Facial Rejuvenation -- September 8, 2008 -- Dr. Deborah Sherman - NewsChannel5.com | Nashville News, Weather & Sports

Facial Rejuvenation -- September 8, 2008 -- Dr. Deborah Sherman


Medical Mondays News Notes
Deborah Sherman, MD, ocular plastic surgeon
SUBJECT: Facial Rejuvenation Options
DATE: Monday, September 8, 2008

The following are questions/topics which will be discussed:

1. What is an Oculo-plastic Surgeon?

2. What is a Hidden Incision Blepharoplasty and Endoscopic browlift?

3. Botox Injection - softens wrinkles caused by overactive muscles.

4. Filler Injections - fills lines of the face to create smoother,more youthful appearance.

5. Fotofacial RF: is a intense pulse light therapy for skin purification & facial rejuvenation

6. Medial microdermabrasion creating a healthy glow and improving the texture and appearance of aging skin.

The Brow Lift

Are you frustrated with sagging skin in your forehead region? Then the forehead lift and eyebrow lift, also called "the brow lift", may be just what you're seeking. This popular procedure is used to help reverse the aging process (think deep wrinkles and creases across your forehead caused by years of facial expressions and environmental effects). But don't be fooled. Younger people are also candidates if they have inherited traits, such as lowbrow or other problems such as deep frown.

What Is a Brow Lift?

The forehead lift is also known as an endobrow lift, an open brow lift, or a temporal lift. The procedure cosmetically corrects sagging in the forehead skin, upper eyelids and eyebrows.

Here's how:

Your surgeon will maneuver tissues and remove segments of muscles and skin that are responsible for wrinkles or deep frown. Sometimes, this procedure is performed in conjunction with a facelift or reshaping of the nose.

Think about it. You want your facial features to have the same contoured appearance. If you only have the work done on your forehead, other areas will appear more aged. If you are interested in learning about other procedures, you can discuss the options with your surgeon.

There are two methods to lift your forehead and eyebrow areas:

  • the classic lift
  • endoscopic lift.

The classic lift involves one continuous incision, beginning at the level of your ears and going up around your hair line. Depending on where your hair line is, the surgeon will move the incision line to avoid a visible scar. For instance, if you are a man who is balding, the surgeon can make the incision mid-scalp, so the scar can be hidden in the remaining hair.

Here's how the endoscopic lift differs: Instead of making one continuous incision, your surgeon will make a few shorter incisions in the scalp. He or she will insert a scope (small camera on the end of a thin tube) into one of the incisions in order to view the tissues and muscles from a screen. At the same time, he or she will use another device inserted in another incision to make the necessary alterations.

In this procedure, small anchors are used to secure the offending tissue once it's altered appropriately. Those anchors are tiny, but mighty. They'll keep your tissue under control for years. Because the incisions are smaller, this procedure is less invasive. You will experience minimal scarring and shortened recovery time.

The Day of Surgery

Typically, you can undergo this procedure at your surgeon's office, in a hospital or outpatient surgery facility. Your surgery should be completed within two hours and you will not normally need to stay overnight. However, you will need to bring someone along who can drive you home and, if you live alone, stay with you the first night or two.

Your surgeon will use local anesthesia. But, if it makes you more comfortable, you can request an anesthesia that will put you to sleep during the operation (general anesthesia). Once the operation has ended, your surgeon will close the incision areas with stitches or staples. Then he or she will cleanse the area to remove blood, etc. and cover the wound area with a soft, sterilized bandage that will surround your face.

It's very important to follow the instructions on how to care for the bandage and how frequently you should change it.

What To Expect After Surgery

Your recovery is going to vary depending upon which procedure you had: classic or endoscopic.

In either case, you will have stitches or staples in the incisions which will need to be removed in about a week. If you have temporary fixation screws, these will be removed in about two weeks (these fixtures are installed beneath the hairline to hold the elevated brow in place).

You will probably experience swelling and bruising, which can also affect other parts of your face, including your cheeks and eyes. The swelling should be gone in about a week. For at least two days following surgery, you should keep your head elevated to help alleviate the swelling, and you can gently apply ice packs to the affected region.

For those who undergo surgery via the classic method, you will most likely experience more pain during your recovery. Your doctor will give you a prescription for a painkiller. You may also experience more itching, which can last for a few months.

Those patients who undergo surgery via endoscopic method will also receive a prescription painkiller. Itching can also be a side effect for those who have undergone the endoscopic method, though it is much more mild than with the classic method.

In either case, you may also experience numbness or tingling. This will subside over time. Those who underwent the classic procedure may experience more numbing.

Most patients can return to work or school within 10 days, some sooner, depending on which procedure you underwent and your own personal rate of recovery.

You should be sure to avoid heavy lifting, vigorous exercise or other activity for the first few weeks after surgery.

Though the side effects are minimal, possible complications can include infection, scars, complications with eyebrow movement or the loss of sensation around the incision site. It's important to remember that these occur rarely.


Botox is the brand name of a toxin produced by the bacterium Clostridium botulinum. In large amounts, this toxin can cause botulism, which you probably associate with food poisoning. Despite the fact that one of the most serious complications of botulism is paralysis, scientists have discovered a way to use it to human advantage. Small, diluted amounts can be directly injected into specific muscles causing controlled weakening of the muscles.

The FDA approved such usage in the late 1980s upon the discovery that Botox could stop ailments like blepharospasm (uncontrolled blinking) and strabismus (lazy eye). Cosmetic physicians have been using Botox for years to successfully treat wrinkles and facial creases. In April 2002, Botox gained FDA approval for treatment of moderate-to-severe frown lines between the eyebrows - called glabellar lines. However, Botox is often used for other areas of the face as well.

How Does Botox Work?

Botox blocks signals from the nerves to the muscles. The injected muscle can no longer contract, which causes the wrinkles to relax and soften.

It is most often used on forehead lines, crow's feet (lines around the eye) and frown lines. Wrinkles caused by sun damage and gravity will not respond to Botox.

How Is the Procedure Performed?

The procedure takes only a few minutes and no anesthesia is required. Botox is injected with a fine needle into specific muscles with only minor discomfort. It generally takes three to seven days to take full effect and it is best to avoid alcohol at least one week prior to treatment. Aspirin and anti-inflammatory medications should be stopped two weeks before treatment as well in order to reduce bruising.

How Long Does a Botox Injection Last?

The effects from Botox will last four to six months. As muscle action gradually returns, the lines and wrinkles begin to re-appear and wrinkles need to be re-treated. The lines and wrinkles often appear less severe with time because the muscles are being trained to relax.

Collagen and Other Injectable Fillers

Collagen injections and other injectable fillers give your skin a plumper, smoother appearance. Although collagen is the best known filler, there are many other substances doctors can use to plump up your skin, including fat from your own body and synthetic materials. Below you will find a detailed explanation of how collagen works, followed by a list other other injectable fillers your doctor may suggest.


To understand collagen, you should first understand your skin.

Skin consists of three layers: the epidermis, dermis and subcutaneous tissue (hypodermis). The upper-most layer, known as the epidermis, controls the loss of water from cells and tissue. Without this protective barrier, the body would quickly dehydrate.

Just below the epidermis lies the second layer, the dermis. The dermis, although it contains blood vessels, nerves and hair follicles, is primarily made up of a protein called "collagen." This protein forms a network of fibers that provides a framework for the growth of cells and blood vessels. Because it is the primary component of the dermis, collagen acts as the support structure for the skin. The hpodermis is a layer of fat and connective tissue that contains larger blood vessels and nerves. It also hosts sweat glands, and fat and collagen cells. The hypodermis is responsible for conserving your body's heat and protecting your vital inner organs.

Why Do Lines Appear?

In young skin, the collagen framework is intact and the skin remains moisturized and elastic. It's resilient to the many facial expressions we adopt as well as everyday environmental exposure. But, over time, the support structure weakens and the skin loses its elasticity. The skin begins to lose its tone as the collagen support wears down. Every time you smile, frown or squint, you put stress on the collagen in your skin. The effect of these facial expressions is cumulative and facial lines begin to appear.

Why Aren't Creams Containing Collagen Enough to Smooth Out Lines?

Collagen creams work only on the skin surface. A moisturizer with or without collagen cannot penetrate the skin and is not designed to be absorbed. No moisturizer can undo the cumulative effect of collagen loss. Creams primarily slow the rate of water loss from the skin and help keep the skin supple.

How Do Collagen Injections Work?

Collagen injections replenish the skin's natural collagen. The natural beauty of your skin is enhanced as the contour of the support structure is restored.

Zyderm and Zyplast are bovine derived collagen products that replace the collagen your skin loses over time. Zyderm and Zyplast collagen are placed just beneath the skin, in the dermis where the body readily accepts it as its own.

CosmoDerm and CosmoPlast are bioengineered human collagen products that are used for similar indications as Zyderm and Zyplast but have the advantage of not requiring a skin test prior to the first treatment.

Collagen should be injected into your skin only by a trained health care professional. By supplementing your skin's own collagen, collagen replacement therapy helps smooth facial lines as well as most types of scars.

Other Injectable Fillers Include:

  • Artecoll is a synthetic filler material. Because it's synthetic, you are at higher risk of having an allergic reaction to it than if you got an injection of collagen or fat, but it lasts much longer than those options.
  • Autologen is an injection of your own collagen, extracted from another place on your body. There's no risk of allergic reaction, however, the results are only temporary.
  • Dermalogen is collagen extracted from deceased human donors. This is also a temporary fix, but your body should not reject it.
  • Fascia injections use a specific type of connective tissue harvested either from your own body or from a deceased human donor. It can be implanted surgically or injected. The main drawback is that within a year of injection, your body will reabsorb the fascia.
  • Fat from your own thighs or abdomen can be also be injected. There's no risk of allergic reaction and you may achieve permanent results. This can also be implanted surgically.
  • HylaForm is a material created from a natural body substance known as hyaluronic acid. There's no risk of infection, but you will need repeated treatments to maintain the result as it's only a temporary fix.
  • Restylane is a clear gel that also contains hyaluronic acid. It's biodegradable, so your body will absorb it within about six months of the injection.

What Can I Expect?

You should expect to receive a small injection of local anesthesia to numb the area being treated. Remember, there is a possibility of slight bruising, and you may experience puffiness, redness and tenderness around the treated site.

It's important to discuss with your physician exactly what you can expect from each treatment. Together, you can prioritize which facial areas are most important to you and discuss how many treatments you may need and the estimated cost. It's important to know that one treatment may not remove every line on your face.

Depending on the substance injected, you may need continued treatments to maintain the smoothing effect.

How Many Injections Will I Need?

That depends on which product you use. Just like natural collagen, collagen replacements begin to lose form and will eventually wear down. Treatment may require collagen injections 2 to 4 times a year to maintain the smoothing effects. Hylaform and Restylane are also eventually reabsorbed by the body. Synthetic materials such as Artecoll lasts longer, but carry a higher risk of allergic reaction. Fat, depending on how it is used, can sometimes achieve permanent results.


Dermabrasion and Microdermabrasion

Dermabrasion, or surgical skin planing, is a procedure in which the skin is frozen and then a specialized instrument is used to "sand" the skin. This abrasive or planing action improves skin contour as a new layer of skin replaces the treated skin. The new skin generally has a smoother appearance. The procedure is performed by a dermatologic or plastic surgeon.

Microdermabrasion (also known as "power peel") is more like softened sandblasting. It involves tiny crystals that are sprayed on the skin - and works best on superficial skin problems like fine lines, dull skin, brown spots, mild acne scars, and age spots.

When Is Dermabrasion or Microdermabrasion Used?

When dermabrasion was first developed, it was used predominantly to improve acne scars, pox marks and scars resulting from accidents or disease. Today, it is used to treat other skin conditions, such as tattoo scars, wrinkles, age (liver) spots, and other skin lesions. Dermabrasion is not effective in treating congenital skin defects, most moles or pigmented birthmarks, or scars due to burns.

Microdermabrasion can improve or eliminate superficial skin problems. It works on all skin types and colors -- producing subtle changes, causing no skin color change or scarring. However, it is not effective for deeper problems like scars, stretch marks, keloids, or deep acne scars.

With microdermabrasion, there is less down time than with dermabrasion; skin fully recovers within 24 hours. Another benefit: Microdermabrasion is a nonsurgical procedure. Therefore, there are none of the risks associated with even minor surgery like dermabrasion, where anesthetics are used and skin bleeds. It's ideal for people who cannot afford to take time off from work or social activities for healing.

What Happens Prior To the Procedure?

During the dermabrasion consultation, the surgeon describes the type of anesthesia to be used, the procedure and what results might realistically be expected. The doctor also explains the possible risks and complications that may occur. Photographs are taken before and after surgery to help evaluate the amount of improvement. Preoperative and postoperative instructions are given to the patient at this time.

With microdermabrasion, the same evaluation is done -- but with less talk about anesthetics, risks, etc., since there are none.

How Does Dermabrasion and Microdermabrasion Work?

Dermabrasion can be performed in the surgeon's office or in an outpatient surgical facility. Medication to relax the patient may be given prior to surgery. The affected area is thoroughly cleansed with an antiseptic cleansing agent and then your doctor will apply a special spray that freezes the skin.

A high-speed rotary instrument with an abrasive wheel or brush is used to remove the outer layers of the skin and improve any irregularities in the skin surface.

In microdermabrasion, tiny crystals are sprayed onto the skin in a gentle abrasion technique that removes the dead outer layer of skin. It is basically an exfoliation and skin rejuvenation procedure. Age spots and fine lines can be erased, creating softer, smoother skin that has a younger feel to the touch.

What Happens Afterwards?

After a dermabrasion procedure, your skin will feel as though it has been severely "brush-burned" for a few days. Your doctor can prescribe or recommend medications to help reduce any discomfort you may have, such as an over-the-counter pain reliever. Healing usually occurs within seven to ten days.

The newly formed skin, which is pink at first, gradually develops a normal color. In most cases, the pinkness largely fades by six to eight weeks. Makeup can be used as a cover-up as soon as the skin is healed.

Generally, most people can resume their normal activities in seven to 14 days after dermabrasion. Patients are instructed to avoid unnecessary direct and indirect sunlight for at least three to six months, and to use sunscreen on a regular basis when outdoors.

With microdermabrasion, skin is pink and feels dry and tight (like sunburn or windburn), for about 24 hours. Moisturizers should be applied. Some types of makeup should not be applied for at least 24 hours after the procedure.

Cosmetic Procedures: Treating Aging Skin

New innovations in skin rejuvenation continue to develop, ranging from topically applied "cosmeceuticals" to new surgical techniques. A thorough understanding of how your skin changes as you age and how the sun affects your skin can help you decide with your doctor what treatment is best.

How Can I Maintain Healthy Skin?

The best way to keep skin healthy is to avoid sun exposure beginning early in life. Here are some other tips:

  • Do not sunbathe or visit tanning parlors and try to stay out of the sun between 10 a.m. and 3 p.m.
  • If you are in the sun between 10 a.m. and 3 p.m. always wear protective clothing-such as a hat, long-sleeved shirt, and sunglasses.
  • Put on sunscreen lotion before going out in the sun to help protect your skin from UV light. Remember to reapply the lotion as needed. Always use products that are SPF (sun protection factor) 15 or higher. It is also important to choose broad spectrum products that privde both UVB and UVA protection.
  • Check your skin often for signs of skin cancer. If there are changes that worry you, call the doctor right away. The American Academy of Dermatology suggests that older, fair-skinned people have a yearly skin check by a doctor as part of a regular physical check-up.
  • Relieve dry skin problems by using a humidifier at home, bathing with soap less often (use a moisturizing body wash instead), and using a moisturizing lotion. If this doesn't work, see your doctor.

What are the Treatment Options for Aging Skin?

The doctor's palette of resurfacing options continues to expand. In patients with early skin aging changes, nonsurgical treatment methods such as tretinoin, vitamin C, and alpha hydroxy acids may provide satisfactory improvement. Chemical peels, dermabrasion and laserabrasion may be used alone or in combination with other surgical procedures to treat moderate to severe degrees of facial photodamage.

Deeper facial lines may be treated with botulinum toxin or soft tissue enhancement, including collagen, autologous fat, and Goretex implants. Patients with more sagging, excess skin may benefit from additional procedures such as a facelift, browlift, or blepharoplasty (surgical reconstruction of the eyelid). Treatment must be individualized according to the patient's facial characteristics and cosmetic concerns.

Here is more detail about some of the more popular treatment options:

  • Chemical peels. Chemical peels are effective for removing fine lines and smoothing out the skin. Chemical peels remove the upper surface of the skin to expose newer, clearer skin. After the upper layers of the skin have been removed, a new layer of skin develops. Chemical peels can be used in areas, such as around the eye and mouth, that are not improved by a facelift. Depending on the patient's skin type and degree of sun damage, a superficial, medium or deep chemical peel may be the appropriate treatment.
  • Dermabrasion. Dermabrasion removes lines and some scarring and can be used to treat moderate to severe photodamage (sun damage). In dermabrasion, the doctor sands away the top layer of skin, thus it has similar side effects and complications as medium to deep chemical peels. However, because of the bleeding associated with dermabrasion and variations in skill and technique, the control of wounding is not as accurate as with current resurfacing technology. Dermabrasion is not done on the thin skin around the eyes. Care must also be taken when dermabrading the skin around the mouth.
  • Laser resurfacing. In the past few years, the development of high-energy lasers has enhanced physicians' ability to improve photoaged skin, various types of scars and other dermatologic conditions. The precise depth control and ability to treat large areas in a relatively short amount of time makes these lasers valuable tools. Before laser resurfacing is performed, your doctor will discuss with you other treatment options, what to expect during recovery, how to take care of your skin after the procedure, and possible side effects and complications. Camouflage makeup suggestions will also be discussed.

Minimally Invasive Procedures Offer Less Risk Than Traditional Plastic Surgery

WebMD Medical News

(Vancouver, BC) -- As minimally invasive facial rejuvenation procedures become more widely available, more men and women are skipping traditional facelifts. But do these simpler procedures really work as well as traditional plastic surgery?

Depends on the procedure, the patient, and the perceived problem area, say experts speaking at the annual meeting of the American Society of Aesthetic Plastic Surgery (ASAPS) in Vancouver, British Columbia.

Examples of these less-invasive procedures are:

  • Thermage. This technique uses radiofrequency waves to tighten tissues, while cooling the skin to minimize redness
  • "Feather" lift. A technique that uses stitches to tighten sagging cheeks and necks,
  • Injectable wrinkle fillers. These include the recently FDA-approved Restylane and others in the works.

But are these youth defying procedures too good to be true?

Is Less More?

Minimally invasive techniques "are terrific for individuals who do not need more invasive procedures to enhance their appearance," says ASAPS president Robert Bernard, MD, a plastic surgeon in White Plains, N.Y.

"There is a very large segment of the population for whom less is more, but there is a very fine line between doing enough to make a difference to justify the cost and doing the procedure," says Peter B. Fodor, MD, a plastic surgeon based in Los Angeles. "A lot of patients would love rejuvenation in a bottle," he says

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