Last time I wrote about different techniques to refresh your look. You have done your research or may have asked around. You have opted for injectables as they fit into your schedule (no down time) and your budget. You have considered the safety and tolerability of the procedure and products and are re-assured. What can we expect?
Congratulations on your decision. Let me tell you how we proceed at Medestetica.
Firstly we do a consultation. This entails a brief evaluation of your general health, allergies and medications.
With the help of a mirror we evaluate ( with you) your face section by section (upper one third of the face/middle and bottom one third). We will discuss the areas of wrinkling and volume loss. This will dictate our approach. Do we need Botox and/or fillers? What quantity of product is needed and how much will it cost?
We need to discuss expected results. The goal is to improve and refresh the look. We are not looking for perfect results. It is impossible to look like that picture of you at age 20. Recall on a previous blog that I discussed the changes of aging which include changes in skin tone and elasticity as well as changes in bone structure. Obviously we cannot change the bones back to their younger status.
Furthermore the procedure may have to be done in steps. We will need to discuss these steps and together decide on the priorities for you.
If we do a Botox treatment, the product is sold by the unit. We pull out of the vial the number of units necessary and inject through very tiny needles in the appropriate areas. The effect will begin in about 2 days with maximal results at 2 weeks or so. The effect is expected to last 3 to 6 months. Complications are very rare and dissatisfaction can result from incomplete effect at which point we can simply add in a small amount more. This will establish the required doses good for you for future treatment. Rarely bruising may occur.
Should we need fillers, the main products are the hyaluronic fillers (HA). These give essentially no allergic reaction. They too are injected in the appropriate areas with a needle. Here too bruising may occur. As with any bruise, it will subside within 4 to 6 days and can be minimized with ice applications and covered up with make-up if need be.
HA is typically sold by the syringe. It will be estimated how many syringes are necessary for the given procedure, and what can be expected. Contrary to Botox, the results of fillers can be seen immediately and therefore the requirements (number of syringes required) will be adjusted as we go along. Even though the effect can be seen immediately results usually get better as the product integrates in the tissue and causes an internal hydration.
Photos are typically taken before and after the procedure. These are for internal use and kept in the patients’ files.
The whole appointment from consultation to photos to procedure typically lasts from 30 to 45 minutes. Future appointments for top-ups or repeat treatments will be quicker as the whole consultation and explanation part will not be necessary or, at least, greatly shortened.
At Medestetica we firmly believe that a satisfied patient is one who understands what we do and how we do it. The patient that has realistic expectations, as discussed with the doctor, will not be disappointed. We will not make false promises and will advise against any treatment that will not satisfy the patient or doctor.
Have a great day and speak to you soon
Dr. Bruno Bernucci
Hello one and all
Due to a too busy schedule and time restraints I have been a little late in writing this blog. Forgive my tardiness, but I still have plenty to share.
In my previous blogs we had discussed historical attempts a attaining beauty and how beauty has been perceived differently at different periods throughout history. We defined the physical features associated with beauty. In the last blog we have seen the changes to skin and bone that result in the undesired facial features associated with aging. We discussed briefly some ‘anti-aging’ methods. This time I wish to discuss what and how we do to negate the changes associated with aging.
I do not wish to belabor this topic as the details of the procedure, its results and post-operative consequences as well as durability will be discussed by the surgeon should you choose this method of treatment.
Facelift: Briefly, incisions are made in hidden areas (hairline/behind the ears) and the skin is pulled or ‘lifted’ to smooth out wrinkling.
Implants: Similarly, through tiny incisions implants can be added to augment volume (chin/breast/buttocks).
Given these are surgical procedures there is anaesthesia, rarely, an overnight stay, more pain and bruising resulting in ‘down time’ away from work and regular activities. There is a greater financial implication as you must pay for the procedure and equipment/materials used as well as the time of the anaesthesist. Although minor, the risk of infection, post-op medication side effects and anaesthesia may be frightening for some patients.
Threadlift: This technique involves passing beaded threads under the skin such that when we pull on the thread we snag the skin pulling/lifting it back.The thread is left there to hold the skin. This is less traumatizing than surgery but wide needles are used to pierce the skin to be able to pass the thread and there will be more pain and bruising. The durability as well, is questionable and the costs,although less than the surgery will bemore than injectables.
Fillers: you may have heard of names such as Juvederm/Restylane/Teosyal/Belotero and others. These are all made of a product known as ‘hyaluronic acid’ which I will refer to simply as HA. This HA is a substance found in ALL living things (people/animals/plants/microbes). Obviously the HA will differ between the species. HA is the skeleton of our cells and tissues. The HA is prepared in different concentrations and ‘thicknesses’ to have different applications. There is one such preparation (quite a ‘thick’ one) that we inject in painful arthritis joints. In aesthetic medicine they have been formulated for skin and tissue. There are a variety of preparations suited to go deep and add volume to those shrinking fat pads beneath the skin (see previous blog) as well as others to go very superficial for tiny wrinkles. We add them to lips as well to make them fuller. Given that HA is already a part of living things, allergic reactions are very rare. There is no down time and pain levels associated with the procedure appear minimal. Furthermore, we even have an antidote that can completely remove the product should we not be satisfied. Depending on the product and where on the face it is applied the durability can be from 6 to 15 months.
Botox: Botox is a product that ‘numbs’ muscle contraction. In certain areas of the face such as around the eyes (crow’s feet), between the eyes (glabella) or on the forehead we can see creases in the skin caused by muscle contractions as we make expressions. These creases may become quite deep and evident even when we do not make the expressions. The botox will reduce or eliminate the contraction such that the creases are less obvious or disappear. It is given in very small quantities and therefore do not add to volume. The quantities are very minimal as compared to the amounts given in medical applications such as the treatment of migraines or bladder problems. Typically the effect lasts 3 to 6 months at which point it should be repeated.
Others: There are other fillers that can be used in particular situations. These may have more tendency to give an allergic reaction and are less reversible. Without dwelling on these, we would suggest and discuss them if you are a good candidate for these alternatives.
As expected, the injectables are given through needles at various areas of the face and neck. They are usually minimally painful and, as with all piercings of skin, there is a little risk of bruising. Of course this heals and disappears quickly.
The secret to good results is to inject the right product at the right place and in the proper quantity. The horror stories of duck lips or a porcelain paralyzed look are because we have not respected these rules. At Medestetica we will not inject any area if not needed and will suggest the appropriate procedure tailored to your needs. Nearly 15 years of experience in doing procedures as well as ongoing exchange with colleagues and keeping up with upcoming methods and techniques have made Medestetica a reliable and sure choice for your injectable aesthetic needs.
Dr. Bruno Bernucci
i pour modifier.
In my last blog I touched on the subject of addressing various facial features to enhance rejuvenation and
beauty. I mentioned how aging can affect our faces. Presently I wish to discuss a little futher what happens to our face as we age. Unfortunately we cannot stop the aging process but we can try to slow down the process or at the very least,not to accelerate it. Medical research is ongoing to try to discern the causes and
processes of aging. Why do some people live to be very elderly (in some cases over 100 years old). Some people seem to age very gracefully and do not appear their age.The opposite is also true where some people look much older than their age and die young. As mentioned in the previous blog,a variety of medical conditions can contribute to the premature aging process. Apart from disease there are genetic issues (unfortunately we cannot choose our parents) that can spare us from appearing older than our age. I mentioned the other environmental factors such as sun,cigarette,excess alcohol or drugs. Stress and anxiety,other than affecting our demeanor will result in behaviour changes that can result in premature aging. There are probably hormonal and immune changes brought about by stress and depression that can adversely contribute to skin changes. This is logical when we consider that medical studies have shown fourfold increase in heart attacks in patients who have depression after their first heart attack as compared to the non depressed patient. This is also true in recurrence of cancer in the depressed or anxious patient
as compared to the emotionally sound cancer patient.
Let us take a closer look at your skin
This is cross section of your skin with its various structures.
As we age the epidermis thins out. The stratum corneum is responsible for retaining moisture and this fuctionn weakens. This will lead to skin dehydration. The pigment cells known as melanocytes become less numerous and the remaning ones enlargen leading to pigment changes (ah those sunspots and liverspots). Deeper in the dermis, it too thins out and there is a reduction of fibroblasts and collagen resulting in loss of elasticity and tone. Thinning of the skin results in a more transparent skin.The blood vessels become more apparent and friable and can break leading to those bruises frequently seen on the arms of older patients. As well the fat under the skin diminishes preventing the body from properly controlling its temperature that can lead to further dehydration. As time passes the contractions of the underlying muscles can also lead tho changes in skin structure. As you have no doubt seen, constant squinting or frowning can lead to the presence of wrinkles (crows feet or frown line). Gravity pulls down the skin and constant pressure as in repeated crushing of skin (leaning on your hand or sleeping on the same side of your face) can also bring about skin changes and wrinkling.
Adding insult to injury
Not only does the skin change but the undferlying bones of your face also change with age. Observe in the
images od CAT scan reproduction of two differently aged skulls how the angle of the jaw widens with age.
This along with a general reduction of jaw lenght and height results in a less well defined jaw line. There is a general decline in bone mass along with reduced fat and muscle bulk that reduces the underlying structure upon which the skin rests. All this leads to further skin sagging.
I have included a few images of the facial transformations resulting from the above changes.
So what can we do?
We cannot change the bone itsel. Surgically it is possible to add implants in some areas as in the chin and mandible. Of course as time goes by,the underlying bone,muscle and fat continue to dimish but the implant remains and can result now in a strange abnormal result unless you do another correctice procedure. We can inject products such as fillers to compensate for the reduced volume under the skin (the wasted muscle and fat) or inject it into the skin to increase tone and volume of the diminishing epidermis and dermis. Theseare the 'fillers'. As to the muscle contractions causing the wrinkling this is where the 'botox' works as it modulates and reduces muscle contractions. More superficially, we can apply a chemical peel. This will allow the top layer of cells to peel away and stimulate the lower layer of regenerating cells to step up and produce newer younger cells. In so doing we are able to reduce those very fine wrinkles and at times even out skin color inconsistencies by rendering blemishes a little paler. Retinoic acid topical products have also been shown to do this. Deeper peels can be utilized (stonger chemicals) or dermabrasions of varying depth serve the same fuction. For deeper pigmented lesions or severe skin surface irregularities various laser treatments may be helpful. Naturally a combination of these treatments usually works best.
So next time we can explore what is in those injections and how they are done
Dr. Bruno Bernucci
What is Beauty?
The quest of beauty has been ongoing endeavour litterally for millenia. The definition of beauty, however, has changed overtime. The eternal questions remain: What is beauty? How can we attain beauty of become more beautiful? Fo we need to be more beautiful?
About beauty over the ages…
If we go back to 1300 BC it is believed that Queen Nefertiti utilized black eye color (eye liner) and red dyes color her lips. She is described as having refined facial features with a well defined jaw line and symmetrical features.
Over the ages women become idealized in different manners. In the 1600’s Rubens and Botticelli painted full figured women as this was though to be ideal. Bosoms also become more noticeable as compared to the prior century when women were encouraged to conceal their bosoms by wearing very tigh bandages and wraps. I
In the 1950’s curves were in (think of Marilyn Monroe and Sofia Loren_ but bye the 1960’s a thinner more androgenous look became more appealing. Since 1970’s and onto present time, it appeard that the athletic or healthy look is the way to go.
All for the sake of being beautiful
The years have also seen all sorts of differents (and many time dangerous) techniques to attain the ideals of beauty. Women would apply antimony sulphide to their eyes to dry them out and make them glitter (no doubt creating discomfort and possible damaging eyes lesions) or belladonna to dilate the pupils but also inhibiting vision not allowing the eye to accommodate to light. Imagine applying a concoction of chalk, vinegar and arsenic to make your skin look translucent and to give you that porcelain skin look.
To get those more desirable bosoms women would inject paraffin, collagen or silicone directly into their bosoms! You may ask: are we not still doing this? Obviously modern techniques are quite safe and have been scrutinized by both the medical and scientific community not to mention the government bodies.
Looking at ourselves
We can also define beauty as beign that wich is in the eye of the beholder. If you are beautiful to your soulmate that is really all that counts after all. If you feel right and your soul male finds you perfect, then there is no issue.
Beauty that is beheld by many people (or most people) such as Angelina Jolie or Brad Pitt may define beauty. To become more beautiful many people want to approach the appearance of the “beautiful people” have. I do not believe that is the way we should go about it.
Patients frequently ask me for lips like Angelina Joli. My answer is « you are not Angelina Jolie». She was born with those lips (although I believe she gets regular treatments to maintain them). They look good on her because they marry well with her other facial features such as the shape of her face and her underlying bone structure. The goal is to improve your lips and assure that they fit into your face. We have all seen Hollywood excesses (duck like un-natural looking lips for example). We do utilize basic principles of beauty and symmetry (the golden rule and phi) to maximize the aesthetic result but the goal is to improve you and not to make you into some-one else. In future blogs we can discuss some of these rules and applications.
Let us also remember that beauty must come from within as well.” A healthy body makes a healthy mind”. I would venture to say that a healthy body and mind makes for an attractive person by virtue of their attitude, vitality and general demeanour.
How can we get there? You guess it : exercise, proper nutrition, relaxation addressing negative thoughts or anxiety – in essence coaching do improving general energy. The holistic approach involves these facets as well as others to enhance your appearance and self esteem. This may include advice on proper fashion wear, make-up, hairstyle, skin care and so on.
At Medestetica our approach to beautification will be exactly like this. Let us include the Botox, fillers and peels, but let us also addresses (when needed) the other issues mentioned above. In future blogs, you will be meeting the members of our team that will inform you on various topic including the psychology behind becoming more beautiful, the evidence role of nutrition and exercises in becoming more attractive as well as expert advice on concept of hairstyling and various cosmetics and how to apply them.
Speak to you soon.
LET US GET SPECIFIC, SHALL-WE?
Concentrating on facially beauty particularly, studies across various cultures (and both genders included) have demonstrated that to strive for beauty we must address some key facial issues. These include the following;
1) The shape of the face and chin, as well as cheek prominence and the symmetry of these structures
2) The height of the forehead
3) Eyebrow shape and fullness
4) Eye size and the distance between the eyes
5) Nose shape and size
6) Lips (size shape and symmetry)
7) Skin texture, clarity, color and imperfections
Granted that we cannot alter some of these issues such as forehead height, eye size or inter-eye distance we can pretty much modify the other features. The chin, cheeks, lips, and nose are all amenable to modification by injectable fillers or surgery. Eyebrow shape can be improved by botox and fillers as well as plucking and contouring.
Many techniques exist to improve skin quality. These can include your usual moisturizers as well as chemical peels, dermabrasions and laser treatments. Marry these to proper make-up applications and hairstyling and the results can be quite impressive. Compliment with an appropriate dress style and positive energetic mental attitude and watch out folks!!!
At Medestetica this is what we want to attain.
Why do we need to do all this in the first place.
Firstly we may have been born with some asymmetries or imperfections that render us self-conscious. They may have been acquired due to a trauma or infection or even a surgery. Given that our face identifies who we are and albeit too many times wrongly defines us, it is the element that most influences our interaction with others. Think of Cyrano de Bergerac who wooed the women he loved with his wonderful words but because of his unsightly nose could only use these words trough a good looking but less eloquent man. Fortunately the women (upon learning the source of these wonderful seductive words) fell in love with Cyrano despite his nose. In modern society I am not certain we always have the time to use our charm and personality to succeed and looks (at least to create a favorable first impression) may be necessary. Whether this is right or wrong is the subject of a potentially long debate and really not the scope of my blog.
Our faces age by the ravages of time and external elements such as sun exposure and toxic chemicals as in cigarette smoke. Medical conditions including dermatological diseases (eczema/psoriasis/keratosis), hormonal issues (post-menopausal/thyroid) and other medical conditions (liver, kidney and heart disease) can all affect skin quality.
As most women have learned over the centuries it is important to maintain skin quality by properly hydrating with moisturizer creams and drinking adequate amounts of fluids. Obviously avoiding sun exposure, using sunscreens and avoiding cigarette smoke is of the order. Consultation with your health provider is necessary to address the medical issues.
Where-as there is not very solid evidence as to the benefits of food types and supplements in skin rejuvenation I will discuss this in a future blog.
In my next blog I will review the effects of aging on our faces and discuss how and why our rejuvenation techniques work with a focus on injectable and topical treatments.
Dr. Bernucci runs a busy medical practice. He is frequently called upon to advise on elaborating educational programs for fellow physicians and as a conference lecturer to other medical doctors. He also speaks frequently to large groups of patients as well as the general public on numerous topics. He is one of the Co-Authors of Managing My Life: Managing My Health.