Three HUGE tips when getting & buying Botox Treatments

So, you have booked your Botox appointments with lifebooker or Groupon or another social marketing site... Now what? 

No 1. Don't Cheapen Yourself. 

You get what you pay for, lower priced procedures tend to be done by non-physician staff and the treatment is typically subpar or "light". Many clients of mine follow up with me after a "deal" booked online with questions about the treatment and problems with the treatment. It blows my mind sometimes how little clients know what is going on, who is injecting them, how trained that person is. Ask questions! 

No 2. Listen to the Injectors Advice. 

Some clients come from previous injectors looking to change doctors for many different reason. Often, a client will tell you how the other doctor used to do it. This is fine, and I actually like this (especially if you used to get great results by that doctor). Unfortunately, every doctor injects a little differently. Most of the time the information relayed to me is a bit off. Unless you are 100% sure what your previous injector did (how many units is KEY), it is best to take your new injectors advice on how much and where to inject. Your new injector wants you to get a great result, after all return and referral business is their livelihood! 

No 3. Don't do anything silly. 

Yes, you shouldn't use retinA, drink alcohol, take aspirin, and a slue of other "No, Nos" in the week leading up to a procedure. As far as Botox and Filler this is a soft recommendation, it can cause some mild complications but is usually not an issue. What is an issue is patients that have plans after the procedure. Yes you can go out to dinner, grab a coffee with a friend, go to the movies, relax, but please please do not plan to do any time of strenuous exercise or any activity that will have your face down or manipulated. Here is a little list of things people have had planned and had to cancel: Yoga, workouts, soul cycle, massages, acupuncture, steam room, sauna, the list goes on. Just be smart, take a day off. Botox effects can last 3 months but some other procedures can last much longer. Do yourself a favor and take it easy for a day!

Alexander L. Blinski M.D. 

305.308.5812 | ablinskimd@gmail.com

Symmetry Medicine ~ Beauty Delivered

New York, NY

www.symmetrymedicine.com

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Juvederm Voluma: The new kid on the block

If you are reading my blog, that means you know what a dermal filler is.  

A quick recap: Dermal fillers are used to plump up areas or add volume underneath the skin. The dermal fillers I use are typically composed of hyaluronic acid (made synthetically, but is a natural occurring substance in our bodies and dissolves over time). Once any of these fillers are placed they soak up water in the area over the next week or so and expand in size. 

These fillers are typically used to: 

• increase lip size
• decrease facial wrinkles 
• decrease size of lines from the nose to the mouth
• fill in smokers lines
• improve under eye volume loss (leading to the "sunken" look)

The new "Big dog" on the market comes from Allergan, the same company that makes Botox and regular Juvederm. The new product is called Juvederm Voluma. It is a hyaluronic acid filler that is aimed at "re-volumizing" the face. As we age we tend to lose our fat pads in the cheek area resulting in a more hollow faced appearance. Juvederm Voluma is an out patient procedure injection that places this "plumper/volumizer" in the cheek and causes a lifting effect to the entire cheek and face. These results last 1-2 years! The best part, if you are unsatisfied with it, this particular filler can be dissolved!

Results are very subtle and a bit pricey, but 1-2 years!! That is pretty darn good!

More to come on fillers soon, alternative uses and more about Belotero for tear trough defects (undereyes).

Dr. B
www.symmetrymedicine.com

The secrets behind Retin-A and Retinol: The cornerstone of anti aging treatments

All trans retinoic acid, commonly known as Retin-A, is truly the cornerstone of cosmetic medicine and should be included in most, if not all cosmetic treatment regimens. As many of my patients know, a skin conditioning regimen that you can stick to is so very important. With at home skin conditioning, maintenance procedures, and corrective procedures, it is very possible to slow down the aging process or reverse signs of aging by up to 10 years!

Later in the blog series we will discuss what components are in a skin conditioning regimen and why some patients need more than just moisturizer.

Retin-A (a vitamin A derivative) is truly the backbone to the field of anti-aging. The anti-aging revolution was started with this product. Retin-A forces the skin to slowly start making more new collagen. Yes, you read that correctly, new collagen. New collagen equals less fine lines! 

It's important to stick to a few guidelines with Retin-A products:

• Always wear sunscreen (you can burn easier when using Retin-A)
• Be consistent: skin needs time to adjust, your skin will likely be dry, flakey, and irritated for two weeks while the pH of your skin adjust to its new regimen
• Use a good moisturizer, dry skin looks good on nobody
• Apply every evening and take a "holiday" a couple times a year. Just stop using the cream for 2-3 weeks
• If you cant tolerate the strength there are great alternatives: Adapalene and Retinol

I like using skinceuticals skincare products who sell a great Retinol.

Hope this helps everyone know some more about a great product.


Dr. B
www.symmetrymedicine.com

Acne Scars: New inexpensive treatments that work!

Acne is a disease that plagues many people through their teens and some into the late 20's and 30's. Recall those gruesome days in high school? Well, if not, consider yourself lucky. Unfortunately numerous people are left with unsightly acne scars resulting from from the uncontrolled inflammation and damage to the skin resulting in irregular collagen formation.

Typically acne scars come in 3 types: 

• boxcar 
• icepick
• rolling

The type of acne scars that exist will likely depict the response to treatment. Fortunately, most patients have mixed presentation of acne scars and all can be improved or resolved with combination treatments. 

Typical treatment in previous years has consisted of peels, laser/light therapy, and surgical removal. Unfortunately many of these procedures have an increased risk of hyper or hypopigmentation (lightening and darkening of the skin) and can carry a heft price tag. In New York City a full series of acne scar removal with laser therapy may run upwards of $3,000. 

Introducing percutaneous microneedling collagen induction therapy, trademarked as Dermapen and many other competitors. This technology uses high-speed vibrating handheld devices to make micro-injury (controlled injury) to the skin allowing numerous growth factors and collagen synthesis to occur in an organized fashion. 

Over the course of 10 weeks your skin will begin to smoothen out and acne scars will be come less noticeable and some will completely resolve. For acne scaring, I typically recommend patients to have 4-6 treatments, each treatment a month or so apart.

The treatments are painless thanks to topical numbing cream and the vibrations of the device. The device makes tiny microscopic almost pinpoint needle tip penetrations of up to 1,000 times per second! These little mirco-wounds are at a controlled depth by the physician and differ on each spot of your face.

The results are spectacular. The risks, little to none... Can't beat that, and to top it off most sessions start at $200/session with multisession discounts (beats that hefty $3,000 Laser price tag, with equivalent results).

What about downtime? With any procedure, different skin reacts different ways, but in my experience people are ready to go back to work in less than 24 hours. Granted you may peel a little like a sunburn over the next week or so, but nothing as drastic as laser. The technique causes less damage to the surface layer than laser, hence... shorter downtime!

It is very important to follow a post procedure skin care regimen that your doctor can prescribe.

Don't forget this treatment is not just for Acne marks.

It works well for: fine lines, smokers lines, skin tightening, skin complexion, pigmentation issues, skin texture, stretch marks (anywhere on the body), and even scars. 

This device is soon to become a very popular treatment due to its cost, effectiveness, and low risk. Happy skin needling!

Dr. B

www.symmetrymedicine.com

 

Is it to early to start BOTOX? The secrets on when to start this magic medicine.

With the commercialization of BOTOX patients come to me younger and younger for consultation on prevention and correction of fine lines and wrinkles. Often I will be asked, "At what age should I start Botox?"

This is a highly scrutinized topic in the cosmetic medical society. Many "oldschool "physicians believe BOTOX should be used for cosmetic purposes to correct existing damage, while other fast thinking physicians have discovered the use to prevent formation of lines and smooth out skin.

The Brilliant idea: if some (not all) wrinkles are caused by excessive and constant facial movement, then relaxing the muscle temporarily from making these movements should result in less wrinkles down the road..

So how young is too young? I have heard of some physicians treating patients younger than 21 with BOTOX but I usually do not recommend this to patients under 21 (for purely cosmetic reasons). Sunscreen and proper skin hygiene will help prevent skin damage very well up to this point. Don't forget 90% of our sun damage is done during our teenage years!

Ages 21-30 reasons for consultation
- Prevention of aging signs
- The "Resting B*tch Face" (Yes, I get this complaint a lot!)
- Fine lines
- Skin conditioning regimen

Ages 31-40
- Correction of fine lines and wrinkles
- Prevention of fine lines and wrinkles
- The "Resting B*tch Face"

Ages 41 and up
- Botox works great to a certain point and then usually cosmetic surgery and/or a change in Botox technique is needed due to changes in facial architecture and sagging of skin.
- With early and continued use of Botox, this may be avoided or prolonged. The verdict is still out since Botox for prevention of aging is a relatively new technique.

In summary,  Consultations are usually free. Check with your doctor about what options are right for your aesthetic needs. I personally do not start anyone with Botox younger than 21.

Again, it is always important to see a well trained injector, as many different off label techniques can be used to achieve the results you are looking for.

Until next time,

Dr. B

Top 6 BOTOX Side effects you need to know right now

Back to my favorite injectable drug... BOTOX and it's not so long a list of side effects.

BOTOX is increasingly safe and has been around for decades, with first documented use for cosmetic purposes in 1989.

With any injectable procedure you should think about possible side effects.

#1 - Bruising

Relatively common (after all, you need a needle to get the injection completed). In my experience, the location of the injection plays an important role. Injections around the eye tend to have a higher chance of bruising, although the bruise can occur anywhere a needle is used. So how do you decrease the chances of a bruise?

• no alcohol 5 days prior to the procedure
• no NSAIDS (Ibuprofen, Advil, Aleve) 5 days prior to procedure - Tylenol is ok
• no retin-a type creams or vitamin E creams 3 days prior to procedure
• Use ice during the procedure
• Arnica cream before and after the procedure
• most importantly try not to have the injections right before an important event. Bruises can be bad sometimes!

#2 - Asymmetry | Uneven Results

Typically BOTOX is used to treat the forehead. The forehead controls our eyebrow height and architecture. When these muscles are relaxed with injections the results can sometimes be seen in the eyebrows. The undesired effect of asymmetry is not common, but does occur. Most faces have resting asymmetry (sorry I just knocked your self esteem down a notch). BOTOX when improperly placed (or even when properly placed) can result in exaggeration or new asymmetry. This is easily fixed with a second time 1 or 2 spots of injection of a few 'extra units' to even out the undesired effect.

#3 - Under treatment | Over treatment

Under treatment - not getting the desired effect of BOTOX can occur and is easily fixed with additional units. Some patients do require more units in order to get the look they want or any effect at all. You can work with your injector to better understand how many units you need.

Over treatment - Too much BOTOX can cause the "frozen appearance" or ptosis (see #5). It is always easier to add more BOTOX, you cannot take it away!

#4 - Spock Brow | Jack Nicholson Brow

When treating the forehead, injectors are extra careful to prevent eyelid drooping (which can happen, see #5). To do this injectors tend to concentrate on the central forehead (more commonly in women). This can sometimes lead to eyebrow arching, some patients request this look, others do not like it. The BOTOX works by relaxing the forehead muscle and if the outer part of your forehead is still very strong it can pick up the eyebrow into an arched shape sometimes. Thankfully this is usually easily corrected with a couple extra units of properly placed injections.  

 #5 - Eyelid drooping | Brow Drooping | Double vision

Thankfully rather rare, but does occur. The more aggressive your treatment is and your injector is, the higher the likelihood of ptosis or eyelid drooping. This is not a fun side-effect but can happen. This is the result of the forehead usually being too heavily treated on the outside. There are special eye drops your injector can likely provide that can help increase your recovery rate to about 2 weeks.

#6 - Headache and flu like symptoms

 A very common side effect is Headache. They are usually short in duration and a results of the BOTOX itself or the needle from the injection. The good news is, BOTOX will usually help you get less headaches over the course of its 3-4 months of action. Tylenol and or a muscle relaxer can help with this short term headache. Flu symptoms are uncommon but do occur and last for up to 3 days.

Do not fret, side effects are usually short lived. Your injector can help facilitate any adverse effects you have and give you an estimated timeline.

More to come..

Dr. B

P.S. Don't jump to conclusions, injections usually take 3-7 days to start working!

Melted Money: The impact on emergent and urgent healthcare of the ice bucket challenge.

The ice bucket challenge has swept the nation and has brought a lot of attention to one of many diseases that truly needed the attention, Amyotrophic lateral sclerosis. ALS and many other progressive spinal cord & neurologic diseases have in no doubt benefited from the selfless donations of numerous Americans over the last few months in thanks to the ice bucket challenge.

If you are unaware, in short. The ice bucket challenge is a viral marketing sensation, mostly on Facebook, of "nominees" usually while pledging a donation dumping a bucket of ice water on their heads and nominating three additional pledgers. I must admit, sounds like a nice summer treat.

From sources close to the ALS foundation I have heard upwards of 22 million dollars in donations to this point, which is fantastic. My growing concern is for the ice bucket challenge "fails". As with any viral phenomenon, nominees want to one-up one another over and over and over again. This has resulted in more "unique" ways to preform the simple task of dumping a bucket of ice water on ones head.

As you may have found out (Google 'ice bucket challenge fail'). People dumping absurdly large buckets of ice from heights that are unsafe and in conditions that are unsafe onto peoples heads. This has resulted in multiple injuries including fractures, lacerations, concussions, eye damage, cardiogenic shock, multiple contusions, and a plethora of other injuries.

The lesser of these injuries in an emergency room likely costs between $600 - $1000, while the more serious can result in surgery, hospital admission, and short-to-long term disability (although I have not seen or heard of any to this point) could run in the five to six digit range.

The economic impact on the healthcare system will likely be minute from these injuries. The challenge has done a wonderful thing pulling awareness for this cause. The point of my article is to bring awareness to the general public on safety.

We have all acted purely on impulse before, all done things we know we should not have. Just try to think before you act during the ice bucket challenge and donate as much as you can to help improve outcomes for ALS.

Happy Icing

How many units do I really need?! BOTOX

This post is for BOTOX newbies and BOTOX veterans.
BOTOX is a very complicated medication to grasp the concept of. I usually explain concept multiple times per day. My goal in this article is to give you a little insight into BOTOX and the dosing.
 

First off:

BOTOX is a trademarked name by Allergan. Kind of like, er..um.. Kleenex.

Good with your analogies?

BOTOX is to botulinum toxin as Kleenex is to tissue paper. Got it?

 

 

Ok lets move on....

 

There are two other alternatives that are FDA approved at the current time of writing (2014): Dysport and Xeomin. They can be used interchangeably with BOTOX and usually have very similar results. Dysport is a completely different dosage and pricing will vary accordingly in most offices.

 

 
 

Females | Typical Areas of Injection

11 lines (Glabellar complex): 20 units on average to start

Horizontal lines of the forehead (furrows): 10 units on average to start

Crows Feet (lateral canthal lines): 10 units per eye on average

 

Males | Typical Areas of Injection

11 lines (Glabellar complex): 20 - 40 units on average depending on muscle bulk

Horizontal lines of forehead (furrows): 10 - 20 units on average depending on muscle bulk

Crows Feet (lateral canthal lines): 10 units per eye on average

 

 

Rarely patients develop antibodies to botulinum toxin and need additional dosing. About 30% of injections need "touch-ups" or follow up in order to achieve the desired results. Do not forget, BOTOX injection are not without complications (thankfully all short term). Talk with you injector in detail to get an idea of what to expect and possible complications. 

 

 

I hope this sheds some light on how many units you are getting or are planning to get. Remember to seek out a qualified injector and be wary of "too good to be true" deals. You get what you pay for!

 

More to come on my favorite injectable med.

Next: Common complications

 

Dr. Alexander Blinski

My Throat Hurts!

Sore throats are one of the most common complaints year round for Primary care and urgent care offices alike and an absolute drag for patients. This article isn't necessarily about what causes a sore throat, but what we can do to help with pain and what to ask the doctor.

Some of the most common causes of sore throat are: post nasal drip, sinus infection, upper respiratory infection, asthma causing cough, heart burn, and strep throat. There are a plethora of other causes, but that is why you ALWAYS go see the doctor. Unfortunately, not every doctor relays some of the tricks of the trade to help alleviate that pain! Antibiotics don't make pain go away.

So what can you do?
1. Magic Mouth Wash - the best kept secret. A lovely concoction of medications to help numb your poor throat at its time in need.

Best served cold and with a prescription.

2. Tea with Honey and Lemon - an old wives tale, but works so well. There is a reason Mom always made you drink this when you were sick. Soothes the throat and that lemon gives you an extra boost of vitamin C to help fight off whatever ails you.

Best served piping hot, add a dash of whiskey.. you know to umm.. err.. fight that bacteria

3. Chloraseptic spray / losanges - You are no fun, but you work in a bind

Best served out of that damn spray bottle.

4. Salt Water Gargles - mother natures best. The ocean does the trick. Poor a glass of warm water and add a couple tables spoons of salt. Stir and gargle.. yum..

Best served warm.

Remember every adult gets 2-4 colds per year that may be accompanied by a sore throat. Always see a physician to make sure its not something dangerous.... Just don't forget to ask for you magic mouth wash...

Dr. B

Dermal Lip Enhancers: What options are out there?

Lip Augmentation with injectable fillers - One of the safest injectable techniques for lip rejuvenation and enhancement.


New statistics show that women are more interested in enhancing their lips than ever before. Rates of women (and some men) have been on a steady increase over the past 5 years. With this increase in growth more research has been put into lip fillers and fillers in general. It is a great time for cosmetic medicine, cosmetic physicians, and cosmetic patients. There are starting to be a wide variety of fillers that the physician (and patient) can choose from to help improve results, decrease risk, and decrease cost in some cases!

Juvederm (Juvederm Ultra XC, Juvederm Ultra)
Juvederm has just come out with its newest filler (not used in the lips yet) Juvederm Voluma which will be discussed at a later date. Juvederm has been the mainstay of lip and facial rejuvenation for years adding robust volume to deflated and drooping facial parts. For lips it is my "go to" filler. It works over a 1-2 week period and can last about 6 months on average! This is the best filler for making the lips larger and more volumized.

Restalyne
Restalyne is a great alternative filler to Juvederm. Effects can last about 3 months on average and is usually considerably cheaper. This may be a good option for someone going to a reunion, going to a wedding, testing fillers out, or just short on cash. The effectiveness is comparable to Juvederm Ultra, but lasts half as much time.

Belotero Balance
Not made for the lips but a nice alternative for someone not wanting to look "Like they had something done." Belotero is a great product for other areas of the face and a wonderful addition to the Hyaluornic acid line. For people looking just for "plumper" lips, this may be a good option. I tend to push more for juvederm for lips, but belotero has its place. Time till re-absorption is about 3-9months.

In the Pipeline (already being used in Europe)

Juvederm volift and vobella
Using newer technology these two new products are able to give smooth results and last up to 12-15 months! Hopefully we can see them in the US market soon after FDA approval. They will be a little more expensive, but long lasting non-permanent results are priceless.

*remember to speak with your physician about all possible side-effects of dermal fillers and lip enhancement. I strongly recommend against any fillers besides hyaluronic acid.

Out Of Country Cosmetic Surgery - A "No No" (Dr. Darryl J Blinski)

Today lets talk about "Out of Country" cosmetic surgery. Easy response 'DON'T DO IT!', to many risks for the benefits. From poorly done operations, scars, infections that can not be treated easily, to ----- DEATHS!!!! Understand I know the $s saved can sway you. But the risks are SOOO high. The cleanness of the operative suite, the experience and qualifications of an unknown surgeon, the 'what if' issues of being away from home are just a few considerations you need to address before seeking these medical tourism avenues. I see every few weeks a "true" surgery disaster from these poor individuals who return soooo unhappy. My question to ALL of you, 'What is your LIFE worth?' a few thousand dollars to stay in US and be at least safe. PLEASE think before you jump. If asked the #1 disaster country for cosmetic surgery is Dominican Republic. But All these: Costa Rica, Columbia, Peru, Brazil, Mexico are not far behind. The CDC (Center for Disease Control in Atlanta) recently released a notice of the infections coming out of DR. The US State Dept. issued a warning to all US citizens on the risks of DR surgery. WHY put your lives in the hands of these "people"? Please seek consults from America board certified Plastic Surgeons....

Plastic Surgery Has Options! Look at them all (Dr. Darryl J. Blinski)

I am writing about the now 3 different options in Cosmetic Medicine and Surgery. They are: #1. Non invasive therapies, i.e. Thermage, fillers, Botox, ThermiSmooth RF, Liquid FaceLifts. #2. Minimally Invasive procedures: or as I label them the "tweener" operations. i.e. ThermiTight RF, Precision Lift, mini facelifts. #3. Invasive Operations i.e. Tummy Tuck, Breast Implants, Rhinoplasty, liposuctions.

Non Invasive Options offer no incisions, minimal downtime, faster recovery in most cases. But results are very very limited. The costs per result is very high. In other words the $s spent to the degree of a noticeable result are costly. Because there can only be modest improvements at best.

"Tweener" Options offer small incisions under local anesthesia to tighten or reduce areas. Some laser therapies can fall into this category also. SmartLipo Triplex for very small areas, ThermiAesthetics Platform for Radio Frequency treatments, Precision Lifts from Cynosure all offer more results, a little more downtime and healing. Costs are slightly more than the non invasive avenues.

Finally the Invasive Options or surgeries. More downtime, more healing, more costs. But best results are attained.

Lip Health (Dr. Alexander L. Blinski)

I see a lot of young women these days looking for lip augmentation options and lip care to help them stay and look young. Lips are one of the first things men notice on a woman and the lips can either depict an aging face or a youthful appearnce. It is vitally important to care for your lips appropriately to prevent age related lip recetion and changes!

• The lips do not have melanin (the stuff that protects us from harmful UV rays) so a protected balm with SPF is vital in any regimen.
• Licking your lips.. thats not good, the saliva has digestive enzymes that hurt your lips!
• Using non-fragranced lip balms is best
• A nightly antioxidant is important, I recommend on from skinceuticals
• Smoking / using a straw / drinking out of a bottle can all lead toward "barcode lines" or "Smokers lines"
• Lip augmentation can be done using many new products that I will talk about in future posts, the two best and newest are Juvederm Ultra XC and Belotero Balance. New ones coming soon will include juvederm volift.
• Exfoliate with a dry toothbrush once a week to help the lips increase collagen production and stay plump.

Remember lips and eyes are so very important for women.. Wear sunglasses and sunscreen!