A Board Certified Plastic Surgeon in Scottsdale
Posts tagged wrinkles
Radiesse®: A versatile dermal filler.
31 year ago
Scottsdale – I continue to be impressed by how versatile Radiesse® has become over the last few years. Plastic surgeons are now injecting Radiesse® in:
- Nasolabial folds or laugh lines.
- Marionette lines.
- Cheeks.
- Submalar or below the cheek
- Nose correction.
- Jaw Line and Jowls.
- Mental Crease & Chin.
- Oral Commissure or corners of the mouth.
- Temporal Hollows.
- Hand Rejuvenation.
Radiesse® is a wrinkle filler that is a safe and FDA-approved for moderate to severe facial wrinkles and folds such as nasolabial folds. Radiesse® wrinkle filler fills and volumizes to correct the signs of facial fat loss and restore a natural look. Radiesse® wrinkle treatment is now FDA-approved to enhance patient comfort with our Accessory Kit for lidocaine mixing. In a recent clinical study, 90% of patients reported significant pain reduction using Radiesse® wrinkle filler mixed with lidocaine.
Nia 24 – Protection For Tough Times…
01 year ago
by Dr. Aldo
in Facial Surgery
Scottsdale – This summer in Arizona is going to be a hot one! When exposed to the sun’s UV radiation, our skin can really take a beating. Let me recommend the Nia 24 line-up of products to protect and restore your skin from sun damage.
Use your Nia24 Skin Strengthening Complex Repair Cream in the morning and at night. Apply a dime-size amount on face and neck. Avoid eye contact. Nia24 is known for being just right, not neither heavy nor too light.
Nia 24 is fortified with key ingredients to visibly reduces the appearance of fine lines and wrinkles by enhancing the barrier function of your skin, accelerating repair and delivering continual moisturization.
Skin Strengthening
Complex Repair Cream
NIA 24™ Benefits
- Clinically shown to improve skin tone, texture and hyperpigmentation.
- Strengthens the skin barrier.
- Delivers continual moisture.
- Wrinkle treatment that reduces fine lines and wrinkles.
- Improves elasticity for smoother, firmer skin.
- Soothes and protects the skin.
NIA 24™ Key Ingredients
- 5% Pro-Niacin allows for conversion of nicotinic acid into NAD, which plays a central role in energy metabolism. NAD helps repair, promotes skin cell generation and stimulates the release of leptin.
- Green tea, a powerful antioxidant soothes the skin.
- Rosemary has anti-inflammatory properties and provides antioxidant protection from environmental damage.
- Ceramides reinforce the skin barrier to maximize the moisture-holding capacity.
- Evening Primrose Oil instantly soothes and hydrates the skin.
- Wheat Germ Oil hydrates and moisturizes.
- Vitamin A helps to improve elasticity and skin texture.
Nia 24 is available only through your physician’s office. Please contact us at the AB Guerra Plastic Surgery Center for more information.
Dermabrasion: Achieving Excellent Results.
11 year ago
by Dr. Aldo
in Facial Surgery
Scottsdale – Last month we introduced a blog post on dermabrasion, a plastic surgery procedure used to improve the appearance of the skin and reduce wrinkles and other signs of aging.
Dermabrasion involves the mechanical removal of the damaged top layer of the facial skin using a high speed rotary wheel. Dermabrasion is performed using a hand-held engine that can reaches a rotation speed of 18,000–35,000 rpm. Rapid planing of the skin is achieved through the combination of this rotation speed, the abrading device, and the pressure applied by the operator. This technique is one of the best wrinkle treatments available. What else do you need to do before having dermabrasion and achieve the best results possible?
Here’s the answer! Pretreat your skin to maximize healing:
- Avoid sun exposure for a minimum of 8 weeks before and after dermabrasion.
- Apply Retin-A 0.05% at night for 2 weeks and then 0.1% for 6 weeks before the procedure. This medication will enhance the ability of the skin to heal – faster and smoother – when compared to no pretreatment.
- Apply Hydroquinone 4%, a skin lightener, for 8 weeks before dermabrasion to avoid blotching after the cosmetic surgery procedure.
- Select a plastic surgeon with significant experience with this procedure.
- Take your medications as prescribed! This will be critical to prevent cold sores or breakouts after the procedure.
- After the procedure, the treated areas are dressed for healing. Be sure you perform your dressing change as instructed.
Spots and wrinkles before Dermabrasion
After Dermabrasion - 3 years
We see in the example above is the results of diamond-fraise dermabrasion with pretreatment of the skin for 8 weeks as prescribed by AB Guerra, MD, a Scottsdale plastic surgeon. There is a drastic reduction in the number of wrinkles around the lips and face. Dermabrasion has a great reputation as a powerful wrinkle treatment. The combination of Hydroquinone and Retin-A has reduced most of the pigments and spots on the patient’s lower face.
Please remember! Throughout the entire process, at our plastic surgery Phoenix office, we will assist you with the most important information about FDA-Approved dermal fillers, Botox, and Dysport, which are also great therapies to reduce wrinkles.
Don't forget high SPF at higher altitudes…
01 year ago
by Dr. Aldo
in In the news
Scottsdale – As if living in the desert was not enough… apparently, going to higher ground increases sun damage to your skin. Reuters news story shows higher SPF 70+ formulation was very effective in protecting skin from sunburns under extreme ultraviolet light and sporting conditions. In the study, 43 golfers playing for an average of 4.5 hours each applied the sunscreen themselves. Twenty-one golfers applied the SPF 70+ sport sunscreen over the entire face before they went out to play golf. The sunscreen was reapplied again about half way through their golf game.
Dr. Darrell Rigel from New York University Medical Center presented his findings at the 68th annual meeting of the American Academy of Dermatology.
“You have to be extra careful at protecting yourself at high altitudes,” Rigel told Reuters Health. “People don’t realize how much additional sun you get at higher altitudes. It’s anywhere from an 8 percent to a 10 percent increase for every thousand feet of elevation. In the summertime, you can get anywhere from 40 percent to 50 percent greater sun intensity than at sea level.”
Dr. Rigel reported that golfers who started out with the SPF 70+ sunscreen on their entire face and then reapplied it to half the face two hours later had no skin reddening at the end of the 4.5 hours, and none of the golfers who used the SPF 70 formulation complained of sunburn. In comparison, 7 of 22 golfers who applied SPF 15 to half the face had noticeable skin reddening on that side.
In a study published last month in the Journal of the American Academy of Dermatology, Rigel and his colleagues reported similar results with ski instructors in Vail, who applied two different sunscreens – one with an SPF of 50 and the other with an SPF of 85 – to different sides of their face. The SPF 50 sunscreen was not enough to protect them from sunburn.
“They put the sunscreen on in the morning, before they went out and skied an average of 5 hours a day and when we evaluated them the next morning, the ones who used the SPF 50 formulation were burned,” he said.
The moral of the study here is that higher SPF formulations tend to protect you better at higher elevations, lasts longer and is more effective at preventing sunburns.
What is sun damage?
01 year ago
by Dr. Aldo
in Facial Surgery
Model showing signs of sun damage.
Scottsdale – Many patients ask what is sun damage? Here’s a quick and short version of what happens.
Sun damage occurs as a result of your skin being exposed to ultraviolet (UV) rays. As UV rays are absorbed, they may cause cells to enter into photo-excited states, which may lead to the formation of free radicals in some skin cells. Free radicals lead to oxidation and cellular damage to occur. UV rays can also produce changes or mutations in the DNA (your genetic information) within the skin cells. Depending on which changes occur, the cells to may malfunction and act differently than normal cells.
With repeated exposure to UV rays, the skin is continually abused, and over time it struggles to repair the signs of sun damage. As the cells begin cellular replication and keratinization, the DNA changes caused by the UV rays are copied into new cells.
Eventually, visual changes on your skin surface may appear including hyper-pigmentation, uneven skin tone, fine lines and wrinkles. More serious conditions like actinic keratosis and even skin cancer could result when your DNA is damaged.
Looking old? New study says its not your genes!
02 years ago
Got wrinkles?
Scottsdale – Got wrinkles? Well, it may not be your genes! A newly published study from the Case Western Reserve School of Medicine in Cleveland, Ohio, demonstrates how environmental factors can affect aging and skin cancer risks. According to the research, the team studied 130 twins, 18 to 77 years old, who lived mostly in the northern Midwest and Eastern parts of the country, who were attending the Twins Days Festival in Ohio in 2002.
The researchers looked at the twins Fitzpatrick type (which tells us about the amount of pigment on the skin), history of skin cancer, smoking habits, alcohol consumption, and weight from the twins. The clinicians then assigned a clinical photodamage score to each participant. Each of the twins reported how their skin burned or tanned without sunscreen.
Identical twins share all of their genes and fraternal twins share only about half. The premise of the study is that because twins share genes, but may have different exposures to environmental factors, the study, “allows to control for genetic susceptibility”, said Dr. Elma D. Baron in the article published in Archives of Dermatology.
Once the data was obtained, the researchers analyzed the environmental skin-damaging factors in 65 pairs of twins. The results suggest that aging of facial skin is related more to environmental and lifestyle exposures than to genetic factors. The research did suggest that when it comes to skin cancer, findings support previous reports that both environmental and genetic factors affect skin cancer risk.
The clinical team’s analysis revealed a strong relationship between smoking, older age, and being overweight, and having facial skin with evidence of environmental damage (and looking older). They also found that sunscreen use and drinking alcohol appeared to correlate with lesser skin damage. The current findings highlight ties between facial aging and potentially avoidable environmental factors, such as, smoking, being overweight, and unprotected exposure to the sunlight. The researchers hope the findings help motivate people to minimize risky behaviors and avoid facial wrinkles.
Considering facial plastic surgery in the Scottsdale and Phoenix, Arizona area? Please call (480) 970-2580 or use our contact form to schedule a complimentary consultation.
Source: Reuters Health
No more scowling! What you can do.
02 years ago
by Dr. Aldo
in Facial Surgery
The no scowling allowed zone!
Scottsdale – Do you sometimes walk by a mirror and catch yourself scowling? It happens to all of us. Those wrinkles that form between the eyebrows, can be tough to reduce. There are a few ways of reducing the frown lines that I am going to blog about today.
Before we get to that, let’s talk about what causes these lines to form?
The lines actually result from the repetitive motion of the skin in the frown area. The muscles underneath, called the glabellar muscles, cause the skin to move and wrinkle up the way it does. If you look carefully, you will notice three set of lines in most people. There is a horizontal line that occurs most often at the bridge of the nose. Then there is the two vertical lines just inside the eyebrows. The more times the skin moves through these motions, the greater the number and the more pronounced the lines become.
Therefore, the older you get, then deeper and more noticeable the lines become.
It is a good idea to reduce the number of times the lines are made by weakening these muscles using one of two techniques.
Botox is the best way to do this if you don’t want surgery. Botulinum Type-A has been shown to be safe and effective in reducing the lines in the frown area, and it’s FDA-approved. Botox works great to prevent and reduce, and perhaps, even to temporarily erase the milder lines.
If you have well-formed lines that are fairly deep and stable, Botox still works to reduce these lines. Some people may also require a filler injection into the really deep creases and lines for better results. An examination by a board certified plastic surgeon, can let you know what you need for your specific case.
A more permanent reduction in these lines can be obtained with surgical techniques. This procedure is called a glabellar muscle reduction, and involves removal of part of the muscle body of each one of the three muscles that cause these lines to form. Removing this portion of the muscle more permanently weakens it so it cannot pull the skin and cause the wrinkles to form. Occasionally, we see the muscle ends reattach and after some time the patient can frown again. I normally replace the muscle body that is removed with a small piece of fat, from the patient, for this reason. With the fat spanning the space between the two muscle heads, then it cannot reattach. The fat helps to keep the normal shape to the frown area and prevents any depressions.
What is nice about glabellar muscle reduction in Scottsdale, is that it can be performed through a standard forehead lift, a mini forehead lit, and endoscopic forehead lift and through an upper eyelid lift incision. With so many options, patients can have the freedom to choose the operation that best suits their needs (model used in illustration).
To find out about Scottsdale Botox days, I recommend you go to JoniRoney.com.
New study: Botox used to treat unsightly (hypertrophic) scars.
12 years ago
Scottsdale – Hypertrophic scarring is best described as a refractory skin disease. Patients with this disease experience major physical deformities, restricted range of motion, pain, and itching where this scarring occurs. Because the basis for hypertrophic scar has not been fully elucidated, the clinical management of these thickened scars remains a problem. A recent article in the journal, Aesthetic Plastic Surgery, demonstrates the efficacy of using botulinum type A, also known as Botox, for the treatment of these thick and unpleasant scars that offers hope for patients.
Nineteen patients were enrolled in the study. All patients had only one lesion, each one had persisted for at least 2 years and had maintained active hypertrophic characteristics. All patients were treated once a month with intralesional botulinum type A for a total of 3 months. Each lesion was injected until slight blanching was visible. The dosage was adjusted to 2.5 U per cubic centimeter of lesion.
The lesions were found, 3 on the face and neck, 5 on the chest, 6 on the back, 3 on the earlobe, and 2 on the buttocks. Patients and surgeons were allowed to assess the results with an average follow up period at 6 months.
All the lesions had some positive response. In the assessment from the plastic surgeons, improvement was seen in 15 lesions that reached a ‘‘good,’’ rating, including 1 on the face, 2 on the neck, 3 on the chest, 5 on the back, 2 on the earlobe, and 2 on the buttocks. Four lesions reached an ‘‘excellent’’ rating, including 1 on the back, 2 on the chest, and 1 on the earlobe.
The authors speculate that botulinum type A affects the cell cycle distribution of fibroblasts derived from the hypertrophic scars as the most likely explanation for their findings.
I like this study because injection of Botox is simple and safe and the before and after photos of the lesions are quite impressive. However, the study has limitations. First, it did not include a control group and was not double blinded, which may affect the degree of confidence. Additionally, the follow-up period was only six months.
It may be possible to offer Botox to some patients based on this research, but it should be made clear to patients that more research will be needed to see how well this technique works and what the long-term results actually last. Moreover, use if Botox in such cases would be off -label.
A Comparison of popular Short Scar Facelift Techniques.
02 years ago
Facelift Surgery
Scottsdale – Short scar facelift is very popular among younger women seeking facial rejuvenation. The procedure has several advantages including reducing the length of the scar. With this procedure, the scar is limited to an area front of the ear and patients avoid an extensive scar in the hairline behind the ear. Additionally, short scar facelift is performed with less surgical dissection and is noteworthy because patients experience less pain and swelling and a faster recovery with minimal bruising.
Several short scar techniques have been developed. The two most popular include the Minimal Access Cranial Suspension (MACS-Lift) and the Lateral SMASectomy techniques. An article has been published in the journal Plastic and Reconstructive Surgery, which examines these two surgical options and gauges the outcome at 1 month and 24 months after surgery. The researchers enrolled 97 patients who had short scar facelift using either of the techniques mentioned earlier that were followed for a total of 24 months.
The results of the study demonstrated that MACS-Lift takes significantly less time to perform when compared to Lateral SMASectomy. Patients after Lateral SMASectomy experience significantly less pain than those having MACS-lift. There was no statistical difference in the aesthetic outcome of the operations at 1 and 24 months after surgery between the two techniques. At 24 months some patients had recurrence of the jowling and did not appear as improved in the neck area.
It is not unexpected to see some laxity in the neck after short scar facelift. This area does not respond particularly well to the short scar techniques which are designed to treat early aging signs in the face, but generally do not treat serious laxity in the neck. When a patient requires more lift in the neck I prefer to use a full facelift technique which addresses the neck issues better. The results of the study are impressive, however, and the before and after photos in the article show some very nice results of the surgery.
The article is important as it attempts to identify how long the results of short scar facelift results actually last. More research will be needed to see the actual time the results will last, but given the findings it is likely that short scar results do not last as long as results from full facelift techniques. What is important to note from this article is that the techniques are comparable with regards to the results and low level complications.
I have used both of these techniques and have been happy with the results. I find that patients do well regardless of technique and have a nice aesthetic improvement (model used in illustration).
Aging in identical twins – factors contributing to an older appearance
02 years ago
by Dr. Aldo
in In the news
Scottsdale, AZ - An interesting new study published in the international journal, Plastic and Reconstructive Surgery, involves sets of twins and makes an assessment of how environmental factors have affected their facial aging. In the study, 186 pairs of identical twins completed a comprehensive questionnaire, and digital images were obtained. An independent panel reviewed the images and recorded the perceived differences in the twins’ ages and their facial features. The perceived age differences were then correlated with multiple environmental factors.
The main purpose of this study was to identify the environmental factors that contribute to facial aging in identical twins, but it also confirms some of the observations noted by plastic surgeons over the years. The results confirm smoking and increased sun exposure lead to significantly increased risks of aged appearance. In fact, the longer they smoked, the older they looked. Additionally, if patients did not use sunscreen and had a history of increased outdoor activity, then the aging appearance was accelerated. Wrinkles on the face were more common in twins who smoked or had a history of skin cancer (which implies more sun exposure). Dark and patchy skin discolorations were also more common in twins with a history of smoking and those with sun exposure.
Twins who used hormone replacement therapy had a statistically significant younger appearance. Dark blotches were seen less in those with a higher body mass index. Patients younger than 40 years with higher body mass index looked older, but the patients older than 40 years appear younger when they had a higher body mass index. The reviewers also noted that those who avoided alcohol looked significantly younger than the twin who consumed alcohol. Patients that had divorced or used antidepressants were also more likely to look significantly older.
Studies of this type confirm that smoking is not only bad for your health, but also for your looks. The study also implies that appropriate hormone replacement and nutrition may be significant in acheiving a more youthful appearance as individuals get older. I recommend avoidance of smoking and sun exposure to all patients contemplating plastic surgery. A good skin care regiment is also recommended for those who may want to reverse the aged appearance. It is important to also recommend good nutritional habits and the avoidance of alcohol.
