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Regional Aesthetic Goals of Facial Rejuvenation

To an artist, the perception of a youthful face is based on light, shadow, shapes, and how these elements relate to one another. The aesthetic goals of facial rejuvenation are to provide a balanced, harmonious and natural look without creating an artificial (“frozen” or “paralyzed”) appearance. 

The youthful face has an ample amount of volume, which allows for a smooth transition from one area to the next. This volume distribution confers a well-rounded, three-dimensional topography with a series of arcs and convexities. With age, these smooth transitions disappear and give rise to sharper delineations. 

Bone reabsorption leads to decreased bony support and dynamic changes in the subcutaneous fat, leading to a lower brow droop (ptosis), less lateral cheek projection and a deeper nasolabial fold. 

Volume loss combined with solar damage leads to the appearance of fine lines and wrinkles as well as skin discoloration, which leads to an aged appearance.

In general, a combination of anti-aging treatments (Botox®/Dysport®, soft tissue fillers, laser treatments) appear to increase the longevity of cosmetic outcomes. Superficial resurfacing with non-ablative and ablative lasers may provide additional benefits in the treatment of fine lines and wrinkles, as well as signs of photodamage.

 

Upper Face

Maintenance of balance is a primary goal of upper face rejuvenation.

Primary goals of rejuvenation in this area are:

  1. Maintenance and/or restoration of brow elevation. Loss of brow elevation is noticeable when the eyebrows descend below the level of the bony orbit (supraorbital ridge).
  2. Reversing droop (ptosis) of the lateral brow. Drooping of the lateral brow is apparent as temporal hooding giving an overall appearance of fatigue and/or other negative expressions such as anger, sadness, or disapproval.
  3. Restoring volume in the temporal area. Loss of volume in the temple area lateral to the tail of the eyebrow is associated with a drop in the tail of the brow.

Treatment Options: a combination of soft tissue fillers for volume restoration in the temporal area combined with non-surgical Botox®/Dysport® forehead lift. The combination of filler and Botox®/Dysport® may increase the longevity of the treatment outcome and provide a very desirable final result.

 

Mid Face

The most apparent effect of aging in the mid face is the loss of volume. Changes in the structure of and relationships between the inferior orbital rim and the upper maxilla (“mustache bone”) markedly influence facial appearance, including appearance of the eyes.

The most important treatment consideration is the degree of volume depletion and flattening that occurs in the malar area. The key to rejuvenating the mid facial area is volume restoration through reflation and re-contouring.

The specific treatment areas of interest are:

  • lateral cheek (cheek bone, malar) projection
  • under-eye dark circles (infraorbital hollow)
  • tear though (nasojugal fold, medial arcus marginalis)
  • nasolabial folds (NLFs)
  • nasal dorsum
  • nasal tip

Treatment Options: restoration of volume in the malar region with soft tissue fillers that results in an overall more youthful, rounded face with less sagging and reduced appearance of facial shadows and hallows.

 

Lower Face

Aging changes due to photodamage, loss of subcutaneous fat, gravitational changes and remodeling of the underlying bony and cartilaginous structures, which are particularly visible in the lips and surrounding tissues.

The appearance of the lower face is also modified by aging changes in the mid face. In addition, dentition changes, resorption of jaw (mandible) and maxillary bone, forward rotation and protrusion of the chin, and other aging changes alter the relative proportions of the lower third of the face to the upper two thirds. Gravitational changes result in sagging skin, jowls, and wattles as well. Repeated muscular contractions lead to furrows and lines that are superimposed on volume loss and exacerbated by loss of elasticity.

Primary goals of rejuvenation in lower face and neck are:

  1. Lips – the lips tend to flatten and lose fullness with age
  2. Outwardly radiating perioral lines, so called “lipstick lines”
  3. Downward radiating lines, called “marionette lines”
  4. Loss of definition occurs around the lower jaw (mandible) leading to a pebbled appearance of the chin “peau d’orange”
  5. Horizontal (necklace) lines of the neck, and the longitudinal rope-like platysmal bands

Treatment Options: In treating the lower face, the primary goals are to restore volume with soft tissue fillers and reduce muscle mobility with Botox®/Dysport® injection. In addition, non-ablative and fractional ablative resurfacing is an invaluable tool in the treatment of fine superficial lines and wrinkles, especially lines around the lips. Lips that are the aesthetic focal point of the lower face deserve special attention. Filler materials can be effectively used to shape and volumize the lips.

Female Hair Loss

Hair loss has a huge impact on person’s well-being and self-esteem.  Female pattern hair loss (FPHL) or androgenetic alopecia is the most common form of non-scarring hair loss that primarily occurs in adult women. The condition is characterized by the progressive loss of terminal hairs over the frontal and vertex regions of the scalp, resulting in a visible reduction in hair density.  Unlike many cases of androgenetic alopecia in men (male pattern hair loss), the frontal hairline is often spared.

Androgenetic alopecia is a very common condition. The prevalence of female pattern hair loss in Caucasian women is about 19 percent. Although FPHL can occur at any time in life beginning in puberty, the condition most commonly occurs following menopause as approximately 38 percent of women over the age of 70 years have FPHL.

The visible thinning of hair over the frontal scalp and vertex of the scalp in FPHL results from a progressive decrease in the ratio of terminal hairs to shorter, thinner vellus hairs in the affected areas, a process known as follicular miniaturization.  As part of this process, the duration of the anagen (growth) phase of hair follicles shortens from a normal duration of a few years to only weeks to months. The mechanism of follicular transformation that occurs in FPHL is not completely understood. Androgens and genetic susceptibility do play a critical role.

Androgens — androgenetic alopecia occurs as a consequence of the effects of dihydrotestosterone (a potent metabolite of testosterone) on susceptible hair follicles. Dihydrotestosterone binds to androgen receptors in hair follicles, resulting in the up regulation of genes responsible for the gradual transformation of terminal hair follicles to miniaturized hair follicles.

It is polygenetic ie. multiple genes from both sides of the families contribute to the symptoms. Occasionally, hair loss can be caused by hormone imbalance or polycystic ovarian syndrome (PCOS).

It is important to distinguish female pattern baldness from another form of hair loss common in women called telogen effluvium. The pattern of telogen effluvium is usually hair loss that is all over the scalp. This usually occurs more suddenly, possibly 3-8 months after a major stressor (illness, hospitalization, childbirth or death in the family). Other causes of telogen effluvium include medications, thyroid disorders and low iron stores.

What are Dr. Reszko’s favorite hair rejuvenation treatment options?

  • PRP (link) (Platelet Rich Plasma) therapy with or without ACELL and micro-needling strengthens, regrows and restores volume
  • Mesopucture with growth factors, anti-inflammatory peptides to restore health of the scalp and enhance hair strength
  • Topical medications: minoxidil and progesterone
  • Oral medications: spironolactone, finasteride, minoxidil
  • Vitamins/supplements: nutrafol, viviscal, biotin, IV therapy

Platelet-rich plasma (PRP) therapy is an increasingly popular hair regrowth solution.  PRP, refers to a portion of whole blood i.e. platelets, that is separated from the blood through the process of centrifugation.

First, blood is withdrawn just like during routine blood testing.  Then the platelets are concentrated and separated.  Once separated, the concentrated platelets are injected into the skin, and also applied topically during and after associated microneedling.  Similar to one’s own stem cells, the platelets can help infuse nutrients into the skin and hair, boosting its natural healing properties.

PRP treatments are used to stimulate the stem cells and inactive scalp hair follicles and help to activate hair regeneration and growth, for thicker, fuller hair.

PRP for Hair Re-Growth

Platelets have been found to contain a number of growth factors and cytokines including:

  • platelet-derived growth factor
  • transforming growth factor beta
  • fibroblast growth factor
  • insulin-like growth factor 1
  • insulin-like growth factor 2
  • vascular endothelial growth factor
  • epidermal growth factor
  • Interleukin 8
  • keratinocyte growth factor
  • connective tissue growth factor

The end benefit of the combination of these growth factors is increased the vascularity to the treated area, decreasing the inflammation, healing and re-generation of tissue and clinically visible hair regrowth.

Length of Procedure/Maintenance Treatments

A single PRP session takes about 60 minutes.  A course of treatments, will be determined by the extent of your hair loss and final goals; however between 3 to 5 sessions, about 4 weeks apart are recommended.  Additional maintenance treatments may be scheduled a 3 to 4 times per year.

Post-treatment

Avoid makeup and sunscreen for 24 hours after the procedure.  Redness or inflammation may be common for a few days, post treatment, at the application site, but quickly resolves.

The benefits of PRP It will vary from person to person. Most people have results lasting over a year, and the process can be repeated.

Menopause and hair loss

By 50 years of age, an average woman will lose about 50% of her hair mass. During menopause, the hair loss is exacerbated as estrogen, the hormone most responsible for promoting hair growth, decreases, and testosterone levels increase, disproportionately. This hormonal imbalance causes thinning of the hair, hair loss and unwanted facial hair.

To Avoid Menopausal Hair Loss

  • Relax. It is important to keep stress managed to help preserve hormonal balance.
  • Right diet. Reduce your intake of saturated fats and increase your intake of whole grains and fruits and vegetables.
  • Supplements. Biotin (Vitamin B6) and folic acid may help to stimulate hair growth.
  • Exercise helps contribute to good hormonal balance.
  • Stay away from hair care products that contain chemicals and dyes as well as avoiding very heat-heavy treatments as they can compromise hair and scalp health.

Medications

  • 2-5% minoxidil
  • Biotin
  • Platelet Rich Plasma (PRP) | Acell MatriStemPRP has been clinically proven to increase hair growth and slow down hair loss resulting in thicker and fuller hair. PRP can restore your hair by attacking the very cause of hair loss or thinning. PRP involves the injection of own plasma and platelets (cells crucial for rapid wound healing after trauma), isolated from the peripheral blood into the scalp. Injected platelets have the ability to produce growth factors, cytokines and other chemical mediators that stimulate and reactivate the dormant hair follicles, initiate the skin regeneration process and stimulate skin remodeling and collagen synthesis. Since own platelets are injected, the PRP treatment is both natural and hypoallergenic.The Acell MatriStem is a synthetic product loaded with factors promoting tissue growth. By injecting these into the scalp, the part of the scalp that feeds the blood to the hair (dermal papilla) is stimulated.PRP can be performed with or without Acell MatriStem.

Male Hair Loss

Androgenetic alopecia (male pattern hair loss) is the most common type of hair loss in men. The condition is characterized by the progressive loss of terminal hairs on the scalp in a characteristic distribution. The anterior scalp, mid scalp, temporal scalp, and vertex of the scalp are typical sites of involvement.

Androgenetic alopecia is considered an androgen-dependent trait that requires a genetic predisposition. The interaction of these factors and other mechanisms that remain to be elucidated contributes to follicular miniaturization (the transition of larger, terminal hair fibers to small vellus hair fibers) in susceptible scalp areas.

Dihydrotestosterone (DHT) is the key androgen involved in the induction and promotion of male androgenetic alopecia. DHT is a potent metabolite of testosterone and, compared with testosterone, has greater affinity for the androgen receptor.

The 5-alpha-reductase enzyme inhibitors, finasteride and dutasteride, mediate the conversion of testosterone to DHT and are main stay therapy for androgenetic alopecia.

What are Dr. Reszko’s favorite hair rejuvenation the treatment options?

  • PRP (Platelet Rich Plasma) therapy with or without ACELL and micro-needling strengthens, regrows and restores volume
  • Mesopucture with growth factors, anti-inflammatory peptides to restore health of the scalp and enhance hair strength
  • Topical medications: minoxidil and finasteride
  • Oral medications: finasteride, minoxidil
  • Vitamins/supplements: nutrafol, viviscal, biotin, IV therapy

Platelet-rich plasma (PRP) therapy is an increasingly popular hair regrowth solution.  PRP, refers to a portion of whole blood i.e. platelets, that is separated from the blood through the process of centrifugation.

First, blood is withdrawn just like during routine blood testing.  Then the platelets are concentrated and separated.  Once separated, the concentrated platelets are injected into the skin, and also applied topically during and after associated microneedling.  Similar to one’s own stem cells, the platelets can help infuse nutrients into the skin and hair, boosting its natural healing properties.

PRP treatments are used to stimulate the stem cells and inactive scalp hair follicles and help to activate hair regeneration and growth, for thicker, fuller hair.

PRP for Hair Re-Growth

Platelets have been found to contain a number of growth factors and cytokines including:

  • platelet-derived growth factor
  • transforming growth factor beta
  • fibroblast growth factor
  • insulin-like growth factor 1
  • insulin-like growth factor 2
  • vascular endothelial growth factor
  • epidermal growth factor
  • Interleukin 8
  • keratinocyte growth factor
  • connective tissue growth factor

The end benefit of the combination of these growth factors is increased the vascularity to the treated area, decreasing the inflammation, healing and re-generation of tissue and clinically visible hair regrowth.

Length of Procedure/Maintenance Treatments

A single PRP session takes about 60 minutes.  A course of treatments, will be determined by the extent of your hair loss and final goals; however between 3 to 5 sessions, about 4 weeks apart are recommended.  Additional maintenance treatments may be scheduled a 3 to 4 times per year.

Post-treatment

Avoid makeup and sunscreen for 24 hours after the procedure.  Redness or inflammation may be common for a few days, post treatment, at the application site, but quickly resolves.

The benefits of PRP It will vary from person to person. Most people have results lasting over a year, and the process can be repeated.

Medications

  • 2-5% minoxidil
  • Biotin
  • Platelet Rich Plasma (PRP) | Acell MatriStemPRP has been clinically proven to increase hair growth and slow down hair loss resulting in thicker and fuller
    hair. PRP can restore your hair by attacking the very cause of hair loss or thinning. PRP involves the injection of
    own plasma and platelets (cells crucial for rapid wound healing after trauma), isolated from the peripheral
    blood into the scalp. Injected platelets have the ability to produce growth factors, cytokines and other
    chemical mediators that stimulate and reactivate the dormant hair follicles, initiate the skin regeneration
    process and stimulate skin remodeling and collagen synthesis. Since own platelets are injected, the PRP
    treatment is both natural and hypoallergenic.The Acell MatriStem is a synthetic product loaded with factors promoting tissue growth. By injecting these
    into the scalp, the part of the scalp that feeds the blood to the hair (dermal papilla) is stimulated.PRP can be performed with or without Acell MatriStem.

Botox/Dysport/Jeaveau/Xeomin

The advent of injectable botulinum toxin (BOTOX, Dysport, Xeomin, and Jeuveau) has revolutionized the approach to wrinkle treatment. It is a quick, relatively straightforward, low-risk outpatient procedure which has now replaced many of the more traditional surgical approaches to treatingfacial aging. A more youthful appearance can be achieved in a single 15-minute session with no downtime.

Botox/Dysport/ Xeomin/Jeuveau can be injected to achieve a natural look.

 

 

How does BOTOX/Dysport/Xeomin/Jeuveau treatment eliminate facial wrinkles?

When BOTOX/Dysport/Xeomin/Jeuveau is injected into the superficial muscles of the face, it relaxes them and prevents skin wrinkling caused by squinting, frowning and raising of the eyebrows. Repeated muscle contractions lead to initial dynamic wrinkles followed by more permanent static lines. By inhibiting contractions of the muscle and stopping continuous creasing of the skin, lines gradually improve and disappear.  BOTOX®/Dysport/Xeomin/ Jeuveau injection is therefore a quick and easy treatment, ideal for improving and smoothing the skin between the eyebrows, the lines of the forehead and the crow’s feet area around the eyes.

Your skin will feel the same after BOTOX®/Dysport®/Xeomin/ Jeuveau and you will have normal sensation in all treated areas. Muscles not treated with BOTOX®/Dysport®/Xeomin/ Jeuveau will not be affected.

 

How is BOTOX®/Dysport®/Xeomin/ Jeuveau used?

A small amount of BOTOX®/Dysport®/Xeomin/ Jeuveau is injected into the muscle which creates clinically visible lines. BOTOX®/Dysport®/Xeomin/ Jeuveau works by blocking the nerve impulse from reaching the muscle fiber and leads to progressive weakening of that muscle.  As the muscle weakens, the BOTOX®/Dysport®-treated areas begin to relax and dynamic (motion related) and static (at rest) wrinkles soften and often completely disappear.

Results become visible in three to seven days and last for three to four months. Repeated Botox®/Dysport®/Xeomin/ Jeuveau treatments may last progressively longer as the facial muscles weaken and atrophy from non-use.

 

 

What areas can be treated with BOTOX®/DYSPORT®/Xeomin/ Jeuveau?

Currently, the FDA-approved use of BOTOX® is to “improve the look of moderate to severe frown lines between the eyebrows (glabellar lines).”

Current FDA-approved indications for DYSPORT® use are for the treatment of adults with cervical dystonia to reduce the severity of abnormal head position and neck pain in both toxin-naive and previously treated patients.

DYSPORT® might be used off-label for the treatment of facial lines and wrinkles in a fashion similar to BOTOX®.

 

Common off-label uses of BOTOX®/DYSPORT®/Xeomin/ Jeuveau include:

  1. Forehead lines are caused by the contraction of the frontalis muscle, seen when eyebrows are raised. The treatment can also be used as an “injectable non-surgical browlift,” to slightly elevate the brow and eliminate horizontal lines across the forehead to help the upper face look younger and more relaxed. Many plastic surgeons consider Botox® to be an integral part of a surgical browlift, since its use before surgery can help relax the muscles and facilitate healing.
  1. Smile lines (“crow’s feet”) around the eyes.  Squinting produces a gathering of the skin next to the eyes in the crow’s feet area caused by a portion of the orbicularis oculi muscles.
  2. Neck rejuvenation by erasing wrinkles and tight cord-like bands are caused by protruding fibers of the platysma muscle.
  3. Upper lip lines caused by pursing the lips.
  4. Down-turned corners of the mouth.
  1. Non-surgical rhinoplasty to relax the muscle that pulls the tip downward, creating a more upturned appearance, or to soften the “bunny lines” on the sides near the top of the nose.
  1. Treatment of hyperhidrosis, or excess sweating of the hands, underarms, feet and face.

 

BOTOX®/DYSPORT®/Xeomin/ Jeuveau for Excessive Sweating

Excessive sweating (hyperhidrosis) of the palms, feet face, and underarms can be treated with a simple 15-30 minute outpatient session of BOTOX®/DYSPORT®/Xeomin/Jeuveau.

Anesthesia of the area to be treated is sometimes obtained with a topical anesthetic (applied at home a few hours before treatment) and/or local application of ice.

The effect of BOTOX®/DYSPORT®/Xeomin/Jeuveau injection begins to be apparent 2-3 days after the injection session, and lasts 6-12 months. Side effects are minimal to non-existent, and include injection related discomfort and minor bruising.

Can Botox®/Dysport®/Xeomin/Jeuveau Prevent Wrinkles From Forming?

Yes. Small amounts of Botox can be used to help break unconscious wrinkle-forming habits, such as frowning and squinting that lead to crow’s-feet.

 

Does a BOTOX®/DYSPORT/Xeomin/Jeuveau injection hurt?

Application of a topical anesthetic cream and/or ice compresses for several minutes prior to BOTOX®/DYSPORT®/Xeomin/Jeuveau treatment will effectively numb the area. When BOTOX®/DYSPORT®is injected, you may feel a slight stinging sensation that quickly subsides.

 

Is BOTOX® safe?

BOTOX®has an excellent safety profile. It has been used by neurologists and ophthalmologists for the past 17 years to correct facial tics and to relax the eye muscles responsible for lazy eye. No toxic effects of BOTOX®/Dysport®/Xeomin/Jeuveau have been reported.

 

Is There Any Danger of Botulism from Treatment?

Botulism occurs when large amounts of the toxin are ingested into the system, usually from eating contaminated food. Doses of about 3,000 units are considered highly toxic. For cosmetic treatment you will be receiving only about 10-200 units, far less than a toxic dose.

 

BOTOX®/Dysport®/Xeomin/Jeuveau Pregnancy and Breast-feeding.

BOTOX®/DYSPORT®/Xeomin/Jeuveau is classified as pregnancy category C.  Category “C” is classified as “animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks”.

There is a lack of controlled studies into the effects of BOTOX®/DYSPORT® on pregnant women and their unborn children, therefore it is impossible to say conclusively whether BOTOX®/DYSPORT® is safe. For the sake of erring on the side of caution, manufacturers of BOTOX®/DYSPORT® recommend that they notto be used on either pregnant women or nursing mothers. As with the effects during pregnancy, there is a lack of information on whether BOTOX®/DYSPORT® injections can pass the toxin into breast milk.

 

 

What are the advantages of BOTOX/DYSPORT/Xeomin/Jeuveau?

  • BOTOX®/DYSPORT®/Xeomin/Jeuveau is a quick, non-surgical and effective way to remove wrinkles. A typical treatment takes 10 minutes. Results are seen within 4 to 7 days.
  • Little discomfort
  • There is no “down-time”. After the BOTOX®/DYSPORT®/Xeomin injection, you may resume normal activity.
  • There is no physical evidence that you had a cosmetic procedure done
  • There is no decrease in sensation or numbness of BOTOX®/DYSPORT®-treated areas
  • The effect of BOTOX®/DYSPORT® is reversiblelasting between 3 to 6 months, depending on the number of previous treatments
  • A memory response may develop with repeated BOTOX®/DYSPORT® injections if performed every 3 months for approximately 1year. So, although the effects are not permanent, there may be a gradual lengthening of the time interval between treatments. This will mean fewer BOTOX®/DYSPORT® treatments to obtain the same effect.

 

What are the Side Effects?

Side effects are minimal when properly administered. There is little discomfort as the solution is injected at the treatment site and there is a small chance of bruising. There have been no known reports of permanent side effects with BOTOX®/DYSPORT®. In very rare cases, there is a temporary, slight lowering of the eyebrow or eyelid.

 

Contraindications to BOTOX®/DYSPORT treatment:

  • Allergy to any of the ingredients in BOTOX®/DYSPORT®or any other Botulinum toxin products including Myobloc®
  • Skin infection at the planned injection site
  • Neuromuscular conditions such as:
  • Amyotrophic lateral sclerosis (ALS or LouGehrig’s disease)
  • Myasthenia gravis or Lambert-Eatonsyndrome

 

 

Biopsy of Skin Lesion

A biopsy of a lesion of the skin can determine the difference between a skin cancer and a benign, non-cancerous, lesion. The skin sample obtained during a biopsy is sent to a laboratory for examination.

How is the biopsy performed?

A biopsy can almost always be performed on an outpatient basis in a physician’s office or at a clinic. A local anesthetic is used during the procedure.

  • In an excision biopsy, the entire suspicious skin lesion is cut out. Excision biopsy is normally done with a scalpel. Stitches are used to close the incision.
  • In a punch biopsy, a sharp cookie cutter -like instrument is used to remove a small cylinder of skin. Sometimes stitches are necessary to close this type of biopsy wound.
  • In a shave biopsy, the outermost part of a lesion can also be shaved off with a scalpel.

Laser Hair Removal

The past decade has brought tremendous advances in laser hair removal technology with newer lasers offering safer, more efficient (fewer sessions required), faster and more comfortable processes.  After laser hair removal, you will have less hair, existing hair will be finer and lighter in color.

To learn more about your unwanted hair treatment options, request a consultation online or call our office at 646 759 8449 to schedule an appointment.

Fillers

Soft tissue dermal filler injections can be used in many ways to address your individual concerns. Areas of possible augmentation include:

  • Lateral eyebrows to provide adequate brow support, “brow lift” and shaping
  • Periorbital volumizing diminishes appearance of infraorbital hallows, “under eye” dark circles
  • Nose – shape and structural irregularities can be address by non-surgical filler rhinoplasty
  • Periorbital wrinkles, “smile lines”, the furrows that develops around the eyes
  • Restoring malar cheek projection, volumetric reconstruction of the lateral cheek and “cheek bones” and lateral cheek with filler material has double benefit.  First it restores more youthful cheek appearance and second by replacing volume decreases sagging and soft tissue loss in the mid face.  As a result the prominence of nasolabial and melolabial folds in reduced.
  • Nasolabial fold – facial “parenthesis”, the lines that run from the nose to the corner of the mouth
  • Chin – shape and structural irregularities can be address by non-surgical filler chin implant
  • Lips – soft tissue fillers are used to fill in and augment thin lips
  • “Marionette lines” – sad, downward expression that appears at the corners of the mouth with advanced age
  • Lips border and volume
  • Lift up jowls or plump up volume along the jaw line where definition has been lost.
  • Acne and depressed scars
  • Static wrinkles; wrinkles at rest, caused by aging, overexposure to the sun, environmental exposures and/or cigarette smoking

While it is not a soft tissue filler, botulinum derivatives Botox, Dysport, Xeomin, Jeuveau are a very popular injectable treatment that works synergistically with fillers for wrinkle treatment and overall facial rejuvenation. BOTOX® and Dysport® are meant for “dynamic” wrinkles that are caused by repeated muscle movements and potentiate effects of fillers that actually plump up wrinkles and facial depressions. Soft tissue filler and BOTOX®/Dysport® injections can be performed on the same during a single session.

Temporary Fillers

  • Restylane
  • Restylane Lyft
  • Restylane Kysse
  • Juvederm Ultra and Ultra Plus
  • Juvederm Voluma XC
  • Juvederm Volbella
  • Juvederm Vollure

Semi-Permanent

  • Radiesse
  • Autologous Fat Transfer

Collagen Stimulators

  • Sculptra

 

Hyaluronic Acid Fillers

Hyaluronic acid is a naturally-occurring, biodegradable complex sugar found in the human body and in all mammals. It is used to restore volume to the aging skin giving a smoother, more youthful appearance.  Results are instantaneous.

Hyaluronic acid is hydrophilic (“water loving”) and constantly draws water into its matrix.  This process hydrates the skin and creates volume, contributing to the improved overall appearance. This ability of hyaluronic acid to bind to water is what helps the filler to provide lasting results.

Hyaluronic acids produce superb, reproducible results that last six to twelve months. They can be injected in a 15 to 30 minute session.

Restylane® and Restylane Lyft®

Restylane® and Restylane Lyft® are cosmetic dermal filler made of hyaluronic acid. The hyaluronic acid in both is a crystal-clear gel called NASHA™ or Non-Animal Stabilized Hyaluronic Acid.  NASHA is completely biocompatible with human hyaluronic acid.

Restylane® and Restylane Lyft® are safe and natural cosmetic dermal fillers that restore volume and fullness to the skin to correct facial wrinkles and folds, such as “smile lines”, “parentheses” (nasolabial folds—the creases that run from the bottom of your nose to the corners of your mouth), glabellar lines, cheeks, tail of the brow, under eye areas, chin and jaw line, depressed scars and marionette lines. Restylane ® is also an excellent lip enhancer..

The difference between Restylane® and Restylane Lyft®  is in the particle size and hyaluronic acid cross-linking.  The hyaluronic acid in Perlane® is chemically cross-linked (the long chemical strands are tied together) to delay breakdown by skin’s enzymes.   Therefore, Restylane Lyft® works well for filling deep lines while Restylane® is better suited for fine tuning and correction of fine lines and wrinkles.

How long the effects of Restylane® and Restylane Lyft® treatments last is very individual and depends on multiple factors such as the structure of the skin, lifestyle and age as well as on the degree of correction desired and expected by the patient.  The majority of scientific literature reports 50 to 80% retention after 6 months for Restylane® and 6-12 months for Lyft®.  When used around eyes, Restylane® tends to last 12 months.

JUVÉDERM , JUVÉDERM® Ultra and JUVÉDERM® Ultra Plus, Juvederm Voluma XC

JUVÉDERM® injectable gel is a hyaluronic acid approved by the FDA for treatment of facial lines and wrinkles.

The smooth consistency gel helps to instantly restore your skin’s volume and smooth away facial wrinkles and folds, like your “smile lines”, nasolabial folds (the creases that run from the bottom of your nose to the corners of your mouth), glabellar lines, cheeks, tail of the brow, under eye areas, chin and jaw line, depressed scars and marionette lines.  Juvéderm™ is also excellent lip filler.

How long the effects of JUVÉDERM™treatment last is very individual and depends on multiple factors such as the structure of the skin, lifestyle and age as well as on the degree of correction desired and expected by the patient.  The majority of scientific literature reports 50 to 70% retention after 6 months for Juvéderm™.

JUVÉDERM™ Ultra is a highly cross-linked (the long chemical strands are tied together) formulation for more versatility in contouring and volumizing of moderate to deep facial wrinkles and folds.  JUVÉDERM® Ultra Plus, a more highly cross-linked robust formulation for facial volumizing and correction of deep folds and wrinkles.

The major difference between JUVÉDERM and other hyaluronic acid fillers is the consistency.  JUVÉDERM, JUVÉDERM® Ultra and JUVÉDERM® Ultra Plus, JUVEDERM Voluma XC can be administered in a smooth-flowing injection, providing physicians with a high level of control for individualized, tailored wrinkle treatment and for achieving a smooth and natural look.

Dr. Reszko can provide advice on which material is right for your particular procedure.

Comparisons Among Selected Commercially Available HA Fillers

HA Fillers Restylane®

Restylane Lyft

 Juvéderm™ Ultra (24 HV)

Juvéderm™ Ultra Plus (30 HV)
Source Bacterial fermentation Bacterial fermentation
Gel sizing process; product consistency Sieving; granular consistency Homogenization; smooth consistency
Cross-linking agent BDDE BDDE
 HA concentration 20 mg/mL 24 mg/mL
Duration of effect (FDA label) ~6 -12 mo ~6-12 mo

 

Collagen Stimulators

Collagen stimulators contain particles that signal the skin to produce more collagen. Instead of just filling in select lines and wrinkles, these are used on larger areas like the cheeks. The results (which are not instant but improve over time) are longer-lasting; you may need a series of treatments for maximum results.

Sculptra

Sculptra® is an FDA-approved injectable product that restores and corrects the signs of facial fat loss by replacing lost volume. Also known as “poly-L-lactic acid,” it is synthetic, and biocompatible (does not harm the body) and biodegradable (able to be broken down by the body).

Sculptra aesthetic is targeted for use in:

  • Deep folds such as nasolabial folds (between the nose and the mouth),” smile lines”
  • Lines framing your mouth (marionette lines)
  • Chin wrinkles
  • Augmenting cheek bones
  • Age associated temporal wasting

The mechanism of action of Sculptra is to stimulate new collagen synthesis, restoring the structure under the skin — for smoother skin and fuller volume.  Typically, several treatments (on average 3-6 treatments) are needed and results develop progressively over several months.  Results seen with Sculptra are long lasting (two or more years).  Gradual resorption is thought to occur over a 2 to 4 year period with eventual breakdown of the material to lactic acid that is found naturally in the body.  No skin test is required prior to use.

Sculptra results are not immediate.  At your first treatment visit, it may appear that Sculptra worked immediately because of swelling from the injections and the water used to dilute Sculptra. In a few days, when the swelling goes down and the water is absorbed by your body, you may look as you did before your treatment. Sculptra takes time to gradually correct depressions in your skin.  On average, patients may require 3 to 6 treatment sessions.

Treatment results will differ for each person. In a clinical study, the treatment results lasted for up to 2 years after the first treatment session or more. Touch-up treatments may be needed to maintain the desired effect.

Immediately following a treatment session with Sculptra, redness, swelling, pain or bruisingmay occur in the treatment area. These signs usually go away in a few hours to a few days. You will be given specific post-treatment care instructions, which will include massaging the area a few times each day for several days after the treatment session.

 

SEMI-PERMANENT FILLERS

RADIESSE

Radiesse®, calcium hydroxyapatite, is safe, new generation cosmetic dermal filler.  It is used for the correction of facial lines and wrinkles, restoring a natural, youthful look in an easy, convenient treatment. Numerous medical studies have shown that Radiesse is a long-lasting treatment to fill and correct smile lines, nasolabial folds jowls and jawline contours, as well as augmenting the mid cheek, chin and facial hollows.

Calcium-based microspheres provide a scaffold that promotes soft tissue in-growth.  Fibroblasts (collagen producing cells) lay down a collagenous matrix.  As matrix is deposited, calcium hydroxyapatite implant becomes integrated into the surrounding tissue, providing long-lasting, natural results.  Calcium hydroxyapatite spheres are biodegradable and break down slowly over months to years.  Because calcium hydroxyapatite is a normal constituent of bone, it does not elicit a chronic inflammatory or immune response lowering the risk of potential side effects.

Radiesse is long lasting, but not permanent filler with none of the risks associated with permanent implants.  It does not require any allergy testing.  Radiesse longevity ranges between 12 and 18 months, Radiesse is a great treatment option for patients who seek a longer lasting correction.

Autologous Fat Transplantation

For patients who desire a longer lasting, natural appearing result, autologous fat transplantation is a superb treatment option. Autologous fat transplantation offers two advantages over other methods for erasing wrinkles. First, the fat we use is your own tissue, eliminating the risk of allergic reactions. Second, most of the fat that is transplanted will remain semi-permanently, resulting in fewer repeat treatments.

Fat transplants are used to fill in contour defects, such as the groove that runs from the nose to the corner of the mouth (nasolabial folds), cheeks, temples, jaw line and to improve the appearance around the corners of the mouth, which often begins to sag with age.

Before the Procedure

To obtain fat for transplantation, a small liposuction procedure is performed in which cells are harvested from the abdomen, buttocks, outer thighs or hips. Virtually painless, this procedure takes less than 30 minutes. Afterwards, the fat tissue is processed for implantation. A small portion of the harvested fat is used for immediate transplantation, and the remainder is processed and stored in a specially designed facility for future use.

The Procedure

After a small amount of local anesthesia is administered, the patient’s own tissue is inserted using special small instruments. Careful attention is paid to the fat insertion technique, ensuring that the results are both smooth and symmetrical. Extreme care is exercised to preserve and enhance natural aesthetic contours, and use precisely controlled movements to create a wrinkle-free appearance.

Recovery

Post-operative care is minimal after this procedure and recovery is quick. Results can be seen within 24 to 48 hours after the swelling recedes and the newly transplanted tissue settles in place.

Bruising is uncommon, and is usually covered easily with makeup. If additional wrinkle correction is desired by the patient, a small touch-up procedure can be performed 3 to 6 months after the initial procedure.

Natural aging process can be divided into photoaging and structural aging.  Structural aging has two components gravitational and volumetric.  As a result of structural aging shape and facial proportions change.

Age associated structural changes include:

  • Dermal thinning and loss of elasticity
    • Photoaging and exposure to environmental pollutants are associated with reduction in collagen and elastin leading to clinically visible fine lines and wrinkles.

Therapy Options: sun protection, topical retinoids, chemical peel, microdermabrasion, intense pulsed light (IPL), photodynamic therapy (PDT), non-ablative and ablative lasers

  • Gravitational aging
    • Leads to drooping of the skin
    • Common manifestations include rhytids, grooves, wrinkles, and jowls (“sags and bags”)

Therapy Options: BOTOX®, Dysport®, fillers, neck and jowl liposuction, contour thread life, S-lift, blepharoplasty, facial implants, brow-lift, CO2 and erbium: YAG laser resurfacing, Thermage®

  • Volumetric aging
    • Leads to development of deep hollows and furrows and thinning of the face
    • Loss and redistribution of fat
      • Loss of temporal fat resulting in loss of natural convexity
      • Loss of lateral cheek (malar, zygomatic) fat leading to sagging and soft tissue loss in the mid face
    • Skeletal and bone remodeling
      • Decreased brow support leading to sagging eyebrows
      • Increased orbit size
      • Sunken maxilla

Therapy Options: fillers, autologous fat transfer, facial implants

Soft tissue injections can be used in many ways to address your individual concerns. Areas of possible augmentation include:

  • Lateral eyebrows to provide adequate brow support, “brow lift” and shaping
  • Periorbital volumizing diminishes appearance of infraorbital hollows, under-eye dark circles
  • Nose – shape and structural irregularities can be addressed by non-surgical filler rhinoplasty
  • Periorbital wrinkles – “smile lines”, the furrows that develop around the eyes
  • Restoring malar cheek projection, volumetric reconstruction of the lateral cheek and “cheek bones” and lateral cheek with filler material has double benefit. First it restores more youthful cheek appearance and second, by replacing volume, decreases sagging and soft tissue loss in the mid face. As a result the prominence of nasolabial and melolabial folds is reduced.
  • Nasolabial fold – facial “parenthesis,” the lines that run from the nose to the corner of the mouth
  • Chin – shape and structural irregularities can be address by non-surgical filler chin implant
  • Lips – soft tissue fillers are used to fill in and augment thin lips.  Improve border and volume.
  • “Marionette lines” – sad, downward expression that appears at the corners of the mouth with advanced age.
  • Lift up jowls or plump up volume along the jawline where definition has been lost.
  • Acne and depressed scars
  • Static wrinkles – wrinkles at rest, caused by aging, overexposure to the sun, environmental exposures and/or cigarette smoking

While they are not a soft tissue filler, botulinum derivatives BOTOX® and Dysport® are a very popular injectable treatment that works synergistically with fillers for wrinkle treatment and overall facial rejuvenation. BOTOX® and Dysport® are meant for “dynamic” wrinkles that are caused by repeated muscle movements and potentiate effects of fillers that actually plump up wrinkles and facial depressions. Soft tissue filler and BOTOX®/Dysport® injections can be performed on the same day during a single session.

Temporary Fillers

Hyaluronic Acid Fillers

  • Restylane®
  • Perlane®
  • Juvederm Ultra® and Ultra Plus®
  • Juvederm Voluma® XC

Semi-Permanent

  • Radiesse®
  • Autologous Fat Transfer

Collagen Stimulators

  • Sculptra®

Hyaluronic Acid Fillers

Hyaluronic acid is a naturally occurring, biodegradable complex sugar found in the human body and in all mammals. It is used to restore volume to the aging skin giving a smoother, more youthful appearance. Results are instant.

Hyaluronic acid is hydrophilic (“water loving”) and constantly draws water into its matrix. This process hydrates the skin and creates volume, contributing to the improved overall appearance. This ability of hyaluronic acid to bind to water is what helps the filler to provide lasting results.

Hyaluronic acids produce superb results that last 6 to 12 months. They can be injected in a single session.

Restylane® and Perlane®

Restylane® and Perlane® are cosmetic dermal fillers made of hyaluronic acid. They are safe and natural cosmetic dermal fillers that restore volume and fullness to the skin to correct facial wrinkles and folds, such as “smile lines,” “parentheses” (nasolabial folds—the creases that run from the bottom of your nose to the corners of your mouth), glabellar lines, cheeks, tail of the brow, under eye areas, chin and jawline, depressed scars and marionette lines. 

Restylane® is also an excellent lip enhancer.

What’s the difference between Restylane® and Perlane®?

The difference between Restylane® and Perlane® is in the particle size and hyaluronic acid cross-linking. Perlane® works well for filling deep lines while Restylane® is better suited for fine tuning and correction of fine lines and wrinkles.

The length of the effects of Restylane® and Perlane® treatments is very individual and depends on multiple factors such as the structure of the skin, lifestyle and age as well as on the degree of correction desired and expected by the patient. The majority of scientific literature reports 50 to 80% retention after 6 months for Restylane® and 6 to 12 months for Perlane®. When used around eyes, Restylane® tends to last 12 months.

Hyaluronic acid consent form PDF

Sculptra consent form PDF

Radiesse_consent_form PDF

Laser Skin Resurfacing

 

Laser skin resurfacing is a gold standard to rejuvenate aging and damaged skin.  It is a superior treatment option for photoaging, sun spots, pore size, melasma, pre-cancers (actinic keratosis), acne and acne scars, and fine lines and wrinkles. Laser resurfacing allows small fragments of the skin to be completely removed, triggering a subsequent healing process resulting in renewed, healthier, smoother and more uniform youthful appearance.

 

Laser Resurfacing: Which do I choose?

 

Ablative (CO2, Erb:YAG) vs. Non-Ablative Lasers (Clear & Brilliant®, Fraxel) 

Non- ablative lasers leave the surface of the skin intact and work by heating up the targeted tissue, without actually destroying it. This process stimulates your body’s collagen production to fill in unwanted skin imperfections such as fine lines or wrinkles.

Because they do not resurface the skin as deeply as ablative lasers, multiple treatment sessions will be necessary to achieve clinical results. However, patients benefit from almost no downtime and the risk of undesirable side effects is greatly reduced.

 

In contrast, ablative lasers (CO2, Erb:YAG) create microinjuries to the surface of the skin, targeting both the surface and deeper layers. This results in more dramatic effects and require more down-time, however, the effects may be achieved in as little as one treatment, when compared to non-ablative lasers. Ablative laser treatments may be a good option for individuals who have more down-time during the holidays and want to target deeper wrinkles, skin discoloration, and deep acne scars.

 

Clear + Brilliant

Clear + Brilliant is a unique skincare treatment that uses safe, fractional laser technology that may address early signs of aging skin such as texture and tone, pore size, fine lines, skin discolorations, and loss of radiance. It is also a great treatment for inflammatory conditions of the skin such as acne and rosacea. There is no downtime required with this laser, with only mild-to-moderate redness that generally lasts less than 24 hours. A few days after the treatment, your skin will start to feel softer, look brighter, and show a more even tone. With each successive treatment, the results will become more noticeable. Results can last for months depending on your skin’s condition and skin protection regimen.

 

Fraxel

With Fraxel fractional resurfacing instead of the entire skin being remodeled and resurfaced with each treatment, a percentage, or a fraction, of the skin is resurfaced. Fraxel allows for the treatment of overall skin texture irregularities, pore size, pigmentary irregularities, acne scarring, surgical and traumatic scars, photodamage, melasma, skin rejuvenation and moderate wrinkles.

 

CO2 (Carbon Dioxide) Laser

The use of the CO2 laser is one of the most comprehensive ways to reduce signs of aging and/or sun damage as it can achieve multiple goals with a single modality.  CO2 laser helps to remove brown spots, deep wrinkles, and irregular texture. It also tones and tightens the skin.  Please note that this laser does require some down time and you should plan for about one week for visible healing.

The fall and winter seasons are perfect times of the year to consider laser treatments. During this time of the year, the sun is less intense and we tend to spend more time indoors.  It is important to determine which laser is right for you based on your personal goals and relative downtime. In choosing the treatment option, it is always best to schedule an in office consultation to help to guide you in determining which options may be best to achieve your desired outcome.

 

 

Photorejuvenation

Intense Pulsed Light (IPL) PHOTOREJUVENATION is a new method to rejuvenate and improve the overall appearance of the skin for a more even skin tone and radiant complexion. IPL provides gradual improvement over 2 to 4 treatments, spaced at 3 to 4 week intervals with very low risk, little discomfort and no downtime. IPL treatments are safe and effective for application on the face, neck, chest and hands.

The IPL photorejuvenation system treats a wide range of skin conditions, including:

  • Photoaging or sun-related skin damage
  • Freckling, brown age spots, skin blotchiness and irregular pigmentation
  • Broken capillaries, telangiectasias (small dilated superficial blood vessels)
  • Redness and flushing of the face, neck and/or chest
  • Rosacea; many people with rosacea see an improvement in facial redness, skin sensitivity, number and duration of rosacea “breakouts”
  • Melasma
  • As an adjunctive procedure to laser resurfacing, chemical peeling, microdermabrasion, Botox®, Dysport®, fillers and other non-ablative treatments.

 

PRE-TREATMENT INSTRUCTIONS

  • Do not take isotretinoin (Accutane) for one month before your treatment. Do not take Oracea, Doxycycline or topical retinoids (Renova, Retin-A, Atralin, Refissa, Ziana, Tazorac, Differin) for one week prior to treatment.
  • If you are tanned please reschedule your appointment.
  • Do not apply make-up or lotions on the day of your treatment, or be prepared to remove them at our office.
  • If you have a history of cold sores (herpes simplex virus, HSV, herpes labialis), take your prescribed medication (e.g., Valtrex, Famvir, Zovirax) as prescribed.
  • Inform us before each treatment session if you
    • take any new medications
    • developed allergies to new medications
    • have beauty marks that you do not want treated
  • Inform us immediately if the area being treated feels “too hot”.

 

POST-TREATMENT INSTRUCTIONS

For a few hours after treatment, you may experience redness, slight swelling and a “sunburned” feeling. Pigmented areas may appear darker. Superficial pigmented lesions darken, dry, and slough off in 7 to 10 days.

To achieve the best results and minimize the risk of complications:

  1. Apply non-comedogenic moisturizer at least 2 times a day or as often as needed when your skin feels dry.
  2. If you plan to be outdoors, driving, or in close proximity to windows, apply sunscreen with SPF of 30 and higher. Avoid prolonged sun exposure between 10 AM and 3 PM.
  3. Use a gentle soapless cleanser like CeraVe, Cetaphil until healing is complete. Avoid scrubbing or using a washcloth.
  4. DO NOT PICK OR PEEL OR SCRATCH the treated area as permanent scarring may result.
  5. Do not undergo any other treatments in the same area for at least 14 days after the IPL treatment.
  6. You may apply cosmetics a day after IPL treatment unless a blister or a superficial ulcer develops. If a blister, a superficial ulceration or a scab develops, apply an antibiotic ointment Bactroban until the blister dries or new skin forms. Do not pick the blister or a scab because a scar may form.
  7. Restart topical retinoids 7 days after the IPL treatment.
  8. Ice packs, cool compresses can help to reduce post-procedural discomfort and swelling.
  9. To limit post-peel swelling, sleep on your back with your head elevated on a few pillows for the first few nights after the treatment.

Call our office 646-759-8449 if any problems, questions, or concerns arise.

Stretch Marks

Stretch marks, striae, are caused by rapid stretching of the skin and resulting breakdown of skin’s structural proteins collagen and elastin. Stretch marks commonly result from pregnancy, rapid growth spurts as in puberty, steroid use, significant weight gain, and increased muscle development in body builders.

Early stretch marks are often red, purple, or pink in color, mature striae are white, depressed, irregularly shaped bands.

 

Treatment Options

The following treatments improve stretch marks by refining skin texture and eliminating unwanted redness:

  • Injection of semi-permanent collagen biostimulators like hyperdiluted Radiesse (calcium hydroxylapatite) and/or
    • Sculptra (polylactic acid) to re-contour and lift to restore lost volume and skin irregularities to smooth out skin contour, reduce dimpling and stimulate new collagen synthesis within skin. One can think of biostimulatory fillers as “seeds” for collagen stimulation.
  • FIBROBLAST THERAPY with PLASMA PEN
    • Plasma Pen is the most advanced, non-invasive, skin lifting, skin tightening and rejuvenation device used to treat both white and red stretch marks by stimulating production of collagen and elastin in the skin
  • MICRONEEDLING RADIOFREQUENCY (RF) VIVACE, GENIUS
    • Minimally invasive procedure that uses radiofrequency energy to precisely deliver heat into the deeper layers of the skin for new collagen stimulation. Ideal for both red and white stretch marks.
  • MESOPUNCTURE
    • Bio-stimulatory peptides stimulate collagen to restore volume and antioxidants and amino acids create an anti-inflammatory effect that encourages healing and optimal rejuvenation
  • PERFECTA V-BEAM VASCULAR LASER, IPL
    • Normalizes redness, reduces broken blood vessels
    • Perfect for treatment of red striae
  • PRP (PLATELET RICH PLASMA)
    • Cutting-edge therapy that harnesses the body’s own growth factor-rich platelets, injected or micro-needled into the skin for optimum repair
  • RESURFACING LASER TREATMENTS
    • Clear & Brilliant Non-Ablative Resurfacing, Fraxel DUAL Non-Ablative Resurfacing, Coolpeel CO2 Resurfacing, Lumenis UltraPulse CO2 Ablative Resurfacing
    • Stimulates new collagen synthesis for a radiantly smooth complexion
    • Promotes skin repair and regeneration
    • Minimizes the appearance of stretch marks
  • ULTHERAPY
    • Non-invasive, no “down-time” ultrasound lift that stimulates new collagen and elastin synthesis deep within the skin’s structural support
    • The only device approved to lift sagging skin

To learn more about your stretch marks treatment options, request a consultation online or call our office at 646 759 8449 to schedule an appointment.