Tag Archives: juvederm

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

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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?)

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

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!)

A Note From Skipper

26 Jan

Skipper and Barbie going to Iceskate at Frog Pond

In response to my post Hey, You Look Just Like Me!, in which I reference my friend/coworker/client Devan (whom I have dubbed Skipper), sent a reply that I felt would be better as it’s own post.  Here was her reply, which starts with an exerpt from the original post:     

“Devan (the girl I live with on the North Shore 2 days a week), turned to me the other day and said, “we look like sisters.”  Well… we certainly did not start out that way.  I’m Boston Bred and Russian/Polish by descent.  She’s from Virginia and sports some very fair skin (more Western European).  Several spray tans, a couple of boxes of Juvederm, some cheek augmentation, and a splash of bleach later… and we look like sisters.  Either she’s blind… or we both have the same idea of beauty.”

Laura,

I would have to agree on this post. Not only am I thrilled that you have involved me in your blog lol I figured I definitely need to give my opinion on this. We obviously have some similar features due to augmentations but our idea of beauty is the same. I was 19 years old the first time I got my lips injected with Juvederm, many of my clients ask me “Why? You are so young, why would you start so early” I always respond with:

 1. “I am in the industry.” How can you possibly promote a product when you physically have not used it and do not believe in it? You can’t and that is false adverstising as far as I am concerned. Don’t knock it till you try it.

2. “My top lip was half the size as my bottom and it was something that bothered me.” When I had the option to alter my look just a little bit to (1) please myself and (2) make me look better I thought why the heck not?

I would have to say that Juvederm is one of the best products out there on the

My Bathroom Shelf

market today (props to the amazing pharameceutical company Allergan- the makers of Botox, Juvederm and Vivite- a glycolic based skincare line).  I have had clients complain about restalyn (especially regaurding cost and duration of result) but never once heard a complaint against Juvederm.

If you can take something that concerns you and change it just a tiny bit to enhance it to the point where many people would say “you look awesome, what are you doing different?” But not actually pin point what it is you have had done. WHY WOULDN’T YOU DO IT? It isn’t harmful, so for me it is a no-brainer.

At the end of the day, it is hard to stay on top of things in the beauty industry, but how can you be a good esthetician, hairdresser, cosmetologist, nurse injector, etc. if you do not strive to use the best products and promote beauty within yourself and most importantly to YOUR CLIENTS.  That’s why I don’t trust Dermatoligists or General Practice MD’s with my injections.  Just because you have the title MD does NOT make you an expert in beauty!

In closing, a little spray tan, Juvederm, Radiesse or blonde hair never hurt anyone!

Representing Boston Beauty and Boston Sports!

P. S- I don’t think you’ve been spending too much time with me. It is awesome to have such a wonderful friendship with someone who strives to be the best at what they do, just like myself, and who also has an amazing concept on what is beauty.

WE ARE BEAU-TIFUL AND FOREVER YOUNG.

Thank you BOTOX and Laura for making BOSTON BEAUTIFUL!

-Devan Ritchie, L.M.E

Go Platinum Salon and Spa

200 Lake Street, Peabody, MA

978-535-8575

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

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!

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