Tag Archives: Merz

More Belotero!

27 Feb

Belotero: The Buzz.

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

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

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



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


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



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

Belotero vs. Juvéderm vs. Restylane

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

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

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

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

More Before and After Pictures


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

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


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

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

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

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


XOXO, LK

Above picture:

2 months after my Belotero treatment

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

1 week post break-up with my boyfriend

And still looking refreshed! Thanks Belo! Qué Bella!
(that’s Spanish I think…)

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Will it hurt?

24 Nov

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

    Source: http://www.pamz.com

On a Scale of 0-10…

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

Beauty is Pain

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

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

Q: How painful are stilettos?

A: Well, that depends.

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

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

The “LK Aesthetic Comparative Assessment Scale”

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

Chemical Peels

Laser Hair Removal


Laser on the Face



Eyeliner Tattoo


Botox


Fillers


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

Tear Troughs    2

Cheeks        2

Marionette Lines    3

Naso-Labial Folds    3

Plastic Surgery

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

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

XOXO. LK.

Softening the Lines

10 Apr

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

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

Before


After


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

Gravity…

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

So What did I do?

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

  1. Cheek Augmentation

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


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

  2. Marionette Lines

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

  3. Naso-labial folds

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

“Softening P.”: A Maintenance Session

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

X = needle insertion point

Line = needle direction of needle





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

Again the Afters


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

Master of Puppets

28 Feb

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

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

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

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

Can you fix it?

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

Before



What Needed To Be Done?

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

Marionette Lines

Prejowel lines

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


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


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

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

After

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

Side Note

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

*If YOU Are Considering Filler*

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

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

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

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

A Tribute to the Year of the 11’s

27 Dec
Allergan, the Botox Company, has used the "Year of the Ones" as a cleaver marketing campaign. 
Many women refer to their glabellar fold (between the eyebrows) as looking like a "1", "11", or a "111".

As 2011 comes to a close, and the “Year of the Ones” is over, I thought I’d go over a timeline of events in the history of this product.  It’s been around longer than you think (almost 60 years)! 

1950:  Scientists discover that botulinum toxin can reduce muscle spasms

1960’s & 1970’s : Studies explore botulinum toxin as a treatment for strabismis (cross-eyes)

1988:  Allergan researches other medical uses of botulinum toxin

1989: Allergan introduces Botox™, the first botulinum toxin with dosing approved by the FDA to treat blepharospasm (eyelid spasms) and strabismus.

2000:  FDA approves Botox™ therapy for cervical dystonia (spinal chord problem)

2002:  FDA approves Botox Cosmetic™ (onabotulinumtoxin A), the same formulation as Botox™ with dosing specific to moderate to severe frown lines between the brow (the 11’s)

2004:  FDA approves Botox™ for severe underarm sweating (hyperhydrosis) when topical medicines don’t work well enough.

May 1, 2009:  FDA approves Dysport™ (abobotulinumtoxin) for the treatment of forehead and frown lines.

2010:  FDA approves Botox™ therapy for increased muscle stiffness in elbow, wrist, and finger muscles with upper limb spasticity.

October 15, 2010:  FDA approves Botox™ for migraine headache therapy.

July 21, 2011:  FDA approves Xeomin™ (incobotulinumtoxinA) from Merz Aesthetic for moderate to severe lines between the brows.

Future Uses…

Botox has been approved in other countries for adult post-stroke spasticity and equinus foot deformity, and is awaiting FDA approval in the U.S.

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