Saturday, October 17, 2015

What to expect in a CoolSculpting consultation

I met with a woman for the first time yesterday for a consultation about CoolSculpting. I'll call her Jane. After we had gone through everything, she shared  that she had had a consultation at a different clinic and that it had been a completely different experience. In fact, it was so different that I feel compelled to let people know what should be included in a consultation.

Here is what Jane experienced at the other place:
She was given something to read about CoolSculpting. She mentioned that she had watched a video about it on the internet at home. She was ushered into the office and the person meeting with her (a nurse? a doctor? a salesperson? we don't know) took one look at her (clothed) and said "I see you have a fair amount of fat to be removed so you should have the package of 10 treatments. You have to buy that package today to get the sale price."

Hmmm, no pressure there, eh?

Here is what should happen in a consultation:
  1. You meet with a healthcare professional. We review your health history and discuss anything that may be pertinent to your ability to tolerate the treatments and get excellent results.
  2. You receive a thorough explanation of how CoolSculpting works, including how the treatment is administered, the common and rare side effects and the sort of results you can expect. All of your questions should be answered to your satisfaction.
  3. The area the you want treated is properly assessed, including manually feeling the thickness of the fat. The CoolSculpting templates are applied to the area to plan the treatment.
  4. You review the planned treatments and the cost of the treatments. You might ask about different options such as proceeding with only part of the plan.
At Advanced Rejuvenation, planning the treatment includes making markings on the skin (with washable marker) to show where the templates would go and then we take a photo of the markings so we have a record of what was planned. We give you a copy of the plan.

It is unacceptable to tell someone how many treatments they need without examining them unclothed. A big belly could be due to fat under the skin but it could also be due to excess fat in the body cavity, under the abdominal wall. CoolSculpting only treats the fat under the skin so you need to feel the skin and the fat to be certain that the treatment will be effective.

It is not uncommon for me to meet with someone who is interested in CoolSculpting and determine that another treatment is much better suited to the problem that they want to address. For instance, if the person is actually more concerned about skin laxity than fat, I am going to recommend skin tightening instead.

In medicine, informed consent means that the patient is advised about the treatment, how it works, how it will be administered, the expected benefits, the expected side effects, the possible complications and the alternatives available. When you sign the consent form for the treatment, you are indicating that all of this has been explained to your satisfaction and all of your questions have been answered.

Clearly none of this occurred with Jane in her first consultation.

You shouldn't accept anything less than a thorough consultation. You should feel that all of your questions were answered before you decide to proceed with the treatment. Your consultant should be assessing the whole you before determining that the treatment is appropriate for you.

And don't let yourself fall for the whole pressure sales thing. If you are not ready to purchase, hold off and address whatever needs to be addressed. It is better to pay a little more and be in a safe, caring and professional environment than to commit to a rock-bottom price in the wrong environment.

Wednesday, September 30, 2015

Wrinkles? Sagging skin? eDermaStamp is the answer

You look in the mirror and see a new wrinkle. Your jawline has lost the tautness it used to have. What's happening?

Year by year, the amount of collagen in your skin is declining. As it declines, the firmness of the skin softens and the skin starts sagging into folds, wrinkles, jowls and bags. A number of things can make this process happen faster -- excessive tanning, smoking, severe illness -- but it feels like nothing slows it down.

I'm a huge fan of doing regular skin-tightening treatments -- treatments that build up the collagen in your skin -- in order to prevent progression and reverse the wrinkles and sagging that you already have. My favourite skin-tightening treatment is the eDermaStamp (eDS for short) and we do a lot here at Advanced Rejuvenation to make it really effective.

eDS falls into the category of microneedling. The key thing that you need to know about microneedling treatments is that there is a huge range of quality in the products being used to provide this treatment. We use the genuine device and supplies made with German precision by the German company Dermaroller GmBH. There are lots of imitators made in Asian countries but they are not made with the same quality and attention to detail.

How does microneedling work?

The needles are on the tip of a pen-like device that is motorized to make the needles go up and down. As we move the pen over your skin, the eDS is making little punctures in your skin (don't worry! you're completely numb before we start!). The punctures turn on all of your healing mechanisms, stimulating your skin to make collagen and new cells.

We apply our growth factor serum, TNS Recovery Complex, to your face during the treatment to help you heal faster. At the end of the treatment, we put a collagen mask on your face for 10 - 15 minutes to soothe and calm your skin.

How we take special care with your treatment

Our medical estheticians are highly trained: they must use advanced aseptic techniques to avoid infection, make the treatment pain-free and give you excellent results.

We customize the length of the needles for the type of skin we are working on. For instance, for the delicate skin around the eye, the needles are shortened; for thicker skin, the needles are lengthened.

We can treat all parts of the face, including around the eyes. To work around the eyes, we have to stay on the bony rim so we pull your skin up at the forehead or down at the cheek to get the skin of the eyelid onto the bony rim. I feel that this treatment is safer around the eyes than doing laser skin tightening. No eye protection is required.

Your needles are only used once and then discarded. I have heard of some clinics saving the dermaroller used on you the first time and reusing it on  you for your subsequent treatments. As the former Head of Infection Control and the Hamilton Civic Hospitals, I have grave concerns about this practice. I strongly recommend using a new set of needles each time.

The picture above shows the single-use needles. It also shows how the needles have a little bit of flexibility side-to-side so that, as the pen moves over the face, the needles slide cleanly out of the skin without any dragging or tearing. A lesser quality microneedling device can leave your skin looking like a slab of raw beef, bleeding and bruised (eew!). With Dermaroller's eDS, your skin may look a bit reddened afterwards but otherwise normal.

Here is a video showing how the treatment is done:  The model looks quite red during the treatment. The redness calms down a lot while the collagen mask is in place. For the majority of our clients, by the time they exit the treatment room, you can barely see any redness from the treatment.

About 3 weeks after the treatment, you will notice fine lines smoothing out, deep lines softening and an overall lift to your face so you have less sagging. Your skin is also smoother, your pores more refined and you have an increase in the overall radiance. You will continue to make new collagen for about 8 weeks after your treatment.

The eDS is excellent for reversing signs of aging. It is also highly effective against scarring.

The number of treatments that you need will depend on how advanced your problem is. If you have lost a lot of collagen in your skin, meaning you have a lot of wrinkling and sagging, I may recommend that you do 6 treatments in a year. For the average person in their 40s or 50s with average wrinkling and sagging, 3 treatments is enough for the first year.

After the first year of intensive treatments, maintenance will be 1 to 3 treatments per year, depending on what your skin is like.

Here are some Before and After pictures:

Saturday, May 23, 2015

Newly published study: Botox better than Xeomin

Botox is the original wrinkle-buster. It relaxes the muscles where it is injected so they can't form the folds in the skin that lead to wrinkles. Now Canadians have access to 2 more muscle relaxants: Xeomin and Dysport.

These 3 agents differ from each other in their composition, leading to differences in onset of action, ability to diffuse (move) through tissues and duration of action. As each new agent was introduced, there was confusion about how the dosage would need to be adjusted to give the same results as Botox.

This new study answers these questions. It is a well-designed study published in a peer-reviewed journal, The Journal of Plastic and Reconstructive Surgery.

They took 45 women and treated one side of the face with Botox and the other side with Xeomin. Both the injectors and the patients were blinded to which side was treated with what agent. The same dosage and location of injections was used on each side. Patients were treated in the frown area, forehead and crow's feet.

Patients were assessed and photographed at baseline, and at 3 days, 2 weeks, 3 months and 4 months after treatment.

The photographs were assessed by 3 physicians independently. The physicians were blinded to the treatment, meaning they didn't know which side was Botox and which was Xeomin. They all used the same rating scale and gave each area a score for the degree of wrinkling still present. The assigned scores were used for the statistical analysis of the results for the 2 agents.

KEY FINDINGS: they found that Botox performed slightly better than Xeomin for dynamic wrinkles. The degree of wrinkle reduction was slightly higher and the duration of the effect was slightly longer with Botox than with Xeomin. These differences were statistically significant.

One reason that may explain why Botox performed better than Xeomin in this study is that the dosages were relatively low. A total of 50 units was used to treat 3 areas (frown, crow's feet and forehead). The investigators cited scientific reasons for using Xeomin in a 1:1 ratio with Botox but other experts recommend 1.5 units of Xeomin for every unit of Botox. Underdosing can result in an insufficient degree of muscle relaxation and a shortened duration of action.

My recommendation if you are going to a clinic that offers Xeomin or Dysport instead of Botox is to make sure that your injector has lots of experience with these agents. Otherwise you may find that you are not getting the results you're used to seeing with Botox.

Saturday, May 9, 2015

Is "Botox in a bottle" for you?

The hot thing right now is a product that you apply to your face to instantly banish wrinkles and bags under your eyes. It goes by names like Instantly Ageless.

Here is what I understand about the basic principle of these types of products:

  • As we age, we lose the collagen and elastin in our skin that gave us the smooth firmness of youth
  • These products are polymers that act like collagen and elastin to firm up the skin. I think of them as stretchy fibres making a web across the skin. If your skin was like a layer over fabric lying over the framework of your face, these polymers are like adding a layer of Lycra to make the skin fit tighter and smoother.
  • These polymers are temporary, lasting only until you disrupt them (like rubbing your skin) or wash them off.
I had a look at Amazon where there were 108 reviews. The average rating was 2 stars. Most people were saying that the product works but only briefly. People found that the polymers could feel like a layer of glue on the skin, and could look whitish. They had difficulty applying makeup over top and found that the product could be disrupted very easily.

In my clinic, we are all about building the collagen and elastin in the skin through treatments and skincare so that you have smooth, firm, glowing skin all of the time. For me personally, I like getting up in the morning and knowing that my skin looks good without having to apply something.

I think these polymer products have their use if it's the last minute before a big event and you haven't had time to restore the collagen in your skin. I would use them with caution, finding out what makeup to use, keeping facial expressions neutral, and like Cinderella, leaving the event before the product starts flaking off.

However for the long term, I would strongly recommend having the rejuvenative treatments to build collagen and elastin in the skin and smooth out bags under the eyes so that you can be confident about your appearance all the time, with no restrictions.

Thursday, January 15, 2015

A filler that teaches your skin to redensify? Now that's smart!

Teosyal has taken hyaluronic acid fillers to a new level with the Redensity I and Redensity II products.

They have added vitamins, minerals and amino acids to the fillers in a combination that has been scientifically proven to stimulate your body to make new collagen in the injection areas. That means long-lasting rejuvenation: your skin will be smoother and tighter, lines will be softened and volume will be restored to thinning tissues.

I am particularly excited to use these products in those delicate areas that require a lot of care, like around the eyes, the tear troughs below the eyes and the lines around the mouth. I have even used Redensity in the lips themselves to create a softly plump lip and to boost hydration of the lips.

Redensity II is a little bit stiffer than Redensity I so it is used to fill wrinkles and restore volume. If people keep asking you why you look so tired, imagine getting rid of the dark hollows under your eyes and smoothing out your crows feet. You will look refreshed and rejuvenated.

Redensity I is used to rejuvenate the skin itself and is injected into the outer layers of skin. Redensity I is an excellent product for rejuvenating the neck and the skin of the face. It changes dull, dry, thin, lax skin into firm, hydrated and radiant.

In 2014, both Redensity I and Redensity II won Anti-Aging and Beauty Trophies, Best Injectable Skin Revitalizer and Best Filler, respectively.

Saturday, September 20, 2014

What's in a name?

I remember feeling so disillusioned when I discovered that the name of a product was just that, a name, and didn't necessarily describe the quality of the product.

For example, if you see Tree Ripened Oranges, it doesn't mean they were ripened on the tree. The brand is Tree Ripened.

I always think about that when I buy hot dogs for my husband. If they're called All Beef Weiners, does that mean they're only made from beef meat? Not necessarily, if All Beef is the brand name. And not to mention that hot dogs are where all the bits and pieces of the animal go that aren't suitable for the table so everything gets ground up, guts, gristle and all, and made into hot dogs.

Sometimes I like to play a little game of guessing what the name really means. For instance, I got an email from Sephora this morning that touted Josie Maran Argan Black Oil Mascara. The copy in the ad states that it contains 100% Pure Argan Oil (sic). Does that mean Pure Argan Oil is a brand name? I'm not sure. The use of capitals could indicate a brand rather than the generic ingredient since the rest of the copy was capitalized.

And why do they call it Argan Black Oil? Argan Oil isn't black and they state that they add iron oxides to make the mascara black. Maybe the name is supposed to make you picture yourself applying black oil to your lashes? That doesn't appeal to me, sorry.

The copy on the website implies that this mascara is made of argan oil, bamboo extract and iron oxides -- just like the Egyptians used to use! (The Egyptians also used cow dung cosmetically but let's not go there.)

Here's the ingredient list:
Water, Beeswax, Sucrose Stearate, Propanediol, Cetearyl Alcohol, Rice Bran Wax, C18-36 Acid Triglyceride, Acrylates/Ethylhexyl Acrylate Copolymer, VP/Eicosene Copolymer, Phenoxyethanol, Hydroxyethylcellulose, Myrica Pubescens Fruit Cera (Myrica Pubescens Fruit Wax), Silica, Panthenol, Organic Argan Kernel Oil, Ethylhexylglycerin, Laureth-21, Glycerin, Bambusa Vulgaris Leaf/Stem Extract, Potassium Sorbate. May Contain: Iron Oxides (CI 77499).
Organic Argan Kernel Oil is in there, at #15. Myrica pubescens fruit wax comes before argan oil. (Myrica pubescens is a fruit tree in the bayberry family.) So why didn't they call it Myrica Black Oil Mascara?

Bamboo comes in at #19.

The listing of the iron oxides is weird. Why does it say May Contain: Iron Oxides last? Being last implies that it is the ingredient in the lowest concentration. Wouldn't that make your lashes grey instead of blackest black? I don't see anything else on the ingredient list that looks like a black pigment so I presume the iron oxides have to be present.

This mascara may be completely fine and safe for your lashes but it certainly isn't the compound that the ad copy touts it to be. The benefits of the product may well be due to the other ingredients rather than the argan oil and bamboo extract. Silica and panthenol (vitamin B5) are nutrients that improve hair, after all.

What I like about the products that I offer here at Advanced Rejuvenation is that they all have science backing them up. I am given the scientific data with the concentrations of the star ingredients and data on the effects of the products in real people. Because the products are medical-grade, they fall under the supervision of Health Canada and are required to contain clinically-effective concentrations.

Less hype, more proof. That's why I like.

Saturday, July 12, 2014

Do Your Hands Look Old?

Our hands age just as our faces do. The key is to look at our hands and determine what is making them look old or unattractive.

If the tendons and veins are getting too prominent, you are losing the softening layer of fat on the backs of the hands. It is easy to inject a dermal filler under the skin to create last softness in the back of the hands.

The dermal filler that I think is ideal for hands is Radiesse. Radiesse is composed of microspheres of calcium hydroxylapatite, which is a compound found naturally in the body. The calcium microspheres are gradually broken down in the weeks after the injection and replaced by new collagen made by your tissues. Radiesse is really good for creating a smooth layer of softness under the skin and filling in the indentations between tendons. Generally one syringe of 1.5mL is sufficient to do both hands. The results last about a year.

Another effect of age on the hands is the accumulation of brown spots, also called liver spots. They are generally caused by sun damage and are usually accompanied by roughness. The best treatment for getting rid of brown spots is the Intense Pulsed Light (IPL) treatment, also called the photofacial on the face or photorejuvenation. However a series of 5 to 8 treatments may be required so I like to combine IPLs with chemical peels to get better results with fewer treatments.

The chemical peels exfoliate the outer layers of pigment (brown spots), allowing the light to penetrate deeper. When we do a shot of IPL light on the surface of the skin, the light only penetrates until it hits pigment and then it is absorbed and can go no deeper. Thus it makes sense to use a treatment that is comfortable and well-tolerated on the body like a chemical peel to remove the outer layers of pigment so the more intense treatment is more effective. The chemical peel will also improve the texture of the skin.

You will see improvement from the very first treatment and need a series of treatments to significantly reduce all of the brown spots. The results are very long-lasting unless you continue to expose your hands and arms to the sun. I strongly recommend the use of sunscreens and protective clothing to avoid the recurrence of brown spots.

Skincare products are very helpful in making hands look more youthful. I'm not talking the pump of hand lotion that we used to use. The old hand lotion was essentially an emulsion of oil and water that gave a temporary effect of smoothness that was more about making the skin slippery than improving the actual health of the skin.

I like to use good exfoliants on my hands, such as SkinTx's Exfoliant Forte, to remove dead skin and reveal younger-looking skin. For brown spots, a lightening agent such as Vivier's SeeQuin, which is a combination of medical-grade Vitamin C and Hydroquinone will block pigment production in the brown spots. It has the added benefit of increasing collagen production in the skin (Vitamin C is essential for collagen production) making the skin firmer and tighter. It will generally take 6 to 12 weeks to see the full effects of these products on the body and around 6 weeks on the face.

If you would like to make your hands look younger and feel smoother, please contact us at 905-340-0401 to find out what products and treatments would help you.

We are doing a special promotion on hand rejuvenation treatments until August 16, 2014.

Thursday, June 26, 2014

I never get emails from you any more!

If you've stopped getting our electronic newsletters and mailings, here's why: Canada's new Anti-Spam Legislation goes into effect on July 1st, 2014. That means that Canadian businesses can no longer send out newsletters and emails to friends and clients for marketing purposes without confirmation that the recipient desires to be on our mailing list.

We sent out an email a few weeks ago asking you to confirm your preference to remain on our mailing list. If you didn't reply to that request, we can't email you. If you would like to continue receiving email from us, you can click on the button in the upper right hand corner of this page to subscribe to our mailing list. You will get an email asking you to confirm your preference to be on our list -- this is called a double opt-in.

You can also stay up to date with us by liking us on Facebook.

We look forward to continuing our conversation with you!

Saturday, January 18, 2014

Permanent fillers can mean permanent problems

Stacey Hohn, 41, shared with the Daily Mail her disfigurement following permanent fillers.

I have seen a few other women in my own practice with similar problems following permanent fillers. Permanent fillers include such products as Dermalive and DermaDeep, Artecoll and Artefill. Dermalive in particular is notorious for causing disfiguring nodules and it can be reactivated by any procedure. The general advice to cosmetic physicians is not to do anything to someone who has had Dermalive injections, as any treatment may cause nodules to develop.

Surgery may not even provide the solution in some cases. It can be difficult to excise every little bit of Dermalive because it has a tendency to spread through the tissues. Any residual product left behind after surgery can cause nodules to develop again.

The other reason to not choose permanent fillers is related to how our faces change over time. Our facial bones actually shrink and change shape as we age so a filler that looks perfect now may not be in the right place in 10 years.

My recommendation is to use fillers that may last anywhere from 1 to 5 years. Avoid permanent fillers. Go to the most skilled injector you can find. If you have a friend who looks amazing, ask her quietly and privately if she knows of a good medical spa.

Saturday, November 9, 2013

Sore eyes?

Did you know that most mascaras contain tar and alcohol? I didn't, until recently. gloMinerals Makeup has changed their mascaras to eliminate tar and alcohol from their formulas. I recently started using glo Lash Boosting Mascara (they also have a water-resistant formula) and I'm finding that I don't have the chronic mild irritation that I used to live with. Obviously, not every case of eye irritation is caused by mascara. However, if your eyes are otherwise healthy but you have some degree of soreness, you might try changing to a non-tar containing mascara.