Retin A is too harsh for my skin. Now what?

Retin-A is a great product. It thickens collagen, reduces fine lines, and evens skin tone. But as you may have discovered, it is also very irritating. Although some people report little to no skin irritation, most of my patients have to start using Retin A only a few days a week, and gradually increase the number of days they apply it until they are using it every day (I’ve discussed how to use Retin-A in a previous blog post). Even with this graduated dosing, dryness, flaking, and irritation of the skin are very common. So what do you do if you are unwilling or unable to tough out the adjustment period?

  1. Try a different strength of Retin-A. There are several different brands of Retin-A on the market, but most are available in several different strengths. 0.1% is the strongest. I usually start patients on the 0.05% Retin-A, but it also comes in a weaker 0.025% formulation. If you don’t want to buy a whole new tube, just apply half much of the pea-sized amount you typically use. You can mix it with a moisturizer prior to application so that it spreads evenly.
  2. Try some topical steroids to help calm your skin down. Some companies actually combine a steroid with the tretinoin (Tri-Luma, for example), but I prefer to use separate products. Continued use to topical steroids can actually thin the skin, so tns serumyou only want to use the steroid cream for as short a time as possible until your skin adjusts to the Retin-A. I definitely recommend talking to your doctor for product recommendations and instructions prior to starting a topical steroids.
  3. Use a different product entirely. I really love Skin Medica’s TNS Essential Serum. The TNS serum has growth factors as well as vitamin C, vitamin E, retinoids and antioxidants. It improves fine lines and skin texture, and unlike Retin A, you can begin using it morning and night right away with no skin irritation.

Have you found any great tricks for dealing with irritated skin? I’d love to hear them!

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Will a face lift make me look unnatural?

This is a great question; many patients are concerned about looking unnatural after having cosmetic procedures done. And we’ve all seen examples of celebrities who look artificial or unnatural after plastic surgery. But I can assure you those are the exceptions. First of all, remember that it is the paparazzi’s job to catch celebrities looking their worst. So many of the photos that you see in those “horrible plastic surgery” before and after photos are taken at awkward angles with unflattering lighting. There may also be photos taken in the postoperative period, when there is still significant swelling. Many photos of Mickey Rourke, for example, appear to be taken shortly after surgery. Joan Rivers is another often-cited example of a celebrity who started to look a bit artificial.

Photo credit: http://www.randomlynew.com/3530/10-celebrities-with-bad-plastic-surgery.html

Photo credit: http://www.randomlynew.com/3530/10-celebrities-with-bad-plastic-surgery.html

So what can you realistically expect after having a facelift?

  • Immediately after surgery you will have swelling and bruising. Your ears will be swollen as well, and may feel tender or full as if you have a cold. If you have drains, they are removed in the first day or two.
  • Weeks 1-2: Your bruising will fade and swelling starts to improve. Your face may feel or look tight.
  • Weeks 3-4: Swelling resolves and the feeling of tightness improves as the skin and underlying tissue stretch and relax. Soon you’ll find that you simply look like a more refreshed version of yourself.

The most common result after a face lift is that you look 5-10 years younger after surgery, and then continue to age naturally. Those people who look very overdone, are often just that: overdone. It takes many, many procedures to create that artificial appearance. If a face lift is something you are interested in, but you’re concerned about looking artificial, I would recommend spending some time looking at real before and after photos. The American Society of Plastic Surgery and Real Self are great places to start, along with the websites of Plastic Surgeons in your area.

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Heavy eyebrows after Botox?

Injecting neurotoxins such as BOTOX® Cosmeticand Xeomin® only takes a couple of minutes, and it seems pretty straightforward. But there is really a lot of room for artistry and tailoring results to individul patients, which makes it one of my favorite treatments to administer. Neurotoxins paralyze the facial muscles which cause wrinkles. So if you get a little frown line between the eyebrows, paralyzing the muscle that frowns will stop that little line from forming. Although everybody has the same facial muscles, we’re all built a little differently. And that is where the artistry comes into play: I love analyzing each individual patient to see how I can give him or her the best results.

One of the complaints I occasionally hear after treating a patient is that her eyebrows feel heavy. This phone call usually comes about a week after treatment, because both BOTOX® and Xeomin® take 5-7 days to take effect. What causes this heaviness? And how long does it last?

The frontalis muscle runs from the brow line to the hair line (the vertically oriented muscle over the forehead in the diagram below), and movement of this muscle is what

"Lateral head anatomy" by Patrick J. Lynch, medical illustrator - Patrick J. Lynch, medical illustrator. Licensed under CC BY 2.5 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Lateral_head_anatomy.jpg#/media/File:Lateral_head_anatomy.jpg

“Lateral head anatomy” by Patrick J. Lynch, medical illustrator 

causes wrinkles over the forehead. BOTOX® paralyzes the frontalis, preventing it from moving, and thus preventing those horizontal wrinkles. But the frontalis muscle is responsible for raising the eyebrows, so many people complain of their eyebrows feeling heavy after having BOTOX® in this area. For this reason, I prefer to use a bit less BOTOX® over the forehead, so that patients can still raise their eyebrows a little bit. Rest assured, this feeling of heavy eyebrows is temporary. It will completely go away once your BOTOX® wears off in 3-4 months, but it usually becomes less noticeable after a week or two. If this has happened to you, be sure to let your doctor know this happened next time you get BOTOX®, so he or she can adjust your treatment to prevent this problem in the future.

 

Do you have any questions about Botox or Xeomin?

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

How is thigh lift surgery done?

Loose skin around the knees and over the thighs is a very common complaint; this is one area of the body where gravity takes a definite toll as skin loses its elasticity. Loose skin may also be a concern after weight loss. Excess skin over the thighs is traditionally addressed with a thigh lift. In this week’s post I’m going to talk about where the incisions are located and what effect the surgery has on the thigh.

Thigh lift surgery is broken down into two anatomic areas: medial and lateral.

  • A lateral thigh lift is done through an incision up over the hip. This incision will
    Outer thigh lift incision - www.plasticsurgery.org

    Outer thigh lift incision – www.plasticsurgery.org

    generally hide well under a bathing suit (see photo to the right). The lateral thigh lift only addresses excess skin over the outside of the leg.

  • A medial thigh lift is done through an incision over the inside of the leg, right near the groin crease.  This thigh lift vectorshorizontally-oriented incision (dark blue line on the photo to the left) will remove skin in the vertical vector (light blue line). This horizontal incision hides very well, even in a bathing suit. If there is excess skin circumferentially around the thigh (light green line), then a vertical incision is needed as well (dark green line). This vertical incision may show when wearing shorts. It is in the inside of the leg, however, so it is not visible from the front or back if you are standing straight up. A medial thigh lift is the best way to address excess skin over the knee.

Depending on your specific areas of concern, your doctor may recommend a lateral thigh lift, a medial thigh lift, or a combination of the two. Liposuction may also be added if there are areas of fat that need to be removed. A thigh lift will not give you the legs you had in your 20s, but it will remove most of the excess skin, and significantly smooth out the contour.

 Do you have any questions about thigh lift surgery?

 

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What is a Vampire Facelift?

A Vampire® Facelift is a procedure created several years ago by a physician in California. It is not a true facelift, but rather falls under the category of nonsurgical facial rejuvenation. A Vampire® Facelift combines the injection of hyaluronic acid fillers such as Juvederm® or Restylane® with the injection of platelet-rich plasma derived from the patient’s own blood.  The patient has blood drawn in the office, and this blood is process to remove the plastma and platelets from the red blood cells.

  • Plasma is the clear part of blood, and platelets are small blood cells that assist in clotting.
  • Platelets have many growth factors, and plasma containing a high concentration of platelets (i.e. platelet-rich plasma) has been studied in wound healing.

The theory behind a Vampire® facelift is that the fillers add volume and smooth out wrinkles, while growth factors from the platelets somehow rejuvenate skin. There have been some studies done suggesting that platelet-rich plasma does actually improve healing. But there are no studies comparing a Vampire® Facelift to other treatment options such as using only fillers without the platelet-rich plasma, or injecting the patient’s own fat to add volume. So we don’t really know whether this procedure gives the benefits advertised.

As will all non-surgical facelifts, the results are not as impressive as a true facelift operation. In addition, treatments will need to be repeated as the filler is gradually reabsorbed.

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.