A Blog about Minimally Invasive Cosmetic Procedures and Aesthetic Ancillaries.
Fillers such as Restylane and Juvederm are one of the most common procedures performed by aesthetic physicians. With aging, not only is the quality of the skin affected with wrinkles but also individuals start to experience volume loss. It is akin to being a grape when we are young and morphing into a raisin with time.
In order to adequately address issues of aging, it is important to restore the lost volume.
The most natural appearing filler products are the hyaluronic acid products (Restylane and Juvederm). These products can restore the areas of deficit to give proper balance to the face.
When injection Juvederm or Restylane we typically use topical anesthetic for 15 minutes to help minimize the discomfort with the injection. Although there are some instances when traditional needles are still used (such as for superficial lines or for injecting into the vermillion border of the lip) needles for injection are more associated with pain, tissue damage, bruising, vessel laceration, multiple punctures and more. Blunt-tip cannulas can achieve the same results as traditional needles, but without many of the associated negative aspects.
My favorite blunt tip cannula is the DermaSculpt cannula (CosmoFrance), approved by the Food and Drug Administration (FDA). The reason is that they are flexible, blunt-tipped and disposable allowing for facial filling with minimal bruising and minimal percutaneous needle sticks. They allow for the fanning technique to be employed from a single point of entery, therefore allowing for a natural placement of the filler product with minimal tissue trauma.
Blunt microcannulas are used at the nasolabial fold and cheek area. I have now started using them for the lips (except vermillion border) and for under the eyes (infraorbital area). To trace the lip edge (vermillion border), the traditional needle is still sometimes employed.
Schedule your filler injection with the blunt tipped microcannula at Saluja Cosmetic and Laser Center (704) 584-4071
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Skin tightening procedures during the spring and summer
There are many different laser modalities which can help tighten the skin. Certainly CO2 is the most aggressive and therefore has the greatest results But standard CO2 has decreased in popularity do the prolonged healing times and risk of infection. It has been largely replaced by fractional CO2 laser.
While fractional CO2 laser has allowed for healing times to be drastically shortened, there is STILL A HEALING TIME! Typically I tell patient that the first four days they will have a “social downtime” where the skin is edematous. There is pinpoint bleeding the first night and after day 2, the swelling begins to slowly reside over the next week. They are allowed to return to make up on day 5, but for the next couple of weeks, there still can be some underlying redness. The length of the redness is dependent on how much photodamage is present at baseline and therefore how aggressive the laser parameters would be.
One of my favorite lasers which has exceptional results as well (but need a series of treatments), is the fractional nonablative combined with the Revlite. This combonation allows for pigment to be targeted as well as skin tightening. It typically takes 3-6 treatments to achieve the intended goal. I do numb for 20 minutes prior to this combination and patients can expect a “social downtime” of one day.
The night after the laser, patients will be red and there will round areas of swelling (the shape of the laser tip). Typically, you most likely would not want to go out to dinner immediately post laser. The next day, there will be some redness that is covered over with make-up. After 36-48 hours, the redness is gone.
This is the combination I use on myself because I simply don’t have the downtime for fractional CO2 and this combination is “color blind” therefore it can be used on patients with color and it can be used during the summer when our skin picks up the bronze hue.
Of course, it is always important to sun protect and wear your sunscreen. Neutrogena Baby with SPF of 60, or Anthelios are my favorites.
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The RevLite Laser Facial
The RevLite Q switched laser is a wonderful nonablative laser used for skin rejuvenation. The system’s unique Q-switch pulsing structure emits short bursts of energy to the target, helping to prevent over-heating in the skin. By delivering maximum power in short timespans, it acts like an aggressive laser without any deep damage.
The primary wavelengths used are the 532 nm and 1064 nm. These two wavelengths have differing penetration depths and properties making the treatment very versatile.
What to expect during the treatment?
The laser will emit short bursts of laser energy to the skin. Your physician will treat the skin until there is slight erythema (pink coloration) or a slight whitish change to the pigmented spots. The erythema will last from 20 min to a couple of hours and make-up can be worn over the treated skin.
Being a Q-switched laser, the very short, high energy pulses impart a photomechanical effect on the pigmentation. This photomechanical effect helps fragment pigment to help minimize epidermal and dermal pigmentation.
The PhotoAcoustic Technology Pulse also helps re-organize the skin’s collagen into parallel arrays of compact fibers therefore giving the skin an overall tightening effect and inducing dermal remodeling.
RevLite Laser Facial (1064nm and 532nm)
The Q switched laser treatment uses both wavelengths to target all layers of the skin. The 1064nm penetrates deeply, thus stimulating new collagen production and targets deep dermal pigmentation. The 532nm penetrates superficially, and targets sun damage and superficial pigmentation.
\short pulse energy is not absorbed by melanin therefore it can be used on all skin types and on tanned skin during the summer, unlike Alexandrite or Ruby lasers that are only safe and effective on lighter skin tones,
RevLite Laser Peel (532nm)
As well as stimulating the fibroblasts to produce more collagen for rejuvenative benefits, light pigmentation can also be treated. This monochromatic green light is best
suited for fairer Fitzpatrick skin types, I and II.
One to three sessions are recommended four weeks apart but good results can be attained with one treatment.
The 532 wavelength helps minimize pore size, even out skin tone and reduce fine lines and wrinkles.
Call Saluja Cosmetic and Laser Center for your consultation. (704) 584-4071
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43141
The tattoo industry is thriving with 25% of Americans flaunting at least one tattoo. The skin serves as a popular canvas for the full expression of an individual’s artistic side, inspired by a past love, a new child or a re-creation of something aesthetic.
While tattoo placement is at an all-time high, what happens to the person with the regrettable tattoo with faded ink or wrinkling of the underlying skin, or simply no longer serves as a form of inspiration?
The antiquated methods used many years ago for tattoo removal included inducing a blister over the tattoo with topical chemical irritants, abrading the tattoo with mechanical abrasion or simply excising the tattoo. All of these methods posed a high risk of unacceptable skin complications and often times the tattoo was replaced by a fibrotic scar.
With the advent of q switched nano second pulsed laser technology the tattoo can be effectively fragmented with wavelength specific laser absorbed by the tattoo pigment. This technology has given us the capability of removing tattoos with a more precise and skin friendly method. With that said, tattoo removal can still be difficult in selective patients with different colored ink, or if there is layering of tattoos.
So if you are looking to clear away a tattoo to make room for another, here are some important points to remember:
1. Laser
Tattoo removal can be achieved with a q switched laser such as Revlite (Cynosure, Westford, MA) which is the industry standard. Any pulse that is longer than the nano second wavelength will not allow for the ink to be fragmented and subjects the skin to greater thermal issues.
2. Skin Type
A q switched laser has to traverse the epithelium to reach the ink in the dermis. So when tattoo removal is considered on darker skinned individuals, the Nd:YAG laser is typically used and it may be difficult to remove colors such as red/yellow/green, however dark inked tattoos can still be removed. The lighter the skin type, the more energy and varying wavelengths can be used.
3. Location
The small fragments of ink created by the Revlite Q switched laser are immediately engulfed by specialized cells (keratinocytes, fibroblasts and macrophages) and carted off by the blood to the lymph nodes. Tattoos placed in areas with higher regional lymph nodes and vascular supply will be more amenable to treatment, such as the head and neck location. Tattoos on the distal extremities (hands and feet) are further away from the regional lymph nodes and therefore require more treatments.
4. Color
By far the easiest color to remove is black! Amateur tattoos are easier to remove than professional tattoos because amateur tattoos use elemental carbon particles like cigarette ash, pencil, graphite or India Ink whereas professional tattoos use organic dyes mixed with metallic elements. Black color typically has smaller sized particles and are easier to remove.
5. Amount of Ink
The more ink, the more treatments. Also if there is layering of tattoos, this too may take more time to clear as well as the condition of the underlying skin. If there is scarring at the site, removal becomes more challenging because the ink can be trapped within the dermal fibrosis.
Typically it will take multiple treatments spaced 6-8 weeks apart for the removal of a tattoo, so choose your tattoo colors and creation wisely and place an even greater importance on the laser technology and professional who removes it.
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One of the most common questions that patients ask during cosmetic consultation relates to the dark circles under their eyes. They want to know what causes them and what the treatment is.
First, it is important to recognize what is the cause. Often times, it is heredity, this coloration just happens to be a stamp of your family. But usually there is a reason. It could range from the bogginess and vascular congestion seen with allergies or atopic dermatitis, sun exposure which can caused increased melanin production and give the darkened appearance. Nasal congestion can dilate the vasculature from the eyes to the nose, showing the prominant color of the vessels, but also ageing, which can thin the elastic and collagen thereby also allowing for the vasculature below to appear more prominant. Ageing can also give volume loss and septal laxity which may cause a slight protrusion of the retroseptal fat pad and give a hollowed out cleft below from atrophic malar fat pads and descent.
So what can we do about this?
If the cause is secondary to pigmentation from the sun, it is important to make sure to wear a UVA/UVB sunscreen. The pigment can be addressed topically with hydroquinone, kojic acid or tretinoin which can help to some degree, or with intense pulsed light or fractional CO2 laser.
When there is volume loss, the best way is to correct this with a hyaluronic acid filler. I prefer Restylane in this area because I have found that Juvederm gives a bit of bogginess and unnecessary prolonged swelling. One syringe is usually plenty to correct this area.
If there is fat pad herniation, then typically a lower lid blepharoplasty is indicated. However, this is not always the case now that fillers and lasers are in the picture. Good results can be achieved in mild to moderate fat herniated patients with filling the contour with Restylane and this will smoothen the defect and push the fat back about 40-50%. The skin can also be tightened with a fractional CO2 laser and the results can be impressive with this minimally invasive approach.
Here is a before, immediately post Restylane injection at Saluja Cosmetic and Laser Center and 3 day post Restylane injection patient. Prior to the injection, the area is anesthetized with a topical cream for 15 min. Restylane does have lidocaine contained within the syringe so this will add to minimizing any discomfort during injection. The fat hernation and infraorbital hollowing appear about 50% improved. This patient has not yet had the CO2 laser which could further improve the results.
B
Before Injection
Immediately post injection
Book your appointment today at Saluja Cosmetic and Laser Center at (704) 584-4071,
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Technorati Tags: filler, hyaluronic acid filler, infraorbital hollows, Restylane
Saluja Cosmetic and Laser Center (SCLC) is delighted to announce that we will be opening our doors on Feb. 6th for aesthetic laser procedures, injectables and facial cosmetic surgery.
We will be providing an array of aesthetic laser procedures with cutting edge lasers to treat pigmentation, wrinkles, skin tightening, hair, blood vessels and cellulite. All procedures are performed by a board certified ophthalmologist who is fellowship trained in dermatologic cosmetic surgery.
Please schedule your complimentary consultation today!
SCLC
(704) 584-4071
9727 Northcross Center Court
Huntersville, NC 28078.
We look forward to working with you to achieve your most radiant look.
Kind Regards,
Dr. Saluja
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Technorati Tags: aesthetic lasers, blood vessels, cellulite, facial surgery, Injectables, pigmentation, saluja cosmetic and laser center, skin tightening, wrinkles
So we have heard in the media and from friends that there are several cellulite treatments on the market, some topical and some laser. Do they work? Have they been studied? Which systems actually produce results. How long do the results last? These are all important questions that are best answered with clinical studies.
There are a couple of landmark studies on the SmoothShapes Laser which answer questions not only on clinical improvements achieved with treatment, but also addressing the duration of time where these results can be appreciated.
Dr. Kulick published a study in Plastic Reconstructive Surgery which was reprinted in Cosmetic Journal. The author performed 8 treatments over 4 weeks and found an 82% improvement in the contour irregularities at one month via Vectra 3-D imaging which was still appreciated at 6 months (76% improvement at 6 months).
Dr. Lach published an article in the Journal of Cosmetic and Laser Therapy which evaluated thighs treated with Smoothshapes (laser and vacuum massage) versus just massage alone. Patients received an average of 14 treatments over 4-6 weeks. What he found was the side treated with the laser AND massage had a 1.19 cm reduction in thigh circumference compared to an actual INCREASE by 3.82 cm in the thigh treated with massage alone.
So there are published benefits to not only improving the appearance of cellulite, but in reducing subcutaneous fat (although it is FDA approved and marketed for cellulite reduction).
This is not a permanent treatment, but there is data showing improvements for up to 18 months post treatment. This may be the stocking stuffer laser treatment that is a gift during the holidays to start in late winter, early spring to be cellulite reduced for the summer!
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Technorati Tags: cellulite treatment, clinical studies, laser, laser treatment, MD, Raminder Saluja, Saluja, Smoothshapes, subcutaneous fat
Cellulite continues to be a nuisance to the female population. The topographical irregularities which are visually obvious and equally disturbing to the patient occur from fat protrusion through the fibrous septae.
There have been numerous treatment modalities which have been sold to the general public, such as various topical creams and differing endermologie treatments. While some have shown a transient benefit, there has always been room for improvement for the treatment of cellulite.
So what is new in the way of laser technology for cellulite?
One advancement is the new SmoothShapes XV laser. This laser system combines a 915 nm wavelength which is preferentially absorbed by the fat cell (adipocyte), thereby causing a thermal raise in temperate of the fat cell with liquifaction of fat. This wavelength is combined with 650 nm light. The light creates transient pores in the fat cell, thereby allowing the liquified fat to spill into the interstitium which is then mechanically manipulated with vacuum suction and roller massage. The end result is a smoother appearance to the topographic alteration of the skin.
Typical Treatment:
The typical treatment consists of 8-12 treatment sessions delivered over 4-8 week course. There can be some transient redness which lasts for less than 2 hours and possibly some swelling which would be minimal if at all.
The improvements in the appearance of cellulite have been cited at 50-60%. While the treatment is not permanent, studies have shown that improvements are still present 18 months post treatment.
Average treatment costs can range from $2000-$4000 dollars for 8-12 treatments.
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Technorati Tags: cellulite, cost, fat, laser, laser treatment, light based treatments, treatment
If you read the news today, you will find a new surge of interest in coconut oil. Initially touted as a “bad fat” because of the high saturated fat content, researchers are finding out that this is not true but that there are real health benefits from incorporating this oil into the diet.
Coconut oil is comprised of medium chain fatty acids as opposed to long chain fatty acids found in most foods. These unique fatty acids have demonstrated antimicrobrial effects, fat burning effects and cardiovascular benefits.
Dr. Bruce Fife with the Coconut Research Center has done extensive research on the benefits of coconut oil and the effects of coconut oil systemically. He even incorporated a section in his new book on Coconut Oil to skin care.
A paper by KG Nevin published in Skin Pharmacology and Physiology in June 2010, evaluated topical virgen coconut oil on wound healing.
Before we discuss this, let’s first define the differences between refined coconut oil and virgen coconut oil.
1. Refined Coconut Oil
Most coconut oils are made from COPRA which is basically the dried kernal (meat) of the coconut. Most copra that is dried is not sanitary therefore it must be refined through heat to deodarize the oil and then filtered through bleaching clays to remove impurities. The end product is RBD coconut oil which stands for refined, bleached and deodarized coconut oil.
2. Virgen Coconut Oil
This oil comes from using fresh coconut meat and chemicals and high heating are not used in refining since this natural type of oil is stable.
For the purposes of the discussing the article on wound healing and coconut oil, it is important to note that virgen coconut oil was studied.
What was found was that the wound healing properties of the virgen coconut oil were superior to non treated skin. This could be do to the minor biologically active components and antimicrobrial fatty acids.
Coconut oil is rich in medium chain fatty acid (lauric acid), and has been shown to minimize bacterial infection and stimulate the immune response. There are also high levels of polyphenols, Vitamin A, Vitamin E and significant antioxidant properties. All of this is important for skin health.
So this is my thought, why not use coconut oil post fractional CO2 laser treatment instead of aquaphor which can lead to acne eruptions? That is exactly what I am doing now for patients.
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Technorati Tags: coconut oil, Coconut Research Center, Dr. Bruce Fife, fatty acid, Fractional CO2, lauric acid, medium chain fatty acid, virgen coconut oil
The idea of a “skin peel” is not only visually, but also verbally appealing in that it could simply “peel” away all the years of sun worshipping that are apparent on our photodamaged skin.
And actually, there is a lot of science associated with the peel. Here are the important issues to think of when you are considering a skin peel.
1. Chemical Peels
With a chemical peel, acids are utilized to denature the protein in the skin which essentially “wounds” the upper layers of the skin. If the papillary or upper dermis of the skin is wounded, then it is considered a medium depth peel. If the deeper, reticular layer of the dermis is wounded, then it is considered a deep peel.
The acids utilized help to exfoliate the upper layers of skin.
The most common acids that you will find in chemical peels are:
a. Alpha Hydroxy Acids: these penetrate the outermost layer of the skin
b. Trichloroacetic Acid (TCA): typically used in concentrations of 30-50%
c. Phenol: This is utilized for a deep peel.
You can classify the peels as either light, medium or deep peels.
1. Light to Medium Peels
These peels are typically performed by first cleansing the skin with a surfactant which removes skin oils and allows for greater penetration of the acid. Then acetone is usually utilized to further remove oil from the skin. Finally, Jessner’s solution is applied to again aid the penetration of the acid.
After the skin has been prepped and cleaned in this fashion, TCA is applied, usually at 35%. Whitening of the skin can occur in 30 seconds to 2 minutes.
If there is erythema and minimal whiteness, then it is a light peel. A medium depth peel will occur when the skin shows a white frosting with surrounding erythema and finally skin appearance with a deep peel will appear white with no erythema.
2. Deep Chemical Peel
These are typically 50% TCA or Baker Gordon phenol peels.
The Phenol peel was introduced in 1981 and became popular. But, present day, the popularity has waned.
In order to have this peel, IV sedation is necessary as well as cardiac monitoring. The goal is to increase the penetration of the phenol at the skin level, but not in the blood, because phenol can be toxic to the heart and lead to ectopic beats or life threatening cardiac issues.
A study published by Landau in 2007 reviewed 181 patients receiving phenol peels and out of these patients, 6.6% suffered cardiac arrhythmia from the full face peel.
Another reason why deep phenol peels are falling out of favor, is the advent of laser technology which can go deep, but in a more controlled fashion. Fractional CO2 laser is more popular in this day and age compared to deep phenol peels.
Until next time…
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Technorati Tags: AHA peel, chemical peel, Fractional CO2, Jessner's solution, phenol peel, skin peel, TCA peel
