“Based on my 15 years of experience with Botox, and more recently with Dysport and Xeomin, I wrote this medical paper to help educate other plastic surgeons on using these great products for facial rejuvenation.”
Karol A. Gutowski, M.D.
Dr. Gutowski has Performed over 1000 Breast Procedures & Offers Breast Enhancement with Fat Injections * Which implant is best for you: Saline or Silicone Gel? Round or Shaped, Smooth or Textured? * Should the implant be above or under the muscle? * What is the dual-plane technique? * Which incision is best? * How does […]Read more
Learn about the No-Drain Tummy Tuck and other new Body Contouring Techniques! * Which liposuction is better: Smart Lipo? WaterJet Lipo? VASER Lipo? * Can I have liposuction with only local anesthetic? * What is lipo-abdominoplasty? * Do I need a tummy tuck or liposuction or both? * What is a Mommy-Makeover? MORE […]Read more
Non-Surgical Face Lifts * Surgical Face Lifts * Injections * Botox * Dysport * Xeomin * Fillers * Artefill * Belotero * Juvederm * Perlane * Radiesse * Restylane * Sculpta *Voluma * Fractional CO2 Laser * Radio Frequency Skin Tightening * Ulthera * Brow Lift * Forehead Lift * Midface Lift * Face Lift […]Read more
Karol A. Gutowski, M.D.
The FDA approved Juvederm Ultra XC for lip injections and around the mouth this month. Juvederm is a smooth hyaluronic acid gel that adds fullness to the lips and is the only dermal filler that lasts up to one year.
“I have been making faces younger with Bellafill (previously called Artefill) for over 9 years and it is one of my go to non-surgical options for facial rejuvenation. The latest studies confirm what I have seen in my patients, the results frequently last 5 years or more!”
Karol A. Gutowski. M.D.
” I have been using Bellafill, formerly known as Artefill, as an injectable collage stimulator for facial rejuvenation. Unlike most other products, Bellafill actually helps your body make its own collagen. Past studies showed at least a 2 year duration but a new evidence shows results maintained up to 5 years!
Karol A. Gutowski, M.D.
A study of the injectable dermal filler Bellafill showed that more than 80 percent of patients were satisfied with the results five years after finishing treatment, maker Suneva Medical said.
The dermal filler, made primarily of bovine collagen, has been approved by the U.S. Food and Drug Administration for smoothening “laugh lines” since 2006 and for treating acne scarring of the cheek since January this year.
The study was the longest and largest post-approval trial of its kind, privately owned Suneva said, noting that such products are typically tracked for only up to a year after treatment.
In 2013 alone, there were more than 2.2 million injectable filler procedures in the United States, according to the American Society of Plastic Surgeons, making it the second most popular minimally invasive cosmetic procedure in the country.
Dermal fillers, which are also used for lip, cheek and hand augmentation, are injected into the skin to fill in wrinkles.
Allergan Inc’s Botox, on the other hand, targets muscles that form wrinkles by relaxing them and typically lasts three to six months.
While the duration of a filler’s effect depends on the material used and the area where it is injected, most products are temporary as they are absorbed by the body over time.
This tends to frustrate consumers as the cost of repeated treatments add up.
Suneva said that in its 1,008-patient study, users experienced a retention rate of 87 percent.
Other dermal fillers on the market have been evaluated for much shorter periods, or studies are ongoing.
The long-term safety and effectiveness of Restylane Lyft, sold by Galderma, unit of Nestle SA, has not been established beyond one year while Galderma’s Sculptra has not been evaluated beyond 25 months after the last injection.
In a tiny study of Allergan’s Juvederm Ultra, seven of nine patients demonstrated improvement in laugh lines a year after being treated.
Earlier this year, the U.S. Food and Drug Administration asked manufacturers of dermal fillers to update their labeling to reflect the risk of serious injuries caused by unintentional injection into the blood vessels in the face.
In the Suneva study, some minor side-effects such as redness and lumpiness were experienced but no major adverse events were reported, the company said.
Is your “Cosmetic Surgeon” a Plastic Surgeon? Best to know before you have a treatment.
On August 31, 2015, the 10th Circuit Court of Appeals affirmed the September 5, 2013 dismissal of an antitrust lawsuit filed by two cosmetic surgeons against an educational campaign that depicted a tearful woman saying, “I didn’t know my “Cosmetic Surgeon” wasn’t a Plastic Surgeon.”
Educating the public about the importance of board certification by the American Board of Plastic Surgery (ABPS) is a priority. The Aesthetic Society congratulates the Utah Plastic Surgery Society, along with ASPS (American Society of Plastic Surgeons), ABPS and 19 of our members in Utah for boldly encouraging patients to understand the differences between cosmetic surgeons and plastic surgeons.
From the New York Times Health section. What really works for fighting wrinkles?
Read the entire article below.
Nostrums that promise to smooth wrinkled skin are a staple of snake-oil salesmen everywhere, but now there is strong evidence that certain kinds of treatment are effective. Over the past decade, researchers have been learning which treatments work, and why.
A recent review in The Archives of Dermatology concludes that three anti-aging treatments are proven clinically effective: the topical application of retinol; carbon dioxide laser resurfacing; and injection of hyaluronic acid, a moisture-retaining acid that occurs naturally in the skin. Each depends on the same mechanism, the interaction of skin cells called fibroblasts with the collagen they produce.
“This is an area where there’s a lot of hype and not much substance,” said David J. Leffell, a professor of dermatology and surgery at Yale who was not involved in the review. But, he said, this study is “good science.”
Theory and experiment back these treatments, the authors write. Fibroblasts — connective tissue cells — secrete a complex group of polysaccharides and proteins that creates collagen, which gives the skin shape and elasticity and supports the blood vessels that permeate it. The network of collagen tissue is maintained by its mechanical tension with these skin cells.
Skin deteriorates as it ages, but its exposure to sunlight inhibits the ability of fibroblasts to produce collagen. The hands, face, neck and upper chest all suffer more than unexposed skin, and light-pigmented people wrinkle more readily than others. This damage, the authors write, is essentially an accelerated version of chronological aging. Ultraviolet radiation induces production of the same enzymes that degrade collagen with age.
Collagen fibers last as long as 30 years. But with age and ultraviolet exposure, they deteriorate and fragment, and fragmented collagen impairs the collagen-producing function of the fibroblasts that created it. As the fragmented collagen accumulates, new collagen production declines, the connections between the fibroblasts and the collagen weaken, and the skin, now lacking support, begins to wrinkle.
But there are treatments that counter this process. Topical application of retinol, a form of vitamin A, was the first to be proved useful. Although the molecular pathways are not well understood, retinol causes new collagen to form in chronologically aged skin and in skin damaged by ultraviolet light.
Skin creams with retinol are available over the counter, but many do not indicate the concentration of the active ingredient. “Many products just refer to retinol or vitamin A as a buzzword,” said Gary J. Fisher, the lead author of the review and a professor of dermatology at the University of Michigan.
Concentrations of 0.2 to 0.6 percent are enough, Dr. Fisher said, but preparations strong enough to have an effect can also have a side effect, a rash called retinoid dermatitis. Dr. Fisher’s advice is to stop using it if a rash occurs. The rash can sometimes be avoided if the concentration is increased gradually.
Retinol also makes the skin more sensitive to damage from ultraviolet light, so protection from the sun while using it is essential. “O.T.C. products tend to try to walk the line between effects and side effects,” Dr. Fisher said. “But many intentionally keep the concentration too low to have any benefit.”
Dr. Robyn S. Gmyrek, an assistant professor of dermatology at Columbia University, is also skeptical of over-the-counter wrinkle creams. “If something shows true biological activity, it’s regulated as a drug,” she said. “A cream bought over the counter is certainly not going to do what prescription-strength retinol will do.” Dr. Gmyrek was not involved in the study.
Carbon dioxide laser resurfacing is another well-tested treatment for wrinkles. The laser removes thin layers of skin without damaging surrounding tissue. As the wound heals, new collagen is produced. The treatment works first by inducing high levels of matrix metalloproteinase, or MMP, an enzyme that destroys fragmented collagen. Then it reduces MMP and increases the production of new and undamaged replacement material. The procedure is also used for removing scars, warts and birthmarks.
Healing takes two to three weeks, and the wound has to be cleaned with saline or diluted vinegar and treated with ointments to prevent scarring. In most cases, the procedure is done only once, Dr. Fisher said, and lasts many years.
There are now some less invasive laser procedures, the authors write, but their effectiveness is doubtful.
The third effective treatment is injecting a form of hyaluronic acid, similar to a substance the skin normally produces, into the dermis that underlies the wrinkles. This was originally designed as a space filler, with no intended physiological effect. But as the injection stretches the dermis, the fibroblasts respond by producing more collagen and less MMP. The authors cite studies that have demonstrated that increased collagen production is visible within a month after the injection. The benefit lasts about six months, Dr. Fisher said.
This type of hyaluronic acid, he said, should not be confused with hyaluronic acid in some topical cosmetic products. Rubbing such products on the skin will not stimulate collagen production.
Do the benefits of these treatments outweigh the risks?
“It’s a matter of the kind of problem a person perceives and how he wants to deal with it,” Dr. Fisher said. “For these treatments, which have sound research behind them, and for people who want to improve their appearance, the benefits far outweigh any problems.”
The authors have no ties to companies that make skin care products, but the University of Michigan, where they teach, has patents on the use of matrix metalloproteinase inhibitors in the treatment and prevention of aging skin.
This article has been revised to reflect the following correction:
Correction: August 21, 2008
Because of an editing error, an article on Tuesday about three treatments proved to be effective against wrinkles described incorrectly part of the process of one of those treatments, carbon dioxide laser resurfacing. After the laser removes thin layers of skin, the healing wound produces more collagen, not less.
Why should you ask for a No-Drain Tummy Tuck? Listen to the interview with Dr Gutowski here.