Daily Skin Fix

Top 10 Skin Tightening Tips
From A Cosmetic Dermatologist

1. Take prevention seriously. Start protecting your skin early from daily sun exposure, by wearing sunscreen every day. Don’t tan. Don’t smoke. Use a retinoid, antioxidant, peptides and an alpha hydroxy acid daily. It’s never too late to start.
2. Non-invasive skin tightening procedures like Thermage work best on mild to moderate skin sagging. Start these procedures early and plan to do them intermittently every couple of years to tighten and slow down sagging. Don’t wait until you have pronounced sagging.
3. Dermal fillers like Juvederm and stimulatory fillers like Sculptra not only make you look better today, they actually provide the right environment for your skin to manufacture additional collagen. Don’t put it off when you start to see early loosening of the skin.
4. Take care of your teeth. You need them. Loss of teeth leads to loss of facial bone structure, accelerating sagging. Do everything you can to avoid having teeth pulled and dentures placed.
5. If you are thinking about surgical tightening procedures like a facelift, choose your plastic surgeon carefully. Opt for structured formal training in plastic surgery, certification in Plastic Surgery by the American Board of Medical Specialties, and experience over glossy ads, media coverage, and smooth bedside manner.  Be cautious about internet reviews; some glowing reviews are planted by the physician, and some bad reviews are planted by a competitor. Get recommendations from friends who have used the surgeon, and from trusted physicians and nurses. Be a little careful with taking all referrals at face value, sometimes the physician you ask is a personal friend of the surgeon. Plastic surgeons often give nurses a professional discount, which could cloud their judgment. Ask multiple people. Get second opinions.
6. This goes for cosmetic dermatologists too. They should be certified by the American Board of Medical Specialties in Dermatology. Get personal recommendations from people you trust who have used them.
7. Don’t get set on having a specific procedure based on something you read on the internet or saw on a TV show. If you have done your homework, your cosmetic dermatologist or plastic surgeon is very experienced in evaluating your face, your medical condition and your desires and deciding which particular procedure is best for you. Be specific in what kind of results you want, how much money you can spend, how much recovery time you can afford. Then let the surgeon guide you in which procedure is right for you. If you don’t feel the physician is the right fit, get a second opinion.
8. Follow your plastic surgeons instructions. Be truthful about your medical history. Don’t lie about smoking. Don’t agree to quit, then sneak “just a couple” while you are recovering from a facelift. If you are having problems after surgery, insist on being seen. Good plastic surgeons will want to see you. They don’t like complications either.
9. Aim for a natural, but rejuvenated look. You are never going to be 28 again, or look like the photo you brought in of yourself at 28. Get over it. Be realistic.
10. Know in advance that your definition of “recovery time” after surgery and the surgeons is the same. Ask specifically when you can expect to be there. There is a difference between “most of the bruising and swelling will be gone” and “no one will know I have had surgery”. Ask for a specific time frame. Then double it and plan accordingly.

Bonus Tip: Don’t decide on an invasive surgical procedure based on an infomercial.

The fine print about skin tightening procedures–risks, complications, side effects, poor cosmetic results, and other unpleasantness

If you are thinking about getting one or more procedures for skin tightening, you will want to know about the risk, side effects, and how happy you will be with the results. The problems that occur with all skin tightening procedures generally fall into one of three categories:

• Risk of medical or surgical complications that are a risk to your health or the integrity of your tissues
• Risk that the procedure performed is not the procedure that you really want or need–either too much, too little or the wrong procedure to address your problem
• Risk that the results will be either unnatural looking or obviously operated upon

My lawyer is again reminding me to remind you that you should not rely upon the following discussion of risks as a basis to decide whether or not to have a procedure. If I am not your doctor, I am not your doctor. Rely upon what your doctor tells you.

Risk of complications that are a risk to your health or the integrity of your tissues

All of the surgical procedures have similar sets of risks, although the likelihood that they will occur vary among the procedures, with the skill of the surgeon, and the patient’s individual medical condition. Differentiation has to be made between events that are expected and occur in most, if not all patients, such as swelling and bruising, and complications that only occur in some and can cause permanent damage. Skin tightening surgical procedure risks include excessive bleeding, infection, nerve damage, tissue death, scarring, swelling, and the risks of general anesthesia, if needed.   Bleeding after surgery can be a problem when the blood collection prevents healing or puts pressure on other structures. Infection can cause damage to the tissue. Nerve damage can cause loss of sensation or muscle movement. Death of tissue at the edges of the area that has been lifted in a facelift can cause significant scarring. Scarring can be unsightly or actually affect function, as when eyelids don’t close properly because of scarring and chronic drying then damages the surface of the eyeball.  Additionally eyelid lifts have a risk of loss of vision (luckily extremely rare), changes in vision, double vision, excess or inadequate tearing.

Fortunately, serious, lasting complications from surgical skin tightening procedures are uncommon. But as with all the risks that your physician discusses with you, they do sometimes occur. Otherwise they wouldn’t be talking to you about them. Each of the surgical procedures has its own relative risk of each complication that is specific to that procedure, based on the extent of surgery performed and the characteristics of the tissue that is located on the surgical field. For example, facelift surgery has the greatest risk of “flap necrosis” or death of skin at the edges of the “flap” that is moved because the area of tissue that must be separated from the underlying blood supply is the greatest. Eyelid surgery affects structures surrounding the eyeball, so the risk of damage to the eye, though very low, is specific to that particular surgical procedure.

The non-surgical procedures risks in general are less severe, reflecting the less invasive nature of the procedures. But, they do occur. Radiofrequency tissue tightening with Thermage risks include very rare risk of burns, surface irregularities or fat atrophy which are reported with current technology and current treatment protocols as less than 2 cases per 10,000 patients treated. Liquid lift with skin filling injections may cause bruising or swelling lasting for up to a few weeks. Bumps under the skin may occur and are occasionally visible. Rarely compression of a blood vessel may occur, which if not successfully treated, can cause damage to the tissue from lack of blood flow. Very rarely, a long lasting infection can occur.

Risk that the procedure performed is not the procedure that you really want or need–either too much, too little or the wrong procedure to address your problem

It is not unusual for a patient to request one procedure when another is indicated. A patient may request an eyelid lift, when the real need is for a brow lift, since a sagging brow doesn’t hold the eyelid up well, so it sags.  Another may request Thermage treatment, when their real need is for a face lift. Plastic surgeons and cosmetic dermatologists are trained to evaluate the real nature of the problem and to suggest the proper procedure to address it. Problems occur when the physician does not accurately evaluate the problem, and/or performs the wrong procedure. That is why formal training, experience, judgment, an artistic eye, and our old friend the Hippocratic oath are important.

Risk that the results will be either unnatural looking or obviously operated upon

Many patients worry more about having a bad cosmetic result than they do about the risk of serious complications from skin tightening. We have all seen results that are unfortunate. Sometimes they are very obviously bad, and sometimes it just doesn’t look right. Too tight, too unnatural, too “done”.

Bad results after surgical procedures include the dreaded “wind tunnel” pulled too tight/too much look. Often this is the result of a surgical face lift, brow lift or eyelid lift that has either removed too much skin or fat, or has pulled skin tight over a face that has very little fat to provide normal contour. Too tight face lifts often leave a “skeletonized” appearance to the face. Too tight brow lifts can raise the eyebrows unnaturally. Eyelid lifts that remove too much fat give a hollowing around the eyes.  Facelifts and brow lifts may cause changes in the hairline shape or localized hair loss. Scars may be visible, thick or distort the shape of the surrounding structures. Shape of the structures may change. This is often noticed as a change in the attachment of the ear to the side of the neck, so called “pixie ear”, after a facelift, or rounding of the normal almond shape of the eye after an eyelid lift. Skin may be pulled in an unnatural direction, such as the “sweep” of the cheek looseness that may change from the pre-surgical downward jowls to a horizontal pouch.  Asymmetry may occur, either as accentuation of pre-existing asymmetry or as a new problem, with one side tighter, higher, flatter or more prominent than the other side.

Poor cosmetic results, as abnormal or too tight appearance after non-surgical radiofrequency treatments have not been reported. Surface irregularity, though very rare, is aesthetically unpleasing. Lack of sufficient improvement in skin tightening may give inadequate cosmetic improvement.  Filler treatment may be either too much or too little. Inadequate filler volume gives inadequate results. Excessive filler volume gives an unnatural, bloated appearance. Shape of structures may be changed, most commonly seen in the “trout pout” of some patients after lip injections. Lumps, bumps, puffiness or visibility of the filler through the skin may occur.

Oh my, such unpleasantness. Fortunately, a good cosmetic outcome without complications is common when the physician is trained and skilled, and the patient does their part. So we better discuss that next.

Next: Top 10 aesthetic skin tightening procedure tips

Let’s finish Restore Volume–Reduce Lines, Give Youthful Fullness and Lift Sagging Skin with my top 10 anti-aging cosmetic skin filler tips.

The first 5:

1) If you can only afford one anti-aging treatment–do cosmetic filler injections

Doing aesthetic filler injections is one of my very favorite procedures because it makes such an improvement in giving a healthy, youthful appearance. But you do have to be realistic about how many syringes you need, and the results that you can achieve with the number of syringes you can afford. It takes a certain volume to get a certain result. It is fine to do it a little at a time as you can afford it, but to say that “filler didn’t work” when you needed three syringes but only did one is not a fair test.

I always try to stay grounded in reality.

2) Don’t expect filler injections to remove etched lines

The hyaluronic acid fillers Juvederm and Restylane plump up wrinkles from below and provide lost fullness. But if the line is etched from being folded ten million times, you will need skin resurfacing to really smooth the sharp line. If you stretch the skin and the wrinkle totally disappears, usually filler is all you need. If there is still a surface crease, you will need resurfacing. But either way the line will look a lot better after filler.

It’s always better to see the glass half full.

3) Treat eyebrows and temples

Yes, the lips, the corners of the mouth, and the smile lines are the first priority; cheeks next. But don’t forget the eyebrows and temples. With age, the eyebrows thin and begin to droop, especially at the outer comers. The fat that sits on the brow bone begins to descend, taking the brows down with it. A relatively small amount of Juvederm or Restylane in the outside wing of the eyebrow gives 3 dimensional structure and helps reduce hooding of the upper eyelid. Sunken temples give you a skeletal look and are aging.

Halloween was last night.

4) Treat corners of the mouth

Turned down corners of the mouth make you look unhappy and older. Juvederm or Restylane is injected below and to the side of the corner to turn it up. It breaks up the line from the corner down to the chin. You look happy.

Even when you’re not.

5) With age, thin faces need volume

They do.

Believe me.

Next: Part 2 of  Top 10 Anti-Aging Cosmetic Filler Tips

Once again, these are the risks and instructions I discuss with my patients. If you are not my patient, you should listen to what your doctor tells you. I know you get tired of hearing this, but my lawyer doesn’t.

In general, the hyaluronic acid fillers last 1 year in the smile lines and lips; longer under the eyes, in the cheeks and temples. Sculptra lasts 2 years on average. Your filler may not last as long, or it may last longer. Results with Juvederm are seen immediately and settle in over a couple of weeks. Results with Sculptra are seen within 6 months.

I am always asked “do filler injections hurt?”  In our office we use a anesthetic cream. The hyaluronic acid fillers now have anesthetic in them. Sculptra is mixed with anesthetic. With the combination of anesthetic in the filler itself, and in a pre-treatment cream, most of our patients find the procedure very tolerable. If needed for lip treatment, additional anesthetic can be given in a dental block just like at the dentist. Now that Juvederm has anesthetic in it, only about 10% of our patients request a dental block. Before the anesthetic was added, 99.9% of our patients wanted a dental block.

There are risks with any medical procedure. The main risks with volume replacement and wrinkle treatment with cosmetic skin fillers are: bruising, infection, swelling, lumps, mild tenderness. Bruising is the most common problem after cosmetic dermal filler injections but can be reduced a great deal if you follow the instructions in my post “if you don’t want to look like I beat you with a stick, read this.” So read it.

Sculptra, or any of the longer lasting fillers, like Radiesse or Artefill, should not be used in the lips, or in the area immediately around the lips or eyes. If used in those areas, long lasting bumps under the skin can occur. Occasionally, they develop in other parts of the face. After Sculptra injections, our patients massage the treated area several times a day for 2 weeks to help prevent bumps under the skin.

Swelling after treatment is rarely a problem, the exception being fat injections in or around the lips, in which swelling may persist for weeks. Rarely unusual swelling occurs months to years after any of the fillers. It is more persistent with the longer lasting fillers Radiesse and Artefill.

Infection is rare but occasionally occurs. The risk is higher with the longer lasting fillers.

Compression of a blood vessel by the filler after injection very rarely occurs, but if not corrected, can cause death of the tissue overlying the occluded vessel. Symptoms include severe pain, gray discoloration (not the same as bruising), often with a light gray or white center, occurring within the first 24 hours after injection. It is most common on the cheeks or the area between the eyebrows. Immediate treatment is required to prevent ulceration of the tissue. If the hyaluronic acid fillers Juvederm or Restylane are involved, they are dissolved with a an injection of a medication, hyaluronidase. Compression of a blood vessel by the longer acting fillers, such as Radiesse, are more difficult to treat.

Occasionally, a patient either develops a lump, too much fullness in an area, or simply doesn’t like the result of treatment (usually lips–and we will talk about lip disasters later). One of the advantages of the hyaluronic acid fillers is that these can be reversed. I don’t know why some doctors don’t offer to reverse an area of filler if the patient is unhappy. I have seen patients, treated elsewhere how suffered with unsightly lips or other areas for a year. Not uncommonly they have seen the injecting doctor multiple times with their concerns, but were not offered reversal with hyaluronidase. So if that is you, know that there are options. In life, the ability to reverse a mistake is worth a lot.

There are quite a few fillers used that have not been approved by the FDA for use in the US. Yes, some doctors in the US use them anyway. Yes, some are used “all over the world.” Yes, some have good safety records. Some don’t. Just say no.

Next: Why you don’t want to look bizarre.

One of the hallmarks of youth and beauty is symmetry, i.e., one half is the mirror image of the other. When one eyebrow is up or down, when one eyelid droops and the other doesn’t, when one cheek is falling more than the other, the symmetry is marred and to our subconscious mind, the person is less attractive.

Classically, aesthetic facial beauty is characterized by the ‘rule of thirds’  in which the face is divided by three horizontal lines. The top third is from the hairline to between the inside ends of the eyebrow;  the middle third is from the inside ends of the eyebrows to immediately under end of the nose; and the lower third is from immediately  under the end of the nose to the tip of the chin.

Each third should be equal in vertical dimension, and each should appear equally dominant. When they are not, as demonstrated by someone with a very large forehead, large nose, or weak chin, again we subconsciously see that person as less attractive.

It’s my job as a cosmetic dermatologist to try to improve a patient’s symmetry and balance the thirds of their face.

Unfortunately, one of the things that I sometimes see are patients who either have had treatment elsewhere,  are Hollywood or Reality TV stars, or just people on the street, in whom the basic rules have not been applied. You have probably seen them too. Sometimes you just know that they are “off” but not entirely sure why.

The most common of these mistakes are augmenting the lips, smile lines, and corners of the mouth, without considering the cheeks, and temples. This is especially noticeable  on a thin individual with fat wasting of the cheeks and temples. They develop a “horsey” look with a prominent lower face, sunken cheeks and temples. The epitome of this look is the very diet conscious, compulsive exerciser, on Adderall and HCG, with a bunch of filler in her lips and smile lines in an attempt to compensate for her falling cheeks. Good thing that doesn’t describe me.

That’s why it is important to develop a plan with your cosmetic dermatologist, that addresses all of the areas of volume loss, to restore youthful symmetry and balance.

Then you won’t end up on TMZ as a “Don’t” with strangers commenting on your looks.

Next: Now the fine print

• Marionette lines and corners of the mouth—Juvederm Ultra XC or Juvederm Ultra Plus XC--1-2 syringes split both sides
• Lips–Juvederm Ultra XC-1 syringe
• Nasolabial folds (smile lines)—Juvederm Ultra XC or Juvederm Ultra Plus XC
• –1-2 syringes split both sides
• Under eye hollows–Restylane-L —1 syringe split both sides
• Cheeks–Juvederm Ultra Plus XC—2 syringes, one for each side.
• Temples–Juvederm Ultra Plus XC—1 syringe or Sculptra
• If doing overall “re-volumizing”-– Sculptra 2 vials per treatment, 3 treatments, (total 6 vials)

What do cosmetic skin fillers cost?

These are our current prices per syringe or vial for cosmetic skin fillers.

Of course they may change as our filler costs change.  We also have a lot of package discounts and intermittent specials on fillers. And the manufacturers offer rebates and discounts which help you out too.

Juvederm Ultra XC– $599

• Two or more syringes are $562.50
• Plus you get 5 units of Botox for chin free. This helps the turn down of the mouth and jowls.

Juvederm Ultra Plus XC– $625

• Two or more syringes are $587.50
• Plus you get 5 units of Botox for chin free. This helps the turn down of the mouth and jowls.

Sculptra Aesthetic– $899 per vial

• For a 3 treatment series, of 2 vials per treatment (total 6 vials)– $4999

When Juvederm Ultra XC and Juvederm Ultra Plus XC came out with anesthetic, our costs went up a substantial amount but we decided not to increase our prices for cosmetic filler. We thought it was important to hold costs down for our patients in this economy.

Are fillers expensive? I think that they are well worth the costs, because you really get a bang for the buck. When budget is an issue, our patients often start with one or two syringes and then add more later. And many patients only need one or two syringes to get the improvement they want. Also, at the time of retreatment, it is not unusual to not need as much treatment, as some of the results are lasting.

For more information on our current cosmetic procedures on sale and discounts check our web site.

Next: Don’t ignore the obvious

The first thing that I do when a patient comes in for a skin rejuvenation consultation is to try to determine whether they need volume correction, as that is likely to give them a big bang for the buck.  I look at all of the areas where volume loss causes aging changes and decide between a targeted filling of a few areas, reduction in specific wrinkles, or a broader volume restoration to larger areas of the face.

Cosmetic Skin Filler Evaluation:

1.    The first areas I look at are the corners of the mouth and the creases leading down from the corner of the mouth to the chin. These “marionette lines”,  that look make you look like a ventriloquist’s dummy, are the most aging changes. They appear to drag your face down and accentuates neck and jowl looseness. So the first thing I recommend is to fill those in.
2.    Then I look at the lips themselves. Often they have lost volume and have radiating lines. I like to plump the lips primarily to treat the lines around the mouth. If I just inject the radiating lines, often the patient will get a “Marge Simpson” upper lip with prominence of the area above the red part of the lip. We will talk more about lips later as they are the area that have potential to look bizarre if not done properly.
3.    Next are the nasolabial folds from the side of the end of the nose down to the mouth. If present, they cause a harsh appearance.
4.    The cheeks have usually lost volume, causing a flat face and pushing down on everything below them. This area is often neglected in filler treatments.
5.    If there are hollows under the eyes causing a tired look, we talk about fillers there.
6.    Last is the temples. After the other areas are corrected, if the temples look sunken then we need to address those.
7.    After I look at the entire face I decide whether we need to fill in certain areas, usually with a hyaluronic acid filler, or do a more complete, less targeted, overall filling with Sculptra.

There are a bunch of fillers available. These are the most commonly used:

• Hyaluronic Acid Fillers–Juvederm Ultra XC, Juvederm Ultra Plus XC, Restylane-L, Perlane-L
• Poly-L-Lactic acid (PLLA)– Sculptra Aesthetic
• Calcium hydroxyl apatite–Radiesse
• Fat injections
• Polymethylmethacrylate (PMMA) suspended in collagen–Artefill
• Surgical implants

I tend to stick with the hyaluronic acid fillers for targeted area and Sculptra Aesthetic for overall volume improvement. Hyaluronic acid fillers are reversible if needed, and Sculptra is great for overall volume improvement. Fat injections involve removing some of the patient’s fat and injecting it into the area to be filled. It is nice because most of us have a ready supply, but fat injections are more unpredictable with some of the fat not surviving transplantation. Also fat is less precise in placement, and causes a fair amount of swelling especially in the lips. I have seen major swelling last for 3 weeks or more. My patients won’t tolerate that. That said, some physicians do it very successfully.

Juvederm Ultra XC, and Restylane-L are for more superficial placements and Juvederm Ultra Plus XC and Perlane-L are for deeper filling. All 4 have a local anesthetic in them which decreases discomfort. All are sold by the syringe. The hyaluronic acid fillers give immediate improvement that lasts on average 1 year. At one year, more or less, we will do another treatment.

Sculptra Aesthetic is a powder that is mixed with an anesthetic and is for overall improvement. Sculptra is designed to be given over several (average of 3) treatments and lasts on average 2 years. At around 2 years most patients choose to do another treatment. Most patients do not need to do 3 treatments again at that time.

Sculptra (and to a lesser degree the hyaluronic acid fillers) are bio-stimulatory, meaning that they actually cause you to make more of your own collagen so some of the results are lasting. The improvement with Sculptra evolves over a 6 month time period so you gradually look better and better.

Fillers are my favorite procedure because they make such a difference and I enjoy the artistry of sculpting the face. I do all of the filler injections in my office. They are more difficult to get right than you might think. If you see someone and you think “wow, look at those bizarre lips” or if you can tell they have filler injections, they have not been served well. I always work to get a completely natural look, only better.

Sounds like a lot of filler injections. How much do we need?

Next: What is it going to take?

Cosmetic dermatologists achieve a youthful, aesthetically pleasing, attractive face by following the 5 R’s of anti-aging treatments: Repair, Relax, Restore, Resurface, Re-drape.

• Repair Sun Damage–Reduce Lines, Wrinkles, Spots, Sagging
• Relax Muscle Action–Reduce Lines
• Restore Volume–Reduce Lines, Give Youthful Fullness and Lift Sagging Skin
• Resurface Skin Texture–Reduce Lines, Wrinkles, Pore Size, Scars
• Re-drape Sagging Skin–Lift and Firm

Let’s go on to Anti-Aging Skin Rejuvenation Plan— –Step #3–Restore Volume

One of the most aging changes that happens over time is the loss of volume in the face. With age there is a loss of  fat, muscle and bone causing an aged, hollowed out, haggard appearance. In youth fat is under the eyeballs, in the cheeks, the temples, and the eyebrows. Over time this is reduced and drops which causes a “flat” face. This can be seen most dramatically in profile. Patients tell me “my face is melting.”

In youth the widest part of the face is the cheekbones, narrowing to the chin; called the “triangle of youth.”  With aging, volume is lost under the eyes leading to under eye bags,  hollows, and dark circles. The eyebrows fall when fat is lost, causing hooding of the eyelids. The high apple of the cheek falls. As the cheeks descend they cause deep lines from the side of the nose down past the corners of the mouth. These lines are like an arrow pointing downward, and appear to drag the face and neck downward.  The temples are hollowed, often with visible veins. The jaw line widens and the upper face narrows. The “triangle of youth” becomes the “pyramid of age.”  The skin’s “envelope” becomes loose over too little underlying structure leading to sagging, a flat and aged appearance and with jowls.

Adding to this is loss of volume in the lips as they become thinner and roll inward. Loss of bone around the mouth compounds the collapse of the mouth. Both cause a pinched and wrinkled mouth with radiating lines.

So basically, everything is falling. Cosmetic dermatologists call this deflation and descent.

And let’s not even talk about anything below the neck.

In the past, the looseness of the skin and the sagging was treated with a face lift alone, But that often lead to a gaunt, skeletonized, “caught in a wind-tunnel” look. The loss of volume needs to be corrected for a natural, rejuvenated appearance.

In any individual patient, either the volume loss or the looseness may predominate. But often it is a combination of both. If so, the problem of loss of volume and loose skin both need to be corrected. Although some patients certainly require a surgical face lift, we see many patients who successfully receive volume replacement only, or volume replacement combined with non-surgical tissue tightening with Thermage, sometimes called Therma-Fill. We will talk about this aesthetic option later.

Volume loss changes occur over time in us all, but may occur earlier in some than others. Of course, smoking or sun damage to collagen and elastic fibers cause the face to fall quicker and increases severity of facial lines. Individuals who have lost a great deal of weight, runners, and very thin individuals often show these changes earlier than others. I have a saying, “At a certain age, you have to choose between your face and your butt.” But actually you don’t– if you are willing to restore the lost fullness to your face.

So what on earth are we going to do?

Next: What we are going to do.

I love  dermal fillers for treating wrinkles and volume loss. Nothing drags your face down and makes you look older more than volume loss in the upper cheeks with aging. It changes the “triangle of youth” where the widest part of the face is the cheekbones into the “pyramid of age” where the central face is flat and the jowls are prominent.. As my patients often lament “my face is melting”.  Dermal fillers restore the lost volume   to the mid face, lifting the jowls–called “liquid lift”.

I use Juvederm XC, Restylane or Sculptra for my patients to restore the youthful volume. Patients love it, it looks and feels natural. But sometimes the injections cause bruising which may prevent a patient from getting treatment when they want it. This is what I tell them to do and it really seems to help. Of course that means you need to read this now and plan ahead. There are also a few other post dermal filler tips.

BEFORE TREATMENT TO REDUCE BRUISING FROM DERMAL FILLER

• For one week before, avoid aspirin, NSAIDs (Ibuprofen, Aleve, Motrin, etc.), St. John’s Wort, Vitamin E, Multivitamins, Fish Oils, Flaxseed Oils, Omega-3, Gingko, Ginseng, Garlic and Glucosamine.
• If you have frequent cold sores, contact us 3 days before treatment for medication.
• Go to store and buy a fresh pineapple. It can be cut up by the store but must be fresh not frozen or canned. Eat half of the pineapple the day before your treatment. Pineapple contains bromelain which is felt to help decrease bruising.

DAY OF TREATMENT TO REDUCE BRUISING FROM DERMAL FILLER

• Eat one quarter of the pineapple before you come in for treatment.
• Eat the final quarter of your pineapple after your treatment.
• You will receive Arnica gel to reduce bruising.  Apply 5 times a day for 2 days after treatment starting 30 min after treatment.
• We use GentleWaves^® LED treatment immediately after injection to reduce swelling and bruising.
• We use cold packs before and after treatment.

AFTER TREATMENT TO REDUCE BRUISING FROM DERMAL FILLER

• For two days after, avoid aspirin, NSAID’s (Ibuprofen, Aleve, Motrin, etc.), St. John’s Wort, Vitamin E (including multivitamins with Vitamin E), Fish Oils, Flaxseed Oils, Omega-3, Gingko, Ginseng, Garlic and Glucosamine.
• You may feel lumpy areas inside your mouth or on lips for a week. This is normal.
• Apply cold compresses for the first 8 hours to reduce swelling.
• Avoid touching the treated area within 6 hours after treatment, except to apply Arnica.  After that  gently wash with soap and water.  Foundation may be patted on.
• If the lips were treated do not put pressure on them with a straw, water bottle nozzle, etc., for one week.
• Do not put significant pressure on treated areas for one week (i.e. don’t lay face down on massage table cradle–I should be the one doing that).
• Bruising may be covered with makeup.  The most complete coverage is Dermablend Cover Cream (we get it at Ulta) although truthfully nothing covers it completely. Plan accordingly.
• Very occasionally an area will be too “puffy” and need an injection of medication to reduce the amount of filler. You don’t have to suffer with an unfortunate result (that you got elsewhere, of course)

Remember if you are not my patient don’t pay attention to what I tell you. Pay attention to what your doctor tells you.