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We just saw a great movie called "The Women" and Candice Bergen's character says that to Meg Ryan about anger. Great Line. But there is truth in that. If you frown a lot you will form lines in the forehead and the frown area and you may need botox to look relaxed and not angry. In fact a lot of people come in asking for Botox because they look angry.

Labels: Botox, Fillers

People are constantly asking me when is dypsport going to be available? Well it will be available in the USA soon and I do not know when it will be released in Canada. Is it going to be better than Botox? I do not think so. There have been comments from some people that it will take a little time getting used to the exact dosages of Dysport that will produce nice results. I think there will some differences in dosages. Some comments have been made that it will last longer.

I am going to wait and see what happens. Let us get beyond the hype and find out exactly what results Dysport gives. All i do know that as with Botox it will require skilled injectors to deliver exacting results.

Labels: Botox, Dysport, Fillers, Reloxin

Facial scars are very common from injuries or surgical procedures. If you call your average physician and tell them that you have a recent scar, the chances are they will tell you that there is nothing that can be done for a year after the injury. Unfortunately, this is frequently misinformation.

There is evidence that by treating a scar early, the outcome of the result can be improved. Some studies have shown that when a scar is treated within 8 weeks of the injury or surgery that it can heal much better than waiting an extended time. I have adopted this method of treating traumatic and surgical scars of the head and neck and it has worked well. When a patient presents with a scar of the head or neck that is less than 8 weeks old, I will begin treatment with various modalities including steroid injection, silicone sheeting and pressure. When the scar reaches its point of primary healing then I will most commonly treat it with the CO2 laser. The laser performs several functions to improve the scar. Number one, it allows uneven tissue margins to be blended or smoothed down. Number two, it causes new collagen to be produced to fill in the irregularities and number three it helps blend the coloration with surrounding tissues. Lasering the scar is usually done under local anesthesia and takes only a few minutes. The area will be raw for the first 5-6 days and then be a smooth pink. This pinkness will fade over the ensuing weeks but may last several months in some cases. Sometimes I will use a V-Beam laser to bring the reddness and swelling down before I clean it up with C02 laser.

Sometimes the scar is lasered multiple times as it improves with each treatment. While simple lasering may work great for simple scars, more complex scars may need surgical intervention first. Many surgical procedures exist to make scars less noticeable by changing the direction of the scar, making it it more random (straight line scars stand out more) or making the margins even. Sometimes I will send the patient out to a surgeon before I use laser resurfacing to blend the scar.

Some depressed scars (those that are like craters) respond will to filler injection. By injecting fillers, many depressed scars can be simply “popped out” by filling the base of the depression with filler. This is useful in acne or pock scars. Subcision is another useful technique. Subcision is a process in which a special needle is used to break up scar tissue at the base of a depressed scar. A depressed scar has spider web like bands called adhesions that, in part, are what keep the depressed scar tethered down. By inserting this cutting needle under the scar and swiping it back and forth, these adhesions can be separated and allow the base of the depressed scar to rise up and fill in. Subcision can be performed multiple times to improve a depressed scar.

There are many myths surrounding the treatment of surgical and traumatic scars. Applying Vitamin E, commercial products like Mederma or Scar Guard or covering the scar with silicone sheeting are probably all useful, even if not scientifically proven. Keeping a new scar protected from the sun is also important.

I am always happy to discuss scar management.

Labels: C02, Fillers, IPL, Laser Resurfacing, Reddness, Scars

There is no best filler. It really depends on what is best for you in terms of your biology and your needs. The "best filler" will depend on many factors including:

1. The length of time the filler will last.

2. The area on the face that needs to be filled.

3. Your skin type, thick or thin, if you have sun damage or acne scarring.

4. The amount of "fill" that is required (fine wrinkles, etched wrinkles, troughs and major volume - cheeks and mid-face).

Hyaluronic acid fillers have become the "gold standard" these days. I believe the other fillers still have niche roles and I still frequently use them. The reason that hyaluronic acid fillers have become so popular is because they are softer than the other fillers, they are more forgiving (harder to feel or see bumps) in thinner skin and soft tissue, they can last up to 12 or 18 months in some locations, they are cheaper than other longer lasting fillers and they can be reversed instantly with a solution of hyaluronidase if needed.

The two major hyaluronic acid players are Juvederm (by Allergan) and Restylane (by Medicis). The major hyaluronic acid fillers can differ in the "particle size" of the hyaluronic polymer, the cross-linking of the polymers and the final concentration of the hyaluronic acid in the syringe. Juvederm has a wider range of particle sizes and Restylane has a more uniform particle size. Both have similar concentrations and cross-linking of hyaluronic acid. The variations of these products have greater concentration or cross-linking to achieve better and longer lasting correction at the expense of a thicker, less forgiving product in thinner skin.

The bottom line is that each of my patients is evaluated first, then I discussed the different filler options available for each area of concern and finally we select a filler to give the best correction for that area. I photograph each patient before and after the treatments to follow the patient's progress and document the length of time each correction lasts. I insist that patients return two weeks after a treatment so we can reevaluate the treatment area and determine if any additional corrections are necessary.

I use radiesse and evolence as well. I tend to reserve these for patients who have already experienced fillers and are comfortable with fillers in the skin and are ready for more longer lasting results.

Labels: Evolence, Fillers, Juvederm, Perlane, Radiesse, Restylane, Soft lift, Volume Loss

"People always say I look angry or worried because I have wrinkles on my forehead. Which wrinkle treatments will get rid of these forehead lines?"

Different forehead wrinkles require different treatment modalities
Forehead wrinkle treatment depends on the underlying cause and extent of damage to the skin.

Dynamic wrinkles are those that are present only during animation (active movement of the face) and are best treated with Botox. Botox will temporarily stop the underlying frontalis muscle from pulling on the skin and creating the furrows and wrinkles. A typical treatment will last three months.

Static wrinkles are those that are always present even when the face is at rest. If these creases are deep, a combination of Botox to stop the primary culprit (frontalis muscle) and a filler material (e.g. Restylane, Juvederm) to fill the dermal defect are quite useful. Filler materials are temporary as well lasting six months or more.

More aggressive and longer lasting treatments include Fractional laser resurfacing that work well on static wrinkles as well as a forehead lift in which the frontalis muscle is weakened.

Every individual requires a customized approach to meet their goals and expectations within their budget and recovery time constraints.

Labels: Botox, Fillers, Wrinkles