What Causes Facial Aging?

A lot of people say sagging skin or loss of elasticity, some say genetics, others say ?things like the sun? and still others say ?volume loss.? �A host of recent studies suggest that the biggest culprit is volume loss.� This includes skin and muscle but it is mostly fat and bone. That?s right, the moment we begin to lose volume, we begin to show our age and that is usually after 35 on average!!

These days it seems like everyone is searching for that elusive anti-aging cure all.� The easiest and cheapest way I know to make you look younger is to use fillers.� As a plastic surgeon, I have tried or seen just about everything, from topical skin products to reduce wrinkles, to surgery.

Fillers have been around for a number of years starting with collagen, followed shortly after by the hyaluronic acids like Restylane and Juvederm.� Longer term filler then became available like Radiesse and Sculptra.� Finally ArteFill was introduced just 6 years ago and there is no question that it is the best of the bunch

Why I Believe ArteFill is the Best Filler

• It is safe: ArteFill is made from material that has been used with orthopedic prostheses for decades. This history shows us that there is little chance of an allergic reaction to it. �In fact over the last couple of years no adverse reactions to the product have been reported.

• It lasts a long time: Studies have shown that clinical results are safely maintained for at least 5 years after treatment.

• It is predictable: The results are essentially 100% predictable with ArteFill making it far superior to fat injections. With fat injections we are never sure of how much will last and where it will stay.� This can result in uneven areas that often need reinjection with fat. �With ArteFill we see the exact result, immediately, and the results are truly remarkable. In addition, the results from ArteFill are without complication and are enduring

• It is more economical than the other fillers: While the initial cost of an ArteFill treatment is certainly more, there is no need to refill or get more injections in 8 to 18 months like the other products making the long term cost much less.� I really like this as I can get a better result and a happier patient who does not have to come back for more unpleasant injections!

Results from ArteFill Injections

The results from ArteFill injections seem to continue to improve over time. �ArteFill induces the body to make its own tissue in the area that is injected, and as time goes on, patients seem to ?age in reverse? because of this new collagen. �The bottom line is that this product works!

Liquid Facelift ArteFill Side Effects

As with any injectable wrinkle filler treatment, you can expect mild swelling and reddening at the site of injection. �These side effects are usually gone within 24 hours. �Bruising is not uncommon and it typically disappears in seven to 14 days.� It can easily be covered with makeup. �Less common side effects include rash and itching more than 48 hours after treatment, persistent swelling or redness, and increased sensitivity at some or all injection sites.

ArteFill is featured on THE DOCTORS

Artefill on The Doctors

I looked at myself in the mirror last night and thought, ?Oh my, I need my BOTOX�!?
There was a day when I wouldn?t have even considered doing anything to my face and I am a plastic surgeon. But then again there was a day when I was young.
Now I am not saying that am old. I am just saying that I am not young. If you are more mature you will understand that one day you look in the mirror and you wonder, ?How in the ***, did that happen??
I understand that I will never look 21 again but is it wrong to want to be able to go to the bar after a day of skiing and not look like the oldest guy in there? I know that I wouldn?t really be fooling anyone but I have decided that I deserve to erase some lines and remove some brown spots. I would like to look in the mirror and not see a big old frown line across my forehead. I want to look like my old ?younger self?.
Here?s how I see it: I?m going to the gym regularly, I?m eating healthy (for the most part? I have my lapses and little indulgences), and I?m getting enough sleep. Basically I think I?m doing my part and my part isn?t cutting it. These age spots aren?t going to lighten themselves and the wrinkles aren?t going to smooth themselves out. It?s time to break out the tool box!
BOTOX� is great for wrinkles on the forehead and around the eyes. We call it the great wrinkle relaxer.
I know the healthy attitude is to accept growing older gracefully. Those wrinkles are really just ?laugh lines? right?
Nope, I am a plastic surgeon! BOTOX�, Juvederm and Artefill are all right there in my tool chest!
?Easy for you? you might say, ?because you get it FREE!? Well it?s not exactly free. Well, sort?a free!
But you can get it FOR FREE too? Well, sort?a free! And you don?t have to steal it!!
Here?s how: If you are a new patient to Peak Aesthetics we will give you 10 units as long as you purchase 30 units! (Until the end of October 2012) If you are already a patient, don?t worry, just bring in a friend and you will get the same deal.
There is one more thing you can do to decrease the cost of your BOTOX� treatments. If you have not signed up for the Brilliant Distinctions program we encourage you to do so because 90 days after that first treatment of 40 units you will have $25 credited to your Brilliant Distinctions account which you can apply to the price of your next treatment. This program is courtesy of the Allergan Corporation, the makers of BOTOX�. Just call us for the details.
One little tip with BOTOX� that not many are willing to tell you, is that if you get treated regularly every 3 to 4 months, after a about 2 years you are not as likely to need as much and you are not as likely to have to come back as frequently. In other words you probably just need to come in for small touch ups if you get ?Botoxed? regularly for a couple of years.
Now for the legal part: BOTOX� treatments are not appropriate for all people. Use of BOTOX� for cosmetic wrinkle reduction anywhere but the glabella (that?s forehead between the eyebrows) is considered off label by the FDA. You and your friend will receive BOTOX� treatments by me only after being examined by me, Dr. Brian Windle, to make sure that you are a good candidate. This offer is sponsored by Allergan.
Please call us for more details. (425)366 8222
See you soon!

I was talking to someone about the Summer Olympics this morning and they mentioned that they watched a lot of it this last weekend. Every four years we get to cheer on our favorite Olympians and some of us become experts in sports we really know nothing about. Many of you will be watching the summer games intently over the next couple of weeks but many others will simply be spending hours outdoors in the sun enjoying your summer athletic activities. You might not be out there as much as the Olympians but nonetheless your skin will confronted with the same elements.

Here are some tips to help you achieve fresh, glowing skin.

Slow it down ? A recent study showed that strenuous physical exertion actually produces oxidative stress that depletes the skin of antioxidants and makes it more vulnerable to skin damage. They found mild to moderate exercise actually has the opposite effect. This does not mean that you should not ?bring it? any more. It simply means that going for the gold every work out is not as good for your skin as a moderated workout routine and that you should protect your skin when you are outside.

Cover up ? When you are working out, especially if you are outside in the heat of the summer, you sweat and sweating decreases your skin’s natural protection against the sun?s harmful rays. It also washes off your sun screen! If you can’t give up your run or walk outside invest in some sun-protective clothing and always wear a hat and sunglasses. Also consider avoiding working out during peak hours (10-2pm).

Go liquid or foam ? Liquid or foam sunscreens have a higher alcohol content and can help you avoid prickly heat. Prickly heat is also known as heat rash and it is thought to arise from plugging of sweat ducts and hair follicles on the skin from sweat. The occluded pores, trapped sweat, give rise to the tiny water bumps seen in this condition. Sunscreens that are hypoallergenic and oil-free should help you avoid this problem.

Hydrate ? Drink plenty of water and use moisturizer daily.

Wash Off ? Human sweat (with its high salt content) is a very potent skin irritant and can cause skin rashes and irritation. It is important to wash off sweat with gentle soap and water. It also helps cleanse your skin of bacteria, oil and dirt. Use a mild soap to open up the pores and prevent breakouts. Exfoliating a tow to three times a week will also help to give you that added glow.

It?s never too early to start thinking about your fall treatment plans including non-invasive procedures such as a dermal filler like Artefill� or BOTOX�. Call us Peak Aesthetics at 425-366-8222 to schedule a consultation or book your next treatment.

Enjoy the rest of your summer!

“Aging gracefully”, that’s what people say and I tell myself all the time. “Yup, you?re aging gracefully”; as my hair gets more gray (distinguished), my face looks a little more tired (mature), I struggle to keep my weight down by working out more and eating less (slower metabolism), I keeping forgetting things (mellowing) and all of a sudden, my skin seems dry and has suddenly developed spots (seasoning). I just don?t get it. I didn?t ask for this. How do those folks who seem to be ageless, do it? For instance, they seem to have glowing skin like we all did when we were growing up. A glowing skin tone is something I think we would all like.
Unquestionably, our skin seems to fade over time. As a plastic surgeon, I have learned that there is no true secret to having that ?youthful glow? but here are some hints that will help.
Our skin condition is often a barometer of how we take care of ourselves.
The research clearly shows that being overweight increases our risk of all those things we keep hearing about: diabetes, heart disease, high blood pressure, kidney disease, Alzheimer?s disease, etc. but did you know it also affects our skin? Being overweight increase the amount of inflammation that is going on in our bodies and causes all of those nasty things I just mentioned but inflammation is a contributor to acne and rosacea and has been linked to a host of other skin disorders.
Smoking is obviously NOT good for your skin. Do I need I say any more about this?
Sun exposure is also not a good thing for our skin. It?s amazing how many times I have said to people, ?Those spots are caused by the sun? and their reply is ?I hardly ever go in the sun, anymore.? The fact is that sun damage is cumulative over our lifetime and the spots I am seeing today were caused by the damage I got, not just last week up at Whistler spring skiing (yes I had my sun screen on but I still got some exposure), but by the damage that I got when I was a toddler and got a sunburn. (I can?t remember that but I know it must be true).
So here are some tips to help your skin and your health as well.
Get in shape and cut out some calories!! Enough said on that one.
There are three lotions that science tells us unequivocally help.
? Sunscreen (at least an SPF 30).
? A good moisturizing cream that offers sunlight protection and moisturizes the skin.
? Retinols like Vitamin A or Retin A
You should be using all three. It is important that you do not over do the retinols however. More and stronger does not mean better. The retinols are really the just acid form of vitamin A and can be detrimental to your skin if not used properly. So consult a medical skin care specialist, dermatologist, plastic surgeon or someone who knows what they are talking about to get the right stuff. (Hint: I like Beaute Pacifica?s Super 3)
When you finally realize that your skin needs some help, the basics I mentioned above may not be enough.
Age or sun spots are due to hyperpigmentation, or increase in melanin content in the skin; again secondary to sun exposure.
Here are some of the popular age spot removal home remedies:
?Mix flour, lemon juice, or milk cream together and use as a scrub. Lemon helps in clearing the spots, and milk cream helps retain the oil content of the skin.
?Make a paste of papaya, straw berries, and lemon juice as a face mask.
A better solution is the alpha hydroxyl acids, also known as AHAs. There are a lot of cosmetic preparations that contain these acids. The acids work by sloughing off dry and dead skin to expose younger looking skin underneath. This also makes your wrinkles appear finer. These lotions and peels can be used on your face as well as your hands. Most of the over the counter preparations are not strong enough to get significant results and again I think a good skin care professional is your best bet for getting the results you really want.
Bleaching creams and lotions can also be used to reduce the ?liver? spots or dark spots that may begin to show with age. Hydroquinone is a natural bleaching agent that can help reduce the natural melanin in your skin. Hydroquinone can be purchased as an over-the-counter cream, ointment or lotion. Preparations of up to 2% are readily available but once again the stronger prescription strength preparation will get the best results.
If you have dry skin, moisturize regularly. Many of us more mature folks seem to have very dry hands and sometimes a little over the counter hydrocortisone cream will help with that.
Finally, as surgeon, I recognize that there is loss of volume that occurs in our skin and other tissues with time. Most people think we get wrinkles because our skin stretches and sags but recent research shows that it is much more a loss of volume. The best analogy I can think of is clothing on a manikin. It can look great but if we shrink the manikin the clothing will look loose and wrinkled. There has been a loss of volume! There is little that can be done to stop this and the fix is either tighten the clothing (surgery), restore the manikin?s size (fill things back up) or a combination of both.
When it comes to fillers you have a lot of choices. First you need to decide who is going to do it. I have heard of offices where the medical assistants do the injections!!! (That is illegal just about everywhere I know of). The gamut of injectors usually runs from nurse, to physician?s assistant, to a nurse practitioner, to dentist, to family doc to ER doc to a physician who is board certified in one of the other specialties that generally and has specialty training in cosmetic medicine and or surgery.
The next decision that needs to be made is what product to get. BOTOX�, Juvederm Ultra or Ultra Plus, Radiesse, Belotero, Sculptra, Restylane, Perlane, Artefill??? And that?s the short list!
A lot to consider if you?re tired of ?growing old gracefully?!

It seems that there are a lot of things that you have to either use or you lose.� For instance my wife is always insisting that I eat the left over food in the fridge or it will spoil.� You need to use the gas in the gas can or else, after a few months of sitting around, it will also spoil.

Botox is another one of those deals. �You have to keep going back every 3 to 4 months for another treatment so those crow?s feet or forehead wrinkles won?t come back.� It is true that if you keep up your Botox every three months for a couple of years you do not have to back very often after that but you still have to go back.� In other words, just a little maintenance is all that is required after a few years of getting your Botox regularly, but even then you cannot just quit if you want the results

Physical fitness is clearly something you have to keep up with or you will lose it as well.

There is a lot of evidence to show that there is very little reduction lung capacity for the first 10 days following inactivity in well-trained athletes. �The decrease is faster if you are not a highly trained athlete.

After 9 weeks of inactivity there is a drop of almost 20% in a trained athlete?s capacity to carry oxygen.� After 11 weeks of no running, Studies demonstrate that this drops by over 25% from peak physical fitness!

So, as you can see, you have very little to worry about if you have to take a break from aerobic exercise for two weeks or less. �Any deconditioning lost in that time is quickly made up. ��But, after two weeks of not training, significant reductions in fitness begin to occur and you?ll have about 2-8 weeks of training (depending on the length of inactivity) ahead of you to get back to your previous level of fitness. �So use it or lose it!

This week there were a few articles in the medical news feeds that I get that talked about a study concerning brain health. �From these articles and the study these articles talk about �it is quite clear that keeping physically and mentally active is good for the brain.

You can find one of these articles here: http://www.webmd.com/healthy-aging/news/20120427/use-it-or-lose-it-key-to-keep-aging-brain-young?src=RSS_PUBLIC

I am keeping this week?s blog short because I have to go eat the left over food in the fridge, mow the lawn to burn off that old gas, go get my Botox, work out and do a few Sudoku puzzles.

Dr. Windle

The other day I was talking to someone who mentioned that she did not know much about Botox. She then said that she had asked a friend if they knew anyone who got Botox injections and her friend said I don?t know anyone who doesn?t get Botox!? Well this drug has certainly come a long way since its beginning 10 years ago. That?s right! BOTOX� is 10 years old this month!

Botox was originally FDA approved treatment for two rare eye muscle disorders (strabismus and blepharospasm). The original name, Oculinum, doesn?t exactly roll off the tongue, but shortly after Allergan, a global specialty pharmaceutical company, secured that first FDA approval in 1989, the product was rebranded Botox. Once physicians realized that Botox could treat wrinkles, the rest was history.

The FDA approved BOTOX� for aesthetic treatment in April 2002 and it has gone from a somewhat controversial treatment to a celebrity-endorsed wrinkle remedy. Injectables have become the new norm in cosmetic treatment. Last year?s statistics compiled by the American Society of Plastic Surgeons show that the most common nonsurgical procedures last year were neurotoxins and hyaluronic acid fillers. That is medical talk for BOTOX� and Dysport� (neurotoxins) as well as products like Jevederm and Restylane (hyaluronic acids or HAs)

BOTOX� reached nearly $1.6 billion in sales last year, attributing 51 percent to therapeutic uses and 49 percent to aesthetic uses. It became so successful that it gained its first FDA-approved wrinkle-reducing competitor in 2009?the sincerest form of flattery in the business world. However, BOTOX� continues to evolve as new uses for the product are discovered. Used off-label, it treats a host of concerns such as crow?s-feet, down-turned corners of the mouth and bands on the neck. You may be surprised to learn that it has also been used, off label, to aesthetically treat enlarged pores, droopy eyebrows, a pointy chin and a droopy nose tip. Additionally, it?s an FDA-approved treatment for medical conditions ranging from chronic migraine to excessive sweating. Next up: the company is seeking FDA approval for the treatment of crow?s-feet.

Why has BOTOX� become so popular? Well, in short, because it works. BOTOX� can be overused or misused and look terrible. But when it is used correctly and conservatively, it creates a look of youthfulness that is undetectable without the need for surgery, high costs or lengthy recovery times.

As they say, everything in moderation. Problems with BOTOX� arise when patients start believing that more of a good thing is better. In this case, a little bit of a good thing is good. More is not necessarily better.

Sure, it has become the drug of choice for many in Hollywood, but BOTOX� has moved way beyond the glitz and glamour of the movie industry. Since its FDA approval for cosmetic use ten years ago, BOTOX� has become mainstream. It’s now the number one cosmetic medical treatment in the country, with nearly six million procedures last year.

Typical treatments range from $350 to $700, a small price to pay for turning back the clock without evidence of “having work done.”

Even men are getting in on the action. More than 300,000 men underwent BOTOX� treatments last year. Their reasons for nudging towards the needle range from simple vanity to gaining a competitive edge in the workplace.

And then there are a growing number of patients who use BOTOX� to treat debilitating conditions such as migraine headaches, muscle spasms and urinary incontinence. Since 2002, Botox has been FDA-approved to treat almost a dozen different medical conditions.

So here we are. Ten years later, with millions of Botox injections for dozens of different treatments, and everybody is happy.

So here’s to you, Botox, on your 10th birthday. You don’t look a day over seven.

Dr. Windle