Jowls and How to Get Rid of Them

Photos Courtesy Malthily Nandedkar, M.D. - Thermage

Jowls – even the sound of the word is enough to throw most of us into a panic.

The lower face “gives away” age like nothing else. Losing that crisp jawline seems to visually throw everything off.

What’s a girl (or guy) to do? New Beauty blogs about jowls and lists two of the the ways we help our own patients who are seriously unhappy with jowls. (We have a couple of other ways to tackle the jowl problem)

Radio Frequency Skin Tightening

Thermage relies on the body’s response to heat generated deep in the subdermal layers. First, old saggy collagen fibers scrunch up – then long term response over 4 to 6 months forces new collagen production that’s more tightly spiraled, thus firming up the treated area.  Typically patients notice a sharper jawline and a tighter upper neck and reduced jowling – all without surgery (though not at the same levels achieved with surgical skin excision and muscle sutures).

If you set your expectations at a realistic level, you’ll most likely be happy with Thermage. BUT, a word to the aging.  The older we get, the less responsive our own collagen production becomes. For that reason – and because we continue to age – those approaching and over 50 may get better results with the cumulative effects of more than one procedure.

Fillers to Fill & Lift

Fillers can be used not only in the cheeks to fill up the deflating facial balloon which can sometimes then pull up jowls, but also just foward of the jowl area to redefine the contour line. Sculptra is an excellent injectable product which actually stimulates new collagen, so you can achieve some excellent results that are borne of your own collagen. Not instant like a gel or Radiesse, but the effects last longer and are actually “you”!

Tightening with Fraxel RePair Laser

Not for the faint hearted, CO2 laser does what no other laser can – and that is actually reduce the amount of skin surface. Fraxel CO2 RePair laser ablates tissue – meaning that tiny columns of skind are vaporized. This reduces the volume of skin in one procedure. The vaporization and the heat response offer a double duty effect by shrinking total skin area and by spurring new tighter collagen.

Neck Tightening with eMatrix

eMatrix is a gentler option and more suitable than CO2 laser for skins that tend to pigment - requiring a series of treatments. More conducive to neck tightening, eMatrix uses radio frequency to resurface the skin – the same heat response works for new collagen build, but you also get the skin smoothing effects of resurfacing without the risk that comes with laser.

Jowl Surgery

Obviously if you have substantial laxity, nothing short of surgery will give you that defined jawline. But for many, and certainly for those who are surgery-averse, other options are well worth condsidering.

Related Blog

Have questions? Get a private phone consult from our Thermage and Laser Nurse Laura

 

 

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Staying Young with some simple Lifestyle Changes

Our practice focuses on “fixes” and “prevention” using technology. But looking younger and feeling younger adds up best when you practice a whole health program.

We came across a blog that undoubtedly will give you a few tips to help you stay on the path to wellness and good looks. Some culprits that you may not be paying attention to?

“Dr. Jennifer Landa, the chief medical officer of anti-aging regenerative medicine at BodyLogicMD, said before deciding on plastic surgery, people should realize staying young has a lot to do with lifestyle.

“Staying away from toxins is a big thing that people can do to avoid looking and feeling old,” said Landa.

The toxin BPA in plastic water bottles mimics hormones, especially estrogen.   That can give women an imbalance and increase risk of heart disease, causing organs to age. Read the full blog on ClickonDetroit by Dr. Jennifer Landa

A big reminder to our readers? SUNSCREEN – it’s right up there with toothpaste, water, sleep and seat belts.

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Professional InjectablesWorkshop with Orange County Dermatologist Nissan Pilest

Dr. Nissan Pilest, Board Certified Dermatologist with over 3 decades’ experience, presided over a Beverly Hills workshop for 45 attendees, including Facial and Oculo Plastic Surgeons, Ophthalmologists, NPs and physician extenders.

All aesthetic physicians understand the benefit from continued education scenarios with their more established and experienced peers. No physician “knows it all”, and the constant changes in the aesthetic market demands time and attention and shared knowledge.

Dr. Pilest was recently invited to provide an educational workshop on the injectable products  Restylane, Perlane and Dysport, all offered by Medicis Phramaceuticals.

Dermal fillers and neurotoxins are the primary means of today’s true “no downtime” aesthetic enhancements. Restylane, the first FDA approved hyaluronic gel, remains a staple in most Dermatology practices and is increasingly being incorporated in the surgeons office and other non-derm practices. Restylane has become the first dermal filler approved by the FDA for use in the lips.

Dysport, a botulinum toxin approved to reduce wrinkles by inhibiting muscle contractions, was the second approved wrinkle relaxer after Botox.

Dr. Pilest’s workshop covered Restylane and Dysport behavior, injectable areas,  various injection techniques, handling unexpected outcomes and the importance of anatomy in both result and safety.

“It’s easy to get too comfortable when you’ve not experienced an injection error,” Dr. Pilest shared with our post workshop interviewer. “Paying attention to the anatomical markers in the skin and the skeleton helps assure that you send your patients home happy with no complications. There are of course factors outside our control that can cause transient problems such as bruising or swelling, but even bruising is becoming a thing of the past with the introduction of microcannulas.”

Dr. Pilest has embraced the use of microcannulas as a delivery tool for dermal fillers. The tip of a cannula is smooth so the structures inside the skin that could be damaged are simply pushed out of the way. He shared that the patient experience is painless aside from a few areas that might sense pressure; and bruising is, thus far, nonexistent. Restylane and Perlane can be placed in the skin with the tiny microcannulas, but Dysport still requires the use of a needle.

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Is your skin just Dry or is it Actinic Keratosis?

It’s dry. Your skin feels rough. Is it calling for more moisture – or is it sending you a bigger message that you need to pay attention to?

Anyone with typical sun exposure levels in Southern California risks the development of actinic keratoses – those dry, rough patches that can turn into skin cancer.

Are you ignoring a potential problem or do you just need a heavy dose of moisturizer?
How do you know if you have nothing more than super dry skin or a lurking health problem? Few of us worry a great deal about skin cancer – after all, it’s usually someone else who has that diagnosis…until it’s our own!

If it’s just dry skin, you can affect a change

Dry skin will respond to treatment. Using a cool mist humidifier, adding bath oils, skin lotions and drinking enough water will begin to show some progress in smoother skin. Some OTC lotions to try are Eucerin, Cetaphil (both lotion and cream) and Amlactin.

If it’s AK, the problems persist

However, if the patches of skin are colored, felt as “different” from your normal skin feel (often an early AK will feel like a spot of dried glue), and have little response to treatment with over the counter measures, then you’re likely dealing with actinic keratosis. Not all AKs become skin cancer, but they are considered a precursor, and if left untreated, they can get pretty ugly or become cancerous.

Treating early AKs is a fairly easy process. The options that currently exist include nitrogen freezing, topicals such as imiquimod and the newly approved short term therapy Picato gel (not yet distributed but we’ll let you know when it is), photo dynamic therapy with ALA or laser that is specific to superficial lesions such as the Fraxel Dual.

Timing treatment

Winter is a great time to wipe out your AKs since you generally have less pigment activity going on and it’s easier to stay “under cover” if you are treating.

Additional slideshow information on skin cancer and actinic keratosis

Knowing for sure

Concerned but can’t tell the difference? Visit a dermatologist who can quickly and accurately determine if you’re simply suffering dry skin or if you need to take medical action.

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No Needles – Skipping the Pain and the Bruising of Injections

30 Jabs with a Needle – or 4 to 6 with a Cannula? No Needles – Skipping the Pain and the Bruising of Injections with New Micro Cannula Delivery of Dermal Fillers

Orange County Dermatologist Nissan Pilest reports positive objective and subjective results from Cannula dermal filler placement. Needles have been replaced with flexible smooth tip micro cannulas for pain-free and near bruise-free placement of dermal fillers.

No longer must patients endure the many needle sticks previously required to access multiple areas. With the cannula, only a few entry points are needed to access the entire lower face. For the needle phobic patient, this change alone opens up a whole new world of possibilities.


As new uses for dermal fillers increase the areas of the face where fillers can be used, this novel approach using cannulas has taken hold of the aesthetic physician community. And for good reasons!

“We’ve all had to contend with the pain and bruising that comes with injection of dermal fillers,” Dr. Pilest notes. “Often it is simply inevitable as areas injected are highly vascular and needle sharpness nicks small vessels, resulting in bruising. And obviously, needles are not known for their pain-free movement through tissue.”

Cannulas are thin, most are very flexible and the tip is rounded. This means nerves and vessels are simply pushed out of the way instead of traumatized or nicked. Patient experience is profoundly different and positive.

Dr. Pilest explains that the process takes longer, but patient comfort and reduced side effects are well worth the additional time it takes.

Dr. Pilest recommends the P.A.L.E.T.T.E. workshops for physicians who wish to learn correct cannula techniques. (P.A.L.E.T.T.E. stands for Progressive Aesthetic Learning Essential to Technical Expertise).  The live workshops widen physician exposure and expertise in the use of flexible smooth tip cannulas to replace needles. Doctors bring their own models and work with P.A.L.E.T.T.E. instructors who teach numerous techniques for ease of injection and best patient results.

“This new technique is something my patients are welcoming with wide open arms,” Dr. Pilest relays. “It is always my goal to provide the most comfortable process available and the micro cannula placement of fillers is proving to be a great leap in improving patient experience both during and after treatment.”

Micro cannula is used for the gel fillers Juvederm, Restylane, Perlane, Radiesse and Artefill and will be used with upcoming Belotero once available in the U.S. market. Treatment areas include Eyebrows, Tear Troughs, Cheek Volumization, Preauricular Fossa, Temples, Perioral Lines, Marionette Lines, Depressor Anguli Oris, Platysmal Bands, Ear Lobes and Nasal Bridge.

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Project Lipstick

We cast around the ‘net and from time to time find causes that are easy to share. This one we find easy to share and heart-ful.

“We all fall down in life. Some fall harder than others. There are many women that fall between the cracks. Lost and forgotten from the rest of the world because of abuse, drug use, or mental illness. These women aren’t any less of a woman because of their struggles. They need the same fundamentals in life as everyone else. Obviously necessities like food and water are important, but what about self-esteem? What about normal life skills to become a productive person in the society? Former model, Breanna Sage is someone who thought outside of the box, followed her passion and realized women in shelters deserved more…. “

Read the full article about Project Lipstick and please share.  It’s amazing what power women have to help each other. Be inspired! We sure are.

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Wrinkle Treatments

Are your wrinkles worthy of injectable fillers, neuroblockers or lasers? or all three? What wrinkle treatments make the most sense?

Granted, we all eventually get wrinkles. Genetics will play a big part. If you look at your parents and grandparents and everyone is smooth as butter, you are indeed lucky, but most of us have some lines and wrinkles by our 40s that we aren’t too pleased with.

So, the question becomes what to do about them?

Options abound and each one will provide a different result. Lasers affect not only wrinkles but skin texture and tone. Fillers only affect the wrinkle and volume stimulators seem to have both a wrinkle effect and also an effect on skin smoothness from the new collagen stimulation (Sculptra users routinely remark that their skin feels smoother all over).

Laser Wrinkle Treatments

Lasers: Best for shallow wrinkles and crinkles. You can prompt collagen response which will soften wrinkles, but unless you’re willing to go for a fully ablative laser and the attendant downtime and recovery, it’s pretty difficult to eradicate all wrinkles with lasers. Choices include Fraxel CO2, Fraxel Restore, eMatrix.

Injectable Wrinkle Treatments

Fillers: Think Juvederm, Restylane, Radiesse and the new Belotero. These products can provide plumping under the wrinkles and some fill OF the wrinkle.

Botox, Dysport or Xeomin: These neuroblockers cancel out the message for muscle contraction that causes all manner of wrinkles and facial expressions.  Frown lines, worry lines, crows feet and uses that have little to do with wrinkles are now the task for neuroblockers. See a New Beauty blog on some of the other unexpected uses of Botox.

Volume stimulators: These are injectable products that cause your skin to create new collagen. Sculptra is by far the most popular, simply because it works well, can be used in nearly all areas of the face and has a wonderful safety profile. Artefill is another, but the method of action is different and it incorporates small beads that stay in the skin permanently, so the collagen response action continues for years.

It’s very common for patients to opt for injectable fillers, blockers and laser to achieve the overall goal they have in mind.

See our blog about “best” wrinkle fillers

When nonsurgical wrinkle treatments aren’t enough

If your wrinkles are part of a larger issue such as excessive lax skin, then plastic surgery is the path you’ll want to explore.

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Something New – Fraxel CO2 600

We admit, the name doesn’t give you a clue – unless you’re a laser doctor!

A Little Background
Fraxel RePair is the flagship fractional CO2 laser we use here at Total Dermatology. It can produce some serious changes in severely sun damaged skin with the deepest laser levels available from any machine. CO2 laser power is unmatched.

Narrow and Deep vs Shallow and Wide
Whereas the standard Fraxel Repair laser goes deep in more narrow beams; the Fraxel 600 has shallow penetration in wider beams capable of treating up to to 70% of the surface in a single treatment. That kind of coverage is almost equivalent to the original full coverage CO2 laser, but with a lot less recovery since you still have “virgin skin” surrounding the lasered tissue to speed healing!

What Problems Does the Fraxel 600 Solve?
Designed for pigmentation issues, texture and tone irregularities and the hated crepy skin, the Fraxel 600 treats skin types I, II and III. Treatable areas include the face, chest and upper arms – all locations exposed to the sun with the attendant sun damage and discoloration.

A Little Pain, a Lot of Gain
As with any ablative laser that actually vaporizes skin tissue, there is some downtime of 3 to 5 days. It’s not painless, but that is easily managed with oral medication before treatment.

The real payoff is a single session reaps the benefits of 3 sessions of other laser technology (such as the Fraxel Dual) and the results come apparent much sooner.

Where Are the Pictures?

We don’t have final patient photos to show you just yet, but we do have clinical study before and afters in the office. Book a no-fee assessment consult with Dr. Pilest to review the photos and to see if the Fraxel 600 is something you could consider.

(949) 769-2562

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12 Tips for Better Skin in 2012

A bit behind on taking care of your skin? Here is a list of 12 simple tips for making your skin look and behave better in 2012.

  1. Nightly cleansing- even if you don’t use makeup, going to bed with an unwashed face simply pushes the environmental grime into your pores. (We all use and LOVE this brush. Cleans, exfoliates and perks up your skin like nothing else.)

    Clarisonic Cleansing Brush Pro for super clean skin

    Clarisonic Cleansing Brush

  2.  Use a night cream/lotion and eye cream for your skin type. Fine lines and wrinkles don’t just “show up” one day – they build over time and a lack of moisture speeds up the process.
  3. Exfoliate weekly. Dead skin cells build up, even with proper cleansing, so a gentle exfoliating product helps skin stay smoother and clearer.
  4. Water – Drink lots. A liter of water upon rising helps your system flush toxins.
  5. Don’t use a deodorant bath bar on your face. Deodorant bars change the pH balance of your skin in a big way. Use a facial cleanser always.
  6. Wash your hands often to keep your face clearer. Surprised? Most of us touch our face dozens of times a day without giving thought to what germs we’ve picked up on our hands.(You’ll get fewer colds and flus too)
  7. Use a lip moisturizer – Carmex contains salicylic acid so it keeps dead skin soughed off. Nivea, Chapstick – pick something you like and use it daily.
  8. Figure sunscreen or sun block is as necessary as brushing your teeth. Remember that sunscreen takes 30 minutes to activate and sunblocks are instant.
  9. Try an RX retinoid cream like RetinA or similar for power results in skin cell turnover.
  10. Diet matters. Lots of sugar causes collagen breakdown.
  11. Alcohol and caffeine dehydrate the skin. Drink much of either and your skin pays.
  12. Salmon really does make your skin look better.
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Is There a Best Wrinkle Filler?

We’re often asked, “What’s the best wrinkle filler?”

In truth, there is no “best” filler. New ones are in the pipeline all the time (though certainly they are approved more slowly here than other countries), making anyone who claims one filler is best subject to being outdated almost overnight.

Certainly there are great choices. But perhaps the best question is, “What is the best wrinkle filler for me, my problem, my treatment goal and my pocketbook?”

The FDA makes pretty sure there are few side effects with fillers  – but when you look at how the FDA looks at clinical studies, you see that the FDA approvals are almost always based on filler response in the Naso Labial Fold.

Gee, what about the areas where most filler is actually used? Like wrinkles, lips, cheeks and jowls? THEN how do you choose what filler will get the most results with the least amount of possible side effect?

Non Derms and “Off label”

That’s where doing your homework steps in. In California any M.D. , not just Dermatologists or Plastic Surgeons, can purchase and inject almost any filler** and it’s up to the physician to choose how and where Who's holding that needle?he or she injects. Injecting any area other than the one cleared in the FDA trials is referred to as “off label” and although completely legal, it’s in your best interest to know that your chosen doctor knows what he or she is doing…both on label or off.

(**Except Sculptra and now Artefill – both companies have stricter rules about what board certifications they open their product sales and use to).

Best for some patients and some areas might be Sculptra – or it might be Restylane or Radiesse. Or best could be a mix of several injectables.

Why not just choose the cheapest filler?

If you have undereye hollows, and there’s a special on a certain filler, is that the one you should choose? Certainly not, because the wrong choice can lead to what’s called the tyndall effect (seeing blue tinge through the skin) or nodules (caused by using a nondissolvable product which could “bunch”). The reason there are different products and even different formulations of the same product is that each functions differently.

Be your own best advocate.

There is an unending supply of educational information. Each filler company has a website you can view. There are patient review sites like Realself.com that are marvelously filled with actual patient and physician reviews and photos.

Go to a physician you trust – one who can show you the results of what you are considering having done – and one who discusses the pros and cons of any recommendation.

 

 

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