by Carol Mandro, Skincare Assoicate

Do you want to be sure your facial products have a better chance of absorbing into your skin so you get the best results?

Do you want your skin to look healthier and feel softer?

Try the Clarisonic Pro Skincare Brush. It will remove six times more makeup than manual cleansing. It is more effective at removing sebum than manual cleansing. It is two times more effective as manual cleansing with soap and water. The Clarisonic Pro Skincare Brush is especially effective for patients with large pores. It is gentle and safe to use for all skin types even on Rosacea patients, acne patients, on mature skin, and on patients with seborrheic dermatitits. Daily cleansing with the Clarisonic Pro prepares your skin to better absorb skin care products. (A recent study showed 61% better absorption of vitamin C.) The Clarisonic Pro Skincare Brush with 4 speeds is available in Pink or White.

Delicate, Sensitive and Normal Brush Heads are available for the face and a Spot Therapy Brush Head is available for body cleansing. Clarisonic also has a complete line of cleansers to compliment the Clarisonic Pro Skincare Brush.

• The Clarisonic Gentle Hydro Cleanser for All/Sensitive Skin with Free Promotional Brush Head
• The Clarisonic Nourishing Care Cleanser for Normal/Dry Skin with Free Promotional Brush Head
• The Clarisonic Refreshing Gel Cleanser for Normal/Oily Skin with Free Promotional Brush Head
• The Clarisonic Refining Skin Polish for All Skin Types with Free Promotional Brush Head

The micro-massage action of the Clarisonic Pro Skincare Brush with 4 speeds works deeply to unclog pores, sweeping away impurities for healthier, softer, younger-looking skin!

To purchase the Clarisonic Pro Skincare Brush with 4 speeds, you must call our aesthetician at Skincare-MD at the telephone number listed below. To order any of the accessories for the Clarisonic Pro Skincare Brush, you can either call Skincare-MD or order directly through our skincare website. Follow the links in this blog for all Clarisonic items.

For more information about the Clarisonic Pro Skincare Brush, please call Skincare-MD at 1-877-415-0600 or 1-603-296-4920 Monday through Friday 8:30 a.m. to 7:30 p.m. EST.

submitted by Carol Madro, Skincare Associate

Do you have adult acne?

Our Skincare-MD practice at the Plastic Surgery Center started carrying the Avene line of products about 6 months ago. I am in my 50’s and am plagued by minor but annoying breakouts. I started using Avene Diacneal Soap-Free Gel Cleanser and the Avene Diacneal Skincare Lotion with Retinaldehyde. It has worked for me.

I use this system at night every night. I can’t say it eliminated breakouts but it has certainly minimized the breakouts and the length of time they remain. My skin remains mostly clear and is a lot smoother too.

The Avene Diacneal Soap-Free Gel Cleanser removes excess sebum, make-up and impurities without drying my skin. It helps restore the hydrolipidic barrier often altered by other acne treatments/products.

I let my face dry completely, I then apply the Avene Diacneal Skincare Lotion with 0.1% Retrinaldehyde which provides the efficacy of Retinoids for blemish-prone skin with little or no irritation. I had no irritation from this form of Vitamin A at all. I am very happy with the results I am seeing with this product plus I am receiving anti-aging benefits of the Vitamin A with the 0.1% Retrinaldehyde.

Try it – Avene Diacneal Soap-Free Gel Cleanser and the Avene Diacneal Skincare Lotion with Retinaldehyde works (no prescription necessary)!

For more information about Avene Diacneal Soap-Free Gel Cleanser and the Avene Diacneal Skincare Lotion with Retinaldehyde, please call Skincare-MD at 1-877-415-0600 or 1-603-296-4920 Monday through Friday 8:30 a.m. to 7:30 p.m. EST.

submitted by Carol Mandro, Skincare Associate

Does your face always look Shiny or Oily?

Jane Iredale Absence Oil Control Primer eliminates shine and controls sebum. Jane Iredale Absence Oil Control Primer also help to keep the base color you put on true to color all day long. This cream to powder primer absorbs and controls oil by reducing sebaceous hypersecretion using hydrated silica which encapsulates the oil and forms a barrier between it and the make up so the wearer stays matte all day. It regulates the pH balance of the skin without affecting the skin’s moisture, only the oil. It calms and soothes the skin, reduces inflammation and redness and provides bacterial protection. You’ll also notice your skin will appear smoother because it fills in fine lines.

Jane Iredale Absence Oil Control Primer can be used on any type of skin. It is available in Absence and Absence 2 for darker skin tones. (Note: the best brush to use for Jane Iredale Absence Oil Control Primer is the Jane Iredale Foundation Brush.

Stay shine free all day with the Jane Iredale Absence Oil Control Primer!

For more information about Jane Iredale Absence Oil Control Primer, please call Skincare-MD at 11-877-415-0600 or 1-603-296-4920 Monday through Friday 8:30 a.m. to 7:30 p.m. EST.

submitted by Carol Madro, Skincare Associate

Do you have light colored eyebrows, sparse eyebrows, a scar in your eyebrow, or do they lack definition?

Now with the cute little Bitty Brow Kit from Jane Iredale, you can define and correct imperfections. The Jane Iredale Bitty Brow kit comes in Blonde and Brunette. Brush the brows with the little spoolie wand included in the kit, fill in with powder (wet it or use it dry) using one angle brow brush, and fix with the wax using the other angle brush.

That’s all there is to it, simply natural looking eyebrows with the Bitty Brow Kit by Jane Iredale!

For more information about Jane Iredale Bitty Brow Kit, please call Skincare-MD at 1-877-415-0600 or 1-603-296-4920 Monday through Friday 8:30 a.m. to 7:30 p.m. EST.

submitted by Daniel A. Sterling, M.D., FACS

Is there a permanent solution for forehead and eye wrinkles?

Any permanent solution for forehead and eye wrinkles would require an operative procedure.  Botox is frequently used for forehead wrinkles and wrinkles on the lateral aspect of the eye known as crow’s feet.  Excellent results are achieved with Botox for horizontal forehead and frown lines as well as for crow’s feet at the lateral aspect of the eye.  A permanent solution for this is a Coronal brow lift which will smooth the forehead and elevate the brows.  This can be combined with resection of the orbicularis oculi muscle at the lateral aspect of the eye to permanently relieve crow’s feet.  This is somewhat of an extensive surgical procedure and most patients opt to use Botox in lieu of this.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE.

submitted by Daniel A. Sterling, MD, FACS

Would liposuction help nasolabial folds and jowling?

Part of facial aging is the development of nasolabial folds and jowling.  The reason for this is that as we age our soft tissue descends from its youthful location on the underlying supportive skeletal frame.  Along with the descent of the facial tissue, there is usually a loss of volume as the facial fat tends to atrophy with age.  This is the reason why facial fillers are used readily as well as fat grafting to reproduce some of the fullness of youth and to give an overall better contour.  Liposuction is not routinely performed for nasolabial folds and is only partially successful in improving jowls.  Depending upon the severity and degree of nasolabial folds, marionette lines and jowling, a number of different interventions can be performed.  For the lesser and intermediate of these, facial fillers or fat grafting can be performed with excellent results.  The most severe problems can only be helped by a face lift which can also be combined with fillers and fat grafting at the same time to greatly improve all of these areas.  In any case, we are very fortunate to have many options to offer patients and women can expect to get an excellent result with any number of them.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE.

Submitted by Daniel A. Sterling, MD, FACS

I am interested in chin augmentation but am nervous as I have been told that the Implant can move.  Is this true?

Chin augmentation is a very safe procedure with consistent excellent results if done properly.  A chin implant can be inserted either through an incision in the mouth or an incision through the skin under the chin.  Both procedures work very well and there is minimal chance of the implant migrating.  At the time of the procedure the implant is secured in position with a dissolvable suture which maintains the position of the implant while the body forms a capsule around the implant which will hold it in position indefinitely.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE.

Submitted by Dr. Daniel A. Sterling

I am interested in having facial fillers, however, I do not do well with numbing agents such as Lidocaine. I would like to have my lips and nasolabial creases done. Is it possible to have the procedure done using a topical?

Not all fillers require “numbing agents” such as Lidocaine.  We used topical agents that work in some cases by temporarily freezing the area and others that work by numbing the area.  Although nerve blocks are still used infrequently when larger procedures are required, topical agents in most cases will provide more than adequate local anesthetic effect. 

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

Submitted by Dr. Daniel A. Sterling

I have lost volume in my face due to weight loss. I am most concerned with my eyes, they are very hollow and sunken looking. Is there a procedure or facial filler that you use to replace the lost volume?

Multiple areas of the body are effected following significant weight loss.  Different areas of the face including the eyes can be effected significantly as well.  Although fillers can be used in specific cases to augment various areas of hollowness in the face the eyes are somewhat less responsive.  Excess loose skin can contribute to a hollow sunken look and by removing that excess skin a greatly improved contour can be achieved.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE .

Submitted by Dr. Daniel A. Sterling

I am considering an Obagi Blue Peel. Is there a preconditioning protocol that needs to be followed prior to having a peel.

No facial resurfacing is done without a preconditioning protocol and that includes laser, acid peels, or dermabrasion. Standard treatment is the use of Retin A (tretinoin), as well as hydroquinone which will condition the skin. Specifically, the Retin A will stimulate thickening of the skin by stimulating increased deposition of elastin and collagen making the overall skin healthier. Hydroquinone is used to prevent post procedure hyper pigmentation or dark spots. This is usually done for a period of six weeks prior to having resurfacing done.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

Some people (mostly women) have considerable muscular activity involving the lips. This often results in lip lines. When pursing the lips (kissing movement) deep furrows are often noted. When we correct lip lines, separate injections of facial filler are first injected into the deep furrows, followed by more superficial injections just beneath the lip lines. Sometimes a chemical peel or dermabrasion is used after the facial filler to get the best result.

Botox helps minimize muscular activity and this helps maintain the facial filler for a longer period of time. Botox is used mostly for frown lines, forehead wrinkles and crow’s feet.  .The combination of Botox and facial filler is very helpful for long term (1-2 years) correction of frown lines.

Botox is used sparingly, if at all, in the lips, because of the undesired effect of changing the facial expressions and smile. Though the combination of Botox and facial filler will last longer than either one alone, it is always important to discuss this with the patient first. If the combination is used, only a small amount is used to get feedback from the patient. If the patient is happy with the combination treatment, this can then be continued in the future.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Injectables and Facial Fillers for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

Not only do certain facial fillers last longer than others, but the same facial filler may last a variable amount of time within the same patient. It is known that increased facial movement causes more rapid disappearance of facial filler. Certain areas of the face have greater motion, such as the area around the lips, and this area may show quicker disappearance of the facial filler. In contrast the areas along the sides of the nose and the cheek bone area have less facial movement and therefore the same facial filler will last a longer time.

Radiesse is probably the longest lasting facial filler of the group of temporary fillers. Artefill is considered to be in the more permanent category of facial fillers. Studies of Juvederm Ultra Plus are showing durations of up to one year. Perlane is known to last about 4 to 6 months and Restylane about 3 to 6 months. Collagen lasts only about 3 months.

One way to decrease motion is to inject Botox at the time of facial filler injection. This is especially effective in the frown lines where the combination of Botox and facial filler can last 1-2 years. Another area that lends itself well is the combination of Botox and facial filler in the marionette lines. Here too increased duration of results can be expected.

It is always best to have additional facial filler before all the filler disappears. In this way a steady state of enhancement can be maintained. Different fillers can be used together. For example the upper parts of the lip can be filled with Radiesse including the nasolabial creases, whereas the vermillion is better enhanced with Restylane or Juvederm Ultra.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Injectables and Facial Fillers for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

A new study published in Plastic and Reconstructive Surgery (v.121 pp.289-304) shows that Juvederm Ultra Plus lasts one year or more when injected into the nasolabial folds.

81% of 87 subjects were noted to have continued improvement during this time frame. When repeated touch up treatments were given, the volume of Juvederm Ultra Plus was less than the amount originally required, showing a lingering effect of the product.

Facial fillers have become mainstream for the many baby boomers who want to maintain their youthfulness, and avoid major surgery. Juvederm Ultra Plus is FDA approved and manufactured by Allergan Corporation. It belongs to the group of hyaluronic acid fillers which have a long safety record. Previous thoughts on this filler were that it lasts 6-8 months or more. This new information shows that Juvederm Ultra Plus lasts longer than previously thought.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Injectables and Facial Fillers for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

It is common for patients to request the simplest and cheapest form of therapy for almost any problem. There are many things that can be done for the aging face including less invasive procedures such as Botox and facial fillers. A wide variety of face lifts gives the surgeon and patients many options. Some of the more common concepts include the so-called “threads” (of which there are many with different names), mini face lifts, standard face lifts with different treatments of the underlying structures, deep plane face lifts and composite face lifts. A surgeon usually chooses the procedure that gives the best result in his practice and then tailors the procedure to fit the patient’s needs.

One of the factors that should be considered when having a face lift is how long the result can be expected to last. American board certified plastic surgeons have spent many years studying the longevity of these various procedures, and have repeatedly debated the pros and cons at our meetings. We all tend to agree that more “minor” approaches to face lifting operations such as “threads” and "mini face lifts" do not appear to stand the test of time. Problems with the “threads” such as breaking, extrusion, and granuloma formation have been reported in our literature. To achieve a lasting facelift most plastic surgeons still favor the traditional facelift. This approach continues to give the patient best result with the fewest complications.

A traditional facelift incision often begins in the hairline at the temples, continues around the ear and ends in the lower scalp. Fat may be sculpted or redistributed from the face, jowls and neck, and underlying tissue is repositioned, commonly the deeper layers of the face and the muscles are also lifted. Skin is redraped over the uplifted contours and excess skin is trimmed away. A second incision under the chin may be necessary to further improve an aging neck. Sutures or skin adhesives close the incisions.

We would be happy to see you in consultation to discuss this. During the consultation before and after photographs are reviewed in order to create a better focus towards the proposed results.  A consultation is especially important as it creates a patient/physician relationship based on trust, experience and expertise.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on face lifts for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

Submitted by Gloria Smith, Medical Assistant for the Plastic Surgery Professional Association and Peter T. Pacik, MD, FACS

Submitted by Gloria Smith, Medical Assistant for the Plastic Surgery Professional Association

Patients who are seen for facial options often have signs of sun damage, and are served well by incorporating an advanced skin care program. All of our patients are encouraged to see our licensed Aesthetician, Lisa Roberge, for a free skin care consultation. If you would like to have a free skin care consultation with Lisa, please make arrangements for this when making an appointment with one of the doctors so that enough time can be allowed for a visit with Lisa.

In addition to our facial rejuvenation services, the Plastic Surgery Center is proud to offer advanced skin care products that complement our services and can help you achieve younger, healthier looking skin.

Our physician strength skin care products are specifically designed to help improve your skin's quality and can help fight signs of aging, sun damage and acne in addition to other skin ailments. We offer these products for sale in our office as well as on our skin care web site. We encourage you to schedule a free skin consultation with our esthetician to help determine which products are ideal for your skin type.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on facial rejuvenation for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

Submitted by Gloria Smith, Medical Assistant of the Plastic Surgery Professional Association.

Acne scarring is one of the more difficult challenges in plastic surgery.  There are a variety of techniques. The most common is resurfacing the skin with dermabrasion.  Also used is excision of deep pits with either closure or grafting, often followed by dermabrasion. It is important to understand that permanent eradication of scars is usually not possible, especially for more severe types of acne scarring. If the scarring is light, repeated microdermabrasions are sometimes helpful. A variety of procedures are available for acne scarring and these will be discussed with you during your consultation and examination.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on acne scarring for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE .

In recent years there has been a movement towards more conservative cosmetic eyelid surgery. Cosmetic eyelid surgery is usually performed for excess skin involving the upper  eyelids, and droopy lower eyelids with or without fat excess. As patients age, the normal fat disappears. This volume depletion is noted in the face and in later years in the eyes. The movement towards conservative fat removal in both the upper and lower eyelids is done to help patients with their immediate problems yet to preserve enough fat so that in later years the eyes do not appear gaunt.

Since lower eyelid fat is usually the major culprit causing bags under the eyes, transconjunctival blepharoplasty has become the procedure of choice for the removal of this offending fat. In this way, the problem is approached via an incision inside the eyelid (in the conjunctiva) which results in less trauma to some of the other nearby structures. When some skin needs to be removed in addition to the fat, this can be done at the same time by simply doing a small pinch blepharoplasty just under the eyelashes. This too helps avoid excessive trauma to the lower lid structures. For more involved lower eyelid skin relaxation, physician strength eye creams such as MD Forte Skin Rejuvenation Eye Cream or the Obagi Elastiderm Eye Cream have been found to be very helpful in tightening the lower eyelids. Both the MD Forte Skin Rejuvenation Eye Cream and the Obagi Elastiderm Eye Cream can be found on our advanced skincare website, Skincare-MD.com.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Eyelid Surgery for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE .

Facial aging often presents itself with considerable lower facial aging. The type of aging shown in the accompanying figure does not lend itself to a face lift because we are dealing with a patient that has loss of volume, and any amount of tightening will not correct the aging problems as shown around the mouth. In addition the lips show the usual thinning that comes with aging.

Fortunately there are a variety of FDA approved facial fillers that can be injected to restore the depleted volume of fat, to plump out the wrinkles around the mouth, and restore the natural more youthful lip volume.

Lip lines are very common, more so in women, and may appear as early as the 30’s. This is often accompanied with thinning of the lip vermillion (red purple area) of the upper and lower lips. The facial fillers of choice are the FDA approved hyaluronic acid fillers such as JUVEDERM™ Ultra Injectable Gel , JUVEDERM™ Ultra Plus Injectable Gel , Restylane®, and Perlane® for the vermillion and the same fillers and or Radiesse® for the upper and lower lips above and below the vermillion. These fillers give a youthful appearance to the lips without appearing overdone. Radiesse® (our choice) and the other facial fillers can also be used to fill the sunken cheeks near the corners of the mouth, as well as the chin, marionette lines, and nasolabial creases.

BOTOX® Cosmetic is helpful in eliminating the platysma bands.

The accompanying photograph is representative of many of the patients we see in our practice. The use of properly selected facial fillers injected conservatively and BOTOX® Cosmetic helps restore a more youthful appearance.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Injectables and Facial Fillers for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

When we speak about Botox, physicians and readers think of the formulation made by Allergan which is FDA approved. Actually other formulations are known and this could be confusing to readers.

Botulinum neurotoxins are produced by various strains of Clostridium Botulinum, of which A and B have been developed for routine clinical use. These various types of toxins have different properties and are used in varying dosage strengths. Only two formulations of Botox have been studied and used for cosmetic and therapeutic indications. The type A is known as the BOTOX® Cosmetic commonly used. The type B is known as Myobloc and is less suitable for cosmetic purposes because of the discomfort of injection and its acidity. Myobloc has a shorter duration of activity and is no longer used by most clinicians.

Another formulation is Dysport which is used in the United Kingdom and is currently undergoing FDA approval. Dysport is more likely to diffuse beyond the targeted muscle which can cause unwanted sequelae, and also has a shorter duration of activity.

Statistics for 2006 (latest available as of May 2008) show that BOTOX® Cosmetic injections continues to be the single most common aesthetic procedure performed in the United States, with nearly 3.2 million BOTOX® Cosmetic procedures performed. It is well recognized as one of the safest procedures available, and has a high level of patient satisfaction.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on BOTOX® Cosmetic for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

Perlane®, a hyaluronic acid facial filler was approved by the FDA on May 4, 2007. Perlane® is similar to Restylane® for volume restoration of the face, but has a larger molecule than Restylane® and is therefore more effective for deeper wrinkles and depressions of the face. Perlane® also lasts longer (about 6 months to 1 year) than Restylane (about 4 to 6 months).

A large European and Canadian experience with Perlane has been shown to be safe and effective.

Perlane is commonly used for the following conditions:

• Wrinkle correction
• Diminishing worry lines, smile lines, crow’s feet, marionette lines at corners of the mouth, and smoker’s lines
• Lip enhancement
• Reducing the severity of nasolabial folds
• Chin augmentation
• Filling cheek depressions
• Redefining lip border
• Softening acne scars

Other, less common, uses for Perlane® filler include:

• Filling hollows under the eyes
• Creating a temporary eyebrow lift
• Correcting facial depressions caused by fat loss
• Softening the appearance of jowls

Before and After Photographs: Perlane® Facial Filler

Left Photograph: Before treatment of Nasolabial folds. Right Photograph: After treatment. Individual results may vary. Photographs courtesy of Medicis Aesthetics.

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE .

An effective treatment to improve blotchy hyperpigmentation is the use of 4% hydroquinone. This concentration of hydroquinone is "physician strength" and not available over-the-counter. 2% hydroquinone is available over-the-counter but is not as effective in achieving results.

Glyquin XM with Sunscreen and Obagi Nu-Derm Clear are two products that contain 4% hydroquinone. Glyquin XM Skin Lightening Cream is designed to slowly "lighten" hyperpigmented skin conditions such as discoloration, brown spots or an uneven skin tone. Glyquin XM Skin Lightening Cream contains 4% hydroquinone, 10% glycolic acid, vitamin C and E, a broad-spectrum sunscreen with SPF 15 and hyaluronic acid. Hyaluronic acid is a super-moisturizing ingredient which was added to Glyquin to relieve the irritation that is sometimes associated with hydroquinone use.

Obagi Nu-Derm Clear is part of an advanced skincare system and contains physician-strength 4% hydroquinoine, glycolics and tretinoin (Retin-A) to enhance effectiveness in improving hyperpigmentation in an easy to use series of numbered containers. It is not available over-the-counter or through spas. 

The Obagi NuDerm System begins to clear the skin in 2 weeks, with dramatic results by 8 to 12 weeks. Sometimes an Obagi Blue Peel at a later date will provide additional clearing.

From Left to Right: 
Photo 1: Before Obagi Nu-Derm Products: This patient came to our office with severe sun damage and mottled hyperpigmentation. Photo 2: 6 week follow-up Obagi Nu-Derm Products: Note improved complexion and reduction of cheek wrinkles. Photo 3:  22 day follow-up Obagi 15 percent Blue Peel: Customized Obagi 15 percent TCA Blue Peel (2 coats). Note tightening of skin and improvement of wrinkles. Continued clearing of complexion. Now on a maintenance program for the Obagi Nu-Derm products. Photo 4:  10 month follow-up Obagi 20 percent Blue Peel:  Customized Obagi 20 percent TCA Blue Peel was performed 2 months after her first 15 percent Blue Peel. Note the rose color is the result of increased blood supply to the collagen layer.
 
If hyperpigmentation is due to Melasma (usually hormonal), treatment with the Obagi NuDerm System is equally effective as shown in the photographs below.

From Left to Right: 
Photo 1: Before Obagi Nu-Derm Products: Severe hyperpigmentation, melasma and acne. Hyperpigmentation may be hormonal. Obagi Nu-Derm Advanced Skincare System recommended with 0.025% Tretinoin. Photo 2: 3 week follow-up Obagi Nu-Derm Products: Reduction in uneven skin tone. Improved skin clarity. Some blemishes due to mild irritation. Photo 3:  6 week follow-up Obagi Nu-Derm Products: Amazing results. Skin tone is more even. Reduction in hyperpigmentation. Fewer blemishes. Patient will continue with the Obagi Nu-Derm System for 2-3 skin care cycles (12 to 18 weeks). Photo 4:  26 week follow-up Obagi Nu-Derm Products: Excellent results after 4 skin cycles. Patient now on maintenance program. Malasma has completely disappeared. Patient very pleased with the results of the Obagi Nu-Derm Advanced Skincare System.

For more information or ordering information on Glyquin XM or the Obagi NuDerm System, visit our Skincare-MD.com website. Additional before and after photographs can also be found on our skincare website.

Contact Us With Your Questions
As always, we encourage you to call our office and speak to our licensed Esthetician, if you have any questions. We are always happy to talk to you about your skin type and condition and make product recommendations based on your conversation. Our MD Forte, Obagi Nu-Derm, Obagi-C Rx and Kinerase Advanced Skin Care Programs are all excellent for skin rejuvenation. We can help you decide which skin care program would be best for you. Our esthetician is available during office hours Monday through Friday 8:30 a.m. to 7:30 p.m. EST at 1-877-415-0600 or (603) 296-4920. You may also email us at info@skincare-md.com if you have any questions.

We know have available a new product called Juvederm Ultra for the correction and enhancement of lips and Juvederm Ultra Plus for the correction of deeper folds and wrinkles.

In the past, we were more limited to the correction of superficial wrinkles and lip lines by using collagen, Restylane and Radiesse. Restylane, which is a hyaluronic acid facial filler comes as a larger molecule under the name of Perlane, suitable for deeper injections to correct deeper folds and for longer lasting improvement of lip volume but is only available through Canada. Radiesse is generally used little or not at all in the lip because of the problem of nodule formation.

Juvederm Ultra  and Juvederm Ultra Plus is a similar larger hyaluronic acid molecule and is now available in the United States and is approved by the FDA. This new facial filler gives us an added modality for the correction of deeper folds and to achieve longer-lasting lip enhancement. Often lip lines can be improved not only by injecting facial filler superficially into the lip lines, but also by enhancing the volume of the lip.

Juvederm injectable gel employs its unique manufacturing process to provide the highest concentration of cross-linked hyaluronic acid of any currently available hyaluronic acid dermal filler for long-lasting results. This advanced manufacturing process also creates a smooth consistency gel that flows consistently and easily into the skin and provides a smooth, natural look and feel.

Obagi Medical Products, Inc. has introduced ELASTIderm Day Eye Gel and ELASTIderm Night Eye Cream, two eye-therapy products clinically proven to help the natural abilities of skin to produce insoluble elastin, decrease the number of wrinkles and increase functional elasticity of the skin. Although most cosmetic treatment products to date utilize moisturizing ingredients to help reduce the appearance of lines around the eyes, ELASTIderm utilizes a patent-pending bi-mineral complex technology with malonic acid to offer a superior approach to anti-aging treatment without the use of line-plumping moisturizers.

ELASTIderm uses Obagi's exclusive Penetrating Therapeutics, an effective patent-pending technology that allows for greater penetration of an active agent across the skin barrier to stimulate functional elasticity and to enhance the resilience of the skin around the eyes. Recent clinical studies on ELASTIderm demonstrated a statistically significant 46% increase in functional elasticity after nine weeks of use.

Formulated with a bi-mineral complex that works to replenish and cross link elastin to support collagen and give skin functional elasticity, the scientific data revealed the patent-pending complex was effective in improving the elasticity of photoaged skin and visibly reducing periorbital lines. A significant increase in elasticity was achieved within only two weeks and elasticity continued to increase over an eight-week period. Importantly, the increase in elasticity was independent of moisturization, indicating the effects of the bi-mineral complex were not simply the consequence of increased hydration.

Contact Us With Your Questions
As always, we encourage you to call our office and speak to Dawn Mailhiot, our licensed Esthetician, if you have any questions. Dawn is happy to talk to you about your skin type and condition and make product recommendations based on your conversation. Our MD Forte, Obagi Nu-Derm, Obagi-C Rx and Kinerase Advanced Skin Care Programs are all excellent for skin rejuvenation. Dawn can help you decide which skin care program would be best for you. She is available during office hours Monday through Friday 8:30 a.m. to 8:30 p.m. EST at 1-877-415-0600 or (603) 296-4920. You may also email Dawn at info@skincare-md.com if you have any questions.

The use of Restylane dates back to 1997 and has a long history of use primarily in Europe. It was not approved by the FDA until 2003, and since then, has had widespread use in the United States.

Radiesse is approved for a number of medical conditions including facial bone augmentation, and has been used off-label in America since 2003 for wrinkle treatment. Radiesse was FDA approved on 12/27/06 for the long lasting correction of moderate to severe facial wrinkles and folds such as the nasolabial folds. Radiesse also has clearance status in Europe, Canada and Latin America for facial esthetics. There is both a large European and American experience with this product.

Restylane tends to last about four to six months which is longer than collagen (2-3 months) and does not require allergy testing. Radiesse lasts about one to two years and also does not require allergy testing. Both facial fillers tend to last longer when Botox is injected which diminishes muscular movement. The concomitant use of Botox is especially helpful in the frown lines, and can be used sparingly in the lips.

The injections of both Restylane and Radiesse are made more comfortable with the use of local anesthesia. Any patient with a history of cold sores (herpes simplex) should be pre-treated with an antiviral agent such as Valtrex for one to two days before using Restylane or Radiesse. Restylane is a non-animal stabilized hyaluronic acid filler. It works by attracting water. The water plus the injected gel maintains the volume injected.

Restylane is hyaluronic acid which is a natural complex sugar found throughout all living organisms that retains water – absorbing more than 1,000 times its weight – and adds volume to the skin’s surface. In addition, hyaluronic acid binds with collagen and elastin and transports essential nutrients to these fibers. The triple combination of collagen, elastin and hyaluronic acid provides structure, elasticity and volume to the skin and contributes to its overall appearance.

The key ingredient in Radiesse is 30% calcium hydroxylapatite in a 70% gel consisting of cellulose, glycerin and sterile water. The calcium  microspheres remain in place to act as a scaffold that allows the in-growth of fibroblasts that lay down collagen. In this way Radiesse stimulates the body to produce new collagen.  This maintains the injected volume for a longer period of time.

Of the 9.2 million non-surgical procedures performed in the United States in 2004, nearly 900,000 involved soft-tissue augmentation using Restylane. Currently, there is a vast worldwide experience with both Restylane and Radiesse.

Juvederm, manufactured by Allergan, is the latest facial filler that will become available in early 2007.

A prospective patient recently emailed us and wanted to verify that Juvederm is superior to Restylane. Both products are hyaluronic acid which attracts water; therefore, helps with volume fill and hydration.

The clinical study involving Juvederm compared Juvederm to Zyplast (collagen), but not to Restylane. Juvederm was the favored drug over collagen. No data exists comparing Juvederm to Restylane.

Of concern is that Juvederm contains less hyaluronic acid than Restylane (24 mg/ml versus 20 mg/ml). Whether or not the longevity of Juvederm will be comparable can only be determined by future controlled scientific studies. Until then, we are dealing with more hype than science.

The platysma is the neck muscle that causes a grimace when it is contracted. As we age, cords or bands make their appearance. These muscular cords can appear in the lateral (outer) part of the neck, though they are more frequently a sign of aging when they appear below the chin area. One or two platysma cords may be present and asymmetry is common.

Though there are a number of surgical procedures to correct platysma cords, the simplest effective method is to inject Botox into the cord itself. Botox will weaken any overactive muscular area, and the platysma bands are no exception. As with other areas of Botox use such as frown lines, forehead wrinkles, crow’s feet, and now the new use to elevate the corners of the mouth and correct marionette folds, injections of Botox need to be repeated about every 3 months, until the involved muscles are sufficiently weak that the patient can be placed on a maintenance program of Botox with fewer injections. This simple approach to correct platysma bands is often all the patient needs and helps avoid an operation in this area.

I recently read an interesting article on the use of Botox and facial filler for marionette folds. Until recently, there was little that could be done for marionette folds. With the advent of facial fillers such as Radiesse, Restylane and fat grafting, these depressions below the corners of the mouth could be filled in, at the same time elevating the drooping corners of the mouth (oral commissures).

The article, which appeared in the September/October 2006 issue of the Aesthetic Surgery Journal, describes the aging anatomy of the depressor muscles of the corners of the mouth (depressor anguli oris) and the benefits of combining a small amount of Botox (3 to 4 units) and facial filler. It has been our experience, that whenever possible, it is helpful to combine Botox and facial filler in that the two treatments together prolong the effects of improvement. An added benefit for the use of Botox in this area is that the depressor muscles to the corners of the mouth are weakened, allowing the angles of the mouth to move into a more favorable upward position.

"D" in the illustration is the depressor anguli oris responsible for turning down the corners of the mouth and is also implicated in the development of marionette folds.

The following before and after photographs show the benefit of Radiesse facial filler for the correction of marionette folds. More complete correction and longer-lasting results can likely be achieved by combining this treatment with Botox injections.

Fat grafting also known as fat transplanation adds volume to areas of deficiency. One of the problems of facial aging is the loss of volume which causes the skin to sag.

Though fat grafting may be permanent, the experience of plastic surgeons throughout the United States is that often additional fat needs to be injected in the future. The reason why fat reabsorbs may relate to inadequate blood supply nourishing the transplanted fat, though at times the reasons are unknown. Considerable research is being done in this field to determine the best methods of harvesting the fat, and the best techniques for injecting the fat. We now have one more excellent modality for treating facial aging and to help fill out unwanted depressions anywhere on the body. We have made great strides in the field of fat grafting thanks to the pioneering work of physicians who helped develop these techniques. We look forward to the research that will continue to improve our results.

Restylane versus Radiesse and Lip Nodules

The September issue of the Plastic and Reconstructive Surgery Journal has an interesting supplement on facial fillers. The collective experience of many physicians is presented.

The section on lip enhancement deals with the pros and cons of Radiesse and Restylane facial filler as used for lip augmentation.

I have had excellent results using both Radiesse and Restylane; however, I have concerns about reports that show a small percentage of lip nodules after the use of Radiesse. I like Radiesse because it lasts longer; therefore, less frequent injections are needed. Though Radiesse takes longer for the swelling to disappear, and for the first few weeks the lips may be somewhat unnatural with more of a firm quality, this settles down and becomes soft. It is thought that the normal muscular activity of the lips causes the Radiesse to bunch up in a small group of patients forming lip nodules.

These lip nodules usually respond to massage, though at times need to be either broken up with a fine needle followed by massage; injected with dilute steroids; or excised (removed surgically). This does not appear to be a problem when Restylane is used.

It is further thought that using a smaller amount of Radiesse in 2 to 3 sittings, massage at home for 2 to 3 weeks, and being careful to limit lip movement for 2 to 3 weeks appear to reduce the incidence of lip nodules after Radiesse injections.

For those patients who do not want to take the risk of lip nodules, it is advised that Restylane be used.

Regardless of the facial filler used, we watch our patients carefully after the procedure so that we can add more facial filler on a timely basis. We do not want the lips or any other area to return to starting levels, rather it is better to add more facial filler as the effects of Restylane or Radiesse begin to wear off.

A common misconception is that children are born with freckles. Freckles are actually the earlier signs of sun damage and appear in young, fair-skinned children exposed to the sun without protection.

Children are born with hydrated, rosy skin. They do not need moisturizers because their skin is healthy and undamaged.

Damage can occur early. If you see freckles, don’t be misled by the cute name of “angel spots” or feel that this is normal and inherited. Instead, sound the alarm and use high quality sunscreens that filter out the burning UVB rays and also the harmful UVA rays which though weaker than UVB actually cause more damage in the deeper tissues, and are responsible for the later sun damaged skin that can lead to melanoma in later years.

Considerable information about quality sunscreens and sun blocks can be found on our skincare website http:www.skincare-md.com. In addition, protective clothing and wide-brimmed hats are very helpful.

Contact Us With Your Questions
As always, we encourage you to call our office and speak to Dawn Mailhiot, our licensed Esthetician, if you have any questions. Dawn is happy to talk to you about your skin type and condition and make product recommendations based on your conversation. Our MD Forte, Obagi Nu-Derm, Obagi-C Rx and Kinerase Advanced Skin Care Programs are all excellent for skin rejuvenation. Dawn can help you decide which skin care program would be best for you. She is available during office hours Monday through Friday 8:30 a.m. to 8:30 p.m. EST at 1-877-415-0600 or (603) 296-4920. You may also email Dawn at info@skincare-md.com if you have any questions.

ELASTIderm Night Eye Cream is a new eye cream, made by the well-known distributors of the Obagi NuDerm Advanced Skin Care System, for wrinkling around the eye. It goes on very smoothly and results are seen as early as 2 weeks. Wrinkles of the lower eyelids and crow’s feet continue to show improvement over the next 6 weeks. It does not contain glycolics; therefore, there is less irritation. Any new product may cause irritation; therefore if this happens, the skin needs to be conditioned by using a smaller around of the product every 2 to 3 days. As with all of our products, we give a money back guarantee if you are not satisfied. Since this is a new product, your comments will be very much appreciated. We are offering Obagi ELASTIderm Night Eye Cream at a 10 % discount off the list price.

Considerable information about Obagi ELASTIderm Night Eye Cream can be found on our skincare website http:www.skincare-md.com.

Contact Us With Your Questions
As always, we encourage you to call our office and speak to Dawn Mailhiot, our licensed Esthetician, if you have any questions. Dawn is happy to talk to you about your skin type and condition and make product recommendations based on your conversation. Our MD Forte, Obagi Nu-Derm, Obagi-C Rx and Kinerase Advanced Skin Care Programs are all excellent for skin rejuvenation. Dawn can help you decide which skin care program would be best for you. She is available during office hours Monday through Friday 8:30 a.m. to 8:30 p.m. EST at 1-877-415-0600 or (603) 296-4920. You may also email Dawn at info@skincare-md.com if you have any questions.

Probably the most common area for Botox injection is the frown area. Some people have very strong muscles in this area (corrugators) that over time cause creases and actual depressions (furrows). With time, they look like they are scowling.

An easy solution for this is the injection of Botox. The heavier the muscles, the more Botox needed. For deeper furrows, facial fillers can be added at the same time. When facial fillers are used at the same time as Botox, the results can be long lasting as shown in the photos below.

Left Photo: Heavy frown lines -- patient frowning. 8 injections of Botox plus 0.7cc Restylane to frown lines. Right Photo: 6 month follow-up. Patient still unable to frown. Frown lines and furrows are filled in with Restylane facial filler. Botox together with facial filler allows both products to work longer.

Together with wrinkles of the lower eyelids, lip lines rank high in terms of patient dissatisfaction with facial aging.
 
In the past, the most we could do was to recommend a chemical peel, dermabrasion or laser. With the popularity of facial fillers (Restylane, Radiesse) and fat grafting, we are now able to plump out aging lips that have lost their volume. This is often all the patient needs, though at times, one of the resurfacing techniques described above will give additional improvement.
 
The injection of facial fillers is done as an office procedure under local anesthesia. Swelling persists for about 3 to 7 days and then subsides rapidly. Repeat injection can be done about 4 to 6 weeks later as a “touch up.” Minimal discomfort is present after the local anesthesia wears off.

Left: Female with radial lip lines. Pre Radiesse Injections.
Right: 9 months post Radiesse injections.

The drying indoor heat often creates a return of dryness of the hands with associated cracking skin involving the fingers. At times, these cracks will bleed, and they are often painful. Treatment with Vaseline or other heavy-duty moisturizers doesn’t seem to do the trick.
 
The Obagi NuDerm System (which does not contain moisturizers!) is probably the most effective treatment I have used for my patients and myself. The physician strength ingredients restore health to damaged skin from below up. This gives the skin a chance to heal starting with the deeper structures, which are responsible for the quality of the top layers of skin.
 
While you’re at it, treat your face in a similar manner to get rid of some of those fine wrinkles and the brown spots of sun damage.

The Obagi Nu-Derm Advanced Skin Care System  is designed to restore health to sun and smoke damaged skin, as well as even out pigmentary problems involving the face and other areas of the body. The Obagi Nu-Derm system corrects surface discoloration and blemishes. It also penetrates into the skin to stimulate skin cell renewal, improve circulation and help rebuild collagen. The normal barrier function of the skin is restored, making the skin less sensitive and better able to hydrate properly.

Contact Us With Your Questions
As always, we encourage you to call our office and speak to Dawn Mailhiot, our licensed Esthetician, if you have any questions. Dawn is happy to talk to you about your skin type and condition and make product recommendations based on your conversation. Our MD Forte, Obagi Nu-Derm, Obagi-C Rx and Kinerase Advanced Skin Care Programs are all excellent for skin rejuvenation. Dawn can help you decide which skin care program would be best for you. She is available during office hours Monday through Friday 8:30 a.m. to 8:30 p.m. EST at 1-877-415-0600 or (603) 296-4920. You may also email Dawn at info@skincare-md.com if you have any questions.

Every time I go to one of the sun-belt states, I’m impressed by the severe sun damage I see in young people. Even in New England, sun damage is prevalent. Diagnosing sun damage is easy: the appearance of freckles or blotchy brown pigmentation as shown in the photographs below gives one an immediate diagnosis (blotchy black in sun damaged naturally darker skin).
 
Treatment is equally easy! We use the Obagi NuDerm System that begins to clear the skin in 2 weeks, with dramatic results by 8 to 12 weeks. Sometimes an Obagi Blue Peel at a later date will provide additional clearing.

From Left to Right: 
Photo 1: Before Obagi Nu-Derm Products: This patient came to our office with severe sun damage and mottled hyperpigmentation. Photo 2: 6 week follow-up Obagi Nu-Derm Products: Note improved complexion and reduction of cheek wrinkles. Photo 3:  22 day follow-up Obagi 15 percent Blue Peel: Customized Obagi 15 percent TCA Blue Peel (2 coats). Note tightening of skin and improvement of wrinkles. Continued clearing of complexion. Now on a maintenance program for the Obagi Nu-Derm products. Photo 4:  10 month follow-up Obagi 20 percent Blue Peel:  Customized Obagi 20 percent TCA Blue Peel was performed 2 months after her first 15 percent Blue Peel. Note the rose color is the result of increased blood supply to the collagen layer.
 
The Obagi NuDerm System contains physician-strength 4% hydroquinoine, glycolics and tretinoin (Retin-A) in an easy to use series of numbered containers. It is not available over-the-counter or through spas. For more information on the Obagi NuDerm System and ordering information, visit our Skincare-MD.com website. Additional before and after photographs can also be found on our skincare website.

If hyperpigmentation is due to Melasma (usually hormonal), treatment with the Obagi NuDerm System is equally effective as shown in the photographs below.

From Left to Right: 
Photo 1: Before Obagi Nu-Derm Products: Severe hyperpigmentation, melasma and acne. Hyperpigmentation may be hormonal. Obagi Nu-Derm Advanced Skincare System recommended with 0.025% Tretinoin. Photo 2: 3 week follow-up Obagi Nu-Derm Products: Reduction in uneven skin tone. Improved skin clarity. Some blemishes due to mild irritation. Photo 3:  6 week follow-up Obagi Nu-Derm Products: Amazing results. Skin tone is more even. Reduction in hyperpigmentation. Fewer blemishes. Patient will continue with the Obagi Nu-Derm System for 2-3 skin care cycles (12 to 18 weeks). Photo 4:  26 week follow-up Obagi Nu-Derm Products: Excellent results after 4 skin cycles. Patient now on maintenance program. Malasma has completely disappeared. Patient very pleased with the results of the Obagi Nu-Derm Advanced Skincare System.

Contact Us With Your Questions
As always, we encourage you to call our office and speak to our licensed Esthetician, if you have any questions. Our esthetician is happy to talk to you about your skin type and condition and make product recommendations based on your conversation. Our MD Forte, Obagi Nu-Derm, Obagi-C Rx and Kinerase Advanced Skin Care Programs are all excellent for skin rejuvenation. Our esthetician can help you decide which skin care program would be best for you. Our esthetician is available during office hours Monday through Friday 8:30 a.m. to 4:30 p.m. EST at 1-877-415-0600 or (603) 296-4920. You may also email us at info@skincare-md.com if you have any questions.

It's not often that a surgeon recommends creams over surgery, but that's exactly what we do for most patients who complain of lower eyelid wrinkling.

Wrinkling of the lower eyelids is at the top of the list for patients who complain of facial aging. Though there are other associated conditions that are more surgical, such as wrinkling of the upper eyelids (needs surgery) crow's feet (needs Botox) and fatty bags of the lower lids (needs surgery), pure wrinkling of the lower lids often responds to physician-strength eye creams. I have had personal success with MD Forte Skin Rejuvenation Eye Cream. I was sure I would need surgery for this inherited condition; but much to my delight, my eyelids are smooth and surgery is no longer needed. I also have the experience of hundreds of patients treated in a similar manner.

A new, less irritating, eye cream is Obagi ELASTIderm Night Eye Cream. We don't have much in the way of clinical studies yet, but it may be worth trying. The before and after photos are impressive and the Obagi name stands behind the product.

Obagi ELASTIderm Night Eye Cream is specially formulated as a nightly, stand-alone product, or for use with the Obagi Nu-Derm System or the Obagi-C Rx System. ELASTIderm can also be used in the day as well as night.

Dawn Mailhiot, our Esthetician, has been using ELASTIderm for about two weeks now and is starting to see subtle changes already. A number of our staff members have just started to use ELASTIderm Night Eye Cream and all indicate that this product goes on smoothly and feels good instantly. For more information on Obagi ELASTIderm Night Eye Cream and ordering information, visit our skincare website http://www.skincare-md.com.

Contact Us With Your Questions
As always, we encourage you to call our office and speak to Dawn Mailhiot, our licensed Esthetician, if you have any questions. Dawn is happy to talk to you about your skin type and condition and make product recommendations based on your conversation. Our MD Forte, Obagi Nu-Derm, Obagi-C Rx and Kinerase Advanced Skin Care Programs are all excellent for skin rejuvenation. Dawn can help you decide which skin care program would be best for you. She is available during office hours Monday through Friday 8:30 a.m. to 8:30 p.m. EST at 1-877-415-0600 or (603) 296-4920. You may also email Dawn at info@skincare-md.com if you have any questions.

As we age, it is common to develop fatty bags involving the lower lids. Often this fat is removed during a lower blepharoplasty operation, though at times it may leave some hollowness in this area. A sign of youth is fullness of the lower eyelids, blending into the inner cheek area without depressions. Nasojugal folds are depressions along the inner aspect of the lower lids and are one more aspect of facial aging.

Blending of the midface was achieved in this patient by injecting facial filler (Radiesse) into the inner cheek area between the lower lids and the upper part of the nasolabial creases to achieve a uniform appearance to this part of the face. This can also be achieved with fat grafting. No fat was removed from the lower lids, allowing for an overall more youthful appearance. Photo courtesy of Bioform (Radiesse)

The use of facial fillers to enhance or correct volume deficiency of certain regions of the face is increasing. So much so, that the Plastic and Reconstructive Surgery Journal devoted an entire supplement for updates and discussion (Vol. 118, Number 3S. September 1, 2006 Supplement). This 132-page supplement reviewed the current status of a variety of facial fillers, and most importantly, presented longer follow-ups and complications.

Radiesse has been used successfully to improve nasolabial folds, marionette lines, corners of the mouth (and commissures), cheeks, chin, lips and radial lip lines. Radiesse (calcium hydroxyl apatite micro spheres) is one of the temporary facial fillers that lasts about 1 to 2 years, and has an “extensive safety profile, having been used as an implant material for more than 20 years.” When injected into soft tissues such as the dermis, it creates bulk as well as supporting new collagen formation.

Left: Female with radial lip lines. Pre Radiesse Injections.
Right: 9 months post Radiesse injections.

There continues to be disagreement about the best facial filler to enhance lips, and to correct lip lines. Some plastic surgeons use only Restylane, others will use either or both Restylane and or Radiesse. A potential problem with Radiesse in the lips is the formation of lip nodules noted in 42 of 338 patients (12.4%), who underwent augmentation of the lip mucosa (red portion of the lip) and in 6 of 163 patients (3.7%) who had injection of lip lines. It was further noted, that when smaller doses are injected in 2 separate visits, that the incidence was reduced to 8.8% of lip nodule formation. Most lip nodules can be managed by massage or injection of a dilute steroid, though at times a nodule may need to be excised.

In our own practice, we use both the shorter acting Restylane (4 to 8 months) and the longer duration Radiesse (1 to 2 years). To overcome the problem of earlier resorption due to the active lip muscles, we often inject a small dose of Botox at the same time when there is over activity of the lip muscles. This allows the facial filler to last a longer time. In addition, we feel that there is a place to combine the more superficially injected Restylane into the lip lines, and the deeper placed Radiesse to give added fullness to the lips. The idea of using smaller doses of Radiesse given on separate days is appealing and will be incorporated into our practice.

Radiesse is approved by the FDA for soft tissue augmentation of oral and maxillofacial defects and for vocal cord problems. Other cosmetic uses are “off label” but can be used by physicians. Radiesse is currently under review by the FDA for facial soft tissue augmentation applications.

The following patient is a good example of the benefit of combining Botox with a facial filler. Lip lines developed as a result of overactive muscles around the mouth (photograph top right). The lips have thinned with age.

Botox was used to reduce the hyperactivity. Only 2 injections, one on each side of the lip, was used to help quiet the muscles but not enough to develop lip droop. Radiesse was injected for volume replacement of both the upper lip and the early marionette lines (depressions in the corner of the mouth). By having less muscular activity (photograph bottom right), the facial filler can be expected to last longer.

The photographs below are at one month. Her photos at one month show better fullness of the lips, marked improvement of the corners of the mouth and near eradication of the lip lines.

In photograph below, the lip is paler on her right side as well as a small central zone where some of the radiesse can be seen through the lip. This will disappear with time.

A frequent consultation in our practice is for "lip lines." The other day, as I was discussing options for a woman in her 60's, I realized how much more we have to offer than in years gone by. In the not so distant past, we were able to offer some type of resurfacing such as dermabrasion, chemical peel or laser. That was it!

Now we are able to offer the same, but in addition, we can offer facial fillers such as Restylane, Radiesse and fat grafting when the volume of the lips is deficient, Botox when the lip lines are a result of too much muscular activity, or a combination of any of the above.

I have seen lip lines as early as the 40's, and the problem is that they become progressively more severe, and also more difficult to treat as a person ages.

The area around the mouth is the devil when it comes to facial aging. Fortunately, there is much that we can offer.