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Nonsurgical Facelift with Topical Resurfacing

7 Apr

I have been doing tons of “Vampire Facelifts,” a treatment that will eventually phase out going under-the-knife completely!  This awesome video was done by the beautiful Kim Fauria!  Not only is she absolutely gorgeous but she is such a boss babe!  Truely one of my favorite people!   Check her out at lipglossandlollipops.com

 

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Mad Face (Resting Bitch Face)

12 May

 
  The line that forms between the eyes as we age is called the glabellar crease.  Because of the way it looks, it is sometimes referred to as a “1” or an “11.”  

I look like my mother.

People always ask me why I’m angry, I’m not.  

This line bothers many women as they age, and these two statements are common complaints in my office.  Deep lines between the eyes make you look angry, less approachable, and let’s face it: like your mother!  

  
Botox and other neurotoxins will relax the lines between the eyes to give a fresh, less angry look.  I consider Botox in this area to be the gate-way drug to injectables. 

  
When should you inject your Glabella?

Actually, it is better to start treatments earlier.  If you have a line in this area, you are a good candidate for Botox, no matter how old you are (as long as you’re 18! Or a Kardashian I suppose!).  Botox is preventative; it will keep lines from getting worse, and you will actually need less product and fewer treatments. 

A Botox treatment between the eyes ranges from 20-35 units typically.  The stronger the muscle, the more Botox required to relax it.  When using higher doses, the possibility of side-effects also increases.  It is more likely to get a drooping eye at larger doses.  Large doses also result in a “waxy” or “embalmed” look, a tell-tale sign of Botox that most Bostonians find undesirable.  

Will Botox Get Rid of Your Line?

Not always.  

If you do not get the correct dose of Botox, your line may not completely go away.  If a small dose was injected, you can return additional units 1-2 weeks post-injection, but again this increases the chances of side-effects. 

  
Fillers in the Glabellar Crease

If you stretch the skin between the eyebrows, and you still have a line, Botox injections will not completely get rid of it.  In which case, you would require a filler.  

If you are told you need a filler, be sure to have Botox injections at least two weeks prior.  This freezes the muscle and gives the injector an easier medium to work with.  Patients who do not have Botox first often complain the filler looks and feel like a big lump.  

Fillers will last a very long time in this area if you keep up with regular Botox treatments.  

What Filler?

It depends on what the crease looks like after Botox.  I’ve used every type of Hyaluronic acid in the glabellar crease.  My preference is usually for Restylane or Belotero, but I have recently tried Restylane Silk, and I think it is a great product for this area as well.  

     

So… If you are feeling happy on the inside, but looking angry on the outside, Botox and fillers may be a good idea!

  

  

Video Blog: Tear Trough Augmentation

18 Nov

Check out my video blog on YouTube: 

One of my favorite procedures to do since the introduction of Belotero Balance in the United States last October.

The tear trough is a grooved demarcation where the cheek skin meets the much thinner and highly vascular eye skin.  Because of the anatomy of this area, a thinner hyaluronic acid like Belotero is the perfect product (Belotero: The Buzz.).  It does not last as long as the more viscous hyaluronic acids, but it also has fewer complications.

Treatments in the middle third of the face, which contains the eyes, nose, and cheeks, require an aesthetic eye and advanced knowledge of facial anatomy.  Filling the tear trough area often requires cheek augmentation as well in order to look natural.  The cheeks can require a large amount of product depending on the degree of volume depletion.  Make sure you discuss this with your injector prior to injections!

This is a very advanced procedure, make sure you check out before and after pictures before being injected!  Many practioners do not offer this procedure because of the advanced training and skill it requires.  When done correctly, it looks AMAZING.  I’m not even a very good iPhone photographer, and I have some great before and after’s on my Pinterest and in other blog posts:

More Belotero!.

I hope you enjoyed my video.  They are really hard to make!

Preventative Botox

22 Jun

The 40-52 year-old age group continues to be the majority of Botox recipients, but injections continue to become increasingly popular amongst younger clients (ASPS 2013 Plastic Surgery Statistics Report).

It’s Never too Soon to Start Botox!

One in four women over the age of 30 is interested in learning more about Botox injections. It is around this age we start to really notice fine lines on our faces. It is actually better to start treating the fine lines of the face at a younger age, preventing the fine lines from becoming deeply etched “railroad tracks,” as one patient of mine in her early 30’s, L.M., so lovingly called her forehead.

There is no specific age that is “perfect;” it’s never too late to start, and so long as you’re over the age of 18 and you have wrinkles forming at rest, you are a candidate for Botox injections. I have a few clients in their lower 20’s with the skin of a 40 year old. The scale we use to determine the age your skin looks is called the Glogau Scale.

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Does your skin look the age it should according to the Glogau Scale? If you think your skin looks older than it should don’t put off trying Botox because you think you need to wait to be a certain age to start. Botox will prevent the premature advancement of mild to moderate wrinkles to “railroad track” status. Botox will completely erase mild to moderate lines with small “natural” looking doses. As lines progress into the advanced to severe stages, higher doses are necessary to soften the lines. At a certain point, Botox will not completely get rid of deep wrinkles, and fillers are needed in conjunction with Botox treatments. Yep… starts to get expensive. Starting early means less Botox needs to be injected, and if you keep up with it regularly, the amount you need will decrease in number of units and periods between treatment times, due to muscle atrophy (your muscles become weaker and more sensitive to the product. And your metabolism slows down… the one good thing about that is that the body doesn’t metabolize your Botox as fast. Or cake. Unfortunately. 😦

Being preventative is always the best approach to your health. SUNBLOCK is your first line of defense! But if you feel like your skin is looking older than it should, a lil Botox never hurt anyone.

I’d say a majority of my patients are in the 20-45 year old age range. It’s becoming more acceptable to openly talk about doing Botox amongst younger people. (Although there’s always that one person who has to put their negative opinion in the mix when it comes up. THEY would NEVER do it. Yea… I’ll see them in five years, when all their friends are doing it!).

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L.M. started doing Botox a few years ago, and doesn’t regret it at all! Her cousin started coming with her to see me, who then brought her friends and her sisters. These women are all starting in their early 30’s, and they look amazing. You would have no idea they are doing Botox unless they told you. They are all health-conscious and hard working (ie not Desperate Housewives!). It is also such a bonding experience to share amongst your close friends. Nothing says friendship like a needle to the face… Errrrr…

If you’re thinking about doing Botox, talk to a professional about whether or not it’s right for you. And if there’s one quote I’ve heard over and over again it’s

No one ever regrets having kids, getting divorced, or doing Botox.

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Bruising After Fillers

29 May

I wrote this post MONTHS ago… And I just made a corresponding video. So if you prefer the sound of my voice to actual reading Botox and Bruising vBlog. It does contain different information then the rest of this blog post. So feel free to read on!

A few months ago, Alyssa Sylvestri (a famous photographer/videographer), Sarah Victor (a super famous youtube make-up artist), and I (just plain super) had a business related girls day that was SUPER fun.  This blog will prove it.

Sarah did my make-up.  Then I injected her lips with Restylane and her forehead with Botox Cosmetic.  She is now an addict and will be attending “I’m Young and Beautiful Forever Anonymous.”

Sarah’s Restylane Experience

Sarah asked me what kind of things my clients were interested in learning about when it came to make-up applications.  Easy.  You all HATE under eye circles (which I fix with Belotero and it’s so amazing, check out my Pinterest before and afters!).  The other thing I thought of was how to cover a bruise.

And for some reason I cannot insert the link to this right now….

Moving on….

Bruising can happen.  Period.  End of Story.  It’s the most likely “complication” when it comes to aesthetic medicine.  I put the word complication in quotes because it’s not really technically a complication, but to some women it’s the worst possible thing that could happen to them.  Ever.  (These are called dramatic patients).  Kidding!  Kidding!  But in all seriousness it sucks, but it will go away.  I PROMISE.

A bruise is caused by blood leaking into the interstitial tissue.  It can happen from any trauma.  When you pierce the skin with a needle, you are creating trauma.  But it’s totally worth it in the case of Botox and Fillers.

There are ways to prevent bruising.

AVOID THE FOLLOWING FOR 24-48 HOURS BEFORE AND AFTER INJECTIONS:

  • Blood thinners like Alcohol.  I understand that it is REALLY hard to avoid alcohol for 4 days, especially if you have children/a husband/a job or all of the above.  Do the best you can.
  • Anti-coagulant medications.  Anything with Ibuprofen in it.  This includes Advil.  Other examples are coumidin and aspirin.  **DO NOT DO THIS IF YOU ARE TAKING THESE MEDICATIONS FOR YOUR HEART!  NEVER DISCONTINUE PRESCRIPTION DRUGS FOR VANITY.  Take tylenol if you need too.
  • Fish Oil.  Because it is some sort of blood thinner/greaser type thing.
  • You may want to avoid getting your period.  If you can?  If you can do this… I have some questions.  But what I mean to say here is book your appointments in a timely manner with your menstrual cycle.

TAKE THE FOLLOWING FOR 24-48 HOURS BEFORE AND AFTER INJECTIONS:

  • Arnica Montana:  you can buy this at Whole Foods or GNC.
  • Eat Pineapple.  I think this is what they make Arnica from.  But I could be wrong.  But it’s definitely good for helping bruises.
  • Immediately after injections ice the site.  This causes constriction of the vessels that carry the blood, which means blood flow slows down.  Which means less blood is available to leak into the tissue.  It also helps with swelling.

DO NOT:

  • Push on a bruise.  You will make it worse.
  • Fall asleep with ice on your face.
  • Put ice directly on your face. You can burn it.
  • Over dose on Arnica Montana or Pineapple.  More is not better.  Arnica in high doses is not good for your liver.  Pineapple in high does is not good for your stomach.  Trust me.  I know!

If you have more questions, make sure you consult your injector.

The Internet Gives Botox A Bad Rep

29 May

I have heard some interesting things from patients over the years about Botox and Fillers and information they gathered from the internet or from friends who have read stories online. The internet is a wonderfully useful place of information… So long as you are reading it on a reputable site (.org) or from a reputable person (for example, I am an expert in Botox and Fillers, please refer to my credentials page!).

When looking at internet sites, you need to take into account the validity and reliability of the information that is being given to you.

Yes, Wikipedia is great… But it is not a reliable source of information. (Although I still use it!).

Consider who is giving you the information when it comes to product safety. When looking at prices it should be unit based. Like when you go into CVS and you compare how much shampoo is by the unit cost because the bottle size is different. Fillers are charged in number of syringes.

Use your judgement, and remember you can’t believe everything you read! If you have a question, ask someone with expertise in the area. If you aren’t sure their answer is true, or you want a second opinion, get one! But please take the stories you read online with a grain of salt.

Interpreting Botox on the internet.

Peanut Head: Volume Loss at the Temples

29 Jul

I’d argue the most over looked sign of aging is loss of volume in the temple. As we age, the temples lose fat and begin to narrow, shifting the balance of the face downward. Volume loss here contributes to the appearance of drooping and sagging of the cheeks and eyes (see Structural Changes in the Aging Face for other changes).  It begins as early as in your 20’s. It is most notable in athletes who have very little fat on their bodies, I’ve found especially runners.

As you can see, the area of total volume loss is pretty big when you actually look at it. In order to achieve the youthful contour of the temple, a patient will require a lot of product here. Adding filler to the temple is easy and almost painless, but deciding what filler to use can be difficult, they all have pro’s and con’s.

Juvéderm

This is usually my first choice with patients. For some reason… people tend to be nervous about filling this area! The great thing about Juvéderm is that it’s disolvable. The bad thing about Juvéderm is… you need a lot of it to fill this area, and that can be expensive. I’ve found great results by diluting the product before injection. The patient can see the result immediately. It may not last as long this way, but it is a good starting point. Most people love the result and usually step up to Sculptra when they notice they need a “refill.”


Radiesse

I personally don’t use Radiesse in the temples. It always reminds me of the scene from the Real Housewives of Beverly Hills when Adrienne Malouff’s husband injects Taylor and she has this big bump in her temple and Adrienne goes “is it supposed to look like that?” Although you get more volume with Radiesse, you also have more of a chance for lumps in this area. It’s not as smooth as Juvéderm (which is literally defined as a smooth consistency gel). It’s just not my preference, but for extreme volume lost I can see it being more cost effective.


Sculptra

I personally have had Sculptra injected into my temples. Sculptra is not a filler, but a biostimulator. Over several weeks post injection it promotes collagen production. It may take more than one treatment (usually 1-3 vials 1-3 treatments) to achieve the desired result. This is the longest lasting, and most cost effective product if you consider the longevity, but up front can be expensive. If you are the type of patient who is doing multiple fillers at a time, you should probably step up to Sculptra.


Fat Transfer

Fat injections can also be used in the temples but are only cost effective if a large amount of volume is needed for the entire face. I recommend only allowing a plastic surgeon perform this procedure (although a nurse can do it in Massachusetts). The fat is harvested from another area of the body (usually the lower back) via liposuction and transferred to areas of volume loss in the face (usually not just the temple). There is a lot of swelling and bruising with this treatment and not all the fat will graft (stay alive after transfer). It is also an expensive and invasive procedure. This being said, it can yield great results for patients who really need it.


The Procedure

Numbing cream is applied to the temple. The product selected is mixed with lidocaine and deposited on the bone until achieving desired volume. There is very little pain associated with all injectable products. Bruising isn’t typical; however, there are many vessels in this area, so it can happen. Expected cost depends on the product selected, but expect to use at least 1-2 syringes during time of treatment.

Good luck!

Trying New Products

27 May

Just like tissues come in the brand “Puffs” or “Kleenex,” there are different brands of products used in aesthetic medicine.

It is very difficult for patients to determine which product is right for them without consulting with a professional… and some professionals only use certain brands of products. I’m very lucky that the office I work with (and a lot of my patients!) let me experiment with different brands.

Right product, right place, right person!

Currently, I’ve been experimenting with different brands of Hyaluronic Acid Fillers (Juvéderm, Restylane, and Belotero). I use these products in tear troughs, temples, lips, vertical lip lines, marionette lines, nasolabial folds, and cheeks. They are not for large areas of hollowness (Radiesse and Sculptra are more cost effective choices). HA’s are great to experiment with because they can be dissolved if you don’t like the result. If you are a virgin to fillers, these are a good idea to start with.

Kiss, Kiss.

We all know I love Belotero under the eyes, and I almost always use this product for tear troughs (More Belotero!.)  The only time I use Juvéderm is for patients I think really should be getting a blepheroplasty…but aren’t ready to go under the knife (Observing Surgery: Blepharoplasty.)  But what about the Lips? ….Well it depends!

The Patient’s Concern

Bigger, Fuller Lips

Juvéderm remains my go to product for lip augmentation. It looks and feels the most natural (when injected right!), and is FDA approved to last up to a year.

I have found a place for Restylane in my heart recently, however. I had my vermillion border injected about 3 weeks ago, and I love it. This product really defines the border of the lip!

Vertical Lip Lines

For women trying to treat vertical lip lines, or “smokers lines,” I have mixed feelings on using HA’s vs. Botox. I usually tell people to try Botox first. Over treating the upper lip with a hyaluronic acid can create a “monkey lip.” It doesn’t look good! I’ve seen this happen a lot with Restylane and Juvéderm.

While Belotero is a good product to treat these lines, I’ve found the results don’t last long when I mix the product with lidocaine (local anesthetic). The lips are VERY sensitive, and require some sort of local and injected numbing agent (anyone who disagrees with this has never had their lips injected—it’s a lil pinchy).

My technique is to use both Juvéderm and Belotero. As you age, you loose collagen and the shape of the jaw and teeth changes. This causes an elongation of the upper lip. If you look really closely at an angle there is a horizontal ridge above the lip line. I fill this ridge with Belotero. The lips also begin to thin as you age. Juvéderm into the wet/dry border replaces this volume loss. I have found it can improve vertical lip lines when injected into the vermillion border and manipulated into the vertical lines. It may not completely get rid of them, but it will improve them, and it looks very natural (not like a monkey lip).

Downturned Corners

Changes in the shape of the jaw and gravity causes the corners of your lips to turn downwards as you age. By giving support to the lower lip in areas of volume loss, that from can be turned upside down before it turns into a full out marionette line (which Radiesse is the best for!).

To read more about lip augmentation check out Pucker-Up, Princess – Damn Sexy Lips.

Love Big Lips!  Lips, Lips, Lips!.

More Belotero!

27 Feb

Belotero: The Buzz.

Belotero has been my #1 selling injectable since it has been on the market (September). It gets into the small little lines that no other product really can with the natural result that Belotero offers.

The procedure I do the most? Under the eyes! It literally takes 10 years off your face! I might not be able to take away sleepless nights and stress, but at least I can make it look like I did by improving Under Eye Circles and Bags! I’m so thrilled with this product I did my own under eyes (called the tear trough). December was so busy and stressful, I was looking really tired. I did my under eyes about a year ago with Juvéderm, but Belotero is much better designed product for this area (read why below).

Do you see how tired I look? (I hate sharing before pictures of myself with no makeup!)



A little numbing cream is put under the eye for about 20 minutes. Then the numbing cream is removed and the face is marked for anatomical landmarks. This is just how I mark the face. Other injectors might do it differently. I am also aware I need an eyelash fill REAL bad.


Looks so much better after!!! It didn’t bruise or hurt at all!



Look at my dark circles. They are TOTALLY gone. I swear I have NO advanced computer knowledge what-so-ever. These are straight off my phone!

Belotero vs. Juvéderm vs. Restylane

Why do I like Belotero under the eyes more than other Hyaluronic Acid (HA) products? Belo doesn’t have any hydrophilic effects (hydrophilic = attracts water molecules). Plus or minus a little bit of swelling, the correction looks the same the next day, the next week, and the next month.

Juvéderm and Restylane are also in the HA family, but have a hydrophilic effect. This means the product will take on water molecules after it is injected, giving the area treated more correction over the next few days to weeks. Great for your lips and cheeks. Not great in the ultra thin skin under the eye. When this area is over treated you will see a bump or a bluish hue from the product. It’s not pretty. But it can be dissolved!  Hyaluronidase; Just In Case: injectables for beginners..

I also like Belotero because the product is thinner, which means it can be deposited in more superficial areas with a smaller needle and less pokes! Yay!

**Remember though: It’s the right product for the right place for the right person! Discuss which product is right for you and why during a consultation!  For more general information on which product is right for you What Goes Where?

More Before and After Pictures


The above patient had 0.2cc of Belotero to her tear trough area. It was two injections. The patient stated she did not even feel it (topical numbing cream was used prior to injection). The patient experienced no bruising associated with the procedure.

The above patient is a good candidate for filler in this area because the dark circles under her eyes are accentuated by a shadowing effect from volume loss. By replacing volume, the skin of the eye and cheek become more continuous as opposed to separate.


The above patient had 0.3cc of Belotero to her tear trough area. Topical numbing cream was used prior to injection, and there was no pain associated with the treatment. The patient experienced minor bruising the day after the injection which was easily covered with make-up.

The above patient would be a good candidate for a blepharoplasty. Although there is a clear demarcation of her tear trough, and filler drastically improved the area, the root cause of the delineation is not so much volume loss as it is a herniated fat pad. This fat pad is supposed to cushion the eye as it sits in the eye socket. Numerous causes contribute to the pad “bulging” out.

Interested in learning more about blephs?  Read Why I Chose To Have an Eyelid Lift.

The above patient had 1cc (1 syringe) of Belotero to her superficial marionette lines with great improvement to the texture of her skin. Topical numbing cream was used. The patient did experience some minimal bruising the day after the procedure. She is very happy with the outcome.


XOXO, LK

Above picture:

2 months after my Belotero treatment

3 days into the annual Cutera Conference in Las Vegas (so, I haven’t slept in 3 days)

1 week post break-up with my boyfriend

And still looking refreshed! Thanks Belo! Qué Bella!

(that’s Spanish I think…)

Will it hurt?

24 Nov

Pain is such an abstract and obscure concept. You can’t really define it. It has so many dimensions. In the hospital, we assess pain on a scale of either facial expression charts or numerically from 0-10. Zero being no pain, and 10 being the worst pain you’ve ever felt in your life. It is an individual experience; the numerical response to a stimulus can differ drastically from person to person. So, whether or not something will hurt is relative.

    Source: http://www.pamz.com

On a Scale of 0-10…

What’s the most painful thing I’ve ever experienced? First, a broken heart. That took a really long time to recover from… and I definitely still have scars! The second most painful thing I’ve ever endured is being in a car accident, which I also still have issues from. I’ve never gone through childbirth, never been divorced, still have both my parents, and never had a kidney stone. So my list has room to change. I’d like to point out that my list does not include Botox, Fillers, or my recent surgery. But that’s what this post is about. Do aesthetic procedures hurt as much as people think they will?

Beauty is Pain

We’ve all endured painful treatments in the name of beauty. Ever tweezed your eyebrows? Waxed your lip? Burned yourself with a curling iron? Stuck an eyelash wand in your eye? Walked more than a street block in stilettos? All painful, but relatable, every day examples of things women do in the name of beauty.

If you asked 100 women the same question, you’d get a 100 different answers. This is because women never have a “yes” or “no” answer. It’s always a story. So here’s a comparison story.

Q: How painful are stilettos?

A: Well, that depends.

  • How big are the stilettos
  • How long are you wearing them for
  • How far will you need to walk in them
  • Who makes them
  • How often do you wear stilettos
  • How often do you wear those particular stilettos (i.e. are they broken in)
  • What condition are your feet in (i.e. do you have any blisters)
  • What size are the stilettos vs. what size are your feet (i.e. does the shoe fit)
  • What are the road conditions for which you will be walking in them (i.e. changes in elevation)
  • What are the weather conditions for which you will be wearing them (i.e. rain or snow, inside or out)
  • Etc, ect, ect.

So, when you ask how badly something will hurt, there are many conditions which will change the outcome. It’s hard to explain the pain factor of beauty. The “Universal Pain Assessment Scale” does not really work when it comes to women and what they’re willing to endure. So… I decided to paint my own comparative scale. Because I love “Paint” (the computer program) and I love making stuff relatable.

The “LK Aesthetic Comparative Assessment Scale”

I’m not going to lie. This took me a long time to create, and it’s pretty scientific (although has no reliability or validity, it is merely my projections). This is how it works. Each treatment is rated in 3 dimensions on a scale of 1-5. Then those 3 numbers are added.

Chemical Peels

Laser Hair Removal


Laser on the Face



Eyeliner Tattoo


Botox


Fillers


Some fillers hurt more than others. The worst is the lips. I used that for the pain scale, but other areas hurt much less.

Tear Troughs    2

Cheeks        2

Marionette Lines    3

Naso-Labial Folds    3

Plastic Surgery

In all fairness… I think surgeries could be subcategorized. I heard liposuction isn’t really that bad. I guess it depends how well you are medicated too. Pain is relative.

I Hope this gave some perspective! Remember, this scale holds no scientific basis.

XOXO. LK.

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