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Your one and only source for NYC's BEST in medicine, aesthetics, health and beauty. Since you can't always believe everything you read in the magazines or what we see and hear on the news. Premiere consultant and President of Integrated Aesthetics Consulting, Inc., Melinda Farina gives us the inside scoop on Manhattan's elite in the health and beauty industry and how to feel and look your best.
Direct email: firstname.lastname@example.org
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When opting to get a facial filler, it can be a bit confusing as to which filler does what, where each filler is best used and why it is best for those certain locations. I want to keep you as informed as possible regarding the different options that are available for non invasive facial rejuvenation. Dermal fillers can be used to plump thin lips, lift your eyebrows, define cheek bones, decrease hollowing under the eye to help reduce dark circles, decrease the appearance of smile lines and overall give you a well-rested and rejuvenated appearance. They can usually be done in less than an hour and have little to no downtime. In some people, dermal fillers may cause some mild bruising, temporary swelling, or temporary redness at the injection site; however these side effects will disappear within 24-48 hours. Below are the top 5 dermal fillers.
1. Juvéderm Ultra Plus XC
Main Ingredient: Hyaluronic Acid
Uses: Good for medium or deeper lines and wrinkles of the faces, such as the nasolabial folds. It is also useful for plumping up lips and cheekbones, and filling acne scars. This version of Juvederm is heavier than its counterpart Juvéderm Ultra. Hence, it is generally reserved for deeper wrinkles and lines and plumping up flattened areas. The XC version of Juvéderm Ultra Plus includes the addition of lidocaine. Lidocaine, an anesthetic, reduces the pain associated with injection.
How It Works: The hyalruronic acid absorbs water and augments the injected area.
Duration: The effects of Juvéderm Ultra Plus last about one year
Price: One syringe of Juvéderm Ultra Plus is priced at $700.
Antidote/Reversal Agent: Hyaluronidase can be used to reverse the effects of Juvéderm Ultra.
Main Ingredient: Hyaluronic Acid
Uses: Perlane is used to add volume to flattened areas, to plump up lips, and to help reduce the appearance of fine lines and deep folds. It is manufactured by the same company that makes Restylane. Perlane is thicker than Restylane, thus it is better for deeper or more prominent folds.
How It Works: Water is absorbed by the injected hyaluronic acid. This has the effect of building up the area of injection.
Duration: Some people find Perlane to be longer lasting than Restylane. However, the FDA commentary is that it lasts up to six months.
Price: One syringe of Perlane is $650.
Antidote/Reversal Agent: Hyaluronidase is the antidote to Perlane.
Main Ingredient: Radiesse is made up of calcium hydroxylapatite in the form of microspheres.
Uses: Radiesse is used for the treatment of moderate to severe facial wrinkles and folds, such as the nasolabial folds. It can also be used to plump up cheek bones.
How It Works: Radiesse stimulates the body to form new collagen. This is supposed to make the product last longer, thus reducing the need for a touch up. Additionally the gel and calcium-based microspheres add volume to the injected area.
Duration: Results are clinically proven to last a year or more.
Price: Radiesse normally costs $700 per syringe.
Antidote/Reversal Agent: There is no antidote for Radiesse.
Main Ingredient: Hyaluronic Acid
Uses: Restylane is used to improve moderate to severe facial folds and wrinkles. It can also be used to enhance the lips.
How It Works: The area of injection is enhanced due to absorption of water by the hyaluronic acid.
Duration: Restylane’s manufacturer claims results can last to up to 18 months. That is however, with repeat injections at 4.5 months or 9 months. Without repeat injections, Restylane may last up to 6 months.
Price: Restylane is priced at $700 a syringe.
Antidote/Reversal Agent: Hyaluronidase is the antidote to Restylane.
Main Ingredient: Poly-L-Lactic Acid
Uses: Sculptra is used for building up the cheeks, filling in hollows or sunken areas of the face, and increasing skin thickness which decreases the appearance of folds and lines. It is not used to enhance the lips
How It Works: Unlike the hyaluronic acid based fillers, Sculptra’s mechanism of action encourages the formation of new collagen in the injected area and the effects are not immediate. Multiple treatments are required, approximately 4 weeks apart. The number of treatments needed depends on the severity of the facial aging. The skin thickness increases gradually.
Duration: In a clinical study, the effects of Sculptra lasted up to 2 years after the first treatment session. A full treatment consists of an average of three injections approximately 4-6 weeks aparts.
Price: Sculptra comes in a vial as opposed to a syringe. One vial will cost around $1000.
Antidote/Reversal Agent: There is no reversal agent for Sculptra.
To summarize, Juvéderm, Perlane, Restylane, and Radiesse will offer immediate results that you will see upon leaving the office. While Radiesse and Sculptra do not have an antidote to remove the product, they do offer longer lasting results and also promote the formation of collagen which in the long run will give your skin that youthful appearance.
Every person is different and different fillers will be more effective for some than others, so we always recommend you come in for a consult before deciding on which filler you prefer.
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These dark blemishes around the eyes are caused by many etiologies, such as heredity and bruising. The genes related to dark circles are actually the genes that cause weakened capillaries in the skin around your eyes. Exposure to the sun can exacerbate dark circles. Sunlight darkens the skin by raising melanin levels and bringing melanin to the surface of the skin. Allergies, age and poor nutrition can also cause dark circles.
These crevices in the skin surface delve into the dermal layer (deep wrinkles) and even into the subcutaneous layer (folds). They are greater than 0.1mm in depth, up to 0.4mm in depth and remain well-defined and evident upon the relaxation of the muscles and the skin.
An artificial tooth root used in dentistry to support restorations that resemble a tooth or group of teeth.
A dental treatment consisting of applying a plastic material to one or more teeth, for the intended purpose of preventing dental caries (cavities) or other forms of tooth decay.
Damage to the nerve that controls the muscles of the eyelid, problems with the muscle strength, or swelling of the lid, may result in droopy eyelids. Drooping lids are either present at birth (congenital) or develop later in life. Drooping eyelids can stay constant, worsen over time (progressive), or come and go (intermittent). It can be one-sided or on both sides. Drooping eyelids may be due to a variety of conditions include aging, diabetes, stroke, Horner syndrome, myasthenia gravis, a brain tumor or other cancer that affects nerve or muscle reactions.
An injectable treatment for wrinkles made from the same neurotoxin (botulinum toxin type A) as Botox. Dysport diffuses a bit farther from the injection point than Botox: one to three centimeters compared to Botox’s one centimeter. This means that fewer injections are needed, but it also means that the health professional doing the injections must be very skilled to ensure that the drug does not spread to nearby muscles and cause eyelid and/or eyebrow drooping or other unwanted side effects. Many people find after several treatments that they don’t need another one for longer, because they have “unlearned” the habit of frowning or squinting that originally led to the development of these lines.
Recently Allure Magazine published an article on what they see as the 11 most overrated cosmetic surgery procedures. Think of this as the opposite of David Letterman’s top ten lists. But, did Allure get it right? But let’s take a closer look.
1. The “Vampire” Facelift
Really? Seriously? Are we still talking about this? This is a very cheeky name for injection of the protein rich plasma derived from the patient’s own blood added to traditional fillers. There’s no evidence that this does anything other than making the patient’s wallet lighter. At first I liked the result- but it is instantly gratifying due to the swelling-Looks like Allure gets this one right.
2. Laser Liposuction
Laser Liposuction, aka “smart liposuction,” has been around for about six years. Its proponents claim that it will tighten skin as well as remove fat. It’s debatable as to whether there is any real skin tightening. While some studies have shown a small amount of tightening, it is not enough for most of us to even notice. However, there is also a limited amount of fat that can be removed with this due to the heat generation from the laser, which can lead to prolonged pain or even burns and tracking on the skin if the heated laser cannula is too close to the surface. This is definitely an overrated procedure which is no better (and possibly worse) than other techniques of liposuction. Allure gets this one right as well.
3. Stem-cell Facelift
There has been a lot of media attention regarding stem-cell facelifts. In fact, the New York Times wrote a very good article about it this week. I agree with Allure that this is an “over hyped” procedure. It involves changing the shape of the face with the transfer of fat which may contain some stem cells. There is no scientific evidence that the stem cells are doing anything at all. So, while stem cells hold a great deal of promise, there is no evidence that they do anything here.
4. Scupltra and Artefill for lips.
Don’t do it. I repeat, don’t do it. The use of Sculptra and Artefill has been plagued with lumps and nodules. These filler may have applications in other areas, but not in the lips. Like I said, don’t do it!
5. Silicone Cheek Implants
I will give Allure only partial credit on this. There are a number of cheek implants that have been very successfully used in the correct patients. But there have also been people who have overdone this look. When done subtly on the properly selected patient, cheek implants can be quite effective. I know a number of plastic surgeons who do it- BUT NOT MY FAVORITE.
This supposedly effective method of ultrasound for skin tightening of the face is expensive, can be very painful and does not appear to work- you may see a 30% difference. Definitely overrated.
7. Fat injection for Breasts
This is an interesting topic that received a lot of attention at the meetings. This is a real operation that can give good results. But, it is not as easy as using breast implants, nor as versatile. There is a limit to how much fat can be injected in a single setting, and the breast skin needs to be stretched before the injection for the best results. Ultimately this will have a place in breast augmentation, but it is much more complicated than implants, and more expensive. So, partial credit to Allure.
8. Brachioplasty (Arm Lift)
Here, Allure is a bit off the mark. If people are looking for a little toning of the upper arm for minimally loose skin or excess fat, then certainly a brachioplasty is not for them, nor was this operation intended to be. On the other hand, this is a great procedure for people who have significant skin excess of the arms, particularly after massive weight loss. Last year’s statistics from the American Society of Plastic Surgeons have shown a major increase in the number of arm lifts being done. There is a drawback: the scar. It will go from the axilla (armpit) to the elbow. But patients have been very accepting of the scar and are pleased with the improved contour of the arm. This a good operation for the right patient. Not overrated, but not for everyone. Liposuction is usually efficient enough.
9. Butt Implants
I don’t like buttock implants at all, and probably never will. However, there are some surgeons who do this quite well- even though I hate the look of them. So I am not sure that is overrated or not. But clearly when done improperly or on the wrong type of patients, there can be problems. So, yes, probably overrated. Fat transfer to this area is much more effective (Ehemm..Like some better known brunette bombshells who have received much media attention for their full derriere)
10. Zerona Fat Melting Laser
Definitely overrated. Next!
11. Foot Lifts
Really? I mean, really? Nobody in their right mind has unnecessary surgery on their feet. This is not only overrated, but stupid. And it can lead to real disability. Your toe cleavage looks great; leave it alone!
As you look over this list of procedures, there is definitely more than enough snake oil to go around. Procedures that are worth it will be widely accepted, have science on their side, and have true benefits with minimal risks. As new techniques and technologies emerge, I will continue to do my best to let you know what is for real and what is not.
Overall, Allure did pretty well on this. If I were grading them, I’d give them about a B+, or even an A-.
Cosmetic surgery that tightens the lower eyelids and it raises the external corners of the eyes. The procedure is performed under local anesthesia, taking anywhere from an hour to three hours to complete. Scars from a Canthopexyare minimal. Canthopexyis also performed to treat conditions such as Entropion (a condition in which the eyelids are turned inwards) and dry eyes.
This procedure involves transplanting the patient’s own healthy cartilage, sometimes from the rib, or cadaver cartilage, to replace damaged areas of cartilage. It can be used for knee, nose and congenital ear defects in children and in adults.
When bacterial processes damage hard tooth structure (enamel, dentin, and cementum), these tissues progressively break down, producing dental caries (holes in the teeth), or cavities. Two groups of bacteria are responsible for initiating caries: Streptococcus mutans and Lactobacillus. If left untreated, the disease can lead to pain, tooth loss, infection and, in severe cases, death.
This lumpy substance, resembling cottage cheese, occurs mainly in women on the pelvic region, lower limbs and abdomen. It is caused by collections of fat that push against the connective tissue beneath a person’s skin, which causes the surface of the skin to dimple or pucker and look lumpy (have an orange-peel like appearance).
This type of facial peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation. Phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used for this purpose.
A surgical procedure that creates a larger or more defined chin, during which a plastic surgeon places an implant in the chin region through an incision either inside the mouth or under the chin, which is barely noticeable after healing.
Chins become dimpled or cleft when the underlying bone structure of the jaw grows with an indentation in the center. Scientists think cleft chins occur when the left and right halves of the jaw fail to fully merge during embryological and fetal development. But unlike other analogous conditions such as cleft palate or harelip, a cleft chin is a neutral trait. It neither makes the possessor more or less biologically fit, although many find it attractive.
A surgical procedure that lessens a prominent-looking chin. A plastic surgeon will make an incision inside the mouth or under the chin to access the bone. The physician will set it back so that it appears less angular, or slide it forward if it is bony and angular, which will soften the contours.
This type of protein is fibrous in nature and connects and supports other bodily tissues, such as skin, bone, tendons, muscles and cartilage. It also supports the internal organs and is even present in teeth. There are more than 25 types of collagens that naturally occur in the body.
Restructure and add volume to fat-deficient areas of the face. There are different types of collagen fillers: Sculptra Aesthetic and Radiesse are the most well-known options.
Contain particles that signal the skin to produce more collagen. Instead of just filling in select lines and wrinkles, these are used on larger areas like the cheeks. The results (which are not instant but improve over time) are longer-lasting; you may need a series of treatments for maximum results. Sculptra is an example of a collagen stimulator.
A leading U.S.-based developer and manufacturer of innovative, advanced laser products for medical professionals. Engineering and science-based, CoolTouch is considered a pioneer in the medical and aesthetics technology industry. In 1994, CoolTouch introduced the first 1320 nm wavelength laser to medical professionals for non-ablative wrinkle treatment. CoolTouch continued to set new standards in the industry with the launch of CoolTouch CTEV™ in 2004 for varicose vein treatment and with CoolLipo™ for laser lipolysis and skin tightening in 2007.
A type of steroid produced naturally by a gland in the body called the adrenal gland. Cortisone is released from the adrenal gland when the body is under stress. Natural cortisone is released into the blood stream and is relatively short-acting.
A powerful anti-inflammatory medication (but not pain-relieving), injectable cortisone is synthetically produced and has many different trade names (e.g. Celestone, Kenalog, etc.), but is a close derivative of the body’s own product. The most significant differences are that synthetic cortisone is not injected into the blood stream, but into a particular area of inflammation. By injecting the cortisone into a particular area of inflammation, very high concentrations of the medication can be given while keeping potential side-effects to a minimum. Cortisone injections usually work within a few days, and the effects can last up to several weeks.
Cosmetic body contouring surgery seeks to improve the shape, contours and proportions of the body through surgery. Body contouring procedures include sculpting procedures such as liposuction of the body as well as augmentation of the buttocks or calves.
A surgical procedure performed by a dentist to expose a greater amount of tooth structure for the purpose of subsequently restoring the tooth prosthetically.
This term is used to describe the wrinkles in the skin at the outer corner of the eyes. These are due to smiling, squinting and activity of the eyelid muscles.
A surgical procedure in which one or more incisions are made through a mother’s abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus. A Caesarean section is usually performed when a vaginal delivery would put the baby’s or mother’s life or health at risk; although in recent times it has been performed upon request for childbirths that could otherwise have been natural.
Body acne caused by the same factors that trigger facial acne: overactive oil glands, excess dead skin cells and a proliferation of acne-causing bacteria. Like the face, the back and upper torso have more sebaceous glands—glands found within the dermis that produce the skin’s natural oil, or sebum—per square inch than other areas of the body, so hair follicles are more likely to become plugged with excess sebum and dead skin cells.
Halitosis can result from poor dental health habits (not brushing and flossing daily) and may be a sign of other health problems. Bad breath can also be made worse by the types of foods you eat and other unhealthy lifestyle habits.
Gel dermal filler that uses a cohesive polydensified matrix (CPM) technology in combination with a hyluronic acid base to create a highly effective, wrinkle-defying filler product. Originally launched in Germany, it is becoming increasingly popular as an injectable dermal filler for the correction of facial wrinkles and folds. Because Belotero has been designed from biofermentation hyaluronic acid, a substance naturally present in our body; the makers claim it is safe and completely biocompatible, as well as wholly biodegradable.
Used for whitening teeth. Impressions are taken of the mouth and a thin custom-made plastic tray is made, which the patient takes home to use. A small amount of a bleaching gel is placed in a tray and worn for a brief amount of time each day. It is the most common tooth-whitening technique because it’s easy to use and costs less. While some results may be seen in a couple days, it usually takes one to two weeks to see the full whitening of the teeth.
These are marks or areas of discoloration on the skin, including acne such as whiteheads, blackheads and pimples.
A surgical modification of the eyelid, in which excess tissue such as skin and fat are removed or repositioned, and surrounding muscles and tendons may be reinforced. It can be both a functional and cosmetic surgery.
Pioneered in Europe, PDT therapy works by applying a light-sensitizing chemical solution to the skin area that needs treatment and then exposing the area to blue light. The photosensitive chemicals, which have been absorbed into the skin, react with the particular wavelength of blue light to generate reactive oxygen radicals that destroy the potentially precancerous or cancerous skin cells.
A similar concept to a facelift—a plastic surgeon strategically places incisions that reshape body contours by reducing fat; lifting, tightening and shaping the underlying skin matrix; and smoothing and reducing the overlying skin. Often used when a patient has lost a large amount of weight that has left them with sagging skin. Sometimes combined with liposuction.
This composite resin filling is used for restoring decayed teeth, making cosmetic improvements and even changing the color of or reshaping the teeth. Bonding will lighten any stains, close up minor gaps and can be used to correct crooked teeth. The cosmetic dentist applies a thin coating of a plastic material on the front surface of your teeth, which is then sculpted and shaped. Finally a high-intensity light hardens the plastic and the surface is polished. These composites should last about seven to eleven years.
This procedure involves removing the unsightly bumps and bulges above or below the bra line while hiding the scar under the bra line. Ideal candidates for the bra-line back lift are those with sagging skin caused by aging, sun exposure or massive weight loss such as that which occurs after bariatric surgery. This surgery does not remove back fat.
This type of butt augmentation procedure results in a youthful, prominent, perky buttocks and a more sensual body profile. Fat is removed from selected areas of the body, purified, and then reinjected into the buttocks. The process of fat reinjection involves scores or hundreds of injections. The procedure is designed to fill the upper quadrant of the buttocks so that the butt appears lifted and perky.
The combination of oil, bacteria and toxins blocks pores causing acne breakouts. Hormones are chemicals that are produced by glands in the body and circulate in the bloodstream. They control numerous body functions including sebum (skin oil) production and regulation. The hormones that are responsible for acne are called androgens. When there are too many androgens in the blood, the sebaceous glands begin to over-produce oil in the skin. When the liver and kidneys are not properly cleansing the blood and are overloaded, the liver is unable to properly ‘deactivate’ used hormones and remove them from the body, therefore causing breakouts.
Cosmetic surgery using breast implants for fuller breasts (breast enlargement) or to restore breast volume lost after weight reduction or pregnancy (breast enhancement).
A breast implant is a prosthesis used to alter the size and shape of a woman’s breasts (known as breast augmentation, breast enlargement, mammoplasty enlargement, augmentation mammoplasty or the common slang term boob job) for cosmetic reasons, to reconstruct the breast (e.g. after a mastectomy or to correct congenital chest wall deformities), or as an aspect of male-to-female gender transition. There are two primary types of breast implants: saline-filled and silicone-gel-filled implants. Saline implants have a silicone elastomer shell filled with sterile saline liquid. Silicone gel implants have a silicone shell filled with a viscous silicone gel.
A capillary is a small blood vessel located in the tissues of the body. When the vessels tear, the blood seeps out and becomes visible on the skin. Some of the most common causes are rosacea and sun exposure. Broken capillaries can also occur as part of the natural aging process.
Cosmetic procedure that minimizes the creases that develop across the forehead, or those that occur high on the bridge of the nose. It improves what are commonly referred to as frown lines; and repositions a low or sagging brow.
A cosmetic procedure used to enhance your rear end. There are two ways to do a buttock augmentation: fat transfer (by injecting your own fat removed by liposuction from other areas of the body) or a buttocks implant (by using prosthetics stronger than breast implants and made of an elastomer that cannot leak).
This area of the body is described as a horizontal crease formed by the inferior aspect of the buttocks and the posterior upper thigh. The gluteal sulcus is formed by the posterior horizontal skin crease of the hip joint and overlying fat, and is not formed by the lower border of gluteus maximus, which crosses the fold obliquely. It is one of the major defining features of the buttocks.
This procedure improves the contour of the buttock and makes it ‘perkier’. The butt lift can be achieved by two methods: Removing excess skin and tightening the skin above the upper part of the buttocks to lift the buttocks; or by using fat injections or implants. The fat injection procedure is also referred to as the Brazilian butt lift. In addition to more volume and prominence, fat injections give the butt more projection or lift.
The heart-shaped or A-shaped butt (picture a heart upside down) is typically considered the prettiest and most desirable shape. Because of the smaller waist and bigger hips, it comes closest to the universally ideal waist-to-hip ratio of 0.7. The round butt is second to the heart-shaped butt in popularity, according to plastic surgeons. A square butt tends to look flat from the side, and almost a little masculine. Plastic surgeons find that this is the most commonly complained-about shape. The V-shaped butt is widely considered the least attractive butt shape, which gets its look from the presence of more fat in the waist and outer thighs. This is also the most challenging shape from a surgical perspective.
Most of us were raised with the message that “strong cheekbones” are an antidote to the aging process and those lucky enough to have them will age well. The April issue of Harper’s Bazaar has a healthy respect for cheekbones but indicates that, sadly, cheekbones lose volume and need a boost sooner or later.
When cheekbones lose volume, skin and muscle start to slide, forming jowls and folds. Lately, building up the cheeks has become a buzzed about antiaging solution. A prominent New York physician thinks building up the cheeks is the ultimate cure all: “You diminish the nasolabial folds, decrease the downturn of the mouth and reduce the hollow of the eye without touching any of those areas.”
You can build up the cheeks with injectable fillers like Restylane and Perlane. These last for about six months to a year. The filler can be injected beneath the muscles and there is virtually no downtime, just minor swelling. The cost ranges from $1,000 to $3,000, depending on how much filler your doctor injects.
Alternately, you can build up your cheeks permanently with cheek implants that can now be custom made based on computer imaging that scans your skeleton so as to produce implants that are just right for you. These implants are placed through incisions inside the mouth beneath the muscle and won’t cause scarring. Recovery takes about two weeks. Made to order implants will add $5,000 to your bill.
Fat transfer is yet another option, which uses fat from your own body and is then re-injected into the face. It is usually longer lasting than fillers and less invasive than cheek implant surgery. Added bonus is that you can liposuction a “fat rich” area like your hips, abdomen or thighs to procure it.
Whether you select fillers, fat or cheek implants, your results will only be as good as the doctor who does your procedure. Make sure your physician is board-certified by the appropriate board in his or her medical specialty.