Posts Tagged ‘facial rejuvenation’

Choosing a Cosmetic Surgeon

Sunday, December 12th, 2010

“He who can swim can get pearls from the bottom of the sea; but he who cannot swim goes under. Hence only he should dive for pearls who is practiced in swimming.”
Translated from German: Abraham Joshua Heschel ‘s Maimonides
As one might guess I am reading Heschel’s Maimonides and I am surprised and pleased at how much I have learned about the Jewish people and about myself. The quotation above somehow contradicts the aphorism: It is better to be a jack-of-all-trades than a master of none. Which of the 2 do you desire in a cosmetic surgeon?
On a trip to Manhattan last week, walking on the Upper East Side, my wife commented that many of the women walking past us had “the same face”. Translation: their cosmetic enhancements looked alike. As we passed a variety of department stores I noticed that many of the display windows, the entire windows, were devoted to marketing a given cosmetic surgeon and his formulas for facial rejuvenation success.
On reviewing a book of facial rejuvenation this weekend I noted that the authors, each seemingly expert in his area of discourse, extolled the virtue of a technique with little mention of what led to the need for the technique or how to evaluate when that technique was suitable. Further, each author promoted his technique as safe and effective, ignoring decades of literature to the contrary.
These seemingly disparate experiences over the past 10 days have again led me to contemplate what differentiates cosmetic surgeons who usually produce excellent results from the majority of cosmetic practitioners and medi-spas. The answer may be that the majority of facilities have a goal of selling a technique or product, sort of one size fits all; and the more exceptional practitioners insist on evaluating the cause of the patient’s concerns. Notice I said patient and not consumer. It is just too much wishful thinking that I accept that a consumer understands the etiology of their concern or that a commercial operation in or out of a doctor-office cares.
I once lectured at an international dermatology forum where I joined 4 experts in demonstrating how to treat a patient for facial rejuvenation. It happened to my advantage that I sat last in the row. The session was ostensibly on the use of facial fillers and each expert in turn looked at a patient across the stage and described how he/she would use a facial-filler with the patient. When I was asked how I would treat the patient I requested to be allowed to examine the patient and describe my findings. The chair of the session dismissed my request saying that I already knew what I was going to do and further discussion was superfluous. The session ended with me refusing to participate.
In answer to my wife’s observation I find the cosmetic surgeons in Manhattan to be skillful and erudite and deservedly experts in their fields. What I think has happened is that the business of selling techniques and products has superceded interpersonal relations and the similarity of the faces of our passersby reflects patient acceptance of the predictable if not the mundane.
Stepford wives anyone?
Mirror mirror on the wall
Who’s the fairest of them all?
Why you my dear, and you and you and you.

Facial Rejuvenation For the Thin Patient

Wednesday, March 31st, 2010

Pan-facial atrophy. The 21st century word for the aging face. As fat and bone, muscle, and skin whither, the face shrinks and wrinkles. Most important, the face looks older. To my regret Google Tyra Banks and Sandra Bullock. What a shame these 2 lovely ladies don’t understand the gestalt they communicate with their newly minted gaunt appearance. It seems strange that in a country where our primary health problem is obesity, a new generation of women and some men seek to enhance their appearance with an asthenic appearance.
Pan-facial atrophy, the whithered aging face, is a natural product of aging and is enhanced when adults do not maintain adequate body weight to support their skin envelope. For people with normal body weight the best solution is fat transfer from a more robust area of the body such as abdomen or hips to the depleted cosmetic units of the face: the temples, the cheeks, the mouth, and in front of the ears. However, it is not uncommon to see patients who have normal to low body fat and aging withered faces, for whom gaining weight is not a psychological option.
The answer for them is Sculptra, poly-L-lactic acid. Poly-L-lactic acid is a synthetic particulate which can be produced as minute fibers that can be suspended in salt water and then injected under the skin. Once injected, this alpha-hydroxy acid acts as a biostimulant to induce collagen production in both fat and skin. There is some consideration in Europe that when layered over bone the collagen may cover the bone and in some way add to its bulk. Regardless, the new collagen restores depth to the subcutaneous layers and, when properly distributed, restores normal contours to the aging face.
Like previous fillers, hyaluronic acid (Restylane, Juvaderm) and collagen, poly-L lactic acid is naturally metabolized in tissue and presents no harmful foreign tissue. Unlike these other fillers the Sculptra fiber does not provide the bulk needed to restore normal contour but rather induces our own body to generate tissue needed to restore shape.
Sculptra is not a new product and was successfully used 10 years ago to treat the facial ravages of HIV patients who had been treated with antiviral agents. It was quickly recognized that it had great potential for treating cosmetic patients. Unfortunately, the dilutions that were recommended and used were too concentrated and they induced unsightly nodules in some patient’s skin. There are numerous, probably exaggerated, horror stories on the web of patients treated with Sculptra. Now however, following reports by Dr. Rebecca Fitzgerald of some 2000 patient interventions treated at UCLA and by Dr Neil Sadick of some 1000 patient interventions in New York City, it is recognized that this is a very safe product when diluted and injected correctly. To protect the public the company, Dermik Sanofi-Aventis, has stipulated that it will not sell its products to medispas or non-board certified cosmetic and plastic surgeons.
This is the first practical use of a group of compounds which will be developed over the next decade that will reverse the stigma of an aging face by inducing the human body to regenerate tissue that was lost through aging and/or a low caloric lifestyle. We have implemented the Sculptra program at MetropolitanMD and Drs Rachel, Franco and I anticipate it quickly becoming the gold standard in facial rejuvenation. For patients who do not want to undergo a fat transfer procedure or who do not wish to gain weight, this is a most significant break-though in preventing and reversing facial aging.

Facial Rejuvenation in 4 Days

Sunday, November 22nd, 2009

Two thousand four hundred years or so ago, Cleopatra spent great amounts of effort preserving the legend of her infamous beauty. Such was her power that the succeeding Roman conquerors agreed to preserve her image in Egypt only after her nose was forcibly amputated from every remaining relic in her likeness. Cleopatra was apparently known for her mineral baths and one supposes her facial treatments consisting of products like milk (lactic acid), sugar (glycolic acid), wine (malic acid) and perhaps other ingredients known now to be alpha hydroxy acids.
While it appears she died around the age of 39, she nevertheless would have identified with the needs of our more long lived brethren, who wish to maintain a state of healthful appearance well into our 70’s. For this a multibillion dollar industry has arisen consisting of potions and creams, skin manipulations and therapies, devices, and when all else fails masks of make-up. Notwithstanding products and therapies which have been more or less effective, technology has, in fact, progressed so that skin and soft tissue rejuvenation is a reality which may only be limited by the amount of damage needing repair.
Enter the technology of fractional laser resurfacing. While resurfacing procedures have been around for more than 100 years (maybe thousands), the most common procedures of the 20th century were chemical peels and dermabrasion. By 1990 laser resurfacing became the gold standard in wrinkle removal and scar reduction. All of these techniques, however, were marred by a long healing period and frequent complications of color alteration which could last for many months. Add to this the problem of treating people with skin of color (this phrase was actually used in the 19th century) and all of the available technologies had severe limitations. In the 21st century non-ablative techniques using IPL (intense pulsed light) and infrared laser and heat producing devices were introduced as avoiding the necessary downtime of the ablative (destructive) techniques. Trouble was they didn’t work so well.
Ultimately fractional laser resurfacing evolved. Basically this technique uses an ablative (CO2 or erbium) laser to shoot microscopic holes in the skin leaving islands of undamaged skin between the holes. Several events quickly follow:
• The removed skin is replaced by new skin
• The surrounding islands regenerate new skin in a matter of a few days
• The inflammatory reaction necessary for healing continues to build collagen for months
The miracle of fractional laser resurfacing is that it can treat face, neck, and body; it heals within days and normal color returns within a few weeks if that long; it can be repeated for enhanced results; it costs significantly less than traditional laser resurfacing,; it can be done on a Friday with normal return to work on Monday for most people.
Good-bye wrinkles, withered vine
Sagging skin and aging signs;
Roll back the clock, sound the chimes
Fractional lasers erased my lines.
Edward Lack MD