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

Peanut Head: Volume Loss at the Temples

I’d argue the most over looked sign of aging is loss of volume in the temple. As we age, the temples lose fat and begin to narrow, shifting the balance of the face downward. Volume loss here contributes to the appearance of drooping and sagging of the cheeks and eyes (see Structural Changes in the Aging Face for other changes).  It begins as early as in your 20’s. It is most notable in athletes who have very little fat on their bodies, I’ve found especially runners.

As you can see, the area of total volume loss is pretty big when you actually look at it. In order to achieve the youthful contour of the temple, a patient will require a lot of product here. Adding filler to the temple is easy and almost painless, but deciding what filler to use can be difficult, they all have pro’s and con’s.

Juvéderm

This is usually my first choice with patients. For some reason… people tend to be nervous about filling this area! The great thing about Juvéderm is that it’s disolvable. The bad thing about Juvéderm is… you need a lot of it to fill this area, and that can be expensive. I’ve found great results by diluting the product before injection. The patient can see the result immediately. It may not last as long this way, but it is a good starting point. Most people love the result and usually step up to Sculptra when they notice they need a “refill.”

Radiesse

I personally don’t use Radiesse in the temples. It always reminds me of the scene from the Real Housewives of Beverly Hills when Adrienne Malouff’s husband injects Taylor and she has this big bump in her temple and Adrienne goes “is it supposed to look like that?” Although you get more volume with Radiesse, you also have more of a chance for lumps in this area. It’s not as smooth as Juvéderm (which is literally defined as a smooth consistency gel). It’s just not my preference, but for extreme volume lost I can see it being more cost effective.

Sculptra

I personally have had Sculptra injected into my temples. Sculptra is not a filler, but a biostimulator. Over several weeks post injection it promotes collagen production. It may take more than one treatment (usually 1-3 vials 1-3 treatments) to achieve the desired result. This is the longest lasting, and most cost effective product if you consider the longevity, but up front can be expensive. If you are the type of patient who is doing multiple fillers at a time, you should probably step up to Sculptra.

Fat Transfer

Fat injections can also be used in the temples but are only cost effective if a large amount of volume is needed for the entire face. I recommend only allowing a plastic surgeon perform this procedure (although a nurse can do it in Massachusetts). The fat is harvested from another area of the body (usually the lower back) via liposuction and transferred to areas of volume loss in the face (usually not just the temple). There is a lot of swelling and bruising with this treatment and not all the fat will graft (stay alive after transfer). It is also an expensive and invasive procedure. This being said, it can yield great results for patients who really need it.

The Procedure

Numbing cream is applied to the temple. The product selected is mixed with lidocaine and deposited on the bone until achieving desired volume. There is very little pain associated with all injectable products. Bruising isn’t typical; however, there are many vessels in this area, so it can happen. Expected cost depends on the product selected, but expect to use at least 1-2 syringes during time of treatment.

Good luck!

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!)

Things You Never Would Think To Find In A Girl’s Bathroom

How I’ve gone from your typical teenage girl to … an aesthetic specialist (for lack of a better term).

I remember when I moved into my first apartment in college, and I asked my mom for a make-up table, because there were 4 of us with one bathroom. I used to wear a lot of make-up. Case in point:

Summer of 2004. My candy raver phase? I guess. Over tweezed eyebrows. Check. Spots on my shoulder from too much tanning beds (which is actually caused from a fungus for all you spotted tanners out there… GROSS). Check. Face make-up too light. Check. Choice in jewelry… no comment. Oh. And I have roots. I think I might have been going to see Roger Waters with my college boyfriend. Man, college is a time for mistakes!

Hey, I also found my college bathroom circa 2004. (I am the original facebook generation… back when you needed a .edu to join).

UMASS. That should explain anything off you might see in this picture. But as you can see. Small space for four people. And a cat.

Anyways. Normal bathroom. Right? Also, I’d just like to point out that I used to eat nothing but candy. But I always brushed my teeth. As evidenced by me brushing my teeth

So I’ve gone from this:

To this:

Well… now fast forward 8 years. I wear very basic make-up that takes me literally five minutes to do, but in return I have the weirdest stuff in my bathroom repertoire! Used for purposes I’m sure very few could guess! So here’s an insiders sneak peak to my bathroom. I hope you find this as ridiculous (and funny) as I do. Welcome to the bathroom of a high maintenance princess.

Shot 1:

I took this pic a few months ago and sent this to one of my co-workers. I thought it was absolutely comical that I had this stuff on my bathroom sink counter.

I believe the tweezers were for applying fake eyelashes. I learned to stop tweezing my own eyebrows. Please refer back to the college years if you are curious as to why.

I suppose pliers wouldn’t be a strange thing to have in the bathroom. I’m not sure what you would actually use them for or how to actually spell that word… but I use them to take out my hair extensions if they’ve gotten a little loose. Not normal.

Revitalash I use to grow my eyelashes longer and stronger for lash extensions… and because sometimes I ruin my lashes with the strip adhesives. Gotta have lovely lashes.

Shot 2:

My make-up bag. Fake Eyelashes. Behind that… Fake hair aka Diva Weava.  I wouldn’t be a Barbie Doll if I didn’t have Fake hair.  And my fav hair tool: my pink GHD

That is a legitimate paintbrush in the middle there.

Shot 3.

Shot 4: Stuff that is Usually on My Bathroom Counter

1. Baby Powder: for my roots because I only wash my hair twice a week.
2. Dry Shampoo: because sometimes baby powder isn’t my scene.
3. QuickTan: Because sometimes you have to go from white to orange in 20 minutes or less.

What I’ve Done.

And then I also did a quick draw a few months ago (back when I was blonde) on all the stuff on my face that was changed. It was kind of shocking to me. I wasn’t going to post it… because there are always people out there that like to tear you down. But I guess I’m somewhat amused by it. And comfortable enough to say, bring on the controversy.

            

1. Botox in my Glabella and Forehead
2. Lip Augmentation  Pucker-Up, Princess – Damn Sexy Lips.
3. Sculptra to my temples
4. Cheek Augmentation
5. Eyeliner tattoo
6. Eyelash extensions
   Lovely Lashes!.
7. Hair extensions
8. I have juvederm under my eyes as well.

No Surgery Needed!

“Plastic surgery and breast implants are fine for people who want that,

if it makes them feel better about who they are. But, it makes these people,

actors especially, fantasy figures for a fantasy world.

Acting is about being real being honest.”
Kate Winslet

Dear Kate Winslet,

I appreciate your support for people to make their own choices on

Plastic Surgery. I assure you, I feel great about myself.

More confident than Superman. Oh wait. Is he real?

Or is that part of my delusional fantasy world?

Is that sarcasm? Or real honesty?

XOXO

LK

Like my Patriotic Red Extensions from July 4^th? Happy Birthday America!

Thank you for giving me the freedom to be delusional and honest.

Hyaluronidase; Just In Case: injectables for beginners.

I’m so good at rhyme. I’m just saying.

One in 5 women has interest in doing Botox, but has a billion questions, and it’s overwhelming. The inability to find the answers leaves this grey area of fear that supports a misguided rumor-mill of what Botox actually is. You can’t believe everything you read, and you certainly can’t believe everything you hear (unless I wrote it or said it. Then it is pretty much a fact).

‘The oldest and strongest emotion of mankind is fear,

and the oldest and strongest kind of fear is fear of the unknown.”

-H.P. Lovecraft ( ßI wonder if his parents are from Amherst… strange name… but good quote none-the-less).

New to the World of Injectables?

Usually, the first place we go to is the internet, but when it comes to health-related issues, this is not the best place to sift through to find information without training in How To Read A Medical Article (this is an ENTIRE class, and it is REALLY hard). And unless your best friend is me… there is a lot of misinformation going around via word of mouth.

To those readers who have never done a procedure, it is all the same. It’s ALL called Botox. (That’s NOT Botox..)

 

It’s Not All Botox!

There are a lot of injectable products on the market, and the world of Botox and Fillers is doing nothing but growing. Every person has a different face and different goals with aesthetics. So it needs to be the right product for the right problem, and really only an expert can decide what that is. Since I love making charts, I made a chart of the basic differences between Botox and Fillers. That’s important to know.

***Super Important Information Chart*** for lack of a better title.

Botox (or Onobotulinum Toxin A)	Fillers
Injected into the muscle.	Injected into folds.
Causes temporary “relaxing” of the muscles into which it is injected.	Causes temporary fill of folds into which it is injected.
Does not give any volume to the face.	Gives varying degrees of volume depending on the product used, the amount of product used, and the area being treated
Goes into lines that are a result of muscle movement.	Goes into folds that are a result of gravity and bone remodeling.
Botulinum Toxin family includes Dysport, Xeomin, Reloxolin, but they all basically do the same thing (but are not interchangeable in dosage) and are injected the same way into the same place.	No one uses collagen anymore. These products are way more advanced. We’re talking Hyaluronic acid (Juvéderm, Restalyne) and Calcium Hydroxylapatite (Radiesse). Sculptra (although technically a biostimulator) is in this family as well.
Lasts 3-6 months.	Lasts 4 months – 2 years depending on the product.
Is a thin liquid when injected.	Ranges from a thick gel (Radiesse) to a thick liquid (Sculptra).
Usually doesn’t bruise.	May bruise, depending on things like the technique used for injection, the amount of product injected, the size of the needle used.
Pinches, but requires no anesthetic.	Requires both topical and local anesthetic. And even then isn’t always completely painless (depends on the area you are injecting).

As we can conclude from my awesome chart, Botox and Fillers are very different products. The left side of the chart is pretty straight forward. If the line is a result of muscle movement you can inject Botox to improve it. The Botulinum Toxin family has the same properties and effects for the most part… and 99.9% of the time you’ll be receiving Botox. It’s a household name.

Fillers on the other hand… way more confusing to the novice patient. To anyone who has never undergone an injectable procedure, they are all called “doing Botox.” But, once the decision has been made to investigate what all the hype is about, there is a very VERY steep learning curve. So where should you start then?

The Hyaluronic Acid Family

There’s a few different kinds of HA’s. Restylane, Juvéderm, and Perlene are all examples of products in the Hyaluronic Acid family. They are all very different as well. They can last from 4 months to a year (Juvéderm lasts the longest… and is currently the #1 seller of HA’s).

Hyaluronic Acid is a sugar that your body naturally makes that attracts water molecules. Everything your body naturally makes, your body also naturally breaks down. One of the best things about trying Botox and Fillers is that they don’t last, so if you decide you don’t like the result of a treatment, the good news is, it isn’t forever. Unfortunately, that is also the bad news. But for a beginner, there literally is a product that can dissolve any HA injection that is not to your liking. This is a huge positive for people who are new to fillers.

Fortunately for me, I’ve never had to use Vitrase. My policy on filler removal has always been to wait two weeks post injection and to re-evaluate the area. Swelling can last about two weeks, and I like to take this into consideration as well as the initial “shock factor” some people can experience.

Hyaluronidase is an enzyme that acts at the site of injection (i.e. does not travel systemically) to break down and hydrolyze hyaluronic acid. Tissue permeability is increased. There is a temporary decrease in the viscosity of the HA, promoting diffusion of the injected product and facilitating the absorption of the fluid carrier.

It appears from the case studies I’ve read that this product can be injected anytime after misplacement of HA’s has occurred. From immediately, to up to five months post injection. It takes 24 hours for a majority of the HA to dissolve post hyaluronidase injection.

****Why not always use HA’s? …because they’re more expensive. But remember: Right product, Right place, Right person.

The world of Fillers is expanding. There’s a handful of products out there, and they’re all formulated just a teeny tiny bit different. It’s not all Botox, and it’s not all the same. If you need a starting off point, because you just don’t feel comfortable with the information overload, HA’s are definitely the safest bet. Because they can easily be dissolved if you don’t like the result… but I’ll put money on the opposite happening. J

XOXO

LK

Under Eye Circles and Bags

Physiology: Broken blood vessels within the lower eyelid. A shadow forms underneath the bag causing the dark circles to appear. As you age, the “bags” (fat pads) can bulge due to gravity, creating an exaggerated space between the skin of the check, and the skin of the eye, over the orbital rim (bone of the eye socket). These dark circles can bring about a chronically fatigued look, or make you appear older than you actually are.

Cause: range from fatigue, vitamin deficiency, hyperpigmentation, allergies, age, and medical conditions. However, heredity is the most common cause for bags under the eye (also, from my patient’s personal experience… I hear children and husbands may also be contributors? It has not been clinically proven however.).

Treatment:

Getting the proper rest and eating the right foods can sometimes help treat and improve dark under eye circles, but if genetic, dark under eye circle will increase if untreated.

Fraxel®, Thermage®, Blue Light Therapy, IPL Photofacial, Dermal Fillers and Chemical Peels (like TCA). Patients with more severe cases of under eye circles, puffiness and loose upper or lower eyelids may want to seek out surgical alternatives including blepheroplasty.

My Best Advice

It is always a good idea to start with the least invasive methods and move on to the most invasive methods. That being said, genetics does play a HUGE role in this, and if your mom or dad has extremely sagging lids, or bulging fat pads, the earlier you do surgery the best result you will have.

Least Invasive to Most Invasive

1. Hydration: The area of skin under the eye is the thinnest in the body. In a hospital setting, we monitor this area as a sign that a patient could be dehydrated. I can always tell when someone needs fluids just by looking at this clinical sign. Start with drinking water… water is good for your body all around. And… it’s FREE!
   
2. Eye Cream: Supply your skin with the nutrients it needs. By depositing certain vitamins and peptides, you can decrease the appearance of dark circles. Before you tell me you’ve tried every cream under the sun… have you read my post on pharmaceutical products? Step 2: Spend wisely.
3. Noninvasive treatments: Laser stuff. Not my area of expertise, however, I have had IPL on melasma, and it worked great. Laser treatments will help with the discoloration, and may subtly tighten the skin, but they will not fill volume loss. If you have volume loss, see step 5.
4. Chemical Peels:  Best done in the winter time when you’re not in the sun.  And actually… this is more for fine lines and wrinkles around the eyes than bags and dark circles.  Although it will help the appearance.
   
5. Dermal Fillers : (That’s NOT Botox..) A hyaluronic acid of low molecular cross linking like Juvéderm Ultra is most recommended for this area. Thicker fillers, like Radiesse, and biostimulators, like Sculptra, are not recommended for this area. Remember this skin is the thinnest in your body, and thicker products can leave bumps here. Be VERY careful about who you see for this treatment. It is a very advanced procedure that your Dentist or Primary Care probably shouldn’t be performing on you.
   
6. Blepheroplasty: Check out my post on Blephs. Observing Surgery: Blepharoplasty.

Dermal Fillers

Dermal Fillers are my area of expertise (Remember photography is also not my thing!!!)

Here’s my Before and After Tear Troughs:

Before: I look tired. And old. Ew. Taken November 2011.

After: As you can see I look more awake and refreshed. Taken February 2011 after I had my tear troughs filled.

I am very happy I did this. Surprisingly, it didn’t hurt at all. The product used was Juvéderm Ultra. It will last about a year. Cost is about $600.

Creams

(The two I like best)

Image Max Eye Cream: This next-generation revolutionary day and night eye crème contains high concentrations of growth-factors derived from plant stem cells to protect skin cells and prevent aging effects caused by free radical damage. Reduces the appearance of fine lines and wrinkles; reduces puffiness and inflammation. Prevents cell aging. Contains grape, alpine edelweiss and apple stem cells for maximum age prevention. Corrective peptide blend for rejuvenation. Retails for about $45

Image Vital C: A scientifically- advanced hydrating, anti-aging eye gel. Contains a blend of nourishing anti-oxidants that reduce the appearance of fine lines and prevent the breakdown of collagen. Vitamin K  (Phytonadion) diminishes dark circles. Restores youthful looking eyes. Retails $31

Softening the Lines

P. is a 50 year old woman who has seen me twice over the past two years. To start, she had deep naso-labial folds that she hated. We first filled them with Juvéderm (which was my product of choice two years ago, but now I like Radiesse better for this area). We then did a little bit of cheek augmentation with a large syringe of Radiesse.

P.’s son is getting married and she wanted a little touch-up before the wedding. This is totally common with treatments (and weddings). Remember, any procedure should be done with plenty of time for healing to occur in regards to bruising or swelling.

Before

After

Again, remember, I’m not a photographer! The goal with P. was to soften the downturn on her mouth, the depth of her chin, and the depth of the NL fold.

Gravity…

As you age gravity causes several changes to occur in your face. The fat pads on which your eyes rest slides out from the socket and begins to bulge. At the same time, fat pockets in the cheeks break down in a known consequential manor. The combination of these two things and the pull of gravity on lax skin deepen the look of the nasolabial folds and add years to the face.

So What did I do?

As I said, P. and I have done a few treatments together before. We did the folds first, to fill the depth caused by lax skin and gravity, and then I did cheek augmentation. As I have become more advanced however, I have changed my practices to moving from the top of the face down (because of gravity) and from the most advanced sign of aging backward. I have found this to be the most effective way to treat aging. In retrospect I would have done the following:

1. Cheek Augmentation
   

   By reconstructing the fat in the cheek area by filling it with product, this will decrease the laxity of the skin which forms the NL fold. I know women start pulling up the sides of their cheeks at around 30, wondering what a facelift would look like. Well this isn’t a facelift. It’s a laxity lift. (I made that up). It’s an improvement which will help me use less product in the laso-labial fold area. This means a better result AND less money. J

   
   

   **Do you do this in the mirror? As you can see, I don’t have much lax skin… from multiple procedures (cheek aug and ulthera mostly). But uh…. I do have roots. No one’s perfect! 😉
   

2. Marionette Lines
   

   This is one of the most advanced signs of aging (because it’s the precursor to jowls). The marionette line starts from gravity pulling down the corners of your mouth and gravity pulling the fat down from the cheek. It’s just a big ol’ gravity mess! Pulling the needle around the corner of the mouth pulls up the downturn of the mouth.

3. Naso-labial folds
   

   While this is the LEAST bad sign of aging, this is usually what women are drawn to fixing first. Depending on your age, and your current amount of fat in your face, and the money your willing to spend to have the best result, are all deciding factors on where to start first. Aging didn’t start overnight, and… to be realistic… one treatment isn’t going to restore the youthfulness to your face. Many women’s biggest fear is looking like a Desperate Housewife (fake and expressionless) but this is not the goal of aesthetic medicine. The goal is to restore and maintain your features.

“Softening P.”: A Maintenance Session

P. still had nice volume in her cheeks, and her N.L. folds still had some nice fill (1 year later). P. just needed a little softening to look her best.

X = needle insertion point

Line = needle direction of needle

1. Mouth Corners
   
2. Marionette Lines
   
3. Lip line
   
4. Chin Sharpening
   
5. Jaw Softening
   
6. Nasolabial fold softening
   

Again the Afters

This round of treatment was to soften and touch up. One large Radiesse syringe was used to treat 6 areas. The result is a softer looking face. There is not a HUGE difference in what P. looks like, but there shouldn’t be. Treating six areas with one syringe will not show a HUGE difference. Six syringes in 6 areas… now that’s a different story. Personally, I will only do ONE syringe at a time. Once you fill one area, you change the skin volume, and laxity changes. If someone tries to sell you six syringes at once, RUN. They are not looking out for your best interest, and you are going to leave the office looking like a different person (or something non-human!).

A Bride’s Guide

Every bride wants to look perfect on her special day, and that takes a lot of hard work and preparation (or so I hear…)… I thought I’d be a big help for all those brides (and their bridal parties!) with a little bit of information you might find helpful!

Actually… I think any time anyone attends a wedding they want to look good. Weddings = Pictures. And now-a-days, pictures – the good, the bad, and the ugly – wind up on Facebook! So if you’re at the age where you will be attending lots of weddings in the near future (i.e. my age) you might want to take some notes…

Non-Invasive

Spray Tan

Spray tan’s typically last 7-14 days.  If your thinking of spraying (which I highly recommend), do it as close to your big day as possible!  You can’t shower for 6 hours after a spray, and you can smell a little bit sugary post-spray, so keep this in mind.  For the best results, spray the day before. As it wears off, it can sometimes look a little patchy. Make sure you exfoliate prior to your appointment (and shave).

Also, I hear there is a new spray out, that has glitter in it (OMG RIGHT!), but it’s only good for 24 hours I think? Maybe someone else knows more about this? I would also like to note here, that if you are not the bride, you should NOT be shining. That’s rude.

Facial

A plain old facial can be done anywhere from a few days to a month before a special date. Healthy skin is essential for a beautiful face. I recommend everyone see an aesthetician and purchasing some products that will keep your skin healthy.

Weddings are super stressful, and your skin responds to stress. Facials will keep break-outs at bay, not only by cleaning your skin, but by giving you some quality relaxation time. Spa days are great to do with your friends, mother, and future mother in law!

*Note: if you are planning on doing Botox or fillers, a facial should be done either immediately before or 5 days after any facial treatments.

Chemical Peel

Degree of peeling can vary, so talk to the aesthetician performing your peel and be CLEAR if you have any wedding events (or any events for that matter) that you don’t want to be shedding for. ‘Tis the Season for Chemical Peels!.  For a real good, deep peel, expect about a week to two of down time. Trust me, it’s worth it.

Very Important:  moisturize often with a pharmaceutical or cosmeceutical grade product after a peel.  Many places have post-treatment kits.  Do NOT pick at your skin!  Stay out of the sun! Do not use Retin-A prior to or post treatment for about 7 days.

Waxing

Waxing your brows or lip shouldn’t be done the day of an event.  The process can irritate your skin, leaving it a little red.  Icing the area helps.  Or an anti-inflammatory like ibuprofen.  Make sure to keep the area clean to keep bacteria out of your pores, and causing break outs.

Microdermabrasion.

Often done during the same time as a facial, and can cause some minor redness.  Protect your skin after this treatment. Again, stay out of the sun, and do not use Retin-A prior to or post treatment for 7 days.

Laser Skin Rejuvenation Treatments

Depending on the laser, and the treatment, there can be some downtime with this (discoloration and flaking), anywhere from a day to a week.  Ask your practitioner what to expect with the treatment you are receiving.  These treatments really make your skin look great!  Never heard of laser skin rejuvenation?  There will be blog posts to come!

Teeth Whitening

It depends on the number of treatments you will need to decide when you should start. Some treatments take a few sessions, some are one and done. Go for a consult. At the very least, do the Crest White Strips.

Long Lashes

A lot of brides ask me about eye-lash extensions. Although a little expensive, they look great for a wedding.  They should be done about a week before your big event.  They take some getting used to! Lovely Lashes!. They also don’t last very long… usually about a month, so don’t do them too soon unless you are going to keep up on them. If you are having your make-up professionally done, the make-up artist will probably offer you some sort of fake-eyelash. If you are doing your own make-up and you want that lashed out look, practice a few times before the big day. I am a master of the strip lash… but it took me about a year to perfect my technique!

Minimally Invasive Procedures

These can be tricky to time.  If you are planning on doing any non-invasive procedures, they should be done either immediately before Botox and Fillers, or 5 days after.  This is because you don’t want Botox to travel into the wrong muscle group, or fillers to be moved into the wrong area.  Use good judgment with timing your treatments!

A lot of women do Botox and fillers before a big wedding!

Check out this article: http://www.nytimes.com/2008/07/24/fashion/24skin.html?pagewanted=all

(I’m the bridesmaid all the way to the left. I would like to add a disclaimer: The bride here is naturally beautiful. And has not let me tempt her into Botox—yet).

Botox

If you are new to Botox, I suggest trying it out 4-6 months prior to the wedding date for a couple of reasons. First, this way you can decide if you like it (which you will, but I still recommend trying it). Second, Botox is a dose dependant medication (your results depend on how large or small a dose you receive). Six months gives you plenty of time to work out with your injector the perfect dose for you! Last, you will not be able to look angry for 3-6 months. This might be helpful to any Bridezilla’s out there. So, when you are in witch mode, at least you won’t look like it. J

If you don’t have six months to do a trial run, if you are a Botox Pro, or if you just want to go for it, you should have your treatment AT LEAST 1 month prior to the big day, and NO MORE than 2 months prior. Anything more than 2 months, it might start wearing off, anything less than a month you might not have the result you desire.

Another interesting use of Botox with Brides: It is becoming popular to be treated for hyperhydrosis (sweating) in the underarm. I recommend this to brides who will be getting married outside in 100 degree weather. Sweating profusely is pretty gross. You’re already going to be nervous, and when you add your layers of dress (which I’m sure is not air conditioned), and all the dancing you’re going to do… might be a good idea. Plus, you didn’t spend all that money on a dress to have pit-stains on it. This procedure requires a pretty big dose of Botox, and is therefore pretty expensive. It’s not for every bride.

(Remember don’t go overboard either!)

Fillers (Radiesse, Juvéderm… Perlene, Restyline, ect. ect.)

Depending on the area of injection, there can be some minor bruising (or major depending on the injector).  Invest in some Arnica cream, and expect the worst (2 weeks).  Cheek augmentation bruises the least, while lip augmentation and nasal labial folds tend to bruise the most.  Gosh, I hate it when I have dental work 😉 The average bruise lasts a few days.

Usually older brides are doing facial fillers, while younger brides might want to plump their lips.

As for the rest of the wedding participants, the mothers of the bride and groom are usually also very interested in fillers (and Botox). After all, they have been looking forward to this day since the days BEFORE their children gave them premature wrinkles. Whether she is interested in a facial or Botox treatment, moms deserve to be asked “is this your sister?”

Things to Do 6 Months or More before a Wedding (or wait until after):

–  Bioenhancers like Sculptra Aesthetic (it can take up to 6 weeks to see a difference)

–  Plastic Surgery. Remember that crazy reality show on TV that brides were competing with each other trying to win plastic surgery procedures so they could be perfect for their big day? Those women were … appalling. Plastic surgery should never be taken lightly. Or have a competitive reality show. Leave competitive reality to “Survivor!”

–  Changing your hair color or cutting it short (stick to what you know looks good on you!)

Master of Puppets

Ha. I made a Metallica reference! Not sure how many of my readers are Metallica fans… but still… go me for creativity points. ANYWAYS. This post is about puppet lines, also known as marionette lines. A client of mine inspired the title of the post.

“My granddaughter looked at me and said Nana you look like a puppet!”

Children are so painfully honest sometimes.  A patient of mine told me her granddaughter’s statement was her reason for being in my office.  (Maybe I should be employing two year olds?… Is that legal?  Can I pay in candy?)

Her granddaughter was referring to the folds that develop from the corner of the mouth to the jaw line, also known as the “marionette line,” one of the more advanced signs of aging.

Can you fix it?

Yes.  By injecting filler medial to the folds.  The product I typically use is Radiesse, because these folds are usually deep and require a thick volumizing fill. How I do things might not necessarily be how other providers do them… but it should be pretty similar. I also stand behind this product choice. If someone tries to use a Hyaluronic Acid in this area, get out of their office, because you will be spending a FORTUNE.

Before

What Needed To Be Done?

In Physical Facial Changes That Occur As We Age I spoke about what happens to the face as we age.  In this case, I’d like to point out prejowels beginning and marionette lines starting.

Marionette Lines

Prejowel lines

Topical numbing cream is applied to the areas that will be treated for about 20 minutes. The skin is then cleaned with alcohol. The full length of the Radiesse needle is inserted and product is deposited in a technique called fanning and product is deposited as the needle is withdrawn. The outside hub of the needle is a gauge larger than the inside to create a tract for the product to be placed. So the only discomfort is the actual needle, I add lidocaine to my Radiesse (which most people do). Really, not so bad as far as pain goes.

 The needle is inserted at the “X” and it goes straight up to the corner of the mouth. Like I said, product is inserted as the needle is withdrawn. This is called retrograde technique. Before the needle is taken out it is repositioned at a 30 degree angle, the full length of the needle is again inserted, and product is deposited as it is withdrawn. It is done again at a 45 degree angle.

Basically, it’s one insertion point (i.e. one poke) on each side, and the needle is pivoted while within the skin layers. It gets less painful as you go along because there is lidocaine mixed into the product.

Last the jaw line is sharpened. “X” is the insertion point. The full length of the needle is then inserted, and product deposited as it’s withdrawn.

After

This picture is immediately after. There is some swelling that has begun, but you can see some of the immediate results. This patient used a 1.5cc Radiesse syringe (the large). She could use a little more product in the jaw line and around the corners of the mouth. I personally like to do things one syringe at a time. Because swelling begins immediately, I find results are best this way. Also, some people don’t want to look perfect, they want to look IMPROVED. The most important thing to note on this client is that she no longer looks like she is frowning when her mouth is at rest. Fillers are AWESOME!

Side Note

Sorry friends, this is a super busy week for me! I have a 20 person Botox Party on Friday, on top of my regular clients! I will actually be seeing this patient again this week, and will have a non-swollen after picture for you. She looks amazing and is super happy! Yay!

*If YOU Are Considering Filler*

Fillers can bruise. Do NOT. I repeat. Do NOT do these things if you have an event within two weeks. This is a worse case scenario for bruising. Highly unlikely you will have a bruise for two weeks… but… I wouldn’t wanna chance it if I was planning on running into my ex-husband at my high school reunion and the whole reason I wanted to get filler was to look too good for words. Just saying.

The reality of the situation is you will bruise. Probably for a few days. You can cover it with make-up. And tell everyone you went to the dentist. (I know my friend Colleen-a dental hygienist- is going to yell at me for making the dentist sound bad. Sorry Col. I love the dentist. I really do. He makes for a great excuse for my clients.)

Expect to pay $300-$800 in the Boston Area for this treatment with Radiesse. The amount of money you spend is a direct correlation to the result you will receive. The amount of product you will require for the result you desire (poetry!) depends on a lot of different factors, so ask your provider!

ICE YOUR FACE AS MUCH AS POSSIBLE AFTER THIS TREATMENT. The more you ice, the less you will swell. Twenty minutes on, 20 minutes off. If you can do it the rest of the day, do it. If not, just ice as much as possible.