Dermal Fillers — Where Bioscience Meets Biochemistry

As a surgeon, my number one goal for my patients is that any procedure I do will be safe, predictable, and based in science and physiology. Many things in life are predictable – sunrise – sunset – freezing weather in Edmonton in January. Unfortunately, many treatments in the field of cosmetic medicine and surgery are not. Fads come and go, sometimes with dire results for the patient. However, if we stick with well-researched and developed products and strategies, and use them in a thoughtful, conservative fashion, we should achieve aesthetically pleasing, long lasting results.

Juvederm Voluma is an example of bioscience meeting biochemistry. Juvederm Voluma is a highly concentrated crossed-linked hyaluronic acid, perfectly suited for volume replacement in deep cheek and nasolabial folds. Its effects are immediate and long lasting – up to a year- and if used properly, very safe. Juvederm has an excellent safety record. FDA approved in 2006, it has been used in thousands of patients, with no significant toxicity. However, if injected too superficially or on areas of very thin skin, i.e. “tear trough” below the eye, it may result in a visible bluish-grey discoloration due to the “Tyndall effect” - the scattering of light through the Juvederm. The lower eyelid is anatomically complex. Very thin skin fuses with a dynamic and well-vascularised muscle. Thus, injecting in this area can be extremely problematic. I am usually reluctant to inject this area and in the rare instance I do, I inject very conservatively – small amounts, slowly. Because of its cross linking, Juvederm Voluma is not suitable for this anatomic area. Lips are another area that can be augmented with Juvederm; however, we need to again be conservative and use the correct product and amount. I have found Juvederm Ultra plus XC to be excellent filler for the lips.

As many women age, the muscle of the lip – the obicularis oris- undergoes atrophy. This leads to a thinning or reduction of vertical height of the lip and a loss of lip definition with an increase in vertical wrinkles or fissures. Proper use of fillers in this area will correct this problem. Usually 0.4cc into the red lip – white lip junction with attention to creating a well-defined “cupids bow” for the upper lip with 0.2 – 0.4 cc’s for the lower lip will create a well-defined lip without the over-filled, pouty appearance many women fear.

In summary, if we choose the right therapeutic solution for the defined cosmetic problem, a solution that is well researched, tested and safe – and use it appropriately, the end result should be an aesthetically pleasing, natural cosmetic appearance.

Spring will be here shortly; stay warm!

Dr. Keohane 

Renewed, Recharged and Refocused...

In early December, I attended a three day course in exciting New York City—“The Cutting Edge 2012". This was an international interdisciplinary rhinoplasty symposium highlighting advances in rhinoplasty and facial cosmetic surgery. This course was co-sponsored by the American Society for Aesthetic Plastic Surgery and the American Academy of Facial Plastic Reconstructive Surgery.  There was great participation from surgeons from all over the world.

The universal theme of this meeting was the integration of rhinoplasty, fillers, Botox and other therapies to achieve a harmonious, natural result that is in balance with the rest of the face. Since rhinoplasty surgery is as much artistic in nature as it is scientific, often nonsurgical modalities, such as radiofrequency therapies like the eMatrix, judicious use of injectable fillers or steroids are used to modify results for those patients who have difficult-to-treat skin types. 

The use of high-volume fillers like Juvederm Voluma accentuate a good rhinoplasty result. Botox placed in the frown lines above the nose will soften the face, highlight the surgical result and provide a pleasing, harmonious result.  It was also reassuring to learn that our standard of care and good quality results are more than comparable with those of international experts from all over the world. 

These international scientific seminars are a wonderful way to recharge and refocus on our practice.  Maintenance of competence and continuing education is something that I take very seriously.  I attend 3 or 4 scientific surgical meetings each year and register and record these events with the Royal College of Physicians and Surgeons of Canada.  I believe this process makes me a better physician and ultimately, the beneficiary is you, my patient.

Whether your 2013 wish list includes younger looking skin or facial rejuvenation through surgical techniques, our team provides safe, effective, natural-looking treatments tailored to your unique needs. On behalf of the Centre, I wish you a beautiful New Year. Hope to see you soon.

Dr. John Keohane

The Skinny on Dermal Nonsurgical Fillers

Innovations in anti-aging skin care are on the fast track to meet the growing demand of baby boomers (and their parents). Nonsurgical fillers are treatment therapies that can improve the skin’s surface texture, reduce irregular pigmentation, and help reverse the effects of sun damage.

Fillers reduce the appearance of facial lines and wrinkles by “plumping” furrows and hollows in the face, giving the skin a more youthful-looking appearance. Fillers (like Juvaderm) are very effective at contouring specific areas on the face, such as around the lips, including long, vertical “marionette” lines that start at the corners of the mouth and extend down the chin. Botox injections also diminish lines and wrinkles associated with facial expression, including vertical lines between the eyebrows and on the bridge of the nose, forehead lines and furrows, and crow’s feet.

Celebrating Twenty Years of Botox Success!

While no one was watching, Botox Cosmetic turned 20 years old this year. The first scientific articles on the cosmetic use of Botox were published in 1992 by a Canadian husband and wife team. Carruthers and Carruthers, a dermatologist and an ophthalmologist, respectively have published over 200 peer-reviewed scientific articles and 5 text books. Since that time, Botox has been used worldwide by millions of patients.

Botox is one of the safest and most effective tools we offer patients. It helps you look great in the short term and prevents long term skin changes that occur as you age. Botox, when used in combination with dermal fillers, leaves you feeling refreshed. It often reverses the signs of age by smoothing wrinkles and restoring volume.