An Addicus Nonfiction BookCopyright 2003 by Michael Byun, M.D., Jon Mendelsohn, M.D., William H. Truswell, M.D. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopied, recorded, or otherwise, without the prior written permission of the publisher. For information, write Addicus Books, Inc., P.O. Box 45327, Omaha, Nebraska 68145.ISBN# 1-886039-67-4

 

Introduction

One of our society’s most striking features is that we are healthier and more vigorous than ever before. The passing years? Forget about them. We’re just as young as our dreams.

Brave words, and we believe them. At the same time, we all know we’re living in a youth culture. It’s part Hollywood, part Madison Avenue. It’s not just vanity that makes us want to look our energetic best, however. There are also real frustrations.

Ageism exists in the workplace, whether we like it or not. Even with a wealth of well-earned savvy, you may feel disadvantaged on the job. Likewise, it can be harder to enjoy a vibrant sexuality when the media blares that it belongs only to the young.

The good news? Today, there’s a tremendous amount you can do to restore and rejuvenate your appearance so that the way

you look is much more in tune with the way you think and feel. And you might be surprised at how non-drastic many of the latest methods are.

The focus of this book is on the newest facial rejuvenation techniques that require no invasive surgery. Changes ranging from subtle to amazing are made possible through cutting- edge technologies that forgo the “cutting edge” completely. Other procedures require only single incisions so tiny that they leave no scars. Recovery is easier, too. Many of these new procedures result in remarkable transformations with a minimum of inconvenience or downtime. Some can literally be done on a lunch hour.

Here, you’ll find a comprehensive look at the latest non-invasive treatments and learn how you, too, can have a “nonsurgical facelift.”

Your Skin & Facial Rejuvenation

Whatever age you are now, you may have already noticed some of the signs of aging in your mirror. The degrees and types of changes vary from person to per- son, of course, but aging is a universal experi- ence. No one is immune from it.

Almost all of us appear fresh-faced throughout our twenties. Only in the late twenties do we begin to notice fine lines and more persistent freckles, the forerunners of age spots. In our thirties, we may see a few more stubborn patches of uneven pigmentation. We may notice early wrinkling—smile lines that linger or a frown line that shows most of the time. Skin tone may be changing too, with areas that appear thinner, thicker, or rougher than they used to be.

In our forties, gravity seems to play a role in the aging process. The skin loses some of its

elasticity and a bit of sagging may appear, perhaps along the jawline or under the eyes. Unwanted hairs may begin to sprout along the chin and lip as hormone levels fluctuate. New wrinkles are more pronounced.

In our fifties and beyond, these changes increase. Deeper lines and wrinkles appear. In facial folds or wrinkles, the skin’s thickness can shrink to just one third of that of the surrounding skin. Other changes may include the appearance of age spots and spider veins.

Still, there’s no need to be disheartened. Instead, now you can explore a constellation of remarkable nonsurgical treatments that will allow you to have much smoother, more luminous, firmer, and younger-looking skin— no matter what decade you’re in.

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Anatomy of Skin

The skin is an amazing organ. Yes, it is considered an organ. In fact, it’s the body’s largest organ, weighing about six pounds. The skin takes care of us in ways we rarely even think about. It acts as a shield for the entire body, protecting us from heat, injury, and infection. It also regulates body temperature and stores water. And through the sense of touch it delivers the sensations of both pain and pleasure.

The skin is made up of three layers:

Your Skin & Facial Rejuvenation

The subcutis, or subcutaneous layer, is made up of a network of collagen and fat cells. This deepest layer acts as an insulator, holding in body heat. The fat layer also “fills out” the skin, giving it plumpness.

Why Skin Ages

As we age, the connective tissues in the skin’s dermis layer begin to break down and cells start losing their ability to repair themselves. With less collagen and elastin, the skin starts to wrinkle and sag. At the same time, skin is unable to retain as much moisture as it did in younger days, and skin becomes drier

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epidermis: the outer layer of the skin dermis: the middle layer subcutis: the deepest layer

The epidermis actually has several layers itself, and as the cells move up through these layers, they form the tougher outer surface of our skin. By the time they reach the surface, the cells are actually dead and they flake off.

The dermis layer contains blood vessels, lymph vessels, hair follicles, and sweat glands. These elements are held together by connective tissues, including collagen and elastin, which give the skin its strength and elasticity.

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and thinner. Drier skin means aging skin. Several factors affect the way our skin ages.

Sun Damage

You may have thought that simply getting older was the reason your face ages. To some degree, certainly, chronological aging leaves its marks on your face. But the truth is that the single most powerful force working to alter your smooth, healthy skin is sun exposure. Sun causes photoaging or premature wrinkling. From sunburns and tanning to the cumulative effects of brief daily exposure such as going out to the mailbox, exposure to the sun is the biggest cause of an aged appearance. It’s estimated that 80 percent of aging of the skin is caused by the sun. And the greater portion of that sun damage has occurred by the time you are twenty years old.

Just as the ultraviolet rays in sunlight can fade fabrics and erode the finish on your car, they also wreak havoc on your skin. Two types of ultraviolet (UV) rays do the damage. UV-A rays gradually and invisibly weaken collagen, the protein-rich supporting layer that keeps your skin firm, supple, and wrinkle-resistant. UV-B rays cause burning and tanning and set

the stage for skin cancer. Tanning beds or lamps are no exception—they also damage your skin.

Tanning may create the appearance of being healthy, but its effect on the skin is anything but healthy. Tanning is actually the skin’s way of trying to protect itself from the sun. Sure, a tan may look good, but that short-term glow has very unpleasant long-term consequences.

Here’s a simple way to evaluate your level of sun damage. Compare the skin of your face to the skin of your buttocks, breasts, or inner upper arm. It’s no coincidence that the parts of

Ranges of Ultraviolet Rays

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UV-A rays are longer, penetrate more deeply, and are associated with premature aging.

UV-B rays are shorter, but cause sunburns.

UV-C rays are filtered by the earth’s ozone layer and are not as threatening to skin.

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your body that have been well shielded from the sun look and feel so much younger. By every conceivable measure, and no matter what your natural skin tone or ethnicity, we’ll say it again—the sun is your skin’s biggest enemy.

Today, you’re also much more vulnerable to devastating skin cancers than people used to be. Because of the depletion of the earth’s ozone layer, far more radiation from the sun reaches you every day. The rate of skin cancer— including the deadliest form, melanoma—has increased by about 30 percent in the last twenty years.

Genes, Gravity, and Unhealthy Habits

Without a doubt, our genetics play a part in our health, including the rate at which our skin ages. To get a glimpse of what your genes suggest, take a look at your family. You may have inherited a tendency to frown, a furrowed brow, or a fair complexion. If you’ve always been told you look like an older relative, the patterns of aging in that relative’s face may reflect what you’re beginning to see in your own. It’s simply your genetic blueprint.

Simple gravity also has a subtle effect on your face. A natural downward pull encourages

Your Skin & Facial Rejuvenation

facial tissues to sag over time. Likewise, if you’ve been carrying extra pounds, the excess weight can also tug your face downward, creating a tired, droopy expression. If you’ve dieted off and on, your skin may have stretched, which also contributes to sagging.

What about unhealthy habits? Skin- sabotaging habits include smoking, drinking, and a poor diet. Smoking decreases the healthy blood flow that brings oxygen and nutrients to your skin, and the constant puckering and squinting cause wrinkles. Anything beyond moderate alcohol consumption on a regular basis dehydrates your skin and produces a pasty, sallow complexion. And a poor diet undermines your skin at every turn—without balanced nutrition your skin cells can’t renew themselves at a normal rate. A diet that’s short on major nutrients also dims your skin’s ability to fight off the effects of environmental pollutants.

Types of Wrinkles

As we age, we experience two basic types of wrinkles: dynamic wrinkles and static wrinkles. Lines caused by repeated facial

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expressions are called dynamic wrinkles. In other words, they form because of our actions. On the other hand, wrinkles that stay visible whether or not you’re making facial expres- sions are known as static wrinkles. They stay put. How to tell the difference? Relax your face and look in the mirror. Any wrinkles you see are static ones. Now frown, and you’ll see a pronounced vertical crease or two; or smile, and crow’s feet may form at the corners of your eyes. These are dynamic wrinkles.

What Is Facial Skin Rejuvenation?

The term facial rejuvenation refers to treating the skin in such a way as to make it look younger. And today, there is no shortage in the number of treatments. In fact, an explosion has occurred in nonsurgical, or non-invasive, cosmetic procedures, those performed on or just under the skin.

Depending on the types of problems you’d like to have corrected, you can choose from a wide array of options. Some of them have been around a while. Others are newer, high-tech techniques. For example, to repair and restore sun-damaged skin, a partial- or

full-face chemical peel may do the job. Laser skin resurfacing, done with a computer-driven laser, is another option.

In this book you’ll find detailed, compre- hensive information on all the most popular facial rejuvenation procedures available today, including:

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Chemical peels: topical solutions that remove layers of aged skin

Microdermabrasion: subtle “sanding” for a younger skin surface

Wrinkle fillers: injections and implants for lines and contours

Botox: injections to relax wrinkles l Lasers: beams of light that correct skin

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defects

Lip augmentation: injections to achieve fuller lips

Many of these procedures require minimal recovery time and can be easily worked into a busy schedule. The short-term aftereffects, such as redness or mild bruising, can usually be camouflaged with makeup. Most people go right back to work, or at most, have the

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procedure done on a Friday, relax over the weekend, and return to work on Monday.

Still, it is important to remember that just because these procedures are nonsurgical, they are not “non-medical.” So rather than heading into the nearest spa that may advertise some of

Your Skin & Facial Rejuvenation

these treatments, it’s very important to seek out a medical doctor who is well trained and experienced in doing facial rejuvenation proce- dures.

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Two

Choosing the Right Physician

Choosing the Right Physician

You’ve decided you want to do all you can to look and feel your best. And now you know that facial rejuvenation is possible without invasive surgery. But who should do it?

That’s a crucial question. Because so many cosmetic procedures today are heavily hyped and marketed, it can be challenging to determine who is qualified—legally, ethically, and practically—to perform them. Next to a realistic appraisal of your needs, your wishes, and any risks involved, the single most important factor in your success is choosing a qualified professional.

Which Doctors Do Facial Rejuvenation?

Today the physicians who perform most skin rejuvenation procedures are facial plastic surgeons, plastic surgeons and dermatologists. It may be easy to find listings of physicians, but

in the field of aesthetic surgery, it can be difficult for the consumer to sort out “who’s who” from a bewildering mass of credentials. Many people are surprised to find out that any licensed medical doctor, regardless of training, can legally perform plastic surgery or claim the title “plastic surgeon.” It is important that the physician you choose is certified by an appro- priate board.

But what does being board-certified mean? According to the American Board of Medical Specialties, “a board-certified physician has completed an approved education training program and an evaluation process including an examination designed to assess the knowledge, skills, and experience necessary to provide quality patient care in that specialty.”

After training and certification, a doctor’s level of experience in the procedure you’re

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Choosing the Right Physician

considering is his or her single most important asset. Many of the procedures available today do not carry high risk for injury; however, other procedures do. For example, lasers are very powerful tools—some lasers vaporize human tissue at temperatures twice that of boiling water. These are great tools for resur- facing damaged skin, and the results can be remarkable. But such tools should be used only by physicians who have a great deal of experience with them.

Choose a physician who specializes in a procedure. Many plastic surgeons become expert in just two or three specific types of noninvasive treatment, which is a real advantage. For example, you probably wouldn’t want a doctor to use a high-powered laser to resurface your facial skin if the doctor spends the biggest portion of his or her time doing liposuction of the abdomen. Sometimes, a doctor who claims enormous experience in every conceivable cutting-edge cosmetic technique may not be as wise a choice as one who has sought out extensive training in only a few procedures.

Plastic Surgeons

General plastic surgeons perform surgery involving the repair, reconstruction, or replacement of physical defects anywhere on the body. Some plastic surgeons specialize exclusively in cosmetic facial procedures. They offer surgical procedures such as facelifts as well as nonsurgical procedures.

In addition to medical school, general plastic surgeons spend three to five years of residency in general surgery, followed by two to three years of plastic surgery residency, which includes facial and cosmetic surgery as well as the repair of wounds or defects of the body, hands, and genitourinary tract. They are certified by the American Board of Plastic Surgery.

Facial Plastic Surgeons

As the name suggests, facial plastic surgeons specialize in procedures for the face. They are qualified to perform both surgical and nonsurgical procedures of the face and neck.

Plastic surgery is more than a doctor’s technique. The doctor should be artistic, caring, and committed.

Michael Byun, M.D. Plastic Surgeon

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The Non-Surgical Facelift Book

Many also offer nonsurgical skin rejuvenation procedures.

Most facial plastic surgeons are otolaryn- gologists, or head and neck surgeons. After graduating from medical school, they spend one to two years in a general surgery residency, then four to five years in head and neck surgery, including facial plastic surgery, followed by a fellowship year in facial plastic and reconstructive surgery. They are certified by both the American Board of Otolaryngology Head and Neck Surgery and the American Board of Facial Plastic and Reconstructive Surgery upon successful completion of a certifi- cation examination.

Dermatologists and Dermatological Surgeons

Dermatologists and dermatological surgeons are physicians who treat disorders of the skin, hair, and nails, including skin cancers, hair loss, and scars, and skin changes associated with aging. Many also offer a variety of non-invasive cosmetic procedures such as chemical peels, dermabrasion, laser resurfacing, and the treatment of varicose veins.

Dermatologists must have graduated from an accredited medical school and completed a

broad-based clinical residency program. In addition, they must have completed a three-year accredited dermatology residency program with at least 75 percent of their work being directly related to dermatology. After completing educational training, they are eligible for the certifying examination adminis- tered by the American Board of Dermatology or the American Board of Dermatological Surgery.

Other Staff and Assistants

Many physicians who perform cosmetic procedures employ highly trained physician assistants and registered nurses who perform procedures under the physician’s supervision. Also, technicians, referred to as estheticians, perform “lighter” treatments such as facial steaming, mask applications, waxing, exfoli- ation, pore cleansing, and mild chemical peels.

Estheticians are licensed by the state; however, requirements vary widely from state to state. Some estheticians are trained by a variety of technical or cosmetology schools, others by physicians. Estheticians are not qualified to diagnose, or to perform any

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treatment that involves injections or that produces bleeding or oozing from the skin.

How to Find a Doctor

There are several ways you can maximize your chances of choosing a well-qualified professional who can help you achieve the results you’re looking for. First, be proactive—educate yourself. Learn everything you can about the types of treatments available and which doctors in your community offer them. A good referral is a great place to begin. Here are some avenues for gathering infor- mation:

Word of mouth. Gather names from people you know who have had positive experiences with a certain doctor. Be sure they provide details on the results of their procedure, not just on the doctor’s great personality or lovely office suite. Ask if they’d mind sharing their own before-and-after photos with you, and ask them to tell you what their procedure was like.

Your family doctor. Ask your primary physician to provide you with the names of plastic surgeons, facial plastic surgeons, or dermatologists he or she knows professionally

Choosing the Right Physician

or by reputation. Other health care profes- sionals, including nurses, may also provide knowledgeable referrals.

Medical societies. These organizations can tell you who is, and is not, a member in good standing of local and regional medical societies and boards.

Local hospitals. Call hospitals in your area and ask for the names of doctors who have

admitting privileges and who perform cosmetic procedures. If there is a nearby teaching hospital, ask which doctors are also involved in training other doctors in cosmetic procedures.

Spas. Today, many spas offer facial rejuve- nation treatments; but is it safe to have a procedure done in a spa? Regulations for spas vary according to the state you live in, but the key point is whether the staff is experienced and well trained. Generally, it’s a better idea to visit a doctor’s office or clinic rather than a spa. The exception? When a spa has an on-staff

When you are in the office, you must be the most important person to the doctor and his/her staff. This will mark the difference between a competent result and an

excellent result.

William Truswell, M.D. Facial Plastic Surgeon

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The Non-Surgical Facelift Book

M.D., such as a facial plastic surgeon, a plastic surgeon, a dermatologist, or another qualified physician. The spa’s doctor should supervise any trained nurses or estheticians who perform the simplest procedures.

Your Consultation

After you’ve done your homework to find good referrals, don’t hesitate to make consul- tation appointments with several different doctors. What’s most important is to select a reputable specialist who will give you the best possible care. Even though these rejuvenation procedures are not surgical, they are medical. Your doctor should be thorough in assessing whether or not you should have a procedure. The purpose of the first consultation with a doctor is to:

It’s important that you feel at ease with your doctor, and especially that you sense you are being advised realistically and appropriately about what to expect from a procedure. Although most non-invasive cosmetic treat- ments involve minimal risks, risks do exist, and a doctor who takes a thorough medical history and carefully explains any risks has your best interests in mind. Honesty and confidence are good; arrogance and wild promises are not. Trust your instincts—if you feel you’re receiving thorough information with sensitivity to your needs and concerns, you’re probably in the right place.

Questions to Ask During Your Consultation

Which cosmetic procedures do you perform on a regular basis, and how many?

If a doctor claims to do a procedure “all the time,” ask for more details. For example, a doctor who has done only a dozen of the procedure you’re considering is still on the learning curve. But if the answer is at least a dozen a month, that’s a better indicator of solid

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establish trust and communication

allow the doctor to take a medical history

establish your needs explain options to you inform you about treatment outcomes

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experience. The largest practices might do over 100 microdermabrasions or chemical peels a month, for example.

Where would my procedure be performed—in your office or in a hospital?

Most non-invasive procedures are performed in the doctor’s office. You’ll sit in a chair similar to a dentist’s chair, with a comfortable headrest. Unless the skin of your upper chest is also being treated, there’s no need to disrobe. A gown will be given to you to wear over your clothing. The few proce- dures that work on your skin at a deeper level, such as complete laser resurfacing or a deep chemical peel, or others that require intra- venous (IV) sedation or twilight anesthesia, are done on a surgical table in a hospital or surgical suite, with sterile draping and other infection control precautions, just as would be done for any surgery.

Has your office or clinic been certified by the American Accreditation Association for Ambulatory Healthcare or the American Association for Ambulatory Plastic Surgery Facilities?

Choosing the Right Physician

Because many surgeons who perform cosmetic procedures work in large practices that incorporate freestanding surgical suites, it’s important to know that these facilities meet quality standards. Certification by either of these organizations ensures that the surgical area is regularly reviewed and inspected for standards including the facility’s general and operating room environments; policy and procedures; general safety in the facility; blood and medications handling; medical records; quality assessment and improvement; and personnel. These organizations also provide standardized practice guidelines for the surgeon operating in single-specialty ambulatory surgical facilities.

Would any of your patients who have had the procedure I am considering be willing to talk to me?

The doctor should be willing to put you in touch with another patient who is willing to be interviewed. To respect their confidentiality, the doctor will not give you another patient’s name and phone number, but more likely will ask a patient who’s willing to talk to contact you. You might ask the former patient:

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The Non-Surgical Facelift Book

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Were the doctor and his or her staff compassionate and supportive?

Did you feel you had been given ample information before the procedure?

Did you have any pain, and if so, how was it managed?

Were there any problems with your procedure, and if so, how were they corrected?

Were you satisfied with the outcome?

Would you continue if this procedure requires repeated treatments?

What are the potential risks with this procedure?

Even though risks may seem minimal, ask about them. How often do they occur? And if they do occur, how are they handled? Avoid any physician who is not willing to thoroughly explain risks and how they are handled.

What will the recovery period be like?

Sometimes we may get caught up in the excitement about the results of a procedure and may forget about recovery time. Nonsurgical procedures do not typically require the same type of recovery we associate with invasive surgery; however, some procedures will mean some down time for you. Ask about any restrictions and how soon you can return to work or other activities.

What is the physician’s policy on “surgical” revisions?

This question mostly refers to surgical procedures. Sometimes after a surgical procedure is performed, an additional procedure, a “revision,” is needed to achieve the final result. However, it is possible for a nonsurgical procedure require follow-up

May I see actual before-and-after photos, not brochures, showing patients you have treated?

As in any other publication, photos in brochures can be airbrushed, and special lighting and makeup can exaggerate the trans- formations between “before” and “after.” An actual photograph is likely to give you a better idea of what you can expect. Keep in mind that individual results will vary, depending on each person’s skin condition, age, and level of skin damage, as well as on the type of treatment.

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attention. Ask how the doctor handles such matters. Is there additional cost for any follow-up treatment?

What is the cost of the procedure?

It is important to clearly establish the cost for your procedure. Insurance does not pay for elective, cosmetic procedures, and most physi- cians require payment in advance. The cost to

Choosing the Right Physician

you covers such things as fees for the surgeon, surgical suite, and anesthesiologist, if one is required. Other costs might include those for blood tests and medications.

Costs vary for nonsurgical facial rejuve- nation procedures, based on geographical location. For example, a chemical peel in New York City will likely cost more than one in the Midwest.

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American Attitudes about Cosmetic Surgery

More than half of Americans, 54 percent, approve of cosmetic surgery. Twenty-four percent say they could consider having a cosmetic procedure.

Nearly one-third of women, 30 percent, say they would consider cosmetic surgery, compared to 18 percent of men.

Nearly 75 percent of men and women say they would not be embarrassed if others knew that they were having a cosmetic procedure.

Survey by the American Society for Aesthetic Plastic Surgery, 2003

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Three

Botox Injections

Botox Injections

In the past few years, Botox injections have topped the list as the most popular nonsurgical facial rejuvenation procedure. It seems an unlikely use for a chemical first dis- covered by ophthalmologists almost twenty years ago to treat two eye muscle disorders: uncontrollable blinking (blepharospasm) and misaligned eyes (strabismus). The ophthalmol- ogists began to notice an unexpected side ef- fect: the frown lines between their patients’ eyebrows seemed to vanish, their foreheads smoothed, and even their crow’s feet were less evident. In April 2002, the Food and Drug Ad- ministration (FDA) officially approved Botox for treating frown lines between the eyes. What makes Botox so popular is that the injections are quick and easy to repeat.

Botox is actually a protein produced by the botulinum bacterium, that causes a form of

food poisoning. That may sound alarming, but you cannot contract botulism from the tiny amount of toxin present in a Botox injection, because it is sterilized and highly purified.

What Botox Does

Botox eliminates dynamic wrinkles, those that form as a result of facial expressions, by paralyzing the underlying muscles which contract and cause the wrinkle. What is the science behind this? Normally, your brain sends electrical messages to your muscles to tell them to contract. These messages are transmitted by a chemical neurotransmitter called acetyl- choline. When Botox is injected into the muscles just beneath the skin, it blocks this chemical’s release. As a result, the message to contract never reaches the muscles. Since the muscles aren’t moving, the creases they

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Before

Patient making frown expression before Botox injections.

normally create are no longer visible. A smoother skin surface and more relaxed look are the results.

Wrinkles Treated with Botox

Frown Lines

Botox is best known for erasing frown lines—the creases that appear between the eyebrows, medically known as the glabella region. Not only will the injections stop the repeated muscle contractions that make you look constantly annoyed or tired (even when

Botox Injections

you’re not), but they can also prevent the surface, static wrinkles there from deepening.

Furrowed Foreheads

Perhaps you’ve developed a worried or even melancholy appearance. This may be due to deep, horizontal forehead wrinkles that appear when you’re puzzled or concerned, or simply because you’ve had a long-standing habit of raising your eyebrows. Botox injections beneath these furrows will prevent these lines from forming, leaving you with a more serene, relaxed-looking brow.

After

Patient making frown expression after Botox injections. Muscles in the glabella region, between the eyes, do not respond.

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The Non-Surgical Facelift Book

Crow’s Feet

Botox injections can greatly reduce the appearance of crow’s feet—the fine lines that appear at the corners of your eyes when you smile or squint. If treatments are continued, the relaxed muscles may never return to their original state, which means you may have a sustained smoothed effect.

Other Wrinkles

Botox can diminish “lipstick” or “smoker’s” lines in the upper lip caused by repeated mouth pursing. Likewise, lines that run straight down from the corners of the mouth can be softened. Such lines are known as “marionette” lines—think of the famous puppet Howdy

Before

Eyebrows raised, creating lines in forehead, before Botox injections.

After

Eyebrows raised after Botox injections. Forehead muscles stay relaxed.

Doody’s chin. Sometimes, Botox is also used to treat vertical neck wrinkles caused by subtle muscle movements, though these are not considered “expression” lines.

Combined with Other Treatments

In areas where Botox can’t completely eliminate a wrinkle, it is often used in combi- nation with other line-smoothing treatments, such as chemical peels, filler injections, laser treatments, or microdermabrasion. Your doctor can create a wrinkle-fighting strategy that includes Botox as part of a broader treatment plan. For example, for upper lip lines, a chemical peel or laser resurfacing might be the

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primary approach, with Botox added to prevent the lines from re-forming.

Are You a Candidate for Botox?

Botox is a safe procedure for the vast majority of people. Some people, however, have conditions that make it an unwise choice.

Your doctor needs to determine whether you have allergies to any of the components in the Botox solution, including albumin (a blood-derived protein), glucose, or yeast; the injections might trigger an allergic response, although this is very unusual. A more common issue is that Botox can interact with some medications, so it’s important to be sure your doctor knows about any drugs you are taking. In particular, calcium channel blockers, quinine, penicillamine, and the antibiotics known as aminoglycosides do not mix safely with Botox. Botox can unpredictably intensify these medications’ effects, meaning that the dosage your doctor has prescribed might suddenly have a more powerful effect.

Botox injections are not recommended for women while they are pregnant or breast- feeding. Some muscle-weakening conditions

Botox Injections

will also rule out Botox. For example, if you have multiple sclerosis, myasthenia gravis, Lou Gehrig’s disease, or Bell’s palsy, you are not a candidate for Botox treatment. Your doctor will review your health history thoroughly before agreeing that Botox is right for you.

Preparing for Botox Injections

Since Botox is simply an injection, there is no advance preparation needed. One exception can be that your doctor may advise you to stop taking certain supplements, such as garlic, gingko biloba, or ginseng, for two weeks beforehand, since these can increase the possi- bility of bruising at the injection sites. Likewise, if you are taking blood-thinners, which may also increase the possibility of bruising, your doctor will want to discuss these medications with your prescribing physician. You should never stop taking an important medicine for a cosmetic procedure, however (and after all, most bruising can be covered with makeup).

You may want to bring in photos of yourself at a younger age and photos of an older relative you may resemble to your first consultation. These can help you and your

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doctor determine which areas you want to have treated. If your discussion indicates that you are a good candidate and there are no pressing reasons to wait, it is often possible to receive your Botox treatments on your first visit. You’ll want to schedule your “Botox day” at least two full days before an important event.

How Is Botox Injected?

highlight creases and shadows. Most patients don’t require anesthesia; however, you may be offered an ice pack for about five minutes, to numb your skin, or a topical numbing cream, which takes about thirty minutes to take effect. Some people skip the cream because the short, thin needles used with Botox mean these injec- tions are less painful than most other shots and cause only a slight burning sensation. Other patients simply don’t want to take the extra time required for the anesthetic. It’s an individual decision.

Your doctor may ask you to grin, scowl, grimace, or make other expressions. While you’re forming these expressions, your doctor will press on areas of your face to determine the location of the dynamic wrinkles; he or she needs to feel the muscle thickness in order to determine the best points to inject.

For the areas most commonly treated, the number of injections required per treatment will vary. It all depends on your own pattern and depth of wrinkling. In the glabella or “frown line” region, usually five to seven injec- tions will do. For crow’s feet, two to seven are given on each side. And in the forehead, from

Most of our Botox patients are women, but more men are getting injections. We do a ton of Botox injections, and about 80% of our patients return for repeat treatments once they’ve

seen the result. Kirsten

Surgical technician

A Botox injection is a simple procedure. What won’t be as simple is the selection of injection sites. The doctor will base decisions not only on how your face looks on the outside, but also on the underlying muscles that create your wrinkles from within. Based on these

observations, the doctor knows where to insert the needles and how much Botox solution to use for each injection.

Before the injections, your skin is cleaned with alcohol. Then, a bright light will be directed on your face to allow your doctor to

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Botox Injections

eight to fifteen or more injections may be needed. In some places, your doctor may gently massage the area to distribute the solution.

The average Botox injection procedure takes about five to seven minutes, depending on how many areas you’re having treated. Afterward, you may be offered an ice compress for about a minute to minimize redness at the injection sites. Then, you’re ready to go.

Before

After

Eyebrows lifted after Botox injections.

How Will I Look?

Immediately after your Botox injections, you’ll have little red bumps at each injection site. This slight swelling is about the size of a mosquito bite. The vast majority of the time these will subside—within just an hour or two, which is why many people schedule their treat- ments during a lunch hour. Occasionally, how- ever, very subtle swelling might linger for a day or two.

It will take anywhere from several days to a few weeks for you to see and feel the full

Lifting eyebrows prior to Botox injections.

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The Non-Surgical Facelift Book

results of your Botox treatments. That’s because the nerves within your muscles already contain some amount of acetylcholine (the chemical that Botox blocks) and it takes time for the existing supply to dissipate. Once that happens, the Botox effect begins.

doctor will go over with you. First, do not rub the places that were injected for twenty-four hours, as you don’t want the Botox to spread into areas not intended for treatment.

Also, some doctors advise that you avoid lying flat and stay upright or in a seated position for three or four hours; others think that’s overkill. Those who do suggest staying upright want to ensure that any yet-unabsorbed Botox can’t drift into other muscles of your face. This is a very unlikely prospect, however. Most doctors agree that after your appointment you can behave as you normally would and that the risk of “Botox budge” is minimal.

If you do have any bruising at the injection sites, a bag of frozen peas or a small ice pack, wrapped in a towel and applied for about twenty minutes, will help relieve it. You can repeat the ice pack application once an hour for several hours, as needed.

How Long Will Results Last?

The effects of Botox are temporary, lasting approximately three to four months for most people. Many who are delighted with the procedure decide to have repeated treatments

Some people notice a dramatic change with Botox. Others find that they’re hearing lots of comments on how terrific they look. Again, it all depends on your “situation.” You’ll certainly see the difference yourself. You’ll have smoother skin, fewer or shallower wrinkles, and a more relaxed and rested look. Because Botox is so subtle, it can bring youthful changes to your face without anyone guessing why. Sometimes, people might just observe that you seem to be “in a really good

I had a Botox injection for the vertical frown line between my eyebrows. It totally relaxed that “crease.” After my husband saw the result, he went in for an injection, too. Ginny, 54

mood.”

Follow-Up Care

After Botox injections, follow-up is uncom- plicated. There are a few basic cautions your

28

Botox Injections

to maintain the effect. And, patients who receive another treatment before the previous treatment stops working find that the results last six to eight months.

If there’s anything you don’t like about your Botox results, however, they are entirely reversible. As the toxin’s effect ebbs from the muscles, you’ll notice a gradual return of the dynamic wrinkles. Because the change is subtle and slow, you can schedule renewal treatments at approximately four-month intervals. However, some people find that injections twice a year maintain their smooth new look.

A bonus to Botox treatment is its gradual effect on the static lines over the deeper, dynamic ones. As muscles stay loose and relaxed in an area where they used to contract, deepening of the static lines is halted. Your body also has time to gradually bring collagen and other surface-building substances to the area of the finer lines, where over time the skin has thinned. So if Botox injections are continued at regular intervals, even though Botox itself is temporary, over time the treatment contributes to permanent wrinkle smoothing.

Potential Risks

Botox has an outstanding safety record. As with any procedure, however, there are some statistical risks. A small percentage of people who’ve had forehead wrinkles treated will develop a headache, for an evening or possibly several days. On occasion, again with the treatment of the forehead, if too much toxin is injected or the area is rubbed too hard, a

“droopy” result. And if improper technique is used near the eyes, there’s a very small risk (2 to 5 percent) that a temporary

I had Botox for the frown line between my eyes. It worked so well, I had injections in my “crow’s feet.” It was quick and painless. I will go back for more treatments when it’s time. Lori, 48

brow can

droopy result. would disappear in a few weeks, however. Great care is required when using Botox near the mouth, because if mouth muscles are overweakened that can conceivably cause drooling or difficulty in speaking clearly. These potential risks are reversible, however, and would diminish as the Botox wears off.

eyelid might This problem

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The Non-Surgical Facelift Book

Botox Parties

One method of marketing Botox has sprung up that should be considered with great care: Botox parties, bashes or other group treatment events. For some time, promoters have been offering parties that provide discount rates and a party atmosphere, even including wine. It has become the “hot” new way to try Botox.

Those events can backfire, however. Do you really want to make a decision about a cosmetic treatment under the influence of pressure from excited friends, or possibly after you have had an alcoholic drink, which may impair your judgment? To be safe, attend group events only if they are information seminars. Then schedule an appointment with the doctor for a consultation and treatment.

Although getting a Botox injection may sound as simple as getting a flu shot from a friendly nurse, it’s not. Only licensed physicians with special training in the procedure should be allowed anywhere near your face with a Botox needle. That’s because to get the proper effect from Botox, your doctor must take a thorough health history and make a careful

Before

“Crow’s feet” around eyes before Botox injections.

After

Three weeks after Botox injections around the corners of the eyes.

30

assessment of your individual wrinkling patterns and facial musculature. Facial anatomy is complex, and this assessment is something that not even a registered nurse is sufficiently trained to do. The injection technique requires

Botox Injections

delicacy, precision, and a great deal of specialized medical knowledge.

Questions to Ask Your Doctor

l Is Botox appropriate for me? l Are most of my wrinkles dynamic or

static?

l What kind of results do you expect from Botox in my case?

l Should I be considering other wrinkle treatments, too?

l How soon will I see my results? l Can you show me before-and-after

photos of other patients?

l How should I care for my skin before and after the injections?

l Should I stop taking my usual medications or supplements?

l

Will I need pain medication?

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The Non-Surgical Facelift Book

32

Four

Chemical Peels

Chemical Peels

Would you like to “peel away” a few years and have smoother, softer, fresher-looking skin? If so, a chemical peel may be right for you. Chemical peels are the oldest method of facial rejuvenation. It’s re- ported that chemical peels were popular in an- cient Egypt; the Egyptians used sand in lotions they concocted to exfoliate the skin.

Certainly, the process has evolved since ancient times. For the last fifty years, doctors have used new and improved peeling agents to renew aging skin. Most of these procedures are quick, healing is relatively rapid, and the results can make a remarkable difference.

What Peels Do

The solution in a chemical peel removes the top layer of skin, leaving your face smoother and fresher. Peels restore sun-

damaged skin. They also diminish wrinkles, acne scars, and can improve irregularities in the skin tone. For example, a peel can eliminate discoloration such as melasma, the brown patches that often accompany pregnancy. Peels will also eliminate age spots and the yellowish bumps called solar elastosis, which are areas of degenerated collagen caused by sun exposure. Peels can remove the precancerous lesions known as actinic keratoses.

Although a chemical peel can soften the appearance of deep wrinkles, such as nasolabial folds and frown lines, it will not totally remove them. A peel won’t tighten skin, but because it improves its surface and texture, your skin may appear firmer. Some research indicates that peels boost collagen production, which may help forestall the formation of new wrinkles.

34

Modern formulas for chemical peels contain a blend of ingredients that offer additional benefits. For example, a peel formula may contain hormones, anti-acne agents, or melanin inhibitors. Hormones enhance the plumpness of the skin by increasing moisture content. Anti-acne ingredients kill bacteria and absorb excess oils. Melanin inhibitors help prohibit the formation of skin discoloration or brown spots.

Types of Peels

Light Peels

The most popular peel is the light peel or superficial peel. These peels remove the top layer of skin—the dead surface cells, called the stratum corneum. The chemical solutions in these peels are alpha hydroxy acids (AHAs). Most of these acids are derived from citrus fruits, milk sugars, and sugar cane. The mildest of the peel formulas, AHAs brighten, freshen, and exfoliate skin, repairing minor sun damage and smoothing dry areas. Because AHAs remove only the most superficial layer of the skin, healing is so swift that these are sometimes called “weekend” peels. Many people will have a light peel done on a Friday,

l l

l l l

Chemical Peels

Chemical Peels Improve:

Fine lines and wrinkles

Uneven pigmentation l Shallow acne scars

Sun-damaged skin Age spots Freckling

and return to work on Monday, with minimal makeup.

Medium Peels

For a medium peel, a more potent chemical is used to remove all of the outer skin layer, or epidermis. The chemical, trichloroacetic acid (TCA), is a colorless synthetic acid, normally used in a concentration of about 35 percent. Because it penetrates more deeply than a light peel, a medium peel goes further to rejuvenate sun-damaged skin. Medium peels also reduce fine surface lines and wrinkles, often completely removing them. A medium peel is particularly effective at treating uneven

35

The Non-Surgical Facelift Book

pigment, such as age spots or melasma. It will also diminish superficial blemishes and shallow scarring from acne, but not deep, “pitted” scars.

Depending on your skin’s condition and what you’d like to have treated, your doctor may combine your medium peel with a simul- taneous light peel. After the AHA exfoliates the most superficial layer of your skin, the TCA

a newer procedure, a modified deep peel is rapidly growing in popularity. For this procedure, the peel solution ingre- dients—liquid soap, Croton oil, phenol, and water—are modified. The modification uses less Croton oil, which enhances the effect, but eliminates the complications and potential toxicity frequently associated with the deeper peels.

You may hear this newer peel referred to as a Hetter Peel, named for Dr. Gregory Hetter, its inventor. It is also called a Croton oil peel, or a modified phenol peel. The effects of modified deep peel are dramatic when used for facial wrinkling, especially the leathery criss-cross lines, and deep lines around the lips, so common with sun damage.

The deeper peels can be done in localized areas such as under the eyes, for “crepey” lower lids, or around the mouth to remove the vertical “smoker’s lines.” Or it can be used on the entire face for an overall skin rejuvenation.

Are You a Candidate for a Peel?

If you simply want to smooth and refresh tired-looking skin, you’re likely a candidate for

Patients usually have the

most wrinkles around the

eyes and mouth. So, I may

adjust the chemical solution

and do a slightly deeper peel

in these areas and a lighter

peel on the rest of the face.

Dr. Jon Mendelsohn Facial Plastic Surgeon

penetrates more deeply, maximizing the benefits.

Deep Peels

The traditional deep peel procedure which you may have heard about over the years uses a chemical called phenol, sometimes referred to as carbolic acid. A deep peel removes all of the epidermis and part of the skin’s middle layer, the

dermis. As a result, it removes wrinkles around the mouth and eyes. Creases in the nasolabial fold and deep crow’s feet soften but do not disappear totally.

Since the risks, recovery, and complica- tions are higher with a traditional phenol peel,

36

Chemical Peels

Before

Wrinkles before full-face deep peel.

Before

After

Three to four months after deep peel.

After

Moderate wrinkles and blotchy skin patches.

Four months after medium peel.

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The Non-Surgical Facelift Book

Before

Facial wrinkles and vertical lines, above upper lip.

Before

Wrinkles and sun-damaged skin.

After

Four months after deep peel.

After

Several months after deep peel.

38

a light peel performed by a qualified physician. Likewise, if you have dark or black skin, your best choice is a light peel, because it is less likely to cause any pigmentation change. Most people can work these peels into their schedules with minimal time off from work.

If you’re fair-skinned you may also be a good candidate for a medium peel. For medium-toned or dark skin there is some risk of irregular pigmentation, however. Be aware that healing can take up to two weeks, so you may want to plan a short vacation around your scheduled procedure.

Modified deep peels are recommended only for people with fair skin—they are not advisable for medium, dark, black, or very oily skin. Recovery may take one to two weeks, with redness lasting up to six months.

Preparing for Your Peel

If you are using Retin-A (retinoic acid), or a similar product, as part of a skin care regimen, you should stop using it for two to three days prior to your peel. The technician doing the peel should be made aware of your Retin-A use since it will affect the penetration

Chemical Peels

of the peel solution. Otherwise, cleansing is the only preparation needed for a light peel. You simply wash your face with the cleanser provided at your doctor’s office when you arrive.

In contrast, for a medium peel or deeper peel, your doctor may recommend that you pretreat your skin for several weeks with a prescription cream such as Retin-A. This exfoliates the skin and allows the solution to penetrate more deeply. Your doctor will instruct you on whether you need to discontinue using the Retin-A before your peel. If one of your problems is dark spots or blotchiness, a bleaching cream, hydroquinone, might also be added to boost your skin’s pretreatment conditioning. This cream suppresses the melanin in the skin, causing dark spots to lighten; using the cream also lessens the risk of pigmentation problems after the peel. If you tend to get cold sores, your doctor will prescribe prophylactic (preventative) antiviral medications to suppress

Chemical peels are effective for

removing wrinkles and sun

damage in the skin under the

eyes. A peel can accomplish

more in these areas than

plastic surgery.

Jon Mendelsohn Facial Plastic Surgeon

39

The Non-Surgical Facelift Book

any new outbreak, which might spread from the lips into a treated facial area.

Before a deep peel, you’ll need a medical checkup. Any patient who plans to undergo anesthesia should be checked for heart, kidney, liver, or lung problems; the procedure carries a slightly increased risk for those with such problems.

Stop smoking for at least a week before your appointment, and avoid alcohol. Both will impede healing—smoking constricts blood vessels and alcohol dehydrates your tissues, which need their natural fluids for repair. Start taking your antibiotics as instructed. These are prescribed because a modified deep peel leaves dermal tissue exposed, and as with any wound to the skin, it’s important to prevent infection. Arrange for someone to drive you home afterward and help you for forty-eight hours; you may be lightheaded from the residual anesthesia.

Before a medium or deep peel, your doctor may have you stop certain medications for several weeks. Anticoagulant, or blood thinning, medicines or herbal supplements may make it harder to recover, because your blood

brings healing nutrients to the raw skin. Most doctors also recommend that if you’re taking drugs known as oral retinoids, used to treat skin conditions such as severe acne or psoriasis, you stop these for six months before a deep peel. These drugs, which include Accutane, can slow new skin formation, and they can also increase the risk of scarring.

How Is a Peel Performed?

All peels involve solutions applied to the skin, but details vary according to the type of peel. Every peel is applied with attention to your individual skin tone, condition, and level of damage. Your doctor will carefully control the depth of penetration for the best results.

Usually, peels are done on the entire face. With the deeper peels, the depth of the peel is usually greater around the eyes and mouth since more wrinkles are usually present in these areas. Sometimes partial peels, or “sub units” of the face, are done when only a portion of the facial skin is damaged and in need of repair. However, such a partial peel may leave a line of demarcation between the treated and nontreated regions.

40

Light Peel

A light peel is performed in your doctor’s office. After you’ve washed your face, your doctor or a technician uses a solvent such as alcohol or diluted acetone to remove every remaining trace of makeup or oil. In some practices, the doctor may pretreat your skin with a simple, painless procedure called dermaplaning, which lightly abrades the skin surface to remove dead skin cells and aid in the penetration of the chemicals. This is usually done by passing a bladed instrument that resembles an electric razor over your skin. Some doctors use a blade, similar to a scalpel.

Then the AHA solution is evenly applied, usually with a cotton pad or brush. You’ll feel stinging, but it is usually not uncomfortable enough to require pain medication. The solution is left on your skin for about seven minutes. If your doctor uses glycolic acid, a chemical that penetrates more readily than other AHAs, it is then rinsed thoroughly with saline solution to neutralize its action and prevent harm to the skin. The other AHAs do not require rinsing. Finally, moisturizing cream is applied to your face.

Chemical Peels

A medium chemical peel solution is applied. Notice the skin turning a frosty white on the side of the patient’s face.

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The Non-Surgical Facelift Book

Before

Prior to a medium peel to even the skin tone.

After

Several weeks after medium peel.

Medium Peel

Like a light peel, a medium peel is performed in your physician’s office. Your skin is cleansed and your doctor applies the solution to your face with a surgical sponge, which usually takes about ten to fifteen minutes. In about forty-five seconds, the chemical solution will cause your skin to temporarily turn a white, frosty color. This reaction is caused by the solution removing the surface skin cells.

Finally, you may sit under a fan for a while to help cool the burn. The burning sensation is stronger with a medium peel, so your doctor may suggest taking a mild sedative and ibuprofen beforehand.

Deep Peel

A deep peel or modified deep peel is usually done with twilight or general anesthesia in an accredited surgical facility. The patient’s heart is monitored throughout the procedure; if too much phenol penetrates into deeply and enters the blood stream, it could cause heart rhythm disturbances.

Once you are asleep, or comfortably dozy, your skin is cleansed, and a solvent is used to

42

Before

Severe sun damage from a lifetime of exposure to sun.

After

Three to four months after deep peel

Chemical Peels

remove surface oil, enabling the solution to penetrate evenly. The peel solution is applied with applicator sticks, focusing on the areas with the most damage. A lighter application is applied to the other areas, taking care to blend the areas and “feather” the edges to prevent lines of demarcation. The entire procedure takes from fifteen minutes to one hour, depending on how much of the face is treated.

Once the procedure is over, your doctor will cover your face with an emollient cream or petroleum jelly. The cream seals the skin, retaining moisture and preventing scab formation and scarring. When you awaken, the sensation is similar to a serious sunburn, easily relieved with pain medication After you rest for an hour or two in the recovery area, you’ll be ready to go home with your driver.

How Will I Look?

Light Peel

For the next few days after a light peel your skin is likely to be somewhat pink, and you may notice some mild dryness or flakiness. All these effects are easily camouflaged with light makeup, however, and soon you’ll be

43

The Non-Surgical Facelift Book

aware only that your skin is fresher and smoother, and that you’re looking more rested than usual.

Medium Peel

After a medium peel, your skin will turn red, darken, peel, and in some cases, may (or may not) develop some soft scabbed areas— better described as soft crusts—during the next

pain medication. Take the medication as needed over the next few days.

Deep Peel

The good news is that a deeper peel produces remarkable results. The bad news? You’ll look a whole lot worse before you look better. After the peel, your face will be very swollen for a day or so. During the first week, the swelling will be followed by peeling like that from a severe sunburn. Parts of your face will ooze.

Many patients report they don’t have a lot of pain after this peel; however, they often report a burning sensation for the first six to eight hours. Keeping the entire face moist with prescribed creams will prevent pain. Your doctor will prescribe mild pain medication, which you may wish to use, depending on how you’re feeling.

You may find it uncomfortable to make facial movements. So, you may not feel like talking for the first few days, and you may be more comfortable drinking liquids and eating soft foods, which require less chewing.

Usually after six to eight days, if you had any crusting, most of it will be gone. Your face

I had crow’s feet and a lot of sun damage. My chemical peel took ten years off my face. Tammy, 39

several days. Crusting will depend on your skin condition and response to the treatment. The areas that received the greatest penetration of acid will be more likely to crust over.

You’ll probably not want to go out. It usually takes up to seven to ten days to feel presentable again, although with makeup, you may feel comfortable after a week. Your skin color will gradually fade from red to a light pink. Once your new skin emerges, most of your fine wrinkles and blotches will have disappeared.

You shouldn’t experience much discomfort, but if you do, ask your doctor for

44

Chemical Peels

will be very red, but you can begin to cover the redness with makeup. About a month after the procedure, your new skin will feel rough or even finely wrinkled. This will smooth out over the next six to eight weeks, and the redness will fade to baby-skin pink. The risk of permanent change in pigmentation is less with a modified deep peel, compared to the original deep peels. Your new skin is likely to be somewhat lighter, though a darker shade is also possible. If your entire face has been peeled, any overall color change is less likely to be noticeable.

Follow-Up Care

After any peel, the number one commitment you must make to your new complexion—permanently—is to protect it from the sun. We’ll discuss how to do this in detail in chapter 9, but two sunscreen facts bear repeating: use copious amounts. For example, use a large marble-sized dollop for your face and three marbles-sized dollops for your neck and upper chest. Wait thirty minutes after applying it before you go out. Meanwhile, here‘s how to care for your face after a peel.

Light Peel

The flaking and dryness that follow an AHA peel are temporary and easily soothed with rich moisturizers and generous daily appli- cations of a good, high-SPF sunscreen. Beyond that there’s no new limit on your daily skin routine; you can wear no makeup or as much as you wish.

Medium Peel

Avoid scratching or picking at your face and any crusts that may develop. Cleanse gently using the products your doctor provides for you to take home. Washing with water may be too drying, and your doctor will want you to protect your skin with appropriate cleansers and ointments. Avoid the sun completely for as long as possible, and once you do go out, never skip your full-spectrum sunblock.

Deep Peel

During the first five to ten days after your peel, you will need to keep the peel area covered with emollient cream or petroleum jelly, prescribed by your doctor. The peeled area must remain moist at all times, until the oozing stops.

45

The Non-Surgical Facelift Book

Before

This 27-year-old woman wanted a chemical peel to A medium peel, an Obaji Blue Peel, has been applied. diminish freckles and patches of blotchy skin. Note the even blue frost.

46

Chemical Peels

After

Three days after the peel, the skin begins to slough. Three weeks after the peel. Skin is brighter, fresher, and skin tone is even.

47

The Non-Surgical Facelift Book

Keeping the skin moist will prevent the skin from drying or crusting, which will create scarring. Also, avoid scarring by picking or scratching your face as it heals.

To cleanse your face, gently use your fingertips and cool water. Pat your face dry with a clean towel and apply the cream your doctor has ordered. You’ll need to continue this washing and moisturizing for seven to ten days. Your doctor will tell you when it’s safe to wear makeup again, and what cleansers and cosmetics to use.

For at least two months, postpone sports and recreation that expose you to the sun; ease slowly back into your exercise routine; and plan on wearing sunblock forever.

Sleep on extra pillows until the swelling subsides. Keeping your head elevated will encourage the dissipation of the excess fluids that have collected in the tissue of your face.

How Long Will Results Last?

Some people elect to repeat light peels every few weeks, but most doctors advise two- to three-month intervals. If light peels are done too often, they will dry the skin. Dryness

promotes wrinkles. (The exception to having a light peel every few weeks may be using a very light glycolic acid solution that is applied weekly for about six weeks, for the cumulative effect of a light peel.)

Medium and deep peels last much longer. Although you might repeat a medium peel after one year if you have still not obtained the results you were aiming for, in most cases and with proper skin care, you’re more likely to wait for years. Since modified deep peels remove the entire top layer of your facial skin, they produce permanent changes and a completely new skin surface.

Potential Risks

There are few risks with a light peel, other than possible lingering dryness. If you have had cold sores recently, a few weeks of antibiotic use beforehand is advisable. If the herpes simplex virus that triggers cold sores is currently active in your skin, the peel could trigger a new outbreak, with a risk of infection and scarring.

With medium peels, there is some risk of permanent scarring, pigmentation change,

48

uneven texture, or demarcation lines. These are uncommon complications when you’re in the hands of a highly experienced professional. Infection is also a potential risk. Closely following your doctor’s aftercare instructions greatly reduces your risk of infection. Your doctor may also prescribe an antibiotic.

Deeper peels can cause heart rhythm disturbance and lasting kidney damage in some

Chemical Peels

people if too much phenol enters the skin. Careful medical monitoring during the procedure should prevent problems. As with medium peels, permanent skin pigmentation changes, in which skin color becomes paler or uneven, are also possible.

Questions to Ask Your Doctor

l What type of peel is appropriate for me?

l How quickly will I recover?

l How should I care for my skin before and after the peel?

l Should I stop taking my usual medications or supplements?

l

Can you show me before-and-after photos of other patients?

49