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Category: Botox

Boutique Botox

Contributed by Heather Rypien

Heather Rypien administering Botox on a patient

OK! Let’s face it. Most of us shudder at the thought of “getting old” – whether it’s facing the fact that our energy level is not what it used to be, or the fact that those dreaded wrinkles are constantly a literal walking advertisement of our age. Most of us are on a mission to preserve the youth we once took for granted. I mean really, who ever thought we would become “that old person”? With advancements in research and technology, we now have available to us many tools to fight Father Time, that dastardly Muther! From hormone replacement therapy, to using plasma rich protein to rejuvenate the skin, it seems the growing possibilities are endless.

That being said….let’s talk some BOTOX…the (safe) gateway drug to youthfulness.

I hope that got your attention.

Seriously, who likes wrinkles? I realize that wrinkles are actually our character lines and tell a story – but why not use them to be a mystery novel? When people hear the word Botox, reactions vary. Many will say they can’t live without it, others…not so much, I mean who wants to look like Keith Richards, then again, who wants to look stone-faced? What’s the happy medium? One of the toughest parts of my job as a nurse injector is properly educating our patients and instilling the confidence to try something new, especially if a consult happens to occur around the same time as the Grammy or Academy awards! To have the confidence to try something new that will still look like YOU…a refreshed, smoother version and natural-looking is key.

I started this little blog with Botox, as it has been the gold standard in wrinkle releasers (ok neuromodulators but who uses that word) since 2002 when it first became FDA approved for the use on those Angry 11 lines between the eyes. Since then, we have come a long way, baby. Not only have we expanded the areas practitioners are able to treat but, there has been some new competition on the market – same game, different name! Although newer products such as Dysport and Xeomin vary in their chemical properties, the mechanism of action is the basically the same. So we know we have options with product, but how many of you really knew that we now have multiple options on what these “refreshers” can do for us?

I decided to incorporate a new approach to non-surgical cosmetic procedures in our practice. I guess if I had to come up with a name for it I could call it Boutique Botox. The experience I give our patients is unique and exciting. We only have one face. I like to think that, similar to purchasing a big ticket item from Best Buy, people do their homework and educate themselves and research all of the options available. It all begins with the consultation process. So many times my patients have told me that they have never had someone explain to them in depth the “why behind the how” when it comes to any cosmetic injection. I have to say this amazes me. Seriously, if you do not know HOW the product works and WHY it is being injected where it is…how could you possibly understand what the outcome will be- Seriously folks there is more out there than just getting rid of a line! I often wonder, did you really just go in somewhere allow them to stick needles in your face and just go home hoping you would wake up with no wrinkles! If this is the case, please do not do it again.

You are in the driver’s seat of you anti-aging process–Let me be your trusted co-pilot!

Wrinkle reducers should come with a menu. It’s all about the muscles. To make it short and sweet, we have two basic muscle functions in the face, depressors (help make the tired mean face, and elevators (our happy approachable face). It is the happy yin/yang balance of manipulating these muscles that helps us achieve our aesthetic goals. Naturally.

Turning That Frown Upside Down, with Botox.

ultherapy3Botox can actually improve depression.

 A new research study has brought to light the possibility of treating depression with the use of Botox. The study will be published in the upcoming Journal of Psychiatric Research. The men behind the study are Eric Finzi, a cosmetic dermatologist, and Norman Rosenthal, a professor of psychiatry at Georgetown Medical School. Their study involved a group of 74 patients with major depression who received either Botox injections or a placebo, in the form of saline injections, to the forehead. The goal was to “freeze” the muscles whose contraction makes it possible to frown. 

About six weeks after the treatments Finzi and Rosenthal found that 52% of the patients who received Botox treatments saw relief from depression, while only 15% of the patients who received the saline placebo felt relief. Other studies have been held over the past several years, and they too have found similar effects of Botox on a person’s mood. Michael Lewis at Cardiff University found in his own study that patients who are nondepressed and received Botox above the eyes frown less, and generally feel better than those who do not receive Botox injections. Another study done by M.Axel Wollmer from the University of Basel found that Botox was superior to a placebo in a group of depressed patients.

These studies stem from the idea that facial expressions may feed information into our brains and thus influence our feelings, challenging the long-held belief that the brain sent information to our bodies that determined our emotions. This goes back to a theory of emotion that was proposed by Charles Darwin. Darwin believed that the control of expressions causes a similar effect on subjective emotions, where the brain examines facial expressions and then creates the appropriate feeling; if you’re smiling your brain sends a signal that you’re happy, and when you’re frowning your brain sends a signal that you’re sad.

 In summary, if you can’t frown, it can actually help you feel better.

For more information, visit this article from the New York Times, by Richard A. Friedman.

Emerging Trends

Woman Applying MakeupEveryone wants to look their best, and while some wish to do so through various topical treatments, others wish to augment their looks with surgical or non-invasive procedures.

As the years keep flying by, new trends in staying youthful are always taking hold, and the “old favorites” stay popular.


• Platelet Rich Plasma (PRP) — PRP has been used for years in other specialties to assist with wound healing because it is rich in growth factors and is emerging in the non-surgical aesthetic industry. By applying PRP either in a minimally invasive fashion, or by injecting it into specific areas of the face, you can induce new collagen formation and create a beautiful more youthful appearance.

• Ultherapy — Ulthera offers a fast treatment for skin contouring and wrinkles. With very little recovery time, Ulthera allows patients to have firm and more radiant skin without surgery.

• Injections of dermal fillers — Dermal fillers such as Juvederm, Voluma, Restylane, or Sculptra have been used to fill in lines and wrinkles are now being used to add volume to the face. Restoring facial volume can give the face a more youthful appearance. Also, injections of purified proteins such as Botox is used to weaken facial muscles that cause wrinkles.

What is a Non-Surgical Facelift?

03Your face often is the first to tell your story. It shows if your life has been one of happiness or sadness, stress or relaxation. It tells how old you are, if you’ve spent your time outdoors or indoors and a slew of other stories about your life. While we all agree that telling our stories can be enjoyable, not all of us want it written all over our faces.

As you age, you may notice these changes to your face that you’d rather not have:

  • Fat loss in the face

Body fat is the substance that gives your face a youthful appearance. Adults that have lost facial volume will have a hollow appearance under the eyes, on the cheeks and through the lips. This will make you look much older than you are — or want to — look.

  • Facial sun damage

Repeated exposure to sun over the years causes less elasticity in the skin fibers. Fine wrinkles often appear as you age, and your skin is often referred to as leathery. If you’ve spent a lot of time in the sun, went tanning a lot when you were younger, or just forgot to wear your sunscreen, you may begin noticing this unsightly change to your skin’s appearance.

  • Extra hanging skin

The loss of elasticity due to less collagen production in the aging body often affects your eyebrows and neck. It can also cause the phenomenon commonly referred to as jowls along the jawline.

Although you may wish to ease these effects of aging, you may also be reluctant to go through surgery. Fortunately, there are newer technologies available which provide a facelift while eliminating the need for surgery.

Fat Injections and Fillers
Though you may have joked about it, a fat transplant really is possible! Plastic surgeons are able to inject fat from your abodomen below the facial skin and plump up the areas that have become hollowed out. However, with all the fabulous new facial fillers we now have, Dr. Pearlman is finding less and less of a need for fat transfer. Why not take something off the shelf that lasts close to a year instead of an invasive fat transfer that requires time off and healing?

A liquid facelift product called Sculptra is also used as an injection to fill in sagging areas. It helps the body create its own collagen with no scarring or negative lasting effects.

Although not technically a filler, Botox relaxes facial muscles. It is best if you have fine wrinkle lines such as those caused by sun damage.

Facial Rejuvenation
The popular product available to stimulate your own body’s collagen production is Thermage. This is a helpful procedure if you have lost elasticity in the face. It applies heat therapy, and the procedure typically only takes an hour. The results are very minor. 

Laser Skin Tightening
The use of lasers has proven successful in everything from correcting vision to removing offending gallbladders. It can also be used for general skin tightening. This is the alternative to the traditional facelift which required cutting and anesthesia and often produced scarring. Again, this is skin tightening and can work great for your skin but won’t lift jowls or saggy neck skin.


Ultherapy is the only non-invasive FDA approved treatment that can specifically target the deep foundation below the skin that is addressed in cosmetic surgery without cutting or disrupting the surface of the skin. It is also the only procedure to use ultrasound imaging, which allows us to actually see the layers of tissue we target during treatment and ensure the energy is deposited precisely to where it will be most effective. Generally patients see about  30% to 50% of the result of a surgical facelift for a quarter of the price.

 Improving your appearance as you age has never been easier.  Remember, in truth there is no such thing as a “non-surgical facelift.” However, marked improvements can be made in skin color, texture, wrinkles and volume loss. Plastic surgery may be just the option for you, except there might not be a need for a scalpel, should you choose to avoid that route.


Copyright 2013. As licensed to Pearlman Aesthetic Surgery. All rights reserved

Cosmetic Treatments and Surgery Increasing in Men and the Alternative to Facelifts.

 Cosmetic facial treatments and surgery increasing in men according to the official AAFPRS stats. I have found the same in my practice. More men are looking to look refreshed.

The face ages in five ways, there are skin changes, dynamic lines,loss of facial volume, loss of elasticity, and the effects of gravity. So when treating these signs you needed to address the specific issue. Improving dynamic lines by using Botox. We treat the skin with lasers and skincare products. We restore facial volume with a procedure we call “Wow cheeks”. However the procedure isn’t fully effective because the real issue is loss of facial volume as well as cheek volume. So fillers will help with cheek volume but it’s not going to lift the tissue. What you really need to do is restore and re-suspend the tissue.

So what do we have that can do this? A Facelift, which re-suspends the tissue by tightening the muscle and lay the skin down gently. Until recently we’ve had no other alternative for this procedure. That is until Ultherapy, the first FDA approved non-surgical face and neck tightening procedure that uses high frequency ultrasonic technology that penetrates all 4 1/2 MM of facial tissue. This restores the jaw lines, the neck, the jowls, and even the brow line.

These are the exact layers I would treat while doing a facelift, without having to preform surgery. Patients will get anywhere from 30% to 50% of the effect you would when getting a facelift. But there are no incisions  it’s a quater of the cost, minimal bruising if any, little down time, and patients can return to work the next day.

Ultherapy is an amazing alternative for either men or women who are considering plastic surgery but either cannot afford the full price or cannot afford being away from work for more than a day.

I talk more about Ultherapy in this Youtube video which you can watch by clicking here or the image above.

Do I need fillers, facelift or facial implants?

04Have you ever wished you could enhance certain parts of your face without surgery?

The good news is that you have multiple options.  If you are not quite ready for a facelift or facial implants; a less invasive procedure might be a good start.

Facial Fillers
Fullness in the cheeks is a highly desired feature for women of all ages.  Through our body’s natural aging process, we lose volume from our upper cheeks. Injectable fillers such as Juvederm, Restylane, Perlane, Belotero, Radiesse, and Sculptra are effective in immediately restoring that volume, and are becoming increasingly popular due to their minimal downtime, and immediate results.  These procedures are performed as outpatient procedures, right here in our office, to fill out any area of the face that needs a little lift, or plumping up.

Not to be confused with facial fillers; Botox,  Dysport, and Xeomin are different types of FDA-approved botulinum toxins which are used to relax the muscles responsible for ‘active’ wrinkles.  An example of a common ‘active’ wrinkle is what is known as the ’11’ between your eyebrows.  We call this an ‘active’ line because it is caused by over-activity of the underlying muscles that you use to frown.  In contrast, facial fillers are effective in treating ‘static’ lines which are not due to activity of underlying musculature.  An example of ‘static’ lines are the naso-labial folds, which run from the outsides of your nostrils, to the corners of your mouth.

When you visit our office we can show you examples of amazing results of restoring youthfulness without the need for a facelift or implants.  The combination of toxins and fillers can shave years off of your appearance both quickly, and inexpensively.

The effects of facial fillers varies by the type of filler used.  Some have a duration of just a few months, while other ‘long lasting’ fillers may last up to two years.  Some of these fillers have even been reported to stimulate new collagen growth; such as Radiesse and Sculptra.  This stimulation of collagen rebuilds the face’s natural support structure, and creates longer lasting effects. The wonderful thing about these products that carry what we call a ‘bio-stimulatory effect’ is that they recruit the help of your body’s own natural materials to rejuvenate your face.

Facial fillers are not meant to correct sagging skin along the neck, brow or jaw line. These cosmetic issues may require surgical procedures (although only a visit to see us can help you be sure).

Facial Implants
If you are seeking a more long lasting solution to your facial features, facial implants are a popular option.  In contrast to the injectables that we discussed earlier, which plump up the soft tissues of the face; facial implants go right to the source and give support to what you already have. Facial Plastic Surgeons insert these facial implants at the bone level to enhance your natural bone tissue, supporting the soft tissue above. Because of this, the results of facial implants are much more predictable.

One common method for inserting these implants used by Facial Plastic Surgeons is to make small incisions in discreet areas of the mouth, so the implants can slide into place. Although the procedure is long lasting, it is reversible if results are not optimal for you.

When you make the decision between injectable facial fillers and facial implants, it is important to consider the long-term effects of your choice. If you want a long lasting change, facial implants are probably your best choice. However, you may just want a temporary, or more subtle fix.  In this case, the use of facial fillers; with or without botilunum toxins, can produce amazing results.

If you’re considering a cheek or other facial enhancement, please take a look at our WOW Cheeks procedure in this video and call us for a consultation: (212) 380-1541

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