Wednesday, November 27, 2013

Puffy Under Eye help beyond tea bags

If your eyes look puffy and tired all the time and you want a more lasting fix, there are a few safe,  and effective treatment options available at the doctor's office.

Muscle-relaxers (Botox) and Fillers

If you have a banana-shaped swelling right under your lower eyelids especially when you smile that you would love to get rid of,  ask your cosmetic doctor to inject Botox ( or Xeomin, or Dysport) in the muscle that lies under that roll of under eye skin.  It should last 3-4 months, and if done regularly (3-4X per year) should weaken the orbicularis oculi muscle longest term.  Your eyes will look more open and awake.

If your puffiness extends from your lower eyelashes to your cheek, and is demarcated by a dark shadowy C-shaped groove at the junction with the cheek, I suggest filler too.  This is referred to by cosmetic doctors as filling the tear trough.  It is often done with a filler containing numbing medicine, and instantly fills the shadowy tear trough groove.  The filler can be extended to fill in a hollow under the rest of the eye as well.  There is no downtime, though some people experience temporary swelling and/or bruising.

Some people have such a prominent under eye swelling that filling the tear trough groove may not be enough to mask it, so we may fill the medial upper cheek (malar area) to help.

Finally, if filler is not enough to mask that under eye swelling, then I might advise lower lid laser blepharoplasty to remove the fat pads that create the swelling.  See my post "Laser Blepharoplasty vs..."

Often I will rejuvenate the upper eyelid in the same session as treating the under eye, by using laser to gently remove redundant wrinkly skin.  The laser can be used on the entire eyelid skin to improve texture and wrinkles.

Please note that if you are experiencing new eyelid swelling this could be a medical problem such as allergy, hypothyroidism, renal failure or sinus problems.  Please see your doctor to discuss these possibilities.

Monday, November 25, 2013


Also known as the pregnancy mask, but may occur (usu. in women) from any hormone change with sun exposure.

There is no perfect cure for melasma yet;  however, there are some treatments that improve it significantly.

At my practice, we have tried many treatments over the years and have our own system of treatment that we believe works the best.  We treat our melasma patients with the 1927nm laser at the office, followed by home use of a mandelic acid cleanser, and a Vitamin C iontophoretic mask.  This treatment regimen was invented by Mark Taylor M.D. CEO of Gateway Aesthetic Institute.

The home topical treatment system, meant to be used after laser treatment, is available for purchase and goes by the name Cosmion.  The kit comes with a very comfortable soft iontophoretic mask, the cleanser, the Vitamin C, a solution to clean the mask, and a battery-powered iontophoresis mask.  The mild current in this gentle iontophoresis system may either not feel like anything or may tingle the skin a little.  Iontophoresis has been used by dermatologists for years to treat sweating of the palms and soles, and more recently to help medications penetrate the skin better.

We advise our patients to use the Cosmion home regimen 3-4 x/week for four weeks after their laser treatment.  We may repeat the monthly regimen as desired.

An article was published by Dr. Taylor in the Journal of Drugs in Dermatology re. this treatment, See the January 2013 issue, Volume 12, Issue 1, pages 45-50.  Here's a link:

Longer Eyelashes

These are my lashes after 12-14 weeks of Latisse.

I have clear mascara on only to lift them up for viewing.  I am very pleased with this product from Allergan.  I tried eyelash extensions for a year before starting Latisse.  I found the extensions (even false mink) to look less natural, and I got more comments from friends and strangers questioning what I did.  Also extensions are way higher maintenance, with the need to fill every 3 wks.  Takes an hour+ to have the fill done, and you may pay $45 to $80 depending on how much of a fill and the salon location.  I have green hazel eyes and the iris did not change color at all from Latisse.  The package has that warning but it was only seen in people who were putting the liquid on their entire eyeball for glaucoma.  When you use it for the upper lashes, you don't get it in the eyeball at all.

My medical assistant has blonde lashes, and says that she uses colored mascara with the Latisse to darken them.

Friday, November 22, 2013

Skin Tightening without cutting

Loose, wrinkly, saggy skin tightening is hot right now, literally. The methods used most often to tighten skin involve heat. In no particular order: laser (Fotona), ultrasound (Ultherapy, Thermage), and radiofrequency (Invasix). We are actively studying at my practice which method does the tightening the best and with the least number of treatments. We have tried all these treatments and continue to try them as their respective manufacturers update and improve their function and protocols.

Right now our favorite is Fotona (1550nm) laser tightening, which seems to do the job with the least amount of pain and treatments. We have been using it to tighten lower face, neck, lateral brows, and tummies. I will provide some photos as they become available. We have been doing Fotona treatments without any anesthesia or sedation because the heat you feel is so mild. Some timid patients we have given numbing cream prior to the treatment.

Wrinkle Filler Update

Allergan (maker of Botox and Latisse) just got FDA approval of a new Hyaluronic Acid filler called Juvederm Voluma XC. What is really cool about Voluma compared to other Hyaluronic Acid wrinkle fillers is that it was formulated to last - TWO YEARS !! This is longer than all other hyaluronic acid fillers (Restylane, Juvederm Ultra, Perlane, Belotero, etc.) which last from 6 to 12 month. Juvederm Ultra Plus is close at 12-18 months. Voluma is approved for use in the mid-face to bring back volume that is lost with age or sun damage. It does contain Lidocaine so would not be suitable for someone with a lidocaine allergy.

Voluma and other hyaluronic acid fillers are non-permanent but do stimulate collagen to regenerate in the wrinkled skin. Many dermatologists believe this collagen stimulation to be a lasting effect so that after having a handful of these treatments you may need less product. Voluma and the other hyaluronic acid fillers can be easily reversed with hyaluronidase enzyme so have no fear if you change your mind.

Voluma is now available at my practice, Gateway Aesthetic Institute and Laser Center of Salt Lake City, Utah.

Improve Your Aerobic Metabolism of Fat with CelluCurve

For those who have stubborn deposits of fat despite diet and exercise, or even if you haven't tried enough exercise yet. Cellucurve was invented in Italy and is all the rage for a safe, non-surgical means of burning stubborn fat. I heard there were lines out the door of the Italian medical offices with this amplified exercise device.

The Italian inventor and engineer (Fabio Marchesi) of CelluCurve and its technology explains that fat in our body burns/metabolizes more efficiently when it is heated or warm. We change from the inefficient anaerobic metabolism to aerobic metabolism of fat with the heat. People with trouble losing weight may have less active aerobic metabolism which is needed to lose the fat and the weight. You can watch Fabio explain the technology on YouTube.

What is Cellucurve?
CelluCurve is an inclined, comfortable, stationary bike with infrared lights that operate as you cycle to gently heat your fat. The light can be adjusted to shine and heat the areas you want to heat, and you can put cool packs on your breasts (if your a woman) and prevent loss of fat there but instead redistribute the other metabolizing fat to the breasts. In other words, you can move fat from your butt to your boobs, yay! For men, you could melt those man boobs.

Is it painful?
No, but you do sweat a lot, and need to keep lots of water on standby.

Where does liposuction fit in?
If you don't want to or can't commit to the CelluCurve program - 15 x 40 minute biking sessions, then you may be a candidate for liposuction. However liposuction won't improve your cardiac output like Cellucurve will.

Where can I find the machine in the U.S.?
I heard that the The Gateway Aesthetic Institute and Laser Center of Utah to date is the only place in the United States with the machine.

How much does it cost?
$1999 for 15 x 40 minute sessions at Gateway Aesthetic Laser Institute.