October 12, 2011

What should I expect with my filler service?

Cosmetic fillers like Restylane®, Perlane®, Juvederm®, and other hyaluronic acid fillers are an excellent alternative to surgical procedures.  These products are composed of a cross-linked sugar gel that can correct wrinkles, volumize the nasolabial fold and lips, fill acne scars, and improve under-eye dark circles.  Dr. Steinsapir is the inventor of a unique and effective method that specifically addresses under-eye discoloration.  This technique is called the Deepfill™ method.  Facial fillers last about a year and treatments are easily adjusted using hyaluronidase, if necessary.  For many years, Bovine Collagen was the gold standard of fillers, but has now been displaced by Restylane® which is now the filler to which all others are compared.

Like Restylane, Perlane® is intended for volumizing, but it differs from Restylane in that Perlane is intended to provide facial volume in the deep dermis and superficial subcutaneous fat.  Perlane and Restylane are not equivalent products.  It is essential that your doctor places Perlane deeper than Restylane.  When used properly, Perlane is an excellent alternative to volumizing products like Scluptra® and Radiesse® and even fat transfer.  Treatment with Perlane also lasts well over a year.

Where are injections commonly performed?

Hyaluronic acid fillers are office-based services. You may see estheticians and unqualified individuals like medical assistants offering injections illegally in spas and salons under the justification that they have a “medical director.”   No States permit this arrangement.  Unless a doctor is present and performs the service, this type of situation is the illegal practice of medicine.  As with BOTOX®, don’t let an unqualified individual perform your Restylane or Perlane service.

Just like BOTOX, only a licensed medical doctor or a nurse under the direct supervision of a licensed medical doctor can inject hyaluronic acid fillers.  The exact details of the required qualifications vary by State so it’s important to research the individual you wish to perform the injection to ensure he or she is qualified.  However, just because your doctor or nurse is minimally qualified to perform the injection does not necessarily indicate he or she is the ideal choice for the procedure.  As with many other medical procedures, the best results require a certain level of qualification, skill and experience; these concerns are perhaps even more important when considering modifications to your physical appearance.

What’s the typical recovery course and what are the physical restrictions?

Many of Dr. Steinsapir’s patients resume their normal activities just after leaving the office with the exception of no workouts for 24 hours.  Wait a day before going to the gym.  If you don’t bruise, there will be about thirty to forty hours during which you experience minimal swelling.  Many patients, both men and women, can hide this swelling right away with a camouflage makeup that matches their skin color if necessary.  If your lower eyelid skin quality is poor and you often collect a small bag of puffiness under the eye, the doctor may counsel you regarding the need to consider a procedure like a chemical peel or surgery prior to getting regular filler treatments so you don’t experience prolonged recovery after each filler service.  This can be discussed when you have your initial consultation.

What are common complications and how are they addressed?

Most people, about 70 percent, do not experience bruising after a Restylane treatment; the other 30 percent experience some degree of bruising; most of it mild.  But a very few (one or two in a hundred) will develop a black eye.  The black eye can take about two to three weeks to completely resolve, and this is a cosmetic concern without health dangers.  The worst part of this is that many will assume that you were the victim of domestic violence.  Glasses and makeup help to hide the bruise while it is resolving.  Considering that Restylane will last over a year, the recovery process is very mild and comfortable even for these few.

For the few Restylane recipients who experience bruising, the short-lived bruise is worth the long-term results.  It’s a good idea to obtain treatment at least three weeks before big events like vacations.  For the biggest occasions such as your own wedding, Dr. Steinsapir advises have treatment 2 months ahead of the event to be completely certain that your pictures will turn out great.

To minimize your risk of bruising, your doctor will ask you to stop taking certain medications that thin the blood, such as aspirin.  If you are taking anything prescribed by a doctor, Dr. Steinsapir strongly advise that you consult with your prescribing physician before discontinuing the medication.  If your doctor suggests that you continue the medication, this does not mean that you aren’t a good Restylane candidate.  If you are willing to be at a slightly elevated risk for bruising, Restylane can still be effective.  Your regular doctor and your cosmetic specialist can help you decide the best route to take.

The incidence of allergic reaction varies with the products used and should be discussed with the treating physician but the incidence of allergies to these products is very low.

For unwanted highlights or bumps that occasionally occur after an otherwise excellent filler treatment, the enzyme hyaluronidase makes Restylane injections easily adjustable to a more desired aesthetic, and your doctor can even erase the treatment completely if you determine together that this is your best option.  In the event that you experience lumps or unwanted effects from your Restylane treatment, hyaluronidase makes it easy to adjust hyaluronic acid fillers like Restylane, Juvederm and Perlane.  This flexibility created by the ability to adjust a service is one of the most important factors making HA fillers such a popular service.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon.  He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, fillers and cutting edge reconstructive eyelid and midface surgery.  He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions.  He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago.  He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage.  He is widely published and lectures to other surgeons nationally and internationally.  He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA.  His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities.  Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care.

To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

September 9, 2011

I had facial fillers and BOTOX and now I look older

If this happened to you, there is no doubt that you are dissatisfied with your treatment and that it makes you feel old – the exact opposite of the reason you chose to undergo the procedure!  There are many reasons your treatment may not have turned out the way you expected it to, but it is not the fault of the BOTOX or the filler, whether it’s Juvederm®, Perlane®, Restylane®, or any other hyluronic acid filler.  Complications from non-surgical treatments like fillers and BOTOX are almost always the result of your surgeon’s talent.  Choosing a skilled surgeon to perform your injections is important, but once the damage is done, choosing a skilled surgeon to fix the problem is imperative.

The Truth About Treatments

As the effects of your BOTOX treatment begin to wear off after several months―Restylane wears off more slowly―your face will slowly regain the looks it had immediately before your treatment.  Restylane and BOTOX treatments will not make you look worse than your original pre-treatment appearance as they wear off, nor are they supposed to make you look worse when treatment is new.  Provided you did not let someone put silicone oil

in your face and treatment is provided by an experienced injector fillers and botulinum toxin A have few side effects.  But if you aren’t happy with your results, you do have options and it is not necessary to wait more than a year for the filler to wear off.

Options for Fixing BOTOX Treatments

Treatments like BOTOX and Restylane are popular because they are noninvasive treatments that together can smooth wrinkles, relax tense muscles, and fill in hollow areas.  BOTOX and Restylane will not permanently alter your looks.  BOTOX is a naturally-occurring purified protein that relaxes muscles, and Restylane is made from a biodegradable sugar-gel that occurs naturally in the body.  Both of these are eventually broken down and expelled from your body completely.

Generally with the botulinum toxin A products (BOTOX, Dysport, Xeomin), the issue is an unbalanced treatment.   These services typically freeze the forehead.  The treatment results can be improved by having the appropriate counter treatment along the eyebrow using Dr. Steinsapir’s Microdroplet method.  However, if your BOTOX treatment has caused eyelid ptosis, Dr. Steinsapir recommends finding an oculoplastic surgeon to help you with this particular issue.  Oculoplastic surgeons are trained to assess and follow upper eyelid ptosis.  They are familiar and have experience treating upper eyelid ptosis.  A prescription for Iopidine (aproclonidine ophthalmic solution) can be helpful in this circumstance.  This medication is a glaucoma medicine that can elevate the eyelid a couple of millimeters. The drops can also be used to assess the severity of the ptosis and predict the likely time frame for the resolution of ptosis.  Dr. Steinsapir recommends trying the drop twice a day for a week.  If the drop is working to open the eye, then it is likely that the ptosis will resolve in 4-6 weeks.

Options for Fixing Filler Treatments

Dr. Steinsapir often sees individuals frustrated with treatments they received elsewhere.  Surprisingly, many people are not aware that the hyaluronic acid fillers can be adjusted using the enzyme hyaluronidase.  This enzyme is delivered with a small injection during a very comfortable office visit.  Dr. Steinsapir has helped people who put up with unsatisfactory treatments for much longer than they need to. These issues are easily dealt with using the enzyme in one or two visits.  It is the ability to make these adjustments that makes it feasible to provide many of the advanced filler services.  Do you have a hyaluronic acid filler issue that is not responding to hyaluronidase?  Some patients have been told they were injected with hyaluronic acid filler but in fact were treated with silicone oil.  Correction of some of these issues can be challenging and need to be approached on a case by case basis.

Restylane is a long-lasting, but not permanent sugar-gel facial filler that is preferred for improving facial contours due to its natural results, even in sensitive areas like dark circles under the eyes and the lip edge.  Restylane and Perlane offer the ability to modify results when necessary.  This includes treatments that were performed in the past and need fine-tuning.  The ability to adjust a treatment with the enzyme can take a good treatment and make it great.  In some cases, as the body slowly breaks down the material over time, slight irregularities may develop despite the initial quality of the treatment.  Sometimes, the answer is adding filler rather than subtracting volume.  For this reason, it is best to start with a detailed assessment with an expert like Dr. Steinsapir.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon.  He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, Fillers and cutting edge reconstructive eyelid and midface surgery.  He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions.  He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago.  He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage.  He is widely published and lectures to other surgeons nationally and internationally.  He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA.  His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities.  Additionally, individuals from all over the country and the world regularly come to Los Angeles for his expert care.

To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

March 28, 2011

I had Restylane service 6 months ago and still have lumps. Can anything be done about this?

Restylane is a long-lasting but not permanent facial filler that is especially suitable for improving facial contours due to its natural-looking results, even in sensitive areas like dark circles under the eyes, and offers the ability to modify your results in the few cases when treatment isn’t completely satisfactory.  The enzyme hyaluronidase makes Restylane injections easily adjustable to a more desired aesthetic, and your doctor can even erase the treatment completely if you determine together that this is your best option.

When we hear from individuals who had dissatisfactory Restylane service long in the past, what is most disconcerting is that the individual was not aware that they could seek a simple adjustment from the start, or that they were not comfortable returning to their original cosmetic surgeon for this procedure.  This may indicate a problem in communication between the provider and the individual receiving services—and while this could simply be a lack of personality compatibility, it’s crucial that you are comfortable openly talking with your doctor about your treatment and any concerns that may arise.

Seeking the Best Restylane Services

While Restylane is considered a safe and routine procedure enjoyed by many who experience its benefits, this does not at all indicate that providing Restylane is an unskilled task.  You should always seek treatment from a leading and qualified provider such as Dr. Steinsapir, who is a cosmetic surgeon and oculoplastic surgeon with a major specialization of his practice being Restylane, including under-eye Restylane.  Your doctor must understand the subtleties of safely placing Restylane for natural results as well as how to adjust it should you have the need, and he or she must understand how Restylane and your facial anatomy interact to a level that could be called an art form.  Your doctor must also understand how to seamlessly adjust your Restylane treatment through comfortable hyaluronidase treatment.

Modifying Your Restylane Results

In the event that you experience lumps or unwanted effects from your Restylane treatment, hyaluronidase makes it easy to adjust hyaluronic acid fillers like Restylane, Juvederm and Perlane.  In most cases its best to return to your original doctor who should be eager to make sure you are happy with your treatment and outcomes.  However, if you are concerned about the skill level of your original provider who may not have specialized in facial fillers, or if you are experiencing a breakdown in communication and lack confidence seeking further direction and treatment from this individual, then you may wish to consider seeking a second opinion.

Dr. Steinsapir often sees individuals dissatisfied with treatment received elsewhere, and in many cases he can help you to restore the relationship with your original doctor.  If this is not possible, then you can seek adjustment and further treatments from someone else like Dr. Steinsapir.  It’s very important that you are comfortable with these decisions and are empowered with knowledge and a good communication rapport with your doctor to ensure best results.  If you have been waiting as long as six months to find out if your experience with Restylane is normal and if you can have your results adjusted, we are sorry to hear that you have been needlessly stressed.  Fortunately, Restylane can be adjusted and you may learn that when your treatment is customized and delivered with great skill and precision, impressive results are possible.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon.  He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, Fillers and cutting edge reconstructive eyelid  and midface surgery.  He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions.  He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago.  He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage.  He is widely published and lectures to other surgeons nationally and internationally.  He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA.  His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities.  Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care.

To learn more about Dr. Steinsapir’s specialization in Restylane treatments, please contact us today.

December 17, 2010

Could I be allergic to Restylane?

Restylane is one of the most popular facial fillers and rightly so, because it is safe, has proven results, and is easy to adjust in case your treatment needs this for any reason.  However, please remember that even the safest medical treatments come with some risk, and there is a very small chance you could be allergic to Restylane.  The key to your positive treatment experience will be in finding the best cosmetic surgeon for you who is a specialist in facial fillers.  Be completely open and honest about your medical history with him or her, and together you can make treatment decisions that minimize your risk.

What is Restylane?
Restylane is a hyaluronic acid filler that is often used to improve deficiencies in facial tissue and dark circles under the eyes.  Technically speaking, hyaluronic acid is a carbohydrate polymer (or in lay terms, a sugar gel) already found throughout our bodies in the fluid of our joints.
Restylane is a sugar gel that is cross-linked to make it last much longer in the body, which is why you can see benefits for about a year.  Restylane is usually the top choice for correcting undereye circles, facial wrinkles, and volume problems in the nasolabial fold and lips.

Reactions Are Rare But Possible
It is rare to have an allergy to a hyaluronic filler, but it is possible.  Fortunately, the incidence of an allergic reaction to Restylane is so unusual that no testing is recommended before your treatment.  It is your responsibility to be completely open about your medical history, any current conditions you may have, and allergies in your family.  There are a few cases in which you should be very cautious; for example, if you’ve had a reaction to something that has some shared components of Restylane, be sure to let your cosmetic surgeon know.

Also be mindful that having no allergic reaction to one hyaluronic filler does not guarantee that you’ll have no reaction to another hyaluronic filler, such as Juvederm.  These are related products but not identical, so consider the risk individually.  However, if you have already shown an allergic reaction to one hyaluronic filler, you will likely be allergic to another.  Given how rare the incidence of these allergies are, it’s considered safe to predict that you’ll have no allergy, but please take responsibility in recognizing the small risk exists.

Obtaining the Safest Treatment
If you are dissatisfied with certain aspects of your facial features, find out if Restylane is right for you.  Treatment with safe Restylane injections improves the appearance and confidence of countless people everyday, and if you have concerns like dark circles, wrinkles, or lack of facial volume, Restylane may help.

Dr. Steinsapir
is a leading Restylane provider and experienced cosmetic surgeon in Beverly Hills and Los Angeles, where he specializes in facial fillers and minimally invasive cosmetic treatments to improve your facial aesthetic.  He is the inventor of Deepfill Restylane, a world-renowned method of correcting dark circles under the eyes, and he has also served as a physician consultant to the manufacturer of Restylane and Perlane.  To learn more about how Dr. Steinsapir can custom-tailor a treatment to your unique needs, please contact us today.

December 15, 2009

Should I Get Perlane® or Restylane®?

Restylane® and Perlane® from Medicis, Inc. are both hyaluronic acid fillers made of sugar gels. It is common to ask which product is better.   The reality is that these are similar products with important differences.  Restylane® is a softer product that provides excellent volume, tends to stay where it is injected, but can be shaped well once placed in the tissue.  Perlane® is also a soft product that provided slight better volumizing, tends to stay where it is injected, and resists shaping more than Restylane®.

Each product has a somewhat different role in facial volumizing.  The right choice for you very much depends on your issues.  This is best determined by an individual consultation with a highly qualified cosmetic surgeon.  Here are some general guidelines and common usages that can give you an idea of when each filler tends to be appropriate, but individualized treatment never takes a one-size-fits-all approach and diagnosis and treatment planning must be done in person.

Before and After: Restylane, Botox and Perlane by Dr. Steinsapir

Before and After: Restylane, Botox and Perlane by Dr. Steinsapir

What’s the Difference between Perlane® and Restylane®?

Both Perlane® and Restylane® are fillers that work especially well when volumizing the face to give it a softer, more youthful look and restore hollow and deflated areas.  Perlane® is a thicker material than Restylane® and it usually lasts a few months longer.  This is an amazing length of time as Restylane can be effective for a year or more.  Restylane® usually works better for the sensitive area under the eye where the skin is thin and there is little fat.  The ability of the Restylane to be readily shaped once it is placed in the tissue means that many potential irregularities can be resolved as the material is placed.  For the same reason, Restylane is also excellent at the lip edge.  Elsewhere in the face, there is much better tissue coverage for the placement of the slightly thicker Perlane®.

Perlane® has a larger molecular structure that Restylane and as a results it is a somewhat better volumizer than Restylane®.  It is preferred in areas like the cheeks, eyebrow, chin, and the tissues around the mouth called the perioral area. Why does it work best in these areas?  Because these areas have more fat to work with than the lower eyelid dark circle.  Perlane®’s thickness necessitates that it be placed deeper than Restylane®, while Restylane® works very well near the surface of the skin and in areas where little fat is present.  Perlane® is wonderful for adding volume to places with more fat under which a doctor can place this filler.  It is less ideal for the lip edge and under eye area where the Restylane serves as a better choice.

Because of both their similarities and differences, Restylane® and Perlane® can be used together to improve the facial aesthetics by eliminating unsightly angles, sunken features, and haggard looks.  For example, Perlane® can be placed in the top of the cheek at the time that Restylane® is used to treat the dark circles in the lower eyelid hollows.  Both of these actions are beneficial in themselves, and when used together they amplify the improvements even more.

What If I’m Unhappy with My Results?

These services are the fastest growing cosmetic services because of how happy people are with the results.  Yet service is not a magic wand and it is sometimes necessary for a treatment to be adjusted.  First make certain that your doctor is aware of your concerns.  If you are having an issue, don’t simply wait until your next visit.  It is a good idea to contact your doctor and let them know what is going on.  There is often a great deal of value in being seen early if there is some issue.  By consulting with your doctor after a procedure, these issues can be readily addressed.

Unlike other fillers, hyaluronic acid fillers like Restylane® and Perlane® can be adjusted after treatment to resolve any surface irregularities that might be present after treatment.   In fact, it is possible to modify these treatments even if it has been quite some time since you were treated.  Over time, these products are absorbed by the body and eventually disappear over a year or two.

Seeking the Right Doctor

Dr. Steinsapir specializes in improving the face in both aesthetic and medically necessary situations.  As a specialist he has some of the highest levels of experience in addressing concerns about the face, including how to best apply fillers like Perlane®.  In fact, Dr. Steinsapir has served as a physician consultant to Medicis, Inc., who distributes both Perlane® and Restylane®, and he is considered among the top 3% users of these products.  He is thought to have the largest under eye filler practice in the World.  Call for a consultation to find out if you are a good candidate for Perlane®, including whether it will improve upon another procedure or could be combined with Restylane® treatment.  Dr. Steinsapir approaches everyone as an individual, customizing treatment to each person’s needs.  Contact us today to find out how he can customize treatment for you.