The following are the more common types of facial rejuvenation treatments. All of these methods carry their own set of risks, benefits, costs, and techniques. The good news is that they work, and getting a good wrinkle treatment can take years of of your facial age.

Facelift: This is a surgical procedure that involves removing excess skin and fat from the facial area. The remaining skin is redraped, and then looks tighter, smoother while removing the appearance of wrinkles.

Contour Threads: This is a surgical procedure that involves inserting barbed hairl like sutures under the skin of the neck and face and produces a gentle face lift effect.

Dermabrasion: This procedure scrapes off the top layers of skin. Dermabrasion can smooth scars, as well as fine lines and wrinkles on the face.

The following are some of the more common minimally-invasive facial rejuvenation and wrinkle procedures:
Microdermabrasion: This is a superficial skin polishing procedure that involves sanding off the first layer of skin with tiny crystals.

Facial Peel: When certain chemicals are applied to the skin, they cause age spots to disappear while tissue appears less transparent. Spider Vein Treatment (Sclerotherapy): The injection of a chemical, known as a sclerosing solution, into unsightly veins which causes them to turn white and gradually disappear.

Hyaluronic acid injections: The injection of hyaluronic acid can be used to improve the skin’s contour and reduce depressions in skin due to age,acne, scars, or injury.

Botox Injections: Botox is the most famous of all wrinkle treatments and without a
doubt a great plastic surgeon with a vial of Botox can do wonders. In this Wrinkle Treatment a botulinum toxin that is injected to prevent the contraction of muscles that form wrinkles, thus reducing them.

Collagen Injections: Derived from purified bovine collagen, this injectable cosmetic filler is designed to replace lost collagen found in the skin.

Fat Injections: Fat can be harvested from the patient’s own body, and is designed to plump up the skin and provide a more youthful appearance.

Gortex Implants: A polymer, non toxic implant that come in a variety of shapes most commonly used for deep wrinkles in smile lines, frown lines, and sometimes acne scars. They can also be used to augment the lips.

Acne treatment: An array of different procedures designed to reduce acne and diminish acne scars.

Cellulite Treatment
Fat Injections to reduce lines in your face

Our face is the most distinguishing feature on our entire body. However, as we grow older, fine lines, wrinkles, age spots, and other signs of aging appear. Age, sun exposure, smoking, and other factors can all contribute to this appearance. While there are those who choose to accept aging as a way of life, many people have been seeking cosmetic surgeons or dermatologists to find how they can recapture their youth. Cosmetic surgery and esthetic medicine procedures offer several techniques that can help restore a youthful appearance to faces. These are known as facial rejuvenation treatments. While some of these facial rejuvenation procedures involve surgery, like facelifts and dermabrasion, more and more minimally-invasive procedures have emerged. These procedures require no incisions and may not require anesthesia, plus these patients experience minimal, or no downtime at all. Minimally-invasive procedures are gaining in popularity. According to the American Society of Plastic Surgeons, 7 million minimally-invasive cosmetic procedures were performed in 2003, up 43 percent from 2002. Plus, three of the top minimal-invasive procedures performed in the U.S. involved facial rejuvenation: Botox injections (2,891,390), chemical peel (995,238), and microdermabrasion (935,984). With the increasing popularity of various cosmetic surgery procedures, including facial rejuvenation, it is important that the prospective patient research and understand different issues like what the procedure can and cannot treat, inherent risks, costs, and other factors.

Benefits of Facial Rejuvenation and wrinkle Treatments

These treatments cannot stop your face from aging, but it can take years off your appearance by reducing the amount of wrinkles and other signs of aging. Benefits can vary depending on the type of treatment used. While some procedures offer no down time, others have longer lasting results.

What happens as we age? Young skin is smooth and elastic and contains a large amount of hyaluronic acid that helps the skin look healthy. As we grow older, the ability of the skin to produce hyaluronic acid decreases and the amount of hyaluronic acid begins to fall. As hyaluronic acid helps to bind water, the ability of the skin to retain water also declines with age. As a result, the skin becomes drier, thinner and less able to restore itself. The loss of skin fullness also means that the skin becomes looser. This leads to wrinkling and the older appearance of the skin.

The layers of your skin Your skin consists of three main layers: the epidermis, dermis and subcutaneous tissue. The epidermis is the outer layer that protects you from heat and cold. The condition of the epidermis determines how your skin looks and also how well your skin absorbs and holds moisture. Wrinkles, however, are formed in lower layers. The dermis is the middle layer of the skin and the skin’s support structure. It is the thickest layer and comprises a network of collagen and elastin fibres. The subcutaneous tissue consists mainly of fat that keeps us warm, stores energy and protects inner organs.

What causes lines and wrinkles? The dermis is the skin layer responsible for the skin’s elasticity and resilience. The dermis functions as the skin’s support structure, containing collagen, elastin and biological substances whose main function is to hold moisture in the skin. One of these substances is hyaluronic acid. As we age, the amount of collagen and hyaluronic acid decreases and the elastic elastin fibres become looser and tend to gather in formations, creating wrinkles and folds. However, age is not the only cause of wrinkles. Smoking, sun bathing and pollution damage the structure of your skin, irrespective of age.

Who would best Represent an Ideal Candidate for Facial Rejuvenation Treatments?
Those people looking to enhance the appearance of their face would represent an ideal candidate for facial rejuvenation treatments. Although reasons vary from person to person, the more common include:
Enhancing appearance and boosting self-confidence.
Becoming less self-conscious about appearance.
Achieving smoother looking skin.
Removing unsightly skin conditions (i.e. age spots, uneven pigmentation, spider veins, etc.).
Regaining a more youthful look.
Facial Rejuvenation Procedures
DERMABRASION (top)

Dermabrasion is a procedure that is used to smooth fine wrinkles and scars left by acne or previous surgery. It involves controlled surgical scraping that ‘refinishes’ the top layers of the skin to give a smoother appearance. Dermabrasion can be performed over the full surface of the face or on small areas, and may be done in conjunction with other cosmetic procedures such as facelift or face peel. Dermabrasion is not an appropriate treatment for some people. Asian or dark-skinned people may experience permanent discoloration and blotchiness. People with freckled skin should avoid dermabrasion over small areas, because their freckles will disappear in the treated areas only. People who develop allergic rashes or other skin reactions are also advised against undergoing dermabrasion. Conditions treated by dermabrasion Dermabrasion is used to treat a range of skin complaints including:
Facial scars (excluding burn scars)
Scarring from prior surgery
Wrinkles and frown lines
Pre-cancerous skin growths (keratoses)
Pigmentation
Sun damage
Tattoos
Age (liver) spots.
Medical issues to consider Before the procedure, you need to discuss a range of issues with your doctor or surgeon including:
Physical examination, to make sure your skin is suitable for the treatment.
Your expectations of how you will look once your skin heals.
Medical history, including any prescription drugs, over-the-counter drugs, herbs, or vitamin or mineral supplements you may be taking. Some preparations can interact with surgical medications and need to be avoided.
Patients who smoke are recommended to stop two weeks before surgery, because smoking decreases blood circulation in the skin and slows the healing process.
Aspirin and other medications that reduce blood clotting should be avoided before surgery.
Treatment procedure
Dermabrasion usually takes up to 90 minutes to perform, depending on the amount of skin to be treated. The procedure may need to be performed in stages, particularly when the scarring is deep or a large area of skin is involved. You will be given medications to help you relax. The area to be treated is wiped over with antiseptic lotion to reduce the risks of infection, and then sprayed with anaesthetic. Injections of anaesthesia may also be administered. The procedure may be done under local or general anaesthesia.

During the dermabrasion procedure, the surgeon scrapes away the outermost layer of the skin using a rough wire brush or a burr containing diamond particles. The scraping continues until an appropriate depth is reached that will make the wrinkle or scar less visible. Once the scraping is finished, the skin is treated and a dressing applied. The skin will be swollen and red. The swelling will last about one week, and a scab forms over the treated area as the skin begins to heal. Underneath the scab, new skin forms which is pink in color and sensitive. Immediately after the treatment After the procedure, you can expect:
Pain
Red and swollen skin
Inflammation and swelling makes talking or eating painful
Large areas of treated skin require dressings
Small areas of treated skin are generally left exposed to the air
Depending on your circumstances, you can return home the same day or you may have a brief hospital stay.
Possible complications The greater the amount of skin removed, the higher the risk of complications. Some of the possible complications of dermabrasion include:
Whiteheads can develop over the treated area, which may need to be surgically removed.
Some patients experience enlargement of the pores over the treated area (these usually return to normal size once the swelling has subsided).
Infection of the treated area.
Scarring.
Change in skin color -may be darker or lighter.
Excessive, uncontrolled scarring (keloid or hypertrophic scars).
Taking care of yourself at home Be guided by your doctor or surgeon, but general suggestions include:
For two weeks, avoid any activities that may cause a bump to the face.
Avoid active sports for about six weeks.
You can return to work one week to 10 days after the procedure.
It is essential that you avoid exposure to direct sunlight, because dermabrasion strips the skin of its protective layer of pigmentation. Always wear sunblock when going outdoors.
Long term outlook:

The pinkness of the skin takes approximately three months to fade. Some patients choose to wear non-allergenic makeup during this time to camouflage the appearance of their skin. It may take between six and 12 months before skin pigmentation returns completely, so sun exposure must be strictly avoided. Other forms of treatment Chemical peel is a similar technique to dermabrasion, but the skin layers are removed chemically instead of mechanically. A solution is wiped over the face, which is then left uncovered or masked with lotion or tape. The chemicals burn the skin and the healing process promotes new growth. Deep burns remove the most wrinkles, but also increase the risk of complications such as scarring and infection.
MICRODERMABRASION (top)

This revolutionary new method of skin rejuvenation is a non-surgical, non-invasive process that offers safe and controlled skin abrasion. Medical grade microcrystals are propelled at a high rate of speed across the skin’s surface and are then suctioned away and discarded. A cooling facial mask is applied after the treatment to sooth and refresh the skin. A microdermabrasion session can be performed in less than an hour and results are seen immediately.

There is no “down time” like that associated with other types of peels, and make-up can usually be applied right away. The stimulated blood flow to the surface of the skin increases the oxygenation, causing an enhancement of cell renewal and collagen re-growth. The massaging action of the microdermabrasion treatment creates a flushing and cleansing effect below the skin surface, resulting in a vibrant healthy appearance and complexion.
The new microdermabrasion method addresses fine lines, wrinkles, and hyperpigmentation, as well as improving the appearance of aging and sun damaged skin. It works well on all skin types; removing dead skin cells from dry skin and unclogging pores on oily skin types.

FACIAL PEELS (top)

Facial peels can give your skin a healthy, “just refreshed” look, or can be aggressive, taking years off of your appearance. Just like other cosmetic procedures, there is a wide range of varying chemicals used and techniques that can be overwhelming if you have to decide which is best for you. Fortunately, this is one area where the physician will often guide the patient to the chemical peel most appropriate for their condition as well as the patient’s skin type. Listed below are some of the realistic vs. unrealistic goals of chemical peels. This may be helpful if you are trying to decide if this procedure is right for you.

Realistic Goals of Chemical Peels:
Chemical peels can correct (sun) damage.
They can reduce mild scarring.
You can experience a reduction or eradication of your wrinkles.
Improvement of dark skin discoloration is possible.
Chemical peels can remove excessive or stubborn blackheads.
The peel may temporarily reduce excessive skin oils.
Unrealistic Goals of Chemical Peels:
It cannot remove or reduce the appearance of blood vessels on the skin.
It is impossible to truly change pore diameter. However, by removing blackheads, the pores may actually appear less pronounced after treatment.
This is not a procedure to get rid of keloidal types of scars
Chemical peels are not a facelift.
This is typically not appropriate for improving dark skin discoloration in people of color (Asians, African Americans, Caucasians of Mediterranean extraction, Hispanics, etc.)
There are a variety of different chemicals used for the purpose of rejuvenating the skin in what are called “chemical peels”. If the skin condition is predominantly superficial, then a milder, less caustic ingredient is selected. If deeply placed conditions exist, then far stronger products with matching levels of potential complications may be necessary.

Chemical peeling agents that perform mild or moderate peels typically provide a safer peel that has less associated long-term side effects. These peels work on the epidermis and possibly the most superficial portion of the dermis (known as the papillary dermis).

Deeper peels go midway into the dermal layer (into the reticular dermis), almost invariably leaving a permanently lighter skin tone. Instead of being able to tan as in the past, this lighter skin often freckles instead. These deeper peels should not be undertaken lightly, and you need to make sure in advance that the peel technique will be feathered into the scalp line and performed down the neck, possibly even the décolletage, or you may find that you have a highly noticeable line marking the difference in your original skin tone and the new one that is on the face.
CHEMICAL PEELS AND RETINOIDS (top)

Chemical peels and retinoid products are used for the purpose of skin exfoliation. The objective is to help your body get rid of dead skin cells and to make your body build new skin quicker. Various products available today such as Retin-A, Alpha Hydroxy Acid (AHA), Beta Hydroxy Acid (BHA), and glycolic acid are all designed to burn dead skin cells off. The active agent in all these products is fruit acids.

Alpha hydroxy acids and beta hydroxy acids are simple organic fruit acids found in nature or synthesized in the laboratory. Beta Hydroxy acids are somewhat different from alpha hydroxy acids in their structure and mode of action. Salicylic acid, a common beta hydroxy acid, has been used for treating acne for decades. In fact, acne treatment remains the primary use for beta hydroxy acids.

There are no studies showing that beta hydroxy acids are superior or even equal to alpha hydroxy acids in skin exfoliation or reducing fine wrinkles however for acne, beta hydroxy acids are clearly superior to alpha hydroxy acids.
BETA HYDROXY ACIDS (top)

Beta Hydroxy Acid or BHA is a derivative of aspirin and is often used in skin care products to accelerate skin cell turnover and help clear pores. It can penetrate more deeply than Alpha Hydroxy Acid and is gentler.

Beta Hydroxy Acid is salicylic acid. This occurs in nature in sweet birch and in wintergreen leaves. Its effect on the epidermis and upper dermis are similar to those of Retin-A, but with less irritation. It is soluble in oil and can exfoliate oily skin areas, even within oil-rich pores. Therefore, it has a beneficial effect on acne, pigmentary disturbances, and sun damaged skin. Because it does exfoliate, use of sun protection is needed.

BHA ingredients may be listed on packaging inserts as:
Salicylic acid
Salicylate
Sodium salicylate
Willow extract
Beta hydroxybutanoic acid
Tropic acid
Trethocanic acid
Currently, the most commonly used BHA in cosmetics is salicylic acid. On rare occasions, citric acid is also listed as a BHA in cosmetic formulations; although, citric acid is more commonly considered to be an AHA.

The long-term safety of salicylic acid in cosmetics is being evaluated in studies initiated by FDA and sponsored by the National Toxicology Program. These U.S. government-sponsored studies are examining the long-term effects of both glycolic acid (an AHA) and salicylic acid on the skin’s response to ultraviolet (UV) light. These studies have determined that applying glycolic acid to the skin can make people more susceptible to the damaging effects of the sun, including sunburn.

Until these safety assessments are completed, FDA advises that similar precautions be taken for the use of cosmetics containing AHAs and BHAs. These precautions are:

Test any product that contains a BHA on a small area of skin before applying it to a large area. If you use cosmetics with BHAs and experience skin irritation or prolonged stinging, stop using the product and consult your physician.

Follow the use instructions on the label. Do not exceed the recommended applications.

Avoid using BHA-containing products on infants and children.

Use sun protection if you use a BHA product.
ALPHA HYDROXY ACIDS (top)

Alpha-Hydroxy Acids or AHA is a compound found naturally in many common fruits and other foods. The principal AHA is glycolic acid which is found in sugar cane and sugar beets. Other AHAs include lactic acid from dairy products and malic acid from fruit.

Glycolic acid is the most skin-active AHA; and its primary action is to accelerate shedding of abnormal cells in the topmost layers of the skin by decreasing their cohesiveness. Continued use of glycolic-acid-based products may result in a normalized, more compact top layer of the epidermis. This makes the skin smoother. Additionally, it helps to remove comedones (blackheads); and, like retinol, it helps to restore the barrier function of the skin, thereby helping naturally to increase its own moisture content. It also leads to increased collagen production in the upper dermis, resulting in reduction of fine lines.

Glycolic acid also has an anti-inflammatory effect and is able to enhance the effects of other topical agents, such as hydroquinone and salicylic acid. It is well-tolerated by many people, but it can cause irritation and stinging in some. It can make the skin more sensitive to the effects of the sun’s UV rays; therefore use of effective sunscreen is essential.

Another alpha hydroxy acid, mandelic acid, which is derived from bitter almonds, can be particularly helpful in controlling mild to moderate acne. Mandelic acid can help fade melasma, also called the “mask of pregnancy.” The is a type of increased pigmentation affecting the face that appears in up to 75 percent of all pregnancies. This condition is often resistant to other topical treatments such as Retin-A or bleaching creams.

The main benefits of alpha hydroxy acids come from its ability to exfoliate skin. Removal of the outermost layer of the skin stimulates the cells in lower layers to grow and divide, causing the skin to thicken and thus diminishing visible signs of aging. The more you exfoliate, the more cell divisions you have occurring in the lower skin layers. There is one problem though. Normal human cells cannot divide indefinitely. Fibroblasts (a key type of cells in the skin) will divide about fifty times and then enter a so-called stage of senescence. This is a state in which cell division becomes sluggish, inefficient and unresponsive to various signals from the body and unable to divide. This is similar to how a plant will slow its leaf and bloom production at the end of its growth cycle. Skin with many senescent cells is usually fragile, blotchy and easily wrinkled. This limit of about fifty cell divisions is called the Hayflick limit (after its discoverer, Dr. Leonard Hayflick).

Exfoliation remains a valuable cosmetic tool but if you overuse it, your skin may “hit the Hayflick limit” earlier than it should. In recent years, researchers have discovered the molecular mechanism of the Hayflick limit. (It has to do with the areas at the tips of chromosomes called telomeres). Medical technologies to eliminate the Hayflick limit may appear at a point in the future, although these advances in technology are likely to work only for those cells whose Hayflick limit has not yet been reached.

The most important precaution to take when using alpha hydroxy acids is to know the percent and pH level of the product. The ideal pH is 3.0-3.5, any lower and the product may be too acidic; any higher and the product’s exfoliating benefits may be nullified. Even at lower levels, though, some alpha hydroxy acids can be irritating, depending on how sensitive your skin is. Mandelic acid is the recommended AHA for those with sensitive skin since it is the most non-irritating. Also, darker skin types should avoid most alpha hydroxy acids due to the risk of hyperpigmentation.

Hyperpigmentation will occur in darker skin if it becomes irritated or inflamed. Those with a skin type which tans easily or rarely burns through skin types which always tan or never burn, should be especially careful and avoid possibly irritating products. Because alpha hydroxy acids peel away the tough outer layers of the skin, the newer and younger skin is more susceptible to the suns UV rays.

If you are currently taking or have taken Accutane within the past six months, you are not a candidate for chemical peels. Patients with healing wounds from recent surgery, patients with active herpes simplex (fever blisters or cold sores) on their face, patients who have had radiation therapy to their face (or to the area which they wish to have peeled), or patients who have had cryotherapy in the past month should not have a chemical peel. A tendency toward hypertrophic or keloidal scarring may also make you not a good candidate for a peel. It is essential that you use very effective photoprotection after a peel; thus, if you are unwilling or unable to do so, you should not consider having a chemical peel.
TRICHOLRACETIC ACID (top)

A medium or TCA peel (tricholracetic acid) provides another option for skin care but is a more extensive treatment. The TCA peel goes deeper than the light peels and will make the skin look tighter and smoother, giving a fresher looking appearance. A TCA peel is often used to treat wrinkles, pigmentary changes and skin blemishes. For spot peeling of limited areas, such as aroung the mouth, TCA formulas are often preferred because they have less bleaching effect than other agents. It can also be effective in treating people with darker skin. The TCA peel can be applied to the whole face, hands and arms or to specific areas and takes about 30 minutes. Medium peels require a shorter recovery time that the deeper phenol peel and usually has to be repeated.
FACIAL FILLERS (top)

What is Hyaluronic Acid?
Hyaluronic acid (also called Hyaluronan) is a component of connective tissue whose function is to cushion and lubricate Hyaluronic acid has been nicknamed by the press as the “key to the fountain of youth” because it has been noted that at least some people who ingest a lot of it in their diets tend to live to ripe old ages. ABC News had a show on a village in Japan and hyaluronic acid entitled, “The Village of Long Life: Could Hyaluronic Acid Be an Anti-Aging Remedy?”.

Skin Treatment

Hyaluronic acid injection can be used to improve the skin’s contour and reduce depressions in the skin due to acne, scars, injury or lines.
Lip augmentation and/or enhancement
Reducing the appearance of lines around the mouth
Modifying nasolabial folds (under the nose) and eye trough deformities
Facial contouring of the cheeks and mouth
Immediately or within a few hours after injection the site may be red and swollen. This usually disappears within a week. Another one or two treatments (at least a week apart) may be necessary to achieve the desired correction. Hyaluronic acid implantation is not permanent. Like natural hyaluronic acid, manufactured hyaluronic acid once injected into the skin will gradually break down and be absorbed by the body. In most cases, the hyaluronic acid augmentation usually lasts between 6-9 months. Compared to collagen implants hyaluronic acid appears to have a longer augmentation effect, possibly lasting 2 to 3 times longer than the average collagen implant. To maintain the initial results, repeat hyaluronic acid injections or top-up treatments will be necessary. Most people following this protocol have 2 to 3 treatments per year.

Side Effects of Hyaluronic Acid Treatments

As previously indicated, Hyaluronic acid is safe and effective when treating moderate to severe wrinkles around the nose and mouth. However, as is the case with any cosmetic procedure or treatment, various side effects are possible. While infrequent, potential side effects associated with the use of hyaluronic acid include: redness, bruising, swelling, tenderness and moderate pain. In those instances where side effects are present, they typically dissipate within a few days.

Alternative Treatments Alternative treatments which impact the hyaluronic acid in the skin include Retinoids prescribed by physicians which increase the natural synthesis of hyaluronic acid and accelerate the shedding of the skin. Chemical peels remove the top, dry layer(s) of the skin. Facials cleanse the pores and superficially moisturize the skin.

Nutritional Supplementation with Hyaluronic Acid
Hyaluronic acid extracted from rooster combs has too large a chemical size for absorption by the intestinal tract. When directly extracted from rooster combs, the molecular weight is 1.2 to 1.5 million Daltons (Da). 2 For comparison, the average molecule weight of an amino acid is approximately 110 Da. But, wouldn’t you know it, Japanese scientists developed a proprietary enzyme-cleaving technique to lower the molecular weight of hyaluronic acid without altering its chemical nature. The final molecular weight of hyaluronic acid processed by the Injuv™ process is 5,000 Daltons . This allows hyaluronic acid to be taken orally as a nutritional supplement.

Oral Hyaluronic acid studies show benefits for most study participants when taken for a period of only 2 to 4 months. Patient reports indicate that continued use of hyaluronic acid sustain the benefits. Some patients are able to decrease the dose after the desired results are achieved.

Conclusion
Hyaluronic acid is essential for the health of the synovial fluid which supports the bones and joints.
Hyaluronic acid is essential for the structure of the extra cellular matrix in the skin and to insure that the matrix has the ability to hold onto its essential fluid – hydration of the skin.
The extra cellular matrix in the skin keeps the skin moist and supple.
The skin responds best with hyaluronic acid introduced from the inside out – from the dermis to the epidermis.
Hyaluronic acid for supplementation is extracted from rooster combs. It is the purest form available.
Proprietary processing by a method such as the Injuv™ method is done to produce low molecular weight hyaluronic acid which is absorbable through the intestinal tract.
Supplementation with hyaluronic acid is crucial due to decreased synthesis or recompartmentalization of hyaluronic acid that occurs with aging.
BOTOX (top)

The FDA recently approved BOTOX® as an effective way to treat wrinkles on the forehead, between the brows, crow’s feet (eye area) and around the mouth. Patients say that they have a softer, friendlier, more rested appearance after BOTOX®. BOTOX® has also been used to treat excessive sweating (hyperhidrosis) in the palms and armpits.

A mini neck lift is effective with injections of BOTOX® in neck bands. The effects of BOTOX® are temporary, usually returning within four to six months. Lines around the mouth return in 2-3 months. BOTOX® is injected directly into the muscle through a small needle in the physician’s office. Patients can return to work that day and in most cases could participate in a social engagement that evening.

BOTOX® ( Allergan Irvine , CA ) is purified Botulinum Toxin Type A produced by the bacteria Clostridium botulinum. BOTOX® works by binding with motor nerve terminals in the body to inhibit the release of a chemical called Acetylcholine. When injected locally into a muscle, BOTOX® produces a reversible paralysis of that muscle. The FDA also has approved Botox® for use in treating conditions known as strabismus and blepharospasm or disorders of the facial nerve in patients aged 12 and above.
COLLAGEN REPLACEMENT (top)

Collagen is a natural protein substance produced by the body. It helps to form our connective tissue giving our skin its strength, and, it also acts to bind water keeping the skin hydrated. As we age the number of collagen fibers decrease, causing the skin to loose its elasticity.

As with fat injections, collagen injections can be used to fill in lines and give the skin a plumper, smoother, more youthful-looking appearance. When injected beneath the skin, collagen plumps up lines and wrinkles and adds fullness to sunken areas of the face.

Prior to treatment the doctor will ask about your medical history, allergies and then perform a simple skin test to rule out allergic reactions. Collagen injections can be performed alone or in conjunction with other cosmetic procedures such as laser skin resurfacing or facelifts. The injections contain local anesthesia and take only minutes in the doctor’s office. Risks, though not common, include allergic reaction, infection, and skin irregularity. Collagen injections are not permanent and can be repeated.
FAT INJECTIONS (top)

Fat grafting fills facial features with a patient’s own fat. The fat used for fat transfer is extracted from part of your body like the abdomen or thighs and injected into another area that requires enhancement. Since the fat is your own, a significant portion of the fat becomes permanent, and therefore it eliminates the need for constant reinjections, as with other materials.

The advantage of fat grafting is that the fat comes from your own body, so you cannot develop an allergic reaction unlike other external implant substances that are introduced into the body. Your body naturally accepts the injected fat.

The fat is processed and re-injected into the area using a fine needle and syringe. The most common areas of fat graft placement are the lips and the nasal-labial fold lines of the face (laugh lines). Other areas that fat is used can also be hands, cheeks, scar depressions, irregularities, or to recontour the face or body. The procedure can take anywhere from one to a few hours. There is usually swelling and mild bruising noted which resolve over the first week after the injection of the fat.
GORTEX AND SOFTFORM IMPLANTS (top)

What are these implants made of? Both Gortex and Softform are made from expanded polytetrafluorethylene or ePTFE. These are non-toxic polymers used in many medical products that have been surgically implanted, such as Gortex mesh to reinforce abdominal walls, and Gortex tubes for vascular grafts. The body does not reject this material, so the implant can remain in place permanently. Where are they used in facial cosmetic procedures? These implants come in a variety of geometric shapes and thickness (sheets, strands, tubes, and tubes attached to introducer needles or mounted on introducer trochars).

They are generally used for soft-tissue defects, such as deep wrinkles in smile lines, frown lines, and sometimes acne scars or traumatic soft-tissue defects. They can also be implanted into the lips for better lip definition. What are the advantages of the ePTFE implants?

These implants are porous, so the body’s tissue can grow into it. The newer tube variants also allow tissue to grow into the central tunnel, which helps to keep the implant from migrating. The implant is soft and flexible, allowing it to be molded into certain shapes prior to placement into the soft tissue. In addition, the implants can be removed if desired, allowing you to choose whether or not your implants are permanent. How are they implanted? The technique is done as an office procedure under local anesthesia, using sterile technique. A small incision is made.

A tunnel is created in the deep skin layer or the implant is introduced via the trochar. Once the implant is in place, it is trimmed to size. The entrance and exit sites are usually closed with a suture, which is removed after one week. What are the complications of these implants? Generally, there is a little aching or swelling and occasional bruising after implantation.

We recommend not using aspirin or Vitamin E products following implantation. The insertion sites rarely have a noticeable mark. It is possible, though unlikely, for a collection of blood or tissue fluid (hematoma or seroma) to form as a pocket beneath the skin. The implant is never visible to an observer, but can initially be felt when palpated.

They will usually soften over time. Because any implant into the skin can become infected, the patient will begin taking antibiotics immediately following the procedure. Implants can occasionally protrude, form a channel to the skin surface (fistula), or migrate. The conformational change of the holes in the tubes seems to have helped the newer implant stay in place, so migration is less of a problem. There are many effective treatments for any of the complications that can occur. Are there people who can’t have these implants? Since there have been no confirmed cases of an allergic reaction to ePTFE, this would be an alternative to individuals with collagen vascular diseases who do not or cannot use collagen. Individuals on a variety of prescription and over-the-counter anticoagulants would be at higher risk for bleeding at implantation. Any facial infection, presence of dental abscess or oral cold sore would require implantation to be delayed until a later date.
ACNE TREATMENT (top)

According to the American Academy of Dermatology, 80 percent of people between 11 and 30 report having had some form of acne. It is one of the most common skin conditions, and a full thirty percent of all visits to dermatologists involve acne or acne-related treatments. Acne is caused by the p.acnes bacteria, which occur normally in the body and are usually released when your skin sheds the outermost layer of dead skin cells. Sometimes, however, the bacteria become trapped within the skin and a pimple forms. Common forms include moderate and inflammatory acne. Many adults are left with disfiguring acne scars caused by incomplete treatment in their youth. Whiteheads, blackhead and pustules, after treatment, also often leave acne scars which can be just as devastating to the patient as was the acne it replaced. There are many myths about acne, such as eating chocolate, pizza or other foods will bring on the condition. Actually, there have been no scientific links made between food and acne. Other myths say that poor hygiene is the cause while sunlight cures it. The actual cause of acne is an increased level of androgens, first encountered in puberty. Androgens, which are also responsible for an increased sex drive, cause more production of a type of facial oil, known as cebum. When the bacteria P. acnes is also present, acne forms. Here how it happens: Sebum brings skin cells to the surface of the skin but when it meets excess oil, the opening of the gland becomes clogged. Excess oil and old cells plug the duct and a whitehead results.

After it enlarges, its dark tip forms a blackhead. Bacteria may then multiple in the clogged pores to cause red, inflamed pimples and the start of acne. The condition is also associated with the hormonal changes associated with a woman’s period, pregnancy or menopause. Additionally, overuse of makeup and masking creams can affect the skin by removing its protective coating of helpful bacteria or causing too much dryness. Moreover, some scientists say stress and acne are related. Acne scars include raised (hyper tropic) and depressed (atrophic,) scars which are the most common. Their appearance ranges from looking like a scar caused by an ice pick to a wide saucer type scar. Because there are different types of ace and acne scars, surgical revisions will depend on the type you have. Your physician can lead you through the many options to the best treatment option for your case.

How are Acne Treatments Performed?

There are several ways cosmetic and plastic surgeons commonly treat acne and acne scars. They are: chemical peels, laser skin resurfacing, dermabrasion, microdermabrasion and injectable fillers.

Chemical peels: strong chemicals remove the top layer of skin to smooth depressed acne scars and give the skin a more even color. Peels are most helpful in treating shallow and superficial acne scars. The surgeon applies the chemical to the skin with ordinary cotton tipped applicator, starting at the forehead and moving over the cheeks to the chin. Various chemicals are used for different depth peels. Light peels require no healing time while deeper peels often need up to two weeks to heal.

Laser skin resurfacing: another technique for treating superficial scars is by laser, a device which uses a high-energy, amplified light to vaporize the top layer of skin, allowing new skin to grow. The ultra pulsed carbon dioxide laser, the erbium YAG laser and the pulsed dye yellow light laser are most commonly used for treating acne scarring.

Dermabrasion: the mechanical sanding of the upper layers of the scar. A new layer of skin replaces the ground down (or, abraded, as a physician would say) layer of skin.

Microdermabrasion: tiny particles passing through a vacuum tube gently scrape away the top layer of scarred skin and stimulate new cell growth.

Patients with mild scarring are the best candidates; multiple treatments are usually required to achieve the best results. For deep pitted scars, the physician cuts out the core of scar tissue with a small needle and stitches up the hole.

During one session, many of these scars are usually treated. Or, the practitioner may replace the excised part with a small graft of normal skin, (often taken from behind the ear) and then taping it in place. Soft tissue augmentation with an injectable filler is yet another option, useful for shallower acne scars. The filler will last anywhere from a few weeks to nine months. Fillers such as Hyaluronic acid can last two to six years after the injections. Most work by stimulating your body’s natural collagen around the filler and plumps up the area injected. Some scars are treated with fat grafting, a technique that takes fat from other areas of your body and then injects it into the scars, filling out the depressed areas.

Benefits of Acne Treatments

Benefits of laser and light treatments include not having to remember to apply or take any medication and the ability to treat hard-to-reach areas, like the back. However, laser and light treatments can be quite expensive and long-term effectiveness has not been proven.

What Are the Risks and Limitations of Acne Treatments?

Your surgeon needs to know about any prescription or non-prescription medications you are taking well in advance of the operation. Laser skin resurfacing may not sufficiently tighten the skin and surgical excision may be necessary to get the results you want. Oral and topical drugs have mixed results. The medications may contain harmful side effects and take a long time to work. Some permanent risks are involved with fillers. Lumpiness, firmness, inflammation and even migration of the material may occur.

How Much Pain is Associated with Acne Treatments?

As with any surgery, you can expect some swelling, mild bruising and minimal pain. Usually, your doctor gives you prescription medications to control any discomfort. The operation is usually performed in the surgeon’s office or in an outpatient surgical center. Dermabrasion requires anesthesia and most patients heal within one to two weeks.

Laser resurfacing treatments work instantly and with minimal bleeding although you may hear it zapping and smell smoke. It is usually done with a local anesthetic or light sedation, depending on the sites to be treated. Afterwards, the treated skin feels like it has mild sunburn. Initial healing takes a week while the redness created on your face continues to fade for several months. Darker skinned patients are susceptible to pigment changes after laser therapy and the changes are usually permanent so the procedure may not be appropriate for all patients.

However, another type laser, the YAG laser, treats acne scars of patients with all skin types, from very dark to very light and with no downtime at all for the patient. Moreover, no anesthesia is required with the YAG laser. With light peel chemicals, the patient only feels some stinging or irritation and sees some redness on the face. It can also cause facial puffiness which subsides after several days. Medium peels usually do not require anesthesia while the deeper peels usually require intravenous sedation. Temporary flaking or scaling, redness and dryness are normal after effects. Ointments, used for seven to ten days following surgery, keep the skin supple. Soft tissue injections usually involve minimal pain because the needles are so fine and because a topical anesthetic is sometimes used.

What are The Long-Term Effects of Acne Treatments?

Fat injecting is more permanent and there is no chance of an allergic reaction because the cells injected are your own. Moreover, the results are more permanent. Short term results from laser treatments will be pronounced for mild to severe acne and 50 percent clearance observed after just one treatment. Long term results are expected to last a year or more but often depend on how regularly you take prescribed medications and follow a good skin care regimen. Most patients treated with laser stay out of direct sunlight.
CELLULITE TREATMENT (top)

Many women are visiting their cosmetic surgeons to inquire about cellulite treatment. It’s a popular cosmetic procedure; according to the American Society of Plastic Surgeons, 44,579 cellulite treatment procedures were performed in 2003. Cellulite is a cosmetic condition many women experience on their thighs, buttocks, or abdomen. Its appearance is that of bumpy, uneven skin resulting from displaced fat and toxins trapped above the fibrous bands of connective tissue in the dermal layer of skin. (Connective tissue is what keeps fat evenly distributed below the skin.) As a result, tissue becomes compressed and hardened, making blood circulation difficult, resulting in cellulite.

Predominately found in women, cellulite is rarely ever found in males. Even though cellulite is fat, it is actually not a symptom of obesity. This condition can easily occur in thin as well as overweight women. Total amount of body fat, as well as age, hormones, diet, smoking, and genetics can all play a part in the cellulite found. This unattractive skin appearance has been called rippling, or more commonly “cottage cheese.” Cellulite treatments offer a solution to women searching to remedy this unsightly condition. Benefits of Cellulite Treatment

Cellulite treatment is a minimally invasive method of temporarily removing the appearance of cellulite from the body. This method is a deep, relaxing treatment that requires no anesthesia. Undergoing this procedure can stimulate blood flow and reduce the appearance of cottage cheese thighs. This can also be helpful to patients that have just undergone liposuction and are experiencing some skin rippling. Having a cellulite treatment after liposuction can help speed up the healing process and enhance the procedure’s overall results. Who would best Represent an Ideal Candidate for Cellulite Treatment?

Women looking to enhance the appearance of their skin in a quick, virtually painless fashion would represent an ideal candidate for cellulite treatment. Although reasons vary from person to person, the more common include:
Enhancing appearance and boosting self-confidence.
Becoming less self-conscious about appearance.
Achieving smoother textured skin.
Reducing the appearance of fat in the body.
How is Cellulite Treatment Performed?

The two most common ways cellulite treatment is performed is through Endermologie and Mesotherapy. Endermologie is a patented technique developed in France during the 1980’s. It did not reach the U.S. until 1996. During this minimally invasive procedure, practitioners use an Endermologie machine, which uses rollers and gentle vacuuming to provide a deep massage to the affected areas. Specifically, Endermologie works by having the skin lifted through the vacuum, which mobilizes the deep tissue, while rollers provide deep, sub dermal massage to the fibrous connective tissue and fat. This simultaneous action loosens the trapped and compressed fat, easing blood circulation. This procedure can take anywhere from 30 minutes to an hour, depending on the size of the area to be treated. The best results require several sessions a week for several weeks. Mesotherapy involves injecting small amounts of medications, amino acids, and vitamins into the mesoderm layer of the skin to break down the cellulite and to improve circulation. CosmeticSurgery.com provides extensive information on this procedure.

How Much Pain is Associated with Cellulite Treatment?

An advantage to Endermologie is that it does not involve incisions, or injections, but massaging-type machines. Patients have compared it to having a rigorous massage. Some patients may experience some discomfort during their initial treatment. However, the machines used can be adjusted to the patient’s comfort level.

What are The Long-Term Effects of Cellulite Treatment?

Actually, cellulite treatment is a procedure that provides only temporary results. Patients must go back for return treatments once a month or every few months in order to maintain results.

What Are the Risks and Limitations of Cellulite Treatment?

These risks depend on which cellulite treatment you undergo. For Endermologie, bruising is possible. However, an even bigger risk is not really so much a health issue, but a financial risk. Even though Endermologie has worked for many patients, there is the possibility that the treatment does not work for everyone. It may take up to four or five treatments before significant results can be noticed. So you might end up spending for a few treatments before discovering the cellulite treatments have no effect.