethna of the Emory Aesthetic Center hosted a live chat on the topic of cosmetic injectables and fillers. Injectables and fillers have revolutionized the field of facial rejuvenation by filling in areas of the face that are missing fullness and restoring volume, without the need for surgery. During the chat, Dr. Sethna answered questions about the different types of products offered, how they each work and what provides the best individualized solution. She also shared a special offer currently being offered by the Emory Aesthetic Center for a limited time discount on dermal fillers and injectables.

There were a few questions from the chat that we didn’t have time to answer, and as promised, Dr. Sethna answered them below in this post.

My friend got Sculptra injections. What is that? Is it the same as other fillers?
Sculptra is poly-L-lactic acid. It is a collagen-stimulating product that is injected in several areas around the cheeks, sometimes temples to assist your body in producing its own collagen. The product itself dissipates over weeks and in its place is the collagen your body produced. The product takes several weeks to take effect, so it is different from traditional fillers, and should last up to 2 years based on the FDA approval. Several vials usually need to be injected to obtain the ideal results, sometimes 3 or more.

Is it true that Restalyne is painful? Which procedures are the least painful? 

Any injectable can be perceived as causing some pain just because it is placed with a small needle–the injectable itself usually is not painful. There are several steps we try to take to reduce the discomfort associated with any injectable. We can use the preparation from the company that contains lidocaine (an anesthetic that is safely used as long as you are not allergic), we can allow you to sit with topical numbing cream which we do in most cases, topical ice right before the injection to numb the skin, and depending on the area to be injected, we can use a blunt needle that requires one needle prick to allow it to go into the skin, but after that, is rounded at the edge so it causes much less discomfort during the injection. These types of blunt needles can also have the benefit of less bruising and swelling in most cases. These days, injectables tend to be pretty easy to tolerate because of these measures, and if these interventions are appropriate for you based on your consultation, they can be done without spending a lot of time in the office.

How do these products affect people of color? Should you see someone who has experience on darker skin?
Most of these products are perfectly safe for use in people of color. Seeing a physician with experience treating your particular skin type is always an option but not always feasible. That being said, there are a few issues that are more common in patients with more pigment in the skin: dark spots, dry skin, melasma, etc. that may be more easily treatable by someone with this particular experience. Topical medications such as hydroquinone and tretinoin are safe in most patients as long as you are not pregnant or breastfeeding, and can have real benefit for patients with these issues. Once you begin discussing other interventions, such as laser treatments, surgery or peels, it becomes more important to seek out people with real experience with darker skin types. Topical medications rarely cause significant issues or complications that are not reversible but surgical interventions/lasers/peels can cause irreversible damage if done improperly.

Which brand of skin care products do you prefer? 
There are plenty of excellent skin care products, pharmaceutical grade, as well as some over-the-counter. There are only a few that I believe truly need to be obtained through a pharmacy or medical-grade spa–tretinoin being one of them. There are several companies that offer these products, and under several trade names: Retin-A, Refissa, Renova just to name a few. Each may be formulated slightly differently to appeal to a different skin type. SkinCeuticals and Revision make some excellent topical vitamin C products that can help with brightening the skin and are easy to tolerate. Several companies make excellent daily sunscreens as well, but for that, i am often using CeraVe or neutrogena products that are relatively inexpensive and easy to obtain at the drugstore. Regular facial moisturizers and cleansers are also fine to obtain that way, and I alternate between some cleansers at our Spa as well as CeraVe products and sometimes Cetaphil. I firmly believe the cosmetic counters that attempt to sell very expensive anti-aging products, with no medical grade ingredients, are not worth the price consumers pay for them. They have expensive additives and perfumes that have absolutely no effect on the structure of the skin and tend to be completely ineffective. I encourage my patients to spend money on the few products that are medical-grade that can effect change on the skin, and the rest they can purchase at the drugstore. I have yet to have problems with this philosophy and it has fared well for me as well!

What creams/moisturizers do you recommend for the face to prevent lines?
Importantly, the best cure is often prevention. Using sunscreen daily (at least SPF 15 or 30 and NOT just the “SPF that’s in your makeup”) can prevent the onset or worsening of lines around the eyes and on the skin. After that, using tretinoin is a fantastic way of reducing the signs of aging. Tretinoin is a vitamin A derivative (not safe in pregnancy or breastfeeding) that resurfaces the skin, stimulates collagen and reduces dark spots/sun spots. I’m a firm believer in using these products every night or every other night to prevent premature aging. Retinols (one step down from tretinoin) are easier to tolerate in most cases and in some preparations, can be safe around the eyes as well for fine lines that are difficult to treat with other OTC preparations. The best idea is to meet with a true skin expert (medical aesthetician, dermatologist, facial plastic surgeon, etc.) to obtain the best initial advice and get a few items that will truly benefit your skin, and continue to wear daily sunscreen!

What is a Life Style Lift?  It seems too good to be true.  I’m interested in having something done on my aging facial skin.  I’ll be 50 in January.  It’s time!!
Lifestyle lift is a proprietary technique that is only taught to those people who perform it under that company’s marketing and treatment guidelines. There are surgeons who “sign-up” for this participation and are taught a specific type of facelift that has been registered. This type of surgical procedure is one that has been done by many of us for many years, but no one thought to trademark it until a few years back so that it could be marketed with a particular message and brand. In most cases, it is a short-scar facelift that has benefits in the right type of patient–very little concerns in the neck, some need for tightening along the jawline but not for a patient with excessive heaviness in the neck and jowl area. At the end of the day, whether or not one of these “short-scar” facelifts, of which there are now plenty of trademarked names, is right for you depends on your anatomy, and your desires. The right surgeon will consult with you about your concerns and be able to explain what type of surgical or nonsurgical procedures you will need to address your these areas in the best possible way. The worst decision is the one made just on price and not taking into consideration what would actually make you happy.

Can you recommend any doctors in the NY area? Atlanta is a little far to go for an injection.
There are some excellent facial plastic surgeons in the NY area: Dr. Steven Pearlman, Dr. Andrew Jacono, Dr. Thomas Romo, III, Dr. Philip Miller to name a few. I have met them personally at many conferences where they have all been speakers and have had the pleasure of hosting some at our Emory facility as well. They have phenomenal professional credentials and I would trust any and all of them to take excellent care of you!

Thank you to those who joined in Tuesday’s chat. If you missed it, you can check out the chat transcript here and you can also check out our Emory Aesthetic Center website for more information.

See you next time!

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