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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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Safety during Pregnancy: What You Should and Shouldn’t Include In Your Beauty Regiment

6 Sep

It seems like it’s in the water with co-workers and friends (as evidenced by the three pregnant ladies to the left from Sylvestre Franc). I’ve had a lot of questions about what is and isn’t safe to do when you’re pregnant in regards to skin care products, laser, and injectables. It is understandable that women want to look their best during this time and hormonal changes during pregnancy can sometimes result in acne, unwanted hair growth, melasma and other skin problems. So what is safe to use and what isn’t?

Not surprisingly (to me anyways), there really is not a lot of information on product safety during pregnancy. The FDA rates products on their risks during pregnancy as follows:

Rating Definition

A

Controlled Studies Show No Risk.  Studies in pregnant women show the medication causes no increased risk to the fetus during pregnancy.

B

No Evidence of Risk In Humans.  Studies in pregnant women have not shown increased risk of fetal abnormalities despite adverse findings in animals or in the absence of adequate human studies, animal studies show no increased fetal risk.

C

Risk Cannot Be Ruled Out.  Studies are unavailable and animal studies have shown a risk to the fetus or are also lacking. There is a chance of fetal harm if taken during pregnancy but the potential benefits may outweigh the potential harm.

D

Positive Evidence Of Risk. Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk such as in life-threatening situations.

X

Contraindicated In Pregnancy. Studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant.

Skin Care Products

Most skin care products fall into the Class C category; however, some products are recommended by doctors not to be used during pregnancy (although there is not enough evidence for or against them).


Not Recommended:

  • Retinoids
    • In A Practical Guide to Dermatological Drug Use in Pregnancy (Zip, MD, FRCPC) category B topical such as erythromycin, clindamycin, and benzoyl peroxide were recommended over topical tretinoin. This study states reports of congenital malformations in infants whose mothers used tretinoin during the first trimester.
    • This ingredient is found in anti-aging products such as moisturizers, and acne products.
    • Chemically a form of vitamin A, which in high doses can cause birth defects.
    • Oral retinoids, such as isotretinoin (Accutane, an acne treatment), are known to cause birth defects.


  • Beta Hydroxy acids (Salicylic Acid)
    • Ingredients used for their exfoliating and acne-treating properties. They penetrate deep inside the pores and clean out excess oil and dead skin cells that can clog pores and cause acne, blackheads and dull-looking skin.
    • High doses of the acid in its oral form have been shown in studies to cause complications and birth defects.
    • Small amounts applied topically are considered safe (over the counter face wash for example), but peels containing Salicylic Acid are not considered safe when pregnant.

  • Hydroquinone
    • Clinically used for pigmentation for conditions such as melasma, and it is used cosmetically as a skin-whitening agent. Although a large percentage of this topical agent is systemically absorbed, the use during pregnancy does not appear to be associated with increased risk of congenital defects. This finding, however, is based off one study, with a small sample size (so it is recommended to avoid hydroquinone during pregnancy).


Safe

  • Vitamin C, Glycolic acid, and Lactic Acid: derived from fruit and milk sugars, considered nontoxic.

  • Hyaluronic Acid. This is a product your body naturally produces (which means its safe). Because of its molecular size, hyaluronic acid cannot penetrate the skin’s surface, and it is not systemically absorbed.


  • Benzoyl peroxide. Only 5% of topical benzoyl peroxide is absorbed through the skin. It is completely metabolized to benzoic acid within the skin and excreted.

Self-Tanners

Dihydroxyacetone is a color additive that is found in self-tanning products to produce an artificial tan. Color develops following topical application. These products contain dihydroxyacetone in concentrations ranging from 1% to 15%, and when applied topically, systemic levels are minimal (0.5%), and are considered safe to use.

Hair Removal and Bleaching Agents

  • Sodium, calcium, and potassium hydroxide, which are also found in depilatory creams, disassociate into sodium, calcium, potassium, and hydroxide ions, which are all present in the human body. Topical application of these products would not disrupt serum levels and would not be considered a problem for use during pregnancy.
  • Hydrogen peroxide. Hair-bleaching creams contain low concentrations of hydrogen peroxide, making it unlikely to be systemically absorbed. In addition, should it be absorbed, hydrogen peroxide is rapidly metabolized. Therefore, use of these products during pregnancy is not expected to be a concern when done in moderation.
  • Laser has some controversy as to whether or not it’s safe; again, there isn’t a lot of information. Lasers do not penetrate very deep and there is not chemical exchange into the body. One interesting thought from me, (not speaking from personal experience) the body becomes more sensitive during pregnancy, and some laser treatments hurt to begin with. I’m not sure I’d want to get laser under those circumstances!

Botox and Fillers

The safety of Botox injections during pregnancy is unknown (Class C), and while I wouldn’t recommend intentionally getting Botox injections during pregnancy, many women receive injections prior to being pregnant or when they do not know they are pregnant, and have not had any problems. Botox Cosmetic has never traveled systemically, and works only on the muscles into which it has been injected. Therefore, one could presume it is safe to undergo this procedure. But I still don’t recommend it.  Unless you’re planning on having a “Toddler and Tiara” baby.  Then it’s ok.

 

xoxo,

not pregnant LK


What Goes Where?

4 Aug

Prior to 2002, there was one type of facial filler: collagen. Many products have been developed over the past ten years which have caused collagen to become obsolete. There are now multiple categories of fillers, all made of different materials. The products in these subcategories have properties which make them better in treating some signs of aging than other areas or other products. Remember, fillers are different than Botox (it’s not all just Botox!). So what goes where?

Hyaluronic Acid (HA’s)

Synthetic forms of hyaluronic acid (a sugar that your body naturally produces) include products like Juvéderm, Perlene and Restylane. HA’s increase fullness and enhance the viscosity of the naturally occurring hyaluronic acid in your body. Although it may cost a little more, Juvéderm is currently the longest lasting product (in some cases lasts twice as long, and therefore is worth the extra $100 or so per syringe). I have performed over 200 Juvéderm procedures, and have personally been injected with this product many times!

*note: My face is just a model, I haven’ had all this work done I swear! I just love “Paint.”

  • Best for superficial lines (not very deep, not folds).
  • They are used in areas where “plumpness” is desired (like your lips!)
  • They can be used in cheek augmentation, vertical lip lines, and nasolabial folds, but might not be the best product. Cheeks and Nasolabial folds typically require a lot of filler, and cost-effectiveness wise, this isn’t the product. But if you just need to fix a little sagging, it can be used in the cheeks. If you want to overpay for deep nasolabial folds, then this product also can be placed in this area.
  • Vertical Lip Lines are usually superficial, which would make Juvéderm a good product, HOWEVER, if it is not placed right, the result is a monkey face.

Tips on Hyaluronic Acid

  • When I’m filling lines in the glabella, I always administer a dose of Botox to the area 2 weeks before injecting Juvéderm. This allows me to inject directly into the line; it is easier to aim at a stationary target! How do you know if you will need Botox and Fillers? If you have a line in between your brows at rest (a “1”, “11”, or “111”) and you pull that line apart with your fingers, do you still see a crease in the skin? If yes, you need both, if no, Botox is enough.
  • I always apply numbing cream 20 minutes before injections.
  • I never inject too close to the outer rim of the eye (distal orbital rim), it usually irregularities in the contour of the face.
  • Injecting into the tear trough is a very advanced procedure. I can’t tell you how many times I’ve seen this area over filled (which looks TERRIBLE). My recommendation: it is better to under-fill and book a follow-up. This area requires a minimal amount of product, and my personal policy is to allow a client to come back at no charge if they require a small amount more (within reason).

Particulated Fillers

These products, like Radiesse and ArteFill, contain synthetic beads or particles in different liquid carriers. They last longer than HA’s, because the body doesn’t break them down as fast. They are also thicker than HA’s, which means they satisfy a larger area of volume loss. These products are injected deeper in the layers of skin (never superficially like HA’s are). Why? Because they’re made out of beads in liquid… and in superficial skin that would make bumps! This means they NEVER get injected into the tear troughs or into the lips. EVER. For very, very deep glabellar crease, Radiesse can be used (but usually an HA is a better choice).

  • These products are for moderate to severe volume loss. As you age, facial skeletal changes, general tissue volume loss, and the effects of gravity flatten out your cheeks. If you look at the contour of my face on right side of my face (your left), you will see how round my cheek is. I think you can see in this picture that the apples of my cheeks are round as well. A lot of women will look in the mirror at their nasolabial folds and want to go straight for filling only those, but that doesn’t give the youthful round shape back to the face. On some people I like to do cheek augmentation with Radiesse as well as nasolabial folds. I always do cheeks before folds, because the cheek bone is the scaffolding for the lower face skin. When you change that, the depth of the NL fold will also change. Always top to bottom, never bottom to top, when it comes to your face fillers! **When you have extra weight on your face, you keep the roundness. Skinny people have really flat cheeks when they age. HA. Take that skinny people.
  • The marionette lines, prejowel, and oral commissure are usually treated as one area that needs to be fixed. They’re kind of like vector components of each other (for all you Geometry dorks out there, *brushes shoulder off*).
  • Again, skeletal changes that occur as you age cause your chin to recess and along with volume loss, change the angles of your jaw and chin. This is another area a lot of people overlook when spending that quality time in the mirror pulling at their face in the “this is what I would look like if I had a face-lift” pose. Even if you do have a traditional facelift, you aren’t doing anything about the volume loss. This contributes to the unnatural look of a face-lift.
  • Radiesse and Juvéderm can be used in conjunction to fix contour irregularities in the nose.

I hope that cleared up the two main classes of fillers. It’s a lot of information!!! The next post will be about Sculptra, which gets grouped in with fillers… but this is already too long! Lol.

xoxo SPRAY TAN – O – REXIC LK

Everybody’s Doing It!

29 Jul

“My wife’s into that Botox Stuff” – weird guy on the cape trying to give me vodka. ????

Anyways, it seems like everybody’s into “that Botox stuff.” But no one will admit to it!!! What’s the deal people? I mean… I fully admit to being an addict. I love my Botox! I guess I’m a little on the young side (although my birthday is coming up July 31!! Yeah!). So who exactly is doing this “Botox stuff”? Here’s some excerpts from my business plan on the “consumer profile” (I wrote this in 2009, so… there is updated information… but… I haven’t updated my stuff. I HATE making graphs on the computer… but if you gave me some colored pens and a whiteboard I would be ALL over it!).

Consumers

A survey by the Aesthetic Cosmetic Surgery Education & Research Foundation (ASERF), 2009, found the typical patient “married, working mother between 41-55 years of age with a household income of under $100,000.” These women were also found to be “health-conscious,” exercising, and eating right. Nearly 7/10 of the responders regard Botox and dermal fillers as an important part of their aesthetic routine.

Smart, health-conscious women ahhhhh? That makes me happy.

Age Distribution

Number of Procedures Performed in 2009, according to the ASAPS:

Injectables:

18 and under

19-34

35-50

51-64

65+

Botulinum Toxin Type A

12,000

371,501

1,256,608

734,751

182,098

Calcium hydroxylapatite

0

9,844

55,635

41,118

11,880

Hyaluronic Acid

3,919

168,629

604,262

420,069

116,159

I’m assuming any of these 18 and under year olds are using Botox for non-cosmetic use, or for correction of facial deformities. Or… they are on “Toddler’s and Tiara’s.”

Percentage totals of Number of Procedures Performed in 2009, according to the ASAPS:

Injectables:

18 and under

19-34

35-50

51-64

65+

Botulinum Toxin Type A

0.5%

14.5%

41.1%

36.2%

7.7%

Calcium hydroxylapatite

0%

8.3%

47.0%

34.7%

10.0%

Hyaluronic Acid

0.3%

12.8%

46.0%

32.0%

8.8%

Gender

In a recent survey by RealSelf.com, of the people who would get cosmetic work, the percentage of men is climbing. Ya, it’s true! Men are vain too! And not just gays! I was sitting in a bar eating by myself (yea… I was banished from my dinner party…) and I met a couple from New York. They were so much fun! The husband and the wife did botox… and they’ve been together for 12 years. And they still liked each other. And other people (like me) had a blast talking to them. …You know me and my tangents. Anyways. Good looking people are happy and stay married longer. I’m not sure if it’s true or not… I actually made that up. But men really are doing the “botox stuff”!

Would Get Cosmetic Work:

18-34

35-44

45-54

55+

Men

64%

67%

64%

47%

Women

82%

82%

80%

71%

From 2008-2009, minimally-invasive procedures increased 2% in the male market (ASPS, 5). And I assure you, it’s not just gay men doing this! I have a pretty large percentage (ok… I have a few) straight men doing this “Botox Stuff.”

                                Source ASPS, 2010 (8, 10)

Location:

The Northeast Region charges the highest amount in fees in the minimally invasive cosmetics procedures industries.

According to 2009 Regional Distribution Data by the American Society of Plastic Surgeons, New England holds 20% of the Botox market and 31% (the largest) of the soft-tissue filler market.

Percent of Total Procedures Performed by Region

Region 1 Region 2 Region 3 Region 4 Region 5
Botulinum Toxin

20%

14% 23% 15% 28%
Calcium Hydroxylapatite 35% 16% 20% 15% 15%
Hyaluronic acid 31% 12% 18% 8% 31%

Source: ASPS 2010 (15)

The Northeast Region has the highest percentage of filler procedures performed (we are Region 1). Midwest is the yellow region 2. Region 3 is light blue. Region 4 is greenish. Five is purple. Interestingly, the Noretheast and West Coast are comparable in the procedures performed. I wonder how much L.A. and New York skew that though. And Miami probably skews region 3. Just saying. Statistics are only as good as their interpretation.

Income level

Data collected by the ASPS in “Demographic Changes among Plastic Surgery Patients” demonstrates that income no longer plays a significant role in elective procedures (1). With the adjunct on patient financing options, the numbers continue to increase.

According to an Allergan Representative, the average income level for a Botox Cosmetic patient is $50,000 nationally.

Social Class

Middle to Upper Class due to income level.

Education

Education level has not shown to be a significant factor in market; however the consumer of the Northeastern market wants to be educated on products/procedures before undergoing them.

Ethnicity:

                Source: ASPS 2009 Cosmetic and Reconstructive Demographics

Most Commonly Requested Minimally-Invasive Procedures for Ethnic Patients

African-American

Asian-American

Hispanic

Botulinum Toxin Type A

Injectable fillers

Injectable fillers

Injectable fillers

Botulinum Toxin Type A

Botulinum Toxin Type A

Source: ASPS 2010 (17)

Boston Market

And I’m not talking about chicken. Finding this information was pretty difficult, but I think I know my market pretty well. If you are under 35, you are probably not thinking about Botox or fillers… but honestly you should be. Remember, volume loss starts at 25. Being preventative is super important, and will cost less and look the most natural in the long run. At the very least, please use medical grade skin care!

If you’re over 35, it’s a good idea to start with the area that bothers you most. Have a long consult with your injector. Work out a schedule/plan with your provider, and make sure you talk about prices! That plan should ALWAYS start with good skin care!!!

I know your mom might disagree… but…

If Everybody’s Doing It, Shouldn’t You Be Too?


xoxo,

LK

Ahhhh… Big Ange is getting the “Botox Stuff.” LOVE IT! (Ok… well maybe she’s not the best ambassador of the Botox Nation. When do I get a t.v. show?)

Lips, Lips, Lips!

13 Jul

I have a client (who is on tv) who came to me for a lip augmentation. She was shocked when I started asking her questions about her teeth and jaw. She had a slight under-bite and her jaw was slightly mis-aligned. This caused her smile to be slightly slanted. I’ve actually seen this many times. Remember my post about symmetry? A symmetrical face is attractive because it shows good underlying bone structure. In nature, this is a desirable for reproduction because it exhibits good genetics. But now that’s what you have me for. And orthodontists. (I’m cheaper.)

One of the best things about this job is getting to use my artistic abilities!

This from before:

The top lip is very thin, and the left side is slightly higher when she smiles.

After (with a little bruising, which make-up can usually cover—this patient has no make-up on!):

After:

Gotta love the quality. Sorry guys. And the last pic was taken with instagram…. So I assure you, when it comes to lip augmentation, I am the as talented as they come in Boston…but with photography not so much! This patient is very happy and her dissymmetry has been much improved.

Inspired by an Angel

I was interviewed for a blog by Angel Boston. She inspired me to post some pictures of lips. Can you guess which of these are augmented and which are not? The answers are below so don’t scroll too fast! (Stuff like this always amuses me in the Tabloid magazines!)





The answer will shock you.

Or maybe it won’t. But I’ve augmented all these lips. Remember everyone wants a different end result. Not everyone wants their lips to look fake. And everyone starts with a different amount of collagen and shape. And the end result will NEVER be perfection. It is unattainable! Except for Kimber from Nip/Tuck. She’s perfect.

I LOVE lip augmentation. It is so sexy!

Mention my blog and get $100 off lip augmentation with me at Sylvestre Franc Spa in Newton 617-969-2252. But… You can’t combine it with any other offers!

YOU’RE WELCOME!

So, as you can tell by my bathing suit I was at the beach… but my awesome beach hair is from this product line called Davines. The product is called #14 Sea Salt Primer. Amazingggg.

Things You Never Would Think To Find In A Girl’s Bathroom

6 Jul

How I’ve gone from your typical teenage girl to … an aesthetic specialist (for lack of a better term).

I remember when I moved into my first apartment in college, and I asked my mom for a make-up table, because there were 4 of us with one bathroom. I used to wear a lot of make-up. Case in point:

Summer of 2004. My candy raver phase? I guess. Over tweezed eyebrows. Check. Spots on my shoulder from too much tanning beds (which is actually caused from a fungus for all you spotted tanners out there… GROSS). Check. Face make-up too light. Check. Choice in jewelry… no comment. Oh. And I have roots. I think I might have been going to see Roger Waters with my college boyfriend. Man, college is a time for mistakes!

Hey, I also found my college bathroom circa 2004. (I am the original facebook generation… back when you needed a .edu to join).

UMASS. That should explain anything off you might see in this picture. But as you can see. Small space for four people. And a cat.

Anyways. Normal bathroom. Right? Also, I’d just like to point out that I used to eat nothing but candy. But I always brushed my teeth. As evidenced by me brushing my teeth

So I’ve gone from this:

To this:

Well… now fast forward 8 years. I wear very basic make-up that takes me literally five minutes to do, but in return I have the weirdest stuff in my bathroom repertoire! Used for purposes I’m sure very few could guess! So here’s an insiders sneak peak to my bathroom. I hope you find this as ridiculous (and funny) as I do. Welcome to the bathroom of a high maintenance princess.

Shot 1:

I took this pic a few months ago and sent this to one of my co-workers. I thought it was absolutely comical that I had this stuff on my bathroom sink counter.

I believe the tweezers were for applying fake eyelashes. I learned to stop tweezing my own eyebrows. Please refer back to the college years if you are curious as to why.

I suppose pliers wouldn’t be a strange thing to have in the bathroom. I’m not sure what you would actually use them for or how to actually spell that word… but I use them to take out my hair extensions if they’ve gotten a little loose. Not normal.

Revitalash I use to grow my eyelashes longer and stronger for lash extensions… and because sometimes I ruin my lashes with the strip adhesives. Gotta have lovely lashes.

Shot 2:

My make-up bag. Fake Eyelashes. Behind that… Fake hair aka Diva Weava.  I wouldn’t be a Barbie Doll if I didn’t have Fake hair.  And my fav hair tool: my pink GHD

That is a legitimate paintbrush in the middle there.

Shot 3.

Shot 4: Stuff that is Usually on My Bathroom Counter

  1. Baby Powder: for my roots because I only wash my hair twice a week.
  2. Dry Shampoo: because sometimes baby powder isn’t my scene.
  3. QuickTan: Because sometimes you have to go from white to orange in 20 minutes or less.

What I’ve Done.

And then I also did a quick draw a few months ago (back when I was blonde) on all the stuff on my face that was changed. It was kind of shocking to me. I wasn’t going to post it… because there are always people out there that like to tear you down. But I guess I’m somewhat amused by it. And comfortable enough to say, bring on the controversy.

            

  1. Botox in my Glabella and Forehead
  2. Lip Augmentation  Pucker-Up, Princess – Damn Sexy Lips.
  3. Sculptra to my temples
  4. Cheek Augmentation
  5. Eyeliner tattoo
  6. Eyelash extensions
    Lovely Lashes!.
  7. Hair extensions
  8. I have juvederm under my eyes as well.

No Surgery Needed!

“Plastic surgery and breast implants are fine for people who want that,

if it makes them feel better about who they are. But, it makes these people,

actors especially, fantasy figures for a fantasy world.

Acting is about being real being honest.”
Kate Winslet

Dear Kate Winslet,

I appreciate your support for people to make their own choices on

Plastic Surgery. I assure you, I feel great about myself.

More confident than Superman. Oh wait. Is he real?

Or is that part of my delusional fantasy world?

Is that sarcasm? Or real honesty?

XOXO

LK

Like my Patriotic Red Extensions from July 4th? Happy Birthday America!

Thank you for giving me the freedom to be delusional and honest.

Hyaluronidase; Just In Case: injectables for beginners.

15 Jun

I’m so good at rhyme. I’m just saying.

One in 5 women has interest in doing Botox, but has a billion questions, and it’s overwhelming. The inability to find the answers leaves this grey area of fear that supports a misguided rumor-mill of what Botox actually is. You can’t believe everything you read, and you certainly can’t believe everything you hear (unless I wrote it or said it. Then it is pretty much a fact).

‘The oldest and strongest emotion of mankind is fear,

and the oldest and strongest kind of fear is fear of the unknown.

-H.P. Lovecraft ( ßI wonder if his parents are from Amherst… strange name… but good quote none-the-less).

New to the World of Injectables?

Usually, the first place we go to is the internet, but when it comes to health-related issues, this is not the best place to sift through to find information without training in How To Read A Medical Article (this is an ENTIRE class, and it is REALLY hard). And unless your best friend is me… there is a lot of misinformation going around via word of mouth.

To those readers who have never done a procedure, it is all the same. It’s ALL called Botox. (That’s NOT Botox..)

 

It’s Not All Botox!

There are a lot of injectable products on the market, and the world of Botox and Fillers is doing nothing but growing. Every person has a different face and different goals with aesthetics. So it needs to be the right product for the right problem, and really only an expert can decide what that is. Since I love making charts, I made a chart of the basic differences between Botox and Fillers. That’s important to know.

***Super Important Information Chart*** for lack of a better title.

Botox (or Onobotulinum Toxin A)

Fillers

Injected into the muscle.

Injected into folds.

Causes temporary “relaxing” of the muscles into which it is injected.

Causes temporary fill of folds into which it is injected.

Does not give any volume to the face.

Gives varying degrees of volume depending on the product used, the amount of product used, and the area being treated

Goes into lines that are a result of muscle movement.

Goes into folds that are a result of gravity and bone remodeling.

Botulinum Toxin family includes Dysport, Xeomin, Reloxolin, but they all basically do the same thing (but are not interchangeable in dosage) and are injected the same way into the same place.

No one uses collagen anymore. These products are way more advanced. We’re talking Hyaluronic acid (Juvéderm, Restalyne) and Calcium Hydroxylapatite (Radiesse). Sculptra (although technically a biostimulator) is in this family as well.

Lasts 3-6 months.

Lasts 4 months – 2 years depending on the product.

Is a thin liquid when injected.

Ranges from a thick gel (Radiesse) to a thick liquid (Sculptra).

Usually doesn’t bruise.

May bruise, depending on things like the technique used for injection, the amount of product injected, the size of the needle used.

Pinches, but requires no anesthetic.

Requires both topical and local anesthetic. And even then isn’t always completely painless (depends on the area you are injecting).

As we can conclude from my awesome chart, Botox and Fillers are very different products. The left side of the chart is pretty straight forward. If the line is a result of muscle movement you can inject Botox to improve it. The Botulinum Toxin family has the same properties and effects for the most part… and 99.9% of the time you’ll be receiving Botox. It’s a household name.

Fillers on the other hand… way more confusing to the novice patient. To anyone who has never undergone an injectable procedure, they are all called “doing Botox.” But, once the decision has been made to investigate what all the hype is about, there is a very VERY steep learning curve. So where should you start then?

The Hyaluronic Acid Family

There’s a few different kinds of HA’s. Restylane, Juvéderm, and Perlene are all examples of products in the Hyaluronic Acid family. They are all very different as well. They can last from 4 months to a year (Juvéderm lasts the longest… and is currently the #1 seller of HA’s).

Hyaluronic Acid is a sugar that your body naturally makes that attracts water molecules. Everything your body naturally makes, your body also naturally breaks down. One of the best things about trying Botox and Fillers is that they don’t last, so if you decide you don’t like the result of a treatment, the good news is, it isn’t forever. Unfortunately, that is also the bad news. But for a beginner, there literally is a product that can dissolve any HA injection that is not to your liking. This is a huge positive for people who are new to fillers.

Fortunately for me, I’ve never had to use Vitrase. My policy on filler removal has always been to wait two weeks post injection and to re-evaluate the area. Swelling can last about two weeks, and I like to take this into consideration as well as the initial “shock factor” some people can experience.

Hyaluronidase is an enzyme that acts at the site of injection (i.e. does not travel systemically) to break down and hydrolyze hyaluronic acid. Tissue permeability is increased. There is a temporary decrease in the viscosity of the HA, promoting diffusion of the injected product and facilitating the absorption of the fluid carrier.

It appears from the case studies I’ve read that this product can be injected anytime after misplacement of HA’s has occurred. From immediately, to up to five months post injection. It takes 24 hours for a majority of the HA to dissolve post hyaluronidase injection.

****Why not always use HA’s? …because they’re more expensive. But remember: Right product, Right place, Right person.

The world of Fillers is expanding. There’s a handful of products out there, and they’re all formulated just a teeny tiny bit different. It’s not all Botox, and it’s not all the same. If you need a starting off point, because you just don’t feel comfortable with the information overload, HA’s are definitely the safest bet. Because they can easily be dissolved if you don’t like the result… but I’ll put money on the opposite happening. J

XOXO

LK

Botox Before and After

9 May

I started doing Botox two years ago, at age 25, when I started my business (you know… injecting Botox). Personal experience has taught me a lot about the products I use for Aesthetic Procedures, and that’s why I make it a point to use all of them. Do I need them? No… Probably not (except the duck lips… those I need…). Are they hurting me? Definitely not, they’ve been around for YEARS (especially Botox).

Remember this face? How could you forget it? I look angry! (it’s from my post on facials). I clearly have needed Botox for some time.

I get migraines when I’m in need of Botox.

I look angry when I’m in need of Botox.

I need Botox.

…hey we all have our addictions right? J

Pre Botox

My Botox Injections

I get Botox in my forehead and glabellar crease. When I started, I got Botox every two months. Here’s my medical records for y’all as an example.

2/19/10    21 units Botox

4/20/10    21 units Botox

7/1/10        21 units Botox

10/15/10    21 units Botox

2/5/11        21 units Botox

6/12/11    35 units Botox (had my 26th birthday… started noticing forehead lines!)

11/10/12    35 units Botox

5/7/12        35 units Botox

**Remember, results will vary. Everyone has a different face!

If you keep up on your Botox, as soon as you have movement back, you will get more and more out of your Botox injections. Most people go down in the amount of Botox they require as well. My doses are minimal. Plus I like that zero movement look. Especially now that I don’t have my Barbie hair… I need to keep my Barbie face (in case you’re a new reader, I recently switched teams… I’m a brunette now).

The reason for this is called muscle atrophy. This process is a natural occurrence in other parts of your body as well. Think about going to the gym a bunch. You get huge muscles. And then you stop. Your muscles die from not being used. The body naturally metabolizes the muscle tissue. Same thing basically happens if you’re not using the muscles in your face. It’s not dangerous. It’s a pretty natural process.

I didn’t take a very good before picture of my forehead, but my glabella (area between brows) is pretty good.


Before


Post Botox Day 1


Post Botox Day 2

As you can see, it takes 2 days to really see a difference from Botox. Some people it kicks in later. I tell people it takes 2 weeks to see the full difference from a Botox treatment. If in two weeks you have not experienced the results you’ve been looking for (i.e. you still have too much movement) then the dose you were injected with was not enough. I charge by the unit, so if you pay by the unit, you will pay for additional units. If you pay by an area, you may wind up paying for an additional treatment as well. Be careful what you payyyyy forrrrr. You want to pay by the unit. Trust me.

And now that my Botox has kicked in, as you can see, I really can’t make that angry face. Makes me look friendly and approachable….


Post Botox Day 3

So I’m all smiles!

It’s a lot softer look than from before huh? But… I still look like me. All Smiles Baby!

Softening the Lines

10 Apr

P. is a 50 year old woman who has seen me twice over the past two years. To start, she had deep naso-labial folds that she hated. We first filled them with Juvéderm (which was my product of choice two years ago, but now I like Radiesse better for this area). We then did a little bit of cheek augmentation with a large syringe of Radiesse.

P.’s son is getting married and she wanted a little touch-up before the wedding. This is totally common with treatments (and weddings). Remember, any procedure should be done with plenty of time for healing to occur in regards to bruising or swelling.

Before


After


Again, remember, I’m not a photographer! The goal with P. was to soften the downturn on her mouth, the depth of her chin, and the depth of the NL fold.

Gravity…

As you age gravity causes several changes to occur in your face. The fat pads on which your eyes rest slides out from the socket and begins to bulge. At the same time, fat pockets in the cheeks break down in a known consequential manor. The combination of these two things and the pull of gravity on lax skin deepen the look of the nasolabial folds and add years to the face.

So What did I do?

As I said, P. and I have done a few treatments together before. We did the folds first, to fill the depth caused by lax skin and gravity, and then I did cheek augmentation. As I have become more advanced however, I have changed my practices to moving from the top of the face down (because of gravity) and from the most advanced sign of aging backward. I have found this to be the most effective way to treat aging. In retrospect I would have done the following:

  1. Cheek Augmentation

    By reconstructing the fat in the cheek area by filling it with product, this will decrease the laxity of the skin which forms the NL fold. I know women start pulling up the sides of their cheeks at around 30, wondering what a facelift would look like. Well this isn’t a facelift. It’s a laxity lift. (I made that up). It’s an improvement which will help me use less product in the laso-labial fold area. This means a better result AND less money. J


    **Do you do this in the mirror? As you can see, I don’t have much lax skin… from multiple procedures (cheek aug and ulthera mostly). But uh…. I do have roots. No one’s perfect! 😉

  2. Marionette Lines

    This is one of the most advanced signs of aging (because it’s the precursor to jowls). The marionette line starts from gravity pulling down the corners of your mouth and gravity pulling the fat down from the cheek. It’s just a big ol’ gravity mess! Pulling the needle around the corner of the mouth pulls up the downturn of the mouth.

  3. Naso-labial folds

    While this is the LEAST bad sign of aging, this is usually what women are drawn to fixing first. Depending on your age, and your current amount of fat in your face, and the money your willing to spend to have the best result, are all deciding factors on where to start first. Aging didn’t start overnight, and… to be realistic… one treatment isn’t going to restore the youthfulness to your face. Many women’s biggest fear is looking like a Desperate Housewife (fake and expressionless) but this is not the goal of aesthetic medicine. The goal is to restore and maintain your features.

“Softening P.”: A Maintenance Session

P. still had nice volume in her cheeks, and her N.L. folds still had some nice fill (1 year later). P. just needed a little softening to look her best.

X = needle insertion point

Line = needle direction of needle





  1. Mouth Corners
  2. Marionette Lines
  3. Lip line
  4. Chin Sharpening
  5. Jaw Softening
  6. Nasolabial fold softening

Again the Afters


This round of treatment was to soften and touch up. One large Radiesse syringe was used to treat 6 areas. The result is a softer looking face. There is not a HUGE difference in what P. looks like, but there shouldn’t be. Treating six areas with one syringe will not show a HUGE difference. Six syringes in 6 areas… now that’s a different story. Personally, I will only do ONE syringe at a time. Once you fill one area, you change the skin volume, and laxity changes. If someone tries to sell you six syringes at once, RUN. They are not looking out for your best interest, and you are going to leave the office looking like a different person (or something non-human!).

Master of Puppets

28 Feb

Ha. I made a Metallica reference! Not sure how many of my readers are Metallica fans… but still… go me for creativity points. ANYWAYS. This post is about puppet lines, also known as marionette lines. A client of mine inspired the title of the post.

“My granddaughter looked at me and said Nana you look like a puppet!”

Children are so painfully honest sometimes.  A patient of mine told me her granddaughter’s statement was her reason for being in my office.  (Maybe I should be employing two year olds?… Is that legal?  Can I pay in candy?)

Her granddaughter was referring to the folds that develop from the corner of the mouth to the jaw line, also known as the “marionette line,” one of the more advanced signs of aging.

Can you fix it?

Yes.  By injecting filler medial to the folds.  The product I typically use is Radiesse, because these folds are usually deep and require a thick volumizing fill. How I do things might not necessarily be how other providers do them… but it should be pretty similar. I also stand behind this product choice. If someone tries to use a Hyaluronic Acid in this area, get out of their office, because you will be spending a FORTUNE.

Before



What Needed To Be Done?

In Physical Facial Changes That Occur As We Age I spoke about what happens to the face as we age.  In this case, I’d like to point out prejowels beginning and marionette lines starting.

Marionette Lines

Prejowel lines

Topical numbing cream is applied to the areas that will be treated for about 20 minutes. The skin is then cleaned with alcohol. The full length of the Radiesse needle is inserted and product is deposited in a technique called fanning and product is deposited as the needle is withdrawn. The outside hub of the needle is a gauge larger than the inside to create a tract for the product to be placed. So the only discomfort is the actual needle, I add lidocaine to my Radiesse (which most people do). Really, not so bad as far as pain goes.


 The needle is inserted at the “X” and it goes straight up to the corner of the mouth. Like I said, product is inserted as the needle is withdrawn. This is called retrograde technique. Before the needle is taken out it is repositioned at a 30 degree angle, the full length of the needle is again inserted, and product is deposited as it is withdrawn. It is done again at a 45 degree angle.


Basically, it’s one insertion point (i.e. one poke) on each side, and the needle is pivoted while within the skin layers. It gets less painful as you go along because there is lidocaine mixed into the product.

Last the jaw line is sharpened. “X” is the insertion point. The full length of the needle is then inserted, and product deposited as it’s withdrawn.

After

This picture is immediately after. There is some swelling that has begun, but you can see some of the immediate results. This patient used a 1.5cc Radiesse syringe (the large). She could use a little more product in the jaw line and around the corners of the mouth. I personally like to do things one syringe at a time. Because swelling begins immediately, I find results are best this way. Also, some people don’t want to look perfect, they want to look IMPROVED. The most important thing to note on this client is that she no longer looks like she is frowning when her mouth is at rest. Fillers are AWESOME!

Side Note

Sorry friends, this is a super busy week for me! I have a 20 person Botox Party on Friday, on top of my regular clients! I will actually be seeing this patient again this week, and will have a non-swollen after picture for you. She looks amazing and is super happy! Yay!

*If YOU Are Considering Filler*

Fillers can bruise. Do NOT. I repeat. Do NOT do these things if you have an event within two weeks. This is a worse case scenario for bruising. Highly unlikely you will have a bruise for two weeks… but… I wouldn’t wanna chance it if I was planning on running into my ex-husband at my high school reunion and the whole reason I wanted to get filler was to look too good for words. Just saying.

The reality of the situation is you will bruise. Probably for a few days. You can cover it with make-up. And tell everyone you went to the dentist. (I know my friend Colleen-a dental hygienist- is going to yell at me for making the dentist sound bad. Sorry Col. I love the dentist. I really do. He makes for a great excuse for my clients.)

Expect to pay $300-$800 in the Boston Area for this treatment with Radiesse. The amount of money you spend is a direct correlation to the result you will receive. The amount of product you will require for the result you desire (poetry!) depends on a lot of different factors, so ask your provider!

ICE YOUR FACE AS MUCH AS POSSIBLE AFTER THIS TREATMENT. The more you ice, the less you will swell. Twenty minutes on, 20 minutes off. If you can do it the rest of the day, do it. If not, just ice as much as possible.

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