Think Young and Beautiful Now by Dr. Tomasello

When Michelangelo was asked about a woman he painted in the Sistene Chapel, he stated she was “worthy of admiration simply because she exists; perfection and imperfection together.” These are sage words from a man who, 500 years later, continues to be admired for his depiction of both young and older beautiful women. It’s like a disease. Women stare into the mirror repeatedly analyzing every blemish, spot, discoloration, line, wrinkle, scar or other perceived imperfection. Feelings range from discomfort to helplessness to utter disgust. Many women who are beautiful unfortunately do not ‘see’ themselves as beautiful. I entered this profession to help people with this problem. Unfortunately, even with all the medical aesthetic procedures available, there are limitations. Despite strides we may make to enhance one’s personal beauty … perceived imperfections may remain.

Do you feel young and beautiful?

We have all heard ‘beauty is in the eye of the beholder.’ However, what if you are the beholder and you don’t see beauty in your reflection in the mirror?

Why do so many women struggle with this? Two points need to be stressed.

  1. You are not necessarily to blame for being critical of your appearance … you have been programmed to be this way.
  2. Give yourself a break. Odds are you are far more beautiful than you think.

Understandably, those delving into the realms of skin care and antiaging for the first time are sure to be overwhelmed. With ongoing research, new products and improved treatments available every year, even the savvy skin care expert may find it a challenge to keep up. While this book will explore every nuance to lookingyounger, the idea of feeling younger needs to be addressed at the outset. You see, there are countless ways to make you look younger. Feeling younger is another story. Sophia Lauren said it best when she noted:

“Nothing makes a woman more beautiful than the belief she is beautiful.”

I have dedicated the last 12 years of my professional life to helping people (primarily women) look more beautiful and presumably feel more beautiful. However, anyone involved in the medical aesthetics profession, from clinic manager to aesthetician to doctor knows that improving outer beauty does not equate to an inner feeling of beauty.

Why does one woman come in to the office, receive a simple treatment, check the mirror and say “beautiful” and walk out smiling while others struggle? Some are never satisfied with their appearance no matter how extensively or how frequently they receive treatments.

When you see a picture of a beautiful woman, don’t believe for a second they believe they are as beautiful as you think they are. In fact, my experience is that someone who is considered gorgeous by most, quite commonly is unable to see the beauty the rest of us see.

Our self-image develops through a complicated interplay between cultural ideas, life experiences, the media and accumulated comments by others. The end result is not necessarily a distortion of reality, it is ourreality. Studies have shown that a person’s eye is drawn to the eyes and nose of someone they meet or when viewing a picture of an unknown individual. If a young girl was teased about having a big nose, regardless of how beautiful she is as an adult, chances are she is going to check that nose when she looks in the mirror. She will focus on it more than most anyone else will.

Women who suffered through years of acne as a teen will understandably become unsettled with a new pimple. One woman is focused on a pimple and another focused on her nose. Largely it is human nature. My goal is certainly help you to look and feel younger. Point is, looking younger and feeling younger doesn’t always go hand in hand.  Changing one’s self –perception is very possible, in fact probable, if you first become aware of it.

When you meet someone, or look at a picture of them you are seeing a single moment in time. In their mind lies a culmination of every positive or negative comment received throughout their lifetime. Vanderbilt University psychologist, David Schlundt notes, “All of your experiences, all the teasing you went through as a child, all the self-consciousness you had as a teenager, and all the worrying about whether you would be accepted as good enough or attractive enough are called forth in how people think of themselves.”

Dr. Vivian Diller, a psychologist and past Wilhelmina model who treats X-dancers and models agrees, “Your upbringing and the criticisms you heard as a child set a strong foundation for your self-perception in adulthood.” Conversely, those who believe themselves to be beautiful may not be beautiful at all by society’s standards. Chances are, in the formative years they received a steady diet of positive feedback from friends and loved ones.

The point to remember is that everyone has beauty. However, the beauty you have is under attack. You are programmed to think you need to be more beautiful than you are. It is not your fault whatsoever. In order for you to feel beautiful about yourself, it is of paramount importance that you become aware of what it is around you that is literally attacking your sense of inner beauty.

The multi-billion dollar cosmetic, skin care and hair industries are well aware that many do not feel beautifulenough. This comes in many forms; the media, the corporate world and society in general.

Imagine opening up a copy of Cosmopolitan or Vogue magazine. There is an image of a woman poised to sell you a product or service. Let’s say it is an anti-aging moisturizer. She is blemish, wrinkle and age spot free with a radiant and glowing face. She will have a flat stomach, thin legs and her weight will be 25% less than the average weight of a US female. (For the record in the US = 5 Ft. 4 in and 166#). What is the message? Buy this product and look like her. We use the product and while it might help, most women are not going to look like ‘her’. Maybe you just need to buy more … or perhaps there is a more expensive option to look beautiful! The corporate world does not want you to feel completely satisfied with your looks. You are exposed to this repeatedly over and over until you literally become programmed into believing that you need to look better than you do.

Nobody goes to see a Star Wars movie and leaves worrying that Darth Vader is going to attack them in the parking lot. It’s fantasy. It’s not real.  The ads you see of perfect faces and bodies are, in many ways, fantasy as well. I know I will never be as handsome as George Clooney, Elvis, or Cary Grant, but I can make strides to move in that direction. Moving in the right direction is good. Expecting to fully get there along with the body of Michelangelo’s David, is setting me up for disappointment. I know that.  Try your best to know it too. Advertisements are just that, someone trying to sell you something. Realize it and absorb it. You don’t see these people in your typical day walking through the grocery store, mall or Walmart. If you did, you and everyone around you may do a double take.

In the 21st century social media comes at us as well. Teenagers and young adults are exposed to a barrage of social media images that many of us were not when we were teens.  Facebook, Instagram, and  Twitter are part of our psyche and are chuck-full of more images for our youth (and adults) to look at and compare to. These platforms are perfect venues for women to show others how beautiful they are. Many are on the edge of their seat to see how many ‘likes’ they can get. This can help some feel beautiful, and others feel less beautiful.  National Institutes of Health researcher, Heather Patrick states, “We compare how we think we look to how other people look, and make a decision about whether we’re much better or much worse.”

When it comes to getting a job, beauty matters big-time. Whether the hiring manager admits to it or not is immaterial. In a study performed in St. Louis, researchers looked at perceived beauty vs. income. People perceived as ‘beautiful’ made 14% more than those perceived to be unattractive.

I began as a family physician where we are taught to treat the entire person. Many come to a doctor’s office or medical spa in an attempt to enhance their beauty or simply look younger. There is nothing wrong with this at all. Having the right skin care regimen or medical aesthetic procedures can make a world of difference. Unlike many skin care professionals, I do not stop there. Let’s take it a step further. After you have had a procedure or treatment to make your appearance more aesthetically pleasing, let’s look at how we can allow that outer beauty to seep inside.

Identify and replace negative inner dialogue:

Inner dialogue: During a typical day ask yourself four important questions:

  1. What did I see or hear today that made me question my beauty?
  2. What did you saying to yourself?
  3. What feelings arose in you? Are you happy? Angry? Disappointed? Anxious?
  4. How often are you saying it?
The Young and Beautiful Replacement: 

If that inner dialogue is telling you things like “I am not pretty enough” or “I will never be as beautiful as _____,” replace it with something positive. This may seem trite or silly (I thought it was the first time I tried it) but study after study as shown that what we tell ourselves has an immense impact on many aspects of our life. It improves posture, sleep, productivity and reduces fear and anxiety.

As yourself: “What is good about you? Are you a good friend? Devoted mother? Valued employee?” And … “What do you like about your appearance?” Beauty may be in the eye of the beholder but if the beholder is you and you don’t like what you see in the mirror, we need to change something. The best results are changes to the outside and inside.

Never underestimate how powerful this inner dialogue can be. We are talking about beauty here, however women (and men) have had an inner dialogue that convinced them to stay in an abusive relationship and have died in many cases because of it. Heavy duty stuff for sure but it makes my point of how powerful our inner dialogue is.

My suggestion is that when this nasty inner dialogue tries to take a hold of your psyche, identify it and replace it with something … anything positive. It is like throwing water on a tiny fire before it gains momentum and literally burns up your self-image. You are beautiful … don’t forget it.

Thank you for reading and be well … and beautiful.

Dean M. Tomasello, MD

Alpha Lipoic Acid and Beautiful Skin - by Dr. Tomasello

Alpha Lipoic Acid is a powerful antioxidant

Alpha lipoic acid (ALA) was discovered in 1951 as an essential ingredient of the mitochondria (powerhouse) of cells. Initial research showed that when additional alpha lipoic acid was made available to cells, it would quickly enter the cells and function as a powerful antioxidant. The beauty of ALA is that in addition to its own antioxidant power, it enhances the antioxidant effects of vitamins C and E. ALA has been called a ‘universal’ antioxidant due to the fact that it is both lipid and water soluble. This is important because it means that ALA is capable of exerting its antioxidant effects both inside the cell as well as between cells. Much of the free radical damage occurs on the surface of the cell (cell membrane) as well as between cells. ALA, being present throughout these areas is able to exert an antioxidant effect far superior to many other antioxidants.

Fighting Inflammation

Skin inflammation causes skin damage and plays an important part in the formation of lines and wrinkles. In addition to the antioxidant effects, ALA prevents the production of cytokines; key substances seen with inflammation. ALA also has the ability to prevent certain messenger cells associated with production of inflammatory enzymes known to harm the cell or even collagen. Therefore, through multiple pathways, ALA not only prevents inflammation but also has the ability to prevent many of the precursors to inflammatory cells.

Boosting Metabolism

Alpha Lipoic Acid (ALA) has the ability to affect metabolism in the cell as well. ALA is normally found in the mitochondria of the cell (the cells powerhouse that determines the metabolic rate of the cell). ALA gives a boost to the metabolic rate of the cell which is of utmost importance in anti-aging. Through improvements in the energy levels of the cell, ALA helps the cell more quickly absorb nutrients, remove waste and repair damage.

Sugar and your Skin

Sugar (glucose) is necessary for our cells to stay alive and function normally. However, excess sugar in our skin cells interacts with collagen to cause the development of cross-links which makes collagen inelastic and inflexible. This cross-linking of collagen leads to the formation of wrinkles. Collagen is a protein and when sugar attaches to it (a process known as glycosylation) cross-linking and stiffness of collagen result. Here ALA comes to the rescue once again. Through prevention of glycosylation, ALA has the ability to keep the sugar molecules from attaching to collagen (protein) thus allowing the collagen to remain smooth and elastic.

Alpha Lipoic Acid Uses

Alpha Lipoic Acid (ALA) has been successfully used as part of a treatment plan for Rosacea. It helps to improve skin texture and tone and helps fade fine lines and wrinkles. Puffiness under the eyes or enlarged pores respond quite well to treatment with ALA. I have found that the use of ALA seems to show the greatest improvement for those with a very dull complexion.

Author: Dean M. Tomasello, MD

Source: www.clearskinmd.net

Anti-Wrinkle Skin Care by Dr. Tomasello

An anti wrinkle skin care ingredient is one that helps reverse the aging process. Hence, these anti-aging ingredients are, in effect, anti wrinkle agents. Let’s face it (no pun intended), when people buy skin care products, the most common reasons are to help their skin to look clearer and younger. Anti wrinkle skin care and anti-aging also means preventing wrinkles from showing up in the first place.

Anti-Oxidants are Anti Wrinkle

 

Free Radicals are atoms or groups of atoms with an odd (unpaired) number of electrons.  This happens when oxygen interacts with certain molecules causing oxidation. Once formed these highly reactive radicals can start a chain reaction, like dominoes. The reactive oxygen will go around seeking another electron. In its search it causes chaos and damage.  It attacks the cells around it; cell proteins, membranes, the outside of the cell (cytoskeleton), the inside of the cell, even the cell’s DNA is at risk. Free radicals form in your skin in response to a multitude of environmental factors including UV rays, heat, cold, smoking, pollution, dust, dietary factors, and allergens to name a few. Antioxidants are anti wrinkle vitamins. They neutralize free radicals AND stimulate collagen production, repair cells and fade redness. Our skin makes its own antioxidants and tries desperately to keep up and clear away all the free radicals but commonly falls short of neutralizing them.

There are countless products available that contain antioxidants.  What is important to remember is certain ingredients are excellent antioxidants. These products are anti wrinkle and are of paramount importance in anti-aging skin care. Look for them in your skin care products and don’t just trust a label that says “anti-oxidant.” These ingredients prevent damage now resulting in more beautiful skin today … and tomorrow.

My Go-To Anti Wrinkle AntiOxidants

Vitamin A (Retinol) – A high power antioxidant and an anti-aging gem.

Vitamin C –  Vitamin C cream needs to be Lipid Soluble (vs. Water Soluble) so it can penetrate the skin to do its multitude of good deeds. First it rids our skin of free radicals, next it stimulates collagen (anti wrinkle), reduces skin discolorations, strengthens the skin’s barrier and reduces inflammation. It also helps the skin withstand UV exposure whether sunscreen is being used or not. Vitamin C breaks down on UV and air exposure so should come in a closed container such as a pump.

Vitamin E (Alpha-tocopherol) –  Found in our body’s membranes and tissues. The alcohol based Alpha tocopherol penetrates the skin best (vs. alpha-tocopherol-acetate). So make sure you read the label and get alcohol based Vitamin E. The attributes to Vitamin E are many. It boosts collagen to reduce fine lines and wrinkles, helps fade age spots and has been shown to decrease sunburn damage and dryness if used prior to UVB exposure. Offering antioxidant properties coupled with less swelling, redness, inflammation and wrinkles makes Vitamin E one of my favorites.

Green Tea – Green tea has polyphenols. The best anti wrinkle polyphenol is CATECHIN, which green tea has. Here is your antioxidant powerhouse. Through this it clears free radicals, prevents cell damage, repairs wrinkles and reduces inflammation.

Resveratrol – This antioxidant is found primarily in grapes, nuts, fruits and red wine. When resveratrol is applied to the skin it protects against damaging UVB rays. Similar to Green Tea, Resveratrol has polyphenols which are strong antioxidants.

Lycopene – Found primarily in red fruits and vegetables, this powerful antioxidant clears free radicals, promotes collagen production thereby reducing fine lines. Lycopene exerts strong anti wrinkle power.

Kojic Acid  Kojic acid is a powerful antioxidant as well as an inhibitor of melanin production. Hence, in addition to clearing free radicals, it helps fade age spots, freckles and melasma.

Anti Wrinkle effects of Alpha and Beta Hydroxy Acids

Alpha and Beta Hydroxy acids have become increasingly popular due to the many ways in which they help to improve our skin. Alpha and Beta Hydroxy acids are used for anti-aging, reversal of sun damage and treatment of acne.  The primary difference in the uses of these two types of acids is related to their solubility (what they dissolve in). Alpha hydroxy acids are soluble in water (water soluble) while Beta Hydroxy acids are soluble in oil (lipid soluble). These differences dictate which one to choose to treat certain skin conditions.

Anti wrinkle
Lactic Acid

ALPHA HYDROXY ACIDS (AHAs)

Common Alpha Hydroxy Acids include Glycolic (from sugar cane), Lactic (from milk), Malic (from apples), Citric (from citrus fruit), and Tartaric (from grape wine). Glycolic acid is the smallest molecule and its small size allows for deeper skin penetration. Hence Glycolic Acid is the AHA used most widely.

AHAs work in several ways to improve the appearance of the skin. Their most important role is skin exfoliation. The term ‘exfoliation’ is defined as removal of the surface. The normal life span of skin cells is 2-4 weeks. Once the skin cells have died they are sloughed to the outer skin surface. The AHAs clear these dead cells from the underlying healthy living cells by basically removing the glue that is holding these dead skin cells to the epidermis (the upper skin layer). Removal of this dead skin layer helps the new, vibrant skin beneath grow and flourish.

Since AHAs (particularly Glycolic Acid) penetrate deeply, they also stimulate the growth of deeper supporting components of the skin (Collagen and Elastin). Glycolic, Lactic and Citric acids work particularly well at increasing collagen and skin thickness. Continued use of these AHAs will therefore help to ‘fill in’ wrinkles making the skin smooth and even. AHAs clearly play a role in reducing unwanted or uneven skin pigment as well.

With AHAs we have newer and more vibrant skin with a boost of the ‘architecture’ supporting it.

Anti Wrinkle
Salicylic Acid

BETA HYDROXY ACIDS (BHA)

Salicylic Acid is the primary Beta Hydroxy Acid (BHA) used in skin care. Salicylic Acid is a derivative of Aspirin giving it anti-inflammatory properties. Salicylic Acid also brings anti-irritant, anti-redness, and anti-microbial properties. Unlike AHAs, BHAs are soluble in oil (lipid), resulting in deep penetration into the sebum-containing pore. Thus, BHAs clear sebum and dead skin cells built up inside the pore. This makes BHAs an excellent choice for use on oily skin or skin with blackheads or whiteheads (acne).  Deep penetration into the pore and clearing of sebum and dead skin cells is what it does best. BHAs seem to work best at lower concentrations (around 2%). Use of BHA has been shown to reduce wrinkles and pigment caused by sun damage if used for six months.

SIMILARITIES

AHAs and BHAs both do a beautiful job of exfoliating the skin (clearing away dead skin cells). AHAs can be more irritating and it is best to start using them every other day initially, while BHAs are effective at lower concentrations and tend to be preferred by dermatologists as they are less irritating.

Both AHAs and BHAs, through clearing dead skin cells and increasing cell turnover, can improve the thickness of the skin, improve the skins barrier properties as well as stimulate growth of the supporting components of the skin (collagen and elastin). More collagen and elastin = less wrinkles.

Regardless, when using AHAs or BHAs you need to wear sun block. These acids, through lowering the skin PH, clearing away dead skin cells and removing protective oils, make you up to 50 % more likely to sunburn. Make sure to use a sun block to protect against both UVA and UVB when using products containing AHAs and BHAs.

Fighting wrinkles is going to take time and consistency in your skin care regimen. Remember, fighting wrinkles starts with prevention … then treatment if they occur. Your two big guns at fighting wrinkles as defined here are antioxidants and chemical exfoliation agents. I can not stress the importance enough of incorporating these anti wrinkle factors into your skin care regimen. As always consistency is key.

Author: Dean M. Tomasello, MD

Source: www.clearskinmd.net

Anti-Aging and your Eyes by Dr. Tomasello

Are your eyes giving your age away? Or even worse – making you look older than you actually are? Without a doubt, the area around your eyes is one of the very first areas of your face to succumb to aging. Studies have shown that upon meeting someone, people look first at a person’s eyes … then nose and mouth. Having dark circles, bags or wrinkles is not the first impression you want to give. The subcutaneous fat (beneath the epidermis and dermis) serves as a type of cushion and support to these upper layers. The skin around the eye is very thin and delicate, containing very little of this subcutaneous fat. This fragile skin becomes even thinner as we age and hence more vulnerable to signs of aging. These changes commonly arrive as unwelcome dark circles, puffiness, fine lines and wrinkles. Let’s take a look at some aging changes around the eyes and how we can reverse or prevent them, keeping your eyes youthful, clear and vibrant.

Eyes: Dark Circles Causes : Genetics / Poor Sleep / Allergies / Eye Irritation / UV Rays

Genetics can play a role in literally any aging seen around the eyes. Dark circles are no exception. People with very fair skin tend to have even thinner than average skin around their eyes. When blood in tiny capillaries pools in this area under the eye it is much more noticeable in those with fair skin. When these capillaries are dilated it gives off a bluish hue. With poor sleep or stress, the problem is exacerbated. Fatigue causes the blood flow to become even more sluggish.

Seasonal allergies (and other allergies including food allergies) and chronic eye irritation cause the body to release a substance called histamine. Although the body is releasing histamine in an attempt to protect itself, around the eyes it simply causes further swelling of the blood vessels and even darker circles. People with chronic eye irritation from allergies or contact lenses make matters worse by rubbing that thin, delicate skin around the eye. UV rays contribute to the problem through an increase in the presence of free radicals and melanin secretion. This makes the circles even darker.

Dark Circle Treatments:

Wear sunglasses – A great way to block those UV rays. Sunblock – In terms of sunblock around the eye, it should contain zinc or titanium oxide which will fully block the UV rays. These ingredients are also less likely to cause eye irritation. Use a moisturizer with a humectant (like hyaluronic acid or glycerin) which will attract moisture to the area, plumping it up slightly so the capillaries are less visible. Take an anti-histamine medication. Speak with your doctor first, but note that Claritin is over the counter and is probably one of the ‘cleanest’ medications out there in terms of good results with rare side effects. I have recommended it for years. Use creams with brightening agents. My favorites include Niacinamide (vitamin B3), Vitamin C, Vitamin C-Ester and Hydroxyquinone. These have been shown to fade excess melanin in the tissues. Have a medical aesthetic treatment. Dermal fillers to the tear tough area (under the eye) with fillers like Belotero or Restylane can be very helpful as can LED treatments. In terms of cosmetic lasers, the use of a Q-Switched 1,064nm laser has been shown to be effective in the treatment of these dark circles.

 

Eyes:Puffy or Baggy Causes: Genetics, Diet (salt), Allergies, Alcohol, UV Rays

Some individuals have puffy eyes based on their genetics. They have larger fat pads around the eyes which can become more visible as they age. The skin around the eye is thin and delicate and is quick to show excess fluid in the body (i.e. puffiness). Alcohol consumption and salty food are two main culprits causing fluid retention and puffy eyes. Stress and/or lack of sleep make matters worse.

Allergies and eye irritation can also exacerbate eye puffiness due to histamine release. UV rays cause more free radicals which can make eyes even more puffy and irritated. In some cases hormonal changes seen with menopause or hypothyroidism may be the cause.

In some fortunate people, gravity itself will help the puffiness resolve once their head is elevated in the morning. This is not always the case.

Puffy or Baggy Eye Treatments/Preventions

Diet: Avoiding alcohol and salty food is a start. Dietary choices can help even more. Foods that are high in anti-oxidants/anti-inflammatory ingredients like green leafy vegetables and vitamin A and C-rich fruits can be very beneficial as can seafood high in omega 3 fatty acids such as salmon and tuna. Allergies or Contact Lens Irritation: As noted above, in some people these allergies/irritations can cause dark circles. In others, the release of histamine results in swelling around the eye. Over the counter histamines can be very helpful in this regard, as can anti-histamine eye drops. Make sure you are following the optometrist’s recommendation regarding cleaning and storing your contact lenses. Sleep with your head elevated: Gravity is not the friend of those with puffy eyes. Some find sleeping on their back on two pillows to be helpful. Provided you can sleep comfortably in this position, it may be worth a try. Hypothyroidism or Hormonal Changes: There indeed are more serious medical conditions with ‘puffy eyes’ showing up as a first symptom. It warrants investigation if your eyes have become puffy and remain so despite dietary changes. See your doctor. A simple blood test can determine if there are hormonal issues behind those puffy eyes. Wash your makeup off before bed. Makeup around your eyes can cause eye irritation resulting in excessive puffiness in the morning.

Eye creams and serums: The use of creams and serums twice a day may be very helpful indeed. Choose one with ingredients such as aloe, vitamin E, and retinol. Cool your eyes down: We are all familiar with the cucumber slice over the eye for eye swelling. Whether it’s a cucumber, tea bag or cold spoon, it is the cold that is helping the puffiness, not anything else. I am not a fan of tea bags or cucumbers due to potential infection. If you want to cool your eyes down, I prefer reusable gel eye masks that can be chilled and disinfected between uses. Wear sunglasses and/or sunblock around the eye. Sunblock should contain zinc or titanium oxide which will fully block the UV rays. Surgical Options: If 1-8 above are not effective (which commonly is the case in those who have genetically large fat pads) speak to a cosmetic surgeon about blepharoplasty. This is a way to surgically correct droopy eyelids or bags under the eyes.

EYES Fine Lines and Wrinkles Causes: UV Rays, Genetics, Eye Strain

Every time you smile, laugh, squint, frown or yawn the small muscles around your eyes contract. In doing so, they are repeatedly scrunching the skin and collagen between them. Over the years, fine lines form and later become deep wrinkles. These creases fan out from the corner of your eye, hence the well-known title “crow’s feet.” Normal movement of the muscles around our eyes can be exacerbated by eye strain/squinting. UV rays and the free radicals they form make matters worse.

Fine Line and Wrinkle Treatment: Block UV rays in the form of sunglasses or sunblock containing zinc or titanium oxide. I prefer SPF of 30+. Many people are very judicious about putting sunblock on their face and neck but miss the area around their eyes. Don’t skip it. Anti-oxidants – The use of alpha and beta hydoxy acids help remove dead skin cells and stimulate the growth of the supporting structures of collagen and elastin. Vitamin A (retinol) creams work similarly while speeding up cell turnover bringing fresher cells more quickly to the surface. Don’t forget antioxidants in the diet in the form of green leafy vegetables, vitamin A and C-rich fruits and omega 3 fatty acid rich seafood. Medical Aesthetic Treatments: Botox Cosmetic has been the gold standard for treatment of crow’s feet for 15 years. Through reversibly blocking nerve impulses the muscles around the eye do not contract and the area smoothens. Dysport and Xeomin work similarly. Other options include the injection of dermal fillers. For fine areas such as these. , the use of Belotero and Restylane has been successful. Other treatments such as microdermabrasion, chemical peels and microneedling can also improve the appearance of fine lines and wrinkles around the eye. Talk to your doctor or aesthetician about which medical aesthetic treatment may be best for you.

 

Author: Dr. Dean Tomacello

Resource:  https://www.clearskinmd.net

Dermal Fillers

Dermal fillers are #2 behind Botox as the most commonly sought after and administered medical aesthetic treatment. Botox may have a topical preparation lurking and potentially replacing it. Not so with dermal fillers; they are here to stay. It has now over 12 years since Restylane was FDA approved (December, 2003) and it would appear as though Ellanse will be the next dermal filler to hit the US marketplace. Dermal fillers are very popular. The reasons are obvious. They offer a safe and effective way to bring youthful results without expensive cosmetic surgery. Most patients who have had dermal fillers are happy and come back for more. However, with the arrival of new dermal fillers and different formulations it can be difficult to determine which filler works best for each ‘wrinkle.’ Dermal fillers are approved by the FDA for treatment of specific areas of the face. Radiesse was approved by the FDA for treatment of naso-labial folds back in 2006. Nine years later in 2005 it received an approval for “improvement of volume loss on the dorsum (back) of the hands.” Dermal fillers are FDA approved for certain areas with other uses designated as ‘off label’ uses.

The FDA and ‘off label uses

Regarding the “off label use” of dermal fillers. There is nothing wrong with a doctor injecting into an area other than the FDA approved area. Mark Jewell, MD, author of Safety with Injectables Workbook agrees. He says, “Off-label use is legitimate, it’s something a doctor discusses with the patient to meet the patient’s specific needs.” So provided the injector is experienced and the doctor and patient are in agreement, there is no problem injecting into areas that are ‘off label.’ It is important to note, however, that advertising off label uses should not occur.

Injector-dependent

Dermal fillers injection results are very injector-dependent. There is no other area of medical aesthetics where the experience, technique and artistic ability of the doctor, nurse or aesthetician are more important. Obtaining a beautiful and natural result has more to do with the ability of the injector than what filler is injected. Dermal filler injection is the most artistic realm of medical aesthetics. Here are the areas of the face that most people look to correct.

 

Need-To-Know Dermal Filler Factors

Certain factors need to be understood to deterine why certain fillers work better in certain areas of the face. These include the primary ingredients, cross-linking, particle size, concentration and G-prime.

Primary Ingredients

Hyaluronic Acid

Hyaluronic acid is a natural substance found in body tissues. It is a glycosaminoglycan that is present in the highest concentrations in connective tissue, cartilage, joint fluids and skin. Hyaluronic acid fillers draw water to themselves. This helps to increase the longevity of the filler provided the individual remains well hydrated. Dermal fillers composed of hyaluronic acid include Restylane, Juvederm, Belotero, Elevess, Prevelle, and Evolence.

Calcium Hydroxylapatite

Calcium hydroxylapatite is a mineral-like substance found in human bone. It is the heaviest of all dermal fillers. While hyaluronic acid fillers are clear in appearance, calcium hydroxylapatite appears milky white. A benefit of injection of this type of dermal filler is that it stimulates collagen formation. The primary example of a Calcium Hydroxylapatite filler is Radiesse.

Poly-L-Lactic Acid (PLLA)

PLLA is a synthetic dermal filler that is injected ‘throughout’ the face. In doing so, similar to Radiesse, it stimulates the production of collagen. This filler is different than other fillers in that it does not produce immediate results. Rather, through the stimulation of collagen formation in the dermis, the results appear gradually over several months. Sculptra is the only FDA approved PLLA dermal filler.

Polymethyl-Methacrylate (PMMA)

PMMA fillers are composed of PMMA microspheres suspended in purified collagen gel. Months following injection the gel breaks down and is replaced by your body’s own collagen. This is commonly referred to as a ‘semi-permanent’ filler but in truth it should be thought of as permanent. PMMA is not metabolized so in-effect it is permanent. An example of this filler is Bellafill. This filler is associated with lumps, nodules, granulomas and requires many injections. I do not recommend it. There are far better options.

Cross Linking

In the discussion of hyaluronic acid fillers, cross-linking is of particular interest. The natural liquid form of hyaluronic acid is quickly metabolized by the body in less than 24 hours. Cross-linking transforms the liquid form of hyaluronic acid to a gel form. Cross-linking dramatically slows the body’s ability to metabolize the hyaluronic acid. Hence, the cross-linked hyaluronic acid fillers will last many months. Dermal fillers with more cross-linking of hyaluronic acid last longer.

Particle Size and Concentration

As a general rule, dermal fillers with higher concentrations and particle sizes tend to be better for deeper injections. A dermal filler with a higher concentration is typically felt to last longer. For instance, Restylane has a concentration of 20mg/ml while Juvederm Ultra’s is 24mg/ml. However, Restylane comes in a 1.0 ml syringe while Juvederm Ultra is a 0.8ml syringe.

Dermal filler concentration is commonly described as ‘particles per ml.’ More particles per ml equates to a smaller particle size. Larger particles tend to last longer and are better for deeper injection. As an example: Restylane’s concentration is 100,000/ml, Restylane Lyft’s is 10,000/ml and Restylane Silk’s is 500,000/ml. Clearly, Lyft is better for deeper injection while Silk would be preferable for more superficial injection to delicate areas.

G-Prime

A dermal filler with a higher G-prime is thicker, heavier and ‘harder.’ They are more resistant to disintegration however may be more painful to the patient when injected. Dermal fillers with a higher G-prime are typically injected deeper into the dermis. They are better suited for injection into deeper folds such as the nasolabial fold or for increased cheek volume. I prefer fillers with a higher G-prime when I desire a ‘lifting’ effect in the cheek area. It is important to note, however, that simply having a higher G-prime does not necessarily equate to a better ‘lifting effect.’ A product such as Juvederm Voluma has a G-prime lower than other dermal fillers yet has an excellent lifting effect. In truth, the lifting effect involves several factors including G-prime, concentration, and ability of the filler to intertwine (or ‘grab’) surrounding tissues. Although Juvederm Voluma has a lower G-prime, it has a superior ability over many other fillers in its ability to intertwine with surrounding tissues. Examples of higher G-prime fillers include Radiesse and Restylane Lyft. Dermal fillers with a lower G-prime are thinner and lighter. They are better suited for injection into delicate areas such as the tear troughs, lips or other superficial wrinkles. Examples include Restylane Silk and Belotero.

The Tyndall Effect

This is an effect that can occur with some hyaluronic fillers when injected superficially. This effect is the result of light reflecting off of the filler giving a bluish hue. We know hyaluronic fillers all have distinct cross-linking, concentrations, particle sizes and G-primes Fillers with more cross-linking and a higher G-prime are better suited for deeper injections to add more volume. They are also more likely to produce a Tyndall effect thus should not be injected superficially. Belotero boasts that its low G-prime and variable cross-linking attributes make it stand alone as the only filler which can be injected superficially and never result in Tyndall effect. I do agree with this. However, the presence of the Tyndall effect is something exceedingly rare in my experience. The likelihood of this effect occurring increases the more superficial the filler is placed. I have seen case reports of these occurrences. In most cases it appears as though the filler was placed at the top of the dermis or even intra-EPIdermally.

All these features of dermal fillers can indeed get confusing. Essentially, dermal fillers with larger particles, higher concentrations, higher G-prime and more extensive cross-linking tend to last longer, be bulkier, ‘stickier,’ add more volume, and are better suited for deeper injection into the dermis. Examples: Radiesse, Juvederm Voluma and Restylane Lyft. For fine and delicate and more superficial injection, fillers with a smaller particle size, lower concentration, less crosslinking and a lower G-prime are preferable. Based on these factors the following guide gives you my preference for which dermal filler ideally should be placed where. The choice of dermal filler relies heavily on the preference of the doctor and experience of the patient and injector. Some fillers shouldn’t be placed in certain areas however. For example, the consistency of Radiesse makes it an excellent choice for cheek augmentation but makes it a terrible choice for lips.

Original Article Source: https://www.clearskinmd.net/dermal-filler/