Botox

Botox, the magic elixir. The most commonly preformed cosmetic procedure in the US currently is Botox injections

Botox is botulinum toxin type A produced by the bacterium Clostridia botulinum. Associated with the condition called botulism that was associated with improper canning and some preserved meats. Initially used in treatment of muscle spasm disorders around the eye, its ability to lessen the appearance of wrinkles was observed leading to its use to lessen the appearance of wrinkles in between the eye brows and the crow's feet area of the eyes.

Currently it is used primarily for the area between the eyebrows and the crow’s feet. However as knowledge grew Botox use spread from just areas mentioned above to around the lips, the chin, neck bands. Not all use is for cosmetic enhancement, Botox has been used to control excessive sweating of the palms and axillae, tension headaches, back spasms, whip lash ,vocal cord spasms, facial spasms, bladder neck , anal fissures, just recently to relieve Raynaud's of the hands and fingers with injections into the fingers and palms.

Not only is Botox effective it is extremely safe. In the millions of doses given, there have been no reports of death or serious injury , however Botox should not be used if someone has a neuromuscular disease such as myasthenia gravis, pregnant or breast feeding.

Botox comes in a powder form in a vial of a 100 units. It is diluted with saline and injected. The amount used varies with the areas to be treated and judgment of the injector. Everyone is unique and each will have different effect and duration of the Botox. I have found that certain people need retreating in 2-3 months and others can go a year between sessions. I notice that type a people (fast movers) such as women realtors, young, work out frequently tend to need more sooner, versus the laid back types who go much longer. Gender also plays a role as men require about twice the amount in an area especially the forehead to get the same result a small women would get.

Results:

The look you should strive to achieve is a rested appearance in the overall facial unit with . You should avoid a “frozen” face look where there is no natural movement when gesticulating or speaking. Occasionally some patients, usually first timers,may  feel they didn’t get their money’s worth if they can produce even the slightest wrinkle or wiggle of the forehead. Those people who concentrate a great deal (businesswomen and teachers)  in their work may develope a prominent  "knife” cut wrinkle between the eyes. These rarely are removed 100% with the first initial sessions but after repeated treatments there will be enough relaxion of the muscles to eradicate it.

Discomfort:

Discomfort is minimal. The discomfort is minimized by using quick acting topical anesthethics on the treated area along with extremely small very sharp atraumatic needles which lessens the discomfort considerably. Ice is used during the injection and post injection period to reduce any swelling or reddness. Make up can be applied immediately after the treatments. Excerise and alcohol should be avoided for 24 hours following treatment. Occasional bruising may occur but this is easily camouflaged with your makeup. 

Price:

Botox is produced by one company, Allergan. The price seems to increase every six months. Some injectors charge by the area, others by the volume, and others by the number of units. By and large the average cost is about $400-800 for treating between the eyes, forehead and crow’s feet.

TCA Peels

TCA or Trichloroacetic acid, a derivative of the acid used to make vinegar, next to glycolic acid, is the most common peeling agent used today. It has been used safely since the early part of the 20^th century as peeling agent for superficial and medium depth peels.

It is used in concentrations from 10 to 50% both singly and in combination with other agents such as glycolic acid, salicylic acid, lactic acid, resorcinol, and retinoic acid. It is the basis for the “Obagi Blue Peel™”. It works well on the face, extremities and back. It can be used as frequently as bi-weekly

Predictable with little down time, it is safe with no toxicity when used in concentrations of 20-35%. It is one of the best cosmetic procedures available today and its results are on par with the more expensive laser and photo-light procedures.

It is undergoing resurgence in popularity as the limitations, expense and complications of lasers are becoming more apparent.  

Alpha Hydroxy Acids (AHAs)

Alpha Hydroxy Acids or AHA’s are acids that naturally occur in nature and are derived from fruit, milk, and sugar cane. Their re-appearred on cosmoceutical stage about 15 years ago with  explosive growth and popularity. They have totally re-made the cosmoceutical industry and created a plethora of new products and new companies which in turn spurred on by the impetus provided by the AHA revolution developed even more new products.

The AHA family:

• Citric (citrus fruit)
• Glycolic (sugar cane)
• Lactic (milk)
• Malic (apples)
• Tartaric (grapes)

The Glycolic acid is by a far the most used of these acids, both as peeling agent and in various home treatment creams. Used correctly is a very safe effective treatment for a wide variety of skin disorders. It aids in the treatment of acne, solar damage, pre cancers( though not as well as TCA), skin rejuvenation, and pigmentation disorders. Derivatives of glycolic acid, mandelic acid and gluconic acid, are also used in cosmoceutical products.

As peeling agents, Glycolic is the most frequently used of this family. Concentrations of 30- 70% with 50% being the most common are used in physicians’ offices. This acid as opposed to TCA, although considered “weaker”, requires monitoring and neutralization. (TCA is neutralized by cellular fluids). After preparation of the skin and application of the acid, it is normally left on the skin for 2-4 minutes, then neutralized with sodium bicarbonate (baking soda) solution. The skin is monitored during application time for any evidence  fo “flashing’” that might indicate a quicker response by the  skin especially more sensitive or prior use of tretinoin (Retin A). Concentrations of 70% concentration not properly monitored and neutralized have caused scarring. Personally I feel 70% should be applied only by a physician or the extremely well trained professional (nurse or esthetician).

The majority of glycolic peels performed by estheticians in salons or spas use prepackaged solutions of 20-30% from reputable companies following the companies’ instructions. They can be done weekly or bi-weekly with good results.

At home use of 5- 20% glycolic creams are a mainstay in exfoliation therapy which plays a key part in a skin rejuvenation regimen. The exfoliation not only  stimuates new collagen growth but it also aids treatment with of other products such as Niacin (Nia24), Vitamin C (SkinCeuticals), Retinols (Dr. Grandel) and Growth hormone(TNS- Skinmedica) by enhancing absorption. Glycolic acid has also been formulated using lactic acid, its derivatives, retinols, Vitamin C, and Vitamin E in a myriad of combinations creating very effective home skin rejuvenation products.

Micro-Dermabrasion, a  painless, non-invasive effective  skincare treatment that arrived on the Cosmetic Dermtatology scene has  become one of  the  most popular  therapies being offered in salons and physicians offices.

It is a simple process  of lightly abrading away the superficial dry dead cells of the outer skin layer, that block pores, by propelling white micro crystals( carbide, sand, salt or other small hard particles) across the skin with a suction activated instrument.

When combined with modern cleansers, glycolic exfoliants and powerful anti-oxidant moisturizers, skin circulation, stimulation and rejuvenation are immediate and impressive.

Affordable, suitable and adaptable to all skin types and conditions, from juvenile acne to age spots, no one need feel left out of the skin rejuvenation revolution.

No skin treatment in history has been so immediately and favorably embraced by those who are concerned about skin health and beauty.  The immediate improvement in skin translucency, luster, texture and vibrancy leaves no doubt that Science for Skin has delivered the long awaited “fountain of youth” treatment

Safe, painless, less invasive and less expensive than chemical peels and laser resurfacing, the recovery time from even the most aggressive treatment in severe conditions is but a few days as compared to weeks or months following those alternative procedures.

Makeup can be reapplied immediately following a routine treatment

There are no messy, painful dressing changes, and no persistent redness that may last for several months, as with some laser and heavy duty chemical peels.

With micro-dermabrasion you can be treated this week and look great for that big social event next week without any downtime

Dermabrasion

The removal of the top layer(s) of skin most commonly using motor driven wire brush or diamond encrusted wheel (fraize) at high speed. Manual dermabrasion using salt, sandpaper and dry wall sanders has had limited use but are not as effective as the motor driven method.

There are many conditions that can be treated using this procedure however the condition most frequently treated with this is acne scarring. Dermabrasion is considered the “gold standard” in acne scar treatment by which all other methods of treatment are measured (lasers, chemical peels).

The procedure was popular in the 60s, 70’s and early 80’s but has been largely supplanted by lasers. This procedure is extremely technique driven (must have a skilled operator for a good results and to avoid complications) with a high learning curve. Because of this with the advent of lasers, it is less frequently used and there is less number of physicians trained in its technique. It is much easier to teach someone the correct way to use laser versus using a wire brush at rotating at 30000 rpm or a diamond wheel at 50-80000 rpm which as it requires a firm deft touch. Also to get best result it is desirable for the skin needs to be immobilized either with freezing or recently tumescent anesthesia popularized by liposuction has migrated over and has been used with good results.

Complications are scarring (too deep), injury to vital structures (lips, eyes, nose), and hypertrophic scarring at the jawline or cheekbones (can happen in best of hands).