Dr. Biesman's Blog | Laser and Facial Surgery

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My eyes make me look old and tired- how can I make them look fresher and brighter? 

The eyes are often the first area to show signs of aging making eyelid rejuvenation one of the most commonly sought-after goals today.  The area around the eyes is complex as heaviness of the eyebrows, flattening or “deflation” of the area under the lower eyelids known as the midface,   development of excess eyelid skin, bulging fat pads, hollowness or dark circles and wrinkling of the eyelid skin and lines at the corner of the eyes (crow’s feet) all contribute to making our eyes look old or tired. 

There is no single treatment that is best for making eyelids look more youthful.  Botulinum toxins such as Botox Cosmetic, Dysport, or Xeomin can be used to provide modest elevation of the eyebrows and to smooth crow’s feet lines.  Noninvasive skin tightening such as Ultherapy can be used to elevate the brows without surgery.  Ultherapy is the only noninvasive treatment cleared by the Food and Drug Administration (FDA) for noninvasive eyebrow lifting and is effective in the vast majority of patients treated.  Ultherapy cannot be used on the eyelids themselves due concerns about providing adequate eye protection.  Fortunately Thermage treatment can be used safely on the eyelids to achieve noninvasive skin tightening.  I developed the Thermage application for eyelid skin tightening several years ago and it remains the only FDA approved treatment in its class.  Skin tightening techniques induce lifting or reduction of folds but does not smooth or rejuvenate wrinkled skin, a condition which is especially common on the lower eyelids.  Wrinkling of the eyelid skin can only be addressed by procedures such as laser skin resurfacing which tightens and smooths eyelid skin.  Skin resurfacing may be performed conservatively or aggressively, depending on the need.  Eyelid lift surgery known as blepharoplasty is used to elevate or suspend the eyebrows and/or eyelids, to remove excess skin from the eyelids, and to remove or redistribute bulging eyelid fat pads.  Laser resurfacing and blepharoplasty surgery are often combined.  Injectable soft tissue fillers such as Restylane, Juvederm, and Belotero can be used around the eyes and are especially helpful in filling in hollow areas underneath the eyes to reduce dark circles.  Finally, good quality, medical grade skin care products are the “icing on the cake” when it comes to eyelid rejuvenation.  While skin care alone is not usually sufficient to make eyelids look more youthful, it is a key component to maintaining and enhancing the results that can be achieved with botulinum toxins, skin tightening, laser resurfacing, surgery, and injectable fillers.

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The Truth About Soft Tissue Fillers

In many consumers’ minds, injectable soft tissue fillers such as Restylane®, Juvederm®, and others have gotten a bad reputation.  Everyone can name a celebrity, friend, acquaintance, or socialite who looks distorted and unnatural as a result of poorly used fillers.  However, most of us probably know or have seen many people who look natural, healthy, youthful and rested who, unbeknownst to us, have achieved this look through the judicious use of fillers.  How is this possible?  Is it the fault of the materials that poorly performed construction does not look nice or last?  Of course not.  Successful results in any project whose outcome depends on appropriate use of materials depends more on the user than the product.  For example, the same paints can be used to make a beautiful painting or an ugly one; similarly the same building materials can be used  to make a striking, durable home or a shoddy one.

So how do you get great, natural results without looking strange or distorted?  There are 2 important steps that you can take to ensure you get the best, most natural outcomes from fillers.  The first is to understand how these products are meant to be used so you can be your own advocate.  The second is to do your homework and find an experienced, well trained, and conservative injector.  Let’s take a closer look at both of these precautions.

So what is the proper use for fillers?  Have you ever noticed that obese people who are older have more youthful looking faces while young, very athletic people who have very low body fat levels look older?  This is because facial soft tissue volume is a key to a youthful appearance.  Over time, even if our weight stays the same, our faces “deflate”.  We lose volume from our central face, under our eyes, our cheeks, lips, chin, and even our temples.  Our faces transform from being heart shaped in our youth- go ahead, pull you those high school graduation photos and you’ll see what I mean) to being more rectangular (or even triangular) as we age.  Soft tissue fillers can be used to replace the volume that has been lost to produce a natural, youthful, look and contour.  Soft tissue fillers are NOT just about filling wrinkles and lines.  At a certain point in time, we all have wrinkles and lines.  Eliminating them entirely can make us look artificial and “plastic”.  While it is certainly desirable to soften lines, this should not come as the price of creating an abnormal appearance.  In the hands of an experienced injector, soft tissue fillers (even in the lips!) create a natural, healthy appearance without being obvious or apparent.  When seeking the opinion of an injector, ask about their experience and their anticipated goals.  Show them old photographs so your injector can see what your features looked like when you were younger and therefore what type of results you are envisioning.  Anyone who simply wants to focus on the lines between your nose and mouth (known as the nasolabial fold) probably does not have a good understanding of how fillers should be used to obtain the best, most natural results. 

The second key to success in favorable outcomes from injectable fillers is to find a credible, experienced, injector who understands you and what you are trying to achieve.  As a general rule when it comes to fillers, less is more.  You can always add more in small increments but it is difficult or impossible to remove fillers in an incremental fashion (and some cannot be removed at all).  Everyone knows that if you are considering a surgical procedure you need to do your homework and check out the doctor you choose. How experienced is the doctor?  Do you like their bedside manner?  Do you feel the doctor listened to you?  How helpful was their staff?  Do you know people who have been treated by them?  If so, are their patients happy and do they look natural?  What is their on-line reputation like?  Would you go to a surgeon just because they were a little closer, a little cheaper, or offered a Groupon discount for their service?  These same criteria should be applied when considering finding an injector to administer soft tissue fillers.

Soft tissue fillers can produce fabulous, natural looking results that can make you look years younger in a natural, relaxed way.  Make sure you do your homework when choosing an injector. Remember that the skill and expertise of the injector is no less important than that of a surgeon- why trust your face to someone who you have not checked out thoroughly?

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Filed under The Truth About Soft Tissue Fillers

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Avoiding the Puffy “Pillow Face” Problem

Many people are talking about the so called “pillow face" that many Hollywood starlets seem to have these days.  Pillow face refers to someone who appears to have too much hyaluronic acid filler such as Restylane, Juvederm or Sculptra.  This is simply a case of too much of a good thing. Volume is one of the hallmarks of youth.  Fillers can can restore volume in areas of the face in which it has been lost with age such as under the eyes, the cheeks, the temples and lips.  A skilled physician with many years of experience injecting fillers can administer them in such a way that the patient looks rested and more youthful.  When fillers are used appropriately and in moderation, they are not apparent.  In fact, they look natural and the "pillow face" can be avoided.

Filed under pillow face fillers dr. biesman restylane juvederm sculptra

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Should Post 50’s Avoid Anti-Aging Treatments?

The Huffington Post recently conducted a survey asking readers whether they think people over the age of 50 should avoid cosmetic treatments.  Instead of looking at the issue in terms of age, we should look at it in terms of having the right mind set about rejuvenation treatments.  A 50-year-old, for example, should not expect to look 25-years-old after a treatment.  The goal is to help the 50-year-old who feels energetic and youthful look their best while still age-appropriate.  Others should not look at them and notice their “work”.  They should notice that they look rested, relaxed, and confident.  If you are considering a cosmetic treatment, find a qualified specialist with extensive training and many years experience in facial rejuvenation who won’t try to change your look, but will help you put your best face forward. 

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What is Madonna’s Secret to the Fountain of Youth?

It seems more people are talking about how Madonna looked while performing on the Super Bowl, than they are about the actual performance.

Madonna definitely looks younger than her 53 years, and while recent articles have attributed her flawless skin to fractional laser resurfacing, this is probably just part of the regimen she uses.

Fractional laser resurfacing is most effective for the treatment of brown “sun spots” and fine wrinkles.  Unlike traditional laser resurfacing, in which the entire outer layer of skin is removed, fractional laser resurfacing involves the use of a laser to deliver treatment to only a fraction of the skins’s surface at each session. This is accomplished by delivering energy in a grid-like pattern, leaving healthy untreated skin between treated areas.  Patients can resume their normal activities within a few days, but several sessions are required to achieve satisfactory results. 

Madonna is also probably treated with a botulinum toxin such as Botox® , Dysport™, or Xeomin.  When administered by an expert, these drugs help us look more youthful and rested by relaxing certain muscles to reduce the appearance of wrinkles or to shape our face,. They are best known for their effectiveness in relaxing the vertical lines between the eyebrows, the horizontal lines on the forehead, the “crow’s feet” lines around the eyes, the “smokers’ lines” around the mouth, and vertical and horizontal lines on the neck. However, they are also used to elevate the eyebrows, correct the downturned corners of the mouth, correct a “gummy” smile and relax the “bunny lines” that occur at the base of our nose.

As we age, our faces lose volume and fullness which is the hallmark of youth. Madonna’s full cheeks suggest she has also been treated with a temporary filler such as  Juvederm™, Perlane® or Restylane®.  These products are made from hyaluronic acid (HA).  HA is a naturally occurring sugar found throughout our bodies in the skin, eyes, kidneys and other areas.  Because they are manufactured in a scientific laboratory, and not isolated from animal or human tissues, they convey no risk of infection or allergic reaction.  These products are administered as a gel and help correct signs of volume loss such as hollowness beneath the eyes, heavy lines between the nose and upper lip, loss of fullness in the cheeks, thinning of the lips, vertical lines on the upper and lower lips, loss of projection of the chin, and downward turning of the corners of the mouth.

If you want a younger, more rested look, seek the advice of an experienced, board-certified specialist in oculoplastic surgery, facial plastic surgery, general plastic surgery or dermatology.  However, do not rely on certification alone.  Make certain you ask how many treatments the doctor has administered.

Filed under Madonna Super Bowl fractional laser resurfacing laser treatments Botox Dysport Fillers Restylane Juvederm

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Gwyneth Paltrow Is A Laser Fan

So Gwyneth Paltrow admits to being a fan of laser treatments, but doesn’t specify what type of treatments she prefers.  There is a great deal of confusion about laser treatments as there are so many devices from which to choose.  Here are a few critically important points to know if you are wondering if “laser surgery” is right for you:

  • Not all devices that can be used to produce cosmetic improvements are lasers.  In the strictest sense of the word, lasers refer to devices that produce a very special type of light energy.  Other popular devices include radiofrequency (Thermage), ultrasound (Ultherapy), intense pulsed light (IPL), and others.
  • When it comes to reduction of wrinkles and correction of sun damage, significant recovery time may be needed to accomplish as much improvement as you need if you have moderate or severe damage.  Mild discoloration and wrinkling can be corrected with less recovery time.
  • Laser hair removal is effective on dark hair only.  All skin types can be treated safely if the proper device is used by a skilled operator.
  • Noninvasive skin tightening can provide lifting and contouring but does not produce outcomes as dramatic as surgery.
  • Lasers and light devices can be used to treat red discoloration in the skin caused by birth marks, sun exposure, or conditions such as rosacea.
  • Lasers should not be used to remove eyebrow hair due to the risk of ocular injury.
  • Lasers can be used to remove tattoos, but some colors are more resistant to treatment than others.  9-12 treatments may be needed to obtain best results.
  • Lasers and similar devices are not the best treatment for melasma (mask of pregnancy) even though they are often advertised as such.
  • Noninvasive body contouring (fat layer reduction) can be achieved with some devices, but the outcomes are not as dramatic as liposuction.
  • When considering treatment with a laser or other device, approach your treatment like you would any other surgical procedure.  Do your homework as to the training, experience and track record of your doctor as carefully as you would if you were undergoing traditional surgery.  Obtaining good results with lasers and other devices requires as much or more skin knowledge, judgment, and experience as achieving a good surgical result so do not base your decision solely on factors such as convenience and cost.  

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