In our last blog, I highlighted the pros of using permanent fillers. You can refer to that before reading this if you’d like, by clicking here.
This is going to sound unbearably snarky, but it’s just plain true. The vast majority of people who are administering fillers shouldn’t be doing it. I’ve seen a lot less of the good than I have of the bad and the ugly, and this is at least partly irrespective of the person’s credentials or “training”.
First of all, unless a physician has finished their residency/fellowship in the core specialties in the past ten years (and even if they have), it’s unlikely that they had any training in fillers at all other then a course where they got “certified” over a weekend or so. And although there are probably some exceptions to this, most people who are not surgeons in the core specialties have not had advanced education in facial embryology (how the face develops in the fetus) or facial anatomy. You have to know it cold. By the way, there are still textbooks being written on this with, believe it or not, new information. One of the major ones was just published in 2012 with a lot of information we didn’t know about before. On top of that, I’ve seen over and over again where the healthcare professional has wisely stayed away from the area around the eyes (because if you don’t have that anatomy down, you take more of a chance of causing visual loss), but then has thrown off the proportion of the face by placing the filler too low on the cheek, giving a heavy, unnatural look to the face. Actually, if done well, filler around the eye area is one of the most beautiful places to put it.
So why isn’t “training” the ticket? Because:
• This is literally sculpting soft tissue from the inside out, on a face, where unlike anything below the neck, every millimeter shows. Plus almost all of us are asymmetric to begin with, so there’s the extra challenge of not only seeing that on an individual, but then being able to correct that asymmetry as much as possible. This requires artistic vision, artistic skill and an eye and a passion for the tiniest detail. That vision is either there or it’s not – you can “train” a little of that into someone, but not a lot.
• In my world, fillers are not to be considered an “ancillary” procedure that is passed on to “ancillary” help. They are to be considered small surgical implants with all the respect and care that any surgeon should take with a surgical implant. This includes meticulous attention to aseptic technique (making sure we don’t drive bacteria or make-up particles under the skin). The consequences of that kind of sloppiness are bad in any situation, but with permanent fillers, the consequences are even more formidable than with temporary fillers.
Given the above, thank goodness most practitioners are not using permanent fillers on their patients. If they were, repairing the damage would be next to impossible and attempts to repair the damage would come with considerably more risk. In my revision patients where nonpermanent fillers have been used, there is a stepwise procedure that I follow, beginning with seeing the person periodically and treating as the old filler wears away -- and then I am always grateful for nonpermanent fillers.
What is it exactly that is happening when our skin sags and wrinkles? The answer may be complex, but most of it boils down to loss of collagen and elastin fibers in the skin. We have known for years that if we cause a “micro-injury” to the skin – just enough to stimulate an exuberant healing reaction – we can end up with that healing reaction creating better skin than we had before it was “injured”.
Microneedling is based on that principle and is producing significant results for mild to moderate wrinkling, laxity, coarseness and acne scars. It is a potent collagen stimulator, can be used anywhere on the body and requires no downtime.
In the office, the face is thoroughly cleansed and a numbing cream is applied for 20 to 30 minutes. The procedure uses a “Micropen” that has tiny needles at its tip. The depth to which the needles go is tailored to each individual and to different parts of the area being treated. The procedure is enhanced by use of a gel containing growth factors that are driven into the skin by the needles. For an even more intense treatment, some people prefer to use platelet-rich plasma (PRP), which is rich in your own growth factors. Most treatments take about 30 minutes and you will look a little rosy for a day.
Over the next three days your skin will be a little flakey, but it’s not bad. Amazingly, the tightening, the improvement in texture and the smoothing of wrinkles and scars will be visible quite rapidly. Some of that is due to imperceptible swelling, but over the next few weeks the improvement becomes obvious. While three to four treatments about four weeks apart are recommended, the result is cumulative and you will see improvement after the first time.
A. The best way to insert soft contact lenses is to place them without stretching the eyelids. The best way to do this is as follows: Place the contact near the tip of your index finger. Make sure it's not too wet - this will allow it to grab onto your eye and not stick on your fingertip when you're trying to insert it. Get in front of a mirror and brace your third or fourth finger on your cheek without pulling down on your eyelid.
Tuck your chin down while looking up into the mirror so you've exposed as much white at the lower part of your eye as possible. Let the contact touch the lower part of the eye and as soon as it "grabs" look up as high as you can (you won't be able to see yourself at this point) and roll your fingertip up slightly to allow the top of the contact to seal onto your eye. It's really easy once you get the hang of it, and it's not that much different than the way people normally insert CL's.
To remove the contact, place the sides of the pads of your fourth fingers together, place them over your contact, and then pinch the pads together a bit to break the seal of the contact with your eye. This way, you can put them in and take them out day after day and year after year without ending up with a saggy lower lid margin down the road.
A. If your eyes seem smaller since you began wearing contact lenses, it may be that the eyes are a little dry. When the eyes are dry we sometimes squint a bit in an unconscious effort to reduce their exposure to the air. If that's the case, you may want to try a contact lens solution that is moisturizing. Opti-Free Replenish is a great solution (no pun intended) for the drying effects of contact lenses. Other than that, contacts should have no effect on the size of your eyes.
The newest Juvederm product, Voluma has been FDA-approved for use in restoring volume in the cheek area. Voluma has been shown to last up to 2 years.
If you loved Juvederm, you will love Juvederm Voluma even more! Voluma is made of hyaluronic acid (HA), a naturally occurring sugar in the body. In large part, the longevity of HA fillers has been determined by the amount of "cross-linking" of the molecules, meaning essentially how densely they're packed together. Voluma is highly cross-linked, to the point where the density of the filler allows it to last up to two years. This added density has not detracted from the smooth, silky way it goes into the face, but (aside from the fact that there is 20% more product in each syringe than there was with Juvederm's former incarnations) Voluma is definitely creating more fullness just from the density alone.
A long lasting filler with immediate results. It works with your body's own collagen to give volume that will last years instead of months.
For people who tend to "burn up" filler, Artefill offers a solution for both needle- and credit card-fatigue. This revolutionary volumizer has been around in its present form since 2006, but I have been watching it all these years to make sure of its safety profile.
Twenty per cent of each syringe-full of Artefill is made up of microspheres -- each one being 40 thousandths of a millimeter in diameter -- of polymethylmethacrylate (known by its acronym, PMMA). PMMA is an inert substance that has been used for decades in medicine, for instance in bone glue and the intraocular lenses that are put in the eyes at the time of cataract extractions.
The other 80% is bovine (cow) collagen, which is what most collagen injections were made of back in the 90's. The reason we don't use bovine collagen anymore as a filler is because it doesn’t last more than a few months.
However it has an ionic charge that suspends the PMMA microspheres the perfect distance from each other while they stimulate the body to form its own collagen around them. PS: For those of us who try to live cruelty-free, I've been assured by the company that the collagen is procured from trimming the hooves of this closed herd of cows - a pedicure, if you will.
For those of you who seem to metabolize away anything, take comfort in knowing that 20% of each Artefill treatment just can't be metabolized, so you get to keep it. Some people ask for multiple sessions over time so that the percentage of filler they retain becomes more and more of the entirety of the volume they want.
Microneedling is a sensational way to smooth and firm your skin. It really makes a difference, and no, it doesn’t hurt.
This procedure has been getting a lot of press lately. We tried it, we love it and we want you to have its benefits too!
We’ll give you 20% off during April and you’ll get the compliments.
And take care of your lashes with Nouriche. This is a $125 value for $89 during April.
Call us today to find out more! 941.951.2220
Oh, did we mention that we’re all about what’s above your shoulders?
Pelleve is a no-downtime procedure that uses radiofrequency waves to tighten your skin and promote collagen formation, all while feeling like a hot stone massage. It firms up the contours of your face and neck while helping to delay further aging changes in the skin.
Oculofacial Plastic Surgeon, Sarasota, Florida
Subscribe to our newsletter