Juvederm To Submalar Area (Plus Botox and Restylane)

I was thrilled to get a touch up with Dr. Jonathan Hoenig in Beverly Hills today.   I am healing from my double layer 8% TCA peel so I look icky, but at least I just had my hair done yesterday, so I am hoping to look human again pretty soon.  I lost a few lb. I am so thankful to be able to pull myself out of this “rut” and get back into high gear

I wasn’t completely sure what I needed, so he advised he would examine my face and see what I had going on once I got there.  I knew I wanted lips and n/l’s for sure and Botox.  Of course I always want more cheeks, I just don’t think the Radiesse Cheek Augmentation did as much as I expected it would.  But then again, it has been over a year!  What did I expect?  And still, something needs to be done with my under eyes.  I feel old.

Read more…

http://yestheyrefake.net/journals/juvederm_submalar.htm

Juvederm To Submalar Area, Restylane to Lips & Botox to Forehead, Glabella & Crow’s Feet

Juvederm To Submalar Area, Restylane to Lips & Botox to Forehead, Glabella & Crow’s Feet

*Firstly, I apologize for not having any before and afters.  I had sent the topical anesthetic pic to a friend, so that is why I have it.  But unfortunately my phone was stolen before I had a chance to remove the other pics off of it for my journal.

I was thrilled to get a touch up with Dr. Jonathan Hoeing in Beverly Hills today.   I am healing from my double layer 8% TCA peel so I look icky, but at least I just had my hair done yesterday, so I am hoping to look human again pretty soon.  I lost a few pounds.  I am so thankful to be able to pull myself out of this “rut” and get back into high gear

I wasn’t completely sure what I needed, so he advised he would examine my face and see what I had going on once I got there.  I knew I wanted lips and n/l’s for sure and Botox.  Of course I always want more cheeks, I just don’t think the Radiesse Cheek Augmentation did as much as I expected it would.  But then again, it has been over a year!  What did I expect?  And still, something needs to be done with my under eyes.  I feel old.  I had to work an event the weekend before and had two people say that I looked “different” since the last time they saw me just a few months ago.  Bleh.  And I got ma’amed 4 times in one day, lol.  Why don’t they just put me out to pasture, right?  Whatever.

I got to my appointment and he looked over my face and the first thing Dr. Hoenig said was, “You need to gain weight.”  
“No way!” I exclaimed.
He then proceeded to suggest I have my submalar area injected, lol. 
“Don’t you think I need more cheeks?”  I told him.
“You wouldn’t have any cheeks if it weren’t for me.”  said Dr. Hoenig.
*gasp!* “Not so!” I told him.  I pride myself on the fact that I have good cheek bones.  Don’t take my ONE plus I still have away from me, hehe!

I was apprehensive about injecting the submalar are but the more I looked, the more gaunt I really did appear.  I agreed.  Even Danya, agreed and I always listen to her.  So Dr. Hoenig applied some topical anesthetic and I waited for it to take effect.

He didn’t inject Restylane under my eyes.  He also didn’t inject anything into my nasolabials.  Dr. Hoenig said that he feels that unless they are deep, injecting that area to look flat causes the area between the upper lip and nose to look elongated which tends to age the face. *drat*

It must be Conservative Day , because this is what I wound up with:
Juvederm: 1 cc Juvederm in the submalar area, feathered to the malar area.  It actually looks better.  I have always been reluctant to get this area injected but I needed it.  I concede. (* had originally had posted that I had .8 Juve, but that was incorrect)

Restylane: 0.3 cc Restylane in my lips.   Bummer, I wanted more, lol.  He just did the cupid’s bow and a little touch to the center of my bottom lip.  I really wanted bigger lips, but he said “NO sausage lips.”    So I look natural.  Yay.  But it really does look natural, which is good. 

Botox: 25 units of Botox to forehead, glabella and only a touch to crow’s feet. Last year when I had my Radiesse, I had 54 units total.  I only got 25 units this time but it lasted until late March (2011). Really!

My Recovery
I bruised from everything!  From the Botox, the Restylane to my lips and I had some bruising in the cheek area from the Juvederm.  Plus, I was SUPER sensitive even with topical anteshetic.  It was very odd.  It’s not normal for me and Dr Hoenig was very surprised as well.  Even with a nerve block to the lip area I still felt the philtrum injections.  I am getting ready to “start” so I am always so super-sensitive beforehand.  I also think that I am anemic again so there ya go.  I have not drank anything lately so it was quite a shock to get bruising.

I still only have slight flaking left over from double layer 8% TCA, waiting another 2 weeks to do peel #2.   The peel really made the past blemishes and hyperigmentations dark this time.   I look like a hag right now.  But the TCA should help my complexion once it heals.

I am thinking about getting laser under my eyes, or the 35% in-office peel, but after the holidays.  He said my piddly 8% peels will do nothing like his 35% will.   I wonder what he thinks about the Vi peel.  I will have to ask next time I go.
Dr Hoenig had commented on a visible superficial vein under my eye that makes it look icky as well.  Aging SUCKS.
Conclusion
I really like the submalar injections.   It did make my face look more filled out and I was so against it for so long, haha.  I know it is difficult to judge how much you should have, as a patient, which is why I need to trust my doctor.  I redeemed myself of any doubt and sent  Thank You card to the office and commented that they told me so and that I shall never doubt him again.

Restylane and Botox Update

As some of you may have read, on Thursday I went to Beverly Hills to see Dr. Hoenig for my quarterly Botox and Restylane injections.  Dr. Hoenig  used only Restylane for my lips and undereyes this time–no Juvederm.  He felt I didn’t need much at all, in fact he thought there was barely any movement in my brow and said “most doctors would throw you out of their office” But, I disagree because if I can make dynamic lines when I raise my eyebrows, I’m not happy! I like it completely smooth  

I unfortunately seemed to have needed a lot of Restylane under my left eye.  Dr. Hoeing feels my skin is very thick in the mid cheek (apple area) and that the oil glands under my skin may be enlarged, causing a demarcation where it meets the thin undereye skin. Apparently they do not complement one another.  I personally feel it is the scar tissue from the fat because my cheek skin thickness has not changed in size since I was younger.  Who knows though?

I had Restylane injected in the cupid’s bow and philtrum (raised lines that run from the cupid’s bow to the nose) of my lips and a touch in the bottom lip.  I also had Restylane injected in my cheeks, very little.  I wanted more but he felt I didn’t need it. I had Botox to the glabella (frown line), forehead and crow’s feet.  Last time it didn’t seem to work very completely, or for as long, so this time I am crossing my fingers.

Dr. Hoenig also put me on topical Azelaic acid which I will be starting in a week.  I have only used it once before, and only from a sample, and I loved it.  I hope it doesn’t cause any irritation or make things worse; I have never had the problem before with azelaic acid.  Here is to a rejuvenated face using less invasive means!

Duck Lips: Knowing When To Say “No More”

After my polite and oh-so-subtle skydiving acquaintances and friends [who know nothing about cosmetic surgery by the way]‘ lovingly’ started calling me Daffy behind my back, I decided to write a little something about going overboard with lip augmentation fillers.  The kicker is that my lips were in need of Restylane when they last saw me, hence our conversation.  They simply overheard me talking about getting my lips injected at dinner a few weeks ago and it became an instant controversy over sushi.

Now, in my opinion my lips are not huge right now at all.  I only received a touch of Restylane this last time around.  But the mentioning of my lips getting injected at all stopped people in the middle of chewing their California rolls. A few were appalled and couldn’t understand why I would do such a thing. Others wanted to know more.  It seems to me that they feel that it is black and white, small lips or large lips–no in-between, no balance, just duck lips. They automatically assumed I was going for the gold and getting them ginormous.  What’s the big deal?

I tried explaining but to no avail. Next thing I know I was getting pics of duck lips and surgery addicts posted on my MySpace. Not cool.  It shows you the maturity level of some of these individuals, doesn’t it?  Well, whatever the case, it has triggered me to write an article about when to say no on injectable fillers.  When poofy is perfect, and over-poof is just not attractive.

The reason that most people over inject over time is not because they usually set out to have lips this large.  It starts little by little, almost like a developing addiction.  You have a little put in, you get a little swollen, you become accustomed to the swelling and you like the ‘high’ you receive from knowing you are going to look better. The swelling subsides and you think that your lips are small again.  What do you do?  You go and get more injected and the cycle starts all over again.  Pretty soon you look almost like a Grouper fish and people are staring or making snide comments. 

How to avoid this situation?  Photos.  Before and after photos are such a great tool to keep you anchored to reality. Many times one does not realize the improvement they do have unless they view their before and after photos.  When your eyes adjust slowly over days when looking in the mirror, you usually lose sight of your improvement, so you schedule another appointment,  When you look at your before and after photos, you can honestly judge , side by side, the improvements that were made. And remember, the enemy of good, is better.  So, please, next time you think you may need more lip augmentation, take a look at some photos that shows you now, as compared to before.  Slow, baby steps are best!

Causes and Treatments for Under Eye Dark Circles

Either hereditary, lack of sleep or simply a result of aging, thinning skin, dark undereye circles are undeniable.  I have friends who carry a concealer stick in their purse or pocket–even men!  I have had them, but I am fortunate that they are easier to deal with than most.  I have seen pretty severe dark circles that look as though they were from a good punch in the eye, and others which only seem to surface from lack of sleep. Still, when they seem permanent and no amount of sleep, diet, or supplements seem to work, they can really get you down.

The cause for dark circles is usually thinning of the skin, and fat loss, which allows the blood vessels below to show through. My dark circles are actually pseudo-dark circles, in that they appear only in some photos where the flash causes a shadow from my cheeks. There is no bluish or purple tint visible from under my skin upon further inspection.  The hollows from fat loss are what actually causes them in photos. So, what do I do? Fill er up with Restylane.  I wish it were permanent, but I suppose I’d rather it not be.  Not that I have commitment issues, but I have had not-so-good permanent results that I regret, so I don’t need any on my face.  My next appointment is actually today in Beverly Hills with Dr. Hoenig!  I figured since I have an event coming up in a week and a half and Thanksgiving is right around the corner, I might as well get it in now.  Let’s hope I don’t bruise badly.  I think the time frame is enough to where anything that may surface can be dealt with in time.

So how do you determine which category your dark circles happen to fall under?  Ask yourself these questions:

• Does your mother or father have them?
• In good lighting, do you see a bluish tint, or see blood vessels right below the surface?
• Are they worse with lack of sleep, or when you are sick?
• Are your under eyes sunken in? When you compare photos of when you were younger, do you feel that you had more volume under your eyes?

Usually all of the above can be dealt with relatively easily. If you feel your skin is thin, Sculptra may be an option for you, although lumps are possible.  Sculptra (polylactic acid) injections cause thickening of the skin due to a low inflammatory response which in turn promotes collagen growth. Restylane may also help in this regard as well, although thickening of the skin may be more suitable for your needs if your skin is truly thin.

If your issue is more from volume loss, even better.  Restylane has been such a Godsend for me.  Even though I have had fat grafting in the past, I love instant gratification.  You can walk almost immediately out of your doctor’s office, feeling refreshed and looking rejuvenated.  Only a skilled plastic surgeon or dermatologist will be able to tell you for sure.  Just be sure to get several opinions before you commit.

In preparation for your treatment, there are some guidelines you can follow to help lessen the chances of bruising.  Be sure to stay away from alcohol for at least a few days, and avoid aspirin, and products containing ibuprofen or naproxen.  Although bruising may be inevitable, hopefully avoiding these products can somewhat help.  Cold compresses before and after can further assist you in this regard.  After 48 hours your doctor may instruct you to switch to warm compresses to increase blood flow to the area to promote faster healing and removal of the contusion. Always adhere to your own doctor’s aftercare protocol, and ask before considering any treatment you were not instructed to do.  Even though this has helped me tremendously, your doctor may not approve.

Although one appointment may be necessary for a lot of patients, it is possible that you may need a touch up once the swelling subsides.  Whatever the case may be, do not let your dark under eye circles get you down. There is hope, I promise!

Injectables for Cheekbones

As many of you may already know I am pretty much obsessed with prominent cheek bones. I love full cheeks, not the fatty, puffy cheeks you see in overly fat-grafted patients, or even the natural, pudgy cheeks. But high, exquisite, chiseled cheekbones with a youthful, but not significant, fat layer on top of them catches my eye above most other facial attributes. In fact, I think one of the first compliments I ever gave my boyfriend before I asked him out (yes, I asked him out) was that he had really great cheekbones. They aren’t too bony so that his face looks gaunt, and not they’re not too plump either—they are just right. He must be incredibly tired of my complimenting him, “I love your cheekbones” as I trace my finger on his face. He just rolls his eyes and thinks I am nuts. I can’t help it.

So, if we don’t have beautiful cheekbones naturally, how do we buy them?? What does it take to create perfect, high cheekbones? Although I have pretty prominent cheekbones I have had my share of injections to make them more so. Unfortunately, it never lasts much past the swollen stage. Let’s look at the most popular options in injectable cheek fillers… •

• Radiesse: I have had Radiesse in my lips, and I don’t recommend it there, but I have seen it used for the jawline, cheeks and chin. The results have been pretty phenomenal although it did not last as long as they had hoped. It is certainly worth a look-see. The cost of Radiesse is still about $1,500. a CC.
• Sculptra: I have had Sculptra injected into my undereyes and nasolabials. I felt that it took too long to achieve nominal results for considerable augmentation. I honestly would not choose it personally, although I have seen fantastic results in those with lypodystrophy. The cost can be a few thousand over a course of 3-6 months.
• Restylane (also JuveDerm, and Perlane): Although I have not had Restylane in my cheeks, I have had it in the upper eyelid, undereyes, the nasolabials, and lips. I love it! It works. But you get a lot of swelling associated with hyaluronic acid injections and this can set you up for disappointment simply based upon becoming accustomed to larger cheeks/lips/etc. even though they are clearly larger in the after photos. I have seen Restylane used for the cheeks and feel it can give you a very nice result. It is also temporary so if you can’t stand it, you won’t have it forever. The cost for Restylane can run you about $900+ for 2 cc. but you may not need that much. Subtlety is a good way to start.
• Fat Grafting: I have had fat grafting twice and both times the fat layer disappeared in the areas I wanted to retain it and stayed in areas I did not like it. When you go slow, fat grafting can be very nice. It can enhance al already existing cheek structure, or it can smooth the harshness of implants under thin skin. Fat grafting can run you anywhere from $2000. to $6000. and may take several sessions.
• Artfil (formerly Artecoll): Microscopic beads of polymethylmethacrylate (or PMMA, the same material PlexiGlas is made from, can be suspended in a carrier and injected in several sessions to trigger your own collagen to grow. It can, however, take a considerable amount of the injectable to make a difference once the carrier is absorbed by your body. Artefil can cost about $1200+ for a cc.
• Cheek Implants: Although not an injectable, cheek implants are still an option. It can be used in conjunction with the above options for a natural result if you go to the right surgeon. Cheek implants can run you about $5000.-$10,000. depending upon whom you choose as your surgeon.

I have always been fascinated by high cheekbones so as their appeal has come and gone, they have always remained a favorite with me. I remember when the trend was to have plump cheeks. However, I felt it never made anyone look younger, rather they looked overstuffed to me (think Rene Zelwegger). When you take a stick-thin woman and fill her face with fat, it doesn’t look natural. But having a gaunt face can age you considerably. You may have heard of The Ogee Curve in facial aesthetics. This enhancement of the gentle concavity of the face, while maintaining a chiseled malar point is a delicate balance indeed. Choosing a skilled surgeon with an impeccable aesthetic eye can help you achieve this balance.

Just remember, a little bit goes a long way. Consider a temporary solution before undergoing a more permanent option. You can always go back for more, or decide on a permanent option later. I truly believe that slow and easy wins the race in plastic surgery. Reversing a bad mistake is far more difficult than avoiding one in the first place.

Women Injected With Unknown Substance in a San Diego Salon

First off, please please, PLEASE do not get injected with anything in the back of a salon, mall spa, someone’s home, or any other back alley operation by some unknown “doctor” or physician’s assistant.  I can’t even tell you how many people I know of who have done this (mostly silicone). The cost should truly not be a determining factor unless one plastic surgeon is charging you twice as much as the other and they are equally skilled.  But slinking off to your friendly neighborhood cosmetic chop-shop is not a good environment for you to be getting injected with unknown substances no matter how cheap it is.

Two California women, Tiffany Barton and Katrina Kalanick, chose to have injections of an unknown, white substance which they though to be collagen in a Clovis, CA salon they often frequented.  Tiffany decided on lip injections and Katrina chose an injection in the glabella–the price: $100.  Tempting yes, but worth it?  No.  In hindsight I am sure that they probably saw the signs, but the excitement of looking good for less has driven more women into a downward spiral of revision procedures than I can count. 

The two women commented that the doctor seemed legitimate and presented himself very professionally.  Most con-artists often do.  Unfortunately for these two ladies, this “professional” has caused them [hopefully only temporary] disfigurement. What’s worse is that Katrina was getting married a week later.

The alleged disfigurer, Mario Nieves Perez was arrested in a sting operation brought on by the complaints of numerous local women.  Chief Jerry Dyer of the Fresno Police Department advised Perez is being charged with 29 felony counts, including his own sister’s!  However Perez did not show up for his court date, and is feared to have fled back to Mexico.

Please don’t let this happen to you.   Actually, I take that back.  It doesn’t just happen to you.  You have to go out and actively seek it.  You do have a part in it. I am sorry if anyone thinks I am being callous, but it is true.  There are a lot of shady characters in the world today, at the market trying to start a conversation, in the parking lot asking for your “help”, calling the elderly on the phone targeting their retirement funds.   Ignorance is not bliss.  Don’t allow yourself to become a victim in any setting. Would you go to the local Laundromat to do your banking?   Would you go to the burly mechanic’s down the street to get a massage? Would you go to a salon to get stitches or a mammogram?  Then why would you go there to get injected with anything?  Use common sense when considering medical procedures.

Tips To Stay Safe

• Always verify the medical professional’s credentials and medical license.  Although physician’s assistants and nurses often inject Botox and collagen, Restylane, etc. with a supervising medical doctor on the premises, I prefer using the doctor himself.  You can verify your doctor’s medical license and query for disciplinary actions and complaints on your state’s medical licensing website.
• Always have your procedure performed in a medical setting.  Although I have been to “Botox Parties” that were held by various doctors of mine, they were still held in-office, after hours.  A salon is not the place to be injected.
• Research the procedure you are getting beforehand. Know what to look for, know what the label should look like. Watch them break the seal on single use syringes of product.  Although Botox comes in a vial that holds 10 units of product, and must be reconstituted before you ever even get there, single use syringes are used.  Often times, when you only get one area treated, the bottle will already be opened and in use.  This is normal.  You do not get your own bottle of Botox unless you plan on using it all.
• Restylane, Collagen are single use, and come with a batch ID sticker that is removed from the syringe and placed in your patient file.  This way if any adverse reactions occur, the batch number can be identified.  Even Botox has a batch ID on the side of the bottle. It will be written down in your chart.
• If it is too good to be true, it probably is.  If you are getting your glabella treated with “Botox” for $50, walk away. That doesn’t even cover the cost of the product.
• Word of Mouth is a great tool.  Although word of mouth seems to work for the back-alley injectors as well.  It is how they operate. Stick with doctors, or physician’s assistants with medical doctors supervising them. 
• Know how long your injector has been using a particular product.  It‘s not just the product, but also the skill of the injector.
• First time to an office you haven’t heard of? Stick together, or tell someone where you are going.  Maybe bring a friend with you.  Be sure to remember all of the details of your visit, your doctor, etc.

I know it is sad that we even have to do this.  Buddy systems which were once for blind dates and walking through dark parking garages are now for healthcare—both elective and necessary.  Some may say I am being overly cautious but I have also heard firsthand reports of way too many illegitimate procedures being performed.  I have also been a watchdog for the FDA for a few illegal silicone injection operations.  Sadly however, in some instances several years ago, local law enforcement agencies didn’t seem to care.  I would report some to the State Medical Licensing office but was told that since the individuals were not doctors, they had no jurisdiction.  The FDA advised they didn’t have a say in some instances either depending upon the situation.  And several local news agencies didn’t seem to care as well.  I would be willing to bet now though that I would get a response from all three in any case.  I know what’s lurking out there, and I don’t even know the half it.  That’s the scary part.