One reason why our facial features lose shape and become less defined is because of fat changes. Fat is essential for fullness but over time it starts to descend in some areas and shift position. Adding your fat or synthetic dermal fillers into your face, restoring volume especially to the mid-face, is a big breakthrough in cosmetic medicine.
The “Liquid Facelift”Restores Lost Definition Surgery is often the go-to for turning back the hands of time, but in the right patient with the right anatomy and realistic expectations, fillers and injectables can work wonders. For those who have lost volume in the face but are not experiencing the looseness that often comes with it, a “Liquid Facelift” may be what you need. Using a variety of fillers and injectables with a mix-and-match approach, Dr. Tanne can re-volumize areas that have become sunken or hollow, namely the temples, cheeks, lips and the jowls. The idea is to restore fullness to the areas that have lost it, not create a tight unnatural look.
Fill Out Thin Lips With Injectables Aging lips means thinning of the lips, which is a common concern among many women. Lips tend to flatten out, lose their Cupid’s bow and become longer. When using filler in the lips, it’s about restoring a youthful, natural looking shape and, if necessary, adding size. Fillers such as Restylane are the best choice for this. For vertical lines in the upper lip, Belotero and Restylane Silk help plump out those lines without adding volume to the lips. To treat deeper wrinkles around the mouth, Dr. Tanne often recommends fractional resurfacing with either eMatrix Sublative treatments or CO2RE fractional CO2 laser treatment, which can act like an eraser.
Plump Up Saggy Cheeks With Fillers Sagging cheeks, which is caused by a loss of fat and changes to the underlying bone structure, can lead to deep lines around the mouth. When the cheeks start to fall, so does the rest of the face. Adding volume conservatively to the cheeks can produce a natural appearance to smooth out the area and add lost fullness. If you are trying to achieve a lift in the cheek, Radiesse injected high in the outer cheek often gives excellent results.
Treat Sun Damage with FotoFacial RF The natural aging process takes its toll on your skin over time. When combined with the effects of hormones, sun exposure and stress, it leaves you looking far from your best. FotoFacial RFsafely and comfortably treats age spots (also known as freckles, brown spots or sun spots) Rosacea, spider veins, sun damage, as well as uneven skin tone created by brown and red spots. With its bipolar radiofrequency, FotoFacial RF will simultaneously stimulate collagen production leading to softer wrinkles and tighter pores.
Refresh Your Skin With Fractional Laser Resurfacing As skin starts to lose its natural healthy glow and the signs of time become more evident, it can cause the face to appear aged and weathered. An effective way to reverse the look of dull, aged skin is with a fractional laser treatment. Whether we use CO2RE fractional CO2 laser (which usually requires only one treatment, but some downtime) or eMatrix Sublative Rejuvenation (which has no downtime but requires a series of about 3 treatments) both accomplish controlled fractional resurfacing, forcing the skin to heal and create new, healthy collagen and a smoother, more even surface.
We have all seen women with those dreaded “smoker’s lines” around the mouth – those tell-tale signs of aging that are impossible to hide with any type of makeup – THE BARCODE! So what are they, and how can we make them disappear?
Well, smoking and sun damage are the top two reasons for these dreaded lines, but aging causes thinning of the lips in most women, resulting in too much skin above those shrunken lips with no place to go except to causes pleats and folds.
While mineral based sunscreen is the best anti-aging product to prevent damage in the first place, once these lines have etched themselves in, it is time for more aggressive measures.
CO2RE fractional laser skin resurfacing or a series of eMatrix Sublative resurfacing treatments will turn back the clock and erase the deep and shallow lines.
For the still present volume loss due to shrinkage of the underlying fat, injectable fillers restore a youthful fullness to this area.
The third component is to soften the puckering movement that continues to create lines with a small amount of Xeomin or Dysport.
The end result is a smooth, youthful mouth with no sign of that dreaded BARCODE!
Now that 2015 is finally here, it’s time to put your best foot forward and kick it into high gear so that you look your absolute best.
GET ENOUGH SLEEP Sleep does a body good. Not only will you feel better, a good night’s rest will leave you with less darkness and puffiness under your eyes and more evenly toned skin that looks fresh come morning. A good night’s sleep can also prevent unnecessary eating. Try to establish a set bedtime every night and never fall asleep with the television on.
EXFOLIATE ON A REGULAR BASIS Dead skin does nothing for your complexion. In fact, it makes your skin look lackluster and dull and can even make your makeup look muddy. The easiest way to get rid of pore-clogging dead skin is by exfoliating regularly with an exfoliator that’s compatible with your skin type. Treat your skin to the professional version, such as a microdermabrasion or light chemical peel, every four to six weeks.
HYDRATE INSIDE AND OUT When your body is void of water, your skin lacks the moisture it needs to look plump and healthy. Hydration is one of the easiest ways to look instantly younger and better—and it’s simple to do. To properly hydrate your body, make sure you drink at least eight glasses of water per day. To keep your skin looking healthy and full, apply moisturizer both day and night.
TAKE A TRIP TO THE DOCTOR For stubborn lines and wrinkles that require a little extra help, nothing does the job quite like injectables. Botox, Dysport and Xeomin work wonders on getting rid of hard-to-erase lines and wrinkles caused by smiling, laughing and squinting (think those that live around your eyes, between your brows and on your forehead), whereas hyaluronic acid fillers like Restylane, Perlane and Belotero can fill in hollows, wrinkles and folds for a more rejuvenated look. Collagen stimulating fillers such as Radiesse are excellent for restoring volume to the cheeks and also last longer than the hyaluronic acid fillers (about one year). Platelet rich plasma (PRP) such as Selphyl, uses your own platelets to “fertilize” the skin with your own growth factors. This “all-natural” treatment restores elasticity and makes you glow! For a long lasting result, fat transfer is an excellent, all natural way to restore youthful volume.
DR. TANNE SPEAKS AT THE AMERICAN SOCIETY OF COSMETIC PHYSICIANS
Certain areas of the face are prone to fat loss—others are not. The cheeks and eyes frequently fall victim to the effects of volume loss first; the lips, eyes and temples eventually catch up.
Around the Upper + Lower Eye Sockets The majority of fat in the face is in the cheeks, and as these pockets deflate, a depression forms from the inner corner of the eyes straight downward (called a tear trough or hollow). The appearance of hollows is related to loss of fat and bone expansion. Since the same amount of tissue is occupying a larger volume, the result is that the eyes look hollow. Sometimes, the fat protrudes, creating a bag. Adding a hyaluronic acid filler or fat restores volume, making the eyes the focus of the face.
Around the Brows A loss of fat and fullness in the brows coupled with lines and wrinkles between the brows and on the forehead can create a saggy brow and hooding on the upper lids. Fillers and fat are the most common ways to fix the problem. Just a little bit of volume (using a filler like Restylane) helps, and it is even more dramatic when combined with a neuromodulator (Dysport, Botox or Xeomin) for an overall rejuvenating effect. The combination of fillers (injectables or fat micro-grafts) plus a neuromodulator produces a better result than either one alone.
At the Temples You wouldn’t think of the temples as an area of concern but they are. As fat diminishes from the temples, they become sunken and appear narrow. Hollow temples can call unwanted attention to the cheeks. Filler such as Restylane, Perlane and Radiesse, used to gently, soften the area for a more youthful look. Fat micrografts are a good alternative and give a more permanent result.
In the Cheeks The cheek area is one of the first parts of the face where a loss of volume is noticeable. As the fat in the cheeks begins to descend, it creates nasolabial folds (smile lines) around the mouth and a flattened look in the cheeks, making you look “tired”. To correct the folds and the cheeks, the natural volume needs to be restored, using either injectable fillers or fat micro-grafts, for a refreshed, natural look.
In the Lips The lips are made of collagen, oil and tissue—not fat—but they too experience the effects of volume loss as they start to thin out. While fillers or fat can help to reinstate plumpness in the lips, the surrounding lines need to be softened with either laser resurfacing or a combination of Botox, Dysport or Xeomin and fillers (I prefer Restylane and Belotero).
At The Corners of the NoseDown Toward the Mouth As the fat in the cheeks begins to fall, there is less support for the skin around the mouth, causing folds to develop in the area where the end of the nose and the lips meet.
On the Jawline The jaw area loses definition with time and the natural contours become boxy and saggy. Volume loss in the jaw area usually comes along with a lack of structure in the cheeks. Injections of hyaluronic acids, Radiesse or fat can all help reshape and revolumize the area.
The Skin Smoother Crystal free DiamondTip™ Microdermabrasion removes the topmost layer of skin, delivering optimum exfoliation for softer, smoother, supple and vibrant skin. This is accomplished by gently abrading the skin with a variety of stainless steel tips imbedded with laser cut diamond chips, while using suction to remove the dead skin cells and stimulate collagen production.
Similar to microdermabrasion, the SilkPeel™ Dermalinfusion™ System combines non–invasive exfoliation with deep delivery of patient–specific solutions directly to the skin without the use of crystal or other chemical exfoliants. These serums are infused deep into the skin where they are most effective, deeply delivering the vitamins, antioxidants, and other therapeutic ingredients that your skin needs most.
Each filler that I use in my practice has its own set of characteristics that make it the right choice. “I tell my patients that what we use depends on what area of the face needs improvement, how long they want the results to last, and how much downtime they can endure,” says Dr. Susan Stevens Tanne, medical director of Cosmetic Laser MD.
For my patients that have never tried any type of fillers or injectables, I usually recommend that they begin with fillers made of hyaluronic acid, such as Restylane, Belotero or Perlane, since they can be reversed if you don’t like the way you look, and they fade over time.
Some of my patients need more significant lifting and/or filling of the cheeks, and filling of the chin area. I see this in patients as they age, with shrinking of the fat pads that normally act as scaffolding for the skin. This is also common in those who are very thin, or are hard-core exercisers. This type of hollowing results in a gaunt, tired look. I use Radiesse or Perlane for a more significant filling effect in these patients. Filling these larger areas require that the filler be placed deeper, which is why Radiesse works well in these patients. “Done properly, my patients achieve very natural looking youthful results, which lasts from six months to one year and sometimes longer,” says Dr. Tanne.
“One of the biggest improvements in the placement of injectable fillers has been the introduction of microcannulas, which I have been using almost exclusively for the past couple of years. Rather than using sharp needles that can result in significant bruising, a small pilot needle is used to just puncture the skin, which has been numbed, and then the needle is removed and replaced with a blunt tipped cannula. This method required much less numbing and is more comfortable for the patient. A microcannulas has a rounded, closed end, rather than a sharp cutting end, typical of traditional needles, and a small side opening to allow the filler to flow out. Patients have responded very favorably to this method, and love the almost total absence of bruising”, says Dr. Tanne.
For some patients, fat transfer is the preferred treatment rather than using synthetic filler in their face. To obtain the fat, a microliposuction procedure is done, removing only a very small amount of fat after you have been carefully numbed with an anesthetic solution. You may be a little swollen for a few days after this part of the procedure. The fat is then spun in a centrifuge to remove any oils and debris, before being re-injected into the face. Unlike fillers, fat transfer requires some downtime, ranging from a few days to one week, if the fat is placed in multiple areas of the face. Fat can be a more cost-effective option for patients that are using many syringes of filler every year, and can be a long-term solution. However, since this can produce a long-term to permanent result, I usually only recommend this option for patients that have tried synthetic fillers several times previously. One added bonus is that fat contains your stem cells, which gives a youthful smoothness and vibrancy to the skin.
This article is based on a recent one in US News and World Report.
Battling the clock No one likes looking older…which is why we spend billions of dollars every year on over-the-counter products, prescription creams and fillers, and, most drastically, cosmetic surgery. Do any of these actually work to reduce the signs of aging? In many cases, yes – at least temporarily. But given the not-inconsiderable costs, it’s important to be smart in your choices.
Aesthetic physicians can prescribe skin creams and perform laser skin-resurfacing and chemical peels, and they can administer injections. Surgical procedures, meantime, can be performed by cosmetic and plastic surgeons. When you pick a doctor, ask how often and how frequently he or she performs the procedure that you’re having (weekly is better than monthly.
Here is a quick guide to some of the most popular treatments and procedures.
1.Retinoid creams A host of over-the-counter products claim to help fight wrinkles. One option: topical retinoid (derived from vitamin A) creams; look for retinol in the ingredient list. They are proven to get rid of wrinkles that you already have. We love our Night Defense Cream, which comes in 3 strengths, suitable for all skin types. A stronger prescription strength version is Retin-A.
2. Over-the-counter peptide creams Creams containing peptides—short snippets of linked amino acids—can be useful for reducing the appearance of wrinkles and fine lines, but they haven’t been shown to work as well as retinoids. As skin ages, it loses collagen and becomes wrinkled and thin; creams containing peptides are supposed to encourage the skin to make new collagen. Our favorite peptide boost is Daily Cocktail, which gives a one-two punch!
3. Microdermabrasion Microdermabrasion uses a very hard diamond-tipped wand to slough off cells from the top layer of the skin and encourage new skin growth. The procedure is usually quite comfortable, doesn’t require an anesthetic or recovery period, and the skin heals quickly. But you may require multiple procedures spaced a few weeks apart. A recent study found that a rougher buffing of the skin is better than a lighter touch. You will be left with ultra-smooth, polished and glowing skin.
4. Laser Skin Resurfacing Laser resurfacing uses high-intensity light to zap and improve the look of wrinkles and scars, and to tighten loose skin. The effect of your treatment and recovery time vary. We use either the eMatrix system which uses fractionated Radio Frequency, and requires little to no downtime and 3 – 4 treatments, and also the CO2RE fractional CO2 laser, which requires 3 – 5 days of downtime, but only one treatment.
These treatments can be tailored to specific needs and can be superficial or intermediate and deep. Depending on which treatment and how aggressive, you may see redness from one day to two weeks. The benefits of laser resurfacing usually last between two and five years, however, if you smoke or don’t use sunscreen, it’s likely to be on the shorter end of that spectrum.
5. Chemical Peels Used to address mild acne scars, age spots, dull skin texture, skin discoloration, or wrinkles around the eyes or mouth, chemical peels remove the outer layers of the skin and encourage the growth of new, smoother, more evenly colored skin. Depending on the peel’s intensity—which can range from superficial to medium to deep—it may cause reddening and peeling that can last up to several weeks. Our favorite peel, the Apeele, is a blended mix of several ingredients that safely and effectively addresses many skin concerns. This peel comes in 3 strengths, depending on the specific needs and concerns of each patient. The benefits of superficial and medium depth peels last up to a few months.
6. Botox or Dysport Injections of the now familiar Botox or of Dysport (our favorite) can relax tiny facial muscles, smoothing out the appearance of lines or wrinkles. The cost of Dysport or Botox will vary depending on how many units are needed. The effects of injections may last three to four months, depending on whether you’re a repeat customer. The more injections you’ve previously had, the longer the results last.
7. Filler Injections Injections of fillers containing hyaluronic acid (Restylane, Perlane, Belotero and Juvederm) and the longer lasting Radiesse, can fill in lines and wrinkles and add volume to skin. Hyaluronic acid is a naturally occurring sugar which is significantly reduced as we age. Radiesse, a longer lasting filler, acts by stimulating your own collagen formation around tiny synthetic microspheres. Injecting these fillers into wrinkles and hollows plumps them up and restores lost volume. The effects generally last between six months (hyaluronic acid fillers) and one year (Radiesse).
8. CosmeticSurgery Lifting the skin on the face, neck, eyelids, and forehead can give a tighter appearance. The effects of cosmetic surgery are somewhat permanent. With this type of surgery you are turning the clock back, but we’re not stopping the clock.
9. Try Prevention If all this sounds extreme (and expensive), remember that you can start immediately to prevent any further damage: Start wearing sunscreen every day. Lifetime exposure to the sun can wreak serious havoc. When many of our patients were younger, they didn’t think that the sun caused any harm. Now, 30 years later, they are really seeing the effects of all that exposure. We advise our patients that without diligent use of mineral based sunscreen daily, our treatments will not be an effective solution for the long term.
Cheek augmentation is a popular procedure since it reinstates lost volume, making the cheeks look fuller and younger. Depending on the current state of your face, there are multiple ways to enhance your cheeks. If the problem at hand is strictly a loss of fat, then injectables can plump up the cheeks. On the flip side, when the skin on the mid-face is loose and accompanied by more extreme volume loss, surgery, like a facelift, is necessary to address all the concerns.
If you have flat, sunken cheeks, then choose fillers like Perlane or Radiesse. Both hyaluronic acid fillers and collagen-stimulating fillers can add dimension and definition to cheeks that have become flat and sunken over time. After injections, your cheeks will be instantly fuller with a natural contour to them. Collagen-stimulating fillers (Radiesse) last longer (12 to 18 months) than hyaluronic acid fillers (Perlane), but neither is permanent.
Dr. Tanne is a specialist in facial revolumizing using injectable fillers, and uses her artistic eye and medical skills to give her patients youthful, natural-looking results.
Think fillers and injectables serve the purpose of just erasing lines and filling wrinkles? Guess again. While these “liquid miracles” may have originally made their mark as wrinkle eliminators, they are now just as well-known for their sheer ability to lift and contour ill-defined and aging features.
When injectables and fillers were first introduced, they pretty much served one purpose: to fill wrinkles. Over time, and with safe off-label experimentation, their use has became more widespread as the effects of volume loss is a constant complaint. In different compartments of our face there is a shifting of the fat pads and re-absorption. Reconstructing the face with filler allows the architecture of the framework of the face to be lifted and restores the youthful contours. With only a handful of product options available, the main difference between filling and lifting comes down to where the filler is placed and how deep.
1. Straight Lifting With Some Volume Perlane: Fills in deeper, thicker lines and folds. Because of its denser nature and thickness, it provides good lift to areas of the face like the cheeks and lower part of the face. Radiesse: Lasts about 1 year. Immediately smoothes out folds around the mouth, lifts the cheeks and the area between the cheeks and the eyes and the jowls. In terms of the longer-lasting fillers, this is said to give more lift.
2. More Volume, Some Lifting Restylane, Juvéderm and Belotero: Lift and contour but on a more superficial level for those that don’t need as much structural improvement for areas like under the eyes, marionette lines and for lip augmentation.
If your lips have slimmed down over the years, the reason is because of collagen loss. Factor in less moisture, sun damage and fine lines (above the lips), and your pout may be looking less-than-full sooner rather than later.
For a fast fix, try lip-plumping products. Lip plumpers employ either ingredients that swell the lips or add moisture to give a fuller-looking pout. A good lip plumper is a quick and easy way to enhance your lips. But if you find those that make use of irritants, essential oils or cinnamon uncomfortable, opt for something that plumps via moisture such as those made with organic ingredients and natural mineral pigments. These richly colored glosses lend a hydrating effect, too.
Injecting the lips with hyaluronic acid (Restylane, Juvéderm, Belotero) gives way to fuller, sexier-looking lips. In order for the lips to look natural, the center part should be slightly fuller with a defined Cupid’s bow. The upper lip to lower lip should be about a one-third to two-thirds ratio. Steer clear of thicker filler as well as silicone and permanent fillers, which can result in lumps, nodules and an unnatural look.
Call us at 973.716.9000 to schedule a complimentary consultation or click the button below. We will discuss your concerns and establish a treatment plan to achieve your aesthetic goals.