Dermal fillers, also called injectables, are a safe and effective way to enhance your appearance without the need for invasive surgery or downtime, but results are very dependent on the injector. At the Appearance Center, our providers are highly-trained medical professionals, familiar with the unique anatomy of the face, and have had extensive training and years of experience.

Dermal fillers can be used to address a variety of different cosmetic concerns – restoring lost volume to depleted areas, creating more attractive facial contours, and improving symmetry.

FIGHT THE SIGNS OF AGING

As the skin is subjected to elements over time, the appearance of a face changes. Dermal fillers reverse this by giving a person back the facial volume they may have lost. These fillers can also make the cheeks look more contoured, give a more defined jawline, and overall make a patient look refreshed.

One of the great things about dermal fillers is that virtually no recovery time is required. After their treatment session, patients can usually return to most activities right away.

More good news: The results of dermal fillers are not permanent. If you don’t love your results from dermal filler injections, take heart knowing the effects are temporary. 

Filler technology enables results to last six to 18 months although there is variation between individuals, as well as according to the type, quantity and depth of the dermal filler placed within your skin.

In many cases, a skilled cosmetic eye can make more immediate corrections or improve upon your previous results. Our providers are also experienced with correcting over-filling or wrong-site filling done at other locations.

A Rhinoplasty, or nose job, is surgery performed to alter the way your nose functions and looks. According to the American Society of Plastic Surgeons, nearly 220,000 rhinoplasties are performed yearly, making this the most common facial plastic surgery procedure. Rhinoplasty can simultaneously help you improve breathing and achieve a more balanced appearance

 

IS RHINOPLASTY RIGHT FOR ME?

A common medical reason for rhinoplasty is difficulty breathing through the nose. Nasal obstruction can cause problems with exercise, disturb sleep, contribute to snoring and sleep apnea, or interfere with other activities. If medical treatments (such as nasal spray or sleep apnea treatment) fail, surgery may be the next step. Rhinoplasty done for medical reasons such as these is often covered by health insurance.
 

WHAT ABOUT COSMETIC RHINOPLASTY?

Patients often ask, “While you’re in there, could you make other changes to my nose?” The answer is yes. The most common requests are reducing a nasal hump, refining the tip, or correcting asymmetries. These cosmetic changes, which are not covered by insurance, are frequently combined with functional rhinoplasty so there is only one recovery.

“I just want to look “x” years younger” is a common request in the dermatology or plastic surgery office. One way to accomplish that is to restore facial volume. Most of us may not initially recognize volume loss in our face because we see ourselves everyday. But the changes become stark when we look at old photographs. Restoring volume is an important and common approach to helping patients achieve the results they desire.

Hyaluronic acid injections, commonly known as “fillers,” are a popular way to increase facial volume. Injectable filler is relatively quick to perform, has minimal downtime, and provides immediate results. The main downside of filler is that the results are temporary, typically lasting between 6 and 18 months. 

A more permanent way to increase volume is fat transfer. Fat is usually collected from the abdomen and strategically injected into areas of the face. It requires from 1 to 3 separate injections spaced 6 weeks apart to achieve results. Fat integrates well and the results last, which probably sounds great. But is there a catch? 

Potentially. An important consideration of fat grafting is that the fat acts like the donor site (abdomen), not the recipient site (face). While people lose weight and volume in their face as they age, they often gain weight in other areas, including the abdomen. As a result, if the patient gains weight over time, the fat in the face will grow too. A well qualified doctor or PA will be able to make the appropriate judgment regarding the volume of fat appropriate to inject. 

Because of fat’s potential to grow, the best candidates for fat transfer tend to be older patients, of stable weight, and if applicable, post-menopausal. Otherwise, filler is a great option to add volume and can be tailored as the patient ages. 

Hyaluronic acid injections, commonly known as “fillers,” are a popular way to increase lip volume. Injectable filler is relatively quick to perform, has minimal downtime, and provides immediate results.

Not all patients will benefit from lip filler, especially patients with a long upper lip. In those cases, a surgical lip lift is the only option for lip enhancement. 

A lip lift strategically removes skin from right beneath the nose. The lifted red lip becomes more exposed.  This adds height to the red lip and the appearance of volume. The “duck lip” look is avoided. And best of all, the results are permanent. 

After the lip lift, the patient may be a better candidate for lip filler. The filler can add tasteful volume to the heightened lip, creating the perfect lips. 

Bruising is common after surgery and filler injections. It usually peaks around 48 hours after intervention and then slowly resolves over 10 days. While most patients expect bruising after surgery, it is less accepted by patients after minimally invasive treatments such as filler. 

Bruising from filler can be minimized by injecting with a cannula instead of a needle. Cannulas have blunt ends (unlike a needle which is sharp) and cause less trauma during the injection. Because there is less trauma, there is usually minimal, if any, bruising.  However, some areas are likely to bruise because of anatomical reasons, even with the cannula technique. 

At the Appearance Center, bruising can be promptly treated with VBeam. Our V-beam pulsed dye laser has been extremely effective at eliminating early bruising. It is typically performed 24-48 hours after initial treatment (ie filler or surgery), and significantly reduces the bruise within 24 hours. In the event of significant bruising, we are pleased to offer complimentary v-beam treatment. As a result, patients can enjoy their results, bruise-free, as quickly as possible. 

Fun fact: Whether the bruise is from a procedure or just an accidental trauma, the v-beam can speed up the recovery and get you looking good to go! 

A common question we get asked is what products we use and recommend to our friends and family. We have compiled a list of our staff’s favorite products, and how they changed our skin! And we are excited to introduce a few members of our Appearance Center team.

The chin plays a critical role in the balance of facial features. A strong chin can create a greater appearance of strength, symmetry and self-confidence. We offer several options to enhance the size and appearance of your chin.

Placement of a chin implant, also known as chin augmentation, provides definition for the lower face and balances the facial profile. Chin implants are made of various biocompatible materials and are custom-shaped for a natural looking fit. The results are permanent but can be reversed if desired.

Chin implants are used to correct a weak chin or to balance a strong nose. Patients who undergo chin augmentation love their results!

Male Chin augmentation can redefine a jawline and strengthen the chin, creating facial harmony. A sharp, powerful chin is often considered the cornerstone of masculinity.

Dr. Daines and Dr. Madorsky perform chin implant procedures.

Keloid scars can occur after ear piercings. They are typically large raised, firm nodules that occur at the site of the piercing. They can become painful and physically disfiguring.

The cause is thought to be epithelial (skin) entrapment along the piercing tract. This can occur if the piercing gets inflamed or is allowed to seal. Trapped skin proliferates uncontrollably and causes inflammatory scar reaction. Cartilage piercing is particularly sensitive to this complication. 

Initial treatment involves injection of steroids into the keloid. If that does not help, injection with a chemotherapy drug such as 5-fluorouracil (5-FU) is done. If that does not work, then surgical removal of the keloid is needed. Re-piercing of the ear can be performed approximately one month after surgery. After re-piercing the ear, it is important to keep the area clean, by cleaning with hydrogen peroxide. Frequent twisting of the earring also keeps the hole open. Most patients do very well after removal and re-piercing of the ear. Rarely, recurrence of the keloid scar may occur. With close follow-up keloids can be prevented with steroid injections.

Acne is caused by a variety of factors. These factors include increased p. acnes bacteria, increased oil production by oil glands, “clogged pores,” genetic susceptibility, and increased androgen hormones. It is important to target multiple causes of acne to best control it. There are many “tried and true” options and some newer and less well known treatment options. 

Initial treatment options for mild to moderate acne focus on consistent application of topical products. 

Face washes should contain an active ingredient against acne. Examples include benzoyl peroxide and salicylic acid. After washing the face, topical retinoids are used. Prescription retinoids such as retin-A and tretinoin increase cell turnover and prevent “clogged pores.” Retinoids work best against comedonal acne which refers to whitehead and blackhead acne. Retinoids are a staple of acne management and are also a popular anti-aging product as they improve skin texture and fine lines. 

Antibiotics are another cornerstone of acne management- especially inflammatory acne. Inflammatory acne usually appears as red bumps or nodules. Topical and oral antibiotics reduce p. acnes bacteria and reduce inflammation leading to acne lesions. These are usually used in conjunction with topical retinoids. 

Hormones contribute to acne because androgens stimulate the oil glands to produce more oil. Oil rich environments allow p. acne bacteria to thrive and cause more acne breakouts. Females who break out during their menstrual cycle or primarily have bumps and nodules along their jawline often respond to hormonal therapies including oral contraceptives and oral spironolactone. Unfortunately, these options are not available to males. However, a new drug, Winlevi, offers a topical antiandrogen option for both males and females. 

The ultimate acne treatment is isotretinoin, previously known by a brand name, “Accutane.” Some patients may be nervous about isotretinoin because it is highly regulated due to causing birth defects in pregnant women. However, it is usually well tolerated and is extremely effective at eliminating active acne. Isotretinoin is also the only medication shown to cause long term remission of acne. 

The above options can control acne well, but it can be frustrating when there are breakthrough lesions. Some additional options for breakthrough lesions include chemical TCA peels (VIPeels), vascular laser (V-beam laser) treatments, and steroid (kenalog) injections. 

VIPeels are a chemical peel that include anti-acne ingredients such as salicylic acid and benzoyl peroxide to promote cell turnover and reduce inflammation and hydroquinone to lighten acne scarring. 

V-beam and Kenalog can be used to spot treat a stubborn or inflamed lesion. V-beam is a laser that delivers energy to kill active acne bacteria or treat red scars left behind by previous acne lesions. Kenalog is a steroid that is injected directly into an acne lesion to reduce inflammation. Kenalog is especially useful before a big event because it works quickly, usually reducing a lesion within 24-48 hours. Kenalog is also useful to treat hypertrophic or keloid scars from cystic acne. 

With so many options available, it is important to meet with a provider to discuss which option(s) are best for you. 

“I’ve got some good news, no more cancer.” Dr. Adam Aronson calmly said to Wade Jackson. A dermatologist and Mohs surgeon, Dr. Aronson confirmed that all cancer had been removed from Wade’s lower eyelid, through the process of Mohs surgery, where layers of skin are removed and viewed under a microscope until cancer cells are no longer present.

Wade was then ushered next door to the SCARS Surgery Center, where oculoplastic surgeon Dr. Justin Karlin reconstructed the eyelid tissue. Although the news was good, it was just one more step in Wade’s years-long dance with skin cancer.

Four years earlier, he was at the SCARS Center having skin cancer removed from his nose, also with Mohs surgery. The deficit was so large that it required an extensive reconstruction by plastic surgeon Dr. Simon Madorsky. Not just one operation, but a multi-stage process was required to rebuild that part of Wade’s nose (see page 3).

When asked what he thinks led to these cancers, Wade is quick to respond. “Well, it was simply a lack of knowledge. Back in the late 60s and 70s, the only time we would apply anything was after we were already burnt to a crisp.” Years of outdoor sports and surfing, and then sun exposure while serving in the US Coast Guard sealed his fate.

“Dr. Madorsky had to perform major reconstruction on my nose, and did so with amazing results. This man is truly an artist.”

Quite a compliment from Wade Jackson, who is himself a professional artist.

When a traumatic brain bleed in 2007 upended his life, Wade was unable to return to the business that he and his family had built. He started to sculpt as a way to get his brain working again. With knowledge of welding from his Coast Guard days, Wade utilized metal and stone as his primary media. A passion for all things aquatic inspires his work. While he still struggles with analytical thinking, the creative side of his brain took off.

By 2013 he had created enough works to sell, and was accepted to the Festival of The Arts in Laguna Beach. “This was my breakout.”

When he met Dr. Madorsky in 2017, little did he know the impact they would have on each other. Over the many months of reconstruction and healing, they developed a connection. “At some point, Simon became a friend,” said Wade.