Maintain glowing skin throughout the winter

Facial Plastic Surgery Today

Facial Plastic Surgery 1For most people, the winter season means cooler temperatures outside and dryer air. Dry heat indoors doesn’t help either. This can lead to uncomfortable dryness, flaking, and cracking of the skin. Find out the best way not only to combat dryness, but also to restore the glow to your skin.

Seek authoritative advice

Before you head to the drug store or department store counter for suggestions, visit your facial plastic surgeon for an optimal skin care regimen. Your physician will be able to analyze your skin type and recommend the best routine and products for your unique needs. This is worth the time and investment.


A diet filled with plenty of whole grains, fruits, and vegetables is important for your skin to get the proper nutrients it needs. Drink plenty of water and exercise on a regular basis, which will promote good circulation of oxygen and nutrients to the skin as well.


Adequate rest can help your skin rejuvenate and glow on a daily basis. During the deepest stage of sleep, your body releases growth hormones for cell repair. Without this regenerative effect, your skin’s texture, thickness, and elasticity are diminished. The average adult requires seven hours of sleep per night.


Cleanse daily to remove accumulated oils and dirt. Oily, dull skin can make you appear older than you are; wash gently twice a day with a mild cleanser. Avoid ordinary soaps, which dry and irritate facial skin. Pat your face dry and apply a moisturizer, preferably with a sun protection factor (SPF) of at least 15. Do you know your skin type—oily, dry, sensitive, combination? Purchase products that are designed for your skin type to ensure your skin will look radiant and youthful.


As weather conditions change, your moisturizer should too. Trade in your light, waterbased moisturizer for an ointment or an oilbased moisturizer. If you have never used a heavier moisturizer, you may want to make the transition progressively until you find the most aggressive one that is well tolerated. This will create a protective layer on the skin, helping your skin retain more moisture. Lessen the harsh dry air by using a humidifier in your bedroom.


While there are a number of steps you can take to enhance the appearance of your skin, there are also a few things you should avoid. If you smoke, quit. Smoking affects the blood supply to the skin, inhibiting proper circulation and increasing wrinkles. Limit exposure to intensely hot baths and showers; this can break down the lipid barriers in the skin causing loss of moisture. And finally, don’t use harsh alcohol-based astringents to clean your face or clay-based masks. These can strip vital oils from your skin and worsen the dryness.


Even after taking preventative measures, you may consider a cosmetic procedure to restore your youthful glow. Minimally invasive procedures such as a glycolic peel, laser resurfacing, or dermabrasion may bring the results you desire.

Make an appointment with your facial plastic surgeon to ensure your skin remains glowing throughout the winter and into spring.

Neurotoxins … a quick and safe remedy for your unwanted lines

Facial Plastic Surgery 2Laughing, frowning, squinting, chewing—i.e., facial movements— contribute to the formation of wrinkles as we age. A quick and safe remedy to reduce the appearance of these wrinkles is an injection of a neurotoxin.

There are four neurotoxin products approved for use in the United States:

  • onabotulinumtoxinA (Botox Cosmetic®, manufactured by Allergan Inc.)
  • abobotulinumtoxinA (Dysport™, manufactured by Medicis Pharmaceutical Corporation)
  • incobotulinumtoxinA (Xeomin®, manufactured by Merz Pharmaceuticals)
  • rimabotulinumtoxinB, a type B neurotoxin (Myobloc®, manufactured by Solstice Neurosciences)

Currently, only Botox and Dysport are approved for cosmetic use by the Federal Drug Administration (FDA). Find out how these neurotoxins work and what might be the best option for you.


Botulinum toxin type A and botulinum toxin type B are both purified substances, derived from the bacterium, clostridium botulinum. When the toxin is injected into the muscle, it blocks muscular nerve signals, which then weakens the muscle so that it cannot contract— diminishing unwanted facial wrinkles. The areas treated are typically the forehead, between the eyes (glabellar region), around the corners of the eyes (crow’s feet), and around the lips.

While the procedure is quick and may appear simple, it requires an experienced and trained professional. There are 43 muscles in your face; the person who performs the injections must be able to pinpoint the exact spots to maximize your results. The number of injections depends on the extent of your wrinkles and the areas being treated. By injecting the toxin into specific muscles, your facial plastic surgeon weakens only the wrinkleproducing muscles, preserving your natural facial expressions. It is a minimally invasive treatment; no anesthesia is required. There is no down time or recovery time.


In 2002, the FDA approved Botox Cosmetic for the temporary improvement in the appearance of moderate to severe glabellar lines (the vertical lines between the eyebrows). Wrinkles formed by dynamic muscles (in motion), such as glabellar lines when we frown or crow’s feet when we smile or squint, can be temporarily smoothed out with Botox injections. After the injection, improvement is seen within three to seven days, with results lasting up to four months. Discuss with your physician a treatment schedule; you can receive injections every four months. With repeated treatments, thinning of the muscles occurs, which may produce longer lasting results.

Botox has proven to be an effective treatment for various conditions, including wrinkles, blepharospasm (excessive blinking), strabismus (misaligned eyes), hyperhidrosis (excessive sweating), cervical dystonia (disorder of head and neck muscles), and chronic and migraine headaches.


Dysport has been approved for aesthetic use in the United States since April 2009. Outside of the U.S., it has been used for aesthetic treatments since 2001. Similar to Botox, it is injected to relax facial muscles and smooth frown lines. Unlike Botox, Dysport is suspended in lactose; Botox is suspended in sodium chloride. Be sure to let your physician know if you are allergic to cow’s milk protein or had an allergic reaction to any other botulinum toxin product.

Results with Dysport show in one to two days and can last between three to five months. The manufacturer recommends that you wait at least 90 days between treatments. Clinical studies prove continued effectiveness with up to four repeated treatments.


Xeomin (incobotulinumtoxinA) was approved by the FDA in July 2010 for the treatment of cervical dystonia and blepharospasm. Xeomin has not yet been approved for any cosmetic indications.

Xeomin is the first neurotoxin that does not need to be refrigerated before use. Xeomin has no additives, just botulinum toxin type A. This may mean that there is less risk of developing antibodies against Xeomin than other available neurotoxins. The body develops antibodies in response to a foreign invader and attacks.

The effects of Xeomin occur within one week, and the results last from three to six months. More information and clinical studies are being done regarding the cosmetic uses.


Myobloc (rimabotulinumtoxinB) was approved by the FDA in December 2000 for the treatment of cervical dystonia to reduce the severity of abnormal head position and neck pain associated with this condition. Although it has not been approved for cosmetic use, physicians have used it as an alternative to Botox for the treatment of moderate to severe frown lines. Myobloc is administered via injections and typically takes three days to see the effects. It has a longer shelf life and thus, may be less costly for the patient. The results last two to three months.

The product that your facial plastic surgeon recommends for you will be based on several factors including what product the surgeon is comfortable using and what is best for your facial features. Regardless of which neurotoxin, the most popular question asked is if you will be able to show facial expressions after treatment. Yes! Unlike how it is portrayed in spoofs and movies, the injections will not prevent you from smiling or frowning—you will be able to do so, just without the wrinkles.

Ensuring your safety…starting with your surgeon

Facial Plastic Surgery 3The uncertain economic environment might tempt you to jump at the cheapest treatment advertised; however, when it comes to your face, research and a consultation appointment are paramount before making a decision.

Trust your face to a facial plastic surgeon

A facial plastic surgeon specializes in performing cosmetic and reconstructive surgery on the face, head, and neck region. The facial plastic surgeon has spent five to six years in postgraduate surgical training, which includes one year of postgraduate training in general surgery and at least four additional years of specialty training in head and neck surgery and facial plastic surgery. A facial plastic surgeon is typically board certified in otolaryngology, the specialty addressing surgery of the head and neck.

Board certification is a process offered by a number of medical specialty organizations in order to evaluate its physician members in terms of their knowledge, experience, judgment, decision-making, and ethics. The goal is ultimately to improve the level of care that the public receives. Certification by a medical board means that a physician has met the standards set by that particular board. Make sure the surgeon’s area of expertise and corresponding board certification is in facial plastic surgery.

Verify experience

Find out how many procedures they perform each year, particularly the one in which you are interested. Review before and after photographs of patients and ask for references. A surgeon’s ability to share patient results and testimonies signifies an aptitude and consistency in surgical technique that comes from having an experienced background in performing facial plastic surgery.

Lookup surgeon’s facility

Where will the procedure be performed? Ensure that the location is accredited to deliver quality patient care; this demonstrates that it has met stringent national standards for equipment, operating room safety, personnel and surgeon credentials, policies, and practices. Check out a facility by visiting the American Association for Accreditation of Ambulatory Surgery Facilities ( or the Accreditation Association for Ambulatory Health Care (

Develop a relationship

Make an appointment to meet with the surgeon. This consultation appointment will provide you the opportunity to connect, ask questions, and discuss options. Come prepared with a list of questions. Be candid and honest. Do you feel comfortable with the surgeon? It is important that you feel you can develop a good rapport. During this appointment, you should be able to assess if your facial plastic surgeon possesses the following qualities: compassion, empathy, strong sense of ethics, pleasant personality, and good judgment.

Regardless if you find a surgeon through word of mouth or from a physician referral, it is still important to check a surgeon’s credentials, facility, and experience before you move forward with a cosmetic or reconstructive procedure. This is a decision that should not be made quickly or lightly.

Botox versus Dysport

A study was performed on 90 people by researchers from the Maas Clinic and the University of California, San Francisco. Doctors injected Botox on one side of the face and Dysport on the other. The researchers using a five-point scale evaluated the results and the patients were asked which side they preferred. It was reported that Dysport improved the appearance of crow’s feet significantly better than Botox. At the 30-day mark, approximately two-thirds of the participants preferred the Dysport-treated side when contracting their facial muscles. There was no difference in appearance when faces were at rest. The complete findings were published in the Archives of Facial Plastic Surgery; the authors noted that additional research was necessary.


Facial Plastic Surgery 4I know that there are many facial plastic surgical procedures, and I am concerned I may pick the wrong one. What should I do?

Make an appointment with a facial plastic surgeon for guidance regarding the procedure(s) most likely to help with your individual concerns. The consultation appointment is your chance to get to know the facial plastic surgeon, ask questions, discuss your medical history, and explore if you are a good candidate for a particular treatment or procedure. Your surgeon will evaluate your overall health and facial features, discuss your reasons for electing a procedure, enquire about your expectations, and propose possible treatment plans.


Ask DoctorIf the label of a cosmetic product states that it is made with “organic” ingredients, this does not mean that it is safer for consumers than those made with ingredients from other sources. An ingredient’s source does not determine its safety. For example, many plants, whether or not they are organically grown, contain substances that may be toxic or allergenic. Under the Federal Food, Drug, and Cosmetic Act, (FD&C Act), all cosmetic products and ingredients are subject to the same safety requirement: They must be safe for consumers under labeled or customary conditions of use [FD&C Act, section 601(a)]. Companies and individuals who market cosmetics have a legal responsibility to ensure that their products and ingredients are safe for the intended use. The Agricultural Marketing Service of the U.S. Department of Agriculture (USDA) oversees the National Organic Program (NOP). The NOP regulations include a definition of “organic” and provide for certification that agricultural ingredients have been produced under conditions that would meet the definition. They also include labeling standards based on the percentage of organic ingredients in a product. For example, if a product contains less than 70 percent organic ingredients, the product cannot use the USDA Organic Seal or the term “organic” anywhere on the principal display panel. The product may, however, identify the specific ingredients that are USDA-certified on the ingredients panel.


Ask Doctor 2ZYTAZE® is a combination of highly absorbable, organic zinc, along with phytase (enzyme) to maximize zinc absorption, thereby enhancing the effectiveness of botulinum toxin injections. It is taken by mouth prior to treatment.

Botulinum toxins, i.e., Botox and Dysport, are widely used to inhibit muscle contractions that cause wrinkles in the forehead, between the brows, and around the eyes. In order for these products to be effective, each botulinum toxin molecule must bind with a molecule of zinc found in the facial tissues after being injected. If a person has inadequate amounts of zinc, then the botulinum toxin will have a significantly decreased effect. A recent study utilizing ZYTAZE® to increase zinc levels for four days prior to botulinum toxin injections resulted in an increase in both the effect of treatments and the duration of botulinum toxin. The study suggests that using ZYTAZE may lead to fewer toxin injections at a lower dose. Talk to your facial plastic surgeon about this product.