Askanesthetician's Blog

An esthetician explores skincare issues and concerns

Just Say No to Botox Parties November 14, 2011

Filed under: beauty,Plastic Surgery — askanesthetician @ 7:00 am
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Sometimes I get the impression that people take medical cosmetic procedures too lightly.  Instead of understanding that any operation has its risks and recovery time people feel that if the procedure is meant for cosmetic reasons rather then life saving ones there shouldn’t be any side effects.  One case in point – Botox and fillers.  In certain circles it is quite popular for girlfriends to get together for Botox and filler parties which are done in someone’s home – not a medical setting.  If you are invited to such a party I would strongly advise against getting anything done.

New Beauty did a great job of breaking down all the reasons you want to avoid Botox and filler parties and instead get these procedures done in a medical setting:

 “I would be wary of any type of ‘pumping’ or injection party,” says La Jolla, CA, plastic surgeon Robert Singer, MD. “It violates so many safety standards and puts patients at risk unnecessarily.”

Fillers or injectables may not have the same risks as more extensive treatments, but they are still medical procedures that have potential complication. It’s a bad decision to treat a cosmetic procedure as a party favor, and, according to Dr. Singer, here’s why:

1. You often don’t know the full background or expertise of the individual performing the procedure—he or she may not even be a physician. You should have fillers performed only by appropriately trained plastic surgeons or dermatologists in a medical office.
2. There is no customization of treatment. “Without thorough evaluations and patient charts, how can the individual doing the injections be sure of how to appropriately treat a patient?” Dr. Singer says.
3. You can’t be certain what materials are being used. “We’ve seen everything from silicone and paraffin to oils (which aren’t safe) being used as injection materials,” Dr. Singer says. These materials are also frequently injected in a nonsterile manner, which has led to infection, he adds.
4. A party isn’t the right atmosphere for medical procedures. “Oftentimes, there is alcohol involved and that dramatically increases chances for serious problems and negates any informed consent about the treatment, which is rarely given in those settings,” Dr. Singer says. If you are undergoing a procedure, you want the undivided attention of the medical provider without the potential distractions of a party.
5. There is no protocol in place to handle emergencies. “What will happen if someone has an allergic reaction that requires immediate medical care?” Dr. Singer asks. If you have the misfortune to have an adverse reaction or complication from a “pumping” party injectable, your injector may not be qualified or experienced in the treatment of your problem.
6. If it sounds like a bargain and “too good to be true,” it usually is.

So if you are thinking of getting fillers and Botox be sure to go to a medical office to have them done.  It is always better to be safe than sorry when it comes to these procedures.

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To Inject or Not to Inject, To Avoid the Knife or Not – That is the Question June 9, 2011

Dominique Browning wrote an article in The New York Times called The Case for Laugh Lines which makes well quite the case that women should accept their bodies, mostly their faces, as they age instead of getting injections and plastic surgery.  Though she admits that a little work isn’t bad Browning writes that she is upset and sick of seeing friends completely change their appearance with injections and plastic surgery until they also get rid of all of their ability to express any emotion.

Browning writes in her essay:

We’ve gone too far. I’m becoming very, very scared.

We’ve reached a stage where cosmetic surgery is so readily available that in certain circles it is expected of women and men to avail themselves of these age-deniers. (You cannot call them youth-enhancers when you are no longer young.) If you choose not to partake of the benefits of needle and knife, you are judged to be making a statement. You are taking a position against the current standards of beauty.

We have triggered a weird, collective, late-onset body dysmorphia. What’s worse is that our anxieties about aging have trickled into our children’s generation, so that the mantra about cosmetic procedures even among some 30-year-olds is “intervention early and often.”   …

Too many people have had procedures that have gone awry. They look strange, and tragic. Is this inevitable? You do one thing, the effects begin to fade, you do another, and so on. You get puffy. You get rigid. Or you slide. And I wonder. Has no one said “stop”? Has no one, particularly the one wielding the needle, gently advised against further work? It used to be an unusual sight to spot cosmetic surgery addicts, but it has become astonishingly common.  …

Many people assume that in saying no to knife and needle, you are making a feminist statement; such is the lackluster aura that hangs over that label. Feminism has nothing to do with it. Feminists worry why women still make only 77 cents to every dollar a man makes, not whether women are going broke on Botox.

Though least you assume that Browning wants everyone to embrace a natural look completely she explains:

This is not an essay about why I am categorically against cosmetic surgeries. I am as supportive as the next gal if a certain someone feels so bad about her neck that she won’t leave home, or if another is so heavy-lidded that every time he blinks he misses half the picture. Plastic surgeons have done wondrous things.

As for the proliferation of smaller cosmetic procedures? The ones your dentist offers to do while he’s in the vicinity of your mouth anyway? The injections of fillers to plump up lips, smooth wrinkles, pad out laugh lines? At this point, it’s a wonder that the salesclerk at Barneys isn’t offering to shoot up your face while you’re trying on hats.

Again, I’m not against it. Well, maybe Botox. I’m the one to call for a rant when my friends are teetering at the brink of succumbing to the needle. I mean, who wants to inject a poison so lethal that it paralyzes nerves, sending tiny muscles to atrophy?

 

I work for a plastic surgeon so I would be a huge hypocrite to say that I don’t think women should get plastic surgery or have injections, but I completely agree with Browning about how and how much of that work should be done.  I liked when Browning wrote the following:

My current rule of thumb, when confronted with an enhanced face, is that if I find myself vaguely wondering whether there was work, the alteration was well done.

I completely agree with Browning’s statement above.  I truly believe in plastic surgery and facial injections if they make you feel better about yourself and help you look like a more refreshed version of yourself.  There is no need to freeze your face, just like there is no need to turn yourself into someone else.  As plastic surgery and injections become more and more easily available and affordable are we all going to end up looking like The Real Housewives of Orange County?  I certainly hope not.  (Also check out the latest issue of New Beauty to see the scary photos of over-injected celebrities)

 In my opinion it never hurts to get a little cosmetic help from a doctor in order to look and thus feel your best.  But avoid going overboard – there is nothing wrong with still being able to show your emotions!

Further Reading:

 

New Trends in Anti-Aging Procedures: “Vampire” Facelift and Ultherapy March 7, 2011

I recently read with great interest two articles about new in office anti-aging procedures.  The first article was in Harper’s Bazaar, and it was about a new nonsurgical browlift called Ultherapy.  The second article was in The New York Times Skin Deep series about a new trend in facelifts called the “vampire facelift”.    Neither of these procedures are surgical or invasive.  The so-called vampire facelift falls under the category of “liquid facelifts” which is a facial rejuvenation procedure that normally means fillers and Botox are used to create a temporary change in the appearance of one’s face without surgery.   Ultherapy uses ultrasound technology and heat to lift the brows and rejuvenate one’s appearance.

I’ll begin by discussing the vampire facelift.   Let me quote The New York Times article in order to further explain the vampire facelift:

[this procedure] entails having blood drawn from your arm, then spun in a centrifuge to separate out the platelets. They are then injected into your face, with the hope of stimulating new collagen production. Selphyl, as the system is called, arrived on the booming facial-rejuvenation market in 2009, and is now used by roughly 300 doctors nationwide in the name of beauty, said Sanjay Batra, the chief executive of Aesthetic Factors, which manufactures the Selphyl system.

Why would someone choose to pursue this procedure as opposed to having Botox and fillers injected into their face? 

Ghoulish as the procedure sounds, some patients prefer the idea of using their own blood rather than a neurotoxin or synthetic filler to rejuvenate their faces. “We all want to look better,” said Joan Sarlo, 56, who underwent a Selphyl “vamp-lift” performed by Dr. Lisa A. Zdinak, a Manhattan-based doctor whose specialty is ophthalmic plastic surgery. But the “less unnatural the better,” Ms. Sarlo said. “What could be better than your own blood?”

Some doctors say that fillers taken from one’s body are less likely to cause irregularities and bumps in thin-skinned areas than synthetic ones like Sculptra Aesthetic. But at this point, it’s hard to tell whether “platelet-rich fibrin matrix,” or P.R.F.M. (the medical term for the golden-hued platelets that Selphyl extracts), is an effective filler for hollowed-out cheeks and wrinkles.

But for me the crux of any cosmetic procedure comes down to safety and proof that the procedure is safe through FDA approval as opposed to testimonials and heresy.  And here is where things get messy, excuse the pun, with the vampire facelift:

What’s more, doctors and consumers aren’t clear on where Selphyl stands with the F.D.A. In a YouTube video featuring Dr. John Argerson, a board-certified family medicine doctor who works out of Refine MediSpa in Johnson City, Tenn., tells consumers that Selphyl is a “newly F.D.A.-approved filler” for nose-to-lip folds. And in a December 2009 article in Dermatology Times, a trade publication, Dr. Ranella Hirsch, a board-certified dermatologist, said Selphyl is “a new F.D.A. approved dermal filler.” This week, Dr. Hirsch, who doesn’t use Selphyl in her practice, said that she couldn’t explain why she misspoke, adding in an e-mail that “the lack of clarity between F.D.A. approval versus F.D.A. clearance to market is a key point.”

Indeed. The F.D.A. has not approved or cleared P.R.F.M. derived in a Selphyl centrifuge to be marketed for facial rejuvenation. In 2002, the agency cleared a blood-collection system called Fibrinet, whose platelet-rich byproducts orthopedic doctors then used to speed tissue repair. In 2009, this same machine was born again as Selphyl, and since then, the company promoted it as a way to “reverse the natural aging process.” This week, Shelly Burgess, an F.D.A. spokeswoman, said that Selphyl’s maker would have to file an amendment to get clearance to market its blood collection system in a new way, and no such amendment could be found at this writing.

Asked whether Aesthetic Factors’ marketing of Selphyl for cosmetic rejuvenation violated any F.D.A. policy, Ms. Burgess simply wrote, “As a regulatory agency we would not discuss whether a firm’s claims violate our regulations.”

In light of the fact that there is little to no clinical data that this procedure works as claimed, and furthermore since the FDA has neither cleared nor approved this procedure I would steer clear of doing it until there is such approval.  There are so many safe options for liquid facelifts that there is really no need to try something that is still in trial stages.  Who knows?  Maybe 15 years from now a vampire facelift will be the norm but until then I would suggest that you proceed with caution.

 

 

Ultherapy is very different from the vampire facelift described above.  This procedure uses ultrasound heat on your forehead in order to greatly increase collagen production beneath the skin’s surface.  As collagen production increases in that area of your face your brow firms.  Immediately after getting the treatment you will see a smoothing effect, and as your collagen production increases over time your results will improve in the months to come.  And what might be the best news of all, these results are pretty much permanent though some patients may need a touch up in a year.  Ultherapy costs somewhere between $1,000 to $4,000 and has been cleared by the FDA for use on the forehead (according to the Harper’s Bazaar article).  If the machine is used incorrectly a burn could result because of the intense heat generated by the machine.  That heat can also make the procedure less than comfortable. 

According to an article in the April, 2011 issue of Vogue (which I can’t find online unfortunately) Ultherapy can be used on both the face and the neck not just the forehead.  The article explains how Ultherapy works thusly:

Thermal energy bypasses the upper layers of the skin (those conventionally targeted by Fraxel and Thermage), safely heating the underlying connective tissue that lines the facial muscles.  That tissue contracts, resulting in an immediate tighting and, ultimately, a tangible lift.  …  In an attempt to target multiple layers of tissue, doctors then set the device to a shallower depth and make a second pass with the hand piece, this time intentionally aiming its heat at the skin’s upper layers in order to stimulate line-smoothing collagen production.

Furthermore, according to the Vogue article it takes about an hour to complete both the neck and the face using ultrasonic imaging so the doctor performing the procedure can view each layer of the muscle and skin as they work on the patient.  Risks include some swelling and bruising and a feeling of tightness for a few days following the procedure.  And one more thing, the procedure doesn’t feel so great.  It can feel like a hot prickling sensation to intense and short bursts of pain.  

Overall as an option for slowing down the aging process Ultherapy sounds promising.  You can try it out if you feel that your face needs a lift but you aren’t ready for a facelift yet.

One more note – it turns out both of these procedures have been featured on The Rachael Ray Show , How to Look 10 Years Younger,  which has made me wonder – do I need to start watching The Rachael Ray Show in order to keep up with cosmetic procedure trends?  I always thought her show was all about cooking. 

 

Cosmetic Procedures and Practices to Avoid February 21, 2011

Recently I read with horror the story of a young woman who died following a botched cosmetic procedure performed in a hotel room in the Philadelphia area.   There were numerous disturbing things about this tragic story but far and away one of the most upsetting aspect was the idea that someone would go to a hotel room to have what was obviously an unsafe cosmetic procedure.  Reading a story like this makes made me wonder what the thought process one would have behind making such a decision in the first place, let alone going through with it.

Needless to say this tragedy was quite avoidable which makes it even more upsetting.  So that begs the question – how can you be sure that the cosmetic procedure you are getting is safe?  And moreover how can you be sure that the person doing the procedure is legit?

There are a lot of procedures being offered by medical spas that are actually quite controversial and it is best to educate yourself before paying any money let alone proceeding with surgery.  Take for instance a procedure called Lipodissolve which promises to remove small pockets of fat through injections.  Sounds great, right?  Well actually it sounds great only on paper.  In reality the procedure is controversial enough that the FDA is cracking down on medspas that advertise that they perform this procedure.  Not only is the procedure not FDA approved, there is no evidence that it actually works. 

So once again, how do you protect yourself both financially and health-wise when you want to get a cosmetic procedure done?  When selecting a plastic surgeon make sure that they are board certified in plastic surgery and work in an accredited facility.  Ask a lot of questions during your consultation.  And it goes without saying that you should do a consult before any procedure.  If  some place wants you to go ahead with a procedure without a consult with a doctor (not a sales person but a doctor) definitely stay away!  Not only should you feel comfortable to ask about all aspects of a procedure during a consult, but any good doctor shouldn’t give you trouble when you ask about their credentials and experience.  You can quickly figure out if the doctor you’ve consulted with is board certified by logging to the American Board of Medical Specialties and looking up the doctor.  Educate yourself!  There even good resources online like The American Society of Plastic Surgeons website and New Beauty can give you details about popular cosmetic procedures.

Above all use your common sense – if your gut feeling tells you that things don’t feel right – stay away.  If someone offers to do your surgery for a cut-rate price there is usually a reason for that, a bad reason – stay away.  Legitimate places can offer discounts on surgery but if you are quoted a price that is way below the going rate there is probably a bad reason for that.  While the results of cosmetic surgery can be life changing and life enhancing do make sure that you proceed with caution and feel good about your decision before going through with anything.

 

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