Facial Treatments

There’s a new face in town. It’s yours! At least it could be, thanks to the myriad of medical esthetic treatments available to put the kibosh on the visible signs of aging. This new face calls for the newest-of-the-new products and procedures that repair damage, restore lost volume and prop up that which gravity and time have pulled down. The objective of these latest facial rejuvenation treatments is not to fundamentally change your face or create a frozen waxy façade, but to subtly push back against the three Ds of aging: degeneration (lasers), deflation (fillers) and descent (Botox).

Lasers: Not just for science fiction anymore

There was a time when lasers were the stuff of space movies and pointing devices. No longer. Today’s cosmetic lasers can treat imperfections from pore size, texture, fine lines, skin tone and pigment to deep wrinkles and sagging. It all depends on the type of laser and the depth to which it penetrates the skin.

One of the most popular laser treatments on the market right now is the “laser facial,” which is marketed under names such as Revlite and LimeLight. These lasers use short, rapid pulses of light to address problems at the skin’s surface — redness, dullness, freckles and sun damage — resulting in a more refreshed appearance, even skin tone and smoother texture.

“It’s perfect to have done on a Friday if you want to freshen up for a weekend event,” says Zorica Spohr, business manager and patient consultant at the Cosmetic Laser and Vein Centre. “There’s no downtime and it’s a very quick procedure — 10 to 15 minutes.”

One of the newest treatments available in the city is the Pearl laser treatment, which has been available in Calgary for less than a year. A more-aggressive treatment than a laser facial, the Pearl is considered a resurfacing laser. It works by removing a portion of the top of the skin.

The Pearl is an effective treatment for addressing fine lines, discolouration and uneven texture; however, it involves at least three to four days of “social downtime,” which basically means not leaving the house. The upside is the desired result can be achieved after only one or two treatments.

According to Angela Robertshaw, managing director and laser clinician at Vive Rejuvenation, most patients rank the procedure — which feels like a series of quick, hot pinches — about a three to five on a pain scale of one to 10. The skin stays red, tender and possibly swollen for two to three days, after which it begins to peel or slough off.

Once the bulk of the peeling is complete — usually on day five — you can wear makeup and return to your daily activities. Results are visible after about one week, with the skin looking brighter and tighter. And the skin continues to improve because the laser stimulates the body’s natural collagen production at the dermal layer, providing structure and elasticity.

The Pearl Fractional Laser, the Pearl’s more aggressive cousin, is the newest laser on the market. It bores deep into the dermis, sending little light sabers into the skin, selectively removing damaged skin and stimulating collagen production.

“It’s like aerating your lawn. By poking tiny holes in it you
allow oxygen, water and nutrients to penetrate, and the result
is a healthier, more attractive lawn,” says Alicia Burns, co-owner of Avanti Skin Centers of Calgary. “It’s a similar process with the Pearl Fractional, except those tiny holes stimulate collagen, plumping the skin from deep down.” 

The Fractional is especially effective on deep wrinkles around the eyes and mouth, or in older patients who have deeper facial wrinkles. With that comes a longer healing time, though — five to seven days. Since the treatment is more painful, patients may be offered sedation, whereas, with the Pearl, topical freezing cream is generally sufficient.

Sean Carson, who represents Pearl-manufacturer Cutera, says the two lasers work well in combination. “We call it Pearl Fusion,” he says. “The Pearl targets epidermal problems on the whole face, so the skin that grows back is 100-percent renewed. The Pearl Fractional targets moderate to deep wrinkles, acne and scarring. The results are amazing.”

People who can’t afford the downtime or prefer a less-aggressive treatment than the Pearl or the Pearl Fractional may look to an option called Laser Genesis. “It works the same way, essentially,” says Burns, “but patients will need up to six treatments to get the same result. It’s great because people leave here looking just a little sun-kissed, and by the next day they’re totally back to normal.”

The aptly named Titan laser also works well below the skin’s surface by sending infrared light energy deep into the tissue.
It’s effective in tightening the loose skin on the face, jawline
and neck, as well as in lifting the brows and tightening bags
under the eyes, says Angie Treasure, a laser technician at
Heritage Pointe Medical Aesthetics. However, she cautions,
the procedure targets sagging, not fat, so patients have to
be realistic about their expectations.

Treasure usually recommends two Titan treatments approximately four to six weeks apart. Although some patients see an immediate difference, results are usually gradual over three to six months. Since Titan doesn’t target surface imperfections, there is minimal pain and any redness or swelling will generally subside in a few hours.

On the horizon: TruForm, a body-sculpting process expected
to hit the market in July, is a radio-frequency laser developed
by Cutera to selectively target and heat fat cells, breaking them down without damaging the underlying muscles.    

Plump it up: Fillers are the new baby fat

When talking about fillers such as Restylane, which has been on the market since 1998, the new buzz word is “facial contouring.” What was once thought of as a product for inflating lips (see “Myth Buster,” page 78) and filling deep lines like nasal labial folds, fillers are rapidly gaining popularity for their ability to restore the volume in the face that is lost as people age. The result is youthful plumpness, as opposed to the pulled tautness of a surgical facelift.

“[Fillers are] being used to add volume to the cheeks, chin and to contour the jaw,” says Jason Olandesca, a registered nurse who trains professionals how to inject Restylane. It’s also used under the eyes to treat deflation, he says, explaining if you fill out the area, it reflects light differently, significantly reducing dark shadows.

A further relatively new use for filler is to reshape and contour the nose. Olandesca says surgeons use fillers to show patients how they’d look with a rhinoplasty, without the permanent commitment.

Treasure points to another area being treated with fillers:
earlobes. “As with other areas, volume loss occurs in the ear-
lobes, so people get these beautiful big earrings and realize their earlobes don’t do them justice,” she explains.

With fillers, much depends on the skill and experience of
the practitioner, since there’s an artistic element to the work. Olandesca stresses patients should ask to see before-and-after photos to gauge the quality of the injector’s work.

Made with non-animal-based hylauronic acid and marketed under brand names including Restylane, Perlane and Juvederm, these fillers are considered a safer alternative to collagen because there’s less risk of an allergic reaction and the results can last about twice as long. (Injectable collagen is derived from pigs, so some patients also prefer other options based on ethical or religious grounds.)

Juvederm recently became available with lidocaine, a local
anesthetic, to provide more comfort both during and after injection. However, some practitioners will use “dental blocking” if needed to freeze sensitive areas in any case, so determining which product is best — Restylane, Perlane, Juvederm — depends on which product the injector is most comfortable using. Sculptra (a lactic acid filler), says Spohr, is used for long-lasting results for people 45 and up and those who are quite thin, and is more expensive than the others mentioned.  

We All Fall Down: Fortunately there’s Botox to prop us back up

Hardly a new treatment, Botox has been unfurrowing brows
in Canada since 2001, and has become a household name.

Despite its popularity, there is still a lot of misinformation about Botox, says Spohr. “Some of the people you see in Hollywood have gone way overboard, but in the hands of an experienced injector you will still have natural facial expression and motion in the face,” she says.

Botox, or botulinum type A, acts on the nerve impulses to reduce muscle contractions that cause frown lines and other facial movements — it doesn’t paralyze muscles as is commonly reported, but rather it puts the muscles at rest, explains Spohr.

While the formula for Botox hasn’t changed over the years,
how it is currently being used has. “The classic use is in the frown lines, but we now know it can be injected along the outer part of the eyebrow for a brow lift,” says Spohr, adding it can also be used to widen the eyes to produce a more rounded look, and to minimize crow’s feet.

Spohr calls the latest procedure that her colleague
Dr. Louis Grondin has been performing the “Nefertiti Neck
Lift.” By injecting the jaw line and neck to relax the muscles
underneath the skin, this procedure recontours the jaw line
to make it more defined and also minimizes neck bands.

Botox typically lasts three to four months, and once
injected it takes about five to 10 days to take effect.
Botox, made by Allergan, has so far been unrivalled for
this kind of treatment, but it looks like that may change.

On the horizon: Reloxin is expected to be approved
for use in Canada later this year. Made from the same
neurotoxin as Botox, it is said to act more quickly —
one to two days — and last longer — five to six months —
than Botox. The product has been available for several
years in Europe, Australia and South America under the
brand name Dysport.

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