Wrinkles Around the Lips

Model (courtesy of Dr. Kent Remington, MD)

Wrinkles around the lips are very common and can be addressed in multiple ways. The cause of these wrinkles is multi-faceted. With age, loss of fat leads to volume loss and loss of collagen leads to the loss of the structural support. Additionally, repetitive use of the muscles around the mouth from activities such as smoking enhances these lines. Using a good skin care regimen with retinoids to stimulate collagen formation and antioxidants and sunscreen to prevent further damage is the foundation of treatment. Botox can be used to relax the muscles around the mouth, but very small amounts must be used to prevent complications such as difficulty with eating and speaking. Fillers such as Juvederm can be used to fill the wrinkles that are formed by volume loss. Finally, treatments such as chemical peels and laser resurfacing can tighten the skin. Contact Dr. Alex (818-835-1833 info@aeskin.com) to discuss the best options for you.

Laser Tattoo Removal

Cosmetic tattoos are rapidly increasing in popularity and more and more people are getting tattoos. At the same time, many people are getting tattoos removed for a variety of reasons. In addition to being used to treat discolorations, fine lines, wrinkles, scars, skin laxity, and unwanted hair, lasers are now being used to remove tattoos. The laser is adjusted so that the pulse is delivered over a very small time, one billionth of a second or even one trillionth of a second, destroying the tattoo particles. While it is possible to remove tattoos in this way, it is not easy nor is it comfortable. Multiple procedures are usually necessary and it can take over two years for full results. Also, the cost for these procedures adds up quickly and is usually many times more than getting the tattoo in the first place. For this reason I recommend people to think long and hard before getting a tattoo.

Skin Care Concerns in Asian Skin

Today is the Chinese new year, the year of the snake. On this occasion, the topic will be skin care concerns in Chinese and other East Asian skin. Asian skin is categorized as Fitzpatrick skin types III, IV, and V  because the skin contains a high amount of pigment. Because of this pigment, the skin has a natural tendency to produce discolorations such as post-inflammatory hyperpigmentation and melasma. There are various measures taken to prevent such complications when doing cosmetic procedures. First it is recommended to start a good skin care regimen using sunscreen, brightening agents, exfoliants, antioxidants, and moisturizers several weeks prior to the procedure. The darker the skin, the more important this is and the longer the regimen should go prior to the procedure. The second measure is using more conservative parameters when doing the procedures. For example, in the case of chemical peels, lighter strength peeling agents are used. When undergoing laser procedures more conservative parameters are used relative to when doing procedures for fair-skinned individuals. When such conservative parameters are used, the risk for complications is minimized. At the same time, the effects are not as strong; so more treatments are required and it will take longer to achieve the desired effect. Patience is key for those with darker skin types. It is important to discuss your skin type with your doctor so that appropriate procedures are selected for you.

Comfort During Cosmetic Procedures

Cosmetic procedures, as their name implies, are performed to improve the appearance of the skin. While this is the primary objective, it does not mean that the procedure must be uncomfortable. There are many ways to improve comfort during procedures such as injectables (Botox, Juvederm, etc.), chemical peels, and laser procedures. The simplest way is to apply something cold onto the skin to numb the area. This could be a cold pack, a cold spray, or cold air. These methods work very well both before and immediately after the procedure. Vibration can also provide comfort; this is common when dentists vibrate the lip prior to injecting an anesthetic. Another method is by using topical numbing cream. Numbing creams can be very effective at providing comfort and can be applied for a few minutes or over an hour prior to a procedure. A professional should apply the numbing cream to avoid potential complications. Oral medications such as Tylenol, Valium, and Vicodin can also be used; some of these require a prescription. Be sure to consult with a doctor prior to taking any of these because after taking certain medications it is not recommend to perform certain activities such as driving. Nerve blocks are injections in the area of treatment which provide nearly immediate comfort and are preferred by many surgeons. Intramuscular injections are done in other areas such as the shoulder. Intravenous conscious sedation, also known as twilight anesthesia provides further comfort. The most aggressive measure is general anesthesia in which the patient is put to sleep during the entire procedure. It is important to know that cosmetic procedures do not have to be uncomfortable. Make sure you discuss your options before undergoing a cosmetic procedure.

Acne Scars

Model (Courtesy of Dr. Adam Baker, MD)

Acne scars are very common and of great concern because they can give a disfigured appearance. These scars are usually formed when pimples are popped; this release of the pus into the skin leads to an inflammatory reaction in which abnormal collagen is generated and the skin does not heal properly. The depressions that are left in the skin are called atrophic scars. It is important to differentiate these acne scars with the discoloration that can occur after blemishes (called post-inflammatory hyperpigmentation) because the treatment is different. The deeper the scars, the more aggressive the treatment required. There are multiple ways to address these scars. I recommend starting with a good skin care regimen with a retinoid, exfoliant, antioxidant, and sunscreen. After several weeks of pre-treatment procedures such as chemical peels and laser treatments may be performed. Fractional ablative lasers, especially when combining them with other procedures as in the A E Skin Ultimate Rejuvenation, can give outstanding results with minimal downtime. A series of three treatments is generally recommended at four to six week intervals. More may be done depending on the severity and response. Women who are pregnant or breast feeding should not be treated.

Topical Numbing Cream

Topical numbing cream is used to provide comfort for a variety of cosmetic procedures such as injectables and laser procedures. There are a variety of different formulations and the most common ingredient is lidocaine. This is the same anesthetic dentists use when doing procedures. Applying the cream topically to the skin is easy and does not require a needle. It is usually applied anywhere from 15 minutes to one hour before to a treatment and cleaned off with water immediately prior to the procedure. Some of the injectable products such as Juvederm Ultra XC contain a numbing ingredient for added comfort. Topical numbing cream should always be applied in a medical office and never by patients at home. The reason is that the ingredients can be absorbed into the bloodstream and cause adverse effects. There have been cases where people have been hospitalized and even died because they applied too much topical numbing cream prior to the procedure. Although these situations are rare, it is important that the numbing cream is applied by in an office to avoid complications. When used appropriately topical numbing cream application is a safe and easy method of providing comfort during procedures.

What is Microdermabrasion?

Microdermabrasion is a simple procedure usually performed by an aesthetician used to remove a thin layer of dead skin cells from the surface of the skin. Removing the dead skin cells lead to a number of improvements in the skin including improvements in both discolorations as well as textural changes such as fine lines, wrinkles, and shallow scars. It also allows skin care products to be absorbed more effectively for improved results and makes makeup easier to apply. Men notice a closer shave after microdermabrasion treatments.

Unlike chemical peels or laser resurfacing, microdermabrasion is a very superficial treatment. The advantage is that there is minimal downtime; for example redness may persist for only a few hours. The disadvantage is that more treatments are required for best results. Treatments are typically done at one to two week intervals.

Traditional microdermabrasion uses fine crystals sprayed on the skin combined with a vacuum that immediately removes the crystals. This is very similar to using sandpaper on the surface of furniture to smooth it out. The depth of penetration can be adjusted by changing the size of the crystal, by adjusting the speed of the crystal flow, and by increasing or decreasing the number of passes applied to the skin. Some new technologies contain a diamond and do not use crystals, which improves comfort during the procedure.

After a microdermabrasion treatment the skin will be sensitive and likely red. Do not apply makeup for several hours after the treatment. It is important to use plenty of moisturizer because the barrier function of the skin changes after the surface layer is removed. Always be sure to use a broad spectrum sunscreen with a minimum SPF of 30 to protect against sun damage.