According to an opinion piece published in JAMA Dermatology, when considering the appropriate ages for aesthetic procedures, the question isn’t so much “What age is too young” as it is “What age is too old?”

In that edition’s Viewpoint feature, the authors write that deeply-etched facial lines that develop as patients age “are caused by repeated folding of the skin and include lines of facial expression and sleep lines,” and that in young adulthood these lines predict “the unique pattern of facial wrinkling that will be seen without expression years later.”
Regular treatment with a neuromodulator when patients are in their 20s or 30s will minimize etched facial lines by the time they’re in their 40s and 60s. They cite the case of identical 38-year-old twin sisters. One began regular botulinum toxin (Botox) injections in the forehead and glabella when she was 25, while the other got injections in the same areas just twice over seven years. They write that while lines glabella and forehead lines were visible at rest, they were not visible in the regularly treated twin four months after her last treatment.
“This observation suggests that regular treatment with a neurotoxin, beginning in young adulthood, can prevent the development of etched-in lines. So there really is rarely a time that is too early. Perhaps the better question is, ‘When is it too late?’”
CST Trends asked two doctors to give their opinions on the issue concerning when is “too early” to begin aesthetic treatments.
“I basically agree with the opinions of the authors but also understand the biopsychosocial implications that may be argued by those who disagree,” says Joe Niamtu III, D.M.D., a Richmond, Va., specialist in facial cosmetic surgery. “I can guarantee that you will see some negative feedback on this viewpoint article, with the opposition saying that we are creating a society of ‘plastic’ people who can’t deal with the normal process of aging … I can see both sides of the argument.”
Dr. Niamtu says he thinks the real “take-home point” of the article is that while preventive treatment can influence the future appearance of aging, “treating younger patients has positive and negative benefits that reach beyond the needle. There are clearly some patients that would benefit from treatment at a younger age and others who would suffer body-image issues if they did do it or wanted to do it and could not afford it.
“The other very important piece of this discussion is that we could not discuss this topic 20 years ago, as there were basically no fillers, neuromodulators or light- and energy-based therapies,” he adds. “I think that the current discussion will become lost in time because in another 20 years we may have easier and more effective treatments that are more effective and preventive and may be highly used by younger patients.”
Joel Schlessinger, M.D., a dermatologist and cosmetic surgeon in Omaha, Neb., concurs with the viewpoint authors.
“I agree wholeheartedly with the authors,” he says. “Sadly, most people take the opposite viewpoint, waiting until it is too late, as the authors comment, and either missing the opportunity to have a full correction or even any chance to have a significant change. On the other side of the equation, there clearly are individuals with body dysmorphic syndrome, who have no issues at all and undergo multiple surgeries in pursuit of a ‘better’ look. This is something that all dermatologists run into at one point or another.
“Overall, it is best to have a discussion with the individual and prepare a plan of action and an ongoing concept of how to diminish signs of aging over time,” Dr. Schlessinger says. “This approach is highly successful and leads to less intervention in later years and, surprisingly, less expenditure over the years.”

 

Dermal fillers are versatile tools for perfecting facial contours.
INJECTABLES ACCOUNT FOR MORE THAN HALF of the minimally invasive procedures performed today. Before Restylane (Medicis, restylaneusa.com), the first non-animal-based hyaluronic acid (HA) dermal filler, was introduced in the United States in 2003, botulinum toxin (Botox) was the most popular injectable in aesthetic medicine. Today, Botox has taken a backseat in growth to HA injections, which have increased to more than 1.3 million procedures per year.
As the demand for fillers has increased, the materials have too. Finding the right dermal filler is like choosing the right brush if you’re a painter. A free-flowing hyaluronic acid gel may be the perfect tool for painting a plumper lip, while a thicker filler with a higher molecular weight may serve you best for adding definition to the chin or cheekbones.

Choosing Your Tools

While today’s HA fillers are all non-animal sourced and stabilized, they do have some important differences, including the manner in which the molecules are cross-linked, the particle size and their affinity to bind water (hydrophilic properties). These distinctions determine a filler’s hardness or resistance to deformation. Picture squirting out the contents of a tube of toothpaste. If the paste retains its shape without flattening, the material reflects a high G prime; a runny liquid that rapidly loses its peak formation has a low G prime.
Restylane (Medicis, restylaneusa.com) demonstrate stiffer qualities, which translates to a higher lift capacity. The stiffer quality of these fillers provides not only lift but also structural support. These would be more suited for creating a cheekbone, increasing chin projection or temple lifting.
Other fillers, like Juvederm (Allergen, juvederm.com), are softer materials that are ideal for filling lips, nasolaboial folds and finer lines.
Juvederm, one of the more hydrophilic fillers, is a popular tool for imparting a soft shape around the lips but is not as well suited for treatment around the eyes. Restylane, which is not quite as hydrophilic, might work better for treating the tear troughs and the nasojugal folds.
For defining the border around the lips or filling fine lines, both Restylane and Juvederm are good choices. Many physicians prefer the softness of Juvederm for filling the lip.

Typically, HA fillers can last anywhere from six to 12 months. Expect fillers to dissipate more quickly in areas subject to more motion, such as the lips, where they generally last five to eight months. In more stationary areas, such as cheekbones, effects can last up to 12 months. In the periorbital area, treatments with HA fillers have been reported to last as long as two to three years.

Collagen-Stimulating Volumizers

While HA fillers are a top choice for specific indications, such as fine lines and icepick acne scars, collagen-stimulating fillers, such as Radiesse (Merz Aesthetics, radiesse.com) and Sculptra (Valeant Aesthetics, sculptraaesthetic.com), can help create volume across a larger region with results extending to 24 months or longer.
The stiffer quality of these fillers provides not only lift but also structural support.

Managing Complications

With modern HA fillers, the potential for allergic reactions is very low, and no skin testing is necessary. That said, injecting fillers can yield potentially significant complications if not managed properly.
The most common complications are bruising and swelling at the injection site, which can last up to a week. To reduce bleeding and bruising, ask patients if they are taking any anticoagulant medications or supplements, including ibuprofen, aspirin, fish oil, omega-3, vitamin E and herbal supplements, including ginkgo biloba, as these may induce more bleeding.
Another common problem is injecting too much of a product or injecting into the wrong plane. HA fillers are somewhat forgiving in that you can use the enzyme hyaluronidase to dissolve the HA when patients are not pleased with the results. This not true with non-HA fillers, such as Radiesse, Artefill and Sculptra.

The Future Of Fillers- Juvederm Voluma XC

Though dermal fillers have been part of cosmetic medicine for almost 30 years now, there are still some truly innovative materials entering the market. Voluma XC (Allergan, allergan.com), an HA filler, will soon offer U.S. patients effects that last 18 months or more and a high G prime for more lift and fill with less product.
JUVÉDERM VOLUMA XC injectable gel is the first and only filler FDA-approved to instantly add volume to the cheek area. Juvederm Voluma is the Juvederm specialty product for volumizing. It is designed for injection in the deep dermis to treat age-related facial volume loss. Voluma has the optimal thickness of a volumizer while still retaining the smooth nature of the Juvederm family.
It gives you a subtle lift, helping to restore contour and for a more youthful profile, for up to 2 years, in patients over the age of 21. It’s different than JUVÉDERM® XC and works on a different area of the face. JUVÉDERM® XC smoothes out moderate to severe wrinkles and folds around the nose and mouth, like parentheses. JUVÉDERM VOLUMA XC, however, adds volume to the cheek area.
As new fillers continue to come to market, the trend toward specialized products that treat specific concerns and regions of the face continues to grow. In the future, physicians can look forward to a growing variety of materials that smooth, volumize and fill the skin with fewer complications and longer results than ever before.

Dr. Mark Bishara offers minimally invasive procedures, such as injectables- for patients. These treatments are designed to provide subtle enhancements that can improve your targeted problem areas, while allowing you to return to work and your regular activities the very same day. Dr. Bishara is proud to offer a wide range of enhancing, minimally invasive procedures such asBotox, Xeomin, Juvederm Ultra Plus XC and Radiesse.  Juvederm Voluma XC will be available soon. We will keep you updated or call our office for more information at (817) 473-2120.
 

 

The US Food and Drug Administration (FDA) has approved Juvéderm Voluma XC(Allergan) to correct age-related volume deficits in the midface in adults aged 21 years and older, the company has announced.

Juvéderm Voluma XC is a gel composed of cross-linked hyaluronic acid suspended in phosphate-buffered saline with 0.3% lidocaine. It is the first dermal filler approved in the United States specifically for deep (subcutaneous and/or supraperiosteal) injection for cheek augmentation to correct age-related volume deficit in the midface.
As reported by Medscape Medical News, the FDA’s General and Plastic Surgery Devices Panel unanimously agreed that Juvéderm Voluma XC is effective and safe and that the benefits outweigh the risks, according to the clinical trial data presented to the panel.
“As people age, the cheek area can lose volume, causing the cheeks to flatten out and the skin to droop and sag,” Derek H. Jones, MD, said in a company news release announcing the approval. Dr. Jones is associate professor of dermatology at the University of California, Los Angeles; founder and medical director of Skin Care and Laser Physicians of Beverly Hills; and clinical investigator in the Juvéderm Voluma XC pivotal study.
In the study, “physicians and patients were able to see instant and visible results, including correction of age-related volume loss in the cheek area and a more youthful appearance to the face,” Dr. Jones said.
JUVEDERM VOLUMA(TM) XC is made with Allergan’s proprietary VYCROSS(TM) technology, an advanced manufacturing process that results in a smooth gel that flows easily and consistently. This unique formulation contributes to the lift capacity to correct volume loss in the cheek area and to the duration of the product.(2,3) Additionally, JUVEDERM VOLUMA(TM) XC contains a small amount of lidocaine which helps to numb the treatment area during the injection procedure. The JUVEDERM VOLUMA(TM) formulation without lidocaine was first introduced in Europe in 2005. JUVEDERM VOLUMA(TM) with lidocaine was first introduced outside the U.S. in 2009. As of August 31, 2013, JUVEDERM VOLUMA(TM) with lidocaine (branded as JUVEDERM VOLUMA(TM) XC in the U.S.) is distributed in 72 countries, including markets in Europe, Latin America, Middle East, Asia Pacific, and Canada. The JUVEDERM(R) family of products, including JUVEDERM(R) Ultra and Ultra Plus, are marketed and sold in 85 countries outside the United States.(4)
The most common adverse effects observed in the clinical trial included temporary injection-site tenderness, swelling, firmness, lumps/bumps, bruising, pain, redness, discoloration, and itching. The adverse effects were predominantly moderate (uncomfortable) in severity and lasted 2 to 4 weeks.
Juvéderm Voluma XC will soon be available at Dr. Mark Bishara’s office.  We will keep everyone updated when the product will be available in both of our Mansfield and Southlake offices.
This news is brought to you courtesy of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa


 

What is JUVÉDERM VOLUMA™ XC injectable gel?

JUVÉDERM VOLUMA XC injectable gel is the first and only filler FDA-approved to instantly add volume to the cheek area.Juvederm Voluma is the Juvederm specialty product for volumizing. It is designed for injection in the deep dermis to treat age-related facial volume loss. Voluma has the optimal thickness of a volumizer while still retaining the smooth nature of the Juvederm family.
It gives you a subtle lift, helping to restore contour and for a more youthful profile, for up to 2 years, in patients over the age of 21. It’s different than JUVÉDERM® XC and works on a different area of the face. JUVÉDERM® XC smoothes out moderate to severe wrinkles and folds around the nose and mouth, like parentheses. JUVÉDERM VOLUMA XC, however, adds volume to the cheek area.
What else should you know about JUVÉDERM VOLUMA XC?

  • First and only Hyaluronic Acid (HA) filler FDA-approved to instantly add volume to the cheek area, resulting in a subtle lift
  • Clinically proven to last up to 2 years with optimal treatment
  • JUVÉDERM VOLUMA XC is from the makers of the #1 family of fillers
  • After 24 hours, you should be able to resume your normal activities
  • Side effects are moderate and generally last 2 to 4 weeks. Common side effects include temporary reactions at the treatment site such as tenderness, swelling, firmness, lumps/bumps, bruising, pain, redness, discoloration, and itching.

Hyaluronic Acid (HA) is a naturally occurring, hydrating substance found in your skin. As you age, you start to lose HA, which causes the skin to lose structure and volume.
Dr. Mark Bishara offers minimally invasive procedures for patients. These treatments are designed to provide subtle enhancements that can improve your targeted problem areas, while allowing you to return to work and your regular activities the very same day. Dr. Bishara is proud to offer a wide range of enhancing, minimally invasive procedures such as Botox, Xeomin, Juvederm Ultra Plus XC and Radiesse.  Juvederm Voluma XC will be available soon. We will keep you updated or call our office for more information at (817) 473-2120.
Rewards Program:
Dr. Bishara and The Paragon Med Spa are proud to offer the Brilliant Distinctions Program for our patients. All you have to do is earn points for your purchase from our particiapting providers, including Botox and Juvederm.  Then start saving by redeeming points per treatment for instant savings off your next purchase.
For example:  For 1 Botox/Juvederm cosmetic treatment you earn 200 points (a $20 Value)
For more information on participating in this program visit https://www.brilliantdistinctionsprogram.com
 

Shopping malls and airports aren’t the only places that see more action around the holidays. This is also the time of year that merry-makers crowd the offices of plastic surgeons everywhere. Whether it’s because people can take extra time off for recovery, or because they want to be in top form for parties, plastic surgeons struggle to keep up with demand in November and December. However, there’s a few things you should keep in mind before booking your pre-holiday procedure.  At the office of Dr. Mark Bishara- we want you to take time to think about any procedure, whether it is during the holiday season or any other time of year.

holiday party
Party Perfect
Holiday parties and family gatherings, while fun, can be pretty stressful. You often see people you haven’t seen in a long time or those you’d like to impress. You splurge on new clothes, get your hair done and dissect your appearance in the mirror, your eye immediately drawn to what you don’t like. We’ve all been there. This added pressure leads many to take a proactive approach and seek cosmetic surgery.
It’s common for those considering cosmetic procedures to be motivated by the opinions of others. Though this is an understandable desire, we encourage patients to think about their own perceptions of themselves above all else. Showing up your snobby cousin over Christmas dinner or attracting a cute colleague at the holiday work party might not be the right reason to undergo major surgery. The decision should be about self-perception, with the understanding that a change to one’s appearance is not life-changing in itself.
Realistic Recovery
Another reason many choose this time of year for their surgery is the fact that it may be easier to take time off from work to recover. However, patients should be realistic about recovery times when considering having a procedure done during such a busy period. Though many surgeries only require a few days of rest, it’s important to err on the side of caution when it comes to recuperating in time for important events.
Though you can recover from a breast augmentation or liposuction over a long weekend, it’s normal for patients to experience some soreness for a few weeks after these procedures. On the other hand, recovering from more invasive procedures, like tummy tucks, can take up to a month.
What may normally seem like effortless tasks could become challenging or even painful when you’re recovering from surgery. Patients may be determined to have a procedure done in time for holiday fun, but they should be realistic about how the surgery will impact their everyday lives for a little while. The last thing you want is to be restricted by a surgery that was meant to increase your enjoyment of the season.
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Good options for those who want a beauty boost without the recovery are Botox and dermal fillers. At the office of Dr. Bishara & The Paragon Med Spa we offer, Botox, Xeomin, Juvederm Ultra Plus XC, Radiesse…..and soon the new Juvederm Voluma XC. These in-office, non-invasive procedures won’t put you out of commission for important holiday events. Dermal fillers are great for giving a bit of extra volume to lips, minimizing the appearance of wrinkles and enhancing contours. And Botox can be the perfect solution to wrinkles, crows feet and those pesky frown lines. Both procedures have immediate payoff and zero downtime, which may make them a better choice for those with packed calendars.
Other great options for short or no recovery time for the holidays are laser services, including laser hair removal, IPL fotofacials, VI Peel, skin resurfacing, skin tightening and skin remodeling.  You can also do a quick microdermabrasion or facial treatment during your lunch hour to look refereshed for your holiday events.
We all know that the holiday season ends in a new year, full of resolutions. This time causes many to seek change, both inside and out…which can result in packed plastic surgery waiting rooms. It can be tempting to try to squeeze in a procedure in time for that Caribbean cruise or the return to work, but make sure that whatever you decide allows you to enjoy the season to the fullest.
Please call our office at (817) 473-2120 if you would like to speak with someone about scheduling an appointment so you can look refreshed for the holidays.
 

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