I was reminded in the last 2 weeks as to how some patients still endure significant angst when embarking on their first experience of cosmetic treatment. This is despite the reality that many treatments such as muscle relaxant injections are really less traumatic than a visit to the hairdresser! Today most treatments are minimally invasive with very little trauma and are performed in the clinic, walk in-walk out.
Usually this anxiety relates to how a partner, family member or close friend may judge them for acceding to such an indulgence! I recently treated a patient with neck liposculpture who did not tell her husband about it until he arrived home that evening. Happily he was very supportive and the outcome was very pleasing! Minimally-Invasive does generally equal Minimal-Risk.
So once people appreciate that what we do does not carry the risk burden of invasive surgery (like face lifting), the angst dissipates like the wrinkles do!
I was drawn to a recent online article about how aesthetic enhancement by muscle relaxant injections impacted on other’s first impressions of them. As you will read the effect is positive!
"The popular cosmetic enhancement, botulinum toxin A (Botox) positively effects first impression judgments in relation to attractiveness, dating success, and athleticism, says new research presented at the 2008 American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO in Chicago, IL.*
According to researchers, first impressions of a person are influenced by facial appearance and improved by cosmetic surgery. They wanted to determine whether or not the use of botulinum toxin A would contribute to a person receiving higher scores on a variety of first impression scales. Photos were taken of the study participants before and after the treatment with the botulinum toxin A, then the photos were randomly divided into books with each subject represented only once per book. Blinded evaluators completed a survey rating their first impression on various measures of success for each photo in the book.
Subjects who received the injections improved first impression scores for scales of dating success, attractiveness, and athletic success The authors did not find any positive correlation between botulinum toxin A injection and increased scores regarding social skills, financial, or relationship success."
*Title: Botulinum Toxin A Can Positively Impact First Impression. Presenters: Amy S. Anstead, MD; Steven H. Dayan, MD. Date: Sunday, September 21.
ScienceDaily (Sep. 22, 2008)
Monday, 18 July 2011
Friday, 15 July 2011
"Muscle Relaxant" Injections-The WOW factor
With judicious application really pleasing aesthetic outcomes are possible with "muscle relaxant" injections and are these injections are always very popular at our clinic. Although muscle relaxant injections do not achieve anything like a face lift, the wrinkles around the eye can be improved, the frown lines relaxed with the eyes rendered more open and engaging in appearance. Actually there are many nice tricks with muscle relaxants to make the face more appealing but it does take a lot of time and experience to get the technique right and correctly tailored to suite the individual patient. As my talented colleague Dr.Naomi McCullum http://www.drnaomi.com.au/HOME.html writes on her great website, treatments must be "bespoke".
There are of course limitations as to what can be achieved with this agent alone. They should be part of an aesthetic treatment plan that may include fillers, lifts, laser treatments and of course good home based skin care management.
Outside cosmetic treatments "muscle relaxant" injections have been perhaps a little hastily lauded as the new "cure-all" therapy in medicine. For example a well constructed recent study of these agents in the treatment of neck induced headaches was not supportive of a true benefit.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD008626/frame.html
In cosmetic facial treatment there is no doubt about treatment efficacy if injected well and in the appropriate patient.
Monday, 11 July 2011
Veins, Veins and more Veins
Injection sclerotherapy of legs veins runs hot here in the winter months. While I love doing veins I don't know how some injectors do this all day every day.
The vast majority of the veins we see respond well to these injections. The veins take several months to fully respond to sclerotherapy, so to look good for the summer months it is necessary to have treatment before the end of September. Nevertheless I seem to treat veins all year long.
The treatments are tolerated very well by patients and although strong compression stockings http://www.venosan.com/index_en.php?TPL=25000&x25000_ID=108 need to be worn for up to 1 week during the day, patients can return to normal life (but no gym work for 1 week).
http://www.phlebology.com.au/varicose-veins-spider-veins
In selected cases I have been using "foamed" sclerotherapy solution for some years now. This upgrades the potency of the sclerosant solution and allows us to achieve improved outcomes for more extensive cases.
http://www.youtube.com/watch?v=ySb9Wxd3A1A&feature=related
While surgery still has a place in treatment cosmetically unsightly veins rarely require surgery these days.
The vast majority of the veins we see respond well to these injections. The veins take several months to fully respond to sclerotherapy, so to look good for the summer months it is necessary to have treatment before the end of September. Nevertheless I seem to treat veins all year long.
The treatments are tolerated very well by patients and although strong compression stockings http://www.venosan.com/index_en.php?TPL=25000&x25000_ID=108 need to be worn for up to 1 week during the day, patients can return to normal life (but no gym work for 1 week).
http://www.phlebology.com.au/varicose-veins-spider-veins
In selected cases I have been using "foamed" sclerotherapy solution for some years now. This upgrades the potency of the sclerosant solution and allows us to achieve improved outcomes for more extensive cases.
http://www.youtube.com/watch?v=ySb9Wxd3A1A&feature=related
While surgery still has a place in treatment cosmetically unsightly veins rarely require surgery these days.
Saturday, 9 July 2011
Mind the Gap!
A recent article in a health,wealth & lifestyle magazine sent out to medicos (available online) has highlighted the "very large gap" between actual cosmetic surgery in a hospital and treatments in a beauty salon. The article proposes that the gap is being filled by "specialist" clinics staffed by an overseeing doctor, nurse injectors and laser technicians. The article suggests that this is the business model for the 'gap" created by an expanding market. It seems that this type of business model will also be available in franchise form.
http://issuu.com/medicallife/docs/physicianlife_final/search
The alternative to this model can be appreciated by noting the numerous private clinician owned and operated clinics that have successfully functioned and have indeed been very popular for over a decade now.
These established clinics generally have one fundamental and very important principle and that is the reassurance that the person actually administering the treatment is the trusted medico (or a practitioner very closely supervised by the medico). Discerning patients may care to ponder whether a franchise business model can morph from concepts such as a fashion house or Gloria Jean's or McDonald's into cosmetic medical clinics. Perhaps! http://www.franchisebusiness.com.au/t/Health-Beauty-Franchises/Medical-Treatments
But it should be borne in mind we are not talking about selling garments, coffees or hamburgers here.
Mind the gap!
http://issuu.com/medicallife/docs/physicianlife_final/search
The alternative to this model can be appreciated by noting the numerous private clinician owned and operated clinics that have successfully functioned and have indeed been very popular for over a decade now.
These established clinics generally have one fundamental and very important principle and that is the reassurance that the person actually administering the treatment is the trusted medico (or a practitioner very closely supervised by the medico). Discerning patients may care to ponder whether a franchise business model can morph from concepts such as a fashion house or Gloria Jean's or McDonald's into cosmetic medical clinics. Perhaps! http://www.franchisebusiness.com.au/t/Health-Beauty-Franchises/Medical-Treatments
But it should be borne in mind we are not talking about selling garments, coffees or hamburgers here.
Mind the gap!
Monday, 4 July 2011
Platelet Rich Plasma-The Future? Maybe!
I am often asked by patients what I think of Platelet Rich Plasma (PRP) treatment for cosmetic improvement of the face. As an early adopter of this treatment I must confess that as a stand alone treatment I was not convinced that I was achieving all that much benefit for my patients and no longer offer it in that way. Nevertheless other practitioners have success with this treatment so in their hands it seems to work for their patients. My excellent colleague Dr. Naomi has a recent blog on this subject and I link to it here. http://drnaomi.blogspot.com/2011/07/platelet-rich-plasma-facts-interview.html
However I'm pleased to report my observation that admixed with autologous fat harvested for grafting, PRP does appear to significantly improve the graft success and I do believe there is supporting evidence in the medical literature for this benefit. Accordingly I use this combination in most of my fat graft cases.
One new interesting, but unusually named, cosmetic procedure is that of the “Vampire Facelift.” In truth, it is not really a facelift nor is it used by vampires or will make you look like one. The Vampire Facelift is far less scary and has much more science to it than most science fiction tales. It is based on the more well known and highly popular injectable filler concept.
The principle of this approach is that platelets are heavily endowed with growth factors. These potent little growth stimulants can induce the growth of new collagen. Collagen, of course, is what gives skin its fullness and suppleness. The implantation of a concentrated platelet mixture could help rejuvenate thin and aging tissues and overlying skin…in theory. It is also appealing to patients in that it is an organic approach to rejuvenation using one’s own tissues to help repair itself.
While the Vampire facelift (perhaps better understood as a PRP filler) treatment sounds intriguing, it is not known if it will last any longer than that of off-the-shelf injectable fillers. The theory is biologically appealing but whether it actually works has not been conclusively shown. I commonly mix PRP concentrates with fat injections with the theory that the platelets may stimulate better fat preservation or stem cell conversion into adipocytes and/or fibroblasts. This is employing the identical approach but with a different substrate. Time will tell if these biologic injectable mixtures will live up to their theoretical benefits.
However I'm pleased to report my observation that admixed with autologous fat harvested for grafting, PRP does appear to significantly improve the graft success and I do believe there is supporting evidence in the medical literature for this benefit. Accordingly I use this combination in most of my fat graft cases.
A recent commentary has been published online by US Plastic Surgeon Dr. Barry Eppley and provides another point of view and is reproduced as follows:
March 4, 2011
The Vampire Facelift - Cosmetic Application of Platelet-Rich Plasma Concentrates
Author: barryeppley
One new interesting, but unusually named, cosmetic procedure is that of the “Vampire Facelift.” In truth, it is not really a facelift nor is it used by vampires or will make you look like one. The Vampire Facelift is far less scary and has much more science to it than most science fiction tales. It is based on the more well known and highly popular injectable filler concept. It works by injecting its magical potion underneath the skin, much like its man made counterparts such as Juvederm or Radiesse. But instead of using a prepackaged synthetic material, the Vampire Facelift (trademarked name by the company Selphyl) uses the patient’s own blood to make the injectable filler. A small amount of blood is first extracted from the patient. Then a device separates the platelet portion from the red blood cells. The concentrated platelets are then combined with the company’s proprietary synthetic mixture and the composite is now ready for injection. The entire preparation process takes less than ten minutes to complete and can be done in an office setting.
The principle of this approach is that platelets are heavily endowed with growth factors. These potent little growth stimulants can induce the growth of new collagen. Collagen, of course, is what gives skin its fullness and suppleness. The implantation of a concentrated platelet mixture could help rejuvenate thin and aging tissues and overlying skin…in theory. It is also appealing to patients in that it is an organic approach to rejuvenation using one’s own tissues to help repair itself.While this cosmetic application of a platelet concentrate is new, the concept is not. PRP (platelet-rich plasma) concentrates have enjoyed widespread use in healthcare in the past decade, particular in orthopedic and musculoskeletal medicine. Numerous companies have PRP technology and application devices. What makes Selphy unique is that they have made a more simple in-office device at a low cost, which are the requirements needed if cosmetic use will gain any popularity.
While the Vampire facelift (perhaps better understood as a PRP filler) treatment sounds intriguing, it is not known if it will last any longer than that of off-the-shelf injectable fillers. The theory is biologically appealing but whether it actually works has not been conclusively shown. I commonly mix PRP concentrates with fat injections with the theory that the platelets may stimulate better fat preservation or stem cell conversion into adipocytes and/or fibroblasts. This is employing the identical approach but with a different substrate. Time will tell if these biologic injectable mixtures will live up to their theoretical benefits. Dr. Barry Eppley
Indianapolis, Indiana
Sunday, 3 July 2011
The Naso-Labial Fold..Is It Normal??
Many of the most recognisably beautiful women have definite Naso-Labial folds.
It does not detract from their beauty.
However not a week passes at our clinic without requests for treatment of a patients naso-labial fold. Sadly this focus remains an unfortunate obsession amongst many cosmetic patients and often a poorly understood phenomenon in our profession. The genesis of the fold is complex and multi-factorial. Fundamentally the naso-labial fold (and the labio-mental {marionette} grooves below) deepen due to contraction (or atrophy/involution) of the teeth and bones surrounding the mouth.
Filling these depressions with injectable fillers and even relaxing them a little with muscle relaxant injections can improve them a little, but not for long. If you place a finger on the naso labial fold you will feel the root of the tooth only millimeters under the skin. So there is very little distensible tissue for a filler to go. So what is the answer? There is a growing appreciation that treatment of the cheeks above and the lips below focuses the eye's attention to the aesthetic improvement in these far more important regions of beauty (and as a bonus can also indirectly improve the folds).
Furthermore some minimally invasive per-cutaneous tissue lifting through tiny skin punctures can improve the aesthetics a little further. The most famous plastic surgeon in history, Professor Ivo Pitanguy recognised this issue in 1999. The conclusion from his published paper on "Round Lifting" is reproduced below as well as a little history of this illustrious colleague.
Treatment of the Aging Face Using the “Round-lifting” Technique
Ivo Pitanguy et al
Department of Plastic Surgery, Pontifical Catholic University of Rio de Janeiro, Brazil
Aesthetic Surgery Journal, Volume 19, Issue 3, May-June 1999,
"There is as yet no ideal solution for the surgical correction of the naso-labial fold component of the aging face. However, all of the techniques described are considered safe and have precise indications. It should be stressed to the patient that the nasolabial fold is part of the anatomy of the face and that the goal of treatment is to soften the appearance of the fold, not to eliminate it completely."
"Ivo Pitanguy is famous throughout the world, but in his native Brazil he’s a legend, eclipsed in public recognition only by Pelé, the soccer god. That a plastic surgeon could reach this level of renown says something about the Brazilian worship of physical beauty and, of course, Pitanguy’s knack with the knife, for which he’s been dubbed “the Michelangelo of the scalpel.” But the doctor clearly possesses other, more subtle qualities as well. “Pitanguiser,” a word coined in the local Portuguese dialect, translates as “human charisma, intelligence and compassion.” In our harshly clinical Nip/Tuck culture, Pitanguy has said he sees his business as “the search for harmony between body and soul.”
Read More http://www.wmagazine.com/beauty/2008/07/ivo_pitanguy#ixzz1R36OHbG6
It does not detract from their beauty.
Filling these depressions with injectable fillers and even relaxing them a little with muscle relaxant injections can improve them a little, but not for long. If you place a finger on the naso labial fold you will feel the root of the tooth only millimeters under the skin. So there is very little distensible tissue for a filler to go. So what is the answer? There is a growing appreciation that treatment of the cheeks above and the lips below focuses the eye's attention to the aesthetic improvement in these far more important regions of beauty (and as a bonus can also indirectly improve the folds).
Furthermore some minimally invasive per-cutaneous tissue lifting through tiny skin punctures can improve the aesthetics a little further. The most famous plastic surgeon in history, Professor Ivo Pitanguy recognised this issue in 1999. The conclusion from his published paper on "Round Lifting" is reproduced below as well as a little history of this illustrious colleague.
Treatment of the Aging Face Using the “Round-lifting” Technique
Ivo Pitanguy et al
Department of Plastic Surgery, Pontifical Catholic University of Rio de Janeiro, Brazil
Aesthetic Surgery Journal, Volume 19, Issue 3, May-June 1999,
"There is as yet no ideal solution for the surgical correction of the naso-labial fold component of the aging face. However, all of the techniques described are considered safe and have precise indications. It should be stressed to the patient that the nasolabial fold is part of the anatomy of the face and that the goal of treatment is to soften the appearance of the fold, not to eliminate it completely."
"Ivo Pitanguy is famous throughout the world, but in his native Brazil he’s a legend, eclipsed in public recognition only by Pelé, the soccer god. That a plastic surgeon could reach this level of renown says something about the Brazilian worship of physical beauty and, of course, Pitanguy’s knack with the knife, for which he’s been dubbed “the Michelangelo of the scalpel.” But the doctor clearly possesses other, more subtle qualities as well. “Pitanguiser,” a word coined in the local Portuguese dialect, translates as “human charisma, intelligence and compassion.” In our harshly clinical Nip/Tuck culture, Pitanguy has said he sees his business as “the search for harmony between body and soul.”
Read More http://www.wmagazine.com/beauty/2008/07/ivo_pitanguy#ixzz1R36OHbG6
Saturday, 2 July 2011
The Eyes Have It-Windows To The Soul
The incomparable Donald Duck knows the hypnotic power of the eyes in the cartoon "The Eyes Have It" http://www.youtube.com/results?search_query=the+eyes+have+it&aq=f
"The eyes are the window to the the soul."
http://the-windows-to-your-soul.webs.com/inalltheirglory.htm
The following are links to excellence in upper eyelid rejuvenation surgery, in many ways similar to what we endeavour to achieve in approach, technique and outcome at our clinic.
http://www.youtube.com/watch?v=kH0Cl1U8h74&feature=related
http://www.youtube.com/watch?v=VCszUm0Pu_c&feature=related
http://www.youtube.com/watch?v=Stjxzc5J5TE&NR=1
Engaging eyes, fulsome cheeks, generous mouth and a sleek jawline and neck are the fundamentals of a beautiful feminine face
Sophia Loren
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