Faces! By Peter Truong M.D.

Facial Exercise: Myth or Fact?

admin — Thu, 03 Mar 2011 19:11:42 +0000

A patient came by the other day and told she was doing facial exercises to try to improve her neck sagging. So I got curious to see if there is any evidence that these exercise do anything positive. The only study I found that offered any evidence is an article in the Journal of Geriatric Dermatology cited by the manufacturer of Facial-Flex facial exerciser device.

Why I Think This Study May Be Flawed

I have never heard of this journal and do not know how carefully they check their facts, or whether the article was reviewed by peers prior to publication. The study involved a small number of subjects (8) with no controls whatsoever. We know nothing about the authors, whether they have any financial interest in the device. The authors found that “biomechanical extensibility had decreased”. I am guessing this means that the skin is more resistant to mechanical stretching (extensibility is defined as the ability to lengthen) which the authors thought consistent with the “panelists”‘ impression that their skin had become firmer and more elastic. This is contradictory because more elastic means less resistant to stretching. You should try not to ask the subjects whether they think the treatment works because of the placebo effect. I do not find this study particularly convincing unfortunately.

There are Good and Bad Studies

The layman’s experience of medical studies is, reading in some magazine with lots of pretty pictures, that a study somewhere showed that eating this or that is good for you (lowers cholesterol, increase well being, promotes weight loss, etc…). A few months later, a different study would show that eating the same thing is bad for you. It’s all very confusing, for instance is drinking coffee good or bad, and is eating a high fat, low carb diet good or bad? A considerable part of medical school is spent reading and evaluating studies. There are good studies and there are poor studies. An example of a good study is a double blind controlled study with large numbers. Good studies tend to be hard to design and expensive to conduct. Even if a study is judged to be good, the result only applies to the subset of patients studied and cannot be generalized.

Cost vs. Benefit

I don’t think there is good evidence that facial exercises do anything beneficial. So should you buy the device and try it? It is cheap enough and if it did not work, so what? The manufacturer offers no guarantee of course. The way I understand facial aging (not much to do with facial muscle strength or tone) facial exercises do not make sense and can be detrimental. I think certain exercise can intensify neck sagging by further weakening the central attachment of the right and left platysma muscle.

We Want to Know

Have you ever done facial exercises to enhance your skins appearance? Have you ever purchased equipment? What were your results? Let us know in the comments below!

5 Least Known Facts About Botox

admin — Thu, 10 Feb 2011 22:25:13 +0000

The story of Botox from a deadly disease to something that is talked about on The View and read about in People magazine is an interesting one. Below are 5 little know facts about Botox:

#1 Medical use of botulinum toxin (BTX) began in the 1950s

Botulism is a form of food poisoning from improperly canned or preserved food that usually begins with abdominal cramps, nausea, vomiting, dry mouth, dizziness, double vision and may progress to difficulty swallowing or speaking and breathing difficulty that may lead to respiratory failure. Early outbreaks were thought to be caused by sausage, thus the name was derived from the Greek word for sausage, botulus. The toxin is produced by Clostridium botulinum, an anaerobic spore-forming bacterium. It comes in different types (A, B,…).

Medical use of botulinum toxin (BOTOX™ ) began in the 1950s. In 1973, a study demonstrated that injections of BOTOXB™-A weaken the extraocular muscles (six muscles that control the movements of the eye) in monkeys. Four years later, this treatment was attempted in humans to correct strabismus or more commonly “crossed eyes”. In 1973, the FDA granted approval to use BOTOX™-A for strabismus and 12 years later for blepharospasm (uncontrolled twitching of the eyelid). Ophthalmologists were then the first physicians to use Botox. The first cosmetic treatment with Botox was published in 1992 by Drs Alastair and Jean Carruthers. Dr Jean Carruthers, an ophthalmologist, noted that many patients being treated for blepharospasms had improvement in the appearance for frown lines. Other physicians began to use BOTOX™ for wrinkles in the forehead and elsewhere.

#2 Early Treatments Can Actually Prevent Wrinkles

www.youtube.com/watch?v=i7zNgq3jYCM

Most facial wrinkles form perpendicular to the direction of muscle activity underneath (dynamic wrinkles). Wrinkles do not form until the skin loses its elasticity with age and sun damage. The appropriate muscle may then be temporarily weakened or paralyzed by local injection of BOTOX™ and the associated wrinkle will relax. Early treatments will prevent the formation of dynamic wrinkles.

BOTOX™ prevents the release of the neurotransmitter acetylcholine at the neuromuscular junction of the muscle. Botox™ does not damage the nerve, nor the muscle. The muscle returns to normal function 3-4 months after injection depending on the dose administered. It was originally thought that new nerve endings grow to innervate the muscle but now it looks as though the new nerve endings go away after the original nerve endings re-establish connection.

Botox from Allergan comes typically in 100 unit vials. The amount of saline used to reconstitute BOTOX™ varies between doctors so doses should be expressed in units rather than in number of cc’s or syringes.

#3 Cure Excessively Sweaty Palms and Armpits

BOTOX™ is typically used to improve the appearance of dynamic lines on the upper face such as frown and forehead lines, and crows’ feet. Advanced practitioners will also use BOTOX™ in the lower face to improve the appearance of gummy smiles, dimply chins (peach pit), downturn of the corner of the mouth, smoker’s lines, neck bands… Excessively sweaty palms and armpits are also treated very effectively with BOTOX™ because of its effect on sweat glands.

#4 Resistance is Rare

Resistance to the effect of BOTOX™ is rare and is due to production of blocking antibodies. The production of these antibodies depends on the immune system of the patient and well as the type of stimulus. Patients treated with high doses (>300 units of Botox/session) at frequent intervals seem the most likely to develop antibodies. Cosmetic patients typically use 25-75 units at intervals of three months are not likely candidates to develop resistance. Patients that are resistant to Botox have successfully used Dysport even though they are the same subtype.

#5 Can Decrease Migraine Pain

Traditional use of Botox™ for pain involves the treatment of severe, chronic muscle spasms. After the source of pain has been identified, BOTOX is administered, controlling it by relaxing the offending muscle or muscle groups.

BOTOX™ type A seems to improve head pain such as migraine and other pain by a different pathway. The mechanism may be an effect on sensory afferent or non-cholinergic nerve fibers. Recent studies have shown that Botox may block or inhibit release of glutamate, CGRP or Substance P from nociceptive neurons 1-3. Botulinum toxin, type A, given intradermally, BOTOX™ shows a marked ability to reduce painful symptoms in many different pain states from painful cervical spasm, diabetic neuropathy, TMJ disorder, to trigeminal neuralgia.

Have you used Botox? What has your experience been like? Leave a comment below and let us know or share this post with your friends!

Until next time,

Dr. Peter Truong, M.D.

Take a Medical Test Drive With Juvederm or Restylane

admin — Tue, 02 Nov 2010 22:48:09 +0000

The New Medical Test Drive Products

Have you ever wanted to try “this” or “that” but are just not sure it would look good or you would like it? Even Botox is not reversible, you just have to wait till the effect goes away. But Juvederm or Restylane fillers are COMPLETELY REVERSIBLE. There is a medication called hyaluronidase which when injected into the same area will dissolve Juvederm or Restylane very quickly. You can date Juvederm but pretty much everything else is a commitment. Most of the procedures I do in the office are irreversible. Think about surgery, even something as simple as removing a small growth on the face. Once I cut, there is no going back. that is why we spend so much time making sure we understand what patients want, that they indeed want what they say they want, that patients understand that what we can deliver may not be exactly what they imagined but comes fairly close. A doctor once told me that there is no such thing as a perfect surgery or a perfect surgical result. If you look close enough or question hard enough, you will find something a little less than perfect. A satisfactory result is when the good far outweighs the bad. Case in point, two weeks ago a patient came to me wanting a little upper lip augmentation and some Botox. She came back a few days later and said she liked the Botox, but was in a state of panic about her upper lip. I looked at her lip, the shape was good and the volume not at all inappropriate. She was feeling very self conscious, just could not get used to the new upper lip. I reassured her that it looked good even then and that it would probalby settle down in a few days and be just fine. She told me she could not tolerate even one more day looking like she did. Well we injected the hyaluronidase that day. I just saw her two days ago, her upper lip had gone back to the way it was. She told me that she liked the full lip better and will try Juvederm again and keep it this time! Have you ever had a procedure that you were not happy with? Or have you done something that you would recommend to others? Leave us a comment below and let us know!

Everything You Need To Know About Photo-Facials (IPL)

admin — Fri, 29 Oct 2010 02:50:08 +0000

Intense pulsed light (IPL) also known as photofacial or photorejuvenation is a non-invasive and non-ablative treatment that uses high intensity pulses of visible light to improve the appearance of the following skin problems: vascular lesions including rosacea, spider veins, port wine stains; freckles and sun spots; fine lines on the face.

IPL may also be helpful for mild to moderate active acne when used with levulan.

How does it work?

IPL systems work on the same principles as lasers in that light energy is absorbed into particular target cells with colour (chromophores) in the skin. The light energy is converted to heat energy, which causes damage to the specific target area. IPL systems are different to lasers in that they deliver many wavelengths (or colours) in each pulse of light instead of just one wavelength. This allows IPL to treat more than one chromophore in the skin (mainly red and brown).

IPL therapy is considered a non-ablative resurfacing technique, which means that it targets the lower layers of skin (dermis) without affecting the top layers of skin (epidermis). The results are not as dramatic as ablative resurfacing such as fractional CO2 resurfacing where both the dermis and epidermis are injured to produce a much more noticeable overall outcome. The advantage of IPL therapy is its minimal downtime – a patient can often have the procedure done in their lunch break and return to work immediately afterward.

What does the procedure involve?

Prior to the procedure your specialist practitioner should explain the process to you and clearly define your expectations of the treatment. They should be able to tell you whether or not the results you are looking for will be achievable using this method. It is important that the correct diagnosis has been made by your doctor prior to treatment.

Avoid sun exposure and sun tanning in the days and weeks before and after treatment.
A topical anesthetic may be applied to the area but is not usually necessary.
The smooth, glass surface of the IPL treatment head is applied to the skin, delivering precise pulses of light to the area being treated.
Treatment sessions usually last about 20 minutes. A course of 4-6 sessions every 3-6 weeks may be needed to achieve desired results.
Most patients can return to work immediately after treatment.

Throughout the treatment session the patient must wear protective eye-wear. IPL treatments are relatively painless compared to ablative techniques. The sensation has been likened to a brief sensation of heat or the snap of a rubber band.

Are there any side effects?

Side effects are minor and include:

Pain during treatment (reduced by contact cooling and if necessary, topical anesthetic)
Skin turning pink and a little sore immediately after the procedure.
Sensation of a mild sunburn (redness, peeling, swelling) that may last a few days after treatment.
Rarely, skin pigment may absorb too much light energy and blistering can occur.
Sometimes the pigment cells (melanocytes) can be damaged leaving darker or paler patches of skin. True hypo-pigmentation is rare. Areas of treated skin appear paler because that is the color of healthier skin.

Have you ever had a IPL? If so what were some of the pro’s or con’s that you experianced? Leave us a comment below or ask a question and I would be happy to answer it for you! Thank you for stopping by and if you like what was shared please share it with your friends. Until next time, Peter Truong M.D.

Perma Facial Implants

admin — Wed, 28 Jul 2010 12:52:51 +0000

Perma Facial Implants

Finally, the safe, definitive solution for permanent tissue augmentation has arrived. Don’t get me wrong. I am quite happy with Juvederm for lip augmentation. I am comfortable with it and have had a lot of success with it. Some patients have asked me if a more permanent solution was available. VeraFil saline implants came along and that seemed like a good idea. Problem was I could not guarantee that they will not leak a few years down the road. I am excited about the new FDA-approved Perma Implants. They are super soft and made out of solid silicone elastomer using an injection molding process to produce a naturally contoured implant with a smooth, non-porous surface. The implant cannot rupture or deflate, and may be removed at any time. Come in and feel them!

For more info, go to my website.