How to Help Your Face – San Francisco Bay Area

Posted January 24, 2016 in Botulinum Toxin (Botox Dysport Xeomin), Chemical Peels, Eyelid Lift (Blepharoplasty), Facelift (Rhytidectomy), Fillers (Restylane Juvederm Perlane Radiesse), Home, Rhinoplasty (Nasal Surgery), Smoking and Plastic Surgery, Wrinkle Reduction (Non-surgical)

If we are lucky, Facial Aging is something we all experience. It can present as changes in skin tone or coloration, fine lines or deeper wrinkles, and even loose or saggy skin. It happens, if we stick around long enough. While Facial Aging cannot be altogether prevented, how you look is influenced by how you treat your skin. Some of our normal daily activities help, while others hinder the effects of time.

Good Genes and Bad Habits

We all know someone who never wears sunscreen, drinks, smokes and whose skin looks great. It’s hard to beat youth and good genes, but you can if you try hard enough. Skin likes Protection, Hydration and Circulation, so here’s how to earn your PhC in beautiful skin:

  • Protect your skin. It protects you.Protection – Prevention is the best medicine, and this is true for your skin, too. While we need a small amount of sunlight to activate vitamin D, the amount we subject our skin to, especially when we are young, is excessive. The high-energy ultra-violet light in the sun’s rays breaks the DNA inside the skin cells. At a minimum, sunshine dehydrates the skin, but it also damages the elastic fibers that keep skin supple, reduces the skin’s ability to heal itself and if too much damage is done, leads to the development of skin cancer. We would all treat cancer after it’s found, but why not treat it before it starts, by protecting your skin?

    Skin cancer can occur even where the sun does not shine, but it is most commonly found in areas exposed to the sun. Moreover, the risk of Skin Cancer increases with the amount of sun exposure. Today, sunscreen is incorporated into many moisturizers, cosmetics and even fabrics. Hats and long sleeves help, but sunscreen is a must. Personally, I could not survive a trip to Hawaii without sunscreen, a hat and a swim shirt. When I was young, it may not have made me look cool, but it did allow me to have fun with my friends without a week of recovering from sunburns. Now, if you go to the beach, sunscreen and sun shirts are common, and using them shows that you care about your body.

  • Your skin likes being hydrated.Hydration – Our skin keeps us from drying out, but it is not impermeable. I remember a junior high school science project during which we placed a plastic bag over one hand. The water that is normally lost through the skin was trapped in the bag. It made it quite clear that we are constantly dehydrating.

    If you’ve ever watched Naked and Afraid, or any of the other survivor “reality” shows, you know that water is more important than food. Keeping hydrated keeps us healthy. It improves circulation and allows the body to rid itself of toxins. Alcohol, on the other hand, tends to dehydrate us, so all things in moderation.

    You can help your skin by using a moisturizer. Moisturizers do not supply moisture to the skin, but trap the normal water that is lost through the skin. Petroleum Jelly (Vaseline) is very effective. It certainly helps injured skin heal with better scars, but its sheen is a bit obvious and it greasiness makes using vaseline quite messy. Most moisturizers are not as good as Vaseline, but are easier to live with. It’s a compromise.

  • Good circulation makes for healthy skin.Circulation – Good hydration promotes good circulation. The blood is mostly water, and when we are dehydrated the skin suffers more than another other organ. Circulation is also effected by our habits. Good habits, like daily exercise, promotes increased circulation and may improve the look of our skin, too. Bad habits, like smoking, decreases circulation, and the skin is especially hard hit.

    As a Cosmetic Plastic Surgeon, I am operating on the skin, and I need healthy skin and circulation to get the best results. Several cosmetic operations are known to have increased risk in people who smoke. For procedures like Face Lifts, Breast Reduction and Tummy Tucks, smoking increases the risk of wound healing problems by six-fold. Because of this, Plastic Surgeons recommend smoking stop at least four weeks before and after any elective surgery. If you can quit smoking for surgery, you can quit for life, literally your life.

Good Genes and Good Sense

There are many simple actions we can take to keep our face and skin happy, and earn our skin a PhC. You have probably heard many of them before, like eating right and sleeping, but good advice only works if you act on it. I will share additional pearls in additional posts.

With the title How to Help Your Face, you might have thought I was going to review all the plastic surgery options for Facial Rejuvenation. That information is certainly available here on the the San Francisco Plastic Surgery Blog. The most common, Eyelid Surgery (Blepharoplasty), Face Lifts (Rhytidectomy), Nasal Surgery (Rhinoplasty), Chemical Peels, Fillers and even Botox, all work better with skin that is cared for.

If you would like to learn more about Facial Plastic Surgery procedures, feel free to follow the links in this post article to access more information, or give me a call at (925) 943-6353, to schedule a personal consultation appointment at our San Francisco Bay Area Plastic Surgery office in Walnut Creek, CA.

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Counterfeit Botox is Back Bay Area

Posted April 25, 2015 in Botulinum Toxin (Botox Dysport Xeomin), Chemical Peels, Facelift (Rhytidectomy), Fillers (Restylane Juvederm Perlane Radiesse), Home, Patient Safety, Wrinkle Reduction (Non-surgical)

The real Botox bottle and box have many security features to prevent counterfeiting.

The real Botox bottle and box have many security features to prevent counterfeiting.

Botulinum Toxin remains the number one non-surgical cosmetic treatment year after year. In 2014, 3,588,218 neuromodulating wrinkle treatments were reported by the American Society for Aesthetic Plastic Surgery alone. Botulinum Toxin Treatments were more popular than the next four nonsurgical beauty treatments combined:

The Top Five Nonsurgical Cosmetic Procedures

  1. Botulinum Toxin (Botox, Dysport, Xeomin, Myobloc) – 3,588,218
  2. Hyaluronic Acid (Restylane, Juvederm, Perlane, etc…) – 1,696,621
  3. Hair Removal (Laser or Pulsed Light) – 828,480
  4. Chemical Peel (TCA, Phenol) – 484,053
  5. Microdermabrasion – 417,034

Counterfeit Botox

The latest counterfeit Botox bottles look a lot like the old Botox bottles. They are taller, thinner, lack holograms, lack unique lot numbers, lot numbers on bottle and box may not match and they have "Botulinum Toxin Type A" instead of "Botox Cosmetic OnabotulinumtoxinA."

The latest counterfeit Botox bottles look a lot like the old Botox bottles. They are taller, thinner, lack holograms, lack unique lot numbers, lot numbers on bottle and box may not match and they have “Botulinum Toxin Type A” instead of “Botox Cosmetic OnabotulinumtoxinA.”

When I say, “Counterfeit Botox,” I am not talking about competitive brands of FDA approved Botulinum Toxin. Botox was the first to market in the US, while Dysport was the first to market in Europe. Both are FDA approved, as are two others:

  • Botox® (onabotulinumtoxinA)
  • Dysport® (abobotulinumtoxinA
  • Xeomin® (incobotulinumtoxinA)
  • Myobloc® (rimabotulinumtoxinB)

FDA Approved Botulinum Toxin – What’s The Difference?

Dysport was the first to market in Europe, second in the US and is also FDA approved.

Dysport was the first to market in Europe, second in the US and is also FDA approved.

There is a big difference between FDA approved Botulinum Toxin and everything else fraudulently making the claim. The approved drugs are deemed safe and effective when administered in the prescribed fashion by a qualified and experienced injector. These drugs have been tested, and are manufactured under the supervision of the FDA. Their factories are open to surprise inspection at any time, and the distribution can be stopped when problems are found.

Counterfeit Botulinum Toxin on the other hand, is not manufactured with the same quality controls. It may not contain any Botulinum Toxin, and when it does, the dosing can range from ineffective to lethal.

How to Avoid Counterfeit Botox

You get what you pay for, and beauty is not cheap. If an offer seems too good to be true, it’s most likely false. It takes experience to become a good injector, so look for an established practice with experienced injectors. Ask questions:

  • How many Botox injections do you do a month?
  • How long have you been performing Botox injections?
  • What is your training?
  • Can I see the bottle? (for Botox look for the Allergan hologram)
  • How long between mixing the Botox and Administration?

Reputable doctors will be happy to explain. Grumpy or evasive responses are a red flag.

Wrinkle Ridding Consultations

As a Board Certified Plastic Surgeon, I perform everything from Botox to Facelifts. Botox is usually performed in the office on the third Wednesday of each month. It’s a busy day, but it allows me to use Botox or Dysport within a few hours of mixing, so nothing gets stale. If you are interested in Botox, Fillers or Surgical Correction of Facial Wrinkles, give me call at (925) 943-6353. More Plastic Surgery Information is available on our newly revamped and mobile friendly web site: DrMele.com.

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Botox for Laugh Lines (Crows Feet) | San Francisco Bay Area | Walnut Creek, California

Posted September 14, 2013 in Botulinum Toxin (Botox Dysport Xeomin), Home, Wrinkle Reduction (Non-surgical)

BOTOX Cosmetic (onabotulinumtoxinA) was the First to Market for Wrinkle Reduction in the US, and now is approved for Frown Lines and Smile Lines too.

BOTOX Cosmetic (onabotulinumtoxinA) was the First to Market for Wrinkle Reduction in the US, and now is approved for Frown Lines and Smile Lines too.

Botox has obtained a new indication from the US FDA. It is now FDA approved for use on Crow’s Feet, the Laugh Lines that form at the corners of the eyes. While most of us like them while we are smiling, many dislike them when they refuse to relax.

Smile Lines Are Fine When We Are Smiling

After a certain age, the lines at the outer corners of the eyes stop going away when we stop smiling. Persistent Smile Lines are a natural sign of aging. They stick around long after the smiling stops, when elasticity begins to leave the skin. The process is accelerated by sun exposure and smoking, so you have been warned. While neuromodulators, like Botox and Dysport, do not restore the thicker, more elastic skin of youth, they do relax the resulting wrinkles.

But My Doctor Has Treated My Crow’s Feet With Botox For Years

Technically, until Botox’s approval this Wednesday, treating Crow’s Feet was an “off label” use, just like treating frown lines was before 2002. Botox was originally approved for blepharospasm and strabismus. Blepharospasm is a disabling spasm of the squinting muscles that makes its sufferers functional blind, due to the inability to fully open the eyes. Strabismus is a misalignment of the eyes, due to imbalance of the muscles that move the eyes. The mechanism of action of Botox is that it blocks the nerve impulse that makes the muscle contract. For those with blepharospasm, it is a quick and easy fix. The muscle relaxes in a few days, and the improvement is dramatic as the eyelid is no longer forced shut. For strabismus, double vision is caused when the muscles that move the eye are unbalanced. The stronger muscle pulls the eye to its side. Strabismus is treated by weakening the stronger muscle. This balances the muscles that move the eye and corrects the double vision. Unfortunately, the results are not permanent, and retreatment is required because the nerves will sprout new functional branches that need to be blocked also.

Plastic Surgeons, Ophthalmologists and Dermatologists Have Used Botox for Wrinkles for Decades

Botox is safe and effective. Since Botox’s 1989 FDA approval for treating Blepharospasm, the off label use for cosmetic purposes began. It is only in the last decade that FDA approval was granted for wrinkles, but only for the glabellar region, between the eyebrows. It may seem odd that approval for the injectable is limited by area, but that’s the way the FDA has gone about it. So now, Plastic Surgeons are on label when treating Frown Lines and Crow’s Feet, but we are still off label when treating the forehead.

Botox Has Multiple Indications

Botox may be the drug with the most indications ever. It seems that a drug which blocks neuromuscular junction has multiple beneficial uses. Besides blepharospasm, strabismus, glabellar frown lines, and now crow’s feet, Botox is also approved for the treatment of migraine headaches, excessive armpit sweating, overactive bladder (spastic bladder) and the associated bladder incontinence, arm spasticity (severe arm muscle spasms) in adults and cervical dystonia (severe neck muscle spasms) in adults. It’s also used off label for forehead wrinkles, and some lower facial muscle induced wrinkles, to provide symmetry to the face after strokes, episodic migraines, sweating of the palms and other areas, and muscle spasticity of the arms and legs in children (most commonly in children with cerebral palsy).

Who Can Administer Botox?

On the California Medical Board Website it says, “Physicians may inject Botox, or they may direct registered nurses, licensed vocational nurses, or physician assistants to perform the injection under their supervision. No unlicensed persons, such as medical assistants, may inject Botox.” The definition of “direct” is open to interpretation. My opinion is that with each treatment, you should be seen by a doctor either they should inject you, or after the evaluation, they can direct an RN, LVN or PA to inject you. If you are only seeing a nurse, or a spa owner, the spirit of the law is being violated. On the other hand, I do walk around San Francisco and Walnut Creek, and see this as a way to provide bargain basement Botox. While safe and effective, Botox is not 100% predictable, even in the most experienced hands, so buyer beware.

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Top 5 Cosmetic Plastic Surgery Procedures – Fifth Place

Posted March 17, 2012 in Botulinum Toxin (Botox Dysport Xeomin), Facelift (Rhytidectomy), Fillers (Restylane Juvederm Perlane Radiesse), Home, Tummy Tuck (Abdominoplasty), Videos, Wrinkle Reduction (Non-surgical)

Over 13.8 million cosmetic procedures where performed last year, and we are counting down the top five cosmetic plastic surgery procedures as reported by the American Society of Plastic Surgeons.

Top 5 Plastic Surgery Videos

Today’s Top 5 Plastic Surgery Video is from a recent Body Beautiful appearance on the Bay Area’s News Station KRON4. This video reveals the procedures tied for fifth place. The top four procedures will be revealed in the coming weeks.

If you have general questions about the Facelift or Tummy Tuck procedures please call (925) 943-6353. You can also schedule an in person private consultation appointment for specific recommendations to achieve your goals. The (415) number shown in this video was only for the live show, for viewers to call in with questions.

Non-Surgical Cosmetic Procedures

12.2 million are non-surgical procedures for Wrinkle Reduction, accounting for 89% of all cosmetic procedures. Treatments with neuromodulators (Botox and Dysport), wrinkle fillers (Restylane, Juvederm, Perlane and Radiesse) and chemical peels lead the way. Laser hair removal and microdermabrasion are also included in the top 5, non-surgical numbers.

Surgical Cosmetic Procedures

1.6 million cosmetic plastic surgeries were performed in the United States last year. With the top 6 procedures accounting for 75% of total cosmetic surgeries performed, a percentage I can confirm at my San Francisco Bay Area plastic surgery practice in Walnut Creek, CA.

Facelifts (Rhytidectomy) and Tummy Tuck (Abdominoplasty) – It’s a Tie

With 120,000 surgeries performed for each last year, the Facelift and the Tummy Tuck are tied for fifth place in our countdown of the most popular cosmetic plastic surgery procedures.

To learn more about the cosmetic procedures listed above, please feel free to search the San Francisco Plastic Surgery Blog or follow the links under Categories. For specific questions, use the contact form or give us a call at (925) 943-6353. The office is open weekdays from 9 AM to 5 PM.

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Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 4 of 4

Posted February 16, 2012 in Botulinum Toxin (Botox Dysport Xeomin), Fillers (Restylane Juvederm Perlane Radiesse), Home, Videos, Wrinkle Reduction (Non-surgical)

Seven million minimally invasive wrinkle reduction procedures were performed in 2011. Neuromodulators like BOTOX Cosmetic, Dysport and Xeomin enjoyed a 5% increase in number of treatments compared to the 2010 statistics, while dermal fillers like Restylane, Juvederm, Perlane and Radiesse experienced a 10% increase from a year ago.

Facial Wrinkle Reduction

Prevention is the best medicine, so sun protection and moisturizers are always recommended, but once the damage is done, how can it be corrected? Facial wrinkle reduction can be actively corrected with cosmetic plastic surgery like:

Or with minimally invasive techniques like:

Minimally Invasive Facial Wrinkle Correction

As a Board Certified Plastic Surgeon, I offer the full spectrum of facial wrinkle correction. From surgical procedures that offer more effective and longer lasting results, to injectables that offer fast results and minimal downtime. The video below focusses on minimally invasive correction, but information on the cosmetic plastic surgery procedures is available on my main web site by clicking on the links above.

Facial Wrinkle Correction Video

Today’s video is the final segment about how to use minimally invasive procedures to achieve maximum results. It is part 4 of a recent television appearance on San Francisco’s KRON‘s Body Beautiful. The (415) number in this video was for viewers to call during the live broadcast only; however, if you have questions about dermal fillers, botox or other cosmetic plastic surgery procedures, please a call us at (925) 943-6353.

The offers in this video expired in 2011; however, special discounts are available from time to time. Be certain to call the office to find out what offers are available now.

Facial Wrinkle Correction Video Contents

This Facial Wrinkle Correction Video includes:

  • Liquid Facelifts and Facial Wrinkle Reduction
  • What are the risks associated with non-surgical wrinkle treatments?
  • How often do bruises occur after non-surgical wrinkle treatments?
  • How long do bruises last after non-surgical wrinkle treatments?
  • What are stretch marks?
  • Are there reliable treatments for stretch marks?

Who Am I?

I am a Board Certified Plastic Surgeon in private practice in the San Francisco Bay Area city of Walnut Creek, California, for 15 years. My practice includes a wide range of plastic surgery, with specialization in cosmetic plastic surgery. To learn more about my practice visit the Meet Dr. Mele page.

Why see a Plastic Surgeon for Non-Surgical Wrinkle Correction?

While I specialize in Cosmetic Plastic Surgery, the development of injectable therapies has revolutionized the way I approach facial rejuvenation. Dermal Fillers and Wrinkle Relaxers are no substitute for real plastic surgery; however, they do allow for real improvement in the appearance of facial lines and wrinkles, in ways that were just not possible before. The advantage of seeing a Board Certified Plastic Surgeon for your non-surgical wrinkle correction is two-fold. You get the immediate advantage of a trained plastic surgeon’s advanced knowledge of facial anatomy, and the future advantage having a trusted relationship with that plastic surgeon should longer lasting, surgical correction be desired.

More Wrinkle Correction Information

Information on facial wrinkle reduction is available in English and Español. Please follow the links below:

More Wrinkle Correction Videos

This is part 4 of 4. Below are links to the previous postings:

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Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 3 of 4

Posted February 08, 2012 in Botulinum Toxin (Botox Dysport Xeomin), Fillers (Restylane Juvederm Perlane Radiesse), Home, Videos, Wrinkle Reduction (Non-surgical)

In the not so distant past, wrinkles were treated with creams or plastic surgery. Now, all that has changed. The new millennium has brought a wide range of treatments that fit nicely between creams and plastic surgery. They offer better, stronger, faster correction than creams, with quicker recovery and lower cost than the gold standard — plastic surgery.

Wrinkle Fillers

Products like Restylane, Juvederm, Perlane and Radiesse allow for quick correction of moderate wrinkles with minimal downtime. They are all dermal fillers, and as the name implies, they are used to fill in unwanted wrinkles and folds. The correction can be increased with increased volume, and the downtime is about 24 hours of mild redness and sometimes longer for resolution of the occasional bruise. The improvement is immediate, and continues to improve for the first month. They can be used anywhere on the face. Since fillers do not inhibit muscle motion, they excel in the correction of lines around the mouth and in the lower face.

Neuromodulators

Products like BOTOX Cosmetic, Dysport and Xeomin are neuromodulators. They relax the muscles that cause wrinkles, like the frown lines found between the eyebrows. These take a few days to relax the muscle, and gradual improvement is seen as the skin is no longer folding from the muscle motion. Since neuromodulators reduce, or even stop, muscle motion, they are used mostly in the upper face. Use around the mouth needs to minimal and requires advanced techniques and good judgement.

Facial Wrinkle Correction Video

Today’s video is about how to use minimally invasive procedures to achieve maximum results. It is from a recent appearance on KRON‘s Body Beautiful. The (415) number in this video was for viewers to call during the live broadcast. If you have questions about dermal fillers or botox, please a call us at (925) 943-6353.

Facial Wrinkle Correction Video Contents

This Facial Wrinkle Correction Video includes:

  • Liquid Facelifts and Facial Wrinkle Reduction
  • Why have a Plastic Surgeon do your non-surgical wrinkle treatments?
  • Is Wrinkle Reduction Art or Science?
  • What happened to Collagen?
  • What are the problems with dermal fillers?
  • What is Hyaluronic Acid?
  • How does Hyaluronic Acid improve wrinkles?
  • Can you get Botulism from Botox?
  • Viewer Question – How can a scar beneath the eye be improved?
  • What can be done at home to improve scars?
  • Does massage or using topical silicone improve scars?

Who Am I?

I am a Board Certified Plastic Surgeon in private practice in the San Francisco Bay Area city of Walnut Creek, California, for 15 years. My practice includes a wide range of plastic surgery, with specialization in cosmetic plastic surgery. To learn more about my practice visit the Meet Dr. Mele page.

Why see a Plastic Surgeon for Non-Surgical Wrinkle Correction?

While I specialize in Cosmetic Plastic Surgery, the development of injectable therapies has revolutionized the way I approach facial rejuvenation. Dermal Fillers and Wrinkle Relaxers are no substitute for real plastic surgery; however, they do allow for real improvement in the appearance of facial lines and wrinkles, in ways that were just not possible before. The advantage of seeing a Board Certified Plastic Surgeon for your non-surgical wrinkle correction is two-fold. You get the immediate advantage of a trained plastic surgeon’s advanced knowledge of facial anatomy, and the future advantage having a trusted relationship with that plastic surgeon should longer lasting, surgical correction be desired.

More Wrinkle Correction Information

Information on facial wrinkle reduction is available in English and Español. Please follow the links below:

More Wrinkle Correction Videos

This is part 3 of 4. Below are links to the rest of the series:

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Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 2 of 4

Posted February 01, 2012 in Botulinum Toxin (Botox Dysport Xeomin), Fillers (Restylane Juvederm Perlane Radiesse), Home, Videos, Wrinkle Reduction (Non-surgical)

Like most Plastic Surgeons, I like to operate. Plastic Surgery is a versatile tool. It can restore function after injury or disease, and it can improve form for even the normal body. But just because I have a hammer, I don’t think the whole world is a nail.

Plastic surgery is extremely personal, and I depend on you to help me know what the best course of treatment will be. Sometimes plastic surgery is the best answer, and sometimes less is more appropriate.

Many plastic surgeons use Botox and Restylane in their practices. While non-surgical, these products are complementary to what we Plastic Surgeons do. For example:

Forehead Wrinkles and Frown Lines

Relaxing the frown lines and forehead wrinkles has always been a part of the Brow Lift procedure. If you have droopy eyebrows that are pushing skin onto your upper eyelids, deep wrinkles running across your forehead, or vertical lines between the eyebrows that make you look angry (frown lines), a brown lift might be for you. On the other hand, if you have the frown lines the forehead wrinkles, but the eyebrows and eyelids are fine, Botox, Dysport and Xeomin, may provide you with an equally attractive result.

Lower Face Wrinkles

Lower facial wrinkles include the Naso-Labial Folds (NLF’s), Marionette Lines (ML’s), lip lines and other wrinkles found on the lower face. These areas can be treated with a Facelift, when coexisting with lower facial skin laxity, but when found in isolation, a face lift is more than what is needed. Dermal fillers like Restylane, Juvederm, Perlane and Radiesse can pinpoint the treatment to exactly where it is needed, without the downtime associated with surgery.

Naso-Labial Folds (NLF’s)

The Naso-Labial Folds are the lines that extend from the sides of the nose down to the lips. They are the result of muscle attachments to the skin, and are deepened when we smile. The more firmly the muscle is attached, the deeper the resulting fold. Filling the NLF’s with Restylane, Juvederm, Perlane or Radiesse can reduce the appearance of folds without affecting the ability to smile. Unlike botox, dermal fillers do not inhibit motion.

Marionette Lines (ML’s)

The Marionette Lines are a continuation of the NLF’s, extending from the corners of the mouth down to the jaw line. These too are reinforced when we talk and smile broadly. Like the Naso-Labial Folds, the Marionette Lines respond well to fillers. The ML’s often require more volume than the NLF’s for what would seem to be wrinkles of similar depth.

Lip Lines

Lip lines are the fine lines that radiate out from the lips. Often referred to as Smoker’s Lines, the lines are formed when we pucker our lips. Lip lines allow lipstick to bleed, and can make maintaining a clean line at the edge of the lip difficult. By carefully filling in the edge of the lip, a smoothed contour can be formed, and less lipstick bleed occurs. This can be done with or without Lip Augmentation, or purposefully adding volume to the lips.

Facial Wrinkle Correction Before and After Photos

This segment focusses on dermal fillers, and shows numerous before and after pictures illustrating the areas more commonly treated with fillers like Restylane, Juvederm, Perlane and Radiesse. Wrinkle relaxers, like Botox, Dysport and Xeomin can complement results in facial wrinkle reduction, but were not used for the areas shown in these before and after pictures.

Facial Wrinkle Correction Video

Today’s video is from a recent appearance on KRON‘s Body Beautiful during which I discuss how to use minimally invasive procedures to achieve maximum results. The (415) number in this video was for viewers to call during the live broadcast. If you have questions about dermal fillers or botox, give us a call at (925) 943-6353.

Facial Wrinkle Correction Video Contents

This Facial Wrinkle Correction Video includes:

  • Liquid Facelifts or Facial Wrinkle Reduction
  • The effects of gravity and aging on the face.
  • Who is a good candidate for wrinkle reduction treatments?
  • Before and After Pictures of Dermal filler treatments
    • Before and After Pictures of Howdy Doody Line treatment
    • Before and After Pictures of Naso-Labial Fold treatment
    • Before and After Pictures of Facial Wrinkle treatment
    • Before and After Pictures of Acne Scar treatment
    • Before and After Pictures of Lip Augmentation
    • Before and After Pictures of Non-Surgical Rhinoplasty
  • Dermal fillers used include
    • Restylane
    • Juvederm
    • Perlane
    • Radiesse
  • Neuromodulators can also enhance the results of fillers. For example:
    • BOTOX Cosmetic
    • Dyport
    • Xeomin
  • The best areas to treat with fillers
  • Temporary vs. “Permanent” Correction

Who Am I?

I am a Board Certified Plastic Surgeon in private practice in the San Francisco Bay Area city of Walnut Creek, California, for 15 years. The development of injectable therapies has revolutionized the way facial rejuvenation is approached. While no substitute for real plastic surgery, they do allow for real improvement in appearance of facial lines and wrinkles, in ways that were just not possible before.

More Wrinkle Correction Information

Information on facial wrinkle reduction is available in English and Español. Please follow the links below:

More Wrinkle Correction Videos

This is part 2 of 4. Below are links to the rest of the series:

Read More

Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 1 of 4

Posted January 24, 2012 in Botulinum Toxin (Botox Dysport Xeomin), Fillers (Restylane Juvederm Perlane Radiesse), Home, Videos, Wrinkle Reduction (Non-surgical)

Wrinkle correction used to mean either small improvements with creams or major improvements with surgery. The ground betwen is now covered with the introduction of wrinkle fillers, like Restylane, Juvederm, Perlane and Radiesse, and wrinkle relaxers, like Botox, Dysport and Xeomin.

San Francisco Bay Area – Leaders in Wrinkle Reduction

San Francisco Bay Area Plastic Surgery patients have always been at the forefront of facial wrinkle correction with fillers. It began in the 70’s with the local development of Collagen, and carries on today with its replacement, hyaluronic acid or HA.

Wrinkle Fillers – Restylane, Juvederm, Perlane & Radiesse

Like collagen, HA is a normal component of the skin, and is also found in our joints. HA dermal fillers are sold under many brands names, with the most popular being Restylane, Juvederm and Perlane. These clear gels allow for the correction of moderate to deep facial rhytids (lines) with minimal down time and quick improvement.

Wrinkle Relaxers – Botox, Dysport & Xeomin

Botulinum toxins have been used for years for the treatment of blepharospasm, a disabling chronic spasm of the muscles around the eyes causing functional blindness. For many years it was the plastic surgeons “secret” weapon, and used off-label, but a few years ago Allergan received approval for a new indication – the cosmetic treatment of frown lines. BOTOX Cosmetic was born. Others have followed with similar approval and results including Dysport and Xeomin.

Facial Wrinkle Correction Video

Today’s video is from a recent appearance on KRON‘s Body Beautiful during which I discuss how to use minimally invasive procedures to achieve maximum results. The discussion includes the use of fillers like Restylane, Juvederm, Perlane and Radiesse, and wrinkle relaxers, like Botox, Dysport and Xeomin. The (415) number in this video was for viewers to call during the live broadcast. If you have questions about dermal fillers or botox, give us a call at (925) 943-6353.

This Facial Wrinkle Correction Video includes:

  • Liquid Facelifts
  • Freshening up for special occasions
  • Dermal fillers
    • Restylane
    • Juvederm
    • Perlane
    • Radiesse
  • Neuromodulators
    • BOTOX Cosmetic
    • Dyport
    • Xeomin
  • The best areas to treat with fillers
  • The best areas to treat with neuromodulators
  • Who is a good candidate for wrinkle reduction treatments?

As a Board Certified Plastic Surgeon in private practice in the San Francisco Bay Area city of Walnut Creek, California, for 15 years, the development of injectable therapies has revolutionized the way facial rejuvenation is approached. While no substitute for real plastic surgery, they allow for real improvement in appearance of facial lines and wrinkles, in ways that were just not possible before.

More Wrinkle Correction Information

Information on facial wrinkle reduction is available in English and Español. Please follow the links below:

More Wrinkle Correction Videos

This is part 1 of 4. Below are links to the rest of the series:

Read More

Non-Surgical Plastic Surgery San Francisco Bay Area – Walnut Creek, CA

Posted November 19, 2011 in Home, Wrinkle Reduction (Non-surgical)

Dermal Filler to Treat Facial Wrinkles - Immediately after Perlane injections to Facial Wrinkles in the Naso-Labial folds with typical post-injection redness and swelling. The redness lasts about 24 hours, and can often be concealed with makeup.

Dermal Filler to Treat Facial Wrinkles – Immediately after Perlane injections to Facial Wrinkles in the Naso-Labial folds with typical post-injection redness and swelling. The redness lasts about 24 hours, and can often be concealed with makeup.

Time flies when you are having fun, and I really enjoy being a Board Certified Plastic Surgeon in the beautiful San Francisco Bay Area. Clear sunny skies the weekend before Thanksgiving, and the rich diversity of the Bay Area’s culture remind me daily that it’s a great place to live, and to practice plastic surgery.

Experienced Hands

I am a board certified surgeon, who after completing my general surgery chief residency, spent three years as a fellow, specializing in plastic surgery right here in San Francisco. As a Board Certified Plastic Surgeon, my practice incorporates a wide variety of plastic and reconstructive surgery, but the majority of my time is spent performing cosmetic plastic surgery in Walnut Creek, San Ramon and Concord, California.

More Than 10,000 Procedures Performed

Time really does fly when you are having fun. A few years ago I performed my 10,000th procedure in private practice. Whether I am performing immediate breast reconstruction in the hospital, complex body shaping procedures after massive weight loss at an accredited surgery center, or a straight forward scar revision in my Walnut Creek plastic surgery office , the goals remain the same: maximum results, minimum recovery and happy patients.

“The noblest art is that of making others happy” – P.T. Barnum

Minimally Invasive Treatments

Sometimes less is all that is needed. A facelift is more than is necessary to correct moderate nasolabial folds (the lines that run from the sides of the nose to the corners of the mouth). As shown in the picture above, we have effective minimally invasive options in the form of dermal fillers like:

  • Restylane
  • Juvederm
  • Perlane
  • Radiesse

These provide a quick fix with minimal down time. They are called liquid facelifts, but they are not meant to be a substitute for facial plastic surgery. These dermal fillers reduce facial wrinkles in three ways:

  • Physically filling the wrinkle
  • Reducing skin folding by thickening the skin
  • Coercing the body to build collagen

Correction – Right Where You Need It

The beauty of facial fillers is the simplicity with which they work. They do not require an extensive medical work up, and treatments are well tolerated. Brand-name fillers are supplied in pre-filled, single-use syringes that provide a sterile, consistent product. Since Restylane, Juvederm and Perlane are HAs, a normal component of your skin and joints, the risk of allergy is extremely low. They are great products to work with, and they work well, right where I put them.

Experience Counts

Now matter how great the product, the most important factor in having your wrinkles treated, is the person doing the injections. Precise correction is imperative. Enough filler must be used to maximize improvement. Too much will give unnatural results; too little leads to under-corection and minimal results. It is also important to place the dermal fillers smoothly to avoid lumps and bumps.

Injectables, by their very natural, are fluid. Care must be taken in the initial placement, and caution used in the hours after injecting to avoid displacement. Forceful squeezing of Restylane, Juvederm, Perlane of Radiesse can mold the result, for better or for worse. After a few hours, the gel is set, and displacement is unlikely.

Recovery After Injectables

Another attractive feature of injectable fillers is the relatively short recovery period. There may be some initial swelling and redness over the area injected, but this tends to resolve in a day or two. Bruising occurs in 10-15% of injections, and this can take several days to resolve.

Ice and elevation help speed the return to normal activities. It is important to inform your doctor if you are taking any blood thinners, and this includes over the counter pain medications like aspirin, ibuprofen (Motrin, Advil), Aleve, as well as, vitamin and herbal preparations like Vitamin E, Fish Oil, Ginsing, Ginko and many others. It is best to let your doctor know before you show up for your injection to avoid a delay in treatment.

Timing of Treatments

Dermal Fillers (Restylane, Juvederm, Perlane, Radiesse) and Muscle Relaxers (Botox, Dysport, Xeomin) last for months. If you are planning your wrinkle treatments around a specific date, do not procrastinate. Since swelling and bruising can last several days, it is ideal to have the treatments three weeks before your goal date. This provides time for correct, recovery and touch-ups in the event that it is necessary.

Dermal Filler Treatments

Dermal filler treatments are offered and performed every day in my office. For new patients, the procedure can be performed at the time of consultation, as long as there are no contraindications. If you are interested in finding out more about dermal fillers, give us a call at (925) 943-6353 or use the contact form on the left.

Also ask about Botox and Dysport. Since the Botox and Dysport not packaged for individual use, treatments are grouped around the first and third Wednesday of each month, or by special arrangement.

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Botox Beware – Dysport is Here and Xeomin is Coming

Posted August 04, 2011 in Home, Wrinkle Reduction (Non-surgical)

BOTOX Cosmetic and Dysport have established their niche in wrinkle reduction, but new drugs are on the way. Xeomin will be here in 2012 and PurTox is staged to launch right behind it.

Botulinum Toxin

Botulinum toxin

Botulinum toxin - Chemical Formula: C6760H10447N1743O2010S32 Hard to believe that this reduces wrinkles!

The first standardized Botulinum Toxin was prepared for therapeutic use by Alan Scott, MD, a San Francisco Ophthalmologist, and Edward Schantz in the 1960’s. In 1980, Dr. Scott was the first to use botulinum toxin type a (BTX-A) to treat strabismus (crossed eyes) and blepharospasm (involuntary forceful squinting). He successfully treated many patients until 1986, when the inability to purchase liability insurance caused his US source to end production.

In December 1989, Allergan was the first company to receive FDA approval for the use of BTX-A for the treatment of strabismus, blepharospasm, and hemifacial spasm in patients over 12 years old. Thus Botox was born.

Botox was not approved for cosmetic uses until 2002; however, the cosmetic effect of BTX-A on wrinkles was published in the Journal Plastic and Reconstructive Surgery in 1989, by a plastic surgeon from Sacramento, California, Dr. Richard Clark

BOTOX Cosmetic® (onabotulinumtoxinA)

BOTOX Cosmetic (onabotulinumtoxinA)

BOTOX Cosmetic was the First to Market for Wrinkle Reduction in the US.

BOTOX Cosmetic is manufactured and distributed by Allergan (Ireland, US, Costa Rica). Plastic surgeons have been using Botox “off-label” for years to treat wrinkles. BOTOX Cosmetic received FDA approval on April 12, 2002, to “temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows” (glabellar frown lines or the elevens). The name for the wrinkle reducer was changed to BOTOX Cosmetic to provide legal “separation” from the Botox used for the treatment of other medical problems. To this day, Botox and all other forms of botulinum toxin, are only FDA approved for the reduction of the glabellar frown lines. Reduction of other wrinkles remains an “off-label” use

Dysport® (abobotulinumtoxinA)

Dysport (abobotulinumtoxinA)

Dysport (abobotulinumtoxinA) was the first Botulinum Toxin A introduced in the European Market, but Second to the US Market.

Dysport is manufactured by Ipsen (Paris), marketed by Medicis (Scotsdale) and distributed by McKesson (San Francisco). Dysport received FDA approval in late April 2009, and began shipping June 15, 2009.

Dysport has been a worthy competitor since its launch, and continues to offer efficacy at a reduced cost. Back by popular demand, the Dysport Challenge of 2010 has been extended, and the ante has been upped. The latest challenge is named Think Outside the Bo**x with the following details:

  • Try Dysport by September 30, 2011 and get $50 back.
  • If you have received BOTOX Cosmetic between 3 and 12 months before your Dysport treatment, get another $50 for making the switch.

Click here for a detailed comparison of -> BOTOX vs. Dysport.

Xeomin® (incobotulinumtoxinA)

Xeomin (incobotulinumtoxinA)

Xeomin has finished its Phase III Trials and received FDA approval. It is expected to be available in the Spring of 2012

Xeomin is the latest arrival in the botulinum toxin business. It is manufactured by Merz, and has just received FDA approval for wrinkle reduction of the glabellar frown lines. Like its predecessors, Xeomin had previously been FDA approved for the treatment of blepharospasm and cervical dystonia (painful contraction of the neck muscles causing abnormal head position). It is expected to hit the cosmetic market in Spring of 2012.

PurTox (anotherbotulinumtoxinA)

Other brands of BTX-A are certain to come, but PurTox will likely be the next. Manufactured by Mentor Corporation, a division of Johnson and Johnson, PurTox has completed all Phase III trials and is currently awaiting FDA approval.

So Which BTX-A is Best?

It remains to be seen how head-to-head consumer comparisons between Botox, Dysport, Xeomin and PurTox will play out. Will one prove itself supreme? Time will tell, and I will be here to let you know.

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