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BENEFITS OF FACELIFT SURGERY

Plastic Surgery Dubai | 8 July 2020

A face-lift (rhytidectomy) is a cosmetic surgical procedure to create a younger appearance in your face. The procedure can reduce the sagging or folds of skin on the cheeks and jawline and other changes in the shape of your face that occur with age. During a face-lift, a flap of skin on each side of the face is pulled back, and tissues below the skin are surgically altered to return the contour of the face to a more youthful shape. Before the flap is sutured closed, excess skin is removed. A neck lift (platysmaplasty) is often done as part of a face-lift to reduce fat deposits and sagging skin on the neck. A face-lift won’t decrease fine creases or wrinkles in your skin or damage from sun exposure. Other cosmetic procedures can address the appearance or quality of the skin itself.

As you get older, the appearance and shape of your face is altered because of normal age-related changes. Your skin becomes less elastic and looser, and fat deposits decrease in some areas of your face and increase in others. Age-related changes in your face that may be reduced with a face-lift include the following:

Sagging appearance of your cheeks

Excess skin at your lower jawline (jowls)

Deepening of the fold of skin from the side of your nose to the corner 

   of your mouth

Sagging skin and excess fat in the neck (if the procedure includes a 

   neck lift)

A face-lift isn’t a treatment for superficial wrinkles, sun damage, creases around the nose and upper lip, or irregularities in skin color.

WHO IS A CANDIDATE?

Men and women with jowl formation (the lower cheeks and jaw line 

   are saggy).

Men and women with a poorly defined jaw line.

Men and women with wrinkled saggy and fatty neck.

INTENDED RESULTS

A sharper and better defined jaw line.

Improved neck and chin angle.

Less tired look with more youthful appearance.

This does not treat the lines around the mouth and will not improve skin surface defects and dis-coloration.

HOW YOU PREPARE

Initially, you’ll talk to Dr. Vigo about a face-lift. The visit will likely include:

MEDICAL HISTORY AND EXAM

Prepare to answer questions about past and current medical conditions, previous surgeries, previous plastic surgeries, complications from previous surgeries, history of smoking etc. Dr. Vigo will do a physical exam, may request recent records from your doctor or order a consultation with a specialist if there are any concerns about your ability to undergo surgery.

MEDICATION REVIEW 

Provide the name and dosages of all medications you regularly take, including prescription drugs, over-the-counter drugs, herbal medications, vitamins and other dietary supplements.

FACIAL EXAM

Dr. Vigo will take photos of your face from different angles and close-up photos of some features. He will also examine your bone structure, shape of your face, fat distribution and quality of your skin to determine your best options for face-lift surgery.

EXPECTATIONS 

Dr. Vigo will ask questions about your expectations for the outcomes of a face-lift. He or she will help you understand how a face-lift will likely change your appearance and what a face-lift doesn’t address, such as fine wrinkles or naturally occurring asymmetry in your face.

BEFORE A FACE-LIFT

Follow medication directions. You’ll receive instructions about what medications to stop taking and when to stop. For example, you’ll likely be asked to discontinue any blood-thinning medication or supplement at least two weeks before surgery. Talk to your doctor about what medications are safe to take or whether the dosage should be adjusted. Wash your face and hair. You’ll likely be asked to wash your hair and face with a germicidal soap the morning of the surgery. Avoid eating. You’ll be asked to avoid eating anything after midnight the night before your face-lift. You will be able to drink water and take medications that have been approved by Dr. Vigo. Arrange for help during recovery. If your face-lift is done as an outpatient procedure, make plans for someone to drive you home after surgery and stay with you the first night after surgery.

BEFORE THE PROCEDURE

Sometimes the procedure is done with sedation and local anesthesia, which numbs only part of your body. In other cases, general anesthesia — which renders you unconscious — is recommended.

DURING THE PROCEDURE

Face Lifts are usually performed in an accredited facility, day care 

  centre or in the hospital.

They may be performed under local anesthesia

  with or without oral sedation, conscious sedation, or general anesthesia.

The surgeon usually makes incisions around the ear. The approach and 

  position of the scar should be discussed with the surgeon.

Sutures are used for closure followed by placement of an elastic 

  dressing around the face and neck. Often a drain is needed to avoid 

  complication of fluid collection.

In general, a face-lift involves elevating the skin and tightening the underlying tissues and muscles. Fat in the face and neck may be sculpted, removed or redistributed. Facial skin is then re-draped over the newly repositioned contours of the face, excess skin is removed, and the wound is stitched or taped closed. The incisions for the procedure depend on the techniques that will be used and the patient’s preferences. Options include:

A traditional face-lift incision starts at your temples in the hairline, 

  continues down and around the front of your ears and ends behind 

  your ears in your lower scalp. An incision might be made under your 

  chin to improve the appearance of your neck.

A limited incision is a shorter incision that begins in your hairline just 

  above your ear, wraps around the front of your ear, but does not extend 

  all the way into the lower scalp.

Neck lift incision starts in front of your earlobe and continues around 

  your ear into your lower scalp. A small incision also is made under your 

  chin.

A face-lift generally takes two to four hours but might take longer if 

  other cosmetic procedures are done at the same time.

AFTER THE PROCEDURE

After a face-lift, you may experience:

Mild to moderate pain

Drainage from the incisions

Swelling

Bruising

Numbness

Contact your doctor immediately if you have:

Severe pain on one side of your face or neck within 24 hours of surgery

Shortness of breath

Chest pain

Irregular heartbeats

Your incisions will likely be covered with bandages that provide gentle pressure to minimize swelling and bruising. A small tube might be placed under the skin behind one or both of your ears to drain any excess blood or fluid. In the first few days after surgery:

Rest with your head elevated

Take pain medication as recommended by your doctor

Apply cool packs to the face to ease pain and reduce swelling

Follow-up appointments

 RECUPERATION AND HEALING

A compression garment may be worn around the lower face and neck 

  for approximately one week.

Bruising and swelling are normal and may take several weeks to resolve.

Stiffness in the neck and some soreness with swallowing and eating is 

  common.

Sutures are removed within two weeks.

Drains, if used are usually removed 1-3 days after the procedure.

Make-up can be applied over the skin immediately but not over the 

  incisions for 2-3 weeks.  

THE BENEFITS OF BODY LIFT SURGERY

Plastic Surgery Dubai | 5 July 2020

A body lift is a surgical procedure to remove loose skin and excess tissue after significant weight loss. The procedure offers numerous benefits to those that have lost weight quickly due to bariatric surgery or their own dieting efforts. If you have reached the target number on the scale but do not see the results you were hoping for when you look in the mirror, body contouring surgery may be the right choice for you. 

During your consultation with Dr. Vigo, he will perform a physical evaluation and review your goals for body lift treatment. Together, you will select the most beneficial combination of procedures to provide you with the most dramatic results that will highlight and enhance your features. A full body lift may include any of the following procedures in the upper, mid, and lower sections of your body:

Abdominoplasty, or tummy tuck, removes excess skin and fat from the abdomen for a tighter and more toned mid-section

Thigh and leg lift removes skin and fat deposits from the thighs and legs for more defined thighs and calves

Buttock lift can trim skin and fat to lift and reshape the buttocks

Arm lift, or brachioplasty, can remove excess, hanging skin from the upper arms

Breast lift removes excess skin and tissue to situate the breasts in a higher position

Each of these procedures will remove excess tissue to tighten and tone your skin for improved contours in that specific area. Dr. Vigo emphasizes clear cosmetic goals for all of his patients. 

FULL BODY LIFT BENEFITS

While each of these procedures on their own can produce quality results, when two or more are combined, your results can be even more dramatic. Benefits of a full body lift may include:

Removal of excess, sagging skin for a slimmer figure and to eliminate 

  health issues such as rashes or skin infections

Firm, toned, and smoother skin that accentuates your weight loss 

  success

Elimination of folds of skin, making personal care easier

Exercise and other physical activities may be easier and more 

  comfortable

Wider variety of clothing options

Rejuvenated and more youthful appearance

Improved confidence and self-image

During your consultation, Dr. Vigo will outline the specific benefits you may see from a full body lift based on the personalized combination of procedures you choose.

Customized to Your Needs

Body lifts can be completely customized to the unique needs of each patient. Dr. Vigo is experienced in a wide range of body lift procedures and will help you determine the right procedures for you. In some cases, your lift procedures will be performed simultaneously to provide you with dramatic results with just one time under anesthesia and one recovery period. Other patients might require two or more procedures to reach their desired outcome without sacrificing their safety.

Creates a Smoother Body Contour

When you started on your weight loss efforts, you probably had an image in your mind of how your final result would look. That image probably did not include extensive folds of loose skin hanging over those newly sculpted areas, marring your overall profile. By removing skin folds, you can streamline your body contour to get much closer to the image you had in your mind before you began your journey. The cosmetic improvement can do much to increase your self-esteem and your self-confidence, as well as your satisfaction with your weight loss success.

Eliminates Skin Irritation, Infection

When you have loose skin rubbing together, you also have an increased risk for skin irritation and even infections. This problem can become quite painful, impacting your ability to wear some types of clothing and participate in some activities. You may require multiple treatments to manage ongoing skin conditions, which can be inconvenient and time consuming in addition to physically painful. When we eliminate the loose skin, we also effectively eliminate the skin issues.

Allows for Smaller Clothing Sizes

Before you began your weight loss, you were probably looking forward to fitting into smaller sizes of clothing. Unfortunately, loose skin left behind can continue to hinder your ability to wear the clothing you had been waiting for. In addition, the extra skin can make clothing uncomfortable, keeping you from donning some of your favorite pieces. Body lift procedures can smooth your body contours to make those smaller clothing sizes more comfortable.

Understanding the Procedure

During a body lift, Dr. Vigo may take one of several approaches, depending on the level of correction needed. The location and amount of excess skin to be removed is another factor, as is any personal preference you may have about your final appearance.

Typically, a body lift begins with a circumferential incision that extends around the lower body. This gives Dr. Vigo access to the treatment areas, including the belly, waist, hips, thighs and buttocks. Next, excess skin and fat are removed, and the remaining skin is repositioned and re-draped. Liposuction may also be incorporated to help remove fatty deposits in the treatment area. Finally, the incisions are closed and the recovery process begins.

Recovery and Results

Most men and women experience discomfort following their body lift, including soreness at the incision site and initial swelling. As these dissipate, more well-defined lower body contours are seen. Most patients can return to work in a week or two. However, more active pursuits should wait until you feel more comfortable.

A body lift helps you feel better about your body following major weight loss or other physical changes that left loose skin behind. Although it’s important to maintain realistic expectations, you can expect to see a permanent improvement in your lower body contours as long as you maintain a healthy and active lifestyle.

Body lift, or body plastic surgery, helps reduce saggy, loose appearance and irregularities on the surface of the skin due to poor elasticity, or laxity in the central area of the body. Loss of elasticity may occur as a result of significant weight loss, aging, sun damage, and genetics, among various other factors. This is a common surgery for patients who have lost weight after weight loss surgery (bariatric procedures).

What Body Lifts Can Treat

A body lift can help your body appear smoother, more toned, and shapelier overall. Body lifts can treat the appearance of excess skin, fat, and cellulite by removing these tissues from various parts of the body. If you are bothered by the appearance of loose, sagging skin or fat tissue in multiple parts of your body, you may benefit from body lift surgery. After weight loss many patients believe they’re able to achieve greater overall satisfaction and quality of life when they look and feel better.

To achieve the best results, it’s recommended that you maintain a normal body weight for at least a year – especially if you’ve just recently achieved significant weight loss – before moving forward to body lift procedures. It may also be best to postpone abdominal body lifts if you’re planning for further weight loss or future pregnancies. The best way to determine whether you’re a good candidate for body lift surgery is through a one-on-one plastic surgery consultation.

Preparing for Body Lift Surgery

The initial step in any surgical procedure is consultation. Before your body lift surgery, be prepared to discuss your expectations with Dr. Vigo.

 

WHAT IS BREAST AUGMENTATION SURGERY?

Breast Augmentation Dubai | 1 July 2020

Breast enlargement surgery, also known as breast augmentation or breast enhancement, is one of the most regularly performed procedures and involves the insertion of implants under the breast tissue to increase the size or change the shape of the breasts. Many women choose to have breast augmentation surgery to boost body confidence and to feel comfortable with the size and shape of their breasts.

WHAT IS BREAST AUGMENTATION SURGERY?

Breast enlargement surgery is an operation to enlarge the breasts, usually using an implant filled with silicone or with physiological saline (a solution containing salt at the same concentration as in the body).Sometimes, the breasts can be enlarged with fat from another part of the body. Patients are usually pleased with the results of breast augmentation, but first it is important to understand what is and isn’t possible, and what care might be needed in the future.

WHY HAVE BREAST AUGMENTATION SURGERY?

People have this surgery to make their breasts larger and improve their shape. Some women have smaller breasts than they would like. Also, breasts can droop with age or after pregnancy, breastfeeding and weight loss. Breast enlargement can improve both the shape and the droop to some degree. Some women have one breast much bigger than the other. Breast enlargement can balance breasts of different sizes.

WHAT WILL HAPPEN BEFORE MY OPERATION?

You will meet your surgeon to talk about why you want surgery and what you want. The surgeon will make a note of any illnesses you have or have had in the past. They will also make a record of any medication you are on, including herbal remedies and medicines that are not prescribed by your doctor.

Your surgeon will examine your breasts, and may take some photographs for your medical records. They will ask you if you want to have someone with you, and ask you to sign a consent form for taking, storing and using the photographs. The surgeon may measure your height and weight to make sure that it is safe to do an operation. If you are overweight, or planning to become pregnant, your surgeon may suggest delaying your operation.

HOW IS THE PROCEDURE PERFORMED?

Implants are placed either behind the breast or behind the muscle the breast sits on. Putting implants behind the breast is the simplest option. Putting implants under the muscle gives more padding in very slim women. Your surgeon will discuss which is best for you. Implants are usually inserted through a cut in the crease under the breast (the inframammary fold). They can also be inserted through a cut in the armpit or around the areola. Sometimes, a drain (a tube attached to a bottle or bag) is left in to drain away any fluid or blood. This is removed after a day or two on the ward.

ABOUT THE IMPLANTS

The outer layer of breast implants is made of silicone or, in some cases, polyurethane. Inside this there is either silicone gel (most common) or saline. Silicone implants usually feel more natural than saline ones, and can have different shapes. Saline-filled implants usually feel less natural, have a greater risk of rippling, and can deflate. Breast implants usually last about 10 years, sometimes less, sometimes more.

IMPLANT SIZE

The size of implants is given in millilitres (ml), in cubic centimetres (cm3) or by weight (grams). When you meet your surgeon before the operation, they will look at your breasts and the size of your ribcage, and check how firm your skin is. They will discuss with you what size of implant will suit you best. Usually, large implants look less natural on slimmer women. Your surgeon will ask you if you want to have someone with you during this examination. Your surgeon cannot promise you an exact cup size, only a range. Tell your surgeon if you would like to aim for the larger or smaller end of the particular range.

IMPLANT SHAPE

Implants can be round or teardrop-shaped (anatomical). Round implants are fuller at the top of the breast. With teardrop-shaped implants, you choose the width and height separately. With both shapes, you can choose for the amount that the implant sticks out (the projection) to be more or less subtle. You and your surgeon will discuss what shape will suit you best.

DO I NEED A BREAST UPLIFT?

Mild droopiness can be improved by breast enlargement surgery. If your breasts are droopy but the right size for you, you can have a breast-uplift operation without an implant. This surgery is called a mastopexy. With this surgery, the nipple is lifted and the breast tissue and skin is tightened through cuts around the areola and under the breasts. Sometimes, both implants and lifting are needed, either at the same time or in two separate operations.

CHOOSING A SURGEON

Breast enlargement is a lifetime commitment. You must be sure that you are making the right choice, and understand the implications of the surgery. You might need more surgery in the future to keep up the results of the breast augmentation, and you should be prepared for this, personally and financially. Nobody needs an urgent breast augmentation. If you are not given time to think about it, you should look elsewhere.

HOW CAN I HELP MY OPERATION BE A SUCCESS?

Be as healthy as possible. It is important to keep your weight steady with a good diet and regular exercise. Your doctor can give you advice on this. If you smoke, stopping at least six weeks before the operation will help to reduce the risk of complications. Do not worry about removing hair near where cuts will be made, but do have a bath or shower during the 24 hours before your operation to make sure that the area is as clean as possible.

WHAT IS THE ALTERNATIVE TREATMENT?

A simple alternative to breast augmentation is to wear padded bras. The only alternative surgical technique to enlarge the breast is lipofilling. This is where fat removed by liposuction from another part of the body (such as the hips or thighs) is injected into the breast area. Because only a relatively small amount of fat can be injected at a time, and some of the fat is reabsorbed into the body, you would need several injections to get a permanent enlargement. Your own fat is the only substance that can be safely injected into the breast. Other materials have been tried, and then banned. Do not allow anyone to inject anything other than your own fat into your breasts.

WHAT ARE THE MAIN RISKS AND COMPLICATIONS OF BREAST AUGMENTATION SURGERY?

As with all operations, there are risks involved in breast augmentation surgery. Although the risks are unlikely, it is important to weigh them up against the potential benefit of the surgery. Discuss each of them with your plastic surgeon to make sure you understand the potential complications and consequences.

SCARS ASSOCIATED WITH THE SURGERY

There will be scars from the surgery. These will usually be red at first, then purple, and then fade to become paler over 12 to 18 months.   

Fillers in Dubai | 29 June 2020

Fillers are typically used to increase the volume and size of the lips. Collagen or hyaluronic acid-based filler are typical. Collagen works by plumping, while hyaluronic acid works by both plumping but also holding water within the lip for a more natural effect.

WHAT ARE LIP FILLERS?

Let’s start with what they’re not: they are not permanent. They last about three months to a year depending on how quickly your body breaks them down. The type I recommend are made of hyaluronic acid — a sugar, found naturally in the body, that adds temporary volume and definition when injected into lips.

CORRECTING BALANCE AND SHAPE

The lips can sometimes tend to be uneven with the top or bottom one thicker than they should be. To get a perfect pout the top lip should be one third and the bottom lip should be two thirds. Sometimes they are also larger on one side than the other and the lips are a little lopsided. Dermal filler can even this out

The objective in treating the upper lip is to artistically create a form that harmonizes with the patient’s unique facial features and takes into account the age and ethnic background of the patient. The goal in treating the lower lip is to create bulk and greater prominence and artistic projection of the vermilion. The physician must establish appropriate guidelines and patient expectations for augmentation relative to normal lip proportions in order to avoid a cartoon-like appearance.

It’s important to see your box of injectables opened in front of you and to be sure only your dermatologist or plastic surgeon is doing the injections. Avoid blood thinners, like aspirin and fish oil, for at least a day beforehand, which can increase bruising. If you opt for numbing cream, expect it to be placed on the lips for approximately 10 minutes. The lips absorb quickly and do not require lengthy topical anaesthesia. Then, the skin surface should be cleansed properly and then injections are performed. Your doctor should go very slowly, often pausing to show you the progress that he or she is making. There is a real balance and art to it, I find that you really need to go little by little, so you normally inject the top lip first, balance it out on the other side, then inject the bottom lip. It takes about 15 to 20 minutes. What you see is what you get, you’re not waiting for it to work, like Botox.

Some doctors will gently mould the filler with their fingers after it is injected by squeezing and patting it into place, while others aim to inject it exactly where they want it and avoid moulding, since it can increase bruising and swelling. Based on my extensive experience, there is no single stance on moulding – it’s a technique that some like, while others do it sparingly.

FILLER SUITABILITY

When selecting a suitable filler for the lips, the following factors are taken into consideration:

Longevity: it is important to advise the patient how long a product is expected to last for, and explain that this is not guaranteed in order to successfully manage their expectations

Crosslinking technology: relates to longevity and propensity to swell

Cost: patient needs to be aware of financial commitment

Company support: specific product knowledge and training/marketing is essential

Reversibility: ensures a safety net incase of vascular accident or other filler-associated complications; you should have an emergency kit including hyaluronidase on site

Strong clinical study evidence: ensures a safe, evidence-based choice

Previous patient experience of product: if a patient has had good clinical results with a certain product and is happy with it, do not use something else as they may be unhappy with the new product

LIP AUGMENTATION TECHNIQUES

There is no single technique that fits every lip, and each practitioner will have his or her own approach to treatment. Below are the factors of which typically followed when it comes to lip augmentation:

Visually assess the lip in 3D: i.e. the lateral and frontal view. This will give an idea of projection required. For an attractive lip, the upper lip should project around 2mm further than the lower lip.

Assess the smile: if the patient has a ‘gummy’ smile and the lip disappears upon smiling then consider botulinum toxin injections to soften the action of the lip elevators. I have found that for best results, it should be a deep injection, 1cm lateral to the lateral alar of the nose. If the patient has an active depressor angulioris, contributing to a downturned mouth, also consider treating this muscle with botulinum toxin to prevent a downward pull of muscle on the corners of the mouth.

Determine the amount of filler: I always agree with the patient the amount of filler that will be used. It is important to not over or underfill the lip (amount is case dependent). For example, overfilling the upper lip can create a ‘duck lip’ appearance, which is usually not regarded as aesthetically appealing. I do not use more than 1ml per visit to prevent overcorrection and reduce the risk of vascular compression.

Enhancement or restoration: I always ask if the patient is seeking enhancement or restoration – this usually depends on the patient’s age – to ensure that you understand their expectations of treatment.

Age appropriateness: ensure that the lips are ‘age appropriate’. I advise not to try to create the lips of a 25 year old on a 60-year-old patient.

In patients showing signs of ageing: treat the perioral complex and not just the lip. To do this, use filler to turn up the corners of the mouth at the oral commissure, to treat oral rhytids and to restore volume in the cutaneous lip and chin area. Botulinum toxin in the mentalis and depressor angular oris can be used to reduce hyperkinetic activity of mouth depressors.

Consider the vermillion border: consider using low viscosity filler when treating the vermillion border. This can create a very sharp and well-defined demarcation by creating maximum light reflection without distorting the delicate lip architecture.

POST-INJECTION CARE

Cool compresses and ice packs can be used to minimize swelling and bruising. Patients should be advised to avoid ASA, NSAIDs, and other medications associated with an increased risk of bleeding. If anti-HSV I medication was prescribed, it should be continued according to physician recommendation. Because HAs are hydrophilic, they attract water from the surrounding tissues and further augment the soft tissue volume beyond that expected from mere implantation. The significant swelling of the vermilion in the immediate post-operative period may be camouflaged by applying flesh-toned foundation or concealer to the entire vermilion. Lipstick can then be applied to a smaller portion of the vermilion than usual so as to not exaggerate the swelling that may be present.

 

SELECTING THE RIGHT FILLER

There are a lot of difficult decisions you have to make when it comes to getting lip injections, but fortunately, picking the right filler isn’t one of them. Hyaluronic acid, in a few different forms, is both the industry standard for temporary lip injections and the only temporary lip filler approved by the FDA. 

They’re marketed under different brand names – Restylane Silk, Belotero, Juvederm – but they’re all made from the same molecule, which is hyaluronic acid, as you may already know, naturally occurs in skin and is a top ingredient in hydrating skin-care products, since it plumps skin by capturing and holding onto water. Picking which of the formulas is best for you is really up to your doctor. Hyaluronic acid is not only the best option, but the only option for those new to the world of injections, since it will dissolve on its own and is well-tolerated, since it’s already in your body. There are irreversible fillers and implants, but those are not for beginners. 

PAIN MANAGEMENT

Lips are one of the more uncomfortable places to inject filler. We have a lot of nerves in our lips, so I can do a combination of topical numbing cream and, sometimes, injectable numbing medications, so patients are comfortable. However, many of the H.A. injectables come with lidocaine (a numbing pain reliever) built right in, so some doctors opt out of additional measures. One, or a combination of the above pain-reducing options, will normally temper the pain of the actual procedure, but you’re likely to experience pain later, since the skin is being stretched. The pain as mild to moderate and notes that it can last for a few days.

SIDE EFFECTS

Any time there is a needle crossing the skin, there is a risk. Bruising, swelling, and pain – all of which can last up to days and in rare cases, even weeks – may occur. There is also the risk of infection. Naturally, this makes it very important to check in with your doctor post-treatment, especially if you’re feeling nervous about side effects.

While hyaluronic acid is a naturally occurring substance in your body, you can still have an allergic reaction to H.A. injectables, since there are often inactive ingredients (like carrying agents) and pain-reducing ingredients (like lidocaine) in the formula. Those prone to allergies or are just plain nervous can do a patch test on their forearm a few days before the procedure to be sure they won’t have an adverse reaction.

Injecting the lips can prompt cold sores for those who are prone to them, so he normally pretreats those patients with a round of anti-viral medication, like Valtrex.

There are also less common side effects that are important to consider. More rare side effects include nodules or palpable material within the lips – basically bumps of H.A. that don’t settle or feel natural. Extremely rarely, lip filler can be introduced into a blood vessel in the lip, which can have more significant consequences if not dealt with immediately and appropriately.

WHAT TO EXPECT

One of the great things about lip injections is that the results are instantaneous, so you’ll leave the office with fairly accurate (albeit swollen) results. For the first 24 to 48 hours, the filler is malleable and your skin is prone to swelling, which means be gentle! This is noted as the time that your injections need to “settle.” No facials, yoga, or exercise is recommended, which can alter the placement of the filler and increase swelling and bruising.

Lips often swell for one to three days after treatment, but this is highly variable and some patients will experience no swelling and some will have more dramatic swelling that will take longer to subside. Bruising can last approximately one week, but can be covered with makeup or lipstick, as needed. Some doctors will offer to treat more significant bruising with a laser treatment if necessary.

While the average length of time H.A. fillers will last is about six months, it varies for everyone, from around three months to a year.  H.A. lasts different lengths, depending on where you put it and how active that body part is. I find that if the labelling says six to 12 months, [patients] normally come back every three to six months.

NON-SURGICAL NOSE RESHAPING

Aesthetic Medicine Dubai | 22 June 2020

Until recently, nose reshaping was a painful surgical procedure that requires an overnight stay in the hospital and long recovery period. Non-Surgical Nose Reshaping, also known as Non-Surgical Rhinoplasty is a safe, non-invasive procedure that uses dermal fillers to alter or reshape your nose, smoothing out any bumps and irregularities.

The non-surgical nose job became a popular treatment for different age groups because it is an excellent choice for those who don’t want to have surgery. Major advantages of Nose Reshaping Fillers are that you can return to work the next day and resume your daily routine. No more hospital stay, leave of absence or long recovery period.

Let me help you to be happy with what you see in the mirror by having a super effective, walk-in walk-out procedure, with no complications and scalpels.

The non surgical rhinoplasty or non surgical nose job is a highly advanced procedure. I will use premium hyaluronic acid nose fillers to shape your nose and balance your profile. As such this treatment is completely tailored to your individual face shape and aesthetic goals.

NON SURGICAL RHINOPLASTY WITH NOSE FILLERS

The non surgical rhinoplasty is an advanced corrective procedure. Using hyaluronic acid dermal fillers, the nose can be reshaped with just a small number of injections in a short period of time with little to no downtime involved. As such, the non surgical rhinoplasy has become extremely popular with both men and women alike. This treatment is performed using premium hyaluronic acid to reshape the nose and provide harmony to the face. 

I use nose fillers to alter the definition, projection, profile and shape of the nose. As such, non surgical rhinoplasty is best for straightening, lengthening, smoothing out bumps or dents and improving asymmetries in the nose. The key benefits of my personalised non surgical rhinoplasty include:

Safe & effective treatment using premium dermal fillers

Fully bespoke non surgical rhinoplasty nose reshaping treatment

Profile balancing by treating the chin area if needed

All treatments performed by an experienced aesthetic doctor

Premium hyaluronic acid dermal fillers

Natural looking results

Dedicated aftercare and follow-up

WHAT ARE THE BENEFITS OF THIS TREATMENT OVER TRADITIONAL RHINOPLASTY?

Aesthetic Medcine now has more and more options for performing non-surgical procedures. Being non-surgical it means less risk, less downtime, fewer side effects and yet with very similar results. The new non-surgical nose job using dermal fillers means I can do so much in minutes and with no pain. Surgical rhinoplasty, however, takes a month or longer to recover from and results are not always perfect. I was one of the first doctors a few years ago who developed the technique of the non-surgical procedure now done by doctors all over the UAE.

WHAT DOES THE NON SURGICAL RHINOPLASTY PROCEDURE INVOLVE?

All of my non surgical rhinoplasties start with a detailed consultation. This allows me to design a bespoke treatment based on your individual needs and aesthetic goals. The treatment starts with a thoroughcleansing of the skin then applying a numbing cream for your comfort. I will then inject the nose filler using either a needle. I may also inject the chin area to help balance the profile of yourself as part of the procedure.

WHO IS BEST SUITED FOR A NON SURGICAL RHINOPLASTY?

Non surgical rhinoplasty is a quick and non invasive method to shape the appearance of the nose. This treatment uses hyaluronic acid dermal fillers which are temporary and slowly broken down by your body over time. I am able to deliver excellent results using nose fillers for:

Mildly crooked nose to improve symmetry

Small nose that needs building up

Hook-shaped nose that requires straightening

Mild or moderate bump on the bridge of the nose that needs smoothing

A mild to moderate drooping of nasal tip that

Noses that would like more height, definition and a nose tip

WHEN WILL I SEE RESULTS AND HOW LONG DO THEY LAST FOR?

You will be able to see the result immediately and the full effect at 1-2 weeks. The results can last for up to 18-24 months. This is dependant on which of our hyaluronic acid dermal fillers you choose and how quickly your body breaks it down. I will help you decide which dermal filler is best for your needs.

HOW SAFE IS A NON-SURGICAL NOSE JOB?

Juvéderm and Restylane Perlane, which are usually used in this procedure, are biocompatible and biodegradable products which means that it is not harmful to the body and is broken down and removed from the body naturally. These hyaluronic acid nose fillers come in the form of a sterile gel produced in the laboratory.

FILLERS IN DUBAI: THE PERFECT LIPS FOR YOUR FACE

Fillers in Dubai | 20 June 2020

Read my lips: I’m not saying you need lip injections. But if you’d like to try them or are curious about the procedure (and it’s kind of impossible not to be, given the current state of pouty celebrities and volumising lip products), it’s important to fill up on facts before you go plumping anything.

The objective in treating the upper lip is to artistically create a form that harmonizes with the patient’s unique facial features and takes into account the age and ethnic background of the patient. The goal in treating the lower lip is to create bulk and greater prominence and artistic projection of the vermilion. The physician must establish appropriate guidelines and patient expectations for augmentation relative to normal lip proportions in order to avoid a cartoon-like appearance.

It’s important to see your box of injectables opened in front of you and to be sure only your dermatologist or plastic surgeon is doing the injections. Avoid blood thinners, like aspirin and fish oil, for at least a day beforehand, which can increase bruising. If you opt for numbing cream, expect it to be placed on the lips for approximately 10 minutes. The lips absorb quickly and do not require lengthy topical anaesthesia. Then, the skin surface should be cleansed properly and then injections are performed. Your doctor should go very slowly, often pausing to show you the progress that he or she is making. There is a real balance and art to it, I find that you really need to go little by little, so you normally inject the top lip first, balance it out on the other side, then inject the bottom lip. It takes about 15 to 20 minutes. What you see is what you get, you’re not waiting for it to work, like Botox.

Some doctors will gently mould the filler with their fingers after it is injected by squeezing and patting it into place, while others aim to inject it exactly where they want it and avoid moulding, since it can increase bruising and swelling. Based on my extensive experience, there is no single stance on moulding – it’s a technique that some like, while others do it sparingly.

FILLER SUITABILITY

When selecting a suitable filler for the lips, the following factors are taken into consideration:

Longevity: it is important to advise the patient how long a product is expected to last for, and explain that this is not guaranteed in order to successfully manage their expectations

Crosslinking technology: relates to longevity and propensity to swell

Cost: patient needs to be aware of financial commitment

Company support: specific product knowledge and training/marketing is essential

Reversibility: ensures a safety net incase of vascular accident or other filler-associated complications; you should have an emergency kit including hyaluronidase on site

Strong clinical study evidence: ensures a safe, evidence-based choice

Previous patient experience of product: if a patient has had good clinical results with a certain product and is happy with it, do not use something else as they may be unhappy with the new product

LIP AUGMENTATION TECHNIQUES

There is no single technique that fits every lip, and each practitioner will have his or her own approach to treatment. Below are the factors of which typically followed when it comes to lip augmentation:

Visually assess the lip in 3D: i.e. the lateral and frontal view. This will give an idea of projection required. For an attractive lip, the upper lip should project around 2mm further than the lower lip.

Assess the smile: if the patient has a ‘gummy’ smile and the lip disappears upon smiling then consider botulinum toxin injections to soften the action of the lip elevators. I have found that for best results, it should be a deep injection, 1cm lateral to the lateral alar of the nose. If the patient has an active depressor angulioris, contributing to a downturned mouth, also consider treating this muscle with botulinum toxin to prevent a downward pull of muscle on the corners of the mouth.

Determine the amount of filler: I always agree with the patient the amount of filler that will be used. It is important to not over or underfill the lip (amount is case dependent). For example, overfilling the upper lip can create a ‘duck lip’ appearance, which is usually not regarded as aesthetically appealing. I do not use more than 1ml per visit to prevent overcorrection and reduce the risk of vascular compression.

Enhancement or restoration: I always ask if the patient is seeking enhancement or restoration – this usually depends on the patient’s age – to ensure that you understand their expectations of treatment.

Age appropriateness: ensure that the lips are ‘age appropriate’. I advise not to try to create the lips of a 25 year old on a 60-year-old patient.

In patients showing signs of ageing: treat the perioral complex and not just the lip. To do this, use filler to turn up the corners of the mouth at the oral commissure, to treat oral rhytids and to restore volume in the cutaneous lip and chin area. Botulinum toxin in the mentalis and depressor angular oris can be used to reduce hyperkinetic activity of mouth depressors.

Consider the vermillion border: consider using low viscosity filler when treating the vermillion border. This can create a very sharp and well-defined demarcation by creating maximum light reflection without distorting the delicate lip architecture.

POST-INJECTION CARE

Cool compresses and ice packs can be used to minimize swelling and bruising. Patients should be advised to avoid ASA, NSAIDs, and other medications associated with an increased risk of bleeding. If anti-HSV I medication was prescribed, it should be continued according to physician recommendation. Because HAs are hydrophilic, they attract water from the surrounding tissues and further augment the soft tissue volume beyond that expected from mere implantation. The significant swelling of the vermilion in the immediate post-operative period may be camouflaged by applying flesh-toned foundation or concealer to the entire vermilion. Lipstick can then be applied to a smaller portion of the vermilion than usual so as to not exaggerate the swelling that may be present.

 

SELECTING THE RIGHT FILLER

There are a lot of difficult decisions you have to make when it comes to getting lip injections, but fortunately, picking the right filler isn’t one of them. Hyaluronic acid, in a few different forms, is both the industry standard for temporary lip injections and the only temporary lip filler approved by the FDA. 

They’re marketed under different brand names – Restylane Silk, Belotero, Juvederm – but they’re all made from the same molecule, which is hyaluronic acid, as you may already know, naturally occurs in skin and is a top ingredient in hydrating skin-care products, since it plumps skin by capturing and holding onto water. Picking which of the formulas is best for you is really up to your doctor. Hyaluronic acid is not only the best option, but the only option for those new to the world of injections, since it will dissolve on its own and is well-tolerated, since it’s already in your body. There are irreversible fillers and implants, but those are not for beginners. 

PAIN MANAGEMENT

Lips are one of the more uncomfortable places to inject filler. We have a lot of nerves in our lips, so I can do a combination of topical numbing cream and, sometimes, injectable numbing medications, so patients are comfortable. However, many of the H.A. injectables come with lidocaine (a numbing pain reliever) built right in, so some doctors opt out of additional measures. One, or a combination of the above pain-reducing options, will normally temper the pain of the actual procedure, but you’re likely to experience pain later, since the skin is being stretched. The pain as mild to moderate and notes that it can last for a few days.

SIDE EFFECTS

Any time there is a needle crossing the skin, there is a risk. Bruising, swelling, and pain – all of which can last up to days and in rare cases, even weeks – may occur. There is also the risk of infection. Naturally, this makes it very important to check in with your doctor post-treatment, especially if you’re feeling nervous about side effects.

While hyaluronic acid is a naturally occurring substance in your body, you can still have an allergic reaction to H.A. injectables, since there are often inactive ingredients (like carrying agents) and pain-reducing ingredients (like lidocaine) in the formula. Those prone to allergies or are just plain nervous can do a patch test on their forearm a few days before the procedure to be sure they won’t have an adverse reaction.

Injecting the lips can prompt cold sores for those who are prone to them, so he normally pretreats those patients with a round of anti-viral medication, like Valtrex.

There are also less common side effects that are important to consider. More rare side effects include nodules or palpable material within the lips – basically bumps of H.A. that don’t settle or feel natural. Extremely rarely, lip filler can be introduced into a blood vessel in the lip, which can have more significant consequences if not dealt with immediately and appropriately.

WHAT TO EXPECT

One of the great things about lip injections is that the results are instantaneous, so you’ll leave the office with fairly accurate (albeit swollen) results. For the first 24 to 48 hours, the filler is malleable and your skin is prone to swelling, which means be gentle! This is noted as the time that your injections need to “settle.” No facials, yoga, or exercise is recommended, which can alter the placement of the filler and increase swelling and bruising.

Lips often swell for one to three days after treatment, but this is highly variable and some patients will experience no swelling and some will have more dramatic swelling that will take longer to subside. Bruising can last approximately one week, but can be covered with makeup or lipstick, as needed. Some doctors will offer to treat more significant bruising with a laser treatment if necessary.

While the average length of time H.A. fillers will last is about six months, it varies for everyone, from around three months to a year.  H.A. lasts different lengths, depending on where you put it and how active that body part is. I find that if the labelling says six to 12 months, [patients] normally come back every three to six months.

REJUVENATE AND TIGHTEN SKIN IN THE FACE, NECK & BODY WITH J PLASMA RENUVION

Aesthetic Medicine Dubai | 18 June 2020

Loss of tissue elasticity and tone is a hallmark of aging skin. It is the characteristic change that makes one start to look older than one feels inside. Until recently, no surgical procedure or energy source achieved consistent significant tightening without an extensive recovery. Now, whether ultrasonic liposuction is used in conjunction with J-Plasma Renuvion for skin tightening or not, there is hardly an area of the body that cannot be treated.

WHAT IS J-PLASMA RENUVION?

J-Plasma Renuvion is a revolutionary minimally invasive procedure that uses cold plasma energy on the underside of the skin to instantly tighten and rejuvenate anywhere on the face and body. A unique alternative to traditional facelifts, tummy tucks, and body sculpting, the J-Plasma Renuvion procedure will shrink and sculpt loose and lax skin without large incisions, downtime or complications of cosmetic surgery.

J-Plasma for the face uses cold plasma energy under the skin to lift, tighten and rejuvenate the face and neck giving you natural-looking results with minimal downtime and no complications of a traditional facelift. J-Plasma Renuvion is unique because the cold plasma energy applied under the skin creates instant skin contraction resulting in improved laxity, tightening and shrinkage.

AM I A CANDIDATE FOR THIS SKIN TIGHTENING PROCEDURE?

Renuvion is a treatment option for patients who want skin tightening results, but do not want to do invasive plastic surgery. No other minimally invasive technology will tighten the skin to this degree with such a:

– tiny incision

– little or no scarring

– minimal downtime

BENEFITS OF J-PLASMA RENUVION FOR THE FACE

– Immediate skin tightening

– Improved skin elasticity

– Eliminates crepey skin

– Scar reduction

– Reduction and/or elimination of age spots, sun damaged pigment and 

   freckles

– Reduction of wrinkles and lines caused by ageing and weight changes

– Tightening of loose skin in known problematic areas of the face

– Improvement of skin texture and tone around the lips, eyes, cheeks, 

   forehead, jaw and neck

– Reduction of eye bags and crow’s feet

– Reduction of acne and pigment issues (chloasma)

J-PLASMA RENUVION COMMON TREATMENTS

Both women and men can undergo J Plasma treatment. However, it is most popular with women and the most common treatment areas are:

– Face

– Neck

– Breasts

– Stomach

– Arms

– Thighs

WHAT IS PLASMA ENERGY?

Cold plasma is created when helium gas is energized by radiofrequency energy and delivered through the J-Plasma device. Because Helium gas is very stable, it can be ionized at very low energy ensuring flexible, precise and safe delivery. Cold plasma is cooler than laser energy making J-Plasma Face a safer procedure with less risk and damage to the tissue and affording patients a quick recovery. The level of improvement and rejuvenation from cold plasma energy is unrivaled in current technologies. No laser, ultrasound or radiofrequency treatment is capable of tightening and firming skin to this level.

J-PLASMA RENUVION CONSULTATION

During your consultation, Dr. Vigo will evaluate your skin elasticity, and your underlying muscle tone. He will thoroughly explain the technique along with its risks, benefits, and recovery times.

J-PLASMA RENUVION FACE PROCEDURE

Performed in a day care facility  and using local anesthesia with sedation, Dr. Vigo starts the J-Plasma (Renuvion) procedure with three tiny, hidden incisions under the chin and behind each ear. He will then use the J-Plasma device sub-dermally (under the skin) to deliver cold plasma, which instantly tightens, shrinks and rejuvenates skin from the inside out. Results are immediate and continue to improve as your body continues to heal. A compressive garment is needed post operatively in order to enhance the result of the procedure.

DOES THE PROCEDURE REQUIRE GENERAL ANESTHESIA?

J-Plasma Renuvion can be done under general anesthesia, sedation or even local anesthesia only for limited areas.  

HOW MANY J-PLASMA RENUVION TREATMENTS WILL I NEED?

J-Plasma Renuvion is a single treatment. You will start seeing results soon after surgery, but the skin continues to tighten over the next several months and up to a year as the skin remodels and deposits new collagen.

RECOVERY AFTER J-PLASMA RENUVION SKIN RESURFACING

Although most patients are up and about at 2 weeks, there is still redness/erythema that lasts approximately 4 weeks. The energy penetrates deep into the skin for maximal result which does lengthen downtime. This is in contrast to J-Plasma Renuvion tightening where I have had patients go back to work within a few days. For limited areas, most patients only require a pain reliever during recovery. 

RECOVERY & SIDE EFFECTS

Recovery from Renuvion procedures can take between two to three weeks depending on the extent of the procedure and the target area.

Larger body parts generally require more downtime and patients will feel more symptoms than that of smaller target areas. Patients should expect to experience symptoms for up to three weeks post treatment. These can include:

– Dry skin

– Peeling skin

– Mild pain

– Redness

– Swelling

– Itching

– Bruising

Medication can be taken to curb symptoms if at any point you feel uncomfortable. However, symptoms are very rarely severe and patients can usually return to regular light activities after two to five days.

It is common for patients to experience a ‘tight’ feeling in the area that has been treated as the sensation post treatment is different than before.

In addition, compression wraps can be worn day and night in the immediate recovery phase to help with the healing process and ensure a more comfortable resting / sleeping state.

However, every patient is different and no two are the same. So if you are feeling like you are experiencing more symptoms than you should, contact your clinician for assistance and advice.

FULL LIPS = YOUTH + BEAUTY

Fillers in Dubai | 16 June 2020

Full lips have always been associated with youth and beauty. Because of this, lip enhancement is one of the most frequently requested procedures in a cosmetic practice. 

The objective in treating the upper lip is to artistically create a form that harmonizes with the patient’s unique facial features and takes into account the age and ethnic background of the patient. The goal in treating the lower lip is to create bulk and greater prominence and artistic projection of the vermilion. The physician must establish appropriate guidelines and patient expectations for augmentation relative to normal lip proportions in order to avoid a cartoon-like appearance.

Any physician performing lip augmentation should recognize that temporary fillers can cause permanent stimulatory effects in tissues.After 2 or 3 sessions of lip augmentation, full correction may be obtained and persist indefinitely. Patients may return for additional filler merely because a certain amount of time has elapsed since their last injection, but the physician must evaluate the proportions of the lips to truly determine if additional filler is warranted. It is helpful to have a hand mirror for the patient to observe her lip proportions as the doctor seeks to determine whether more filler is needed. It is also beneficial to show the patient her lips from the lateral view; digital photography is extremely useful in this regard.

THE PROCEDURE

It’s important to see your box of injectables opened in front of you and to be sure only your dermatologist or plastic surgeon is doing the injections. Avoid blood thinners, like aspirin and fish oil, for at least a day beforehand, which can increase bruising. If you opt for numbing cream, expect it to be placed on the lips for approximately 10 minutes. The lips absorb quickly and do not require lengthy topical anaesthesia. Then, the skin surface should be cleansed properly and then injections are performed. Your doctor should go very slowly, often pausing to show you the progress that he or she is making. There is a real balance and art to it, I find that you really need to go little by little, so you normally inject the top lip first, balance it out on the other side, then inject the bottom lip. It takes about 15 to 20 minutes. What you see is what you get, you’re not waiting for it to work, like Botox.

Some doctors will gently mould the filler with their fingers after it is injected by squeezing and patting it into place, while others aim to inject it exactly where they want it and avoid moulding, since it can increase bruising and swelling. Based on my extensive experience, there is no single stance on moulding – it’s a technique that some like, while others do it sparingly.

Your doctor should let you chime in along the way and help decide whether or not to add more or stop. I even recommend my patients go lighter than they think they may want, live with it for a week, and then decide whether or not to do more. “It’s best to start with baby steps.

After the injections, ice packs are applied. That evening, I suggest patients sleep on two pillows to decrease swelling. Use ice sparingly at home (getting the H.A. too cold or hot can prevent it from settling properly) and ask your doctor if additional anti-swelling measures are right for you, like oral antihistamines, pain relievers, or topical corticosteroids.

The entire procedure should take under 30 minutes.

NATURAL RATIO

It’s no secret that some lip augmentations look incredibly natural and some look not so incredibly natural. This is partially because of the size that you and your doctor select, but it goes deeper than that. The fact of the matter is that some doctors have a better feel for nuance and aesthetics than others.

It’s something you have to have an appreciation for, to get the proportions right for each person. There is a lot more artistry to injecting lips than just injecting a wrinkle or a line. That is another reason why the consultation is so important. I show actual before and afters of my patients, so that everyone has a realistic expectation for the type of filler I do.

Selecting where, and at what volume, to inject the lips is also an important decision to make in the consultation. The lips are supposed to be filled in a natural ratio, where the upper lip is approximately 2/3 the size of the lower lip.

That means that sometimes, only one lip needs to be filled, sometimes both, and often at different volumes, since not everyone’s pout is symmetrical. Where to inject is also a delicate matter. The lips can be injected into the skin surrounding the lips (to define the Cupid’s bow, for example), into the lips (for fullness), and into the lipline (for definition). It’s like sculpting.

Creating Philtrum Columns

Sculpted philtrum columns are in style today. As we age, these well-defined longitudinal pillars are lost, leading to a flattened, ill-defined, unattractive upper lip. If the patient still has discernible philtrum columns, the object is to further enhance them. If the philtrum columns have been completely effaced, it is imperative to re-create them. This is accomplished by superficial vertical injection of filler into each philtrum column. It is important to realize that the philtrum columns are not parallel to each other, but rather they form an inverted “V” that narrows as it approaches the nostril sills and columella of the nose.

Creating Cupid’s Bow

The pouty, Cupid’s bow appearance of the central portion of the upper lip is considered sexy, desirable, and very much in fashion today. 

Creating Lower Lip “Pillows” or Tubercles on Each Side of the Midline

Here I ask the patient to evert the lower lip. I deposit approximately ~0.1 cc of filler as a depot injection into the orbicularis oris muscle at the vermilion-mucosal junction on each side of the midline. The depot injection is about one third of the distance from the midline to the oral commissure. This is gently massaged to prevent superficial lumpiness. 

Supporting or Bolstering the Oral Commissures

Placing a small amount of filler in the most lateral aspect of the cutaneous lower lip so as to provide upward support to the commissures. Injectable neuromodulating agents (botulinum toxin A) placed into the depressor anguli oris muscles can be used as an adjunct to further elevate the commissures. This combines structural support with chemical neuromodulation to shape the oral commissures. 

Filling the Nasolabial Creases

Placing a small amount of filler in the upper portion of the nasolabial crease helps to evert the upper lip. Augmentation lateral to the nasolabial crease only serves to deepen the appearance of the crease.

POST-INJECTION CARE

Cool compresses and ice packs can be used to minimize swelling and bruising. Patients should be advised to avoid ASA, NSAIDs, and other medications associated with an increased risk of bleeding. If anti-HSV I medication was prescribed, it should be continued according to physician recommendation. Because HAs are hydrophilic, they attract water from the surrounding tissues and further augment the soft tissue volume beyond that expected from mere implantation. The significant swelling of the vermilion in the immediate post-operative period may be camouflaged by applying flesh-toned foundation or concealer to the entire vermilion. Lipstick can then be applied to a smaller portion of the vermilion than usual so as to not exaggerate the swelling that may be present.

 

SELECTING THE RIGHT FILLER

There are a lot of difficult decisions you have to make when it comes to getting lip injections, but fortunately, picking the right filler isn’t one of them. Hyaluronic acid, in a few different forms, is both the industry standard for temporary lip injections and the only temporary lip filler approved by the FDA. 

They’re marketed under different brand names – Restylane Kisse, Neauvia Lips, Juvederm Volbella – but they’re all made from the same molecule, which is hyaluronic acid, as you may already know, naturally occurs in skin and is a top ingredient in hydrating skin-care products, since it plumps skin by capturing and holding onto water. Picking which of the formulas is best for you is really up to your doctor. Hyaluronic acid is not only the best option, but the only option for those new to the world of injections, since it will dissolve on its own and is well-tolerated, since it’s already in your body. There are irreversible fillers and implants, but those are not for beginners. 

PAIN MANAGEMENT

Lips are one of the more uncomfortable places to inject filler. We have a lot of nerves in our lips, so I can do a combination of topical numbing cream and, sometimes, injectable numbing medications, so patients are comfortable. However, many of the H.A. injectables come with lidocaine (a numbing pain reliever) built right in, so some doctors opt out of additional measures.

One, or a combination of the above pain-reducing options, will normally temper the pain of the actual procedure, but you’re likely to experience pain later, since the skin is being stretched. The pain as mild to moderate and notes that it can last for a few days.

SIDE EFFECTS

Any time there is a needle crossing the skin, there is a risk. Bruising, swelling, and pain – all of which can last up to days and in rare cases, even weeks – may occur. There is also the risk of infection. Naturally, this makes it very important to check in with your doctor post-treatment, especially if you’re feeling nervous about side effects.

While hyaluronic acid is a naturally occurring substance in your body, you can still have an allergic reaction to H.A. injectables, since there are often inactive ingredients (like carrying agents) and pain-reducing ingredients (like lidocaine) in the formula. Those prone to allergies or are just plain nervous can do a patch test on their forearm a few days before the procedure to be sure they won’t have an adverse reaction.

Injecting the lips can prompt cold sores for those who are prone to them, so he normally pretreats those patients with a round of anti-viral medication, like Valtrex.

There are also less common side effects that are important to consider. More rare side effects include nodules or palpable material within the lips – basically bumps of H.A. that don’t settle or feel natural. Extremely rarely, lip filler can be introduced into a blood vessel in the lip, which can have more significant consequences if not dealt with immediately and appropriately.

WHAT TO EXPECT

One of the great things about lip injections is that the results are instantaneous, so you’ll leave the office with fairly accurate (albeit swollen) results. For the first 24 to 48 hours, the filler is malleable and your skin is prone to swelling, which means be gentle! This is noted as the time that your injections need to “settle.” No facials, yoga, or exercise is recommended, which can alter the placement of the filler and increase swelling and bruising.

Lips often swell for one to three days after treatment, but this is highly variable and some patients will experience no swelling and some will have more dramatic swelling that will take longer to subside. Bruising can last approximately one week, but can be covered with makeup or lipstick, as needed. Some doctors will offer to treat more significant bruising with a laser treatment if necessary.

While the average length of time H.A. fillers will last is about six months, it varies for everyone, from around three months to a year.  H.A. lasts different lengths, depending on where you put it and how active that body part is. I find that if the labelling says six to 12 months, patients normally come back every three to six months.

 

PLATELET-RICH PLASMA THERAPY FOR HAIR LOSS

Aesthetic Medicine Dubai | 11 June 2020

Are you looking for a hair loss solution? A therapy that promotes healing in injured joints may help restore your lost hair.  

Millions of men and women have male- or female-pattern baldness. It can begin early in life, but is much more common after the age of 50, when more than 50 percent of men will experience some kind of hair loss.   However, an emerging treatment — platelet-rich plasma (PRP) therapy — appears to help regrow lost hair. And, there are virtually no side effects from PRP, except for a mild feeling of pressure at the injection site.

HOW DOES PRP THERAPY WORK? 

Physicians began using PRP therapy about a decade ago to speed up the healing process in damaged joints after injury or surgery. During the treatment, a technician draws your blood and spins it in a centrifuge to separate out the platelets and plasma. Doctors then inject the plasma, which helps repair blood vessels, promote cell growth and wound healing, and stimulate collagen production.

Doctors began using PRP in dermatology after researchers found that high concentrations of platelets in plasma cells help promote hair growth by prolonging the growing phase of the hair cycle. Doctors inject plasma into the scalp where hair loss has occurred. They typically administer injections monthly for three months, then spread them out over about three or four months for up to two years. The injection schedule will depend on your genetics, pattern and amount of hair loss, age and hormones.  

HOW DOES PRP THERAPY COMPARE WITH OTHER OPTIONS? 

Other treatments for hair loss currently on the market are often more problematic for many patients.  There are two medications for treating hair loss: finasteride and minoxidil. But you must take these drugs consistently over time and results are inconsistent. Each drug also sometimes has side effects: 

• Minoxidil may cause dryness and itching on the scalp.

• Finasteride may cause sexual dysfunction in men.

RESEARCHERS SEE PROMISING RESULTS 

Recent research bears out the potential of PRP therapy.  In a 2014 study, researchers looked at men with male-pattern baldness who used both approved medications, but saw little change in their hair growth.   After four PRP treatments, they had about 30 percent more growth in thinning areas.  A 2017 study out of Italy also found male patients had increased hair and density in areas where doctors used PRP therapy.

It takes about three months to see an improvement. After that time, most  patients – both male and female – have regrown 30 to 40 percent of the hair they’ve lost.  

WHAT MAKES YOU A GOOD CANDIDATE FOR PRP THERAPY? 

Part of the success of PRP comes from selecting the right patients for therapy, PRP is safe and effective for many people. However, you should not have PRP therapy if you fall into either of these groups: 

• If you have an underlying disorder such as thyroid disease or lupus, you aren’t likely to have good results because these conditions will continue to cause hair loss over time.

• If you are on blood thinners, your platelets won’t work as effectively and the procedure is not as effective.

PRP therapy works better if your hair loss is recent. It is more challenging to “wake up” hair follicles that have been dormant for a long time.

FILLERS IN DUBAI: WHICH FILLERS ARE RIGHT FOR YOU?

Fillers in Dubai | 8 June 2020

Which filler is the best for you, and which filler should you choose for a specific treatment: nasolabial wrinkles, lips, nose, cheeks, quality of skin tone, or undereye bags? The internet and media are full of contradictory information.  

Although there are dermal fillers such as Radiesse (calcium hydroxylapatite crystals), Sculptra (poly L-lactic acid), and permanent fillers like Aquamid, in this guide, I cover dermal fillers based on hyaluronic acid – as these are the only dermal fillers I personally recommend. The reason for this is that hyaluronic fillers are not permanent, they have no lasting effects, they yield the most natural results, and if necessary, can be removed and dissolved using a special enzyme.

If a doctor prefers the use of renowned brands such as Restylane, Juvéderm, or some other (i.e. Teosyal and Belotero hyaluronic fillers), then the patient is definitely in very good hands, because these brands offer a whole range of different fillers, with various densities, hyaluronic concentration, and molecule size, let alone years of medical testing and research. My medical experience in aesthetic medicine has shown me that no specific brand is ideal, which is why it is in every patient’s interest that their doctor has a selection of at least 2 of these brands of fillers. 

Hyaluronic dermal fillers, along with Botox are the main tool of modern aesthetic medicine. Hyaluronic acid is a natural component of our skin, and its main task is skin hydration, as well as collagen reinforcement, and the restoration of elasticity. Our skin thus acquires a glow, stays firm, we have a healthier skin tone, and lost volume is restored in the face.

The history of hyaluronic dermal fillers is a relatively brief one. Bengt Agerup, a Swedish scientist and genius, was the first to stabilise hyaluronic acid in 1996. Up to then we only had inferior collagen and dangerous silicone fillers, but when the first dermal filler, Restylane, was produced in Uppsala, the world of aesthetic medicine changed forever. Over 25 million treatments using Restylane fillers have been performed all over the world to date. Most hyaluronic fillers are produced by fermenting bacteria in a laboratory, meaning they are produced in a natural and organic way (rare brands of hyaluronic fillers such as Dermavisca stem from animal sources – the fleshy comb of a rooster). This hyaluronic acid (the largest production plants of natural hyaluronic acid are in France and China) is used not only in dermal fillers, but in cosmetics and many creams, as well as in mesotherapy. Each brand of filler uses a different method and technology to stabilise and bind the hyaluronic acid, so that it can last in the skin for an average of 6-36 months. There can be a great difference between various dermal fillers. The stabilisation process and binding of hyaluronic acid varies with each brand, and the consistency of each filler is also different, as well as the concentration of hyaluronic acid, size of the molecules, and density. Furthermore, only some dermal fillers such as Restylane, Juvéderm and Teosyal contain lidocaine, a local anaesthetic. This, for me, is essential, because the treatments are less painful, and are a mark of a serious dermal filler brand.

WHICH FILLER IS THE BEST FOR WHICH TREATMENT?

LIPS

I will begin with the lips because in my many years of experience I have come across the greatest controversies especially when it comes to this treatment. Although it appears to be simple, it is one of the most difficult procedures in aesthetic medicine, and one which requires years of experience.

Today I am proud to say that I perform countless lip augmentations and contouring on a monthly basis.  Restylane Classic is a dermal filler I have used for years for lip augmentation. The results are excellent and yield very natural and soft lips. It is still one of my favourite lip fillers because it contains the optimum concentration of hyaluronic acid. Drawbacks? The results only last 6 months, and the lips are very swollen right after the procedure; however, the swelling dies off in just 24 hours.

Restylane Lyps is a newer version of Restylane Classic filler, with everything the same, except that results last over 9 months, because of the larger molecules and higher concentration of hyaluronic acid. The latest lip filler from the house of Galderma has a very fitting name – Restylane Kysse, which uses the new Emervel technology. There is no significant swelling following the procedure, the lips look exceptionally natural and very sensual, and results last over 9 months.

Juvéderm Ultra 3 is a very good lip filler from the house of Allergan, but offers subtle results that last for only 6 months. Allergan has recently launched its new Vycross technology, under which is its selected lip filler, Juvéderm Volift, although Juvéderm Volbella can also be used.

Juvéderm Volift lasts for 12 months, there is no significant swelling following the procedure, but I have noticed minor swelling in some patients, which can be manifest as small balls and thickening of the upper lip after a couple of weeks. However, this problem quickly dissipates on its own, or after a massage.

Teosyal Kiss is also a very good dermal lip filler. As its name suggests, it is specially formulated for lip treatment. It yields great results, with minimal side effects. Although it is difficult for me to determine the best filler for this treatment, I would give the title to a specially designed lip filler – Restylane Kysse. Right behind are definitely Juvéderm Volift and Restylane Lyps. In most cases, only 1ml of filler is enough per treatment, and it is not recommended to do more than that. It is wiser to come back after a month’s time and add another 1ml if your doctor finds it appropriate. What is most important is that the results are natural, and the face proportional.

UNDEREYE BAGS

Many doctors believe that there is no dermal filler suitable for this procedure, but from my own personal experience and following many successful treatments, I can confirm that this is not true. With my experience of undereye treatments, this is a remarkable treatment that yields outstanding results, and the best fillers for it are Restylane Classic and Restylane Lyft (Perlane). Here it is possible, with great expertise, to use both thinner and thicker dermal fillers. Knowledge is what counts most. Over the years, I have tried using other dermal fillers in this facial zone such as Teosyal Redensity, Juvéderm Volbella, Belotero, and although they yielded adequate results, too much oedema was reported, and the effects were not as good as the above-mentioned fillers. Restylane is the absolute king for undereye bags. In 80% of cases, 2ml of dermal filler is enough to erase bags under the eyes – even extra-large ones. 10% of patients require only 1ml, while 10% need to come back for their third ml.

NON-SURGICAL FACE-LIFTING / CHEEK AUGMENTATION

This increasingly popular treatment offers a natural facelift for skin that has lost volume and appears relaxed. With the expert administration of hyaluronic dermal fillers, there is no more need for a scalpel and surgery, because this can yield very effective and natural results with non-surgical face-lifting, and requires the use of 2ml – 5ml of dermal filler. What’s more, the effects can last for even 18 – 36 months (because this treatment uses denser fillers with larger molecules). The first such filler on the market was Restylane Sub Q, but it has proven to be too hard a filler, and so over the last 5 years my favourite filler for lifting the face, cheeks and saggy skin around the chin is definitely Juvéderm Voluma. It is a wonderful filler with large molecules that provides an adequate lift, which can easily be injected. 

For these procedures, I can also pay compliments to Restylane Volyme, which has recently emerged on the market. It is a new technology from Galderma which is now keeping stride with Juvéderm. These two brands are unique in that they come in 1ml doses and can be injected with a syringe. Other brands either do not have these fillers with larger molecules (vital for an adequate facelift), or only offer 2ml ampules that can solely be applied through a cannula, which may be unsuitable for many patients. It is my opinion that in the majority of cases, fillers must be administered with a syringe and not a cannula, as this yields better and more accurate results, which is logical. From patient to patient, if we take into account their age, skin type and condition, at least 2ml of filler is needed for a non-surgical facelift, but the dosage can rise up to 8 – 10ml of filler, which is obviously administered in 2 to 3 separate treatments.

NOSE

When it comes to the nose, dermal fillers should not be too dense due to the sensitive anatomy of the nose, yet must also have enough strength to lift and contour, fill in imperfections and align the nose. Restylane Classic can achieve perfect results with no side effects, I only use this and have done for years. Juvéderm, Teosyal, Belotero and other fillers, are also suitable for this treatment. As always, the most important factor is the expertise and experience of the doctor. If we select a proper brand of hyaluronic acid, along with a good quality doctor, in most cases 1ml is enough to yield results that last over 18 months.

NASOLABIAL WRINKLES

The correction of nasolabial wrinkles is still the most sought-after dermal filler treatment. It is a procedure that is most easily performed with the longest lasting effects. But, just a word of warning – I must emphasise that extensive knowledge, skill and expertise is also required here, not only to achieve the best results, but also because this zone demands detailed cognisance of its anatomy, in order to avoid side-effects such as vascular compromise, which cannot occur when administered by an expert, but becomes highly probable when one is in “unprofessional” hands. Here, many dermal fillers are very suitable, and so one can choose from a wide pallet. The dermal filler should be thinner, with less molecules, such as is the case with Juvéderm Volbella or Volift filler, Restylane Classic, Teosyal Global Action or Belotero Soft filler. When dealing with shallow wrinkles, 1ml is enough for both wrinkles, but in many cases 2ml are required.

REJUVENATING THE SKIN OF THE FACE, NECK, DÉCOLLETÉ AND HANDS WITH STABILISED HYALURONIC ACID (“SKINBOOSTERS”)

Modern aesthetic medicine is turning more and more to treatments of the skin itself and its rejuvenation. Laser treatments, plasma treatments, and dermal rollers are increasingly popular, but hyaluronic preparations achieve the best results. The skin of the face, neck, décolleté and hands gain a new glow, while wrinkles, pores and scars disappear. Elasticity is restored, and the skin is firmer. In a treatment which I call medical mesotherapy, the best product is Restylane Vital Skinbooster. It’s greatest advantage is the technology of the syringe itself that has a special “clicker” to provide a precise dose with each prick of the needle. The latest product of this type on the market is Juvéderm Volite, which yields excellent results, but we must also mention Profhilo, a recent market launch by Ibsa. It is an innovative dermal filler that is something between a dermal filler and a skinbooster.  

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