January 7th, 2010
The perfect eyebrows
New York, NY:
The perfect brow is club-shaped centrally then tapers along the tail with the center portion beginning at a vertical line drawn upward from the edge of the nostril. The tail extends to a line that runs from the corner of the nose through the corner of the eye. The height of the brow should be equal at both ends; typically at or just above the rim of the eye socket. Generally, in women, the brow should arc delicately with the highest peak between the corner of the iris and the corner of the eye. The male brow should rest on or at the rim of the eye socket and is more horizontal in shape. Aestheticians commonly use the “pencil trick”* to guide them in eye shaping. The skin portion between the brow and the eye should be smooth and have a youthful fullness, with little excess skin and no over-hang of the skin. This leaves a nice platform to apply eye shadow without flaking or cracking.
Center
- Peak of brow
Tail of brow
All the above is well and good for teens and models, but as we age, the brow may flatten and droop as well as deflate. There are a number of non-surgical as well as surgical techniques to rejuvenate an aging eyebrow. Eyebrows can be elevated non-surgically by the use of expertly placed Botox. Not only can brows be lifted, but shaped as well. Crow’s feet can also be smoothed. Sometimes it’s more a deflation of the eyebrow instead of drooping. In that case, fillers such as Restylane or Juvederm can be used to restore youthful fullness that mimics a browlift but actually doesn’t lift the brow.
When is surgery necessary? When there is significant wrinkling and redundancy of the eyelid skin, which may be due to excess skin or drooping of the eyebrows. If the brows are in good position and the overhanging skin doesn’t extend far beyond the corner of the eye, a blepharoplasty is the best solution. When the excess skin goes well past the eye, that means that the brow has dropped; a browlift is more helpful. Another way to tell if it is the brows or eyelids that are the problem: if you look worried, sad or angry it’s more likely due to a brow problem. If you look tired it’s usually more from the eyelids. Another way is to pull out photos of yourself from your mid 20’s, and check where your eyebrows once were.
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November 30th, 2009
Treating Crows feet and more with Botox
Treating crows feet comes with relative ease since the arrival of Botox
New York City, NY - One of the first areas to show the signs of aging is the crows feet area. These are the lines that are adjacent to one’s eyes. We all have some lines when we smile but and the lines remain when the smile is long gone, it may be time to do something about them. Maybe this is why oversized sunglasses are so popular; for the younger set sunglasses can help prevent lines and cover them in the older set.
Thank goodness we have Botox. Years ago, we used to inject collagen filler into these lines. Unfortunately, this skin is so thin and delicate, that no fillers are really useful and can leave behind both lumps and serious bruising. While many very popular creams and lasers are touted to remedy crow’s feet, if the cause isn’t addressed (overactive underlying muscle) all these treatments will be ineffective. Botox relaxes the thin circular muscle around the eye called the orbicularis oculi muscle. The skin is less compressed with smiling and squinting so most of the lines go away. However some lines will always remain. If you push your cheek up to simulate a smile, a few lines still form from the skin being bunched.
As an experienced Botox physician, we can extend treatment to adjacent areas. The tail of the brow can be raised in many patients creating a “Botox browlift.”
Browlift with Botox only
Deep lines under the eyes can also be treated… however they should be treated with caution. If a patient has a weak eyelid, the eyelids can become droopy. Also, the orbicularis muscle may be the only layer left holding back lower eyelid fat from pouching out. If you have early “eye-bags” then you might not be a candidate for treatment within this area of the eyelid. I caution all patients who are treated in this area of the eyelids and find that about 1 out of three do not repeat treatment under the eyes.
Some patients even have lines extending down their faces from and below the crow’s feet. Now that we are getting into the mid-face area, Micro-Botox is a better solution. Very tiny amounts are used to help the superficial lines but not change the smile.
Lastly, relaxing the muscle needs help with the overlying skin. Quality skin products such as TNS and rejuvenating eye creams work very well with Botox beneath. Many of the popular over the counter creams make amazing claims but produce little results.
Steven J. Pearlman, M.D., F.A.C.S.
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October 16th, 2009
Dysport has been around in Europe almost as long as Botox. Recently it was FDA approved for cosmetic use in the U.S. for glabellar lines. These are the “angry 11’s” or frown lines between the eyebrows. Intentionally, this is the same area that Botox Cosmetic is approved for. Any other cosmetic uses, such as horizontal brow lines, crows’ feet, eyebrow lifts, raise down-turned corners of the mouth, plus loads of other uses, are called “off label.” What this means is that treatments for anything other than frown lines, is up to the doctor to explain to patients that the use is off label, but given the doctor’s professional experience and knowledge they are using the drug in a non-approved yet acceptable way. Off label issues was recently addressed in the NY Times by Natasha Singer.
So, what are the differences? Botox is now formally called anabotulinum toxinA and Dysport is abobotulinum toxinA. I won’t bore you with the technical stuff; these are very similar molecules and most importantly both are Botulinum Toxin Type A. Other Botulinum toxins are currently being investigated, but none have been found to be as effective and have as low a side effect rate as Botulinum Toxin Type A. Clinically, the new kid on the block is always touted as being better. Every new filler company says their filler lasts longer and in the long run, most didn’t. I polled my neurotoxin “guru” at the recent AAFPRS meeting, plus attended the new technology session. Their take is that the effects of Dysport may come on earlier and may last longer than Botox. However, Dysport may also have more diffusion. What that means is that there is slightly more spread from the point of injection. This occurs with Botox as well, but for both I use a very low dilution so spread with either should be minimal.
Will I switch? I had my official training from the Medicis Company for Dysport yesterday. I treated four loyal, astute patients. I will follow them and see for myself how fast it worked and how long it lasts on them, also if they note any differences. What my guru said was that it’s like Restylane and Juvederm, we first had only Restylane and once Juvederm came on the market I found that each has specific advantages and learned which one to use for each individual patient and area of the face to get the best results. I will keep you posted.
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April 27th, 2009
It has been well documented in the plastic surgery community that when people have cosmetic surgery or minimally invasive procedures, it improves self confidence, often beyond the aesthetic improvement seen by others. Given the current recession, aesthetic enhancement has become even more important for more people. I have a number of patients who are looking for new jobs in the work place. The competition is typically younger, less experienced candidates. My patients desire to look as young on the outside as they feel on the inside. I was quoted on Yahoo.com as well as in a live interview on CNBC, Thursday April 9 on the subject of people seeking cosmetic facial surgery to compete in the job market.
For example, a recent patient is a very energetic, young appearing, 60 something year old woman. She is looking for a new job in publishing. Publishing is a very youth oriented business. She underwent a facelift and blepharoplasty. She looks and feels great. This has given her new vigor and she admittedly finds that she has renewed vigor when going on interviews. She intends to send me the “good news” when she gets that publishing industry job.
Minimally invasive procedures, such as BotoxR and facial fillers are quick, easy fixes for looking refreshed. I have a number of patients who get BotoxR to smooth the furrows between their brows, often called the “angry 11’s.” In business, they felt that it made them look worried; that their portfolio, investment or business deal was being questioned, when it really was only overactive brow muscles. Relaxing these muscles relieves this harried appearance. The same applies to people going for job interviews, if you appear worried, it can undermine inner self confidence. You want to look cool and confident, smooth and ready to take on any challenge.
To reiterate my quote in Yahoo.com “People are fed up and are starting to figure that it’s time to live a little. Cosmetic surgery is about investing in yourself. It makes you look good and feel better about yourself, a dozen times a day when you look in the mirror.”
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