Tag Archives: Cheek Augmentation

Aesthetic Consultation: Botox and Fillers

25 May

What to ask for and expect during consultations for Botox and fillers. consultation video

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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.

Belotero: The Buzz

18 Sep

I’ve been waiting to announce this for months!

Merz Aesthetics (the company that makes Radiesse) has released a new product: Belotero Balance. The product was FDA approved in November, 2011. My office was involved in clinical trials, so I (of course) got a sneak peak at the product, and have been anxiously awaiting it’s arrival.

Why am I so excited you ask? Well, first, I think Merz makes awesome products (Radiesse is my favorite to use!). Second, and most important, this product can go into vertical lip lines! That’s right. No more “smoker’s lines!” I have SO many clients who complain about “smoker’s lines” around their lips!

Prior to this product’s release, there were two ways to treat the vertical lip line: with Botox or with HA Fillers.

Botox


  • Some people like it, some people don’t. I’ve personally never had Botox injected in my lips (I have however had many, many syringes of Juvéderm), but I’ve been told it is a strange sensation. It feels weird to spit out your tooth paste, or use a straw, or kiss, because the muscle that is used for these things is “relaxed.” Obviously, you don’t want to relax it too much, or you’ll look like a stroke victim, so I’ve found it doesn’t last long in the lips.

Fillers (Juvéderm and Restylane)

  • As you can see from the picture below (this is a great example), by injecting product into the border of the lip (vermillion border), the vertical lip lines do visibly improve, but they are still there.

  • OR, you can have what I like to call “the monkey face effect” (I couldn’t find an excellent picture of this, but I’ve seen some real bad monkey faces. I would have tried to take a picture of this, but I’ve found people don’t respond well when you tell them they look like a monkey face from their filler. Or a cat face.)

Anyways, Back to Belo…

The Hyaluronic Family

Belotero is a hyaluronic acid injectable gel, like Juvéderm and Restylane. Belotero more easily integrates into the skin and adapts to facial contours than other HA’s because it is softer. This results in a more natural and subtle look (but may require more product in some areas). Belo is designed to treat superficial facial lines and moderate to severe wrinkles that are closer to the surface of the skin. Unlike Belo, fillers such as Juvéderm leave a bluish hue under the skin called the Tyndall Effect, when it is injected too superficially, like in vertical lip lines. Injections of Belo last up to 12 months, which is comparable to Juvéderm (Restylane lasts about 6 months—does anyone even use Restylane anymore? Anyone?).

Belotero is made of sugars which naturally occur in our skin. No allergy test is required, and treatment is very safe. Like with all injectables, bruising and swelling are always a possible. My friend Colleen who is a dental hygienist is going to hate me for saying this again, but, for those of you in Boston who don’t tell anyone you do this stuff (even though EVERYONE does it) the best excuse for bruising is a “dental appointment.”

For fine superficial folds/fine lines. Including:

  • Periorbital folds or “crow’s feet” (also referred to as Periorbital lines)
  • Perioral Lines (aka Smoker’s lines)
  • Tear troughs
  • Deep forehead lines

For medium wrinkles, moderate-to-deep folds, lip contouring, and facial contouring. Including:

  • Glabellar crease, or frown line (the line that forms between the eyebrows).
  • Nasolabial folds, or smile lines (from the edge of the nose to the corners of the mouth).
  • Mentolabial crease, or chin folds (horizontal line that forms across the middle of the chin).
  • Marionette lines (from the corners of the mouth to the chin and jawline).
  • Earlobes (which of course aren’t in my picture! Oops!)
  • Lips and philtrum (which is the area between the nose and the upper lip)

(Do you like my feather lashes? I love Halloween Eyelashes!)

The world of Aesthetic Medicine is always changing. New products are being developed as we speak. For the latest info on the best new technology, stay tuned! I’m psyched for my newly approved Sientra Silicone Breast Implants! One more month until surgery!!!!

XOXO, 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

Cheek Augmentation with Radiesse: A Personal Experience

28 Oct

“Executive Decision:  I’m getting my cheeks done!”

85 Facebook post responses later…

I know I haven’t written any posts on Botox or Fillers yet.  I wanted to start my education with the basics, which I’m certainly not done talking about yet.  However, I insighted such a riot on my facebook page with my decision I wanted to talk about my experience while the topic was still hot!

First of all, a person’s decision to undergo a procedure, be it botox, breast augmenation, or becoming a blonde, is a personal decision (yes I posted my decision on facebook, because I want to share my experiences with people!).  It doesn’t matter what your best friend thinks, what your husband or boyfriend thinks, or what your mother thinks.  It matters what YOU think.

Did I think I had such bad volume loss I needed my cheeks done?  No, I’m under 30, and I did it as a product trial (and–I won’t lie–I did a client of mine who is a model–age 21–and it looked so good I wanted to try it).

I was so excited the night before I couldn’t sleep!  I woke up at 7:45 (which is an ungodly hour for me).

I was at the office at 10:30 getting my cheeks numbed with topical lidocaine and couldn’t wait to begin.  My colleagues and I do each other’s botox and fillers, and I would like to thank Julie K. for her work.

I sat with the girls for 30 minutes while my topical numbed my cheeks.  Julie

(that would be numbing cream on my face)

cleaned off the topical in the procedure room, and I could feel it was numb.  I have a high tolerance to pain (I think it’s my Russian blood), but for people who don’t, you can request a dental block (like when you go to the dentist).  Julie added xylocaine to the syringe of Radiesse.  This was sufficient for my pain tolerance.  I had ZERO discomfort.

Julie placed product along my zygomatic arch (cheek bone), focusing on the outter rim.  She did not put any product into my central cheek area, because I still have good volume there.  She did place a small amount in the cheek area near my nose where I had lost some volume.

Like I said, I had no pain or discomfort at all.  The numbing agent in the product traveled down the nerve making my lips feel slightly numb for about an hour.  Not like dentist-drooly numb, more like plumping lipgloss numb or that feeling from Icy-Hot (the product for muscle pain).

A few hours after I didn’t have any pain, I couldn’t feel any product, and I had no bruising.  It looks great and I’m very happy with the result!  I want to be clear that this is something I personally do in my office, and I think it’s important to be able to tell people how things feel, I think it’s part of my job.

before

Cheek Augmentation and Lip Augmentation

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