Gail Humble,M.D.
Cosmetic & Laser Specialist

SUMMER BEAUTY

Happy Summer everyone! I will be in Hermosa Beach the 6th thru the 10th of August, and will be in San Francisco the rest of the month. For Hermosa Beach, call Debbie at 310-408-9770 to check availability & schedule an appointment. For San Francisco, call Sharon at 415-400-5447.

SPECIALS: Buy one Radiesse get the second half off PRP this month is only $900 with micro-needling

Much has changed in the field of aesthetic dermatology. The industry has moved from a 2D to a 3D approach and the desire for a ‘dramatic’ result has evolved into the search for a ‘natural’ look; with more patients desiring a fresh and natural appearance after treatment. At the same time, new areas for correction, new products and devices for treatment, a deepening knowledge of the anatomy, and an understanding of the risks involved in each treated area offers practitioner and patients a choice in respect to treatment protocols.

Treatment Plan for the Upper Face

When formulating the treatment plan, aesthetic and anatomical peculiarities of the patient, and the individual nature of the aging processes have to be taken into account . The key problem zones of the face are very individual by nature but the most commonly encountered in the upper face are horizontal and glabellar lines, lowered eyebrows, crow’s feet lines, changes of volume in the temporal and forehead areas, and age related changes at the periorbital area. The most commonly performed treatments for the upper face are injections of botulinum toxin and hyaluronic acid fillers (HA fillers), When a patient presents with not one but several areas that need correction, the treatment should begin with the upper face. As we are changing the anatomy of the upper face of course that then changes the anatomy of the lower face. Sometimes volumizing certain areas in the upper area result in such a lift, so further volumization of the lower face may not even be necessary, or at least minimized.

1.Temporal Hollowing Significant temporal bone and frontalis bone resorption occurs beginning in the third decade in addition Loss of the subcutaneous fat pad beneath the lateral brow adds to the volume loss in the upper eye area The most common indications for treatment with fillers in this area are to smooth the transition from the cheekbone area, or to directly treat age related lipoatrophy and volume loss in the temporal area directly. Several long acting volumizers are excellent for treating this include voluma, juviderm plus as well as Radiesse. Deep temporal injections are suitable for the correction of volume loss . To minimize the risk of vascular complications, we use a bolus technique in each temple. A superficial temporal injection can be performed to smooth the transition from the temples to the lateral area of the cheekbone as well.

2.Lower and upper Brow Lift Lifting of the lateral eyebrow is one of the most frequently requested treatments among patients for which botulinum toxin injection is generally recommended. These can be supplemented by the use of fillers. The goal of the treatment with fillers in this area is to lift the eyebrows, correction of volume loss, and, creating the contrast of light and shadow. it is important to consider the relationships between the position of the eyebrows and orbital rim. When eyebrows are located below the upper orbital rim treatment with fillers in this area can cause the opposite intended result, such as heaviness of the lateral part of the brows. .It is often said that ‘the eyes are the mirror of the soul’; therefore, the appropriate treatment for the areas around the eyes should be done in a way that is harmonious with the indidivuals entire face.   The first photo is showing filler used on the brow bone. The second is the results four days after botox to the lateral and medial brow.

3.Sunken, Hollow Appearance of Upper Eyelid This area is a perfect continuation of the brow area. As mentioned above, the brow often falls because the brow area and upper eyelid looses fat and boney support with age. Not only does this drop the brow but it causes the upper eyelid to appear sunken and hollow. Traditional plastic surgery utilizing a blepharoplasty is effective but often this leads to a hollow appearance with time. The updated treatment is to treat the lost volume with a soft tissue filler or fat.

4.Sunken Eye As boney resorption occurs the orbital fossa (eye socket) actually becomes larger and the orbital globe sinks in, making the eye appear smaller. This can be corrected by applying filler directly onto the inferior edge base of the orbital rim. This gives a natural elevation and returns the youthful look to the eye. It is also important to address the loss of volume at the very top of the cheek as it transitions into the cheek. This then returns the convex curves to the face which are characteristic of a youthful face.

Before we leave the eye area lets address what can be done with neurotoxins (Xeomin,Dysport and Botox)Most patients are extremely knowledgable about Botox and are very comfortable with using it to minimize their crowsfeet. But Botox has multipole other uses on the upper face as well as the neck and body.

5.The non-surgical nose job A non surgical nose correction is becoming increasingly more popular. As we age the upper part of our nose (where it joins with the forehead area) begins to collapse . As this happens we have tissue redundancy form in the area between our forehead and our nose. Sometimes botox alone is enough to address this issue but if there horizontal line persists, it can be simply rectified with filler.

6.Threads Finally I would like to introduce the concept of threads in rejuvenation of the upper face. Threads will be discussed more next month when we address the midface. The shorter Nova threads (both spiral and smooth can work very in both lifting the brow as well as supporting the gentle undereye skin. Also by stacking nova threads on top of each other we can fill even the deepest wrinkles. These threads cause collagen production.