Pan-Facial Filling: The End Of The Facelift?


As our understanding of what causes facial aging advances, our approaches to this problem are advancing as well. Gravity as an explanation for the aging changes in the face has been discredited. Three factors are now recognized as important in facial aging: changes in the skin quality, mostly due to insults from the environment, but also due to biological changes that are not fully understood; repeated folding of the skin and loss of volume of the underlying tissues that support the skin. It is the last of these changes that I will discuss here.

For a while we have recognized that the loss of facial soft tissue: fat, muscle and connective tissue, have played an important part in facial aging. More recently it has become clear that loss of bone also plays a very important role. The openngs for the eyes are much larger in the skull of a 50 year old, than in the skull of a 20 year old. The jaw bone of a 20 year old is thicker and wider than the jaw bone of a 50 year old. These changes not only cause deflation of the face, but change the proportions. In the young individual the upper lip occupies 1/3 of the distance from the bottom of the nose to the tip of the chin. In the elderly it takes up 1/2.

Since these aging changes are due to changes in the volumes of various tissues, we should be able to reverse them by adding volume in the appropriate locations. Ideally we would prefer to replace the lost tissue with something that resembles it. Currently we have relatively good replacements for soft tissue, but we are only starting to develop replacements for bone, although progress is being made in this area.
If the volumes and proportions of our deep tissues are changing, producing loose skin among other changes, it doesn’t make much sense to try to correct aging changes by tightening the loose skin over the altered deeper tissues. Ideally we’d like to keep the facial volumes youthful, either by restoring what is loss or, even better, by prevent the deeper changes in the first place.

We are now closer to approaching this goal. We now know that filling less obvious areas of tissue loss, what I call pan-facial filling, can produce a fresher younger appearance. We know that significant facial volume loss begins in our early 30s, and ideally this is when filling should begin. We are fortunate in that our fillers not only replace volume, but induce our skin to make new collagen. Thus, repeat filler injections can be performed less frequently. Fillers are still expensive, but less frequent treatments reduce the cost. New products are on the horizon and hopefully competition will further drive down the cost.

My prediction is that more people will come to understand the advantages of starting fillers early, and maintaining them. These people will continue to look better than those who go untreated, they will age in appearance much more slowly and many of them will never come to the point where they want a surgical procedure.

Gerald N. Bock MD

Plastic Surgery And Graduation: Bad Present. Good Timing.


This is an article from our guest doctor, David Reath, MD. Here it goes:

I have written about plastic surgery for graduation before, but as this is the time of the year when we starting getting  announcements from our family and friends with children who are graduating from high school and college, it is a good time to revisit the subject. As you might imagine, doing what I do, I occasionally get questions about plastic surgery as a graduation present. Is this a good gift? Generally, I would probably say, no.

My Graduation Gift Thoughts

Philosophically, I have never been a believer of rewarding my kids with gifts or money for getting good grades. Just as my job is to do good work in the operating room, I believe a student’s job is to do the best work he or she can in school.  It seems to me that giving someone an operation for graduation (and let’s face it, this is going to come from the Mom and Dad and not dear old uncle Clem), is sort of the same thing.  We’re giving a big reward for doing what is expected.

Don’t get me wrong, graduation is a milestone and one that should be honored. Inviting the family in from out of town to celebrate and honoring the grad is definitely the way to go. What we gave each of our kids when they graduated from high school was a family trip and they got to decide where to go. We all had great experiences and have wonderful memories from these travels. They’re some of our best family times ever!

Graduation Can Be Good Timing For Plastic Surgery

While I do not think that plastic surgery is a good graduation present, per se, sometimes this can be good timing. Let me explain: let’s say that there is something that your child really wants to change about their appearance, something they and you have been thinking about, something that they have a realistic attitude about, and something that seems to be a reasonable thing to do. The interval between high school and college, for instance, can be a very good time to do this, because it will bring less attention to the fact that your child has had something done.  As they move on to college, or a new career, they will be among a different group of people on a day to day basis.  A group who didn’t really know what this feature of their body looked like before.  So, there wouldn’t be as many of the “Did you see what Ashley had done last summer?  OMG!” type of comments.

Here’s the bottom line: if your child is going to have something done which is reasonable, have it done. But not because they have graduated, rather because it is a sensible thing to do. The break between high school and college can be a great time to do it without bringing any more notice to themselves than necessary.

All the best,

David B.

How is Botox procedure performed?


Botox is actually the trade name of the neurotoxin Botulinum Toxin Type A, which is used as an anti-aging cosmetic drug for the removal of wrinkles and frown lines from the facial skin. It has been proven beyond any doubt to be the most effective and safe procedure that quickly removes 80% of the facial wrinkles.

Botox cannot be applied to every person. Any person seeking Botox treatment should be determined whether he is the right candidate or not for the treatment by a medical practitioner. In general, a person is considered to be the right candidate for Botox treatment if he/ she is:

  • between 18 to 65 years old
  • having excellent health condition
  • is not into drugs
  • has no neurological or muscle disorder
  • is not pregnant or breast feeding in case of a women

The most common aging symptoms that are effectively treated by Botox include the forehead furrows, frown line and crow’s feet, which are caused by the repeated contractions of facial muscles. This repeated contraction of facial muscles occurs when we express a facial expression especially while squinting and frowning.

Botox has a local effect as it simply blocks the neural transmission between the nerve endings and the muscles to lessen the facial muscles contraction that cause wrinkles. Botox injection also known as Botulinum injection is a non-surgical cosmetic treatment that is mostly performed at the doctor’s clinic. This procedure does not involve the use of any anesthesia as alternatively a numbing cream is applied to the area under treatment. The person seeking treatment may experience minimal pain and discomfort during the injection process. The treatment procedure usually lasts for about 20 minutes or less and the patient is free to go home after that. There is no need to stay at the clinic for further medications. Being a non-surgical cosmetic treatment, it does not involve any type of stitches or bandages like the traditional cosmetic treatments that lasts for weeks. You can instantly resume your daily life activities, however direct exposure to sunlight must be avoided until the treatment process is fully completed.

Botox treatment has proved to be very helpful for millions of people around the world in eliminating facial wrinkles, frown line and crow’s feet. It has provided the opportunity to have a more vibrant and younger look than before. Botox application is not limited to cosmetic purpose only as it has also been proved helpful for medicinal purposes especially for migraine.  Like any other drug treatment, its effects diminish over time and lasts for 3 to 4 months only after which wrinkles start appearing again on the face. However, repeated treatments after proper consultation can significantly lessen the wrinkles and frown line. If you want to have your facial wrinkles treated through Botox, you need to consult your doctor to be determined as the right candidate for the treatment. After getting the green signal from your doctor you need to find an experienced and qualified cosmetic surgeon to administer the process.