Restylane Silk for Aging Lips

  

A New Addition to the Restylane Family

Restylane Silk is now FDA approved for submucosal implantation for lip augmentation and dermal implantation for correction of perioral rhytids (smoker’s lines) and it is currently available on the US market.   This product provides a subtle solution to aging signs around the lip and mouth area.  It’s greatest quality is subtle enhancement; your lips will not look “done” or “artificial.”  

  

Hyaluronic Acid for Lip Augmentation

Although Restylane Silk is the first product to be FDA approved for lips, we have been using other products for years.  Juvederm and Restylane are commonly used to augment the lips in an “off-label” treatment (FDA approval costs millions of dollars and takes many years.  These products are all very safe to inject in the lips by a trained professional).  

These products, along with Belotero, are all in the hyaluronic acid family.  Hyaluronic acid (HA) is a sugar your body naturally produces; these products are synthetic gels.  Because your body naturally makes this sugar, the chances of being allergic are almost zero.  This family of products IS reversible, if for any reason, you are unhappy with the results.

The molecular structure of Silk is smaller, and the product flows to where it is needed.  It doesn’t over bulk, and is a perfect finishing agent for fine lines.  

Which product is best is really dependent on who the client is, and what result they want.  If you are looking for subtle and natural lip augmentation, Restylane Silk is the product for you!  

My Experience 

At the beginning of March, I was told this product would be available and I was so excited to try it.  Lip augmentation has always been a specialty of mine, and I was told “I would love this product for the vermillion border” (where the color changes from pink to skin-toned).  

 

I was excited to try it, but my idea of an “ideal” client for this product was way off!  I first tried it on a 24 year-old patient.  She (and I for that matter) were not impressed, it looked like nothing was done.  Then I realized I was supposed to be using it for a whole different population of client.  The older patient who didn’t want to look like anything was done!   Oops… Probably should have read the email about the product FIRST. 

So then I tried it on an employee in her 50’s.  The results blew me away!  Like always, the pictures do the results no justice.   

The final result is very natural looking.  It is hard to see from the picture, but the before has a defined ridge above the lip, which is SO much improved with the Silk injections.  (The spray tan and make-up can throw you off in the after pictures.) 

The technique used to inject this product is VERY different than previous products used to treat lips.  If incorrectly injected, the product will not give you the best results, cause swelling, and has been reported as painful by patients.  This product requires the knowledge and expertise of a skilled injector.  

I had a few clients trial the product (including my awesome mom!).  They sent me their after pictures via text.  Again, not the greatest quality pictures, but every client was extremely happy with the results and gave great feedback.  (Thank you ladies!). 

    

Final Thoughts

Because the typical Silk client is older, make sure you consider timing in booking an appointment for this procedure.  Like any injectable product, swelling and bruising are always a possibility.  You want to avoid icing post-procedure to allow the product to smoothly integrate into the tissue.  If you have a big meeting at work the next day, you probably should reschedule (…the meeting OBVIOUSLY!  Who wants to wait for such amazing results!  Plus, then the meeting will go better with your new confidence!).   

How long will a bruise last?  Remember everyone is different.  Some people don’t bruise at all.  Check out my blog on bruising info.  

Other Uses

I read Silk was also a fabulous filler to use in the glabellar crease… Blog post coming soon!   

For questions or to book an appointment with me, call my office at 781-235-4957.  You can also book online at http://www.LauraKimberleyRN.com.  

When Tear Trough Fillers Go Bad…

Don’t worry!  You can be fixed!

There are plenty of scary things on the internet about aesthetic injectables gone wrong, and although I hate to add fuel to that fire (because majority of the time the result is amazing!), I had a client come see me over the holidays who was having one of such situations (not from me!).  She allowed her pictures to be used, so should someone else experience a similar situation, they would hopefully find her story!

Remember, no one is every perfect, and filler is meant to improve your natural beauty.

I have had many people contact me about tear troughs.  Belotero is a game changer for this area, and I LOVE the results from it.  I am very experienced with this area and this product.  If you are seeking tear trough augmentation, make sure you seek out someone who specializes in it!

Because Photoshop doesn’t work in person… only on the internet!

Want a good photographer?  Everyone should have one!  Check out one of my favorite fashion photographers, Alyssa Silvestri.

More info on Belotero?  Check out my previous blogs!

Video Blog: Tear Trough Augmentation.

Video Blog: Tear Trough Augmentation

Check out my video blog on YouTube: 

One of my favorite procedures to do since the introduction of Belotero Balance in the United States last October.

The tear trough is a grooved demarcation where the cheek skin meets the much thinner and highly vascular eye skin.  Because of the anatomy of this area, a thinner hyaluronic acid like Belotero is the perfect product (Belotero: The Buzz.).  It does not last as long as the more viscous hyaluronic acids, but it also has fewer complications.

Treatments in the middle third of the face, which contains the eyes, nose, and cheeks, require an aesthetic eye and advanced knowledge of facial anatomy.  Filling the tear trough area often requires cheek augmentation as well in order to look natural.  The cheeks can require a large amount of product depending on the degree of volume depletion.  Make sure you discuss this with your injector prior to injections!

This is a very advanced procedure, make sure you check out before and after pictures before being injected!  Many practioners do not offer this procedure because of the advanced training and skill it requires.  When done correctly, it looks AMAZING.  I’m not even a very good iPhone photographer, and I have some great before and after’s on my Pinterest and in other blog posts:

More Belotero!.

I hope you enjoyed my video.  They are really hard to make!

Aesthetic Consultation: Botox and Fillers

What to ask for and expect during consultations for Botox and fillers. consultation video

Trying New Products

Just like tissues come in the brand “Puffs” or “Kleenex,” there are different brands of products used in aesthetic medicine.

It is very difficult for patients to determine which product is right for them without consulting with a professional… and some professionals only use certain brands of products. I’m very lucky that the office I work with (and a lot of my patients!) let me experiment with different brands.

Right product, right place, right person!

Currently, I’ve been experimenting with different brands of Hyaluronic Acid Fillers (Juvéderm, Restylane, and Belotero). I use these products in tear troughs, temples, lips, vertical lip lines, marionette lines, nasolabial folds, and cheeks. They are not for large areas of hollowness (Radiesse and Sculptra are more cost effective choices). HA’s are great to experiment with because they can be dissolved if you don’t like the result. If you are a virgin to fillers, these are a good idea to start with.

Kiss, Kiss.

We all know I love Belotero under the eyes, and I almost always use this product for tear troughs (More Belotero!.)  The only time I use Juvéderm is for patients I think really should be getting a blepheroplasty…but aren’t ready to go under the knife (Observing Surgery: Blepharoplasty.)  But what about the Lips? ….Well it depends!

The Patient’s Concern

Bigger, Fuller Lips

Juvéderm remains my go to product for lip augmentation. It looks and feels the most natural (when injected right!), and is FDA approved to last up to a year.

I have found a place for Restylane in my heart recently, however. I had my vermillion border injected about 3 weeks ago, and I love it. This product really defines the border of the lip!

Vertical Lip Lines

For women trying to treat vertical lip lines, or “smokers lines,” I have mixed feelings on using HA’s vs. Botox. I usually tell people to try Botox first. Over treating the upper lip with a hyaluronic acid can create a “monkey lip.” It doesn’t look good! I’ve seen this happen a lot with Restylane and Juvéderm.

While Belotero is a good product to treat these lines, I’ve found the results don’t last long when I mix the product with lidocaine (local anesthetic). The lips are VERY sensitive, and require some sort of local and injected numbing agent (anyone who disagrees with this has never had their lips injected—it’s a lil pinchy).

My technique is to use both Juvéderm and Belotero. As you age, you loose collagen and the shape of the jaw and teeth changes. This causes an elongation of the upper lip. If you look really closely at an angle there is a horizontal ridge above the lip line. I fill this ridge with Belotero. The lips also begin to thin as you age. Juvéderm into the wet/dry border replaces this volume loss. I have found it can improve vertical lip lines when injected into the vermillion border and manipulated into the vertical lines. It may not completely get rid of them, but it will improve them, and it looks very natural (not like a monkey lip).

Downturned Corners

Changes in the shape of the jaw and gravity causes the corners of your lips to turn downwards as you age. By giving support to the lower lip in areas of volume loss, that from can be turned upside down before it turns into a full out marionette line (which Radiesse is the best for!).

To read more about lip augmentation check out Pucker-Up, Princess – Damn Sexy Lips.

Love Big Lips!  Lips, Lips, Lips!.

More Belotero!

Belotero: The Buzz.

Belotero has been my #1 selling injectable since it has been on the market (September). It gets into the small little lines that no other product really can with the natural result that Belotero offers.

The procedure I do the most? Under the eyes! It literally takes 10 years off your face! I might not be able to take away sleepless nights and stress, but at least I can make it look like I did by improving Under Eye Circles and Bags! I’m so thrilled with this product I did my own under eyes (called the tear trough). December was so busy and stressful, I was looking really tired. I did my under eyes about a year ago with Juvéderm, but Belotero is much better designed product for this area (read why below).

Do you see how tired I look? (I hate sharing before pictures of myself with no makeup!)

A little numbing cream is put under the eye for about 20 minutes. Then the numbing cream is removed and the face is marked for anatomical landmarks. This is just how I mark the face. Other injectors might do it differently. I am also aware I need an eyelash fill REAL bad.

Looks so much better after!!! It didn’t bruise or hurt at all!

Look at my dark circles. They are TOTALLY gone. I swear I have NO advanced computer knowledge what-so-ever. These are straight off my phone!

Belotero vs. Juvéderm vs. Restylane

Why do I like Belotero under the eyes more than other Hyaluronic Acid (HA) products? Belo doesn’t have any hydrophilic effects (hydrophilic = attracts water molecules). Plus or minus a little bit of swelling, the correction looks the same the next day, the next week, and the next month.

Juvéderm and Restylane are also in the HA family, but have a hydrophilic effect. This means the product will take on water molecules after it is injected, giving the area treated more correction over the next few days to weeks. Great for your lips and cheeks. Not great in the ultra thin skin under the eye. When this area is over treated you will see a bump or a bluish hue from the product. It’s not pretty. But it can be dissolved!  Hyaluronidase; Just In Case: injectables for beginners..

I also like Belotero because the product is thinner, which means it can be deposited in more superficial areas with a smaller needle and less pokes! Yay!

**Remember though: It’s the right product for the right place for the right person! Discuss which product is right for you and why during a consultation!  For more general information on which product is right for you What Goes Where?

More Before and After Pictures

The above patient had 0.2cc of Belotero to her tear trough area. It was two injections. The patient stated she did not even feel it (topical numbing cream was used prior to injection). The patient experienced no bruising associated with the procedure.

The above patient is a good candidate for filler in this area because the dark circles under her eyes are accentuated by a shadowing effect from volume loss. By replacing volume, the skin of the eye and cheek become more continuous as opposed to separate.

The above patient had 0.3cc of Belotero to her tear trough area. Topical numbing cream was used prior to injection, and there was no pain associated with the treatment. The patient experienced minor bruising the day after the injection which was easily covered with make-up.

The above patient would be a good candidate for a blepharoplasty. Although there is a clear demarcation of her tear trough, and filler drastically improved the area, the root cause of the delineation is not so much volume loss as it is a herniated fat pad. This fat pad is supposed to cushion the eye as it sits in the eye socket. Numerous causes contribute to the pad “bulging” out.

Interested in learning more about blephs?  Read Why I Chose To Have an Eyelid Lift.

The above patient had 1cc (1 syringe) of Belotero to her superficial marionette lines with great improvement to the texture of her skin. Topical numbing cream was used. The patient did experience some minimal bruising the day after the procedure. She is very happy with the outcome.

XOXO, LK

Above picture:

2 months after my Belotero treatment

3 days into the annual Cutera Conference in Las Vegas (so, I haven’t slept in 3 days)

1 week post break-up with my boyfriend

And still looking refreshed! Thanks Belo! Qué Bella!
(that’s Spanish I think…)

Structural Changes in the Aging Face

Wrinkles and sun spots aren’t the only things we can expect to happen to our face as we age. There are many structural changes going on below the skins surface that contribute to an aging face that most people would never have noticed when they look in the mirror.

The young face on the left is round, contoured at the cheeks, and has a sharp jaw line (oh and hair and no wrinkles). The face on the right appears narrower, sunken, and droopy.

So besides the integrity of your skin, what else has changed?

Below the Skin

Bone Structure

Let’s start at the ground level. Your bones.

Your bones are always being built up and broken down. The rate at which the bone is broken down slowly starts to exceed the rate at which the bone is being built up as you age.

Bone changes cause:

• a reduction in facial height
• Increase in facial width and depth
• The fat pad under the eye to bulge
• A change in the shape and projection of the chin

Teeth

Injury and periodontal diseases result in loss of teeth, and it’s not like when you were young and the tooth fairy came and left you a dollar and a new tooth grew in (I hear with inflation it’s like $5 now!).

Loosing teeth affects the jaw bone and the muscles which attach to the jaw bone, which can result in make the face look narrower, hollow, and concave on profile.

Taking care of your teeth is super important, and not just for that pretty smile!

Fat Compartments

Collapsing fat compartments in the cheeks and temples reduce support to the overlying skin (side note: don’t worry! These fat cells go to other places… like your hips! j/k).

Splitting the face into thirds

Upper Third

Most people miss this when they look into the mirror at their aging face, but loss of fat in the temples results in the phenomenon I like to call “peanut head, ” which is also noticeable on super athletic people.

The presence of peanut head reflects a lack of support of the outer brow, which, along with loss of subcutaneous fat in the upper lid, causes the appearance of a droopy upper brow.

Blephroplasty anyone?  (Observing Surgery: Blepharoplasty.)

Middle Third

Eye sockets become wider and longer, resulting in a bulge of the cushiony fat pad that lies underneath the eye.

The cheeks start to flatten out, and the fat from the cheek descends to create a deep nasolabial fold.

The tear trough (area where eye skin and cheek skin meet) becomes noticeable. The middle third no longer has that fluid contour. This loss of fullness and form change causes shadowing in the trough, making a person appear to have dark circles, resulting in a tired appearance (just one of the things that causes dark circles).

Angles of the nose change, giving the appearance of increased length and the tip of the nose begins to droop.

Decrease of collagen and increase in tooth display at rest cause the upper lip to lengthen. Fun Fact: the upper lip can stretch by almost 4mm as you age.

(Stolen from another site…shhhh…) Image A shows a youthful face. Look at the contouring from the eye to the cheek. As you age, it can be convex like image B, which shows the fat pad bulging, or it can be concave like image C, making the eyes look hollow. Both B and C show a flat cheek when compared to Image A.

Lower Third

With all this stuff happening in the upper portions of the face, skin sags and starts to hang in the lower third. Adding insult to injury, the angle of the jaw changes, the jaw line, becomes less defined, and the chin shortens. Excess skin droops from the jaw line from gravity and loss of elasticity. Loss of ligament support in the jaw leads to the formation of jowls.

Even with droopy skin, the lower portion of the face starts to look smaller than the upper and middle third.

advancedskinwisdom.com a

(This image was also stolen).

What are your options?

Don’t worry. There are things you can do for volume loss! They do NOT include Oil of Olay, although the new commercial on tv claims it can (they lie).

Injections

For advanced volume loss, Sculptra is really the best injectable product. This product is a biostimulator; it works by stimulating your body’s own natural collagen. Results are the most natural of all the fillers, and the product lasts 2 years. I plan on writing a lot more about Sculptra, so stay tuned!

If you aren’t mentally or financially ready to jump into Sculptra, Radiesse is a wonderful thick, volumizing filler. It is usually my product of choice for cheek augmentation, naso-labial folds, and marionette lines.

For tear troughs, I LOVE Belotero (which is made by the same company as Radiesse). Filling this area literally takes ten years off your face, but remember, it is a very advanced procedure. Stick to a friend’s referral as to who to go to; I have seen a lot of over treated troughs!

For more help with fillers, check out What Goes Where?.

Surgical

Another option is fat transfer. I have assisted in several fat transfers; it is a very interesting procedure. If you are planning on liposuction, I highly suggest inquiring about fat transfer as well.

For sagging skin around the neck and jaw line, surgery is the only real option to date.

XOXO, old LK

(I found the ‘Age My Face’ Ap… yes… there’s an ap for that!)

Belotero: The Buzz

I’ve been waiting to announce this for months!

Merz Aesthetics (the company that makes Radiesse) has released a new product: Belotero Balance. The product was FDA approved in November, 2011. My office was involved in clinical trials, so I (of course) got a sneak peak at the product, and have been anxiously awaiting it’s arrival.

Why am I so excited you ask? Well, first, I think Merz makes awesome products (Radiesse is my favorite to use!). Second, and most important, this product can go into vertical lip lines! That’s right. No more “smoker’s lines!” I have SO many clients who complain about “smoker’s lines” around their lips!

Prior to this product’s release, there were two ways to treat the vertical lip line: with Botox or with HA Fillers.

Botox

• Some people like it, some people don’t. I’ve personally never had Botox injected in my lips (I have however had many, many syringes of Juvéderm), but I’ve been told it is a strange sensation. It feels weird to spit out your tooth paste, or use a straw, or kiss, because the muscle that is used for these things is “relaxed.” Obviously, you don’t want to relax it too much, or you’ll look like a stroke victim, so I’ve found it doesn’t last long in the lips.

Fillers (Juvéderm and Restylane)

• As you can see from the picture below (this is a great example), by injecting product into the border of the lip (vermillion border), the vertical lip lines do visibly improve, but they are still there.

• OR, you can have what I like to call “the monkey face effect” (I couldn’t find an excellent picture of this, but I’ve seen some real bad monkey faces. I would have tried to take a picture of this, but I’ve found people don’t respond well when you tell them they look like a monkey face from their filler. Or a cat face.)

Anyways, Back to Belo…

The Hyaluronic Family

Belotero is a hyaluronic acid injectable gel, like Juvéderm and Restylane. Belotero more easily integrates into the skin and adapts to facial contours than other HA’s because it is softer. This results in a more natural and subtle look (but may require more product in some areas). Belo is designed to treat superficial facial lines and moderate to severe wrinkles that are closer to the surface of the skin. Unlike Belo, fillers such as Juvéderm leave a bluish hue under the skin called the Tyndall Effect, when it is injected too superficially, like in vertical lip lines. Injections of Belo last up to 12 months, which is comparable to Juvéderm (Restylane lasts about 6 months—does anyone even use Restylane anymore? Anyone?).

Belotero is made of sugars which naturally occur in our skin. No allergy test is required, and treatment is very safe. Like with all injectables, bruising and swelling are always a possible. My friend Colleen who is a dental hygienist is going to hate me for saying this again, but, for those of you in Boston who don’t tell anyone you do this stuff (even though EVERYONE does it) the best excuse for bruising is a “dental appointment.”

For fine superficial folds/fine lines. Including:

• Periorbital folds or “crow’s feet” (also referred to as Periorbital lines)
  
• Perioral Lines (aka Smoker’s lines)
  
• Tear troughs
  
• Deep forehead lines
  

For medium wrinkles, moderate-to-deep folds, lip contouring, and facial contouring. Including:

• Glabellar crease, or frown line (the line that forms between the eyebrows).
  
• Nasolabial folds, or smile lines (from the edge of the nose to the corners of the mouth).
  
• Mentolabial crease, or chin folds (horizontal line that forms across the middle of the chin).
  
• Marionette lines (from the corners of the mouth to the chin and jawline).
  
• Earlobes (which of course aren’t in my picture! Oops!)
  
• Lips and philtrum (which is the area between the nose and the upper lip)
  

(Do you like my feather lashes? I love Halloween Eyelashes!)

The world of Aesthetic Medicine is always changing. New products are being developed as we speak. For the latest info on the best new technology, stay tuned! I’m psyched for my newly approved Sientra Silicone Breast Implants! One more month until surgery!!!!

XOXO, LK