Fashion And Beauty

Bargains on consumer goods and services may be designed to encourage spending in tough economic times, however when related to cosmetic injections like Restylane, Juvederm or Botox, the multi-specialty Physicians Coalition for Injectable Safety warns that discounts raise a red flag. “Bargain prices, deep discounts or purported sales on cosmetic injections are warning signs of potential counterfeit or illegally imported cosmetic injectables, or an injector who is inexperienced or does not specialize in the procedure,” cautions facial plastic surgeon and Coalition spokesperson Mary Lynn Moran, MD of Woodside, CA. “Consumers must adopt a buyer-beware approach to offers that seem too good to be true.”

Unlike common over-the-counter and prescription medications, cosmetic injectables do not have lower-priced generic alternatives. “FDA approved, branded cosmetic drugs or devices are sold to all physicians at defined prices,” said Coalition leader, plastic surgeon Renato Saltz, MD of Salt Lake City, UT. “There are generic lower, priced brands, no sales for physicians who stock up on injectables and no bona-fide sources who sell genuine product at lower than market prices, and therefore there are no deep discounts physicians can pass along to consumers.” Some injectable brands do, however, offer post-treatment rebates directly to the consumer. The Coalition warns consumers that deep discounts or savings can potentially risk:

- Counterfeit or illegally imported substances, resulting in potential health risk, injury or serious complications
- Illegally compounded and unbranded substances, resulting in potential health risk or injury, and unpredictable outcomes
- Diluted or improperly administered substance, potentially resulting in little or no outcome, a poor outcome, or a short duration for results obtained
- Bait and switch, or pressure to elect additional or unnecessary procedures
- Unqualified providers, lowering prices to create demand, and potentially risking poor or undesirable outcomes

Consumers can find average U.S. costs for cosmetic injections listed by U.S. FDA approved brand at http://www.injectablesafety.org/html/ataglance.php.

The Coalition, charged with educating consumers on safe choices in cosmetic injections and eradicating the use of counterfeit and illegally imported cosmetic injectables suggests all consumers follow very cautious steps for both safe, and positive outcomes:

- Doctor: Ask specifically about your doctor or injectors qualifications. Choose a doctor who specializes in treating all cosmetic concerns of the face, such as a board certified plastic surgeon, facial plastic surgeon, oculoplastic surgeon or dermatology and who examines you, prescribes and performs cosmetic injections in a licensed and properly equipped medical facility. Establish a positive and on-going relationship with your doctor and follow-up as directed. A nurse or physician’s assistant may perform your injection if you elect, but a licensed physician must prescribe the treatment.

- Brand: Ask specifically the brand name of the injectable recommended for you, the approval status of regulatory agencies in the country where you will be treated (the U.S. FDA in the United States) and about any potential outcomes and the likelihood of adverse events. If your doctor does not offer, ask specifically to see the packaging and identifying marks that can verify authenticity, including the serial and lot number (which as a matter of proper procedure must be recorded in your medical chart). For reference, images of all U.S. FDA approved brand logos and packaging are available at. http://www.injectablesafety.org/html/ataglance.php.

- Safety: If you suspect your injector is not properly trained, is not following proper procedure or is injecting you with a non-branded, non-approved or unsafe substance, do not accept treatment. Follow-up by anonymously reporting suspected illegal activity to your local FDA field office that can be found at http://www.fda.gov/consumer/updates/oci072307.html.

To learn more about the benefits of cosmetic injections, the uses for approved cosmetic injectables, to plan for your treatment, see video of live, appropriately administered injectables and more visit http://www.injectablesafety.org and http://www.realself.com/injectable-safety-campaign.

The Physicians Coalition for Injectable Safety is an alliance of specialty physician organizations including the American Society for Aesthetic Plastic Surgery, American Academy of Facial Plastic and Reconstructive Surgery, the American Society of Ophthalmic Plastic and Reconstructive Surgery, the International Society for Aesthetic Plastic Surgery and the Canadian Society for Aesthetic Plastic Surgery. The mission of the Coalition is to provide the public with unbiased and necessary information on injectable cosmetic treatments, appropriate injectors and where to safely access cosmetic medical procedures. Our goal is to promote treatment supervised by properly qualified and trained, board-certified doctors and to promote only the use of U.S. FDA-approved, appropriately administered product.

Physicians Coalition for Injectable Safety

From frizzy perms to over-bleached waves, “bad hair days” could soon become a less frequent occurrence. Chemists report the first detailed microscopic analysis of what happens to individual hair fibers when they interact with each other, an advance in knowledge key to the development of improved shampoos, conditioners, and other products for repairing damaged hair, the researchers say. They presented the study at the American Chemical Society’s 236th National Meeting.

Embracing that adage, “Personal care begins with hair,” consumers now spend almost $60 billion annually on hair care products, one of the personal care industry’s largest market segments. Despite the increasing availability of new hair care products within the past century, many products are inadequate for tackling today’s rigorous hair treatments, the researchers say.

“Given all the new hair treatments out there, there’s a growing need to make hair feel more natural, especially for women,” says study co-author Eva Max, a doctoral student in chemistry at the University of Bayreuth in Germany. She notes, however, that researchers still are scrambling to put hair care on a firm scientific basis. The research involves “haptics,” the science of touch - how the subjective perception of touch connects to objective surface properties of hair and other materials

“For the first time, we present an experimental setup that allows measuring the subtle forces, both physical and chemical, that arise when single hairs slide past each other or are pressed against each other,” Max says. “The findings will help provide clearer strategies for optimizing hair care products.”

Max points out that conventional methods for testing the effectiveness of hair care products involve measuring the forces required to comb hair under standardized laboratory conditions. Test volunteers are also asked to assess hair feel, but this approach is largely subjective. A more scientific way to study hair conditioning is needed, the researchers say.

In the new study, the researchers invented a unique technology for analyzing hair that involves mounting individual hair fibers on a cantilever tip of an atomic force microscope and measuring their interactions as they touch each other. “The system will allow scientists to explore how different hair care products affect hair-to-hair interactions so that these products can be optimized in a more systematic fashion,” Max says.

The researchers used this new technique to analyze hair samples collected from volunteers. The samples, which were previously bleached, ranged from light blond to dark blonde in color.

The researchers found that hair feels rough and difficult to comb for two main reasons. On the one hand, mechanical damage to a hair’s surface, or cuticle, creates scaly projections that jut out at perpendicular angles to other hair fibers. When hair fibers slide past each other, these scales create more friction than smooth hairs, causing a rough feel and making hair more difficult to comb. To soften hair, conditioners must contain active agents to smooth-out these scales so that they produce less friction, the researchers say.

On the other hand, chemical changes occur when hair fibers interact. Negative charges build up on the surface of hair that causes repulsion between single hairs. This repulsion causes friction and makes hair rough and difficult to comb. To solve the problem, positively-charged polymers that neutralize the negatively charged surfaces are included in conditioner formula to provide a silky feel to hair.

But finding the right formula for repairing damaged hair is no easy task, notes Claudia Wood, Ph.D., a senior scientist at BASF in Bayreuth, Germany. In addition to hair interactions, many other external factors, such as humidity, water content of hair, and hair stickiness, all affect hair quality, Wood says.

The key to repairing these processes is to find the right ratio of beneficial components in a conditioner or shampoo that optimize hair feel, Max and colleagues say. This new method will allow developers of hair care products to achieve this goal more easily, giving consumers a more reliable product, the researchers say. Their study was funded by BASF Care Chemicals Division.
Charmayne Marsh
Michael Bernstein
American Chemical Society

Acne just seems to never go away for many adolescents. A new study published in the August issue of Archives of Dermatology reports results of a teen survey and finds that teens would pay about $275 to have never had acne. Researchers also found that adolescents said that they would be willing to pay more be free of acne than to have half of their acne cleared or to have clear skin with acne scars.

More formally known as acne vulgaris, the skin disorder impacts almost all adolescents and is often a factor that leads to anxiety, depression, embarrassment and social dysfunction. Cynthia L. Chen, M.D. (University of California, San Francisco) and colleagues write that, “Reducing the psychosocial impact of acne is considered one of the guiding principles for its clinical management and it is important to measure and evaluate this impact.”

Results from this study come from an analysis of 266 teen volunteers with acne from four public high schools in San Francisco. Chen and colleagues administered written surveys to the students that asked them to answer hypothetical questions such as how much of their lifetime they would forgo or how much money they would pay:

• To have never had acne,
• To be 100-percent acne-free from then on,
• To have 100-percent acne clearance but with visible scarring, or
• To have 50-percent acne clearance.

The survey also included questions for parents regarding their acne history and severity. Since parents usually pay for children’s acne treatments, they were also asked about their willingness to pay.

With the teens’ responses to the time trade-off questions, the researchers calculated current acne state utility scores by dividing the participants’ reduced life expectancy in years without acne by his or her life expectancy in years with acne. The average utility score for a teen in his or her current acne state was 0.961. Scores improved to 0.978 for 100% clearance, 0.967 for 50% clearance, and 0.965 for 100% clearance but with scarring.

The median price that teens were willing to pay to have never had acne was $275. For 100% clearance of acne, they were willing to pay $100. The median price of 50% clearance would be $10, and of 100% clearance with scarring would be zero dollars. Parents had somewhat similar responses to the willingness-to-pay analysis, indicating a median of $250 for their child to never have had acne, $100 for 100%, $100 for 50%, and zero dollars for 100% clearance with scarring.

As expected, teens who believe their acne is more severe are willing to trade more time and money for acne clearance than those who rate their acne as less severe.

“Knowledge of these patient preferences may help dermatologists balance clinical trial results with patients’ expectations of therapy,” write the authors. “Randomized, blinded, placebo-controlled trials have shown that three to four months of conventional acne therapy, including topical benzoyl peroxide, topical retinoids and oral antibiotics, typically produces reductions in lesion counts in the 40 percent to 60 percent range.”

They add that, “It has also been suggested that the incidence of scarring from facial acne approaches 95 percent…Thus, adolescents’ marked preference for total clearance over partial (50 percent) clearance or clearance with scarring suggests that physicians must weigh high patient expectations against these clinical data regarding efficacy and risk of sequelae.”

In an accompanying editorial, written by Marta J. VanBeek, M.D., M.P.H. (University of Iowa Hospitals and Clinics), “Dermatologists are keenly aware of the ways skin diseases may have a substantial impact on a patient’s overall quality of life. However, in an environment in which health expenditures are allocated by non-physicians, it is critical to demonstrate the burden of skin disease relative to non-dermatologic disease to funding sources, government agencies and the lay public.”

“In terms of social value, preference-weighted questionnaires are instrumental in evaluating the extent to which increased health care expenditures lead to patient benefits because they incorporate a summary description of health status, social values and life expectancy,” concludes Dr. VanBeek. “Fundamentally, utilities measure true patient preferences, uninhibited by physician assumptions. Such measurement refocuses physicians on the primary goal of our profession: improving the care of our patients.”

A Community-Based Study of Acne-Related Health Preferences in Adolescents
Cynthia L. Chen, MD; Miriam Kuppermann, PhD, MPH; Aaron B. Caughey, MD, MPP, MPH; Lee T. Zane, MD, MAS
Archives of Dermatology (2008). 144[8]: pp. 988-994.
Click Here to View Abstract

In what is believed to be the first time in the United States, a nerve transfer was performed on a paraplegic to relieve life-threatening pressure ulcers - a common side effect associated with wheelchair-bound patients. The surgery took place on November 11, 2008, at Monmouth County Medical Center, and was performed by a team of medical professionals led by Dr. Andrew Elkwood, M.D. of the Plastic Surgery Center in Shrewsbury, NJ.

Yesterday’s surgery was performed on a 65-year old Monmouth County man, who was left paraplegic after being caught in a gunshot crossfire several years ago. As part of the procedure, Dr. Elkwood and his team surgically removed nerves from the patient’s paralyzed legs to his chest and successfully relieved the acute pain caused by the pressure ulcers. Ultimately, the surgery is intended to stimulate sensation in the patient’s posterior.

Dr. Elkwood commented, “Our goal was to first fix the immediate problem, the pressure sores, and then attempt to fix the cause. We are extremely pleased with the initial results of the procedure and are therefore encouraged by the long-term potential for the surgery. Specifically, if this proves successful, it can be life-altering for tens of thousands of wheelchair-bound patients whose lives are subjugated by acute pressure ulcers and sores.”

Images available upon request.

About Dr. Elkwood

Dr. Andrew Elkwood, M.D., is a plastic and reconstructive surgeon who practices at The Plastic Surgery Center in Shrewsbury, NJ. He performs unique operations involving nerve transplantation and complex reconstruction. Dr. Elkwood is a pioneer in sural nerve grafting procedures, where he transfers nerves from one part of a patient’s body to another to treat life-altering injuries. He also uses this procedure to eliminate common side effects caused by prostate cancer removal, such as impotence and incontinence. Dr. Elkwood serves as the Chief of the Division of Plastic Surgery at Monmouth Medical Center in Long Branch, NJ, and is certified by the American Board of Surgery and the American Board of Plastic Surgery in General Surgery and Plastic Surgery. He is also a Fellow of the American College of Surgery (FACS) and a Fellow of the American Society of Aesthetic Plastic Surgery.

Plastic Surgery Center

Born out of war, plastic surgery remains at the forefront of surgical innovation, and advances from the war in Iraq and Afghanistan benefit victims of inner city wars being fought on our streets. At the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2008 conference, Oct. 31 - Nov. 5, in Chicago, civilian and military plastic surgeons will participate in a panel discussion about the challenges created by today’s high-powered weaponry and the advances in facial reconstruction accelerated by wartime.

“Plastic surgery is a specialty that, unfortunately, always makes significant advances in wartime,” said Colonel Thomas Crabtree, MD, ASPS Member Surgeon and panel moderator. “The surgical problems we face from the frontlines to stateside military hospitals are challenging to say the least, but the advances made benefit both wounded warriors and civilians hurt in inner-city violence or trauma.”

Plastic surgeons specialize in bone and soft tissue reconstruction of the face and skull. From the war in Iraq and Afghanistan, ASPS Member Surgeons face patients who have suffered large scale blast trauma wounds from high explosive detonations or high velocity missiles. At Walter Reed Army Medical Center, Lieutenant Colonel Raymond Harshbarger, MD, ASPS Member Surgeon and panel participant, treats soldiers with facial and skull injuries with a 3-D model of their skull, created from CT scans. These models help in pre-operative planning and surgery.

“From these models, we can help soldiers who are missing half their skull or the upper part of their face by fashioning an innovative prefabricated, patient-specific implant to remodel their lost bone,” said Dr. Harshbarger. “We also use special woven titanium as implants for the skull on soldiers who have large-scale defects of missing bone and tissue.”

Dr. Harshbarger added they are working toward bridging these innovative technologies - modeling and implants - with tissue engineering. “In the future we hope to produce an implant that is biodegradable and will induce bone formation so that the implant (in the shape of the deformity) will absorb over time and new bone will be created. We’re moving down this pathway, but it will be years before it becomes reality.”

Back on the streets of America, Eduardo Rodriguez, MD, ASPS Member Surgeon and panel participant, treats injuries from gun shots and high-speed auto and motorcycle accidents. “I treated a young woman from the inner city who was protecting her sleeping child by covering him with her body when high velocity gunshots blew off one of her arms and she lost a large part of her cheek. Many of the bones in her face were fractured and there was major tissue missing.”

Reconstruction of these types of injuries involves free tissue transfer where Dr. Rodriguez takes tissue from a different area of the body like the hip with its blood vessels, and reconnects it to the missing area of the face. “These cases are incredibly difficult to perform, often taking up to 10 hours,” said Dr. Rodriguez. “But you get so committed to these cases. This young lady saved her baby’s life, now I wanted to help her. The pressure is incredible, it’s like you are in the Super Bowl and its 4th and goal. But the rewards are amazing. We can do so much to help these patients now, where they previously would be left with devastating injuries.”

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

American Society of Plastic Surgeons
http://www.plasticsurgery.org

Researchers at McGill University, King’s College London and GlaxoSmithKline Inc. have identified two genetic variants in caucasians that together produce an astounding sevenfold increase in the risk of male pattern baldness. Their results were published Oct. 12 in the journal Nature Genetics.

About a third of all men are affected by male pattern baldness by age 45. The condition’s social and economic impact is considerable: expenditures for hair transplantation in the United States alone exceeded $115 million (U.S.) in 2007, while global revenues for medical therapy for male-pattern baldness recently surpassed $405 million. Male pattern baldness is the most common form of baldness, where hair is lost in a well-defined pattern beginning above both temples, and results in a distinctive M-shaped hairline. Estimates suggest more than 80 per cent of cases are hereditary.

This study was conducted by Dr. Vincent Mooser of GlaxoSmithKline, Dr. Brent Richards of McGill University’s Faculty of Medicine and the affiliated Jewish General Hospital (and formerly of King’s College), and Dr. Tim Spector of King’s College. Along with colleagues in Iceland, Switzerland and the Netherlands, the researchers conducted a genome-wide association study of 1,125 caucasian men who had been assessed for male pattern baldness. They found two previously unknown genetic variants on chromosome 20 that substantially increased the risk of male pattern baldness. They then confirmed these findings in an additional 1,650 caucasian men.

“I would presume male pattern baldness is caused by the same genetic variation in non-caucasians,” said Richards, an assistant professor in genetic epidemiology, “but we haven’t studied those populations, so we can’t say for certain.”

Though the researchers consider their discovery to be a scientific breakthrough, they caution that it does not mean a treatment or cure for male pattern baldness is imminent.

“We’ve only identified a cause,” Richards said. “Treating male pattern baldness will require more research. But, of course, the first step in finding a way to treat most conditions it is to first identify the cause.”

“Early prediction before hair loss starts may lead to some interesting therapies that are more effective than treating late stage hair loss,” added Spector, of King’s College and director of the TwinsUK cohort study.

Researchers have long been aware of a genetic variant on the X chromosome that was linked to male pattern baldness, Richards said.

“That’s where the idea that baldness is inherited from the mother’s side of the family comes from,” he explained. “However it’s been long recognized that that there must be several genes causing male pattern baldness. Until now, no one could identify those other genes. If you have both the risk variants we discovered on chromosome 20 and the unrelated known variant on the X chromosome, your risk of becoming bald increases sevenfold.”

“What’s startling is that one in seven men have both of those risk variants. That’s 14 per cent of the total population!”

Mark Shainblum
McGill University

Artes Medical, Inc. (Nasdaq:ARTE), a medical aesthetics company, today announced completion of the enrollment and treatment of patients in the ArteFill® Skin Test study.

The Company reports that 498 study participants are enrolled in the study and have received ArteFill Skin Test injections. The lead investigator in the study is David Wilson, M.D., of The Education and Research Foundation in Lynchburg, VA.

Each participant in the study received the ArteFill Skin Test and was assessed for a positive hypersensitivity reaction to the skin test. Any adverse events were also collected. The primary endpoint of the study is the Investigator’s clinical determination of a positive skin test reaction with histopathology verification. In addition, subjects will have serum antibody levels against bovine collagen evaluated prior to and after treatment in this study.

“We are pleased to announce the completion of enrollment and treatment of patients in this important study,” said Christopher J. Reinhard, Executive Chairman, Artes Medical. “Once all of the data has been fully analyzed, we will determine the appropriate next steps. Positive safety data from this study will be used to support a regulatory submission seeking an amendment to the ArteFill product usage labeling to remove the pre-treatment collagen skin test requirement.”

About ArteFill®

ArteFill is the first and only FDA-approved non-resorbable injectable dermal filler for the correction of wrinkles known as smile lines or nasolabial folds. The unique microspheres in ArteFill are not absorbed by the body and therefore provide the first-of-its-kind permanent support for long-lasting wrinkle correction in one to two treatments.

ArteFill was approved by the FDA in October 2006 based on data from the Company’s 12-month controlled, randomized, double-masked, multi-center U.S. clinical trial, which compared outcomes for patients treated with ArteFill with those of patients treated with the leading bovine collagen-based filler. At the 6-month evaluation, which was the primary efficacy evaluation period for the clinical trial, the wrinkle correction in patients treated with ArteFill persisted and showed statistically significant improvement compared to the wrinkle correction in the patients treated with the collagen control, who returned to their pretreatment status. The ArteFill patients were also evaluated one year after treatment, demonstrating continued safety and wrinkle correction.

In December 2007, the Company announced that ArteFill’s 5-year safety and efficacy data was published in the peer-reviewed publication Dermatologic Surgery “Filler Issue.” This publication addresses the robust, long-term, efficacy and safety profile of ArteFill. This 5-year follow-up study included 145 patients who were treated with ArteFill in the Company’s U.S. clinical trial. In addition to demonstrating the safety profile of ArteFill, the study showed statistically significant (p<0.001) improvement in patient wrinkle correction five years after the patient’s last ArteFill treatment, and a statistically significant (p=0.002) improvement in wrinkle correction at the 5-year point compared to the 6-month evaluation period. As part of the study, physician investigators and patients were asked to provide their assessment of ArteFill treatment. Over 90% of the physician assessments were either “completely successful” or “very successful;” and over 90% of the patient assessments were either “very satisfied” or “satisfied.”

An ArteFill Skin Test is required before initial treatment. The most common adverse events associated with ArteFill treatment, similar to those observed with other dermal fillers, are lumpiness, persistent swelling or redness and increased sensitivity at the injection site.

ArteFill is a proprietary formulation comprised of polymethylmethacrylate, or PMMA, microspheres and bovine collagen, and is the only PMMA-based injectable product that has been approved by the FDA for the treatment of facial wrinkles. Artes Medical is the sole manufacturer of ArteFill, which is only available in the United States through Artes Medical, and Artes Medical has not entered into distribution or licensing arrangements with any third party for the distribution or sale of ArteFill, or any other PMMA-based dermal filler, outside the United States.

About Artes Medical, Inc.

Artes Medical is a medical aesthetics company focused on developing, manufacturing and commercializing a new category of injectable products for the dermatology and plastic surgery markets. The Company’s flagship product, ArteFill, is being marketed to men and women as a long-lasting treatment option for the correction of nasolabial folds. The Company also markets Elevess™, the first FDA-approved hyaluronic acid-based wrinkle filler with lidocaine for patient comfort. Additional information about Artes Medical, ArteFill and Elevess is available at www.artesmedical.com, www.artefill.com and www.myelevess.com respectively.

Researchers in Germany are describing a potential alternative to Botox and cosmetic surgery for easing facial wrinkles. Their study, scheduled for the November 5 issue of ACS’ Crystal Growth & Design, a bi-monthly journal, reports that high intensity visible light from light emitting diodes (LEDs) applied daily for several weeks resulted in “rejuvenated skin, reduced wrinkle levels, juvenile complexion and lasting resilience.” LEDs are the miniature lights used in an array of products, from TV remote controls to traffic lights.

In the study, Andrei P. Sommer and Dan Zhu point out that high-intensity visible light has been used in medicine for more than 40 years to speed healing of wounds. That light actually penetrates into the skin, causing changes in the sub-surface tissue. Until now, however, scientists have not known the physicochemical nature of those changes.

They report identifying how the visible light works - by changing the molecular structure of a glue-like layer of water on elastin, the protein that provides elasticity in skin, blood vessels, heart and other body structures. Figuratively speaking, the light strips away those water molecules that are involved in the immobilization of elastin, gradually restoring its elastic function and thus reducing facial wrinkles. “We are justified in believing that our approach can be easily converted to deep body rejuvenation programs,” the researchers state.

Article
“From Microtornadoes to Facial Rejuvenation: Implication of Interfacial Water Layers”
Crystal Growth & Design
DOWNLOAD FULL TEXT ARTICLE

American Chemical Society
(The world’s largest scientific society)
http://www.acs.org

From the 1970’s through the 1990’s cosmetic eyelid surgery consisted primarily of cutting out skin and fat from the eyelids and reconnecting the skin for a tighter look. However, as time went on, these patients’ eyes began to look hollow. More recent eyelid plastic surgery procedures have moved toward preservation and redistribution of the precious eyelid fat. By preserving the fat and redistributing it throughout the eye area, a plump, smooth, youthful look can be achieved, which lasts much longer.

New Eyelid Surgery Procedures and Their Advantages

In the youthful face there is a smooth, flawless, convex connection between the lower eyelid and the cheek. Recreating this smooth “lid-cheek junction” is the key to rejuvenating the eye region. As people age, there is a disruption of the smooth lid-cheek junction. The fat bags of your lower lids start to protrude during your fourth decade of life. Simultaneously a hollowing occurs below the bag creating a valley or trough, hence the term “tear trough.” The result is a tired worn reflection on the face. “The area where we most commonly to see this hollowing effect take place, is in the tear trough, just below the bags on the lower lids,” says Dr. Gilbert Lee, of Changes Plastic Surgery in San Diego, CA. By plumping up that area, with either fat injections or fillers such as Juvederm and Restylane, you can achieve a flawless transition from eyelid to cheek.

If tiny lines and wrinkles around your eyes are your problem, an alternative to fillers is to treat the lines with lasers. The laser treatments, in effect, cause the skin around the eye to shrink and contract, smoothing out those tiny lines. If the contour irregularities are more pronounced, then an eyelid procedure (blepharoplasty) is necessary to redistribute the fat from the bags and use that fat to fill the tear trough. A tightening of the eyelid muscle and skin layers is done simultaneously.

If your lower eyelids aren’t hollowing or bulging, perhaps it’s your top eyelid which is sagging and slowly covering your eye, making it difficult to apply make-up. Some of this may be attributed to excess fat and skin in the upper lid, while it could also be a weakening of your Levator Muscle. The levator muscle, lies within the eyelid and is responsible for opening your eye. As it contracts, the muscle pulls your eyelid into a crease (the supratarsal crease), forming the skin fold above your upper eye lashes. As you age, the levator muscle can weaken, creating sagging in the eyelid. By making a small incision on the natural crease of the upper eyelid, the excess skin, muscle and underlying fatty tissue can be removed and the levator muscle can be repaired if necessary.

Important Factors in Successful Eyelid Surgery

Dr. Lee, voted San Diego’s top plastic surgeon for 2007 and 2008, says that by using preservation techniques and combining procedures (fat injections, fillers, and fat relocation) that meet the patients’ specific objectives, plastic surgery for eyelids has become much more natural and lasting. Additionally, Dr. Lee and his staff use local anesthesia and oral sedation for eyelid surgery. “This is unique,” says Dr. Lee. “Using local anesthesia keeps plastic surgery costs down for the patient and is much easier on the body than general anesthesia. Patients often comment that their eyelid surgery was a ‘neat experience’ under local.”

Best Approach for Asian Eyelid Surgery

Asian eyelids differ from Caucasian eyelids in that they lack a fold or skin crease above the upper lashes. One of the most popular procedures for Asian patients is the creation of an eyelid fold, commonly called an Asian blepharoplasty or a double fold procedure. The change to a “double fold” eyelid is considered by many to open up the eye, creating a wider more beautiful appearance. There are two common techniques for Asian eyelid surgery: the suture technique or incision technique. The suture technique is a type of quilting stitch that is used to attach the skin of the eyelid to the underlying muscle, creating a crease. This technique is quick and easy, but less reliable than the incision technique.

As reported by Dr. Lee, 30-40% of sutures can release over time leading to the loss or weakening of the upper eyelid crease. On the other hand, the incision technique leaves a permanent and crisp fold in the eyelid. No matter which technique is used, the key is to create a youthful, attractive eyelid, which maintains its Asian character. “Many surgeons inadvertently make the Asian eyelids look Caucasian. They often make the fold too high or remove too much fat,” says Dr. Lee, who is also a top Asian blepharoplasty surgeon in San Diego. “What you want to do is maintain the natural ethnic features of the eye and create enhanced, attractive Asian eyelids, and not try to convert them to Caucasian eyelids.”

Quality Eyelid Surgery Cost in the U.S.

Blepharoplasty - Upper and lower: $5000-$7000
Blepharoplasty - Upper or lower: $3000-$5000
Restylane: $600/treatment

Dr. Gilbert Lee is triple board certified, including certifications by the American Board of Plastic Surgery, and the American Board of Surgery. He has been one of the top plastic surgeons in San Diego in 2007 and 2008 (voted by the San Diego County Medical Society). Find more information on eyelid surgery by Dr. Lee in San Diego, Changes Plastic Surgery San Diego, eyelid surgery before and after images at www.changesplasticsurgery.com

The Three Ways of Facial Aging - Facial aging has always been associated with the visual signs of sagging skin. For decades, the favored treatment of this sagging skin has been a facelift. When aging recurred, another facelift was done, and so on. After a second or third facelift, the individual no longer looked natural, and instead had a “tight or pulled” appearance.

Over the last 10 years, there has been a general “awakening” and acknowledgment among plastic surgeons as to how aging really occurs. Aging in the face occurs in three ways:

1. There is a loss of fat or volume in the face.
2. There is photo damage from the sun’s harmful rays
3. There develops an abundance of hanging excess skin.

So what do each of these components look like?

– Loss of fat or volume in the face leaves a sallow, hollow or deflated appearance. Areas most commonly affected by fat loss are the tear trough (the groove that forms below the lower eyelid fat bag), the cheeks, temples, lips and upper eyelids.

– Photo damage is caused by solar radiation. The sun’s radiating rays physically break the elastic fibers in the skin and damage the DNA of the skin causing cells to grow with abnormal coloration (sun spots and freckles) or even to develop skin cancer. Those who have spent too much time in the sun will manifest the sun damage as fine wrinkles around the eyes and lips, sun spots and freckles, and a dull leathery texture to the skin.

– Aging, the sagging skin, is seen as large hanging bags under the eyes, eyebrows which hang so low as to hood the eyes, hanging jowls, and loose skinned necks.

From the 1960’s through the 1990’s, each of these three distinct signs of aging was solved with one procedure: the facelift. At the time, this procedure was complex, fairly risky and had a 3-6 month recovery time. In more recent years, a shift has been made to more natural rejuvenation of the face, including a host of non-surgical facial procedures. Anyone who has looked into these new procedures knows that the options seem endless - surgical and non-surgical treatments, “liquid facelifts”, Botox, fillers, peels, lasers, dermabrasion, mini-facelift, lunch time-facelift… the list goes on. The big question is, how do you choose?

Dr. Gilbert Lee, a renouned plastic facial surgeon based in San Diego, recommends that you treat all three of the aging factors that affect your skin. “All these options allow you to treat specific issues in a much more natural and lasting way,” he says. Dr. Lee recommends that you “start with the aging factor is most apparent.”

The Natural Volume Facelift

If an individual has a gaunt, sallow face, then fillers or “volumizers” are the appropriate pick me up. Do people inject fat into their face to look younger? Yes! In fact, the procedure of removing fat from another area of the body and injecting it into the face is not only a popular one, but also considered to be very natural. “We normally take the fat from the tummy,” says Dr. Lee. He explains that to treat loss of fat or volume in the face, it’s best to use fillers or fat injections. The alternative to fat injections are fillers such as Sculptra (the “liquid facelift”), Radiesse, Juvederm and Restylane. These fillers are used to plump up the skin, “filling in” smaller sections or single creases.

Sculptra Liquid Facelift is a synthetic injectable material known as poly-L-lactic acid. Once this bio-stimulator is injected below the surface of the skin, it helps your body regenerate its own collagen. Sculptra is used to plump up larger surfaces of the skin, creating an overall smooth appearance without any scarring. Its effect will last years.

Botox is a muscle relaxer and is not a filler. Botox is best at treating expression lines because it relaxes the muscles underneath the wrinkle site, therefore relaxing or eliminating the wrinkle. What you choose is very much dependent on what you want to correct, how long you want your results to last, and how much you are willing to spend. A trained plastic surgeon can guide you through the myriad of options.

Facelift via Laser Treatment or Skin Resurfacing

To treat the effects of too much time spent in the sun (ie. freckles, sun spots, leathery skin texture), the options include strong topical treatments (medications), laser peels, dermabrasion, Intense Pulsed Light (IPL) and other laser treatments.

One of the more interesting laser treatments is called Fraxel Laser Treatment. This treatment performed under a topical anesthetic produces thousands of tiny laser columns that reach deep beneath your skin. These lasers eliminate old epidermal pigmented cells and cause new collagen growth and tightening within the dermis. Because the laser lays down laser columns of energy, it leaves skin in between laser spots unaffected and intact. This “fractional” treatment allows the skin to heal much faster than if the entire area were treated at once. And, with the newer laser technologies, there is little to no downtime.

A New Kind of Surgical Face Lift

If loose or excess skin is your top aging factor, the best option for you may be a surgical facelift. Unlike facelifts of the past, advancements in facelift techniques now allow plastic surgeons to work faster, safer and in some cases less expensively. With this new kind of facelift, smaller incisions are made, which not only result in less swelling, but also in less visible scaring. Depending on the patient and the procedure they are having done, doctors may be able to use a local anesthetic. Using a local anesthetic is often safer and can save you several thousand dollars in operating room and anesthesia fees.

The modern day facelifts offer more options delivered in less time. There are even more new procedures on the horizon. But, whether you choose fillers, lasers or lifts, the results you’ll likely receive are going to be safer, more natural, and, if you’re really lucky, less expensive. The best advice may be to treat each of the three signs of aging separately, pick what works best for your skin (and for your wallet), and ask lots of questions.

Dr. Gilbert Lee is triple board certified, including certifications by the American Board of Plastic Surgery, and the American Board of Surgery. He has been voted one of the Top Plastic Facial Surgeons in San Diego by the San Diego County Medical Society in 2007 and 2008. Find more information on facial surgery in San Diego by Dr. Lee, facelift before and after images at www.changesplasticsurgery.com