Tag Archives: Filler

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

Under Eye Circles and Bags

16 May

Physiology: Broken blood vessels within the lower eyelid. A shadow forms underneath the bag causing the dark circles to appear. As you age, the “bags” (fat pads) can bulge due to gravity, creating an exaggerated space between the skin of the check, and the skin of the eye, over the orbital rim (bone of the eye socket). These dark circles can bring about a chronically fatigued look, or make you appear older than you actually are.

Cause: range from fatigue, vitamin deficiency, hyperpigmentation, allergies, age, and medical conditions. However, heredity is the most common cause for bags under the eye (also, from my patient’s personal experience… I hear children and husbands may also be contributors? It has not been clinically proven however.).

Treatment:

Getting the proper rest and eating the right foods can sometimes help treat and improve dark under eye circles, but if genetic, dark under eye circle will increase if untreated.

Fraxel®, Thermage®, Blue Light Therapy, IPL Photofacial, Dermal Fillers and Chemical Peels (like TCA). Patients with more severe cases of under eye circles, puffiness and loose upper or lower eyelids may want to seek out surgical alternatives including blepheroplasty.

My Best Advice

It is always a good idea to start with the least invasive methods and move on to the most invasive methods. That being said, genetics does play a HUGE role in this, and if your mom or dad has extremely sagging lids, or bulging fat pads, the earlier you do surgery the best result you will have.

Least Invasive to Most Invasive

  1. Hydration: The area of skin under the eye is the thinnest in the body. In a hospital setting, we monitor this area as a sign that a patient could be dehydrated. I can always tell when someone needs fluids just by looking at this clinical sign. Start with drinking water… water is good for your body all around. And… it’s FREE!
  2. Eye Cream: Supply your skin with the nutrients it needs. By depositing certain vitamins and peptides, you can decrease the appearance of dark circles. Before you tell me you’ve tried every cream under the sun… have you read my post on pharmaceutical products? Step 2: Spend wisely.
  3. Noninvasive treatments: Laser stuff. Not my area of expertise, however, I have had IPL on melasma, and it worked great. Laser treatments will help with the discoloration, and may subtly tighten the skin, but they will not fill volume loss. If you have volume loss, see step 5.
  4. Chemical Peels:  Best done in the winter time when you’re not in the sun.  And actually… this is more for fine lines and wrinkles around the eyes than bags and dark circles.  Although it will help the appearance.
  5. Dermal Fillers : (That’s NOT Botox..) A hyaluronic acid of low molecular cross linking like Juvéderm Ultra is most recommended for this area. Thicker fillers, like Radiesse, and biostimulators, like Sculptra, are not recommended for this area. Remember this skin is the thinnest in your body, and thicker products can leave bumps here. Be VERY careful about who you see for this treatment. It is a very advanced procedure that your Dentist or Primary Care probably shouldn’t be performing on you.
  6. Blepheroplasty: Check out my post on Blephs. Observing Surgery: Blepharoplasty.

Dermal Fillers

Dermal Fillers are my area of expertise (Remember photography is also not my thing!!!)

Here’s my Before and After Tear Troughs:


Before: I look tired. And old. Ew. Taken November 2011.


After: As you can see I look more awake and refreshed. Taken February 2011 after I had my tear troughs filled.

I am very happy I did this. Surprisingly, it didn’t hurt at all. The product used was Juvéderm Ultra. It will last about a year. Cost is about $600.

Creams

(The two I like best)

Image Max Eye Cream: This next-generation revolutionary day and night eye crème contains high concentrations of growth-factors derived from plant stem cells to protect skin cells and prevent aging effects caused by free radical damage. Reduces the appearance of fine lines and wrinkles; reduces puffiness and inflammation. Prevents cell aging. Contains grape, alpine edelweiss and apple stem cells for maximum age prevention. Corrective peptide blend for rejuvenation. Retails for about $45

Image Vital C: A scientifically- advanced hydrating, anti-aging eye gel. Contains a blend of nourishing anti-oxidants that reduce the appearance of fine lines and prevent the breakdown of collagen. Vitamin K  (Phytonadion) diminishes dark circles. Restores youthful looking eyes. Retails $31


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!).

A Bride’s Guide

17 Mar


Every bride wants to look perfect on her special day, and that takes a lot of hard work and preparation (or so I hear…)… I thought I’d be a big help for all those brides (and their bridal parties!) with a little bit of information you might find helpful!

Actually… I think any time anyone attends a wedding they want to look good. Weddings = Pictures. And now-a-days, pictures – the good, the bad, and the ugly – wind up on Facebook! So if you’re at the age where you will be attending lots of weddings in the near future (i.e. my age) you might want to take some notes…

Non-Invasive

Spray Tan

Spray tan’s typically last 7-14 days.  If your thinking of spraying (which I highly recommend), do it as close to your big day as possible!  You can’t shower for 6 hours after a spray, and you can smell a little bit sugary post-spray, so keep this in mind.  For the best results, spray the day before. As it wears off, it can sometimes look a little patchy. Make sure you exfoliate prior to your appointment (and shave).

Also, I hear there is a new spray out, that has glitter in it (OMG RIGHT!), but it’s only good for 24 hours I think? Maybe someone else knows more about this? I would also like to note here, that if you are not the bride, you should NOT be shining. That’s rude.


Facial

A plain old facial can be done anywhere from a few days to a month before a special date. Healthy skin is essential for a beautiful face. I recommend everyone see an aesthetician and purchasing some products that will keep your skin healthy.

Weddings are super stressful, and your skin responds to stress. Facials will keep break-outs at bay, not only by cleaning your skin, but by giving you some quality relaxation time. Spa days are great to do with your friends, mother, and future mother in law!


*Note: if you are planning on doing Botox or fillers, a facial should be done either immediately before or 5 days after any facial treatments.

Chemical Peel

Degree of peeling can vary, so talk to the aesthetician performing your peel and be CLEAR if you have any wedding events (or any events for that matter) that you don’t want to be shedding for. ‘Tis the Season for Chemical Peels!.  For a real good, deep peel, expect about a week to two of down time. Trust me, it’s worth it.

Very Important:  moisturize often with a pharmaceutical or cosmeceutical grade product after a peel.  Many places have post-treatment kits.  Do NOT pick at your skin!  Stay out of the sun! Do not use Retin-A prior to or post treatment for about 7 days.

Waxing

Waxing your brows or lip shouldn’t be done the day of an event.  The process can irritate your skin, leaving it a little red.  Icing the area helps.  Or an anti-inflammatory like ibuprofen.  Make sure to keep the area clean to keep bacteria out of your pores, and causing break outs.

Microdermabrasion.

Often done during the same time as a facial, and can cause some minor redness.  Protect your skin after this treatment. Again, stay out of the sun, and do not use Retin-A prior to or post treatment for 7 days.

Laser Skin Rejuvenation Treatments

Depending on the laser, and the treatment, there can be some downtime with this (discoloration and flaking), anywhere from a day to a week.  Ask your practitioner what to expect with the treatment you are receiving.  These treatments really make your skin look great!  Never heard of laser skin rejuvenation?  There will be blog posts to come!

Teeth Whitening

It depends on the number of treatments you will need to decide when you should start. Some treatments take a few sessions, some are one and done. Go for a consult. At the very least, do the Crest White Strips.

Long Lashes

A lot of brides ask me about eye-lash extensions. Although a little expensive, they look great for a wedding.  They should be done about a week before your big event.  They take some getting used to! Lovely Lashes!. They also don’t last very long… usually about a month, so don’t do them too soon unless you are going to keep up on them. If you are having your make-up professionally done, the make-up artist will probably offer you some sort of fake-eyelash. If you are doing your own make-up and you want that lashed out look, practice a few times before the big day. I am a master of the strip lash… but it took me about a year to perfect my technique!

Minimally Invasive Procedures

These can be tricky to time.  If you are planning on doing any non-invasive procedures, they should be done either immediately before Botox and Fillers, or 5 days after.  This is because you don’t want Botox to travel into the wrong muscle group, or fillers to be moved into the wrong area.  Use good judgment with timing your treatments!

A lot of women do Botox and fillers before a big wedding!

Check out this article: http://www.nytimes.com/2008/07/24/fashion/24skin.html?pagewanted=all


(I’m the bridesmaid all the way to the left. I would like to add a disclaimer: The bride here is naturally beautiful. And has not let me tempt her into Botox—yet).

Botox

If you are new to Botox, I suggest trying it out 4-6 months prior to the wedding date for a couple of reasons. First, this way you can decide if you like it (which you will, but I still recommend trying it). Second, Botox is a dose dependant medication (your results depend on how large or small a dose you receive). Six months gives you plenty of time to work out with your injector the perfect dose for you! Last, you will not be able to look angry for 3-6 months. This might be helpful to any Bridezilla’s out there. So, when you are in witch mode, at least you won’t look like it. J

If you don’t have six months to do a trial run, if you are a Botox Pro, or if you just want to go for it, you should have your treatment AT LEAST 1 month prior to the big day, and NO MORE than 2 months prior. Anything more than 2 months, it might start wearing off, anything less than a month you might not have the result you desire.

Another interesting use of Botox with Brides: It is becoming popular to be treated for hyperhydrosis (sweating) in the underarm. I recommend this to brides who will be getting married outside in 100 degree weather. Sweating profusely is pretty gross. You’re already going to be nervous, and when you add your layers of dress (which I’m sure is not air conditioned), and all the dancing you’re going to do… might be a good idea. Plus, you didn’t spend all that money on a dress to have pit-stains on it. This procedure requires a pretty big dose of Botox, and is therefore pretty expensive. It’s not for every bride.


(Remember don’t go overboard either!)

Fillers (Radiesse, Juvéderm… Perlene, Restyline, ect. ect.)

Depending on the area of injection, there can be some minor bruising (or major depending on the injector).  Invest in some Arnica cream, and expect the worst (2 weeks).  Cheek augmentation bruises the least, while lip augmentation and nasal labial folds tend to bruise the most.  Gosh, I hate it when I have dental work 😉 The average bruise lasts a few days.

Usually older brides are doing facial fillers, while younger brides might want to plump their lips.

As for the rest of the wedding participants, the mothers of the bride and groom are usually also very interested in fillers (and Botox). After all, they have been looking forward to this day since the days BEFORE their children gave them premature wrinkles. Whether she is interested in a facial or Botox treatment, moms deserve to be asked “is this your sister?”

Things to Do 6 Months or More before a Wedding (or wait until after):

–  Bioenhancers like Sculptra Aesthetic (it can take up to 6 weeks to see a difference)

–  Plastic Surgery. Remember that crazy reality show on TV that brides were competing with each other trying to win plastic surgery procedures so they could be perfect for their big day? Those women were … appalling. Plastic surgery should never be taken lightly. Or have a competitive reality show. Leave competitive reality to “Survivor!”

–  Changing your hair color or cutting it short (stick to what you know looks good on you!)

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.

Pucker-Up, Princess – Damn Sexy Lips

7 Jan

Joy in one’s heart and some laughter on one’s lips is a sign that the person down deep has a pretty good grasp of life.

Or a good grasp of what Juvéderm is. (That’s NOT Botox.)

Juvedérm is a hyaluronic acid that is injected into the lip to make it fuller.  It is also used in deep “1” lines in between the eyebrows and sometimes in the cheeks and naso-labial folds.  It’s a sugar your body naturally produces.  You don’t need allergy testing with this product.

It can be natural looking.  

There are two techniques for augmenting the natural lip.  A lot of women want/need volume.  As you age, your lip naturally beings to thin out.  Physical Facial Changes That Occur As We Age.  In order to restore the volume, the product must be placed in the wet/dry border (where your lip goes from wet to dry).

* The Black Dashes represent where product is put.  The Red X’s represent needle insertion points.  They are a representation.  You might have more insertions if you have asymmetry, or less if you are trying to achieve several changes at the same insertion point.    
**Remember when looking at the pictures I’m not a graphic designer.  I’m a nurse.  And I’m pretty proud of my skills in the program Paint and my Pout.  God, I love alliteration!   

The full length of the needle is inserted into the border of the lip.  Yes.  It sounds like it hurts, but a topical numbing  cream should be applied 15-30 minutes prior to the procedure.  A lot of places will cheap out on this.  The stuff is expensive.  Trust me you want it.  Even if the product being used has a numbing agent in it (like Juvéderm XC – the XC stands for xylocaine, which is in the lidocaine family).  Plan on being numb from 1-4 hours.

If you have a low pain tolerance, request having a dental block.  This the procedure you have before you have dental work done.  The nerves are blocked with a pain killer, and you don’t feel anyyyyything.  Don’t drink or eat for 4 hours after a block.  I rarely do blocks, because I’m so good with a needle.  But natural redheads and light blondes are usually more sensitive to pain.  I usually recommend them for these Fitzpatrick I and II’s!

The Duck Look

I like my lips ducky.  Other people who like the duck look:  models, 21 year-old’s, bartenders, strippers… you get the point.  People who need to look sexy.  (You can WANT to look sexy and any age and any profession though!!!)  This look is achieved by inserting the length of the needle into the lip line, otherwise known as the vermillion border.  The volume there curls up the line.  Again, it should be numb so it won’t hurt as much.

Mouth Corners

Gravity turns down the corners of your mouth making you look a little frown-y as you age.  By inserting the needle at the lower lip and curving it around the lip’s corner, the lip turns more upward, getting rid of that frown.  A nice smile is attractive.  A frown is not.  This can be a little painful even with numbing cream, because of the location of nerve endings.

Columns

The Philtrum Columns are the two lines that come from your nose to your cupids bow.  They flatten as you age, so by recreating them, you look YEARS younger.   It pulls up the “Cupid’s Bow” area, which also becomes flatter as you age.  I’m not going to lie.  This hurts.  A lot.  There are a ton of nerve endings that come out of your nose and it’s very difficult to block them.  Expect there to be tears.  In this case, the tears are worth it though.  It lasts a good year or more.  And although I haven’t gone through child birth, it can’t possibly be as painful.   

The Pout

I am fully aware not everyone likes the Trout Pout (a term my friend Lauren gave me – http://www.shapeupwithLauren.com).  It’s another look I really like though.  Depending on how your natural lip is pre-injection, the product is deposited along the wet/dry border and/or the vermillion border.  I usually like to do both to make it extra pouty.

Proportions.

Proportion: The Rule of Thirds and Fifths and what should it be when it comes to  your lips?  The natural lip is 1/3 volume top lip and 2/3 volume bottom lip.  I see this isn’t necessarily true with darker Fitzpatrick types (V and VI).

Balance.

Many women who have larger noses and big eyes don’t need a nose job.  We need balance.  I naturally have huge eyes and a large nose.  By augmenting my lips, I’ve found some peace with my face.  I look proportional and balanced.  I have tons of clients who feel this way.  Lip Aug is way cheaper than a nose job!

Symmetry

You can use lip augmentation to fix a-symmetry.  Don’t expect it to be PERFECT though.  We all have a little a-symmetry with our face.  If you look at my lips, they aren’t perfectly symmetrical.  But, if you had your lips done, and your friends point stuff out without you telling them, go back to the practitioner.  If it’s real bad, they should fix it free of cost.  If it’s not noticeable, they’ll re-assure you that you’re crazy and you might have Body Dysmorphic Disorder.  It takes about 2 weeks for swelling to go down completely (even if you don’t see it, the inflammatory process is still in gear), therefore, wait two weeks before going back.

Pearls of Wisdom:

  • Expect that you might bruise.  Everyone bruises differently.  If you are anemic (which many of us are during menstruation) or very fair skinned (Fitzpatrick I and II) I highly recommend buying Arnica cream and Bare Essentials makes a purple tinted gloss that works wonders, called Starr.
  • Because you might bruise, don’t do your lips the day/week before a family get-together or a big party.  Questions will be asked.  That dentist was such a witch.  Wink wink.
  • You will be swollen.  Anytime you puncture or traumatize the tissue your body responds with inflammation.  ICE.  20 minutes on 20 minutes off.  The more you ice, the less you swell.
  • The next day, you will look a little more swollen, and your lips will feel very dry.  That is because hyaluronic acid attracts water molecules and you are still swollen from the injection.  Keep icing and applying a hydrating product to your lips.  I like Image’s Ormedic Balancing Lip Complex.  Pharmaceutical grade repair!  A lot of people like Burt’s Bees too.
  • Juvéderm Ultra Plus XC is the best product for your lips.  It lasts 1 year + in most people, unlike Restyline, which lasts about 6 months or less.  Juvéderm Ultra isn’t as plumping because it’s not as concentrated with hyaluronic acid (although it is cheaper – so make sure your practitioner is using Ultra PLUS).

In Conclusion.

It’s ok to be sexy!  This isn’t 1820.  The Feminist Movement doesn’t restrict you to Intellectual Sexiness.  You can be pretty AND smart.  I am (and modest)!   Let’s face it ladies… men like tits and ass.  But they also like what I’ll refer to as DSL (Damn Sexy Lips… or if you want to be crass—D*ck Sucking Lips).  More importantly, it will make YOU feel sexy.  In case you don’t remember why I love my lip augmentation, you can read about it in The Halo Effect.  You want your husband/boyfriend to pay for this?  You mention this part.  “Imagine the Possibilities.” 

My Before…

People always request pictures of how I looked before.  I have a few of my photo’s from when I was in my early 20’s (that don’t have Pabst Blue Ribbon in them).  As you can see I had a nice lip line to begin with.  Symmetrical.  Nice Shape.  Full.  21 (ish).  The top is pretty flat, and thins a lot when I smile.  To me, my face looks out of proportion: big eyes, big nose… small lips… over tweezed eyebrows (hey, I didn’t always have such perfect style!)  I’d like to thank my dog, Nila, for posing.  Pitbull Love.

…After

From Girl-Next-Door to Diva.  See how my nose looks more balanced?

                                   If that face doesn’t scream “I

                               need Botox”  I don’t know what

                                 does!

For beautiful eyes, look for the good in others; for beautiful lips, speak only words of kindness; and for poise, walk with the knowledge that you are never alone. 

Audrey Hepburn

New Year, New You: Plan Accordingly!

1 Dec
Looking to enter the New Year looking younger and more refreshed?  It’s important to plan your beauty needs around a hectic holiday schedule, so if you’re thinking of amping up your look for the New Year (or any Holiday Parties) here’s some helpful hints/guidelines:

Non-Invasive

Spray Tan

Spray tans typically last 7-14 days.  If your thinking of spraying (which I highly recommend), do it as close to your event as possible!  You can’t shower for 6 hours after a spray, and you can smell a little bit sugary post-spray, so keep this in mind.  For the best results, spray the day before.  

Facial

A plain old facial can be done anywhere from a few days to a month before a special date.  But remember, book early, because this is a very popular treat during this time of year!  It’s also a great gift to give to someone who is impossible to shop for!  Everyone enjoys being pampered.  If you are planning on doing Botox or fillers, a facial should be done either immediately before or 5 days after any treatments! 

Chemical Peel

Degree of peeling can vary, and you don’t want to look like a snake shedding its hide for your holiday parties (it’s slightly unattractive, and not the attention you want!).  Talk to the aesthetician performing your peel and be CLEAR if you have any Holiday parties. ‘Tis the Season for Chemical Peels!.  For a real good, deep peel, expect about a week to two of down time.

Very Important:  moisturize often with a pharmaceutical or cosmeceutical grade product after a peel.  Many places have post-treatment kits.  Do NOT pick at your skin!  Stay out of the sun!

Waxing

Remember, waxing your brows or lip shouldn’t be done the day of an event.  The process can irritate your skin, leaving it a little red.  Icing the area helps.  Or an anti-inflammatory like ibuprofen.  Make sure to keep the area clean to keep bacteria out of your pores, and causing break outs.

Microdermabrasion.

Often done during the same time as a facial, and can cause some minor redness.  Protect your skin after this treatment. Stay out of the sun.

Laser Skin Rejuvenation Treatments

Depending on the laser, and the treatment, there can be some downtime with this (discoloration and flaking), anywhere from a day to a week.  Ask your practitioner what to expect with the treatment you are receiving.  These treatments really make your skin look great!  Never heard of laser skin rejuvenation?  There will be blog posts to come!

Eyelash Extensions

Although a little expensive, they look great for the holiday season.  They should be done about a week before your big event.  They take some getting used to! Lovely Lashes!.

Minimally Invasive Procedures

These can be tricky to time.  If you are planning on doing any non-invasive procedures, they should be done either immediately before Botox and Fillers, or 5 days after.  This is because you don’t want Botox to travel into the wrong muscle group, or fillers to be moved into the wrong area.  Use good judgement with timing your treatments!
 
Also, I think this year is the time to abolish the false notion and rumors about these products.  With small doses and a trained injector, you will look amazing!  If you don’t believe me, just ask my mom! 

Botox

It takes a few days for this treatment to work (anywhere from 2-14), fortunately, there is no downtime with this procedure (no bruising, no swelling).  If you want the best results from your Botox, plan on having your treatment 2 weeks prior to the 1st!

Fillers (Radiesse, Juvéderm… Perlene, Restyline, ect. ect.)

Depending on the area of injection, there can be some minor bruising (or major depending on the injector).  Invest in some Arnica cream, and expect the worst (2 weeks).  Cheek augmentation bruises the least, while lip augmentation and nasal labial folds tend to bruise the most.  Gosh, I hate it when I have dental work 😉  — A great excuse one client came up with!

Things Probably Best Left to do Until After the Holiday Season:

–  Bioenhancers like Sculptra Aesthetic (it can take up to 6 weeks to see a difference)

–  Plastic Surgery (unless you are planning on using your vacation time to get that breast aug you’ve been waiting for!)

–  Changing your hair color (stick to what you know looks good on you!)

–  Trying a new cream on your face.  (Although everyone should be using pharmaceutical grade products, sometimes they can irritate the skin at first.  Now is not the time to find out).  HINT HINT:  Especially Rentin-A!

Questions?  Feel Free To Email Me!  info@bostonbeautyblog.co

That’s NOT Botox.

18 Nov
Another strong misunderstanding a lot of people have around the Boston Area is what products go where Botox does not.   If it’s caused by gravity:  THAT’S NOT BOTOX!

HYALURONIC ACID (HA) FILLERS (TEMPORARY)

Hyaluronic acid fillers are synthetic sugars that attract water molecules.  They are placed in actual wrinkles or other areas that need volume and offer instant results. They fill in marionette lines, lift up jowls or plump up volume along the jaw line where definition has been lost.

Restylane, Perlane and Juvéderm (www.juvederm.com) are the most commonly used hyaluronic acid fillers, with Juvéderm being the leading product (I refer to Restylane as ‘old school’).  There is no need for allergy testing, as these products are sugars your body naturally makes.  There is little pain with injection, as the new products come with lidocaine added as a powder to the product.   Expect a topical numbing agent (topical lidocaine) to be applied prior to injection.  This should be left on for AT LEAST 20 minutes.  The actual procedure only takes about 15 minutes.  Swelling and bruising are possible and you should probably not do a filler if you have an important event within a week from treatment.  ICE ICE ICE!  I also recommend arnica montana cream which can be purchased at GNC or Whole Foods.  You can expect results to last from six months to a year, depending on the brand and where it is placed (Juvéderm lasts the longest).

I have Juvéderm filler in my lips.  It feels and looks natural.  It was the first injectable I tried, and I’m very happy with it.  😉  I mostly just use HA’s in the lips and very deep frown lines between the brows.  Reason being, HA’s are injected into the superficial dermis and do not give as good of a fill for the cost for deep lines and folds.  I like other products more for those very deep lines.

Calcium Hydroxylapitate (SEMI-PERMANENT)

Radiesse (www.radiesse.com) is an example of a semi-permanent filler and it is made from calcium molecules suspended in a gel which stimulates your collagen. The microspheres in it create “scaffolding” that your own collagen will grow around, but is eventually broken down by the body. Radiesse can be used to fill the nasolabial folds and marionette lines, as well as define the contours of the face.  It goes deep in the dermal layer of skin, and should NEVER go in the lips!

Lidocaine topical should be applied 20 minutes prior to injection.  Lidocaine is added to the product immediately prior to injection.

I recently had a little lift put in my cheeks (as described in a prior blog).  I had zero pain or discomfort.  The lidocaine eventually traveled down my nerve from my cheek to my lips.  It felt a little funny!  It looks and feels completely natural. 

COLLAGEN STIMULATORS (aka collagen builders or stimulating fillers)

Collagen stimulators contain particles that signal the skin to produce more collagen. Instead of just filling in select lines and wrinkles, these are used on larger areas like the cheeks.  They can be used in areas where synthetic fillers look somewhat unnatural (like the lower face under the cheek area).  Results are not immediate; it takes about 6 weeks to see the result of the collagen stimulation; however, the product lasts two years.  Most women prefer the gradual change in their facial contour.

Sculptra (www.sculptraaesthetic.com) is an example of a collagen stimulator. It is approved by the FDA for restoration and/or correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus (as is Radiesse). Most patients require an average of two to three treatments six weeks apart for optimal results.

I had Sculptra injected into my temples.  Zero pain.  My patients are in LOVE with this product.  It costs about as much as other fillers when you take into consideration how long it lasts.  It also looks COMPLETELY natural due to the fact it’s ALL your own collagen produced.  I foresee this product being my number one injectable within the next year!  Move over Botox!!! 

COLLAGEN FILLERS

Although collagen fillers changed the face of beauty when they entered the marketplace in the 1980s, they quickly fell out of favor when longer-lasting hyaluronic acid was introduced. However, many doctors still use collagen, especially for plumping the lips and filling in “smoker’s lines” around the mouth.  Although overfilling is necessary to achieve the desired result, the excess fluid is absorbed over the first few hours after treatment, and minor redness and swelling subside in a few days.  Results last from two to three months… also known as a waste of money when there are so many better products!

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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